Post on 27-Mar-2015
Diana Joyce, Ph.D. NCSP Douglas Jones, B.A. Angela Dobbins, M.Ed. djoyce@coe.ufl.edu djonesnd2000@ufl.edu dobbinad1@ufl.edu
University of Florida
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All Presentation Materials Including Sample Reports are Available at http://www.nasponline.org/
Tier ITier IUniversal – All Students
Tier IITier IISupplemental, Targeted, Short-Term
Tier IIITier IIIIntensive, Individual, Long-Term
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Positive Behavioral Support: Frequent recognition for appropriate behaviors, proximity control, cueing, build-in appropriate movement opportunities (e.g., Kagan Brain Ex.), predictable structure, positively-phrased and highly visible behavioral expectations.
Embedded Social Curriculum: Instruction in prosocial behavior/attitudes.
Data Screening: School-wide climate survey, ISS/OSS data, incidence mapping, rating scales for emotional risk and social skills (SSIS, BESS, SOS) Observations, FBAs, Behavior Plans: Classroom observations to determine environmental contributors, antecedents, sustaining factors, frequency, patterns across subjects or time-of-day and task demands, self-monitoring or reinforcement plans, DRCs
Counseling: Social Skills, Anger Mgmt, Test Anxiety, Friendship Groups
Data Progress Monitoring: Tier II data
Behavior Plans & Counseling Therapy: Individualized, greater frequency and intensity, often addressing multiple issues simultaneouslyMulti-agency Plans: Coordinate w/out-side agencies on counseling, behavioral plans, meds, family therapy, juvenile justice, etc. Data Progress Monitoring: Psychological assessment, Tier III data
Disorder Effective Interventions
Internalizing
Anxiety CBT, family anxiety management
Depression CBT, coping skills training, behavioral self-control therapy
Fears/ Phobias
Graduated exposure, modeling, reinforced practice, In-vivo exposure, CBT, imaginal desensitization, self-calming techniques
OCD CBT with exposure and response prevention, parent training
Externalizing
ADHD Behavior modification, reinforcement of other behaviors, organizers, parent training, medication
ODD/CD Behavioral modification, anger management, CBT, REBT, time-out, problem-solving training, parent-child therapy, parent training
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(Kendall & Hedtke, 2006)
Three Counseling Approaches Solution-Focused
▪ Conflicts, personal goals Psychoeducational
▪ E.g., Teach social skills, teach study skills Cognitive Behavioral Therapy
▪ Anxious behaviors, anger management, grief management
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First Session Intro, Rapport-Building, Confidentiality,
RulesCore Sessions Targeted Skills
CurriculumLast Session, ClosureBooster or Follow-up
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Behavioral Observations
FBA Data Knowledge Surveys Rating Scales
BASC-2 Self-report BECK Youth Inventory RCMAS Outcome Rating Scales;
Session Rating scales, etc.
Discipline Referral Rates
Work Completion Rates
Improved Grades Absence/Tardy Rates Single Subject
Design Daily Behavior
Report Cards SUDS
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Focus on what want to achieve (not past)
Focus how to obtain goal Positive stated goals, measurable
Case study Male, 6th grade, good grades Prior counseling aggression, anxiety Weekly sessions, 1 month CBT, 5 month
SFBT
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(Sklare, 2005)
1. Miracle Question▪ If you woke up & miracle happened, all of
your problems were fixed…
2. What is 1st sign miracle occurred?▪ What would be different?
3. If we videotaped you after the miracle happened
▪ What would you be doing?
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(Sklare, 2005)
1. Miracle = Areas needing remediating2. First sign of miracle = guides goal
development3. Discussed when the “miracle” has
occurred▪ Builds positive thinking and reflection on
when the student made behavioral changes
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(Sklare, 2005)
Scaling Questions: Rate progress of goals on Likert scale Use scaling as discussion point
▪ When score high--What is preventing you from lower score? When score low– What need to do to allow that to happen?
Coping Questions: Strengths - Actions - Goals “Things must be difficult for you. How do
you manage to do so well in school?”
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(Sklare, 2005)
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Basic Components: Teach & Model Skill (Knowledge Deficit)
Role Play w/Feedback (Performance Deficit)
Practice-Practice (Fluency Deficit)
Review Generalization
(NASP, 2004)
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Four skill areas: Survival Skills (respect, listening,
following directions, boundaries) Interpersonal Skills (express feelings,
manners, sharing, turn-taking, nonverbal cues)
Problem-solving Skills (asking for help, apologizing, generate solutions)
Conflict Resolution Skills (dealing with teasing, peer pressure, assertion)
(NASP, 2004)
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Unit I: Empathy Training Focus on building feeling vocabulary Identifying physical and situational cues
Unit II: Emotion Management Focus on three strategies:
1. Self-coaching (“Stay Calm”)2. Deep (Belly) Breathing,3. Cognitive Distractions (Counting)
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Unit III: Problem-Solving Step 1 - How do I feel? Step 2 - What is the problem? Step 3 – What can I do?
Prosocial behaviors and assertive “I” statements reinforced
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3 Kindergarten Males Identified Referral Concerns:
Impulsive Inattentive Oppositional
Pre-intervention Data BASC-2 Behavioral and Emotional
Screening System (BESS) Parent Rating Scales
Teacher Interviews16
Group Focus: Empathy Training Impulse Control Problem-Solving
Weekly, 30 Minute Sessions
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Relaxation Training Diaphragmatic (deep) breathing Progressive muscle relaxation (PMR)
Cognitive Strategies Reducing negative self-talk Challenging unrealistic and dysfunctional thoughts Considering different perspectives
Behavior Strategies Behavioral exposures Successive approximation
Problem-Solving Techniques
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Marked by obsessive thoughts or impulses (i.e., intrusive thoughts, feelings that produce anxiety) and anxiety-reductive behaviors (compulsions).
Negative reinforcement (i.e., the removal of something aversive) reinforces compulsive behaviors
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Obsessions
Compulsions
Fear/Anxiety
Reduction in Distress
The Obsessive-Compulsive Cycle
Negative Reinforcement
(Piacentini et al, 2006)
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Ritual Cycle
SUDS = Subjective Units of Distress (0-100)
SUDS
Storch, 200623
Psychoeducation Conceptualization of OCD Rationale for Treatment
Creation of Symptom HierarchyExposure plus Response Prevention
Addressing ObsessionsContingency Management
(Piacentini et al, 2006)
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StepStep SUDSSUDS
10. Bathing with toilet water10. Bathing with toilet water 1010
9. Putting hand in public toilet w/o washing – 1 day9. Putting hand in public toilet w/o washing – 1 day 99
8. Flushing public toilet w/o washing – 12 hr8. Flushing public toilet w/o washing – 12 hr 88
7. Flushing public toilet w/o washing – 30 min7. Flushing public toilet w/o washing – 30 min 77
6. Standing near urinal w/o washing6. Standing near urinal w/o washing 66
5. Flushing home toilet w/o washing5. Flushing home toilet w/o washing 55
4. Touching public sink w/o washing4. Touching public sink w/o washing 55
3. Touching sink in house w/o washing3. Touching sink in house w/o washing 44
2. Touching floor w/o washing2. Touching floor w/o washing 33
1. Touching doorknob w/o washing1. Touching doorknob w/o washing 22Storch, 2006
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Make a OCD Thermometer (Subject Units of Distress Scale [SUDS])
Create a list of events that cause rituals (easiest to hardest)▪ Be creative and ‘intense’
Progress up that list slowly where the person does not engage in rituals.
Tackle things one at a time. Don’t leave the situation until anxiety
drops.▪ SUDS = Subjective Units of Distress (0-100
or 0-10)Storch, 2006
OCD Thermometer
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Patients are gradually exposed to anxiety-provoking stimuli while refraining (or prevented) from engaging in anxiety-reductive compulsive behaviors.
Avoid providing the child with reassurance (e.g., you wont get sick) or accommodating anxiety driven behaviors (e.g., I’ll open the door for you).
CBT with exposure and response prevention (ERP) is the best established psychological treatment for OCD
(Abramowitz et al., 2005; Chambless et al., 1998)
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Can collaborate with other mental health professionals to facilitate treatments
Schools provide many opportunities to conduct exposures
For more information see:
Sloman, G. M., Gallant, J., & Storch, E. A. (2007). A School-Based Treatment Model for Pediatric Obsessive-Compulsive Disorder. Child Psychiatry and Human Development, 38, 303-319.
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10 yr-old male Learning Disorder ADHD Autism Spectrum Disorder OCD
Referral concerns: Frustration Compulsive Behaviors
▪ Touching / Retouching▪ Cloth Picking
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Weekly CBT Sessions Coping Strategies Role Plays
▪ Frustration Exposures ERP for OCD symptoms
▪ Graduated Exposures Behavioral Management
▪ Compliance Training▪ Contingency Reinforcement
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Christner, R. W., Forrest, E., Morley, J., & Weinstein, E. (2007). Taking cognitive-behavior therapy to school: a school-based mental health approach. Journal of Contemporary Psychotherapy, 37, 175-183.
Kendall, E C., Choudhury, M. A., Hudson,J, & Pc'ebb, A. (2002). The C.A.T. Project Manual Ardmore, PA: Workbook Publishing.
Kendall, P. & Hedtke, K. (2006). Cognitive-Behavioral Therapy for Anxious Children: Therapist Manual (3rd ed). Ardmore, PA: Workbook Publishing.
Nelson III, M. W., Finch, A. J., & Ghee, C. (2006). Anger management with children and adolescents. In P. Kendall (Ed.). Child and adolescent therapy: cognitive-behavioral procedures. New York, NY: Guilford.
Stallard, P. (2002). Think good- Feel good: A cognitive behavioral therapy workbook for children and young people. Hoboken, NJ: John Wiley & Sons.
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ACHIEVE: A Collaborative School-based Reform Process, Howard Knoff, Social Skills, Conflict Resolution, Self Regulation, Positive School Climate, www.stopandthinksocialskills.com
Aggression Replacement Training, Mark Amendola, Anger Control, Aggression, Moral Reasoning Training www.aggressionreplacementtraining.org
I Can Problem Solve, Myrna Shure, Aggression, Emotionality, Withdrawal, Rejected www.researchpress.com
Intervention Central, Jim Wright, ADHD, Bullying, Defiance http://www.interventioncentral.org/
Life Skills Training, Gilbert Botvin, Self-esteem, Social Skills, Substance Abuse, Social Anxiety, Peer Pressure, www.lifeskillstraining.com
On-Line Graphing Resources http://www.interventioncentral.org PeaceBuilders, Michael Krupnick, Positive School Climate, Prosocial Behaviors,
Conflict, Sibling Fighting, School Attachment, Peer Rejection www.peacebuilders.com Peace Education Foundation, Conflict Resolution Programs, Peer Mediation, Crisis
Management, http://www.peaceeducation.com/ Primary Mental Health Project, Deborah Johnson, Mild Aggression, Withdrawal,
Shyness, Anxious, Poor Classroom Adjustment, www.childrensinstitute.net Second Step Prevention Curriculum, Committee for Children
http://www.cfchildren.org/programs/ssp/overview/ Skill Streaming, A. Goldstein & E. McGinnis, Prosocial Skills, Stress Coping,
Friendship Building, Sharing http://www.skillstreaming.com/ 34
Abramowitz, J. S., Whiteside, S. P., and Deacon, B. J. (2005). The effectiveness of treatment for pediatric obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 36, 55-63.
Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-Christoph, P., et al. (1998). Update on empirically validated therapies, II. Clinical Psychologist, 51, 3-16.
Kendall, P. C. (Ed.). (2006). Child and adolescent therapy: Cognitive–behavioral procedures (3rd ed.). New York: Guilford Press.
National Association of School Psychologists. (2004). Social skills: Building skills for success in school and life. Bethesda, MD: Author.
Piacentini, J., March, J., & Franklin, M. (2006). Cognitive–behavioral therapy for youth with obsessive−compulsive disorder. In P. C. Kendall (Ed.), Child and adolescent therapy: Cognitive–behavioral procedures (3rd ed., (pp. 297–321). New York: Guilford Press.
Sklare, G. B. (2005). Brief counseling that works: A solution-focused approach for school counselors and administrators . Thousand Oaks, CA: Corwin Press.
Sloman, G. M., Gallant, J., & Storch, E. A. (2007). A School-Based Treatment Model for Pediatric Obsessive-Compulsive Disorder. Child Psychiatry and Human Development, 38, 303-319.
Storch, E. A.(2006). Treatment of a patient with Obsessive-Compulsive Disorder. Journal of Family Practice, 55, 329-333.
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