This article presents an example of how school time was monitored to facilitate a cost analysis of school-wide systems of positive behavior support (PBS). The article provides descriptions of how (a) PBS efforts were initiated in the school, (b) time and money were spent preparing for and implementing PBS, and (c) changes in behavior referrals and suspension were used to evaluate the effect of PBS on the larger system. The results indicated a positive assessment of PBS based on predetermined criteria. The discussion focuses on larger issues of cost analyses as systemic evaluation tools for assessing lifestyle change.

Scaling of evidence-based practices in education has received extensive discussion but little empirical evaluation. We present here a descriptive summary of the experience from seven states with a history of implementing and scaling School-Wide Positive Behavioral Interventions and Supports (SWPBIS) over the past decade. Each state has been successful in establishing at least 500 schools using SWPBIS across approximately a third or more of the schools in their state. The implementation elements proposed by Sugai, Horner, and Lewis (2009) and the stages of implementation described by Fixsen, Naoom, Blase, Friedman, and Wallace (2005) were used within a survey with each element assessed at each stage by the SWPBIS coordinators and policy makers in the seven states. Consistent themes from analysis of the responses were defined and confirmed with the surveyed participants. Results point to four central areas of state “capacity” as being perceived as critical for a state to move SWPBIS to scale (administrative leadership and funding, local training and coaching capacity, behavioral expertise, and local evaluation capacity), and an iterative process in which initial implementation success (100–200 demonstrations) is needed to recruit the political and fiscal support required for larger scaling efforts.

As multitiered systems of support (MTSS) for improving student emotional/behavioral (EB) functioning are being scaled up nationally (Horner et al., 2014), there is a critical need to define how these approaches meet the needs of students presenting internalizing EB problems such as depression, anxiety, and trauma-related concerns. Contributing to the improvement of MTSS is the systematic joining of positive behavioral interventions and supports (PBIS) and school mental health (SMH) services. A recently defined interconnected systems framework (ISF; Barrett, Eber, & Weist, 2013) provides explicit guidance on doing this work, and a national workgroup for ISF is exploring its implementation in sites around the country. The theme of improving prevention and intervention for youth with internalizing issues is a significant emphasis in this effort. However, many schools and collaborating partners from the mental health and other youth-serving systems struggle to develop multitiered programs for youth with internalizing challenges. The underlying tenets and approaches for addressing internalizing problem behavior differ from those that focus on improving more distinct externalizing behaviors such as noncompliance, disruptiveness, rule violation, aggression, attention problems, and acting out. The overall goal of this article is to build from important prior reviews (e.g., McIntosh, Ty, & Miller, 2014) and lessons being learned as the ISF is implemented in sites across the country to improve multitiered promotion/prevention, early intervention, and intervention for students presenting internalizing problems. Within MTSS efforts, school staff and community collaborators (as in the ISF) continue to struggle to implement programs for youth with internalizing problems. Objectives of this article are to review background factors limiting attention to internalizing issues within MTSS and to present recommendations for moving the field forward in improving practice, research, and policy on these issues, with particular attention paid to the ISF and its critical role in this agenda. There are three sections to the article.

We compared two rapid, point-of care nucleic acid amplification tests for detection of influenza A and B viruses (Alere i [Alere] and cobas Liat [Roche Diagnostics]) with the influenza A and B virus test components of the FilmArray respiratory panel (BioFire Diagnostics) using 129 respiratory specimens collected in universal viral transport medium (80 influenza A virus and 16 influenza B virus positive) from both adult and pediatric patients. The sensitivities of the Alere test were 71.3% for influenza A virus and 93.3% for influenza B virus, with specificities of 100% for both viruses. The sensitivities and specificities of the Liat test were 100% for both influenza A and B viruses. The poor sensitivity of the Alere test for detection of influenza A virus was likely due to a study set that included many low-positive samples that were below its limit of detection. Influenza is a significant cause of morbidity and mortality worldwide. Although the diagnosis is often made by clinical signs and symptoms alone, laboratory testing may be needed to guide antiviral therapy, determine isolation precautions, and provide epidemiologic data, since many different respiratory viruses can cause influenza-like illness. The laboratory diagnosis of influenza has evolved from the use of culture and antigen detection tests to nucleic acid amplification tests that are now considered the new gold standard.Until recently, point-of-care diagnostic testing has been limited to rapid antigen tests based on chromatographic immunoassay technology designed in simple-to-use formats with results available in Ͻ30 min. The chromatographic immunoassays typically have suffered from moderate to low sensitivity; however, recent improvements in test chemistries and instrument readout of results have improved their performance characteristics (1-4). Currently, there are two CLIA-waived, FDA-cleared nucleic acid amplification tests designed to be performed as point-of-care tests by nonlaboratory personnel, the Alere i (Alere, Scarborough, MA) and cobas Liat (Roche Diagnostics, Indianapolis IN) influenza A and B tests. These tests hold promise to significantly improve near-patient diagnostic testing for influenza and may facilitate true practice changes in how clinicians manage these patients.The Alere test is semiautomated and uses an isothermal nicking enzyme amplification reaction and fluorescently labeled molecular beacons to amplify and detect a region of the polymerase basic protein 2 gene in influenza A virus, a region of the polymerase acid protein gene in influenza B virus, and an internal control in less than 15 min (5). The Alere test is intended to be used for direct nasal swabs (CLIA complexity, waived) and for nasal and nasopharyngeal swabs eluted in viral transport medium (CLIA complexity, moderate). The Alere test has reported sensitivities and specificities of from 80 to 99.3% and from 62.5 to 100%, respectively, for detection of influenza A virus and from 45.2 to 97.6% and 53.6 to 100%, respectively, for detection of influenza B vir...

Schools continue to be an important context for preventive interventions targeting a range of behavioral and mental health problems. Yet competing demands on teachers and shifting priorities in response to federal legislation have posed some unique challenges to prevention researchers working in school settings. This paper summarizes an approach to prevention partnerships developed over a decade and centered on the three-tiered Positive Behavioral Interventions and Supports (PBIS) model. A state-wide initiative was formed and led through a partnership between the Maryland State Department of Education, Sheppard Pratt Health System, and Johns Hopkins University, which focused on implementing evidence-based practices and conducting prevention research in Maryland public schools. Drawing on a community-based participatory research framework for developing research partnerships, we highlight the importance of forming and sustaining authentic relationships to support school-based prevention research and implementation of evidence-based programs. We also discuss how these relationships have been used to disseminate PBIS and rigorously test its effectiveness. We describe some lessons learned from the partnership and identify potential areas for future research on the prevention partnership model. We conclude with a discussion of the implications for both researchers and community partners engaged in translational research in school settings.