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Choice as an antecedent intervention has been shown to improve student behavior in a variety of ways. This investigation examined whether students could be influenced to choose whether and how to be instructed while directly measuring effects on academic performance. Using a multiple-probe design, the reading fluency of two middle school students with Behavioral Disorders was measured repeatedly across passages. Students could earn a tangible reward for meeting a pre-determined performance criterion in passage reading. Prior to reading the criterion passage, each student was told that he or she could choose to be instructed or not be instructed in a similar passage with high content overlap. Both students consistently chose to be instructed (as well as how they would be instructed) and stable increases in oral reading fluency were obtained. Results are discussed in terms of how motivational variables can be used to influence students' choice of instructional procedures in ways that increase their opportunities to respond and measured learning.

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• Only the presence of a home concern appears to influence the selection of CBC.The odds ratio for communication concerns is significant; however, that significance did not hold up when taking into account other concerns. Medical concerns also did not appear to be important in determining CBC services.o Communication, school, and medical concerns may not have been key factors in the selection of CBC since they can be addressed via a broader range of services (e.g., IEP consultation, teacher consultation, and observations).• After adjusting for the other concerns, the odds are approximately 10 times higher that CBC services were delivered if a home concern was noted than if it was not. The odds ratio for home concerns and CBC is highly significant, and the significance holds up even when medical and communication concerns are taken into account.o Only CBC and parent consultation target concerns at home, making them the most likely options when home concerns were present; however, since most cases involved school concerns, it would be time and resource effective to use a strategy that addresses both home and school concerns at once (e.g., CBC).• ADHD was the most frequent diagnosis for referred clients.o This may be representative of a large population of clients with ADHD at the outpatient clinic; alternatively, pediatric school psychologists may be referred clients with ADHD in greater number because symptoms present across settings and may be viewed as responsive to collaborative intervention (e.g., CBC).• Half of referred clients had comorbid diagnoses, and it was not uncommon for pediatric school psychologists to be referred clients with low incidence diagnoses.o These are clients that comprise a low percentage of the population in schools, but seek services in behavioral pediatric clinics. The high referral rate may indicate the relevance of pediatric school psychology services for these clients.• School observation was the most frequently delivered service for referred clients and occurred in the majority of cases.o Pediatric school psychologists may use observations to gather critical information that can be used to identify needs and direct service selection.• CBC was the second most common service, occurring in over a quarter of cases.This may suggest that CBC is a portable service that is useful and valued in the pediatric setting. RESEARCH QUESTIONS1. What clinical services are pediatric school psychologists providing and for whom are they providing them?2. What types of referral concerns are pediatric school psychologists addressing and which of those are associated with CBC service delivery?3. Under what conditions are CBC services desirable and appropriate in medical settings and when are such services not warranted? BACKGROUND IN PEDIATRIC SCHOOL PSYCHOLOGY• With an increasing number of children presenting with health conditions, pediatric care has expanded from solely a medical definition to a more comprehensive service delivery approach that includes psychology and education (Perrin, 1999).• An i...