list, and direct observation of students whose scores on the teacher ratings exceed normative cutoffs.

SSBD has a national normative base of over 4,400 cases representing schools in eight states distributed across the United States. The two behavioral observation codes in Stage 3 were normed on 1,300 cases drawn from these same participating schools. Elliott and Busse (2004) reported that SSBD reliably differentiated students having and not having behavioral disorders.

Walker, Seeley, and colleagues (in press) reported a randomized control trial in which SSBD was used to identify the 2 percent of primary grade children who were most aggressive. They identified 200 students (70 percent of whom were Hispanic) in two cohorts and provided an evidence-based intervention involving both parenting skills training and a classroom intervention. The intervention resulted in significant improvements in symptoms, function, and academic domains.

Preschool and Day Care. A large proportion of children in the United States regularly attend day care, nursery school, or an alternative out-of-the-home setting prior to age 5. Identification of risk or early indicators of MEB disorders in these settings provides for early detection and the opportunity for preventive interventions. A significant number of children arrive in kindergarten without the self-regulatory skills to function productively in the classroom (Rimm-Kaufman, Pianta, and Cox, 2000) or are expelled from preschool due to behavioral issues (Gilliam, 2005; Gilliam and Shahar, 2006). Although Head Start has adopted standards mandating mental health assessment and intervention for social-emotional problems of enrolled children (Head Start Quality Research Consortium, 2003), it is unclear if they have been fully implemented. Although numerous screening tools are available, there is no single, widely accepted easy-to-use instrument. Barbarin (2007) recently developed a simple tool aimed at identifying children at risk of early onset social-emotional difficulties designed to address barriers to screening in the preschool context. There are promising indications that mental health consultation in preschool settings can improve behavioral outcomes (Perry, Dunne, et al., 2008). McDermott, Mamum, and colleagues (2008) found that screening children ages 2-4 with a standardized questionnaire for irregular eating patterns identified those more likely to have behavioral problems. Children with a chronic illness in the preschool setting are at risk for depressive symptoms and impairment in several social domains (Curtis and Luby, 2008). However, broad implementation of screening for mental, emotional, and behavioral issues linked with prevention programs has not occurred. Reimbursement, the availability of trained staff, and the ability to provide follow-up services impede screening in this setting as well. Federal agencies and knowledgeable professional

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