Students with Emotional Disturbance1

http://cecp.air.org/resources/20th/intro.asp Students with Emotional Disturbance1 Children and youth with emotional disturbance are a heterogeneous group of young people with a variety of strengths and needs. Much is known about the school and community factors that place young people at risk for developing emotional disturbance and about what must be done to improve school and community results for them. This knowledge has been incorporated into OSEP’s National Agenda for Achieving Better Results for Children and Youth with Serious Emotional Disturbance (U.S. Department of Education, 1994), which has framed OSEP’s recent research and development efforts. Unfortunately, a gap exists between what is known and what is done to identify and address the strengths and needs of these young people and their families. OSEP is addressing the gap through its Research to Practice efforts, which support the exchange and effective use of research-based knowledge on how to improve results for children and youth with emotional disturbance. The first section of this module addresses eligibility for services and the characteristics of children with emotional disturbance. The second discusses the educational environments of and services provided to these students and the results that follow for them. The final section presents an overview of what OSEP is doing to improve results for children and youth with emotional disturbance. Children and youth with emotional disturbance frequently require and receive services from a variety of agencies that apply different eligibility criteria. These young people are also quite diverse in terms of their needs and strengths. The students present with a complex range of disabilities, from conduct disorder to schizophrenia. Within this statistically and diagnostically diverse population, females appear to be underrepresented, and African Americans appear to be overrepresented. The following paragraphs elaborate on service eligibility for and the characteristics of these students. Eligibility for Services Emotional disturbance is 1 of 12 disability categories specified under IDEA. It is defined as follows: "(i) The term means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance: (A) An inability to learn that cannot be explained by intellectual, sensory, or health factors (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. (C) Inappropriate types of behavior or feelings under normal circumstances. (D) A general pervasive mood of unhappiness or depression. (E) A tendency to develop physical symptoms or fears associated with personal or school problems. (ii) The term includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance" (CFR §300.7 (a) 9). Children who meet these criteria, as determined by a multidisciplinary team, may receive services under IDEA. Children under the age of 9 who exhibit delays in social or emotional development may receive services under the developmental delay category. Other Federal agencies use different eligibility criteria for youth with emotional disturbance. Their definitions cover a broad array of mental health conditions, some of which may also lead to eligibility under IDEA: • The Center for Mental Health Services’ (CMHS) definition covers children under 18. This definition requires the presence of a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), and which results in a functional impairment that substantially interferes with or limits the child’s role or functioning in family, school, or community activities (Substance Abuse and Mental Health Services Administration, 1993). • The Social Security Administration’s (SSA) definition of eligibility for the children’s Supplemental Security Income program is the presence of a mental condition that can be medically proven and that results in marked and severe functional limitations of substantial duration. Children identified under these two definitions may be eligible for services under IDEA or under Section 504 of the Rehabilitation Act of 1973. However, eligibility is not automatic. A child must meet the requirements of the Department of Education’s regulatory definition of emotional disturbance to receive services under IDEA (or must meet the requirements of other IDEA eligibility categories). Therefore, identification of a child as emotionally disturbed under the CMHS or SSA definitions does not necessarily lead to identification under IDEA. States also define emotional disturbance and specify the criteria to be used by local school districts in the identification of children with this disability. Although they must specify criteria that are not inconsistent with the Federal definition, States interpret that definition based on their own standards, programs, and requirements (McInerney, Kane, & Pelavin, 1992). In fact, many States have adopted their own specific terminology and criteria (Tallmadge, Gund, Munson, & Hanley, 1985; Swartz, Mosley, & Koenig-Jerz, 1987; Gonzalez, 1991). Local variation may affect the ability of Federal authorities to monitor the impact of the IDEA Amendments of 1997. According to a 1992 report, "The resulting differences in definition and eligibility criteria make it difficult to evaluate the identification rates of children with serious emotional disturbance" (McInerney et al., 1992, p. 46). For example, students identified as having conduct disorder are eligible for services in some States, but not in others. Conduct disorder is a persistent pattern of anti-social, rulebreaking, or aggressive behavior, including defiance, fighting, bullying, disruptiveness, exploitiveness, and disturbed relations with both peers and adults (Cohen, 1994; Forness, 1992; Forness, Kavale, & Lopez, 1993). Research suggests that conduct disorder frequently co-occurs with attention deficit hyperactivity disorder (ADHD), reading disabilities, anxiety disorders, and depression (Clarizio, 1992; Hinshaw, Lahey, & Hart, 1993; McConaughy & Skiba, 1993; Zoccolillo, 1992). The literature also suggests that there are no valid theoretical or empirical grounds for differentiating between conduct disorders and other behavioral and emotional disorders and that there are no reliable or socially validated instruments for making such a distinction (Cohen, 1994; Nelson, 1992; Nelson & Rutherford, 1988; Skiba & Grizzle, 1992; Stein & Merrell, 1992). Children with emotional disturbance may also be socially maladjusted, but to receive services under IDEA, they must satisfy additional requirements. Since IDEA excludes social maladjustment without emotional disturbance from the definition of emotional disturbance, some State definitions and eligibility requirements serve to exclude students with conduct disorder (Gonzalez, 1991). Alternatively, some research has found that students with conduct disorder constituted the largest percentage of students with emotional disturbance who were served in day schools and residential schools (Forness, 1992; Forness, Kavale, King, & Kasari, 1994; Sinclair & Alexson, 1992). Children with conduct disorder were the largest diagnostic group in the National Adolescent and Child Treatment Study (Silver et al., 1992). That study was co-sponsored by the National Institute for Disability and Rehabilitative Research (OSERS/NIDRR) and the National Institute of Mental Health. Its purpose was to "describe. . . children with [emotional disturbance] and their families" (Greenbaum et al., 1998, p. 21). Students with conduct disorder were also the largest group served at the 31 sites of the CMHS’ Comprehensive Mental Health Services for Children and Their Families program (Doucette, 1997). In general, the literature documents varying orientations to children with different patterns of behavior. While some of these students are "provided access to therapeutic services, and considered victims of their disorders . . . students who are considered antisocial or socially maladjusted are usually blamed for their aversive and maladaptive behavior patterns and exposed to control, containment, or punishment strategies" (Walker, Stieber, & O’Neill, 1990, p. 62). Student Characteristics Students with emotional disturbance who are eligible for services under IDEA typically exhibit mood disorders, anxiety disorders, ADHD, conduct disorders, or other psychiatric disorders (Forness et al., 1994; Mattison & Felix, 1997). Comorbidity of emotional and behavioral disorders is common (Caron & Rutter, 1991; Friedman, Kutash, & Duchnowski, 1996). In addition, the co-occurrence of emotional disturbance and other disabilities may intensify students’ behavioral problems and further compromise academic performance. Many students with emotional disturbance are at great risk for substance abuse disorders (Capaldi & Dishion, 1993; Leone, 1991; Leone, Greenberg, Trickett, & Spero, 1989) and negative encounters with the juvenile justice system (Gilliam & Scott, 1987; Leone, 1991). These problems may exacerbate the impact of emotional disturbance and of any co-occurring disabilities. In comparison with other students, both with and without disabilities, children with emotional disturbance are more likely to be male, African American, and economically disadvantaged. They are also more likely to live with one parent, in foster care, or in another alternative living arrangement (Cullinan, Epstein, & Sabornie, 1992; Marder, 1992; Wagner, 1995). Students with emotional disturbance are particularly vulnerable to environmental changes such as transitions and to a lack of positive behavioral support during transitions. These students’ presenting behavior, as well as its intensity, is episodic, subject to change over time (Strayhorn, Strain, & Walker, 1993), and may serve to direct attention away from underlying issues such as depression (McCracken, Cantwell, & Hanna, 1993; Wehby & Symons, 1996; Wehby, Symons, & Shores, 1995). These variations in behavior often result in students with emotional disturbance being blamed for disability-related behavior or subject to negative reactions from their peers and teachers (Forness, Kavale, MacMillan, Asarnow, & Duncan, 1996; Lewis, Chard, & Scott, 1994). Identification IDEA requires each State to have in effect a policy ensuring all children with disabilities the right to a free appropriate public education (FAPE) (20 U.S.C. 1412 (1)). Thus, it is the obligation of State educational agencies (SEAs) and local educational agencies (LEAs) to evaluate a child who is suspected of having a disability in order to determine his or her need for special education and related services (Davila, Williams, & MacDonald, 1991). But research suggests that the identification process, as implemented, is often reactive, subjective, limited by a local lack of culturally and linguistically appropriate assessment tools, driven by institutional needs, and constrained by parental concerns about pejorative labels (U.S. House of Representatives, 1997) and inappropriate placement, as well as by the inability of some professionals to collaborate with families or with each other (McInerney et al., 1992; Osher & Hanley, 1996; Smith, 1997). Nationally, the identification rate for emotional disturbance has remained stable at approximately 0.9 percent since OSEP began collecting these data in 1976 (Oswald & Coutinho, 1995). This rate is significantly less than the predicted prevalence of emotional disturbance within schools. For example, the U.S. Department of Education’s Second Annual Report to Congress on the Implementation of P.L. 94-142 estimated a prevalence rate of 2 percent for students with emotional disturbance (U.S. Department of Education, 1980). Similarly, many experts believe that an identification rate of 3-6 percent would be more accurate (Eber & Nelson, 1994; Friedman et al., 1996; Grosenick & Huntze, 1980; Institute of Medicine, 1989; Kauffman, 1994; Smith, Wood, & Grimes, 1988). In fact, mental health epidemiological studies suggest even higher rates of diagnosable psychological and psychiatric impairments in youth (Costello et al., 1988; Friedman et al., 1996; McInerney et al., 1992). There is also great variation in State and local identification rates. One example is the 33-fold difference between the lowest and highest State identification rates of school-aged youth for the 1996-97 school year (see figure II-10 and table AA13, p. A-40, which presents the actual rates). Identification rates are lower for girls and young women among students identified with emotional disturbance (U.S. Department of Education, 1994). In the National Longitudinal Transition Study (NLTS), more than three-fourths (76.4 percent) of secondary students with emotional disturbance were male, the highest proportion of males to females in any of the disability categories (Marder & Cox, 1991). Lower identification rates among females have been attributed to an assessment and identification process that is subjective (Walker & Fabre, 1988; Wehby, Symons, & Hollo, 1997), and largely driven by how schools operationalize behavioral norms and standards (Gerber & Semmel, 1984; Talbott, 1997; Walker & Severson, 1990). Some researchers and theorists have proposed that the apparent underidentification of girls and young women may also be due to the different ways in which emotional disturbance is manifested in females (Zahn-Waxler, 1993). Girls and young women are more likely to exhibit internalizing problems such as anxiety and depression that do not usually interfere with classroom management, while males are more likely to demonstrate the externalizing behaviors that do disrupt the classroom. Other possible explanations include the gender-specific expectations of teachers and evaluators (Caseau, Luckasson, & Kroth, 1994; Talbott & Lloyd, 1997) and a lack of gender-appropriate diagnostic criteria (Zoccolillo, 1993). Although some screening and assessment tools are available to aid in the identification of withdrawn, isolated students and others who internalize their problems, those tools are used infrequently. Teachers, the primary gatekeepers in the identification process, are more likely to identify students who exhibit externalizing behaviors (Boggiano & Barrett, 1992; Caseau et al., 1994; Gresham, MacMillan, & Bocian, 1996; Kazdin, 1990; Walker & Severson, 1990). Interestingly, a new assessment tool (Epstein & Cullinan, 1998), incorporating national norms derived from students with emotional disturbance and from their nondisabled peers, explicitly addresses the specific, multiple characteristics of emotional disturbance in the IDEA definition. The instrument also incorporates a subscale on social maladjustment, providing for distinctions between emotional disturbance with or without social maladjustment, and vice versa. While females appear to be underrepresented among students identified with emotional disturbance, African Americans appear to be overrepresented. Research suggests that the high identification rates for African Americans may be due both to teacher expectations regarding normative behavior (Horowitz, Bility, Plichta, Leaf, & Haynes, 1998; McLaughlin & Talbert, 1992; Metz, 1994) and to a paucity of culturally sensitive and linguistically appropriate assessment instruments (Harry, 1994). Culturally competent approaches are needed to work effectively with racially and ethnically diverse students and families (Cross, Bazron, Dennis, & Isaacs, 1989; Comer, 1996; Isaacs-Shockley, Cross, Bazron, Dennis, & Benjamin, 1996). Culturally relevant and responsive techniques can increase the efficacy of both primary prevention efforts (Comer, 1996) and targeted prereferral strategies (Zins, Coyne, & Ponti, 1988). Although many children with emotional disturbance exhibit problems at an early age (Knitzer, 1996; Marder, 1992), students with this disability are usually identified later than those with other disabilities, despite the availability of valid and reliable screening tools. Research suggests that behavioral and emotional problems identified during adolescence can often be linked to early childhood behavioral patterns (Hinshaw et al., 1993; Walker, Colvin, & Ramsey, 1995; Walker, Shinn, O’Neil, & Ramsey, 1987; Walker et al., 1990). Early intervention appears to be both possible and cost effective (Forness et al., 1996; Hinshaw, Han, Erhardt, & Huber, 1992; Knitzer, 1996; Walker, 1995; Zigler, Taussig, & Black 1992). Table II-7 shows the percentage of students with disabilities who were identified as having emotional disturbance in 1995-96 by age. Table II-7 Percentage of Students with Disabilities Identified as Having Emotional Disturbance (1995-96) Age (years) 6-7 8-9 10-11 12-13 14-15 16-17 Percentage 3.5% 5.6% 7.3% 10.2% 13.1% 13.0% Source: U.S. Department of Education, Office of Special Education Programs, Data Analysis System (DANS). Once identified, students with emotional disturbance are served in a variety of settings, with placement rates varying by States and localities. For example, in 1994-95, 80 percent of Iowa’s students with emotional disturbance and 78 percent of Vermont’s were served in regular schools. In contrast, some other States served less than 20 percent of their students with emotional disturbance in such environments. In general, educational environment and service decisions are often driven by the availability of resources (Hallenbeck, Kauffman, & Lloyd, 1995; Kauffman & Smucker, 1995). The majority of students with emotional disturbance continue to receive most of their services in environments that separate them from students who do not have emotional disturbance. Between 1984-85 and 1994-95 the percentage of students receiving services in special classes, day schools, and residential facilities ranged from 54 percent to 57 percent. The restrictiveness of these environments contrasts with the environments of most students with disabilities. This is particularly true for students who, in the absence of appropriate school or community-based services, had to receive services in residential settings or at home. During 1995-96, 4.78 percent of students with emotional disturbance were served in residential settings, in hospitals, or at home, in contrast to 1.22 percent of all students with disabilities. The percentage of students with emotional disturbance reported to be receiving the majority of their education, special education, and related services in regular classrooms increased from 12 percent in 1984-85 to 23 percent in 1995-96. Figure II-11 displays the percentages of students with emotional disturbance served in resource rooms or regular classes from 1987-88 to 1995-96. The diminished use of resource rooms may be significant because, although some students can succeed in regular classes, research suggests that many of these students and their teachers do not currently receive the supports that they need to succeed in regular class environments, particularly at a time of rising academic and behavioral standards (Eber & Nelson, 1994; Lewis et al., 1994). According to the NLTS, of the students with emotional disturbance who were served in regular education environments, only 11 percent had behavior management plans. In the same study, just 6 percent of the regular education teachers serving students with emotional disturbance received the support that teachers identify as being most important--a reduced teacher-student ratio (Marder, 1992; Wagner, 1995). Three key provisions in the IDEA Amendments of 1997 address these issues. The first provision is that regular educators and general education must be included in the development of individualized education programs (IEPs). The second is that IEP teams must explore the need for strategies and support systems to address any behavior that may impede the learning of a child with a disability or that of his or her peers. The third provision requires States to address the needs of in-service and preservice personnel, as they relate to the development and implementation of positive intervention strategies. Some schools achieve high outcomes for students with emotional disturbance. During the winter of 1997-98, OSEP and the Safe and Drug Free Schools (SDFS) program in the Office of Elementary and Secondary Education collaboratively supported a research project to identify such schools and synthesize information that could help other schools replicate effective programs. The results of the study were included in a special report titled Safe, Drug-Free Schools, and Effective Schools for ALL Students: What Works! (Quinn, Osher, Hoffman, & Hanley, 1998). These schools have high behavioral and academic expectations and provide students and staff with the support needed to achieve those standards. They combine schoolwide prevention efforts with early intervention for students who are at risk of developing emotional disturbance, and individualized services for students already identified with emotional disturbance. These schools also provide students with positive behavioral supports, offer ongoing training and support to staff, collaborate with families, and coordinate services (Mayer, 1995; Nelson, Crabtree, Marchand-Martella, & Martella, 1998; Quinn et al., 1998; Sugai & Horner, in press). Unfortunately, in some other schools, the support services that students and teachers receive are often fragmented, inadequate, or inappropriate (Grosenick, George, & George, 1987; McLaughlin, Leone, Warren & Schofield, 1994; Smith & Farrell, 1993). Some schools unintentionally set the stage for or reinforce inappropriate behavior (Gunter, Denny, Jack, Shores, & Nelson, 1993; Shores, Gunter, & Jack, 1993). Staff may emphasize behavioral management and a "curriculum of control" instead of engaging students’ interests and supporting their emotional needs (Knitzer et al., 1990; Zabel, 1988). Some programs frequently fail to address students’ individual needs (Cessna & Skiba, 1996; Dunlap & Childs, 1996; Reiher, 1992; Neel, Alexander, & Meadows, 1997), or use strategies that are not empirically supported (Scheuermann, Webber, Partin, & Knies, 1994; Smith & Farrell, 1993). In sum, services for students with emotional disturbance often do not provide them with the supports that would enable them to succeed: tutoring, counseling, schoolwide behavior support plans, and collaboration with families and other service providers (Cheney & Osher, 1997; Eber, 1996; Marder, 1992; McLaughlin, Leone, Meisel, & Henderson, 1997; Myles & Simpson, 1992; Nelson & Colvin, 1996; Quinn, Gable, Rutherford, Nelson, & Howell, 1998; Valdes, Williamson, & Wagner, 1990; Wagner, Blackorby, & Hebbeler, 1993). Results Not surprisingly, many students with emotional disturbance experience poor academic results. They fail more courses, earn lower grade point averages, miss more days of school, and are retained at grade more than students with other disabilities (Wagner, Blackorby, & Hebbeler, 1993). Fifty-five percent leave school before graduating; only 42 percent graduate (Wagner, 1995). School factors such as a lack of academic and social supports, reactive teaching styles, and frequent placement changes contribute to poor results (Kortering & Blackorby, 1992; Mayer, 1995; Munk & Repp, 1994; Osher & Hanley, 1996; Rumberger & Larson, 1994). Gender, race, and poverty mediate service provision and results for students with emotional disturbance. (Kortering & Blackorby, 1992; Osher & Hanley, 1995; Valdes et al., 1990). Males, African Americans, and students with family income under $12,000 are more likely to be placed in restrictive settings, less likely to receive counseling in school, less likely to graduate, and more likely to drop out of school than their female, White, and more affluent counterparts. For example, students with family incomes under $12,000 are almost 2.5 times more likely to drop out of school than those whose families earn over $25,000 (Osher & Osher, 1996). Failure to address the needs of students with emotional disturbance is a portent for poor community results as well as poor academic results. Researchers conducting the NLTS found that within 3 to 5 years of leaving school, 48 percent of young women with emotional disturbance were mothers, as compared to 28 percent of young women with other disabilities. Fifty-eight percent of the students with emotional disturbance had been arrested, versus 19 percent of those with other disabilities. And 10 percent of youth with emotional disturbance were living in a correctional facility, halfway house, drug treatment center, or "on the street"--twice as many as among the students with other disabilities (Wagner, 1995; Wagner, Blackorby, Cameto, Hebbeler, & Newman, 1993). In the past two decades, researchers and practitioners have developed an extensive knowledge base about children with emotional disturbance. These intensive research efforts suggest that results for students with emotional disturbance can be improved through interventions that are sustained, flexible, positive, collaborative, culturally appropriate, and regularly evaluated. These interventions should have multiple components tailored to individual needs; they should build on the strengths of youth and their families, address academic as well as social concerns, be implemented by trained and supported practitioners, and be continually evaluated (Carpenter & Apter, 1988; Clarke et al., 1995; Eber, Nelson, & Miles, 1997; Epstein, Nelson, Polsgrove, Coutinho, Cumblad, & Quinn, 1993; Huntze, 1988; Knitzer, Steinberg, & Fleisch, 1990; McLaughlin et al., 1994; Nelson & Rutherford, 1988; Peacock Hill Working Group, 1991; Stroul & Friedman, 1996; Sugai, Bullis, & Cumblad, 1997). OSEP continues to play an active role in developing and applying knowledge to improve results for young people with emotional disturbance. OSEP-supported research projects like the National Needs Assessment in Behavior Disorders and the NLTS have helped pinpoint problem areas in these students’ development and have made significant contributions to the development of promising approaches to early intervention and school discipline (e.g., Walker et al., 1995). OSEP research investments have developed tools such as functional behavioral assessments to identify and address the needs of individual students (Horner, 1994; Umbreit & Blair, 1997; Wehby et al., 1997). OSEP has also supported demonstration projects that build on research in children’s mental health (e.g., Stroul, Lourie, Goldman, & Katz-Leavy, 1992) to create flexible, results-driven, family responsive services and comprehensive education and support systems to reduce the need for restrictive out-of-home placements (Petr, 1994; Stroul & Friedman, 1996). This knowledge base was influential in the development of The National Agenda for Achieving Better Results for Children and Youth with Serious Emotional Disturbance (U.S. Department of Education, 1994). To create this agenda, OSEP garnered extensive input from researchers, practitioners, and families (Smith & Coutinho, 1997) to "focus the attention of educators, parents, advocates, and professionals from a variety of disciplines on what is needed to be done to encourage, assist, and support our nation’s schools in their efforts to improve the educational process to achieve better outcomes for children and youth with serious emotional disturbance" (Osher, Osher, & Smith, 1994). The agenda featured seven interdependent targets: expanding positive learning opportunities and results, strengthening school and community capacity, valuing and addressing diversity, collaborating with families, promoting appropriate assessment, providing ongoing skill development and support, and creative comprehensive and collaborative systems (U.S. Department of Education, 1994). The National Agenda has served as the basis for State planning and evaluation efforts such as the Serious Emotional Disturbance Network (SEDNET, 1996). It is also the foundation of Federal interagency collaboration on issues of concern to children with emotional disturbance and their families. In a cooperative effort, the Department of Health and Human Services and the Department of Justice, OSERS, the Head Start Bureau, the Children’s Bureau, CMHS, and the Office of Juvenile Justice and Delinquency Prevention (OJJDP) co-sponsored an invitational conference entitled "Making Collaboration Work for Children, Youth, Families, Schools and Communities." This project brought together youth and their families with researchers, practitioners, administrators, and public officials. The meeting highlighted exemplary programs and documented the extent to which all service areas work simultaneously to serve children and families. The conference also delineated what is necessary to ensure effective interagency collaboration (Bullock & Gable, 1997; U.S. Department of Education, 1996; U.S. Department of Education, 1997). In the same vein, OSEP has joined with OJJDP and CMHS to fund collaborative research and technical assistance efforts on education’s role in systems of care and in the prevention of juvenile delinquency. OSERS has made the National Agenda the basis for targeting OSEP’s research to practice investments in the field of childhood and youth emotional disturbance. OSEP currently funds projects that focus on prevention, positive approaches to learning, cultural competence, and assessment of children with emotional disturbance. In fiscal year 1998, the National Agenda became a Focus Area under OSEP’s Model/Demonstration priority, and three new awards were granted to support comprehensive programs that implement services in conformance with the seven target areas of the Agenda. OSEP continues to address the gap between research and practice--between what is known and what is done. The Center for Effective Collaboration and Practice, housed at the American Institutes for Research, was created to promote a national reorientation toward fostering the development and adjustment of children with or at risk of emotional disturbance. The Center engages in strategic activities intended to help family members, practitioners, administrators, researchers and policy makers collaborate effectively in the efficient production and use of knowledge to improve results for children with or at risk of emotional disturbance. In the summer of 1998, the Center teamed with the National Association of School Psychologists, in a special collaborative project jointly led by the Departments of Education and Justice and in response to President Clinton’s directive, to produce Early Warning--Timely Response: A Guide to Safe Schools, which was disseminated to all American schools in the fall. The guide emphasized the importance of child-centered and school- and community-supported prevention and intervention approaches. Children and youth with emotional disturbance have a variety of needs and receive services that vary by State. Nationally, these students often realize poor school and community results. Such results tend to reflect fragmented, inappropriate, inadequate, and tardy interventions that frequently fail to address the complex factors that contribute to emotional disturbance. Fortunately, a great deal is known about how to improve results for students with emotional disturbance. OSEP is working to promote culturally appropriate, child- and family-centered, sustained, flexible, collaborative, positive, data-based interventions with multicomponent treatments. These interventions should be built on the strengths of youth and their families, be subject to ongoing evaluation, and be tailored to students’ individual needs. 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