A Precision-Based Approach to Implement Evidence-Based Interventions for Students with Externalizing Behaviors in Developing Countries: A Single Case Experimental Study in China

The prevalence of externalizing behaviors imposes a far-reaching negative impact on students' social, behavioral, and academic outcomes, which constitute a public health issue in low-resource and populous developing countries (e.g., China). Compared to the “One-Size-Fits-All” approach (OSFA; forcing a single evidence-based intervention (EBIs) on any struggling students) that is prevalent in many countries, a precision-based approach (PBA, e.g., Student Intervention Matching System; SIMS) to intervention programming can better meet students' heterogeneous needs by matching individual characteristics to active components of EBIs. But a PBA cannot fulfill its potential in developing countries unless the contextual implementation barriers (e.g., high student-teacher ratio) are remedied with attention to feasibility, acceptability, and cultural compatibility. This collaborative pilot study with Chinese school stakeholders examined the efficacy, feasibility, acceptability, and cultural compatibility of SIMS to match behavioral EBIs to students with externalizing behaviors. A concurrent multiple-baseline across-participant design was used with six students (three dyads). Visual and quantitative analyses evidenced the superior efficacy of SIMS in improving externalizing behaviors compared to the OSFA approach. Social validity data endorsed the feasibility, acceptability, and cultural compatibility of SIMS and the matched EBIs perceived by school stakeholders (educators, students, and parents). Implications, limitations, and future directions for adapting PBAs in low-resource and populous countries are discussed.