Do you ever think about where you are and how you got there? I don't mean logistically how you got to this physical place. What I mean is, do you think about the series of events that led you to the profession, or the relationship, or yeah, maybe the actual city where you live? Every decision, big or small, when you could have gone one way and instead chose another. I think about it all the time. I can trace my current job back to a casual conversation sitting on the sideline at my little brother's soccer game nearly 20 years ago.

The moments that set off a series of events and culminate in something new go by a few different names:

• ‍Ripple effect: a spreading, pervasive, and usually unintentional effect or influence^[1]‍

• Butterfly effect: a property of chaotic systems by which small changes in initial conditions can lead to large-scale and unpredictable variation in the future state of the system^[2]‍
• Happy accident: something good that happens as a result of chance instead of skill or planning^[3]

All of these definitions describe the unintended results of the decisions we make. Coincidences we can trace back to a moment. What about the intended outcomes? Those go by another name: domino effect.

A domino effect is a "cumulative effect produced when one event initiates a succession of similar events."^[4] If you’ve ever set up a domino run, the expression makes a lot of sense.

A domino effect is a "cumulative effect produced when one event initiates a succession of similar events."^[1] If you’ve ever set up a domino run, the expression makes a lot of sense. Line up a series of dominoes standing on their short edge, one in front of the other. It’s a precarious lineup. If one domino falls, the rest are sure to follow. And that’s the difference! You know what’s going to happen once you tip that first domino. It’s predictable, intentional even. These are the systems and practices we want to implement.

Mechanical vs. Complex Systems

The most predictable systems are mechanical ones like engines, clocks, and assembly lines. They're the kind of things that are repeatable. They generate the same outcome every time. Some of the least predictable systems are complex. These systems are made up of many independent systems that work together to create an outcome. Healthcare, our government, and education are all examples of complex systems.^[2],[3]

While individual schools operate on defined policies, schedules, and rules, it's the human element that makes them complex. It's us, guys!

We bring experience, creativity, and independence to the equation. Students add their own colorful blend to the mix. Each day is different because we're different. That kind of unpredictability seems like the least likely environment to experience a domino effect, and yet...Research demonstrates that PBIS is an evidence-based practice for reducing exclusionary discipline and improving social, emotional, and behavioral outcomes.^[4] In spite of the very human element guiding the way, it would seem PBIS implementation creates the predictability you need to set up your dominoes. How can that be?

The Predictability of PBIS

The PBIS Implementation Blueprint defines PBIS as “an evidence-based, multi-tiered, problem-solving, and team-based framework educators use to build a continuum of supports to promote all students’ social, emotional, behavioral, and mental health.”^[5] Because it’s a framework, and not a curriculum, it serves as the foundation for everything else you do as a school. The same set of systems, data, and practices serving one school are the same ones serving every school implementing PBIS, only the context changes.

At this point in our conversation, we need to talk about fidelity. When we implement the elements of PBIS the way they were intended to be implemented, the outcomes you want to see are more and more attainable. We also know from research that when you adapt your implementation to match the context, culture, and community in your school, even more is possible.^[6] That combination of adaptation and adherence to the framework feels tricky. That’s where data come in!

While systems and practices make PBIS visible in your school, consistent, reliable data help you sustain those efforts over the long haul. Data not only give you feedback about student outcomes in your school, they also keep us on track to implement the systems and practices with fidelity. Data are one way to keep the human element of our complex PBIS system predictable.

If ever there was a time to invest in evidence-based practices creating predictable, positive spaces with the potential to achieve high-priority outcomes, it's now. Here are just some of the dominoes research tells us PBIS implementation can set off in your school.

Improved Outcomes for Students with Disabilities

PBIS is implemented schoolwide. All students experience the continuum of support. The Tier 1 systems, data, and practices you implement serve as the foundational elements of the support you provide at Tiers 2 and 3. When all students access Tier 1 support, outcomes improve, including for students with disabilities.

How you incorporate schoolwide systems and practices into your classroom setting is one of the most influential ways to support students with disabilities. Some really good classroom practices to improve outcomes for all students...including students with disabilities are:

• ‍Adapting the physical layout of the classroom to meet students’ physical needs.
• Developing and teaching predictable classroom routines to help students navigate their learning as independently as possible.
• Posting, defining, and teaching how your schoolwide expectations look and feel in your classroom.
• Offering pre-corrections or reminders to students before certain times of the day when behavior is likely to be more challenging.
• Positively acknowledging students when you notice them following expectations...correct them when they don’t.

When teachers implement PBIS in their classrooms, students with disabilities are:

• More likely to be academically engaged
• Less likely to experience suspensions and other exclusionary discipline
• More likely to improve social, emotional, and behavioral skills

Increased Student Engagement and Academic Achievement

Students spend the majority of their time in classrooms, which means classrooms are their primary place to experience your school's PBIS implementation. For schoolwide outcomes to improve, classroom-level implementation has to be done with fidelity. There are five classroom supports you won't want to skip. Make sure to:

• Link classroom practices back to your schoolwide framework
• Integrate instructional and social, emotional, and behavioral practices
• Make classroom support decisions guided by classroom data.
• Implement effective, equitable, culturally-relevant, evidence-based, preventative instructional practices based on student needs.
• Implement positive, proactive systems to support educators in each classroom

When teachers implement PBIS in their classrooms:

• Classroom disruptions decrease
• Academic performance improves, especially for students receiving additional behavior support
• Student attendance improves
• Students feel better about their own academic performance

Improved Mental Health and Wellbeing

As a multi-tiered framework, PBIS offers the structure you need to embed social, emotional, and mental health support directly into your schoolwide implementation. In this way, PBIS isn't an extra thing you do. It's an integrated model capable of organizing all the work you do as a team. Social workers sit at the table on Tier 1 teams. Students and families extend their voices to provide a wider context of your community than just what's in the walls of your building. At Tier 1, your team focuses on:

• Promoting wellness and mental health literacy for everyone, schoolwide.
• Using universal screening data to uncover externalizing and internalizing needs
• Embedding social, emotional, and behavioral curriculum in academic content with coaching support
• When schools integrate school mental health within their PBIS framework, students experience:
• Greater access to targeted and intensive support
• Improved social, emotional, and behavioral skills and wellness
• Reduced referrals for intensive support.

On the surface, PBIS is a complex framework with lots of moving parts implemented by one of the most chaotic drivers of all: us. But, maybe that's the beauty of it. Every school is as unique as the community it serves. PBIS offers the structure we need to organize and prioritize the systems, data, and practices associated with the positive outcomes we know are possible. When we do it well, we create the predictability we need to lay out our dominoes and start knocking them down one at a time.

Over the course of the school year, we'll explore the domino effect PBIS implementation can have on the outcomes that matter most to you. From academics to attendance and your ability to predict the future, we'll talk about it all. We hope you'll join us.

Is Positive Behavioral Interventions and Supports (PBIS) an Evidence-Based Practice?

Santiago-Rosario, M. R., McIntosh, K., Izzard, S., Cohen-Lissman, D., & Calhoun, T. E. (2023). Is Positive Behavioral Interventions and Supports (PBIS) an Evidence-Based Practice? Center on PBIS, University of Oregon. www.pbis.org.

Literature review exploring how Tier 1 PBIS implementation affects valued educational outcomes.  Studies included met the following criteria:

• Implemented PBIS across a continuum of Tier 1, 2, and 3 supports
• Measured intervention effects on students, educators, and institutional outcomes
• Conducted in educational settings
• Compared business as usual control schools with PBIS implementation schools OR school/district outcomes during baseline years with outcomes during or after PBIS implementation
• Designed as randomized controlled trials, quasi-experimental research studies, descriptive or correlational, single-case studies, case studies, and meta-analyses.

Findings demonstrate that PBIS can be designated an evidence-based practice for reducing exclusionary discipline and improving social, emotional, and behavioral outcomes.

Reduces the use of and inequities in the use of exclusionary discipline

PBIS reduces referral rates overall and reduces inequities in exclusionary discipline for Black students and students with disabilities.

Studies show an overall reduction in suspension rates and the number of school days missed due to suspension across all grade levels.

One study indicated a reduction in the number of students expelled, referred to alternative settings or law enforcement, or arrested as a result of school-related behaviors.

Improves Social, emotional, and behavioral competencies

Elementary students are more likely to demonstrate prosocial skills and emotional regulation after PBIS implementation.

It’s been associated with improved on-task behavior among elementary students, and their teachers report improvement in things like assertiveness, communication, cooperation, empathy, engagement, and peer relationships.

High schools report an increase in academic engagement when Tier 2 supports were incorporated into a solid Tier 1 foundation.

Reduces Disruptive Behavior

PBIS has been links to reductions in off-task behavior, aggressive behavior, and disruptive behavior among elementary students...especially students who struggle with behavioral issues.

Teachers reported less bullying and lower levels of rejection in schools randomly assigned to implement PBIS.

When schools combined PBIS and social-emotional learning, implementation showed the greatest improvements in mental health and the biggest reduction in externalizing behavior challenges.

Positively Influence Attendance

Elementary, middle, and high school student tardiness improved after implementation.

Descriptive reductions in student dropout rates.

Improves School Climate, School Safety, and Organizational Health

Across all grade levels, students and staff report more positive attitudes toward school. Students enjoy attending school more and climate perceptions become more positive.

Students report improved relationships with teachers, sense of safety, and support from educators.

Teaching conditions improved:

• Improved student-teacher relationships
• More positive staff affiliation (warmer, friendlier interactions among colleagues, sense of accomplishment, etc.)
• Greater focus on academics
• Increased resource allotment (ability for administrator to lobby for and allocate resources for initiatives)
• Improved proactive behavior management skills
• Improved collective and/or self-efficacy.

Expect the Unexpected: A Qualitative Study of the Ripple Effects of Children’s Mental Health Services Implementation Efforts

Pullmann, M. D., Dorsey, S., Duong, M. T., Lyon, A. R., Muse, I., Corbin, C. M., ... & Powell, B. J. (2022). Expect the unexpected: a qualitative study of the ripple effects of children’s mental health services implementation efforts. Implementation Research and Practice, 3, 26334895221120797.

“This research can serve to increase understanding of the complexity of implementation efforts and the recognition that implementation of EBIs is but one action in a larger, interconnected system.”

Ripple effects: “positive or negative outcomes that are caused by evidence-based intervention implementation strategies and are unplanned, unanticipated, and/or more salient to stakeholders other than researchers and implementers.”

• Unintentional
• Caused by implementation strategies
• Any type of valence (positive, negative, or neutral)
• Impacting any role or level
• Constructs that are intended mediators or outcomes in the context of one implementation effort may be ripple effects in a different implementation effort.

Other words:

• “unexpected mechanisms”
• “unintended consequences” - unintended negative outcomes resulting from an intervention and can impact any party
• “balancing measures” - any secondary outcome generated by a quality improvement or quality assurance effort and can feature any other compilation of the other features.
• “spillover effects” - unintended or intended outcomes on non-participants generated by any causal action.

Ripple Effects of Children’s Mental Health Services

After 404 responses, they identified 66 unique ripple effects and grouped those into 13 categories.

• General knowledge, skills, attitudes, and confidence about using evidence-based interventions
• General job-related ripple effects (worker retention, job satisfaction, job burnout) Example: Decreased turnover – Increasing clinicians” offers a sense of effectiveness may decrease the desire to switch jobs.‍
• EBI tratment adherence, fidelity, and alignment.
• Gaming the system to (manipulating data, tokenism, insufficient use of data tracking systems) Example: People game their therapies to get more money from clients and from agencies to say they did a more elaborate treatment than they truly did.‍
• Equity and stigma (availability, access, quality, outcomes, and stigma associated with mental health) Example: When localities are mandated to perform EBP, there could be a potential for localities with fewer resources to struggle implementing the EBP compared to localities with more resources.‍
• Economic costs and benefits Example: Training caregiver and youth as peer supporters provides income/employment to family members who may have had to quit their day jobs already.‍
• Youth client and caregiver outcomes (informal support systems, caregiver strain, empowerment, re-traumatization, hope) Evidence based treatments that improve client functioning can also improve their performance and retention in school, ‍
• Use of EBI strategies and insight in one’s own life (using strategies for self-care, using strategies with friends and family members) EBPs such as deep breathing are utilized by practitioners to avoid work burnout.

Example: Confidence – feeling self-assured to provide a service because you have had the proper training.

Lipsitz, L. A. (2012). Understanding health care as a complex system: the foundation for unintended consequences. Jama, 308(3), 243-244.

In contrast to mechanical systems in which component parts interact linearly to produce a predictable output, the components of complex systems interact nonlinearly over multiple scales and produce unexpected results. The output of a mechanical system can be controlled by manipulating each of its parts, while the output of a complex system is dynamic,behavingdifferently according to its initial conditions and feedback. For example, the health care system comprises networks of components(hospitals, clinics, nursing homes, rehabilitation units, patient homes, families, and patients) that interact nonlinearly on different scales (the patient, family, medical center, and government), and often produce unintended consequences (adverse drug reactions, nosocomial infections, rehospitalizations, and functional decline).

^[1] Merriam-Webster. (n.d.). Domino effect. In Merriam-Webster.com dictionary. Retrieved August 5, 2026, from https://www.merriam-webster.com/dictionary/domino%20effect

^[2] Di Miceli, A., (2020, October 15). Complex or complicated? Medium. https://alexdimiceli.medium.com/complex-or-complicated-41b2937ed01b

^[3] Plsek, P. (2001). Appendix B: Redesigning health care with insights from the science of complex adaptive systems. Crossing the quality chasm: A new health system for the 21st century, 2001, 309-322.

^[4] Santiago-Rosario, M. R., McIntosh, K., Izzard, S., Cohen-Lissman, D., & Calhoun, T. E. (2023). Is Positive Behavioral Interventions and Supports (PBIS) an Evidence-Based Practice? Center on PBIS, University of Oregon. www.pbis.org.

^[5] Center on Positive Behavioral Interventions and Supports (July 2023). Positive Behavioral Interventions and Supports (PBIS) Implementation Blueprint. University of Oregon. www.pbis.org.

^[6] Harn, B., Parisi, D. and Stoolmiller, M. (2013). Balancing Fidelity with Flexibility and Fit: What Do We Really Know about Fidelity of Implementation in Schools?. Exceptional Children, 79(2), pp.181-193.