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.
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
Two popular books for teachers based on the coercion model: William Jensen & Ginger Rhode
Coercion Model in School Ignoring Arguing Verbal &/or Physical Aggression Asking Begging Threatening Wins Aggressive Demanding Loses Gives in Stalling
Three Conceptual Models: (1)Main Effect Child’s outcome is product of either adult or child characteristics Child Adult Explosive Outcome or 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 ) + (C 0 ) = (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 (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 domains 1.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 anxiety 4.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 tool for exploring skill 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.
Exploring Triggers & Pathways Two 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 & Pathways The 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… Impact on Cognitive Pathways Affected (from the ALSUP) Triggers (Unsolved Problems) Freq Per Day Other Kids The Teacher Executive Skills Language Skills Emotion- Regulation Skills Cognitive Flexibility Skills Social Skills RANKRANK When other kids push ahead of him 6 Often 33 1 Asked to correct his written work 4 Some- times 23 2 Asked to work with a new partner 1 Some- times 22 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…
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: REWARD “Look, if you __, I’ll give you ___.” REWARD PUNISHMENT “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.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 relationship 2.Solve the problems (triggers) precipitating explosive episodes 3.Teach lagging skills within the 5 cognitive pathways 4.Reduce the frequency, intensity, and duration of challenging behaviour 5.Help pursue adult expectations
How well does each plan achieve the goals of an effective intervention? Goals Achieved by Each Plan Create Helping Relationship Teach Skills Solve Problems (triggers) Reduce Outbursts Pursue Expecta- 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.
this is preferred 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).
What if student continues to Escalate? Emergency Plan B or
Proactive Plan B Three 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
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. Empathy Plan B You tend to ___ when… ___ occurs when you…
Step 1. Empathy More 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
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.CPS “Deciding on Solutions” form 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.
Step 2. Define The Problem Words: “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’s Concern
Step 2. Define The Problem Don’t… Start talking about solutions yet Sermonize Judge Lecture Use sarcasm
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.
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” formCPS “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”
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.
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 Please fill out the Workshop Evaluation form Thank You