Collaborative Problem SolvingAn Approach to Helping Explosive Students with Challenging Behaviour

By Ron Teffaine, M.Ed., CSC

Agenda for Today• 9:00 am - 10:15 am CPS (theory, research, tools) • 10:15 am - 10:20 am Nutrition Break• 10:20 am - 11:30 am CPS (Plan A, C, B)• 11:30 am - 1:15 pm Lunch & HTA AGM• 1:15 pm - 2:30 pm CPS (videos & practicing the

Plan B steps in groups)• 2:30 pm – 2:50 pm Nutrition Break• 2:50 pm – 3:45 pm CPS (group practice,

questions, fill out evaluation form)

• What do I want from this workshop today? Jot down an idea, and be prepared to share it.

What Would You Do?

• Read over the two scenarios in your handout.

• Briefly write down what you would do if you were the teachers of those students.

• Be prepared to share an idea or two with the rest of the class.

Ross W. Greene, Ph.D.• Director of the Collaborative Problem Solving

Institute at Massachusetts General Hospital,• Associate professor of Psychiatry at Harvard

Medical School.

Originator of the Collaborative Problem Solving Approach

Wrote two popular books about CPS

CPS for parents CPS for teachers

Who was CPS Designed for?

Explosive children and adolescents:• Severely resistant to adults • Have explosive outbursts• A heterogeneous group, with a

variety of diagnoses:

e.g., ADHD, ODD, CD, IED, Dysthymia, Bipolar Disorder, Temper Dysregulation Disorder, Asperger’s Disorder, FASD, etc.

Why A New Model? The Coercion Model dominated the conceptualization &

treatment of explosive behaviour for 45 years prior to CPS. It says that 4 patterns of discipline contribute to coercive adult-

child interactions: (1) Inconsistent (2) Irritable explosive(3) Low supervision/involvement(4) Inflexible or rigid

Children learn that arguing and tantrums coerce adults to give in to their wishes.

The solution has been Parent Training (PT).

PT has limitations:• Many parents give up or drop out• 30-40% of parents report behaviour problems at follow-up• 50% of treated children never reach normal

Parent Training books based on Coercion Model

Two popular books for teachers based on the coercion model:

William Jensen & Ginger Rhode

Coercion Model in School

Ignoring

Arguing

Verbal &/or PhysicalAggression

Asking

Begging

Threatening

Wins

AggressiveDemanding

Loses

Gives in

Stalling

Three Conceptual Models:(1) Main Effect

• Child’s outcome is product of either adult or child characteristics

Child

Adult

ExplosiveOutcomeor

A or C = Outcome

Poor parenting

skills

Has a disorder, (e.g., ADHD)

The solution is Parent Training!

The solution is Medication!

Three Conceptual Models:(2) Interactional

• Child’s outcome depends on the combination of adult & child characteristics

Adult Child Outcome+

A + C = Outcome

(A-1) + (C-1) = (O-2)

(A-1) + (C0) = (O-1)

Severe

Moderate

Three Conceptual Models:(3) Transactional

• Child’s outcome depends on degree of “fit” or “compatibility” between adult & child characteristics

Unique Fit

CPS is based on this model

Goal of treatment

Is not to fix the adult or the child, it is to improve the

“compatibility” between adult

and child.

How well does CPS work?

Subjects - 50 children (ages 4-12) with ODD

Journal of Consulting and Clinical Psychology 2004, Vol. 72., No. 6, 1157-1164

Conclusion: CPS resulted in better outcomes than PT.

CPS Philosophy:

“Children do well if they can.”

VS.

“Children do well if they want to.”

Suggests explosive kids are

attention-seeking, manipulative, limit-testing, or poorly

motivated

Suggests kids would do well if they had the right

skills to appropriately adapt to the

environmental demands

Explosive kids have a Learning Disability in three global domains:

(1) Flexibility / adaptability

(2) Frustration tolerance

(3) Problem solving

These disabilities hinder a child’s ability to adapt to changes or demands, and internalize standards of conduct.

As a result, explosive children find it difficult to comply with adults’ imposed goals and standards.

Different parts of the brain contribute to the LD in flexibility/adaptability, frustration tolerance, & problem solving:

Prefrontal Cortex – executive functioning

Limbic System – emotions

Right Brain –novel,

holistic, analogical,

spatial processing

Left Brain –routine,

sequential, analytical, linguistic

processing

Problems in Five Cognitive Pathways contribute to the LD in the 3 domains1. Executive skills:

• Impulsivity, perseveration, trouble remembering things, enmeshed thoughts & feelings, weak forethought, and disorganization

2. Language-processing skills:• Trouble comprehending, weak grammatical expression, slow

verbal fluency, difficulty labeling feelings, poor pragmatics 3. Emotion regulation skills:

• Chronic irritability, depression, and/or anxiety4. Cognitive flexibility skills:

• Concrete, literal, black-and-white thinkers, who are rigid and detail-oriented

5. Social skills:• Cognitive distortions, inaccurate interpretations, lacks empathy,

poor self-monitoring, lacks interpersonal skills

Exploring the Cognitive Pathways

The Pathways Inventory

is an excellent toolfor exploringskill deficits among the 5

pathways

• As you observe a student’s explosive behaviour over time, think about which pathways are needed to meet the demands of the problem situations.

• e.g., If John gets upset every time you tell him to get a partner or join a group, he may lack the necessary social skills.

• e.g., If John gets nervous and upset just before show-and-tell time, he may have language processing deficits and/or excessive anxiety because of poor emotional regulation.

Exploring “Pathway” skill deficits

Exploring “Triggers” – Unsolved Problems• Triggers – are “problems that have yet to be solved.”

These are situations that precipitate or increase the likelihood of explosive episodes.• e.g., telling a student to do some written work,

telling a student to put materials away, when a student loses a game, when criticized for being late, when accidentally bumped, asking for homework, etc.

• By identifying triggers and pathway deficits, explosive episodes become more predictable. can help with generating possible solutions, can anticipate what adaptations can be used to

prevent and reduce explosive episodes.

High Probability Triggers

Exploring Triggers & PathwaysTwo other tools can be used to explore common triggers and lagging skills among the 5 pathways:

The ALSUP Checklist The ALSUP Rating Scale

Exploring Triggers & PathwaysThe ALSUP Rating Scale

Use one ALSUP Rating Scale for each student scenario presented at the beginning of the workshop to identify the “Triggers” & “Pathways” likely involved.

Individual Exercise

Prioritize Triggers & Pathways Examine the collected data using the Pathways

Inventory, ALSUP Checklist or Rating Scale. Transfer the problems to the Prioritizing Triggers

& Cognitive Pathways form. Determine which Triggers are the most frequent or

interfere the most. Observe which Pathway lagging skills are affected

most often. Rank order the problems in order of priority, so

that each can be worked through.

Prioritize Triggers & Pathways cont’d…

Impacton

Cognitive Pathways Affected(from the ALSUP)

Triggers(Unsolved Problems)

FreqPerDay

OtherKids

TheTeacher

ExecutiveSkills

LanguageSkills

Emotion-Regulation

Skills

CognitiveFlexibility

Skills

SocialSkills

RANK

When other kids push ahead of him

6Often

3 3 1

Asked to correct his written work

4Some-times

2 3 2

Asked to work with a new partner

1Some-times

2 2 3

• Use the CPS PLAN form to categorize items into High Priority unsolved problems and lagging skills, as well as Low Priority unsolved problems/accommodations.

Prioritize Triggers & Pathways cont’d…

Document Plan B Sessions

Three plans for handling problems

1. Plan A – imposition of adult will. Insisting that expectations be met. Adult assumes motivation is the problem, so may offer incentives or threaten punishment.• Entry phrases: “No,” “You must..,” “You have

to…” “You can’t..,” etc.• Escalating insistence:

“Look, if you __, I’ll give you ___.” REWARD

“If you don’t __, you’ll miss __!” PUNISHMENT

Three plans for handling problems

2. Plan C – involves reducing or removing expectations, at least temporarily. • Adults signal this when they say nothing, or do

not object to a student’s request or behaviour.• When Plan C follows Plan A, it could be

interpreted as “giving in” to a child’s explosive behaviour. This may increase it.

• However; starting with Plan C simply means you’re choosing not to impose an expectation just yet.

Three plans for handling problems

3. Plan B – engaging the student in a collaborative attempt at problem solving to achieve a mutually satisfying (win-win) resolution of whatever concerns or factors are interfering with expectations being met. • Although Plan A seems quicker, it can

precipitate explosive episodes, which are more time consuming than solving the problems durably with Plan B.

Criteria for an Effective Intervention

1. Create a helping relationship2. Solve the problems (triggers)

precipitating explosive episodes3. Teach lagging skills within the 5

cognitive pathways4. Reduce the frequency, intensity, and

duration of challenging behaviour5. Help pursue adult expectations

How well does each plan achieve the goals of an effective intervention?

Goals Achieved by Each Plan

Create Helping

Relationship

TeachSkills

SolveProblems(triggers)

ReduceOutbursts

PursueExpecta-

tions

Plan A With FBA

With FBA

?temporarily

Plan C Plan B

How Does Plan B Teach Skills? Executive skills:

• Organized, planful (nonimpulsive) thinking develops as adults guide students’ thinking with Plan B.

• Separation of affect develops as kids learn that solutions to problems take their concerns into account.

• Shifting cognitive set develops as students learn to anticipate triggers and agree to solutions (e.g., teacher reminders, visual schedules, social stories, etc.).

Language-Processing skills: • Expressing frustration in a socially acceptable manner

(e.g., “I’m frustrated” vs. “Screw you!”) can develop based on teacher suggestions during brainstorming.

How Does Plan B Teach Skills? Emotion Regulation skills:

• Reduction of anxiety & irritability occurs as chronic problems associated with these feelings are resolved using Plan B.

• Dispelling cognitive distortions (e.g., labeling, overgeneralizing, catastrophizing, etc.) associated with anxiety & depression can occur as Plan B identifies them and provides disconfirming evidence for them.

Cognitive Flexibility skills: • Thinking becomes more flexible as anxiety is

decreased through the “Empathy” step & reassurance.• Considering another’s perspective develops through

the “Defining the Problem” step.

How Does Plan B Teach Skills? Social Skills:

• Some skills are trained simply by using Plan B:e.g., Assertiveness, cooperation, problem solving, etc.

• Other skills may need to be trained directly using strategies similar to published social skills training programs:

e.g., Skillstreaming – Dr. Arnold Goldstein & Dr. Ellen McGinnis

• Social skills are taught in a collaborative fashion, so there’s a better chance the info. will be heard.

• Plan B often teaches social skills in the natural environment, therefore, there’s better generalization.

1. Proactive Plan B – this is preferred!• This is a proactive procedure, done at a time

when each person is calm and able to think well (e.g., before/after school, lunchtime, recess, etc.)

2. Emergency Plan B• This is done at the start of challenging behaviour

or after an explosive episode.• If done too often, this is called “Perpetual Plan B”

and signals the urgency for Proactive Plan B.

Plan B Two main types:

What if student starts to Escalate?

• Use the student’s interests or passions• Ask student to deliver a message• Send to designated “comfort zone”• Go for a walk with the student & allow venting

(From “No More Meltdowns”- Jed Baker, Ph.D).

• Use Non-violent Crisis Intervention

Anxious Student:• Noticeable change from usual behaviour (e.g.,

quieter, louder, fidgety, etc.); student has a problem Offer assistance; be nonjudgmental, caring,

empathic, and supportive

• Try Distraction

What if student continues to Escalate?Use Non-violent Crisis Intervention

Defensive Student:• Agitated – now we have the problem• Starting to lose rationality; challenging

1. Questioning Give info., redirect2. Refusal Set limits (+ then -)3. Release Allow venting4. Intimidation Get help, keep hands off5. Tension Reduction Therapeutic rapport

Emergency Plan B C.O.P.I.N.G. or

Proactive Plan BThree steps or ingredients:

1. Empathy• Gather information about and achieve a clear

understanding of the student’s concern or perspective on the unsolved problem.

2. Define the problem• Enter the adult’s concern for consideration.

3. Invitation• Brainstorm ideas that are realistic and mutually

satisfactory (i.e., win-win solutions).

B

Proactive Plan B in Action

Proactive Plan B

STEP 1 – Empathy

Words to use: Initial inquiry

• “I’ve noticed that …(insert unsolved problem) … what’s up?”

Drilling for Information• Ask W4 (who, what, where, when) & How

questions about the unsolved problem.• Explore facts, thoughts, beliefs, feelings,

physical reactions, relationships, choices, etc.• Investigate the conditions under which it

occurs, & those under which it doesn’t. What’s the difference to the student?

• Use active listening, reflect & summarize ideas.• Take your time; don’t rush this step.

Step 1. EmpathyPlan B

You tend to ___ when…___ occurs when you…

Step 1. EmpathyMore Help: If you’re not sure what to say next, say:

• “How so?” “I’m confused.” “I don’t quite understand.” “Can you tell me about that?” “Let me think about that for a second.”

If the student doesn’t talk or says, “I don’t know,” try to figure out why. Maybe…• your observation wasn’t very neutral• the problem was too vague• you’re using Plan A• he/she really doesn’t know – give time, break down

problem

Plan B

Step 1. Empathy

What You’re Thinking: Am I using a concerned, caring, and

respectful tone of voice? What don’t I yet understand about the kid’s

concern or perspective? What doesn’t make sense to me yet? What do I need to ask to understand it

better?

?

Plan B

Step 1. Empathy

Don’t…• Skip the Empathy step• Assume you already know the student’s

concern• Rush through the step without sufficient drilling

– “Perfunctory Empathy”• Leave the Empathy step before you completely

understand the kid’s concern or perspective• Talk about solutions yet

Plan B

Plan B - Empathy Step – Drilling for Information

Group Work Time

Observer

Teacher

Student

Step 1

Plan B exercise: Step 1 - Empathy• Break up into groups of 3.• One person will be the student (1), one the teacher

(2), and one the observer (3).• Each group member will get a “Role-Play Sheet” that

lists two unsolved problems.• The teacher (2) will try out Step 1 of Plan B with one

problem.• The teacher and observer use the “Cheat Sheet.”• The teacher may also use the

CPS “Deciding on Solutions” form if desired.• The observer will use the “Feedback Form” to record

what went well under step 1 of Plan B, and a helpful comment or two under the suggestions column.

• Once step 1 is completed, rotate so that each group member has a turn.

Proactive Plan B

STEP 2 – Define The Problem

Step 2. Define The ProblemWords:

“The thing is (insert adult concern)…” “My concern is (insert adult concern)…”

More Help: Most adult concerns fall into 2 categories:

• How the problem is affecting the student• How the problem is affecting others

What You’re Thinking: Have I been clear about my concern? Does the student understand what I said?

Well,…

Adult’sConcern

Step 2. Define The Problem

Don’t…• Start talking about solutions yet• Sermonize• Judge• Lecture• Use sarcasm

Group Work Time

Observer

Teacher

Student

Step 2

Plan B exercise: Step 2 – Define the Problem• Stay in your groups.• Decide who will be the student (1), teacher (2), and the

observer (3).• Continue using the “Role-Play Sheet” that lists two

unsolved problems.• The teacher (2) will try out Step 2 of Plan B with one

problem.• The teacher and observer use the “Cheat Sheet.”• The observer will use the “Feedback Form” to record

what went well under Step 2 of Plan B, and a helpful comment or two under the suggestions column.

• Once step 2 is completed, rotate so that each group member has a turn.

Proactive Plan B

STEP 3 – Invitation

Step 3. Invitation

Words to use: Restate the concerns, usually beginning with:

• “I wonder if there is a way we can…”• “Let’s see if we can figure that out”• “Let’s see what we can do about that”• “Do you have any ideas?” (Let the student go first!)• “Well, I have a few ideas… would you like to hear

them?”

Plan B

Step 3. Invitation

More Help: Stick closely to the identified concerns Let the student go first, but remember it’s a team

effort Consider the odds of a solution actually working:

• If they’re below 60-70%, talk about what is making you skeptical

Try the CPS “Deciding on Solutions” form At the end, agree to return to Plan B again if the

first solution doesn’t work

Plan B

Brainstorming

Step 3. Invitation

What You’re Thinking: Have I summarized both concerns accurately?

Have we truly considered whether both of us can do what we’ve agreed upon?

Does the solution address both of our concerns?

What are the odds of this solution working?

?

Plan B

Step 3. Invitation

Don’t… Rush through this step Enter this step with pre-ordained,

“ingenious” solutions Agree to solutions that both you and the

student can’t actually perform Agree to solutions that don’t truly address

both your concerns

Plan B

Plan B - Invitation Step – “Ingenious Solutions”

Group Work Time

Observer

Teacher

Student

Step 3

Plan B exercise: Step 3 – Invitation• Stay in your groups.• Decide who will be the student (1), teacher (2), and the

observer (3).• Continue using the “Role-Play Sheet” that lists two

unsolved problems.• The teacher (2) will try out Step 3 of Plan B with one

problem.• The teacher and observer use the “Cheat Sheet.”• The observer will use the “Feedback Form” to record

what went well under Step 3 of Plan B, and a helpful comment or two under the suggestions column.

• Once step 3 is completed, rotate so that each group member has a turn.

Plan B in Groups

Plan B in Groups• The teacher acts as the group facilitator.• Establish expectations for communicating (e.g.,

respectful I-messages), listening, and taking turns (e.g., use a foam talking ball).

• Record expectations on chart paper for all to see.• Remind the group of the expectations if they

aren’t being met.• Display a Plan B Outline on the wall.• Be neutral – there are no good or bad concerns,

only ones that need to be addressed.• Help the students prioritize problems to address.

Plan B in Groups• Empathy Step - all students take turns offering

their perspective on a problem that affects the class or individuals within the class.

• Define the Problem - the adult offers his/her concerns and perceptions after the kids are done.

• Invitation Step - have kids brainstorm solutions based on at least 2 criteria: (1) ideas are realistic, (2) ideas are mutually satisfactory. The teacher joins in after letting students try first.

• Recording - When “drilling” or “brainstorming,” record the information on a whiteboard, flip chart, overhead, or Mimio display so all can see.

Questions or

Final Comments?

For more information about CPS, visit the

“Lives In the Balance” website at:

http://www.livesinthebalance.org

Please fill out the Workshop Evaluation form

Thank You