A School-Based Trial of an Intervention to Improve the Self-Regulation and Executive Functioning Skills of Children Attending Australian Aboriginal Community Primary Schools [article]

Bree Wagner
2020
Self-regulation and executive functioning have been implicated in a range of long term health, wellbeing, economic, and social outcomes across the life-course. However, some individuals are at greater risk than others of impaired self-regulation and executive functioning skill development. This includes individuals who have had adverse childhood experiences or have fetal alcohol spectrum disorder (FASD). Aboriginal community leaders from the Fitzroy Valley region of Western Australia (WA) have
more » ... ustralia (WA) have been at the forefront of Australian efforts to overcome the impacts of FASD and early life trauma (ELT) on children and families through prevention, diagnosis, and support for affected individuals. A FASD prevalence study conducted in the Fitzroy Valley between 2010 and 2011 found an overall FASD prevalence of 194.4 per 1000 children born between 2002 and 2003. Given these data, which suggest that many Fitzroy Valley children experience or are at risk of experiencing self-regulation and executive functioning impairments, support for children and school staff was highlighted as a key community priority by community members, schools, and health professionals. The Alert Program® for Self-Regulation (Alert Program®) was identified as a suitable intervention to support school children to improve these skills. The overall aim of this thesis was to determine the effectiveness of an 8-week teacher-delivered, manualised intervention based on the Alert Program®, for improving self-regulation and executive functioning skills of children attending Aboriginal community primary schools in the remote Fitzroy Valley. To achieve this aim, a year-long, three-phase formative process was undertaken to develop, implement, and evaluate the first iteration of the Alert Program® intervention. The formative process included a pilot study that evaluated the suitability of teacher training, the Alert Program® curriculum guide, lesson plans and resources, and outcome measures to the Fitzroy Valley context. A further aim of the single group pre-, post-, follow-up intervention design pilot study was to report preliminary effectiveness findings. Promisingly, the frequency of students' disruptive behaviours as rated by teachers and parents (as a proxy for self-regulation), reduced following the Alert Program® intervention. Importantly, these results were maintained at eight-weeks follow-up. Some improvements to students' executive functioning skills were detected using parent and teacher-rated questionnaires, however, these results were not maintained at follow-up. While the small sample size suggests the pilot study results should be interpreted with caution, it was concluded that a vi larger Fitzroy Valley Alert Program® trial was needed and would be feasible if stakeholder feedback was incorporated into the development of the study protocol. Subsequently, the results of the formative process and pilot study were used to develop a study protocol for a self-controlled cluster randomised controlled trial of the Alert Program® in eight remote Aboriginal community primary schools. Following the intervention, the frequency of students' disruptive behaviours as rated by teachers did not decrease, nor did student executive functioning skills increase, between any time-points. However, teachers perceived student behaviour as significantly less problematic immediately post-intervention compared to preintervention. In contrast, results from parent-rated questionnaires showed significant improvements to children's behaviour and executive functioning skills at follow-up compared to pre-intervention. Lastly, the RE-AIM framework (Reach, Efficacy, Adoption, Implementation, Maintenance) was used to report the implementation and impact of the Alert Program® intervention from the perspective of teachers responsible for delivering the program to students in their class during the self-controlled cluster randomised trial. Feedback from teacher surveys indicated the Alert Program® training and intervention had helped them to support students to self-regulate, and to better plan for and cater to the varying needs of students. Moreover, most teachers who completed the survey recommended the program be adopted across Fitzroy Valley schools. These results are important as children at risk of impaired self-regulation and executive functioning skills, such as those with FASD or exposed to ELT, require educators who recognise and understand the need to accommodate the neurodiversity of children in their classrooms for students to attain academic and social success. Despite the null finding on the primary outcome measure of child behaviour in the classroom, this research found that upskilling teachers in self-regulation concepts has some benefits for both teachers and students. Furthermore, this research has provided valuable information about the feasibility and implementation of intervention research conducted in remote and complex Aboriginal community school settings. vii
doi:10.26182/ybnw-mc57 fatcat:mnaens3n55ht3o3bhetivbsr7u