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Paraeducator-Delivered Interventions for Students with Extensive Support Needs in Inclusive School Settings: A Systematic Review

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Title: Paraeducator-Delivered Interventions for Students with Extensive Support Needs in Inclusive School Settings: A Systematic Review
Language: English
Authors: Walker, Virginia L. (ORCID 0000-0003-3248-7290), Kurth, Jennifer (ORCID 0000-0002-5947-7642), Carpenter, Megan E., Tapp, Melissa C. (ORCID 0000-0001-7805-4146), Clausen, Amy (ORCID 0000-0002-4109-4133), Lockman Turner, Elissa (ORCID 0000-0002-5836-3088)
Source: Research and Practice for Persons with Severe Disabilities. Dec 2021 46(4):278-295.
Availability: SAGE Publications. 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: http://sagepub.com
Peer Reviewed: Y
Page Count: 18
Publication Date: 2021
Document Type: Journal Articles
Information Analyses
Education Level: Elementary Secondary Education
Descriptors: Paraprofessional School Personnel, Students with Disabilities, Educational Research, Program Effectiveness, Staff Development, Program Implementation, Intervention, Severe Disabilities, Elementary Secondary Education, Training, Inclusion, Regular and Special Education Relationship
DOI: 10.1177/15407969211055127
ISSN: 1540-7969
Abstract: Schools have continued to rely on paraeducators to assist special education teachers and other professionals in the provision of special education and related services. Although paraeducators often support students with extensive support needs (ESN) in a range of school environments, the subset of intervention studies focused on paraeducators who support students with ESN in inclusive settings has not been systematically reviewed. The purpose of this literature review was to synthesize single-case research studies involving paraeducator-delivered interventions for students with ESN in inclusive school environments. Our findings suggest that research primarily has focused on communication and social skills interventions that involved paraeducator-facilitated peer supports in core academic classes and specials (e.g., art, music, physical education). Overall, paraeducator-delivered interventions resulted in improved student outcomes. Likewise, paraeducator training, which typically included an oral description, modeling, and/or performance feedback, was effective in improving paraeducator implementation of the target interventions. We present implications for practice specific to paraeducators who support students with ESN in inclusive settings and future research directions.
Abstractor: As Provided
Entry Date: 2021
Accession Number: EJ1317694
Database: ERIC
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  Value: <anid>AN0153477328;myx01dec.21;2021Nov11.02:13;v2.2.500</anid> <title id="AN0153477328-1">Paraeducator-Delivered Interventions for Students with Extensive Support Needs in Inclusive School Settings: A Systematic Review </title> <p>Schools have continued to rely on paraeducators to assist special education teachers and other professionals in the provision of special education and related services. Although paraeducators often support students with extensive support needs (ESN) in a range of school environments, the subset of intervention studies focused on paraeducators who support students with ESN in inclusive settings has not been systematically reviewed. The purpose of this literature review was to synthesize single-case research studies involving paraeducator-delivered interventions for students with ESN in inclusive school environments. Our findings suggest that research primarily has focused on communication and social skills interventions that involved paraeducator-facilitated peer supports in core academic classes and specials (e.g., art, music, physical education). Overall, paraeducator-delivered interventions resulted in improved student outcomes. Likewise, paraeducator training, which typically included an oral description, modeling, and/or performance feedback, was effective in improving paraeducator implementation of the target interventions. We present implications for practice specific to paraeducators who support students with ESN in inclusive settings and future research directions.</p> <p>Keywords: paraeducator; paraprofessional; extensive support needs; severe disabilities; inclusion</p> <p>Inclusive education for students with extensive support needs (ESN; i.e., the 1%–2% of students with intellectual disability, autism, and multiple disabilities who are eligible for alternate assessment; [<reflink idref="bib54" id="ref1">54</reflink>]) continues to be at the forefront of research and advocacy agendas in the field of special education (e.g., [<reflink idref="bib42" id="ref2">42</reflink>]). Inclusive education is defined here as embodying the following three characteristics: (a) students with disabilities are taught in the general education classroom, attending the school they would attend if they did not have a disability; (b) students with disabilities learn the general education curriculum, including grade-aligned content standards and non-academic instruction; and (c) students with disabilities have supports and services brought to them in the general education context to facilitate their learning and participation. Inclusive education has been described as necessary to promote positive student outcomes, including progress in the general education curriculum ([<reflink idref="bib29" id="ref3">29</reflink>]). Relatedly, students with ESN are provided more opportunities to learn in general education settings when compared to self-contained, special education settings ([<reflink idref="bib37" id="ref4">37</reflink>]; [<reflink idref="bib45" id="ref5">45</reflink>]). For example, [<reflink idref="bib50" id="ref6">50</reflink>] recently found that students with ESN were 10 times more likely to experience literacy instruction in inclusive versus self-contained, special education classrooms. In one of the largest descriptive analyses, [<reflink idref="bib33" id="ref7">33</reflink>] surveyed students across 15 states and found a significant positive correlation between expressive communication and reading and math assessment scores for students with ESN when taught in inclusive settings.</p> <p>Despite the many benefits associated with inclusive education, students with ESN overwhelmingly continue to receive their education in separate settings, including special classes and schools. In fact, there has been little, if any, change in this persistent segregation for decades ([<reflink idref="bib38" id="ref8">38</reflink>]), and students with ESN remain disproportionality segregated compared with students in high-incidence disability categories ([<reflink idref="bib43" id="ref9">43</reflink>]). Due to physical and programmatic separation from general education activities, curriculum, and discourse, students with ESN may be at risk of experiencing diminished postschool outcomes ([<reflink idref="bib55" id="ref10">55</reflink>]).</p> <p>A range of rationales have been posited to explain why inclusive education for students with ESN remains elusive, despite its many benefits ([<reflink idref="bib1" id="ref11">1</reflink>]). As articulated by [<reflink idref="bib1" id="ref12">1</reflink>], these include low expectations regarding the competency and capability of students, lack of teacher preparation and experience, unawareness of research, and lack of resources. To address issues concerning limited resources, schools often rely on paraeducators to support students with disabilities in general education settings ([<reflink idref="bib21" id="ref13">21</reflink>]). According to the most recent federal data, approximately 458,676 paraeducators support students with disabilities ages 6 through 21 in the United States, a number that far exceeds that of special education teachers ([<reflink idref="bib57" id="ref14">57</reflink>]), with over 72% working in inclusive settings according to one report ([<reflink idref="bib13" id="ref15">13</reflink>]).</p> <p>Paraeducators assist special education teachers and other professionals in delivering special education and related services to students with disabilities ([<reflink idref="bib28" id="ref16">28</reflink>]). In this role, paraeducators are expected to demonstrate a range of competencies related to data collection, instructional delivery, behavioral and social support, and collaborative teaming, among others ([<reflink idref="bib18" id="ref17">18</reflink>]), and report assuming a number of responsibilities including, but not limited to, clerical work, delivering one-to-one instruction, supporting social relationships, and behavior management ([<reflink idref="bib13" id="ref18">13</reflink>]). Although paraeducators are commonly regarded as an essential resource in the provision of special education services, experts have raised several concerns about the overreliance or misuse of paraeducators in inclusive settings. Specifically, students with disabilities may experience limited access to qualified instructors in inclusive settings, as paraeducators often assume the role of primary instructor despite their lack of training and supervision ([<reflink idref="bib15" id="ref19">15</reflink>]). Other concerns relate to increased student dependence on paraeducators, interference with peer relationships, and decreased engagement from the general education teacher ([<reflink idref="bib20" id="ref20">20</reflink>]).</p> <p>Given the continued reliance on paraeducators in K-12 schools and concerns related to the paraeducator role in inclusive settings, the field would benefit from understanding the current status of research on paraeducator-delivered interventions for students with ESN in inclusive settings, as this information has the potential to inform planning efforts around appropriate paraeducator utilization. [<reflink idref="bib24" id="ref21">24</reflink>] conducted a scoping review of research focused on paraeducators in inclusive school settings and found that research on this topic had more than doubled since a previous review ([<reflink idref="bib23" id="ref22">23</reflink>]) and covered a wider range of topics, including hiring and retaining paraeducators, paraeducator training, paraeducator roles and responsibilities, paraeducator supervision and oversight, and alternatives to paraeducators, among others. Although these two reviews provided important insight into paraeducator issues and practices, their scope was broad and, therefore, did not offer a systematic review of intervention research in inclusive settings. Since then, several reviews have systematically examined paraeducator-implemented interventions across specific disability categories (e.g., intellectual and developmental disabilities [IDD], [<reflink idref="bib5" id="ref23">5</reflink>]; autism spectrum disorder, [<reflink idref="bib47" id="ref24">47</reflink>]; [<reflink idref="bib61" id="ref25">61</reflink>]) and intervention domains (e.g., behavioral interventions, [<reflink idref="bib60" id="ref26">60</reflink>]).</p> <p>For example, [<reflink idref="bib5" id="ref27">5</reflink>] recently synthesized 36 studies on paraeducator-delivered interventions for students with IDD and found that paraeducators effectively supported students in both inclusive and separate settings through a variety of strategies, including peer support arrangements, systematic prompting, and communication support. The researchers identified performance feedback, modeling, and implementation checklists as effective training strategies, though researchers primarily assumed responsibility for paraeducator oversight. In another recent example, [<reflink idref="bib60" id="ref28">60</reflink>] explored 17 studies in which paraeducators provided behavioral supports to students with disabilities who engaged in challenging behavior. Findings from this review indicated that paraeducators successfully supported the behavioral needs of students with autism spectrum disorder, intellectual disability, and multiple disabilities through a variety of strategies including multi-component function-based intervention, systematic prompting, and reinforcement-based strategies, and that behavioral supports delivered in inclusive school settings may be more impactful in terms of student outcomes. However, researchers primarily were responsible for delivering didactic and experiential training approaches to paraeducator participants.</p> <p>Although these recent reviews offer important information about paraeducator supports in a range of school environments, to our knowledge, no systematic literature reviews have been conducted that specifically focus on utilization of paraeducators in inclusive settings for students with ESN. To address this gap in the literature and examine the current status of paraeducator-delivered interventions in the inclusive school context, including the effectiveness of these interventions, we conducted a systematic review of single-case research studies in which students with ESN received intervention from paraeducators in inclusive school environments. Reviewing single-case research is advantageous in that it allows for an in-depth examination of student and intervention characteristics relevant to the inclusive context and unique features of the study design (e.g., generalization and maintenance of skills within inclusive settings). In addition, by reviewing studies with the student as the unit of analysis, researchers can easily identify gaps in the literature (e.g., underrepresentation of students from specific age groups or disability categories). The following research questions guided our review: (a) What are the participant and intervention characteristics among studies involving paraeducator-delivered interventions for students with ESN in inclusive school settings? (b) What is the overall quality of these studies? (c) What effect do paraeducator-delivered interventions have on student outcomes in inclusive settings? and (d) What effect does paraeducator training have on paraeducator-delivered interventions in inclusive settings?</p> <hd id="AN0153477328-2">Method</hd> <p>We conducted a systematic literature review to summarize the research on paraeducator-delivered interventions to support students with ESN in inclusive school settings. Each phase of the review is described in detail in the sections that follow. Figure 1 provides an overview of the literature identification and screening phases of the review process.</p> <p>Graph: Figure 1. Overview of the literature identification, screening, and eligibility processes.</p> <hd id="AN0153477328-3">Literature Identification</hd> <p>We conducted a comprehensive literature search in April 2020 to identify studies for inclusion in the review. First, we searched three online databases (i.e., PsycINFO, ERIC, Medline) using search terms related to (a) paraeducators (e.g., paraprofessional, assistant) and (b) students with ESN (e.g., intellectual disability, multiple disabilities). A complete list of search terms can be found in Supplemental Table 1. We searched for publications in English but did not limit the publication years. To address concerns of publication bias ([<reflink idref="bib19" id="ref29">19</reflink>]), we also searched ProQuest Dissertations and Theses Global for unpublished dissertations and theses; we applied the same search terms but narrowed the search to abstracts only. Results of the initial online database search were as follows: PsycINFO (<emph>n</emph> = 792), ERIC (<emph>n</emph> = 801), Medline (<emph>n</emph> = 209), and Proquest Dissertations and Theses Global (<emph>n</emph> = 128).</p> <p>Second, we conducted a hand search of all issues and volumes of 14 special education and behavior analytic journals with a history of publishing studies involving paraeducators and students with ESN, resulting in 3,284 references (see Supplemental Table 2). Third, we conducted searches within an online database of published articles related to paraeducators (see https://<ulink href="http://www.uvm.edu/cess/cdci/selected-paraeducator-references;">www.uvm.edu/cess/cdci/selected-paraeducator-references;</ulink><emph>n</emph> = 25) and a different database of dissertations related to paraeducators (see https://<ulink href="http://www.uvm.edu/cess/cdci/recent-dissertation-abstracts-paraprofessional-topics;">www.uvm.edu/cess/cdci/recent-dissertation-abstracts-paraprofessional-topics;</ulink><emph>n</emph> = 10). Finally, we searched the reference list of six previously published paraeducator-focused literature reviews (i.e., [<reflink idref="bib7" id="ref30">7</reflink>], [<reflink idref="bib9" id="ref31">9</reflink>]; [<reflink idref="bib47" id="ref32">47</reflink>]; [<reflink idref="bib60" id="ref33">60</reflink>]; [<reflink idref="bib61" id="ref34">61</reflink>]; [<reflink idref="bib64" id="ref35">64</reflink>]), resulting in 40 additional references. After removing duplicates and irrelevant references (e.g., newsletters, conference proceedings), we identified a total of 420 references to include for further consideration.</p> <hd id="AN0153477328-4">Screening and Eligibility</hd> <p>Next, we screened abstracts of the remaining 420 references to determine eligibility for inclusion in the review. When the abstract did not provide the necessary information to determine eligibility, we examined the full text. We initially applied the following four inclusion criteria: (a) the study involved paraeducator-implemented interventions within K-12 public schools, (b) the student(s) receiving intervention had IDD, (c) the intervention was delivered within an inclusive setting (e.g., grade-appropriate academic classroom, cafeteria, playground, music class), and (d) an experimental single-case research design was used. We focused on single-case research given our aim to code and synthesize at the student participant level and excluded studies that took place outside of school settings, involved students in early childhood education or adults, or were not conducted in inclusive settings (as defined earlier). A total of 47 studies were eligible as a result of this initial screening process. Next, due to our interest in students with ESN, we refined inclusion criterion (b) from students with IDD to students with ESN. A student was considered to have ESN when (a) their reported IQ score fell below 55 and adaptive scores were three or more standard deviations below the mean, (b) they participated or were eligible to participate in alternate assessment, and/or (c) student descriptions included terms commonly used in published research to describe this student population (e.g., severe disability, ESN, significant support needs, severe intellectual disability, profound intellectual disability, multiple disabilities, significant cognitive disability). After this review, we excluded 17 additional studies, and during the descriptive coding phase, excluded another eight studies, resulting in 22 included studies.</p> <p>Two doctoral students in special education (the third and fourth authors) each applied the criteria to 50% (<emph>n</emph> = 210) of the articles as primary reviewer and coded an additional 30% (<emph>n</emph> = 63) selected at random as the secondary reviewer. The reviewers met to discuss disagreements and determine final eligibility. We calculated interrater agreement (IRA) using a percent agreement approach by dividing the total number of disagreements by the total number of references and multiplied by 100 to obtain an overall IRA score of 91.4%.</p> <hd id="AN0153477328-5">Coding</hd> <p>Two doctoral students in special education (the third and fifth authors) served as primary reviewers and each independently coded 50% of the studies meeting the eligibility criteria. They used a researcher-developed coding form (available upon request) to code information across each qualifying student participant (i.e., student with ESN who received paraeducator-implemented intervention in an inclusive school environment). The coding form was structured as follows: (a) student participant characteristics, (b) paraeducator participant characteristics, (c) paraeducator-implemented intervention characteristics, (d) paraeducator training characteristics, and (e) study quality indicators.</p> <p>The coding categories under the student participant characteristics section were as follows: age, gender, race and ethnicity, disability label ([<reflink idref="bib28" id="ref36">28</reflink>] eligibility categories), grade level, educational placement (percentage of time spent in general education), and general education classes and other inclusive settings attended by the student participant (core academic classes, other academic classes [e.g., foreign language class], specials [e.g., music, art, theater], cafeteria, playground). The paraeducator participant characteristics coding categories included age, gender, race and ethnicity, educational level (high school degree, some college, 2-year college degree, 4-year college degree, graduate degree), years as a paraeducator, and prior training specifically related to the target intervention.</p> <p>The coding categories under the paraeducator-implemented intervention characteristics section were as follows: intervention domain (academic skills including math, literacy, social studies, and science; embedded skills including self-determination, physical/motor, and communication/social; and challenging behavior), intervention type, instructional format (one-to-one, small group with or without peers with disabilities, whole group), intervention setting (core academic classes, other academic classes, specials, cafeteria, playground), instructional context (contextualized, decontextualized), others who delivered intervention (teacher, therapist, experimenter, peers), intervention dosage (number of sessions per day, trials per session, days per week, duration, sessions per intervention phase), student dependent measures (academic, social/emotional/communication, challenging behavior, essential skills), and research design associated with student dependent measures (multiple baseline design or variations thereof, changing criterion, reversal/ABAB, alternating treatment/multielement, combination of two or more designs).</p> <p>The paraeducator training characteristics coding categories included whether the paraeducator received training directly related to the target intervention, trainer role (teacher, therapist, experimenter), training type (performance feedback, oral description/lecture, modeling, written instructions, skill rehearsal, question and answer session, self-monitoring), training dosage (frequency, duration), and research design associated with paraeducator dependent measures. We examined study quality by coding whether studies reported acceptable interobserver agreement (IOA) and included measures of social validity, generalization, and maintenance for student and paraeducator measures.</p> <p>In addition, we followed guidelines from [<reflink idref="bib40" id="ref37">40</reflink>] to apply the [<reflink idref="bib66" id="ref38">66</reflink>] standards for evaluating single-case research for the primary dependent measure across each study with the exception of [<reflink idref="bib53" id="ref39">53</reflink>]. In this particular study, data were displayed in a scatterplot that did not permit visual analysis. Initially, we applied the following design standards to determine whether studies met, met with reservations, or did not meet design standards: (a) the independent variable was systematically manipulated, (b) each outcome variable was measured repeatedly by more than one assessor, (c) IOA was measured for at least 20% of data points, (d) IOA was acceptable, and (e) the study included at least three attempts to demonstrate an intervention effect with each phase having at least five data points to meet standards or three data points to meet standards with or without reservations. For those studies that met the design standards with reservations, we applied the following evidence standards to determine whether studies provided strong, moderate, or no evidence: (a) the study included at least three attempts to demonstrate an intervention effect with each phase having at least five data points to have strong evidence or three data points to have moderate evidence, (b) the study included at least three demonstrations of intervention effect, and (c) the study did not include any instances of non-effect to have strong evidence or a ratio of effects to non-effects was less than or equal to 3:1 to have moderate evidence.</p> <p>A different doctoral student in special education (the sixth author) served as a secondary reviewer for the descriptive coding phase and coded 36.4% of the primary reviewers' articles to evaluate IRA. The primary and secondary reviewers met to discuss discrepancies in coding and reach consensus on final code application. We used the percent agreement approach to calculate IRA, with overall agreement at 99.1% (range: 95.7%–100%). The first and fourth authors applied the [<reflink idref="bib66" id="ref40">66</reflink>] standards to 21 eligible studies. The fourth author served as a secondary reviewer to apply the WWC standards to 33.3% (<emph>n</emph> = 7) of studies that evaluated student outcomes and the first author served as a secondary reviewer to apply the standards to 37.5% (<emph>n</emph> = 3) of studies that evaluated paraeducator outcomes. Overall agreement was 100% for the WWC standards.</p> <hd id="AN0153477328-6">Tau-U Application and Visual Analysis</hd> <p>To estimate changes in participant outcomes across study conditions, we calculated Tau-U for the primary dependent measures across eligible student and paraeducator participants with the exception of participants from [<reflink idref="bib53" id="ref41">53</reflink>]. Tau-U is a nonoverlap index that is appropriate for estimating intervention effect for single-case research, and due to its ability to account for undesirable baseline trends, Tau-U is advantageous over other nonoverlap indices ([<reflink idref="bib44" id="ref42">44</reflink>]). According to [<reflink idref="bib58" id="ref43">58</reflink>], Tau-U scores can be interpreted as a small change (<0.20), moderate change (0.20 to 0.60), large change (0.60 to 0.80), and large to very large change (>0.80). We extracted data point values from student and paraeducator graphs using WebPlot Digitizer Version 4.3 ([<reflink idref="bib49" id="ref44">49</reflink>]) and subsequently calculated Tau-U using a free online Tau-U calculator ([<reflink idref="bib59" id="ref45">59</reflink>]). We also conducted visual analysis ([<reflink idref="bib39" id="ref46">39</reflink>]) to supplement Tau-U and identify whether there were no effects, positive effects, or mixed effects for eligible participants across studies (e.g., [<reflink idref="bib62" id="ref47">62</reflink>]).</p> <hd id="AN0153477328-7">Data Analysis</hd> <p>We calculated descriptive statistics for all coded data, including a percentage for closed-ended coding items (e.g., disability label, intervention setting) and mean and range for numerical open-ended coding items (e.g., paraeducator age). In some cases, multiple codes were selected under a specific coding item and, therefore, percentages for some items exceeded 100%. It should be noted that we treated each eligible student participant as the unit of analysis with the exception of the [<reflink idref="bib66" id="ref48">66</reflink>] standards, in which case standards were applied at the study level. When calculating Tau-U for the primary dependent measure across each study, we first conducted phase contrasts for each eligible student or paraeducator participant within the study, correcting for baseline when appropriate, and then calculated a weighted combined score across all qualifying participants to obtain an aggregate Tau-U score for each study and across studies.</p> <hd id="AN0153477328-8">Results</hd> <p>In this section, we report findings related to (a) participant and intervention characteristics, (b) study quality, and (c) Tau-U and visual analysis for paraeducator-delivered intervention and paraeducator training outcomes. Table 1 provides a summary of study characteristics.</p> <p>Graph</p> <p>Table 1. Summary of Study Characteristics.</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="." /><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">Study</th><th align="center">#</th><th align="center">Grade level</th><th align="center">Intervention setting/class</th><th align="center">Intervention type</th><th align="center">Primary dependent measure</th><th align="center">WWC DS</th><th align="center">WWC ES</th><th align="center">Tau-U</th><th align="center"><italic>p</italic></th><th align="center">95% CI</th><th align="center">Visual analysis<xref ref-type="table-fn" rid="tfn2">a</xref></th></tr></thead><tbody><tr><td><xref ref-type="bibr" rid="bibr3">Biggs et al. (2017)</xref></td><td>4</td><td>K-5, 6-8</td><td>Spanish, ELA, Science, Science/Social Studies</td><td>Paraeducator facilitated peer supports</td><td>Student: communication to peers</td><td>2</td><td>2</td><td>0.99</td><td><.001</td><td>[0.70, 1.00]</td><td>Positive (4/4)</td></tr><tr><td><xref ref-type="bibr" rid="bibr2">Biggs et al. (2018)</xref></td><td>4</td><td>K-5</td><td>Cafeteria, Indoor recess</td><td>Peer network + aided AAC modeling</td><td>Student: peer interaction</td><td>2</td><td>2</td><td>0.92</td><td><.001</td><td>[0.72, 1.00]</td><td>Positive (4/4)</td></tr><tr><td><xref ref-type="bibr" rid="bibr6">Brock et al. (2016)</xref></td><td>4</td><td>K-5, 6-8</td><td>Computer, Art</td><td>Paraeducator facilitated peer supports</td><td>Paraeducator: facilitating peer support</td><td>1</td><td>1</td><td>0.82</td><td><.001</td><td>[0.48, 1.00]</td><td>Positive (4/4)</td></tr><tr><td><xref ref-type="bibr" rid="bibr8">Brock & Carter (2016)</xref></td><td>4</td><td>K-5, 6-8</td><td>Science, Science/Math block</td><td>Paraeducator facilitated peer supports</td><td>Paraeducator: facilitating peer support</td><td>1</td><td>1</td><td>0.69</td><td><.001</td><td>[0.42, 0.95]</td><td>Positive (4/4)</td></tr><tr><td><xref ref-type="bibr" rid="bibr11">Carter et al. (2005)</xref></td><td>2</td><td>6-8, 9-12</td><td>Science, English</td><td>Paraeducator facilitated peer supports</td><td>Student: curricular contact</td><td>2</td><td>2</td><td>0.37<xref ref-type="table-fn" rid="tfn2">b</xref></td><td>0.07</td><td>[0.04, 0.77]</td><td>Positive (1/2); No effect (1/2)</td></tr><tr><td><xref ref-type="bibr" rid="bibr12">Carter et al. (2011)</xref></td><td>3</td><td>9-12</td><td>Culinary Arts, Ceramics</td><td>Paraeducator facilitated peer supports</td><td>Student: peer interaction</td><td>1</td><td>1</td><td>0.82</td><td><.001</td><td>[0.51, 1.00]</td><td>Positive (3/3)</td></tr><tr><td><xref ref-type="bibr" rid="bibr14">Causton-Theoharis & Malmgren (2005)</xref></td><td>4</td><td>K-5</td><td>Core academic not specified</td><td>Paraeducator facilitated peer communication</td><td>Paraeducator: facilitative behaviors</td><td>0</td><td /><td>0.84</td><td><.001</td><td>[0.64, 1.00]</td><td>Positive (4/4)</td></tr><tr><td><xref ref-type="bibr" rid="bibr16">Chung & Carter (2013)</xref></td><td>2</td><td>K-5; 6-8</td><td>Art, Science, Social Studies, Homeroom</td><td>Paraeducator facilitated peer communication</td><td>Student: peer interactions</td><td>2</td><td>1</td><td>0.74</td><td><.001</td><td>[0.48, 0.99]</td><td>Positive (1/2); Mixed (1/2)</td></tr><tr><td><xref ref-type="bibr" rid="bibr17">Chung & Douglas (2015)</xref></td><td>3</td><td>K-5</td><td>Art, Library</td><td>Paraeducator facilitated peer communication</td><td>Student: peer interactions</td><td>0</td><td /><td>1.00</td><td><.001</td><td>[0.53, 1.00]</td><td>Positive (3/3)</td></tr><tr><td><xref ref-type="bibr" rid="bibr26">Huber et al. (2018)</xref></td><td>3</td><td>9-12</td><td>World History, Art, Nutrition</td><td>Paraeducator facilitated peer supports</td><td>Student: social initiations</td><td>2</td><td>2</td><td>0.88</td><td><.001</td><td>[0.62, 1.00]</td><td>Positive (3/3)</td></tr><tr><td><xref ref-type="bibr" rid="bibr27">Hunt et al. (2003)</xref></td><td>3</td><td>K-5</td><td>Core academic not specified</td><td>Paraeducator facilitated peer supports</td><td>Student: levels of engagement and interaction</td><td>0</td><td /><td>1.00</td><td><.001</td><td>[0.60, 1.00]</td><td>Positive (3/3)</td></tr><tr><td><xref ref-type="bibr" rid="bibr30">Jameson et al. (2007)</xref></td><td>2</td><td>6-8. 9-12</td><td>Science, Teen Living</td><td>Embedded instruction</td><td>Student: correct responses</td><td>1</td><td>0</td><td>1.00<xref ref-type="table-fn" rid="tfn2">c</xref></td><td><.01</td><td>[0.34, 1.00]</td><td>Positive (2/2)</td></tr><tr><td><xref ref-type="bibr" rid="bibr31">Jimenez & Barron (2019)</xref></td><td>3</td><td>K-5</td><td>Science, Math, ELA</td><td>Team planning for embedded instruction</td><td>Paraeducator: opportunities to respond</td><td>1</td><td>1</td><td>1.00</td><td><.001</td><td>[0.55, 1.00]</td><td>Positive (3/3)</td></tr><tr><td><xref ref-type="bibr" rid="bibr32">Johnson et al. (2004)</xref></td><td>1</td><td>K-5</td><td>ELA, Science, Homeroom, Fine arts</td><td>Embedded instruction (CTD)</td><td>Student: correct responses</td><td>1</td><td>1</td><td>0.84</td><td><.001</td><td>[0.46, 1.00]</td><td>Positive (1/1)</td></tr><tr><td><xref ref-type="bibr" rid="bibr34">Knight et al. (2018)</xref></td><td>3</td><td>K-5</td><td>Math, Science, Cannot determine</td><td>Video modeling</td><td>Student: independent correct steps in academic skill task analysis</td><td>1</td><td>1</td><td>0.99</td><td><.001</td><td>[0.72, 1.00]</td><td>Positive (3/3)</td></tr><tr><td><xref ref-type="bibr" rid="bibr36">R. L. Koegel et al. (2014)</xref></td><td>1</td><td>K-5</td><td>Recess</td><td>Paraeducator facilitated peer interaction</td><td>Student: engagement intervals</td><td>1</td><td>1</td><td>1.00</td><td>0.02</td><td>[0.29, 1.00]</td><td>Positive (1/1)</td></tr><tr><td><xref ref-type="bibr" rid="bibr41">McDonnell et al. (2002)</xref></td><td>4</td><td>6-8</td><td>Food and Nutrition, Health, Computer</td><td>Embedded instruction (CTD)</td><td>Student: correct responses</td><td>0</td><td /><td>0.97</td><td><.001</td><td>[0.68, 1.00]</td><td>Positive (4/4)</td></tr><tr><td><xref ref-type="bibr" rid="bibr46">Reyes (2020)</xref></td><td>1</td><td>K-5</td><td>Math, ELA, Lunch</td><td>Video self-monitoring with SLP</td><td>Student: completion of transitional routines</td><td>2</td><td>2</td><td>1.00</td><td><.001</td><td>[0.70, 1.00]</td><td>Positive (1/1)</td></tr><tr><td><xref ref-type="bibr" rid="bibr48">Robinson (2011)</xref></td><td>3</td><td>K-5</td><td>Playground, Classroom not specified</td><td>PRT</td><td>Paraeducator: implementation fidelity</td><td>0</td><td>0</td><td>1.00</td><td><.001</td><td>[0.47, 1.00]</td><td>Positive (3/3)</td></tr><tr><td><xref ref-type="bibr" rid="bibr51">Ryan et al. (2019)</xref></td><td>3</td><td>6-8</td><td>Social Studies</td><td>Inquiry based embedded trials</td><td>Student: correct concept statements</td><td>1</td><td>1</td><td>0.99</td><td><.001</td><td>[0.69, 1.00]</td><td>Positive (3/3)</td></tr><tr><td><xref ref-type="bibr" rid="bibr53">Shukla et al. (1999)</xref></td><td>3</td><td>6-8</td><td>Art, Industrial Crafts, Math, Social Studies</td><td>Paraeducator facilitated peer supports</td><td>Student: active engagement</td><td /><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr65">Walker & Snell (2017)</xref></td><td>2</td><td>K-5, 6-8</td><td>Math, Art</td><td>Function-based intervention</td><td>Paraeducator: implementation fidelity</td><td>1</td><td>1</td><td>1.00</td><td><.001</td><td>[0.50, 1.00]</td><td>Positive (2/2)</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note.</emph> WWC = What Works Clearinghouse; DS = design standards (0 = did not meet standards, 1 = met standards with reservations, 2 = met standards); ES = evidence standards (0 = no evidence, 1 = moderate evidence, 2 = strong evidence); CI = confidence interval; ELA = English language arts; CTD = constant time delay; SLP = system of least prompts; PRT = pivotal response teaching.</p> <p>2 Positive effects, mixed effects, or no effects reported for eligible participants. <sups>b</sups>This study involved a parametric analysis of peer support arrangements. Tau-U was computed based on phase contrasts between the "2 peers" and "1 peer" conditions. <sups>c</sups>This study involved a comparison of "embedded instruction" and "one-to-one instruction." Tau-U was computed based on phase contrasts between "baseline" and "embedded instruction" conditions.</p> <hd id="AN0153477328-9">Participant and Intervention Characteristics</hd> <p></p> <hd id="AN0153477328-10">Student characteristics</hd> <p>A total of 62 students with ESN received paraeducator-delivered interventions in inclusive school settings. These students were, on average, 11.6 years of age (range: 5–18 years) and primarily attended elementary school (Grade K–5; 51.6%) and middle school (Grade 6–8; 35.5%), with only 12.9% attending high school (Grade 9–12). In terms of educational placement, 21.0% of students spent at least 80% of their day in general education and 1.6% spent less than 40% of their day in general education, with time spent in the general education setting unknown for 77.4% of students. General education classes and inclusive settings attended by students prior to intervention included specials (e.g., art, music, physical education; 45.2%), core academic classes (33.9%), other classes and settings (e.g., special events, study hall; 24.2%), cafeteria (9.7%), playground (4.8%), and other academic classes (e.g., Spanish, computer class; 6%).</p> <p>We were unable to determine gender for three (4.8%) of the student participants. However, among those for whom gender was reported, most were male (71%) and far fewer were female (24.2%). Race and ethnicity were reported in all but 15 cases (24.2%), with students described as follows: White (48.4%), Black or African American (12.9%), Hispanic/Latinx (16.1%), and Asian (1.6%). Many students (32.3%) had more than one reported disability label. Students largely had disability labels of either autism spectrum disorder (38.7%) or intellectual disability (43.5%). Other disability labels included educational labels not explicitly found in the [<reflink idref="bib28" id="ref49">28</reflink>] eligibility categories (e.g., profound disability, Down syndrome, cerebral palsy, Angelman syndrome; 24.2%), speech language impairment (8.1%), hearing impairment (3.2%), orthopedic impairment (3.2%), other health impairment (3.2%), visual impairment (3.2%), and traumatic brain injury (1.6%). We were unable to determine disability label for 14.5% of students, though these students qualified as having ESN based on the authors' description of the students having a severe disability.</p> <hd id="AN0153477328-11">Paraeducator characteristics</hd> <p>A total of 63 paraeducators delivered interventions to students with ESN in inclusive school settings. In one study ([<reflink idref="bib16" id="ref50">16</reflink>]), two paraeducators supported the same student. Paraeducators were, on average, 42.1 years of age (range: 18–69 years) and reported to have the following educational experiences: high school degree (22.6%), 4-year college degree (12.9%), some college experience (11.3%), 2-year college degree (11.3%), and graduate degree (1.6%); we could not determine educational level for 40.3% of paraeducators. We were unable to determine gender for 15 (23.8%) of the paraeducator participants. However, among those for whom gender was reported, most were female (65.1%) and far fewer were male (11.1%). Race and ethnicity were reported for 36 paraeducators (57.1%), with these paraeducators described as follows: White (41.3%) and Black or African American (15.8%). In terms of experience, paraeducators, on average, had spent 6.6 years (range: <1–19 years) in their role as a paraeducator. In 38.7% of cases, paraeducators had not received prior training related to the target intervention, whereas only 4.8% had received such training; we could not make this determination in over half of the cases (56.5%).</p> <hd id="AN0153477328-12">Paraeducator-implemented intervention characteristics</hd> <p>Paraeducators delivered a variety of interventions that addressed different domains across a range of inclusive settings (see Supplemental Table 3). In a majority of cases, paraeducators delivered interventions that fell under the communication/social domain (61.1%). The specific type of intervention for each study is described in Table 1; a large number of paraeducators delivered interventions that involved supports from peers without disabilities. In terms of instructional format, intervention was most often delivered within a whole group instructional arrangement (27.4%) or during independent work time (16.1%) and less often in a one-to-one arrangement (9.7%). In over half of the cases (53.2%), we were unable to determine instructional format. Paraeducators delivered interventions in a range of general education classes and inclusive settings as follows: core academic classes (51.6%), specials (40.3%), playground (8.1%), cafeteria (4.8%), and other general education classrooms not otherwise specified (3.2%); we were unable to determine the specific setting for one student (1.6%).</p> <p>Paraeducators delivered interventions in the natural context (contextualized; e.g., during whole group instruction) in a majority of cases (88.7%) and less often (3.2%) outside of the natural context (decontextualized; e.g., during transitions, breaks). For five students (8.1%), we were unable to determine the specific instructional context within the inclusive setting. In addition to paraeducators, peers without disabilities (51.6%), special education teachers (9.7%), general education teachers (9.7%), and researchers (4.8%) were involved in intervention delivery. Paraeducators delivered interventions to address social-emotional and communication needs (69.4%), academics (32.3%), challenging behavior (3.2%), and essential life skills (1.6%). Most studies did not report intervention dosage. Sessions per day was reported for 22 students (35.5%) and ranged from one to three sessions. Trials per session was reported for 11 students (17.7%) and ranged from one to 30 trials. Days of intervention per week was reported for 17 students (27.4%) and ranged from 1 to 5 days per week. To determine the effects of the intervention, a majority of cases involved a multiple baseline or multiple probe design (79%) and less often a reversal design (8.1%), alternating treatment design (3.2%), or a combination of research designs (4.8%).</p> <hd id="AN0153477328-13">Paraeducator training characteristics</hd> <p>Most paraeducators received training prior to delivering intervention (85.5%), although the trainer and training type varied (see Supplemental Table 4). When paraeducators received training, researchers primarily delivered training that usually involved a combination of didactic and experiential training methods, with oral descriptions of the intervention procedures (84.9%), modeling (73.6%), and performance feedback (64.2%) as the most commonly applied training approaches. In almost all cases (96.2%), at least one aspect of training dosage was reported. Didactic trainings were held over one to four sessions that lasted between 15 min and 4 hrs, whereas experiential training sessions lasted between 20 min and 1 hr and were held on a weekly basis or over multiple sessions (e.g., three to six sessions) until the paraeducator met the performance criteria. A multiple baseline design (45.3%) was used in a majority of cases to measure the effects of paraeducator training on paraeducator-delivered intervention. In 12 cases (22.6%), no experimental design was used despite paraeducator data being reported and, in 17 cases (32.1%), paraeducator outcomes were not measured.</p> <hd id="AN0153477328-14">Study quality</hd> <p>Acceptable levels of IOA were reported across all student outcome measures. Social validity of paraeducator-delivered intervention was measured and reported as acceptable across 71.0% of students. However, generalization (17.6%) and maintenance (37.1%) of student outcomes were measured less often. Generalization measures included generalization to multiple settings, different implementers, and different materials and activities. Maintenance probes were collected anywhere from immediately after intervention up to 2 months post intervention. Acceptable levels of IOA were reported across all paraeducator outcome measures. For studies that involved paraeducator training, social validity data were collected across 67.9% of cases, all with acceptable outcomes. Generalization and maintenance of paraeducator outcomes were measured in 17.6% and 20.5% of cases, respectively. Generalization measures included generalization to multiple settings, different implementers, and new students. Maintenance probes were collected anywhere from 4 weeks to 2 months post intervention. Table 1 includes outcomes for the [<reflink idref="bib66" id="ref51">66</reflink>] standards. Most studies met the design standards with reservations (45.0%), with fewer meeting without reservations (30.0%) or not meeting the standards (25.0%). Studies that were eligible for the evidence standards review met the standards either with reservations (66.7%) or without reservations (33.3%).</p> <hd id="AN0153477328-15">Estimate of Intervention Effect</hd> <p>Overall, paraeducator-delivered interventions in inclusive school settings resulted in positive student outcomes; the aggregate Tau-U across studies with primary student dependent measures reflects a large to very large change in student outcomes (0.88, <emph>p</emph> <.001, 90% CI = [0.75, 1.00]). Likewise, paraeducator training resulted in positive paraeducator outcomes, including improved implementation fidelity; the aggregate Tau-U across studies with primary paraeducator dependent measures reflects a large to very large change in paraeducator outcomes (0.83, <emph>p</emph> <.001, 90% CI = [0.73, 0.86]). Table 1 provides the aggregate Tau-U and visual analysis for primary dependent measures across eligible student and paraeducator participants in each study. Based on the Tau-U interpretation guidelines from [<reflink idref="bib58" id="ref52">58</reflink>], there was a large to very large change in student or paraeducator outcomes across a majority of the studies (85.7%), with large (9.5%) and moderate (4.8%) changes in a smaller number of studies.</p> <hd id="AN0153477328-16">Discussion</hd> <p>The purpose of this literature review was to systematically review studies involving paraeducator-delivered interventions among students with ESN in inclusive settings. Inclusive education for students with ESN remains elusive (e.g., [<reflink idref="bib38" id="ref53">38</reflink>]) despite the well-documented positive outcomes associated with inclusive versus segregated instruction (e.g., [<reflink idref="bib33" id="ref54">33</reflink>]). Given the disconnect between practices and practice-based outcomes, understanding that school systems report limited resources to adequately implement inclusive instruction might explain some of the stalled progress toward more inclusive experiences for students with ESN. Further, to maximize limited resources and implement "quick fixes" to more systemic problems, school districts continue to rely on paraeducators ([<reflink idref="bib20" id="ref55">20</reflink>]; [<reflink idref="bib57" id="ref56">57</reflink>]), despite concerns regarding the overreliance and misuse of paraeducators in inclusive settings ([<reflink idref="bib15" id="ref57">15</reflink>]). Considering these factors, we conducted this review to explore the current status of research on paraeducator-delivered interventions in inclusive school settings for students with ESN. Specifically, this review expands on (a) existing literature reviews that have summarized paraeducator intervention studies focused on students with specific disability labels and specific intervention domains (e.g., [<reflink idref="bib5" id="ref58">5</reflink>]; [<reflink idref="bib61" id="ref59">61</reflink>]) and (b) [<reflink idref="bib23" id="ref60">23</reflink>], [<reflink idref="bib24" id="ref61">24</reflink>]) initial work that examined practices and issues concerning paraeducator supports in inclusive school settings.</p> <p>There are several key findings that have important implications for practice and future research directions. First, we found that paraeducator-delivered interventions resulted in positive outcomes among students with ESN in inclusive settings. Likewise, we found that paraeducator training resulted in high levels of paraeducator implementation across a variety of interventions, an outcome that has been documented for paraeducators supporting students with IDD in non-inclusive and inclusive school settings (e.g., [<reflink idref="bib5" id="ref62">5</reflink>]; [<reflink idref="bib7" id="ref63">7</reflink>]). Similar to findings from recent paraeducator literature reviews ([<reflink idref="bib5" id="ref64">5</reflink>]; [<reflink idref="bib60" id="ref65">60</reflink>]), training that consisted of a description of the skill, modeling, and performance feedback contributed to accurate intervention delivery by paraeducators. Paraeducators also reported through social validity assessments that interventions and training experiences were practical and effective across inclusive settings.</p> <p>Second, we found that paraeducator training was largely delivered by researchers, a common limitation among paraeducator intervention studies that also has been reported in other paraeducator literature reviews (e.g., [<reflink idref="bib5" id="ref66">5</reflink>]; [<reflink idref="bib7" id="ref67">7</reflink>]; [<reflink idref="bib60" id="ref68">60</reflink>]). In only 15.1% of cases, a special education teacher supported paraeducator intervention implementation in the inclusive setting, and there were no instances of general education teachers training paraeducators in the reviewed studies. However, it should be noted that the number of teacher-delivered paraeducator training studies has grown over time, particularly among studies in which paraeducators support students with IDD ([<reflink idref="bib5" id="ref69">5</reflink>]). Collectively, these studies suggest that teachers can successfully apply training methods that researchers have effectively used to support paraeducators. We also found that only 9.7% of students received intervention that was delivered by both a paraeducator and a special or general education teacher; similarly, [<reflink idref="bib60" id="ref70">60</reflink>] also reported that only 10% of students received paraeducator and teacher-delivered interventions to address challenging behavior.</p> <p>Third, several encouraging findings emerged that centered on paraeducator-delivered supports. Paraeducators provided more whole-group and independent work arrangements versus traditional one-to-one support, and unlike other literature reviews of studies reflecting a wide range of intervention domains (e.g., academic, social, communication, challenging behavior, vocational; [<reflink idref="bib5" id="ref71">5</reflink>]), interventions in the current review tended to focus on social and communication interactions with peers without disabilities in the inclusive setting.</p> <hd id="AN0153477328-17">Implications for Practice</hd> <p>Given that paraeducators typically are inadequately prepared to meet the needs of students with disabilities, concerns have been raised related to the instructional role that paraeducators often play in inclusive settings ([<reflink idref="bib15" id="ref72">15</reflink>]; [<reflink idref="bib20" id="ref73">20</reflink>]). Our findings highlight the importance of paraeducator preparation and suggest that when paraeducators are provided with effective supervision and training, they can be successful in delivering individualized supports in such settings. However, it was less clear whether paraeducators were able to transfer their newly-acquired knowledge and skills to different contexts (e.g., different students, different instructional routines, different inclusive environments). It will be important for those responsible for paraeducator oversight to not only consider how and which skills to teach paraeducators but also carefully design training opportunities that promote skill generalization and maintenance to reduce the need for ongoing, intensive support ([<reflink idref="bib5" id="ref74">5</reflink>]; [<reflink idref="bib61" id="ref75">61</reflink>]). Schools will need to determine how to apply well-established paraeducator training practices within the inclusive context. Given the strong research evidence supporting training approaches that were utilized to support paraeducators in the reviewed studies, we recommend that schools develop paraeducator training protocols that include a description of the skill, modeling the skill, practice opportunities, and performance feedback on paraeducator implementation of the skill, with subsequent progress monitoring and feedback once the paraeducator begins implementation with students ([<reflink idref="bib67" id="ref76">67</reflink>]).</p> <p>Schools will also need to consider the role of special education teachers in relation to supporting paraeducators in inclusive, general education classrooms. Our findings raise important questions about the collaboration between special education teachers (who often are not present in general education classrooms) and general education teachers to develop systems for effective paraeducator supervision in inclusive settings. Without direct paraeducator supervision and support and shared responsibility for supports implementation with general education teachers, inappropriate use and overreliance on paraeducators in inclusive settings for students with ESN will likely persist ([<reflink idref="bib15" id="ref77">15</reflink>]). It will be incumbent on school leadership to support both general and special education teachers in navigating how best to utilize and oversee paraeducators in inclusive settings, especially given that teachers are not always prepared for this important responsibility ([<reflink idref="bib4" id="ref78">4</reflink>]) and often report limited time for collaborative planning ([<reflink idref="bib56" id="ref79">56</reflink>]).</p> <p>Although our findings, and others, demonstrate that paraeducators can be trained to support students in a one-to-one context, school leaders and teachers must maintain an awareness of the potential negative consequences of one-to-one paraeducator arrangements (c.f., [<reflink idref="bib25" id="ref80">25</reflink>]). Consequently, alternatives such as class-wide paraeducators or whole-group adult supports should be considered ([<reflink idref="bib20" id="ref81">20</reflink>], [<reflink idref="bib22" id="ref82">22</reflink>]) and research investigating training and supervision requirements of these paraeducator arrangements must continue. Another alternative to one-to-one paraeducator support that school leaders and IEP teams should consider is peer support arrangements ([<reflink idref="bib10" id="ref83">10</reflink>]); when implemented in inclusive settings, this may serve an important role in promoting pivotal social and communication skills ([<reflink idref="bib35" id="ref84">35</reflink>]) that will be instrumental across the lifespan, creating opportunities for work, recreation, and relationships, while also offering opportunities for enhanced quality of life.</p> <p>Additional implications emerge from the demographics of paraeducators in our sample. Paraeducators tended to be middle-aged, White females, suggesting a gender mismatch with students (who were predominantly male). As noted by [<reflink idref="bib24" id="ref85">24</reflink>], this mismatch can result in loss of gender identity, and may also result in negative social consequences for the student. Thus, more effort must be made to ensure that when paraeducators are assigned to support students, they are aware of the potentially negative consequences of their presence and work to mitigate those consequences. Finally, we assert all student supports should be student-directed, meaning students learn skills to identify what supports they require and when, and then direct how others provide such supports in ways that are most effective, dignifying, and efficient for the student. At present, no empirical studies have been identified investigating the extent to which students with ESN can be taught to direct and manage paraeducator supports in inclusive settings. However, student-directed supports would build upon the foundations established in self-determination (e.g., [<reflink idref="bib52" id="ref86">52</reflink>]), and is therefore an area in need of further investigation and consideration.</p> <hd id="AN0153477328-18">Limitations and Future Research</hd> <p>There are several limitations that should be considered when interpreting the findings of this literature review. Studies often provided limited descriptions of paraeducator participants (e.g., education level, prior training) and intervention characteristics (e.g., instructional format, rationale for paraeducator support, intervention dosage). Future researchers should aim to include detailed descriptions of participants and interventions to allow for analysis of such characteristics. We also discovered a clear gap concerning student age and target skill domain. Specifically, a majority of students were elementary-aged and interventions largely addressed social and communication skills with peer support, despite primarily being conducted in core academic classes where academic instruction is central. Additional research focused on older students is needed to determine the effectiveness of paraeducator-implemented supports in inclusive secondary settings and across a range of skill domains relevant to inclusive settings.</p> <p>Research evidence indicates that paraeducator-delivered systematic instruction can improve academic outcomes for students in self-contained settings (e.g., [<reflink idref="bib62" id="ref87">62</reflink>]). However, our findings suggest that more work is needed to explore the benefits of systematic instruction in inclusive settings ([<reflink idref="bib42" id="ref88">42</reflink>]). Likewise, emerging evidence suggests paraeducators can successfully implement behavioral interventions ([<reflink idref="bib60" id="ref89">60</reflink>]), though examining how paraeducators support behavior among students with ESN in inclusive settings will be critical. It also is important to note the value of continued research on placement decisions for students with ESN, as the presence of challenging behavior can influence these decisions ([<reflink idref="bib63" id="ref90">63</reflink>]); this may explain why few studies in this review focused on behavioral supports.</p> <p>In addition, studies rarely provided a rich description of the general education setting and context or the quality of inclusion. Qualitative research has the potential to help the field develop a deeper understanding of contextual variables that influence decisions related to paraeducator support in inclusive settings. We also found that plans for fading paraeducator support were not described in the studies. A needed next step in the research base is to identify strategies and training that encourages adults (teachers and paraeducators) to teach students to direct their supports. Relatedly, all paraeducator supports should be viewed as temporary ([<reflink idref="bib20" id="ref91">20</reflink>]). To accomplish this, research is needed that focuses on teaching students to use technological and other supports to replace paraeducator and other unnatural adult-directed supports. Future research should address strategies for effectively fading paraeducator supports by transferring responsibility to teachers, enhancing peer supports, and replacing paraeducator supports with student-directed supports.</p> <p>Another limitation that should be considered when interpreting findings from this review is the inclusion of studies with questionable quality based on the [<reflink idref="bib66" id="ref92">66</reflink>] standards. In particular, a quarter of studies did not meet the design standards, and therefore were not eligible for review against the evidence standards. Although this finding might reflect the increasing emphasis on study rigor over the past few decades, it will be important for researchers to conduct high-quality studies that allow for an evaluation of study evidence to further understand the evidence-base for paraeducator supports in inclusive school environments. We also discovered that study quality varied in terms of measurement of skill maintenance and generalization. Future work should focus specifically on whether and how paraeducators generalize newly acquired skills to different contexts and maintain implementation over extended periods of time. Likewise, measures of generalization and maintenance will be important to include in research that focuses on the effectiveness of paraeducator training methods. Finally, the scope our review was limited to a descriptive analysis of participant and intervention characteristics and Tau-U calculation across single-case research studies. Once the research base has expanded and improved in quality, moderator analyses can be conducted to identify variables that potentially influence the effectiveness of paraeducator-delivered interventions in inclusive settings (e.g., type or dosage of training received). In addition, because single-case research follows a specific methodology and addresses specific types of research questions, generalization of findings from this review is somewhat limited. As noted previously, qualitative research can enrich the field's understanding of paraeducator utilization in inclusive settings, and the inclusion of randomized controlled trials in future reviews can provide additional evidence of paraeducator effectiveness in these settings (see [<reflink idref="bib5" id="ref93">5</reflink>]).</p> <hd id="AN0153477328-19">Supplemental Material</hd> <p>sj-docx-1-rps-10.1177_15407969211055127.docx</p> <p>sj-docx-1-rps-10.1177_15407969211055127 – Supplemental material for Paraeducator-Delivered Interventions for Students with Extensive Support Needs in Inclusive School Settings: A Systematic Review</p> <p></p> <p>Supplemental material, sj-docx-1-rps-10.1177_15407969211055127 for Paraeducator-Delivered Interventions for Students with Extensive Support Needs in Inclusive School Settings: A Systematic Review by Virginia L. Walker, Jennifer Kurth, Megan E. Carpenter, Melissa C. Tapp, Amy Clausen and Elissa Lockman Turner in Research and Practice for Persons with Severe Disabilities</p> <p></p> <hd id="AN0153477328-20">Author Biographies</hd> <p> <bold>Virginia L. Walker</bold> is an associate professor of special education at the University of North Carolina at Charlotte. Her research interests include positive behavioral interventions and supports, inclusive education, and teacher and paraprofessional preparation to support students with extensive support needs.</p> <p> <bold>Jennifer Kurth</bold> is an associate professor of special education at the University of Kansas. Her research centers on inclusive education for students with extensive and pervasive support needs. This includes examining outcomes of inclusion in terms of skill development and quality of life indicators for students with disabilities, as well as how educators develop skills and dispositions for inclusive practices.</p> <p> <bold>Megan E. Carpenter</bold> is a postdoctoral researcher at the University of Kansas. Her current research focuses on supporting educators to implement behavioral interventions that promote access and meaningful participation in inclusive, general education settings for students with extensive support needs.</p> <p> <bold>Melissa C. Tapp</bold> is doctoral candidate of special education at the University of North Carolina at Charlotte. Her research interests include increasing engagement of students with extensive support needs within school settings with a focus on communication and behavioral interventions and teacher education.</p> <p> <bold>Amy Clausen</bold> is a doctoral candidate at the University of North Carolina at Charlotte. Her research interests include promoting general curriculum access for students with extensive support needs and preparing teachers for inclusive settings.</p> <p> <bold>Elissa Lockman Turner</bold> is a doctoral student at the University of Kansas. 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Carpenter is now affiliated with The University of Kansas, Lawrence, USA.</bibtext> </blist> <blist> <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> <bibtext> The author(s) received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> Virginia L. Walker</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0003-3248-7290 Jennifer Kurth</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-5947-7642 Melissa C. Tapp</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0001-7805-4146 Amy Clausen</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-4109-4133 Elissa Lockman Turner</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0002-5836-3088</bibtext> </blist> <blist> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> <blist> <bibtext> Editor in Charge: Susan R. Copeland</bibtext> </blist> </ref> <aug> <p>By Virginia L. Walker; Jennifer Kurth; Megan E. Carpenter; Melissa C. Tapp; Amy Clausen and Elissa Lockman Turner</p> <p>Reported by Author; Author; Author; Author; Author; Author</p> <p></p> <p>Virginia L. Walker is an associate professor of special education at the University of North Carolina at Charlotte. Her research interests include positive behavioral interventions and supports, inclusive education, and teacher and paraprofessional preparation to support students with extensive support needs.</p> <p>Jennifer Kurth is an associate professor of special education at the University of Kansas. Her research centers on inclusive education for students with extensive and pervasive support needs. This includes examining outcomes of inclusion in terms of skill development and quality of life indicators for students with disabilities, as well as how educators develop skills and dispositions for inclusive practices.</p> <p>Megan E. Carpenter is a postdoctoral researcher at the University of Kansas. Her current research focuses on supporting educators to implement behavioral interventions that promote access and meaningful participation in inclusive, general education settings for students with extensive support needs.</p> <p>Melissa C. Tapp is doctoral candidate of special education at the University of North Carolina at Charlotte. Her research interests include increasing engagement of students with extensive support needs within school settings with a focus on communication and behavioral interventions and teacher education.</p> <p>Amy Clausen is a doctoral candidate at the University of North Carolina at Charlotte. Her research interests include promoting general curriculum access for students with extensive support needs and preparing teachers for inclusive settings.</p> <p>Elissa Lockman Turner is a doctoral student at the University of Kansas. Her research is focuses on environments and practices that support positive outcomes for students with extensive support needs, including the implementation of equitable inclusive education, how environments are built to enable student learning, and effective teacher practices and paraprofessional utilization.</p> </aug> <nolink nlid="nl1" bibid="bib54" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib42" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib29" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib37" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib45" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib50" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib33" firstref="ref7"></nolink> <nolink nlid="nl8" bibid="bib38" firstref="ref8"></nolink> <nolink nlid="nl9" bibid="bib43" firstref="ref9"></nolink> <nolink nlid="nl10" bibid="bib55" firstref="ref10"></nolink> <nolink nlid="nl11" bibid="bib21" firstref="ref13"></nolink> <nolink nlid="nl12" bibid="bib57" firstref="ref14"></nolink> <nolink nlid="nl13" bibid="bib13" firstref="ref15"></nolink> <nolink nlid="nl14" bibid="bib28" firstref="ref16"></nolink> <nolink nlid="nl15" bibid="bib18" firstref="ref17"></nolink> <nolink nlid="nl16" bibid="bib15" firstref="ref19"></nolink> <nolink nlid="nl17" bibid="bib20" firstref="ref20"></nolink> <nolink nlid="nl18" bibid="bib24" firstref="ref21"></nolink> <nolink nlid="nl19" bibid="bib23" firstref="ref22"></nolink> <nolink nlid="nl20" bibid="bib47" firstref="ref24"></nolink> <nolink nlid="nl21" bibid="bib61" firstref="ref25"></nolink> <nolink nlid="nl22" bibid="bib60" firstref="ref26"></nolink> <nolink nlid="nl23" bibid="bib19" firstref="ref29"></nolink> <nolink nlid="nl24" bibid="bib64" firstref="ref35"></nolink> <nolink nlid="nl25" bibid="bib40" firstref="ref37"></nolink> <nolink nlid="nl26" bibid="bib66" firstref="ref38"></nolink> <nolink nlid="nl27" bibid="bib53" firstref="ref39"></nolink> <nolink nlid="nl28" bibid="bib44" firstref="ref42"></nolink> <nolink nlid="nl29" bibid="bib58" firstref="ref43"></nolink> <nolink nlid="nl30" bibid="bib49" firstref="ref44"></nolink> <nolink nlid="nl31" bibid="bib59" firstref="ref45"></nolink> <nolink nlid="nl32" bibid="bib39" firstref="ref46"></nolink> <nolink nlid="nl33" bibid="bib62" firstref="ref47"></nolink> <nolink nlid="nl34" bibid="bib16" firstref="ref50"></nolink> <nolink nlid="nl35" bibid="bib67" firstref="ref76"></nolink> <nolink nlid="nl36" bibid="bib56" firstref="ref79"></nolink> <nolink nlid="nl37" bibid="bib25" firstref="ref80"></nolink> <nolink nlid="nl38" bibid="bib22" firstref="ref82"></nolink> <nolink nlid="nl39" bibid="bib10" firstref="ref83"></nolink> <nolink nlid="nl40" bibid="bib35" firstref="ref84"></nolink> <nolink nlid="nl41" bibid="bib52" firstref="ref86"></nolink> <nolink nlid="nl42" bibid="bib63" firstref="ref90"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Paraeducator-Delivered Interventions for Students with Extensive Support Needs in Inclusive School Settings: A Systematic Review
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Walker%2C+Virginia+L%2E%22">Walker, Virginia L.</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-3248-7290">0000-0003-3248-7290</externalLink>)<br /><searchLink fieldCode="AR" term="%22Kurth%2C+Jennifer%22">Kurth, Jennifer</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5947-7642">0000-0002-5947-7642</externalLink>)<br /><searchLink fieldCode="AR" term="%22Carpenter%2C+Megan+E%2E%22">Carpenter, Megan E.</searchLink><br /><searchLink fieldCode="AR" term="%22Tapp%2C+Melissa+C%2E%22">Tapp, Melissa C.</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7805-4146">0000-0001-7805-4146</externalLink>)<br /><searchLink fieldCode="AR" term="%22Clausen%2C+Amy%22">Clausen, Amy</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4109-4133">0000-0002-4109-4133</externalLink>)<br /><searchLink fieldCode="AR" term="%22Lockman+Turner%2C+Elissa%22">Lockman Turner, Elissa</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5836-3088">0000-0002-5836-3088</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Research+and+Practice+for+Persons+with+Severe+Disabilities%22"><i>Research and Practice for Persons with Severe Disabilities</i></searchLink>. Dec 2021 46(4):278-295.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 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: http://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 18
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2021
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Information Analyses
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Elementary+Secondary+Education%22">Elementary Secondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Paraprofessional+School+Personnel%22">Paraprofessional School Personnel</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Research%22">Educational Research</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Staff+Development%22">Staff Development</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Implementation%22">Program Implementation</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Severe+Disabilities%22">Severe Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Elementary+Secondary+Education%22">Elementary Secondary Education</searchLink><br /><searchLink fieldCode="DE" term="%22Training%22">Training</searchLink><br /><searchLink fieldCode="DE" term="%22Inclusion%22">Inclusion</searchLink><br /><searchLink fieldCode="DE" term="%22Regular+and+Special+Education+Relationship%22">Regular and Special Education Relationship</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/15407969211055127
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1540-7969
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Schools have continued to rely on paraeducators to assist special education teachers and other professionals in the provision of special education and related services. Although paraeducators often support students with extensive support needs (ESN) in a range of school environments, the subset of intervention studies focused on paraeducators who support students with ESN in inclusive settings has not been systematically reviewed. The purpose of this literature review was to synthesize single-case research studies involving paraeducator-delivered interventions for students with ESN in inclusive school environments. Our findings suggest that research primarily has focused on communication and social skills interventions that involved paraeducator-facilitated peer supports in core academic classes and specials (e.g., art, music, physical education). Overall, paraeducator-delivered interventions resulted in improved student outcomes. Likewise, paraeducator training, which typically included an oral description, modeling, and/or performance feedback, was effective in improving paraeducator implementation of the target interventions. We present implications for practice specific to paraeducators who support students with ESN in inclusive settings and future research directions.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2021
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1317694
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1317694
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      – Type: doi
        Value: 10.1177/15407969211055127
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 18
        StartPage: 278
    Subjects:
      – SubjectFull: Paraprofessional School Personnel
        Type: general
      – SubjectFull: Students with Disabilities
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      – SubjectFull: Educational Research
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      – SubjectFull: Program Effectiveness
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      – SubjectFull: Inclusion
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      – SubjectFull: Regular and Special Education Relationship
        Type: general
    Titles:
      – TitleFull: Paraeducator-Delivered Interventions for Students with Extensive Support Needs in Inclusive School Settings: A Systematic Review
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