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A Family-Based Intervention for Early Elementary Students with Reading and Behavioral Difficulties: A Pilot Study

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Title: A Family-Based Intervention for Early Elementary Students with Reading and Behavioral Difficulties: A Pilot Study
Language: English
Authors: Garrett J. Roberts (ORCID 0000-0003-1128-5577), Philip Capin (ORCID 0000-0003-4955-9879), Anna Handy, Brooke Coté, Zaira Jimenez
Source: Journal of Learning Disabilities. 2025 58(5):343-358.
Availability: SAGE Publications and Hammill Institute on Disabilities. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 16
Publication Date: 2025
Sponsoring Agency: Institute of Education Sciences (ED)
Contract Number: R324B190010
Document Type: Journal Articles
Reports - Research
Education Level: Elementary Education
Early Childhood Education
Grade 1
Primary Education
Grade 2
Descriptors: Family Relationship, Intervention, Elementary School Students, Reading Difficulties, Behavior Problems, Grade 1, Grade 2, Reading Comprehension, Learner Engagement, Behavior Modification, Story Reading, Instructional Effectiveness, Family Attitudes, Outcomes of Education, Urban Areas, Child Behavior
Assessment and Survey Identifiers: Behavior Assessment System for Children
DOI: 10.1177/00222194241263649
ISSN: 0022-2194
1538-4780
Abstract: We created and tested a family-based intervention with a sample of U.S. families of children in Grades 1 and 2 with reading and behavioral difficulties to investigate its impact on text comprehension. Developed with input from parents, reading experts, and behavior specialists, Family-RISE (Reading Intervention with Supports for Engagement) integrates evidence-based practices for enhancing students' knowledge of narrative texts with effective behavioral supports to maximize student engagement and minimize disruptive behaviors to help parents engage successfully in shared storybook reading. We assessed the effects of Family-RISE on children's narrative text comprehension using a multiple-baseline design. A functional relation was established between Family-RISE and narrative text comprehension, indicating Family-RISE substantially improved narrative text comprehension. Furthermore, nonoverlap of all pairs, Tau-U, and standard mean difference effect sizes were all considered large in favor of the intervention. Family members reported that the intervention was highly usable, feasible to implement, and socially valid. These findings underscore the promise of the Family-RISE intervention and the value of developing interventions that simultaneously support reading and behavior for children with co-occurring difficulties in these areas.
Abstractor: As Provided
IES Funded: Yes
Entry Date: 2025
Accession Number: EJ1480524
Database: ERIC
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  Value: <anid>AN0187349785;led01sep.25;2025Aug19.05:37;v2.2.500</anid> <title id="AN0187349785-1">A Family-Based Intervention for Early Elementary Students With Reading and Behavioral Difficulties: A Pilot Study </title> <p>We created and tested a family-based intervention with a sample of U.S. families of children in Grades 1 and 2 with reading and behavioral difficulties to investigate its impact on text comprehension. Developed with input from parents, reading experts, and behavior specialists, Family-RISE (Reading Intervention with Supports for Engagement) integrates evidence-based practices for enhancing students' knowledge of narrative texts with effective behavioral supports to maximize student engagement and minimize disruptive behaviors to help parents engage successfully in shared storybook reading. We assessed the effects of Family-RISE on children's narrative text comprehension using a multiple-baseline design. A functional relation was established between Family-RISE and narrative text comprehension, indicating Family-RISE substantially improved narrative text comprehension. Furthermore, nonoverlap of all pairs, Tau- U, and standard mean difference effect sizes were all considered large in favor of the intervention. Family members reported that the intervention was highly usable, feasible to implement, and socially valid. These findings underscore the promise of the Family-RISE intervention and the value of developing interventions that simultaneously support reading and behavior for children with co-occurring difficulties in these areas.</p> <p>Keywords: elementary school; family; literacy; single-case design; positive behavior</p> <p>The frequent co-occurrence between behavior problems and academic difficulties, particularly in the area of reading, is well documented ([<reflink idref="bib10" id="ref1">10</reflink>]; [<reflink idref="bib27" id="ref2">27</reflink>]; [<reflink idref="bib35" id="ref3">35</reflink>]; [<reflink idref="bib47" id="ref4">47</reflink>]). Frequently cited co-occurrence rates of reading and behavioral disorders (e.g., attention-deficit/hyperactivity disorder, conduct disorder) range from 20% to 50% ([<reflink idref="bib26" id="ref5">26</reflink>]; [<reflink idref="bib27" id="ref6">27</reflink>]; [<reflink idref="bib28" id="ref7">28</reflink>]; [<reflink idref="bib46" id="ref8">46</reflink>]; [<reflink idref="bib81" id="ref9">81</reflink>]). It is widely assumed there is a bidirectional relationship between these variables such that behavioral difficulties lead to academic underperformance and vice versa. This relationship is well known to educators, as children who are experiencing reading difficulties often disengage in reading and engage in off-task, avoidant, or problem behaviors. This finding is substantiated by research showing students who struggle in reading in the early elementary grades are at greater risk of later problem behaviors, as difficulties with reading can evoke feelings of frustration or lead to avoidant behaviors to escape or avoid increasingly difficult reading instruction (C. R. [<reflink idref="bib12" id="ref10">12</reflink>]; [<reflink idref="bib27" id="ref11">27</reflink>]; [<reflink idref="bib43" id="ref12">43</reflink>]; [<reflink idref="bib49" id="ref13">49</reflink>]). Conversely, students with behavioral problems may have difficulty engaging in instruction, which becomes an important factor in why they demonstrate difficulties with fully benefiting from high-quality reading instruction ([<reflink idref="bib32" id="ref14">32</reflink>]; [<reflink idref="bib44" id="ref15">44</reflink>]; [<reflink idref="bib52" id="ref16">52</reflink>]; [<reflink idref="bib62" id="ref17">62</reflink>]).</p> <p>Despite the reciprocal relationship between reading and behavior difficulties, schools often address reading and behavior difficulties in isolation (e.g., [<reflink idref="bib5" id="ref18">5</reflink>]; [<reflink idref="bib51" id="ref19">51</reflink>]). This circumstance is problematic because reading-only interventions (without behavior support) do not consistently lead to substantial collateral effects on behavior (C. R. [<reflink idref="bib12" id="ref20">12</reflink>]; [<reflink idref="bib61" id="ref21">61</reflink>], [<reflink idref="bib57" id="ref22">57</reflink>]; [<reflink idref="bib59" id="ref23">59</reflink>]) nor do behavior interventions substantially improve reading ([<reflink idref="bib61" id="ref24">61</reflink>], [<reflink idref="bib57" id="ref25">57</reflink>]; [<reflink idref="bib59" id="ref26">59</reflink>]). Therefore, one possible mechanism for supporting students with co-occurring reading and behavior difficulties may be to develop and test an intervention that addresses both reading and behavior concurrently ([<reflink idref="bib5" id="ref27">5</reflink>]; C. R. [<reflink idref="bib12" id="ref28">12</reflink>]; [<reflink idref="bib41" id="ref29">41</reflink>]; [<reflink idref="bib44" id="ref30">44</reflink>]; [<reflink idref="bib61" id="ref31">61</reflink>], [<reflink idref="bib57" id="ref32">57</reflink>]). Based on school-based research, initial evidence suggests that interventions that address behavioral challenges within reading instruction can be both feasible and lead to improved outcomes ([<reflink idref="bib48" id="ref33">48</reflink>]; [<reflink idref="bib57" id="ref34">57</reflink>], [<reflink idref="bib62" id="ref35">62</reflink>]; [<reflink idref="bib59" id="ref36">59</reflink>]; [<reflink idref="bib60" id="ref37">60</reflink>]). Furthermore, feedback from students and educators suggests these approaches are important and can be feasibly implemented in school settings ([<reflink idref="bib60" id="ref38">60</reflink>]). Although findings from school-based research underscore the promise of addressing reading and behavior difficulties within a single intervention, questions about the extent to which home-based integrated reading and behavior approaches can improve outcomes have been unasked and unanswered.</p> <hd id="AN0187349785-2">Family-Based Reading Intervention With Supports for Engagement</hd> <p>Based on our prior experiences developing school-based approaches that simultaneously address reading and behavioral difficulties, we developed a Family-Based Reading Intervention with Supports for Engagement (Family-RISE) as a home-based intervention focused on helping families engage in a shared storybook reading routine for early elementary children. We focused on Grades 1 and 2 as the target population because of the importance of early interventions to prevent long-term reading difficulties ([<reflink idref="bib21" id="ref39">21</reflink>]; [<reflink idref="bib22" id="ref40">22</reflink>]; [<reflink idref="bib80" id="ref41">80</reflink>]). We were also interested in supporting families to successfully engage with their children during shared storybook reading because it is consistently shown to nurture children's vocabulary and language development (e.g., [<reflink idref="bib6" id="ref42">6</reflink>]; [<reflink idref="bib65" id="ref43">65</reflink>]; [<reflink idref="bib68" id="ref44">68</reflink>]). A meta-analysis conducted by [<reflink idref="bib66" id="ref45">66</reflink>] examining the effects of family literacy interventions for K-3 students was statistically significant and moderately large (<emph>g</emph> = 0.65). Their findings also revealed that the effects of family literacy interventions were greatest when parents were trained to complete specific reading activities with children, as opposed to asking family members to read-aloud to their children or listen to their children as they read without a specific purpose. This finding was further supported by a more recent meta-analysis examining the effects of home literacy interventions for young children from low-socioeconomic status (SES) families ([<reflink idref="bib19" id="ref46">19</reflink>]), which found focused shared reading programs in which family members provided some formal instruction on a constrained set of skills were associated with the strongest literacy gains.</p> <hd id="AN0187349785-3">Theoretical and Empirical Underpinnings of Family-RISE</hd> <p>Family-RISE is based on contemporary reading and behavior theories and empirical findings that shed light on evidence-based practices for enhancing reading and behavioral outcomes for children with room for growth in these areas. The simple view of reading ([<reflink idref="bib25" id="ref47">25</reflink>]), which posits that reading comprehension is the product of word recognition and linguistic comprehension and that weaknesses in one or both areas contribute to reading difficulties, informed the development of the instruction. The reading intervention focused on developing linguistic comprehension of narrative texts through shared book reading. A focus was placed on shared book reading based on experimental findings indicating that shared book reading enhances vocabulary, oral language development, and narrative skills (e.g., [<reflink idref="bib66" id="ref48">66</reflink>]).</p> <p>The development of the Family-RISE reading practices was primarily influenced by Kintsch's Construction-Integration model of text comprehension ([<reflink idref="bib36" id="ref49">36</reflink>]). This theory and its derivatives (e.g., [<reflink idref="bib78" id="ref50">78</reflink>]) identify multiple levels of text understanding, including the surface level (understanding words and phrases), the textbase (connecting surface-level information to construct individual propositions or units of meaning), and the situation model (a rich mental representation of text that reflects the integration of the textbase with the reader's prior knowledge). Family-RISE aligned with the Construction-Integration model of text comprehension by teaching story grammar elements (e.g., character, setting, problem, and solution) that form the textbase of narrative texts. Instructional practices focused on teaching students to identify and connect story grammar elements into a coherent story retelling to support the construction of coherent situation models.</p> <p>The focus on story grammar elements is also well supported by empirical findings for developing narrative text comprehension. The What Works Clearinghouse practice guide for developing reading for understanding in Grades K–3 ([<reflink idref="bib20" id="ref51">20</reflink>]) recommends (a) explicit instruction in story grammar elements, (b) modeling and providing scaffolding to support children's ability to retell stories, and (c) the gradual reduction of prompts to enable students to become independent. These recommendations were operationalized within Family-RISE through lesson procedures that called for parents to explicitly teach the most critical story grammar elements over the course of five instructional sessions. Families and children used a graphic organizer (story map) to support children in identifying story grammar elements in the story. Families were also provided with guidance on how to model story retells and fade supports over time. The intervention description presents a further explanation and lesson materials.</p> <p>To develop the behavior supports, we drew on behavioral theories and empirical evidence from school- and family-based interventions ([<reflink idref="bib8" id="ref52">8</reflink>]; [<reflink idref="bib14" id="ref53">14</reflink>]; [<reflink idref="bib16" id="ref54">16</reflink>]; [<reflink idref="bib17" id="ref55">17</reflink>]). Behavioral treatments grounded in behavioral psychology that focus on training family members and teachers to manipulate or modify environmental antecedents and behavioral contingencies for children are the psychosocial intervention with the strongest evidence base ([<reflink idref="bib9" id="ref56">9</reflink>]; [<reflink idref="bib17" id="ref57">17</reflink>]; [<reflink idref="bib33" id="ref58">33</reflink>]; [<reflink idref="bib56" id="ref59">56</reflink>]). Utilizing intervention research (e.g., [<reflink idref="bib8" id="ref60">8</reflink>]; [<reflink idref="bib14" id="ref61">14</reflink>]; [<reflink idref="bib60" id="ref62">60</reflink>]), we chose to include the following components that are effective and feasible for parents to implement with minimal coaching (a) visual schedule to support routines, (b) taught and practiced group expectations, and (c) behavior-specific praise to reinforce expected behaviors. Each of these components is further described in the intervention procedure section.</p> <hd id="AN0187349785-4">Study Purpose and Research Questions</hd> <p>The purpose of this study was to conduct an initial evaluation of a novel approach to supporting the needs of young children with or at risk of reading and behavioral difficulties. This research builds on our previous research examining the effects of integrated approaches to reading and behavior in school-based interventions ([<reflink idref="bib58" id="ref63">58</reflink>]; [<reflink idref="bib59" id="ref64">59</reflink>]; [<reflink idref="bib60" id="ref65">60</reflink>]). We are not aware of a home-based reading intervention that has sought to address the needs of children with co-occurring reading and behavioral challenges. Thus, this study will provide a unique contribution to the extant research examining home literacy interventions by examining the effects of integrating behavioral strategies with family-led reading intervention for a population of students who have been understudied and have demonstrated difficulties with fully benefiting from high-quality reading instruction provided in schools ([<reflink idref="bib1" id="ref66">1</reflink>]; [<reflink idref="bib32" id="ref67">32</reflink>]; [<reflink idref="bib52" id="ref68">52</reflink>]; [<reflink idref="bib57" id="ref69">57</reflink>]). To assess the promise of Family-RISE and families' perceptions of the intervention materials and procedures, we addressed three research questions:</p> <p></p> <ulist> <item> <bold> Research Question 1: </bold> What is the impact of a family-implemented reading and behavior support intervention on narrative text comprehension for Grade 1 and 2 students with co-occurring reading and behavioral difficulties?</item> <p></p> <item> <bold> Research Question 2: </bold> To what extent do families consider the reading and behavior intervention materials and procedures to be usable, feasible to implement, socially valid, and promising in improving outcomes?</item> <p></p> <item> <bold> Research Question 3: </bold> To what extent were families able to implement the intervention with fidelity?</item> </ulist> <hd id="AN0187349785-5">Method</hd> <p></p> <hd id="AN0187349785-6">Setting</hd> <p>Students were recruited from two urban elementary schools in one district in the Rocky Mountain region of the United States. The number of students at each school averaged 530 (<emph>SD</emph> = 314). On average, 46% (<emph>SD</emph> = 41) of the students at each school were White, 24% (<emph>SD</emph> = 28) were African American, and 19% (<emph>SD</emph> = 13) were Hispanic. Between 0% and 3% of students at each school identified as Asian/Pacific Islander, American Indian, Native Hawaiian, or multiple races. The mean number of students identified as English language learners was 18% (<emph>SD</emph> = 19), and 45% (<emph>SD</emph> = 51) of students qualified for free or reduced-price lunch. An average of 12% (<emph>SD</emph> = 6) of students qualified for special education services across the two schools.</p> <hd id="AN0187349785-7">Participants</hd> <p>We asked first- and second-grade general education teachers at participating schools to nominate students with co-occurring reading and behavior difficulties. To the teachers, we defined reading difficulties as needing support to understand text and behavior difficulties as presenting behaviors that interfered with their ability to access reading instruction. Teachers sent study information and parent consent forms to the families of nominated students. Recruitment ended once we had a total of eight consenting families and therefore was based on the order in which families responded and consented. Consenting families identified one family member who would act as the primary implementer which included participating in all trainings and sessions. One family withdrew from the study due to a family member's health issues. Information about this family is not included in the data.</p> <p>The participants included six first-grade students and one second-grade student (<emph>N</emph> = 7). Six children identified as White, non-Hispanic, and one student identified as two or more races. No students received special education services or were identified as English learners at the time of the intervention. Across the seven families, each family member who implemented the intervention was a parent or guardian. Table 1 provides the demographic information for the child and primary implementer information. Table 2 provides child pretest scores to characterize the sample. The measures provided in Table 2 are described in the following section.</p> <p>Table 1. Demographics of Student Participants in Study of Family-RISE.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="center">Participant</th><th align="center">Grade</th><th align="center">Gender</th><th align="center">Race/ethnicity</th><th align="center">EL</th><th align="center">SPED</th><th align="center">Implementer</th></tr></thead><tbody><tr><td>Kade</td><td>1</td><td>Male</td><td>White</td><td>No</td><td>No</td><td>Father</td></tr><tr><td>Mia</td><td>1</td><td>Female</td><td>White</td><td>No</td><td>No</td><td>Father</td></tr><tr><td>Blake</td><td>1</td><td>Male</td><td>White</td><td>No</td><td>No</td><td>Mother</td></tr><tr><td>Leo</td><td>1</td><td>Male</td><td>White</td><td>No</td><td>No</td><td>Father</td></tr><tr><td>Faye</td><td>1</td><td>Female</td><td>White</td><td>No</td><td>No</td><td>Father</td></tr><tr><td>Jordan</td><td>1</td><td>Male</td><td>White</td><td>No</td><td>No</td><td>Mother</td></tr><tr><td>Micah</td><td>2</td><td>Male</td><td>Multiple races</td><td>No</td><td>No</td><td>Stepmother</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note.</emph> Family-RISE = Family-Based Reading Intervention with Supports for Engagement; EL = English learner; SPED = special education.</p> <p>Table 2. Reading and Behavior Pretest Data.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Participant</th><th align="center" colspan="2">TOWRE-2</th><th align="center" colspan="4">BASC-3 BESS</th></tr><tr><th align="center">PDE<xref ref-type="table-fn" rid="tfn3">a</xref></th><th align="center">SWE<xref ref-type="table-fn" rid="tfn3">a</xref></th><th align="center">BERI<xref ref-type="table-fn" rid="tfn3">b</xref></th><th align="center">ERI<xref ref-type="table-fn" rid="tfn3">c</xref></th><th align="center">IRiI<xref ref-type="table-fn" rid="tfn3">c</xref></th><th align="center">ASRI<xref ref-type="table-fn" rid="tfn3">d</xref></th></tr></thead><tbody><tr><td>Kade</td><td>93</td><td>94</td><td>48</td><td>4</td><td>4</td><td>16</td></tr><tr><td>Mia</td><td>85</td><td>90</td><td>61</td><td>10</td><td>10</td><td>13</td></tr><tr><td>Blake</td><td>85</td><td>87</td><td>48</td><td>4</td><td>5</td><td>17</td></tr><tr><td>Leo</td><td>72</td><td>92</td><td>55</td><td>9</td><td>8</td><td>18</td></tr><tr><td>Faye</td><td>75</td><td>70</td><td>46</td><td>4</td><td>6</td><td>21</td></tr><tr><td>Jordan</td><td>91</td><td>95</td><td>39</td><td>1</td><td>5</td><td>25</td></tr><tr><td>Micah</td><td>71</td><td>87</td><td>55</td><td>12</td><td>5</td><td>17</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 <emph>Note.</emph> TOWRE-2 = The Test of Word Reading Efficiency—2 ([<reflink idref="bib76" id="ref70">76</reflink>]); BASC-3 BESS = Behavior Assessment Scale for Children, Third Edition Behavioral and Emotional Screening System ([<reflink idref="bib34" id="ref71">34</reflink>]); PDE = phonemic decoding efficiency; SWE = sight word efficiency; BERI = behavioral and emotional risk index; ERI = externalizing risk index; ASRI = adaptive skills risk index.</item> <item>3 Standard score. <sups>b</sups>T-score (<emph>M</emph> = 50; <emph>SD</emph> = 10). <sups>c</sups>Raw score with < 10 representing normal risk. <sups>d</sups>Raw score with > 9 representing normal risk.</item> </ulist> <hd id="AN0187349785-8">Measures</hd> <p>This study included (a) pretest reading and behavior measures to characterize the sample, (b) a per-session narrative text comprehension measure to address the primary research question, and (c) posttest family member perception measures to address the second research question. Following a test administrator training and obtaining 100% reliability with the lead trainer, assessment team members conducted the pretest reading measures in person. The family member (i.e., primary implementer) administered the story grammar comprehension measure after every session (family member training is further described in the baseline training section). All sessions were video recorded via Zoom and used for recording and scoring the narrative text comprehension measure and treatment integrity.</p> <hd id="AN0187349785-9">Reading</hd> <p></p> <hd id="AN0187349785-10">Phonemic Decoding, Sight Word Reading</hd> <p>The Test of Sight Word Reading Efficiency second edition (TOWRE-2), Sight Word Efficiency subtest (TOWRE-SWE), and Phonemic Decoding Efficiency subtest (TOWRE-PDE) were administered as a pretest measure prior to baseline. The TOWRE-SWE and TOWRE-PDE are 45 sec individually administered measures of word reading and phonemic decoding, respectively ([<reflink idref="bib76" id="ref72">76</reflink>]). These measures have students read a list of increasingly difficult words or non-real words, respectively. The alternate form reliability coefficients across both subtests ranged from.91 to.92.</p> <hd id="AN0187349785-11">Narrative Text Comprehension</hd> <p>Students' understanding of narrative texts was assessed using a measure of narrative text comprehension administered by parents. Similar to several previous studies examining narrative text comprehension (e.g., [<reflink idref="bib2" id="ref73">2</reflink>]; [<reflink idref="bib3" id="ref74">3</reflink>]; [<reflink idref="bib13" id="ref75">13</reflink>]; [<reflink idref="bib23" id="ref76">23</reflink>]; [<reflink idref="bib50" id="ref77">50</reflink>]; [<reflink idref="bib67" id="ref78">67</reflink>]; [<reflink idref="bib69" id="ref79">69</reflink>]; [<reflink idref="bib70" id="ref80">70</reflink>]; [<reflink idref="bib71" id="ref81">71</reflink>]; [<reflink idref="bib72" id="ref82">72</reflink>]), our measure of narrative text comprehension was adapted from [<reflink idref="bib30" id="ref83">30</reflink>]. Our measure, like [<reflink idref="bib30" id="ref84">30</reflink>], included 10 open-ended items and assessed the common story grammar elements, including character, setting, problem, internal feelings, actions, complicating event, solution, ending, and theme. For instance, family members asked their child "who is the main character?"; "what is the main problem in the story?"; and "what was the solution to the problem?" The measure was administered by parents at the end of all sessions (baseline, intervention, and maintenance) and referred to in the study materials as the <emph>Show What You Know Quiz</emph>. Students did not have access to the text or teaching materials during the narrative text comprehension measure. In all sessions, the research team videorecorded the family member's test administration and student's responses. Two graduate students independently transcribed child responses. Transcription discrepancies were resolved through conversation between transcribers and the first author. Graduate students blind to the study purpose scored student responses as a 0 (<emph>incorrect</emph>), 1 (<emph>partially correct</emph>), or 2 (<emph>fully correct</emph>) using a story-specific rubric created prior to the start of the study. Supplemental File Table S1 presents a sample story-specific rubric.</p> <hd id="AN0187349785-12">Behavior</hd> <p>The Behavior Assessment System for Children-3 Behavioral and Emotional Screening System (BASC-3 BESS; [<reflink idref="bib34" id="ref85">34</reflink>]) is a 5- to 10-min behavior screening measure with 25 to 30 questions on behavioral problems and strengths. The BASC-3 BESS was completed by a family member of each participating child. A behavioral and emotional risk composite score is reported in T-scores (mean of 50 and standard deviation of 10; higher scores represent higher behavior levels). Subindex externalizing, internalizing, and adaptive skills risk index classifications are reported in raw scores, with scores less than 10, less than 9, and greater than 9 representing normal risk, respectively. Reliability coefficients range from.88 to.94. The BASC-3 BESS was administered at a pretest to characterize students' behavior performance.</p> <hd id="AN0187349785-13">Family Member Survey</hd> <p>Family members were asked to complete a five-point Likert-type scale (<emph>strongly disagree</emph> = 1; <emph>strongly agree</emph> = 5). The 24-item researcher-created survey (see Supplemental File Table S2) had items related to the intervention's social validity, usability, feasibility, promise, future plans to use the intervention practices, confidence in using the intervention, and overall satisfaction. This survey was based on previous surveys relating to reading, behavior, and home-based interventions (e.g., [<reflink idref="bib73" id="ref86">73</reflink>]) and was created to align with our study characteristics (e.g., setting, implementer, and components) as well as to support the future development of Family-RISE. Families completed the survey following the last intervention session.</p> <hd id="AN0187349785-14">Experimental Design</hd> <p>To test the impact of the Family-RISE intervention on narrative text comprehension, we employed a concurrent multiple-baseline across participants with a baseline, five-lesson intervention, and maintenance phase. Phase change decisions were based on a visual inspection of the narrative text comprehension measure data (i.e., response-guided single-case design) to identify data stability in level or trend ([<reflink idref="bib40" id="ref87">40</reflink>]). We chose to use a response-guided single-case design, as compared to a randomized single-case design, because Family-RISE is in the pilot stage with research questions and design decisions more focused on questions related to internal validity (e.g., [<reflink idref="bib18" id="ref88">18</reflink>]; [<reflink idref="bib38" id="ref89">38</reflink>]; [<reflink idref="bib42" id="ref90">42</reflink>]) than external validity (i.e., generalization).</p> <hd id="AN0187349785-15">Procedures</hd> <p>This 10-week study had three phases: baseline, five-lesson intervention, and maintenance. During each phase, family members read one book to their child every session. In the baseline phase, family members chose how they read the books to their child. In the five-lesson intervention and maintenance phase, family members followed Family-RISE lessons. The lessons are further described in the intervention and maintenance phase sections. We created a book reading schedule by randomly assigning the 19 books to sessions so that in a given session all families read the same book (e.g., on session 10, families read <emph>Jabari Jumps</emph>). Families held two sessions per week either before or after school. A research assistant (RA) was present, via Zoom, with families for every session. The first and second authors provided training to the family members and RAs prior to the baseline and intervention phases.</p> <hd id="AN0187349785-16">Research Assistants</hd> <p>The amount of support the RAs provided during each study phase varied (see phase descriptions). Each RA was assigned one family. Of the seven RAs, there were four doctoral students, one master's student, one education specialist student, and one who held a PhD in school psychology. All RAs identified as female, four identified as White, two identified as Hispanic, and one identified as Asian.</p> <hd id="AN0187349785-17">Materials</hd> <p>The study included the following materials: (a) iPad to allow coaches to be virtually present during each session; (b) 19 narrative books; (c) baseline phase protocols; (d) intervention phase protocols; and (e) maintenance phase protocols. Books were chosen to align with a range of culturally diverse backgrounds by the research team and teachers within the participating school district.</p> <p>The baseline phase protocols included directions for using the iPad and logging into the Zoom sessions, a book sequence list, and the narrative text comprehension measure with implementation directions. The intervention materials included all the baseline phase materials as well as (a) Family-RISE lessons; (b) blank story maps for the family member to complete with their child when reading the books; (c) story map exemplars to support parents completing the blank story maps; (d) a visual schedule; and (e) a reading expectations chart. The maintenance phase materials included the baseline and intervention materials and maintenance phase lessons.</p> <hd id="AN0187349785-18">Baseline Phase</hd> <p></p> <hd id="AN0187349785-19">Trainings</hd> <p>Prior to the baseline phase, the first and second authors conducted a 15-min family member and 30-min RA training. During the family member training, each family member received a checklist with all the baseline phase protocols (e.g., information about logging into Zoom) and materials (e.g., books, book sequence list, iPad). Next, family members were informed of the baseline phase session protocols: (a) join Zoom session with coach; (b) read the session's book with their child; (c) administer the narrative text comprehension measure to their child; and (d) ask the RA questions, if necessary. As a last step of the training, the family member reviewed and practiced the following three-step narrative text comprehension measure administration procedure: (a) remove all materials (e.g., book) from their child's sight; (b) read each question (e.g., Who is the main character?) without additional prompts (e.g., "you are close, try again"); and (c) ask the next question following child response. All family members administered the three-step narrative text comprehension measure with 100% assessment fidelity prior to the first baseline session.</p> <p>The first and second authors also led the RA's baseline phase training. During this training, coaches reviewed and practiced session protocols. The checklist protocol procedure included: (a) begin recording the Zoom session; (b) greet the family and ask if they have any questions; (c) ensure the family member has the correct book to read; (d) remain present during the session; (e) do not provide instructional support (e.g., how to ask questions of the child during book reading); (f) ensure that the family member administered the narrative text comprehension measure to their child with fidelity (e.g., no additional prompts, all items read; (g) following the quiz, provide procedural (e.g., how to administer the quiz) feedback as needed; and (h) confirm next session date and time with the family. All RAs were able to follow the checklist protocol procedure with 100% accuracy following the training.</p> <hd id="AN0187349785-20">Baseline Procedures</hd> <p>During the baseline phase, the family member read the book assigned for that given session. After the book was read, the family member administered the narrative text comprehension measure. RAs provided no instructional support. Families were instructed not to read any of the books to their children prior to the scheduled session.</p> <hd id="AN0187349785-21">Intervention Phase</hd> <p></p> <hd id="AN0187349785-22">Trainings</hd> <p>The first, second, and third authors led the second training for the family member (30 min) and RAs (90 min) after the baseline and prior to the intervention phase. Each training described the study purpose, Family-RISE lesson plans, and associated materials (e.g., story maps and books). Each of these components is further described in the five-lesson intervention procedures section below. Training also included explicit instruction, video modeling, opportunities for practice, feedback from the presenter, and time to ask questions. Given the time constraints that many families experience, the family member training was designed to be brief, and we did not require families to meet a fidelity threshold prior to implementing the intervention.</p> <p>The RA training introduced the coaching protocol and coaching supports available in the intervention phase. The coaching protocol included before-, during-, and after-lesson procedures. Before the lesson, RAs reviewed the feedback from the previous session and answered all family questions. During the lesson, the RAs recorded information on the coaching protocol form (based on [<reflink idref="bib14" id="ref91">14</reflink>]). This form had sections to record (a) the extent to which the family member executed the intervention's critical components and how the child responded to instruction, (b) general observation notes, and (c) family member feedback and questions. During the lesson, and when necessary, the RAs briefly modeled the lesson components and gave feedback to the parents and child (e.g., "I think I just heard the story's complication. Let us try reading that page again. Don't forget to listen for the complication and give a thumb's up when you hear it"). The goal of the RAs' modeling and feedback during the lesson was to ensure high levels of fidelity to the lesson and support student engagement. After the lesson, the RA and family member met to discuss the information recorded on the coaching protocol form, identify the strengths of the session and one goal for the next session, and answer family member questions. Following the training, all RAs demonstrated mastery of the before-, during-, and after-lesson coaching protocols by meeting the 90% accuracy criteria with the first, second, or third author.</p> <hd id="AN0187349785-23">Intervention Procedures</hd> <p>The intervention included five lessons (delivered over five sessions), each approximately 30 min in length. Each lesson introduced new story grammar elements (10 story grammar elements were introduced across the five lessons) and included an identical read-aloud routine. The first lesson varied slightly from Lessons 2 to 5, where in Lesson 1, the visual schedule and reading expectations were introduced, and in Lessons 2–5, they were reviewed. As previously noted, during the intervention phase, RAs supported lesson implementation through before, during, and after the lesson.</p> <hd id="AN0187349785-24">Family-RISE Lessons</hd> <p>Lesson 1 first focuses on behavior support with the family clearing a reading space of non-necessary items and ensuring that all materials (e.g., story map, pencil, lesson plan, book) are easily accessible. Second, families reviewed two printed posters (i.e., visual schedule and reading behavior expectations). The first poster had a visual schedule of the session's activities. The second poster included three reading behavior expectations: calm body, look and listen, and engaged brains. Third, the family member and the child created two to three observable positive behavior examples (e.g., keep your eyes on the book or reader) for each of the three expectations. Finally, the family member and child discussed why it is important to follow the expectations. The observable positive behavior examples were reviewed (and revised if needed) in Lessons 2–5. Throughout all Family-RISE lesson plans, family members provided differential reinforcement in the form of behavior-specific praise when their child demonstrated the behavioral expectations (e.g., "Great job having a calm body, sitting up straight in your chair, and listening to the story") and when misbehavior did occur (e.g., talking about off-topic subjects), family members restated the expectations followed by behavior-specific praise when the child re-engaged with the behavioral expectations ([<reflink idref="bib8" id="ref92">8</reflink>]; [<reflink idref="bib14" id="ref93">14</reflink>]; [<reflink idref="bib15" id="ref94">15</reflink>]; [<reflink idref="bib33" id="ref95">33</reflink>]; [<reflink idref="bib56" id="ref96">56</reflink>]).</p> <p>Next, the family member introduced the reading lesson with the first three story grammar elements: characters, setting (where), and setting (when). For each story grammar element, the family member (a) showed their child the associated symbol on a story map, (b) provided a definition and examples, and (c) checked for understanding (e.g., can you think of some characters that are people?). Seven additional story grammar elements were taught across Lessons 2–5: problem and feelings in Lesson 2, action and complication in Lesson 3, solution and ending in Lesson 4, and theme in Lesson 5. In Lessons 2–5, the family members would also quickly review the definition of previously taught story grammar elements by completing the following steps: (a) point to the story map icon; (b) ask their child to explain the story grammar element; and (c) provide the correct explanation if their child inaccurately explained the story grammar element or could not provide a response.</p> <p>Next, the family member implemented the story read-aloud routine: (a) introduce the story, (b) read and complete the story map, (c) student retell, and (d) Show What You Know quiz (i.e., narrative text comprehension measure). To introduce the story, family members described the book cover and previewed the story. Read and complete story map had the family member read the story aloud and have the child give a thumbs up when they heard a previously taught story grammar element (i.e., in Lesson 1, they were only listening for characters and the setting). The child then stated the story element; it was briefly discussed between the family member and child, and, if correct, it was added to the story map. A researcher-provided completed story map answer key supported the family member in identifying appropriate responses. The lesson plan also included prompts the family member could use if the child did not recognize a story element (e.g., "What story elements came up on this page?"). During the student retell, the child and family used the completed portions of the story map to retell the story (note: story maps were not fully completed until all story grammar elements were taught in Lesson 5). Before administering the Show What You Know quiz at the end of each lesson to assess narrative text comprehension, the family member removed the book and the story map from their child's view.</p> <hd id="AN0187349785-25">Maintenance Phase</hd> <p>Lessons in the maintenance phase were identical to those in the intervention with two exceptions. First, the story grammar element lesson only included a review of the previously taught story grammar element definitions (no new story grammar elements were taught). Second, the RAs did not provide instructional feedback during the lesson, and, instead, the RAs only answered questions prior to the lesson and debriefed with the family following the lesson.</p> <hd id="AN0187349785-26">Procedural Fidelity</hd> <p>Video recordings were used to calculate the procedural fidelity. We measured the procedural fidelity during all sessions in all phases of the study ([<reflink idref="bib39" id="ref97">39</reflink>]) using a fidelity form that aligned to Family-RISE lesson plan components. The fidelity form included components divided into reading and behavior support components. The reading components completed by the family member included: (a) follows story grammar element lesson script (i.e., teaches first story grammar element using say and ask procedure, teaches second story grammar element using say and ask procedure, reviews each previously taught story grammar element); (b) introduces the story (i.e., shows their child the cover of the book, provides a story overview in one to two sentences); (c) reads story aloud; (d) pauses to discuss each story element throughout the story reading; (e) writes the identified story elements on the story map; and (f) asks child to retell the story using the story map. The fidelity form reading components completed by the family member included (a) reviews all three behavior expectations at the beginning of the lesson and (b) delivers at least one behavioral expectation or a behavior-specific praise during each reading component (i.e., e.g., story grammar element, introduce story; student retell of story). We used this fidelity form to also measure the extent to which families implemented intervention components during the baseline phase. Each previously described reading and behavior component was scored 0 to 3 representing 0% to 25%, 26% to 50%, 51% to 75%, or 76% to 100% implementation of the lesson plan as designed, respectively. For example, if a parent introduced the story by showing the front cover of the book without providing a story overview, this would be scored as a 1, because 50% of this reading component was implemented as designed. As expected, the baseline phase fidelity was low, which suggests that families did not incorporate the Family-RISE intervention practices during the baseline phase. The average reading and behavior support fidelity were 0.69 (<emph>SD</emph> = 0.23) and 0.06 (<emph>SD</emph> = 0.21), respectively. The intervention phase had an average reading and behavior support fidelity score of 2.47 (<emph>SD</emph> = 0.81) and 2.33 (<emph>SD</emph> = 0.71), respectively. The maintenance phase had an average reading and behavior support fidelity score of 2.72 (<emph>SD</emph> = 0.55) and 2.19 (<emph>SD</emph> = 0.87), respectively.</p> <hd id="AN0187349785-27">Interobserver Agreement</hd> <p>The first and fourth authors trained graduate students in the college of education to score the narrative text comprehension measures and code for procedural fidelity, respectively. Each 1-hour training included a definition of relevant variables, examples and non-example and coding practice. Following the training, each graduate student met a minimum of 90% interobserver agreement (IOA) with the lead trainer, prior to independently scoring or coding.</p> <p>To calculate IOA, we used interval-by-interval comparisons; the sum of the number of intervals with agreements was divided by the sum of the total number of intervals (i.e., agreements plus disagreements), and then we converted the result to a percentage. We double-coded and calculated IOA on a minimum of 20% of randomly selected sessions per phase ([<reflink idref="bib31" id="ref98">31</reflink>]) per family. In the baseline, intervention, and maintenance phases, 23%, 20%, and 21% of the sessions, respectively, were coded for both narrative text comprehension and fidelity IOA. The mean narrative text comprehension and fidelity IOA percentage across all phases were 94.58 (<emph>SD</emph> = 7.79) and 92.59 (<emph>SD</emph> = 7.80), respectively.</p> <hd id="AN0187349785-28">Analysis</hd> <p>To measure the intervention effect, we used visual analysis (e.g., [<reflink idref="bib29" id="ref99">29</reflink>]; [<reflink idref="bib37" id="ref100">37</reflink>]; [<reflink idref="bib40" id="ref101">40</reflink>]), two nonparametric effect sizes, two overlap effect sizes, and one parametric effect size. We report all effect sizes as a baseline-intervention phase comparison and baseline-maintenance phase comparison. For all effect sizes, a higher score indicates a larger effect.</p> <p>We used visual analysis of the plotted data on a line graph to first determine if the narrative text comprehension outcome changed across phases for a given participant (i.e., demonstration of effect). To determine if a demonstration of effect was present, the visual analysis procedure included a comparison of within- and across-phase data characteristics (e.g., [<reflink idref="bib29" id="ref102">29</reflink>]; [<reflink idref="bib37" id="ref103">37</reflink>]; [<reflink idref="bib40" id="ref104">40</reflink>]). Within-phase characteristics included level (i.e., average score), trend or slope, and variability around the trend line. Across-phase characteristics included immediacy of effect (i.e., level change from last three to first three data points in adjoining phases), overlap of data points across phases, and consistency of data in similar phases. Next, we investigated if there was a replication of a demonstration of effect across participants (i.e., direct replication). Finally, and to establish a functional relation, we identified if the effect was replicated a minimum of three times (e.g., [<reflink idref="bib29" id="ref105">29</reflink>]; [<reflink idref="bib40" id="ref106">40</reflink>]). Differing from the effect sizes presented in the proceeding sections, visual analysis is used to determine the presence (or absence) of a functional relation, as compared with evaluating the magnitude of the effect ([<reflink idref="bib40" id="ref107">40</reflink>]).</p> <p>To measure the extent to which data overlapped across phases, we calculated two non-overlap effect sizes: nonoverlap of all pairs (NAPs; [<reflink idref="bib53" id="ref108">53</reflink>]) and Tau-<emph>U</emph> ([<reflink idref="bib54" id="ref109">54</reflink>]). NAP is a measure of the proportion of all pair-wise comparisons with scores ranging from 0 to 1. For the purpose of our study, NAP represents the estimated probability that a randomly selected narrative text comprehension data point in the intervention or maintenance phase exceeds a randomly selected data point in the baseline phase. NAP is also a What Works Clearinghouse ([<reflink idref="bib31" id="ref110">31</reflink>]) recommended overlap effect size.</p> <p>We also included Tau-<emph>U</emph> as it is a commonly used single-case design overlap effect size ([<reflink idref="bib79" id="ref111">79</reflink>]) that controls for monotonic trends (i.e., upward or downward linear, curvilinear, or mixed pattern trends) ([<reflink idref="bib54" id="ref112">54</reflink>]). Unlike NAP, Tau-<emph>U</emph> is a correlation coefficient not bound between −1 and 1 ([<reflink idref="bib4" id="ref113">4</reflink>]; [<reflink idref="bib74" id="ref114">74</reflink>]). Tau-<emph>U</emph> requires each case to be tested for monotonic baseline trends (i.e., upward or downward linear, curvilinear, or mixed pattern trends; [<reflink idref="bib64" id="ref115">64</reflink>]; [<reflink idref="bib75" id="ref116">75</reflink>]). A Baseline Corrected Tau effect size ([<reflink idref="bib74" id="ref117">74</reflink>]) is needed when statistically significant monotonic trends are present. We tested and did not identify any statistically significant monotonic baseline trends, and therefore, we do not report a Baseline Corrected Tau for any cases.</p> <p>Finally, we report a within-case standardized mean difference (WC-SMD; [<reflink idref="bib7" id="ref118">7</reflink>]; [<reflink idref="bib24" id="ref119">24</reflink>]), a parametric effect size representing the difference between the baseline phase mean and intervention (or maintenance) phase mean divided by the baseline standard deviation. We chose to use WC-SMD for two reasons. First, relative to measures of overlap, WC-SMD is more comparable to group-design study effect sizes (B. G. [<reflink idref="bib11" id="ref120">11</reflink>]; [<reflink idref="bib45" id="ref121">45</reflink>]). Second, a single-case design study's procedural differences (e.g., number of sessions per phase, length of observation or measure) strongly influence the magnitude of overlap effect sizes, making it difficult to compare overlap effect sizes across studies ([<reflink idref="bib77" id="ref122">77</reflink>]). For all effect size calculations and tests for statistically significant monotonic trends, we used the effect size calculator at https://jepusto.shinyapps.io/SCD-effect-sizes/ ([<reflink idref="bib55" id="ref123">55</reflink>]).</p> <hd id="AN0187349785-29">Results</hd> <p>The average NAP, Tau-<emph>U</emph>, and WC-SMD effect sizes for the intervention phase were 0.96, 0.94, and 2.28, respectively. The average NAP, Tau-<emph>U</emph>, and WC-SMD effect sizes for the maintenance phase were 1.00, 1.08, and 3.64, respectively. These effect size results are all considered large (see [<reflink idref="bib45" id="ref124">45</reflink>]). Table 3 presents the narrative text comprehension outcome means, standard deviations, ranges, and effect sizes for each child and the study average. Figure 1 provides child narrative text comprehension data in graphical form to allow for visual analysis. The visual analysis and family member survey are described in the following sections.</p> <p>Table 3. Narrative Text Comprehension Data.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Participant</th><th /><th /><th /><th align="center" colspan="3">Effect sizes</th></tr><tr><th align="center">Phase</th><th align="center"><italic>M (SD)</italic></th><th align="center">Range</th><th align="center">NAP (<italic>SE</italic>)</th><th align="center">Tau-<italic>U</italic></th><th align="center">SMD (<italic>SE</italic>)</th></tr></thead><tbody><tr><td>Kade</td><td>Baseline</td><td>36.0 (8.9)</td><td>25.0–45.0</td><td /><td /><td /></tr><tr><td /><td>Intervention</td><td>57.0 (6.7)</td><td>50.0–65.0</td><td>1.00 (0.04)</td><td>1.20</td><td>2.74 (0.91)</td></tr><tr><td /><td>Maintenance</td><td>72.0 (12.6)</td><td>55.0–90.0</td><td>1.00 (0.04)</td><td>1.20</td><td>4.54 (1.41)</td></tr><tr><td>Mia</td><td>Baseline</td><td>20.0 (8.2)</td><td>10.0–30.0</td><td /><td /><td /></tr><tr><td /><td>Intervention</td><td>48.0 (11.5)</td><td>35.0–60.0</td><td>1.00 (0.05)</td><td>1.3</td><td>2.20 (0.77)</td></tr><tr><td /><td>Maintenance</td><td>79.0 (9.6)</td><td>70.0–95.0</td><td>1.00 (0.05)</td><td>1.30</td><td>4.30 (1.35)</td></tr><tr><td>Blake</td><td>Baseline</td><td>28.8 (12.5)</td><td>10.0–35.0</td><td /><td /><td /></tr><tr><td /><td>Intervention</td><td>50.0 (7.1)</td><td>45.0–60.0</td><td>0.88 (1.29)</td><td>1.05</td><td>1.77 (0.80)</td></tr><tr><td /><td>Maintenance</td><td>65.0 (6.12)</td><td>55.0–70.0</td><td>1.00 (0.05)</td><td>1.30</td><td>3.56 (1.16)</td></tr><tr><td>Leo</td><td>Baseline</td><td>36.7 (10.3)</td><td>25.0–50.0</td><td /><td /><td /></tr><tr><td /><td>Intervention</td><td>66.0 (13.4)</td><td>45.0–90.0</td><td>0.98 (0.03)</td><td>0.87</td><td>2.56 (0.93)</td></tr><tr><td /><td>Maintenance</td><td>84.4 (9.6)</td><td>75.0–95.0</td><td>1.00 (0.03)</td><td>0.90</td><td>4.41 (1.26)</td></tr><tr><td>Faye</td><td>Baseline</td><td>43.3 (12.3)</td><td>30.0–60.0</td><td /><td /><td /></tr><tr><td /><td>Intervention</td><td>61.0 (10.8)</td><td>50.0–75.0</td><td>0.98 (0.02)</td><td>0.71</td><td>2.48 (0.83)</td></tr><tr><td /><td>Maintenance</td><td>64.0 (13.9)</td><td>50.0–80.0</td><td>0.98 (0.02)</td><td>0.71</td><td>2.21 (0.74)</td></tr><tr><td>Jordan</td><td>Baseline</td><td>33.3 (11.5)</td><td>15.0–50.0</td><td /><td /><td /></tr><tr><td /><td>Intervention</td><td>59.0 (8.9)</td><td>45.0–70.0</td><td>0.93 (0.06)</td><td>0.91</td><td>2.19 (0.79)</td></tr><tr><td /><td>Maintenance</td><td>63.3 (11.6)</td><td>50.0–70.0</td><td>1.00 (0.03)</td><td>1.07</td><td>2.83 (0.75)</td></tr><tr><td>Micah</td><td>Baseline</td><td>43.5 (10.6)</td><td>30.0–60.0</td><td /><td /><td /></tr><tr><td /><td>Intervention</td><td>71.0 (11.9)</td><td>60.0–90.0</td><td>0.94 (0.06)</td><td>0.56</td><td>1.98 (0.64)</td></tr><tr><td /><td>Maintenance</td><td>N/A</td><td>N/A</td><td>N/A</td><td>N/A</td><td /></tr><tr><td colspan="3">Overall intervention mean (<italic>SE</italic>)</td><td /><td>0.96 (0.02)</td><td>0.94</td><td>2.28 (0.31)</td></tr><tr><td colspan="3">Overall maintenance mean (<italic>SE</italic>)</td><td /><td>1.00 (0.01)</td><td>1.08</td><td>3.64 (0.47)</td></tr></tbody></table> </ephtml> </p> <p>4 <emph>Note.</emph> NAP = nonoverlap of all pairs; WC-SMD = standardized mean difference. Effect sizes compare the intervention and maintenance phases to the baseline.</p> <p>Graph: Figure 1. Narrative Text Comprehension Outcomes.</p> <hd id="AN0187349785-30">Visual Analysis</hd> <p>Kade, Mia, and Blake were the first children to transition from the baseline to the intervention phase. They all had downward slopes with minimal variability in the baseline. Upon entering the intervention, they all experienced an immediate increase in narrative text comprehension performance. These improvements were maintained or increased throughout the intervention and maintenance phases.</p> <p>Leo transitioned next to the intervention phase. He had a slight upward slope in the baseline, followed by an immediate increase upon entering the intervention phase. The intervention and maintenance phases also had upward trends. The narrative text comprehension scores had a higher level in the intervention and maintenance phases than the baseline phase.</p> <p>Next, Faye and Jordan transitioned from baseline to intervention. They both had high variability and flat slopes in the baseline phase. Similar to Leo, the narrative text comprehension data in the intervention and maintenance phases had an upward slope and a higher level, relative to the baseline phase. Neither child's data displayed an immediacy of effect upon entering the intervention phase.</p> <p>Micah was the last child to transition to intervention. Micah's data had high variability and a slight upward trend in the baseline phase. The family went on a vacation just prior to the start of the intervention and missed 1 week of sessions (i.e., two sessions). Upon entering the intervention phase, the data did not present an immediacy of effect, although the data had an increasing slope (with minimal variability) and increased level relative to the baseline. Due to the number of baseline sessions, there were an insufficient number of lessons (i.e., books with completed story maps) to continue to a maintenance phase.</p> <hd id="AN0187349785-31">Family Member Survey</hd> <p>Across all items, family member five-point scale ratings of the intervention's social validity, usability, feasibility, promise, future plans, confidence, and overall satisfaction were all high and averaged 4.64 (<emph>SD</emph> = 0.49), 4.61 (<emph>SD</emph> = 0.57), 4.68 (<emph>SD</emph> = 0.48), 4.61 (<emph>SD</emph> = 0.57), 4.37 (<emph>SD</emph> = 0.74), 4.71 (<emph>SD</emph> = 0.46), and 4.71 (<emph>SD</emph> = 0.49), respectively. All family members <emph>agreed</emph> or <emph>strongly agreed</emph> with all statements related to social validity, usability, feasibility, their confidence in the ability to use Family-RISE, and satisfaction with using the Family-RISE program. In addition, all families responded as <emph>neutral, agreed</emph>, or <emph>strongly agreed</emph> to all items related to promise and future plans to use Family-RISE. Supplemental File Table S3 provides item-level responses as well as a mean and standard deviation for each category (e.g., usability, confidence) for each family.</p> <hd id="AN0187349785-32">Discussion</hd> <p>We developed Family-RISE to be a concise and focused shared book reading intervention aimed at supporting family members in successfully engaging their early elementary-age children to understand narrative texts. We focused on supporting family members in their shared storybook reading routines with their child because these have high ecological validity, can be feasible to implement at home and support the development of narrative text knowledge. The intervention was designed to address the needs of children with co-occurring reading and behavioral difficulties, a large yet understudied population of children. We used a rigorous multiple-baseline design to evaluate the effect of Family-RISE relative to the family's typical practices of shared book reading. To the best of our knowledge, this is the first home-based reading intervention that addressed the needs of children with co-occurring reading and behavioral difficulties with a systematic reading intervention with integrated behavior support.</p> <hd id="AN0187349785-33">Key Findings</hd> <p>This study produced consistently large effect sizes across all effect size measures. Visual analysis also suggested that all the children experienced an increase in their average narrative text comprehension from baseline to intervention and maintenance. Given the amount of variability in the baseline phase for Faye and Jordan and the modest increase in scores from baseline to intervention and maintenance, the evidence for a demonstration of an effect between the intervention and outcome is less conclusive for these two children. However, the combined findings suggest that the Family-RISE intervention led to improved narrative text comprehension performance.</p> <p>Family members rated the social validity, usability, feasibility, promise, future plans, confidence, and satisfaction of Family-RISE highly. All families either "agreed" or "strongly agreed" with all statements related to five of the seven constructs, such as "The instructional goals of this program are of high importance to me" (social validity) and "The instructional materials were easy to use" (usability). Although still rated relatively high (4.37 out of 5), family-rated items related to future use (e.g., "I plan to continue using these practices") were rated slightly lower than other domains. This may represent an area for future improvement.</p> <p>Finally, as previously noted, during the intervention phase, the RAs supported family members' implementation of ongoing lessons through modeling and feedback. This level of coaching support was reduced during the maintenance phase to feedback before and after the lesson. Fidelity outcomes support the finding that when coaching support was reduced in the maintenance phase, high levels of fidelity were maintained, and narrative text comprehension performance continued to increase. In other words, it appears that within session coaching support during five intervention sessions was successful in supporting family members to independently implement Family-RISE with high levels of fidelity.</p> <hd id="AN0187349785-34">Promise of Family-RISE</hd> <p>The development of the Family-RISE instructional approach was heavily influenced by story grammar instruction that targets students' knowledge of narrative text structures and behavioral principles for supporting on task engagement. We integrated these two approaches, which are firmly grounded in theory and empirical research (e.g., [<reflink idref="bib8" id="ref125">8</reflink>]; [<reflink idref="bib20" id="ref126">20</reflink>]; [<reflink idref="bib25" id="ref127">25</reflink>]; [<reflink idref="bib66" id="ref128">66</reflink>]; [<reflink idref="bib78" id="ref129">78</reflink>]), in a set of user-friendly instructional materials that families could implement with limited training and preparation. When comparing our results to previous studies examining the effects of our instruction with other home-based reading interventions, we find that Family-RISE yielded a higher effect size than [<reflink idref="bib66" id="ref130">66</reflink>] meta-analysis with a statistically significant effect size (<emph>g</emph> = 0.65) from family literacy interventions for K-3 students. However, we are hesitant to place much emphasis on how the effect size in our study compares to prior research for several reasons. For one, these comparisons are most appropriate when the prior studies reflect the nature of the intervention being tested, the target population, the study design, and the outcome measure. Our study varies from past studies on multiple dimensions. Past meta-analyses of home-based interventions, such as [<reflink idref="bib19" id="ref131">19</reflink>] and [<reflink idref="bib66" id="ref132">66</reflink>], examined the average effects of group-design studies. Our study also focused on students with reading and behavioral difficulties, which makes it different than past studies.</p> <p>Nonetheless, visual analyses of the data and the WC-SMD parametric effect sizes ranging from 1.77 to 4.54 yielded in this study suggest Family-RISE is a promising intervention. We hypothesize Family-RISE resulted in a strong effect on narrative text comprehension because (a) there was alignment between the reading instructional practices and the outcome measure and (b) the behavioral practices supported students in establishing and maintaining attention to the task. Teaching family members how to quickly develop behavioral expectations in the first treatment session was intended to establish higher attention to task and the behavior-specific praise reinforced and maintained expected behaviors during treatment and maintenance sessions. The narrative text structure (story grammar) instruction embedded within the lessons was meant to increase their knowledge of the organizational structure of stories (macrostructure) as well as the key components that contribute to the narrative's overarching framework (microstructure). This instruction unfolded over the five intervention sessions, which may help explain the positive slope within the intervention phase. We believe the integration of reading and behavioral practices coupled with simple materials that families could use without much preparation contributed to the success of Family-RISE for participants. It is notable these practices were effective with this population of children who typically demonstrate difficulties with fully benefiting from high quality reading instruction.</p> <hd id="AN0187349785-35">Limitations and Future Research</hd> <p>There are a few key limitations that are worth considering when evaluating this study's findings. First, our sample of children was based on a teacher nomination process, with recruitment ending once a total of eight families consented to participate. These criteria may have led to a sample of families that was more responsive to participate and attend sessions. Second, we focused on a single near-transfer measure of narrative text comprehension. This measure type was sensitive to changes in narrative text comprehension outcomes across phases. However, evaluating the technical adequacy of the measure of narrative text comprehension assessment will be necessary. Furthermore, administering a mix of near and far-transfer measures will be critical in future group-design studies to determine the extent to which Family-RISE results in performance changes on transfer tasks. Incorporating established measures of social validity with both parents and children will also be valuable. It is possible that story complexity across books could have been associated with session-level narrative text comprehension outcome differences. To ensure that this did not occur, we randomized books to sessions. This resulted in all families reading the same book in the same session. However, important to the rigor of our multiple-baseline design, families read the same book in different phases. Visual inspections of the data revealed that changes in performance occurred due to the implementation of the intervention and this effect was replicated across most students. Such evidence provides strong support for a functional relation between the intervention and narrative text comprehension performance.</p> <p>Third, we did not measure child behavior during the intervention. We made this decision because we were primarily interested in improving narrative text comprehension for children. It may have also been beneficial to collect additional information on child behavior in the school setting (e.g., teacher survey, observation) to better characterize the sample. The behavioral supports were focused on improving academic engagement as a mechanism for supporting narrative text comprehension. Given phase changes were based on the narrative text comprehension measure, it would have been both resource-intensive and challenging to simultaneously establish a functional relation between reading and behavior. Fourth, although we did instruct families not to read the provided books prior to the scheduled session, it is possible that some families read the books with their child before a session or had prior exposure to the book in a different setting (e.g., school). The fifth limitation relates to one of the participants. Micah missed two sessions at the start of the intervention due to a family vacation. Unfortunately, this was unavoidable and should be considered when interpreting the data. Another limitation is that we used a response-guided single-case design to determine phase changes, as compared with a randomized single-case design, which would have allowed for greater external validity. As previously noted, this decision was based on the pilot study nature of this work. Therefore, when interpreting the results, it is worth considering that using a response-guided approach (as compared to a randomized approach) did limit the external validity (i.e., generalizability) of the study's findings, even though the internal validity remained high (e.g., [<reflink idref="bib18" id="ref133">18</reflink>]; [<reflink idref="bib38" id="ref134">38</reflink>]; [<reflink idref="bib42" id="ref135">42</reflink>]). A final potential limitation relates to the possible influence of Hawthorne effects. It is possible that the behavior of parents and children were influenced by the videorecording procedures.</p> <p>To address these limitations, future research may involve identifying participants with a two-gate screening process with reading and behavior measures to conduct a randomized controlled trial with follow-up testing of Family-RISE. A three-arm randomized controlled trial that includes Family-RISE, Family-RISE without the behavioral supports, and a business-as-usual comparison condition could test the additive effects of the integrated behavioral supports. This design would also support the inclusion of far-transfer measures and be able to assess the long-term effects of the intervention. This research may also consider having a more robust reading and behavior measure battery, as well as measuring the extent to which family members continue to use the intervention practices after the study has concluded and the impact the program has on the amount of overall reading families do at home. Future research may also consider replicating this study with more diverse samples of students. Finally, given that coaching is resource-intensive at larger scales, it may be worth considering the optimal format and dosage of coaching needed to maintain high levels of fidelity and narrative text comprehension.</p> <hd id="AN0187349785-36">Implications for Practice</hd> <p>In spite of these limitations, results of our pilot study suggest that using an integrated intervention to teach students with co-occurring reading and behavior difficulties resulted in meaningful growth in narrative text comprehension. This study addresses an important population who has shown resistance to evidence-based reading practices, particularly when they are not combined with behavioral practices. The findings from this study expand on our school-based findings, which have shown that integrating reading and behavioral practices are beneficial for students with co-occurring difficulties, to show these practices may be valuable in home-settings as well. We focused on narrative text comprehension in Family-RISE because we thought it may have high ecological validity. It is common for families to read stories to early elementary children at night. Family-RISE sought to make this time more productive. All adult family members who participated in this pilot study reported that improving their child's ability to understand stories and behavior while reading was an important goal and that Family-RISE helped them to achieve this goal, so it is plausible that this intervention will have strong scalability. In fact, Mia's father stated, "... the week-to-week progression was obvious..." and "Ever since kindergarten, when she started reading, it's always been a chore. Over the last 3–4 weeks, she actually likes and looks forward to it."</p> <p>These comments underscore the value of Family-RISE and its potential for scalability. The comments also suggest that family members of children with reading and behavior difficulties are yearning for ways they can more successfully engage with their children in academic activities at home. It appears Family-RISE may be a feasible and effective approach to help these families. We do not interpret the findings of this single study as conclusive that Family-RISE is effective for Grade 1 and 2 students with co-occurring reading and behavior difficulties; however, the results demonstrate that larger-scale experimental studies of Family-RISE and other similar interventions are warranted.</p> <hd id="AN0187349785-37">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-ldx-10.1177_00222194241263649 for A Family-Based Intervention for Early Elementary Students With Reading and Behavioral Difficulties: A Pilot Study by Garrett J. Roberts, Philip Capin, Anna Handy, Brooke Coté and Zaira Jimenez in Journal of Learning Disabilities</p> <ref id="AN0187349785-38"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref66" type="bt">1</bibl> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref73" type="bt">2</bibl> <bibtext> The research reported here was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R324B190010 to the University of Denver. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref74" type="bt">3</bibl> <bibtext> Garrett J. Roberts</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0003-1128-5577 Philip Capin</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0003-4955-9879</bibtext> </blist> <blist> <bibl id="bib4" idref="ref113" type="bt">4</bibl> <bibtext> Supplemental material for this article is available at https://doi.org/10.1177/00222194241263649</bibtext> </blist> <blist> <bibl id="bib5" idref="ref18" type="bt">5</bibl> <bibtext> Philip Capin is now affiliated with Harvard Graduate School of Education, Harvard University, Cambridge, MA, USA.</bibtext> </blist> </ref> <ref id="AN0187349785-39"> <title> References </title> <blist> <bibtext> Al Otaiba S., Fuchs D. (2002). Characteristics of children who are unresponsive to early literacy intervention: A review of the literature. Remedial and Special Education, 23(5), 300–316. https://doi.org/10.1177/07419325020230050501</bibtext> </blist> <blist> <bibtext> Alves K. D., Kennedy M. 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  Data: A Family-Based Intervention for Early Elementary Students with Reading and Behavioral Difficulties: A Pilot Study
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  Data: English
– Name: Author
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  Data: <searchLink fieldCode="AR" term="%22Garrett+J%2E+Roberts%22">Garrett J. Roberts</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1128-5577">0000-0003-1128-5577</externalLink>)<br /><searchLink fieldCode="AR" term="%22Philip+Capin%22">Philip Capin</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4955-9879">0000-0003-4955-9879</externalLink>)<br /><searchLink fieldCode="AR" term="%22Anna+Handy%22">Anna Handy</searchLink><br /><searchLink fieldCode="AR" term="%22Brooke+Coté%22">Brooke Coté</searchLink><br /><searchLink fieldCode="AR" term="%22Zaira+Jimenez%22">Zaira Jimenez</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Learning+Disabilities%22"><i>Journal of Learning Disabilities</i></searchLink>. 2025 58(5):343-358.
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  Data: SAGE Publications and Hammill Institute on Disabilities. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 16
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
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  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: Institute of Education Sciences (ED)
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  Label: Contract Number
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  Data: R324B190010
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
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  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Elementary+Education%22">Elementary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="EL" term="%22Grade+1%22">Grade 1</searchLink><br /><searchLink fieldCode="EL" term="%22Primary+Education%22">Primary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Grade+2%22">Grade 2</searchLink>
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  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22Family+Relationship%22">Family Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Elementary+School+Students%22">Elementary School Students</searchLink><br /><searchLink fieldCode="DE" term="%22Reading+Difficulties%22">Reading Difficulties</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Grade+1%22">Grade 1</searchLink><br /><searchLink fieldCode="DE" term="%22Grade+2%22">Grade 2</searchLink><br /><searchLink fieldCode="DE" term="%22Reading+Comprehension%22">Reading Comprehension</searchLink><br /><searchLink fieldCode="DE" term="%22Learner+Engagement%22">Learner Engagement</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Story+Reading%22">Story Reading</searchLink><br /><searchLink fieldCode="DE" term="%22Instructional+Effectiveness%22">Instructional Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Attitudes%22">Family Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Outcomes+of+Education%22">Outcomes of Education</searchLink><br /><searchLink fieldCode="DE" term="%22Urban+Areas%22">Urban Areas</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Behavior%22">Child Behavior</searchLink>
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  Label: Assessment and Survey Identifiers
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  Data: <searchLink fieldCode="SU" term="%22Behavior+Assessment+System+for+Children%22">Behavior Assessment System for Children</searchLink>
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  Data: 10.1177/00222194241263649
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  Label: ISSN
  Group: ISSN
  Data: 0022-2194<br />1538-4780
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: We created and tested a family-based intervention with a sample of U.S. families of children in Grades 1 and 2 with reading and behavioral difficulties to investigate its impact on text comprehension. Developed with input from parents, reading experts, and behavior specialists, Family-RISE (Reading Intervention with Supports for Engagement) integrates evidence-based practices for enhancing students' knowledge of narrative texts with effective behavioral supports to maximize student engagement and minimize disruptive behaviors to help parents engage successfully in shared storybook reading. We assessed the effects of Family-RISE on children's narrative text comprehension using a multiple-baseline design. A functional relation was established between Family-RISE and narrative text comprehension, indicating Family-RISE substantially improved narrative text comprehension. Furthermore, nonoverlap of all pairs, Tau-U, and standard mean difference effect sizes were all considered large in favor of the intervention. Family members reported that the intervention was highly usable, feasible to implement, and socially valid. These findings underscore the promise of the Family-RISE intervention and the value of developing interventions that simultaneously support reading and behavior for children with co-occurring difficulties in these areas.
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  Data: As Provided
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  Data: Yes
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  Data: 2025
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  Data: EJ1480524
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      – Type: doi
        Value: 10.1177/00222194241263649
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 16
        StartPage: 343
    Subjects:
      – SubjectFull: Family Relationship
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Elementary School Students
        Type: general
      – SubjectFull: Reading Difficulties
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Grade 1
        Type: general
      – SubjectFull: Grade 2
        Type: general
      – SubjectFull: Reading Comprehension
        Type: general
      – SubjectFull: Learner Engagement
        Type: general
      – SubjectFull: Behavior Modification
        Type: general
      – SubjectFull: Story Reading
        Type: general
      – SubjectFull: Instructional Effectiveness
        Type: general
      – SubjectFull: Family Attitudes
        Type: general
      – SubjectFull: Outcomes of Education
        Type: general
      – SubjectFull: Urban Areas
        Type: general
      – SubjectFull: Child Behavior
        Type: general
      – SubjectFull: Behavior Assessment System for Children
        Type: general
    Titles:
      – TitleFull: A Family-Based Intervention for Early Elementary Students with Reading and Behavioral Difficulties: A Pilot Study
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      – PersonEntity:
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            NameFull: Garrett J. Roberts
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            NameFull: Philip Capin
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            NameFull: Anna Handy
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            NameFull: Brooke Coté
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            NameFull: Zaira Jimenez
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          Dates:
            – D: 01
              M: 09
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 0022-2194
            – Type: issn-electronic
              Value: 1538-4780
          Numbering:
            – Type: volume
              Value: 58
            – Type: issue
              Value: 5
          Titles:
            – TitleFull: Journal of Learning Disabilities
              Type: main
ResultId 1