Precision Approach to Matching Evidence-Based Interventions to Individual Needs of Students with Externalizing Behaviors: A Double-Masked Randomized Controlled Trial

Although prevalent across schools in the US, the “One-Size-Fits-All” (OSFA) approach to selecting evidence-based interventions (EBIs) for student externalizing behaviors often yields lackluster outcomes, due to the mismatch between the EBI and students' heterogeneous needs. Emerging literature highlighted the promise of the precision approach to intervention (e.g., Student Intervention Matching System; SIMS), whereas EBIs were selected based on the match between a student's individual needs and the active components of EBIs. This pilot study tested the efficacy, feasibility, and acceptability of SIMS to match EBIs to students with externalizing behaviors. We ran a double-masked randomized waitlist-controlled trial in a diverse urban district. Students at risk for externalizing behaviors were recruited and randomly assigned to the treatment (EBIs matched via SIMS; ntreatment = 25) or control condition (mismatched social-skill training; ncontrol = 26). Students received EBIs based on their assigned condition for 10 weeks. Students' externalizing behaviors were assessed via a multi-method approach at baseline and 10-week posttest. Teachers rated the feasibility and acceptability of SIMS at 10-week posttest. Results from cluster-adjusted ANCOVAs supported the superior efficacy of matched EBIs via SIMS against that of the mismatched social skill training in reducing student externalizing behaviors. Treatment effect heterogeneity analyses indicated that the efficacy of SIMS held regardless of students' demographics or baseline behaviors. The findings underscore the promising efficacy of SIMS as a pragmatic precision approach to informing educators' data-based selection of EBIs for students with externalizing behaviors. Implications, limitations, and future directions for using SIMS in schools were discussed.