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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