1. Social and Emotional Learning for Students with Internalizing Behaviors Paul Caldarella, Leslie Gunter, Thomas J. Kramer, Luke A. Marvin BYU - Positive Behavior Support Initiative Presented at the TECBD Conference Tempe, AZ October 25, 2013

2. Acknowledgements Dr. Ken Merrell November 24, 1957 to August 19, 2011

3. Overview I.Mental health problems in schools II.Internalizing behaviors III.Prevention IV.Screening V.Social-Emotional Learning VI.Strong Kids VII.Evaluation results

4. Mental Health Needs in Schools  ~20% students in need of services Only ~20% receive services  Demands on educators Insufficient resources, overworked Limited time, academic requirements  Ineffective Programs Not evidence based (e.g., “fads”) Reactive “get tough” approaches Address problems too late, less responsive to treatment

5. Internalizing Behaviors Expression of distress inwards Anxiety, depression, social withdrawal, somatic complaints Can be difficult to detect through observation Associated with negative academic and social outcomes Prevalence: higher in girls & adolescents

6. Development of depression from preadolescence to young adulthood: Emerging gender differences in a 10-year longitudinal study. By: Hankin, Benjamin L., Abramson, Lyn Y., Moffitt, Terrie E., Silva, Phil A., McGee, Rob, Angell, Kathryn E., Journal of Abnormal Psychology, 0021843X, 1998, Vol. 107, Issue 1

7. Anxiety Disorders Source: http://emedicine.medscape.com/article/286227-overview#aw2aab6b2b8 based in part on Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry. Feb 1996;53(2):159-68.

8. Internalizing Behaviors Attempts to regulate internal emotional and cognitive states in a manner that is maladaptive May be elicited by the way youth: –think about their experiences –behaviorally cope with unpleasant events

9. Learning social and emotional skills and altering maladaptive thought and behavior patterns may help prevent and reduce internalizing symptoms. Three Pronged Prevention Approach Affective: emotional education Behavioral: social skills training Cognitive: change thinking Behavior Cognition Affect

10. Prevention of Internalizing Disorders –Look at the “big picture” –Consider the needs of all students –Move some resources and effort towards those not experiencing severe difficulties –Address problems before they become severe

11. Merrell, K. W., Parisi, D. M., & Whitcomb, S. A. (2007). Strong Start grades K-2: A social and emotional learning curriculum. Baltimore, MD: Paul H Brookes Publishing.

12. Primary Prevention: Universal Interventions Secondary Prevention: Specialized interventions Tertiary Prevention: Intensive interventions ~80% of Students ~15%~15% ~5% 1) Build Relationships 2) Establish Expectations 3) Teach Academic and Social-Emotional Skills 4) Reinforce Appropriate Behavior 5) Use Interventions Based on Data decisions

13. Identifying Needs Systematic Screening for Behavior Disorders (SSBD) (Walker & Severson 1992) –Screens All Students –Internalizing & Externalizing Teacher ratings Multi-gated Suggests risk level

15. School-University Collaboration Screening Review of results Discussion of PBS interventions Social and emotional learning

16. www.casel.org

17. Social and Emotional Learning (SEL) Promotes resilience by teaching the skills to: –Recognize and manage emotions –Develop care and concern for others –Make responsible decisions –Form positive relationships –Handle challenging situations effectively

18. Strong Start (ages 5-8) Strong Kids (ages 8-12) Strong Kids (ages 12-14) Strong Teens (ages 14-18) Strong Kids Series – SEL Curricula Strong Start Pre-K (ages 3-5)

19. Objectives of Strong Kids Prevent internalizing disorders Understand emotions Learn to: monitor and regulate emotions, thoughts, feelings handle challenges solve interpersonal problems set goals

20. Based on: Principles of effective instruction Premise that social-emotional skills must be specifically taught, learned, and practiced just like academic skills Semi-scripted developmentally appropriate lessons School to home practice application Home bulletin (Strong Start Pre-K/K-2) Home work (Strong Kids/Teens) Practical and easy to use Wide range of appropriate settings, purposes, leaders About Strong Kids

21. How Strong Kids differs from other SEL programs? Emphasis on internalizing behaviors Brief: 10-12 lessons, 25-50 minutes each Empirically-based SEL skills taught directly Three-pronged instructional focus –Affective: emotional education –Behavioral: social skills training –Cognitive: change thinking

22. Strengths Low-cost, low-tech Semi-structured Covers specific objectives and goals Feasible and easy to implement Highly flexible across school settings and student populations Limitations o Not a comprehensive program o May not meet needs of all students

23. Teaching Strong Kids Direct Instruction –Use scripts to directly teach concepts and skills Discussion –Ask students to volunteer to share and discuss experiences Activities –Conduct small groups, model examples, and role-plays –Read children’s literature –Create drawings/posters –Practice relaxation exercises Application –Precorrect, remind, and reinforce

24. Required Materials Projector or transparencies Handouts Chalk or marker board Stuffed animal mascot and children's literature for Strong Start

25. Overview of Lessons

26. Lesson Summaries Lesson 1: About Strong Kids –Critical terms defined (e.g., self-esteem, depression, anxiety) –Overview of upcoming lessons –Behavioral expectations outlined –Pre-assessment of knowledge and symptoms (optional)

27. Sample – Symptom Checklist Items

28. Lessons 2 and 3: Understanding Your Feelings Improve emotional awareness and vocabulary Identify and distinguish feelings as comfortable or uncomfortable Recognize situations that cause particular feelings Learn appropriate vs. inappropriate ways to express feelings

29. This activity will help you learn to identify comfortable and uncomfortable feelings…put a plus (+) mark next to any words that you think describe comfortable feelings, and put a minus (-) mark next to any words that you think describe uncomfortable feelings. Comfortable feelings: make people feel good, can help you have fun and enjoy life Uncomfortable feelings: make people feel bad, can also help people grow and change for the better Feeling List happylonelyscaredbored angrysadupsetsurprised strongproudafraidglad shyworriedtiredlove Feelings Identification Activity

30. Lesson 4: Dealing with Anger Describe anger, causes, and function Anger model Distinguish between anger and aggression Steps for delaying impulsive anger reactions Appropriate ways to express anger

31. Anger Model TriggerAny situation that results in you feeling angry. InterpretationThe process of thinking about what has happened to you and deciding what it means. Emotional Reaction (Anger)What you feel after interpreting a situation or trigger. DecisionMaking a choice about the action you will take. BehaviorActing out the decision that you made. ConsequenceThe direct results of your behavior.

32. Sample - Anger Management Strategy

33. Lessons 5: Understanding Other People’s Feelings Empathy training Identify feelings and perspectives of other people Consider body language, facial expression Role play scenarios

34. Sample - Empathy Assignment Think of two times when you could tell how someone else was feeling. _________________________________________________ How could you tell? (What were the clues that you noticed?) _________________________________________________ What did you do, or what could you do to help that person? _________________________________________________

35. Lessons 6 and 7: Clear Thinking Positive vs. negative thought patterns Thoughts influence mood, choices, actions Determining the level of the emotion Common thinking errors Dispelling negative thoughts

36. Binocular vision: looking at things in a way that makes them seem bigger or smaller than they really are. Black-and-white thinking: looking at things in only extreme or opposite ways. For example, thinking of things as being good or bad, never or always, all or none. Dark glasses: thinking about only the negative parts of things. Fortune-telling: making predictions about what will happen in the future without enough evidence. Making it personal: blaming yourself for things that are not your fault. Blame game: blaming others for things you should take responsibility for. Sample – Common Thinking Errors

37. HIGH MEDIUM LOW Supplement 6.1 (Overhead Transparency) Feelings Thermometer

38. Lesson 8: The Power of Positive Thinking Learn to redirect pessimistic feelings Foster optimistic thinking Do not attribute negative events to oneself Change negative thoughts

39. Example of Using the ABCDE Model (Positive Thinking) A: Adversity (Any problem): Michelle answers a question wrong in Math class. B: Belief (Bad thoughts): Michelle believes the teacher is angry and the whole class thinks she is stupid. C: Consequence (Crummy feelings): Michelle feels depressed and thinks "I wish I could run out of this classroom and never have to come back here again.“ D: Disputation or Decide (Decide not to accept thoughts): Michelle thinks "Okay, I answered the question wrong but that doesn't mean the teacher is mad. We are just learning these equations and she can't expect that all the students will always answer the questions right. The other kids in the class probably don't think I'm stupid because they get questions wrong too sometimes.“ E: Energization (Enjoy): Michelle thinks "I'm still a little embarrassed about getting the question wrong but I don't think the teacher is mad and the kids think I am stupid anymore. I no longer wish that I could run out of the classroom."

40. Lesson 9: Solving People Problems How to resolve conflict –Identify problem –Brainstorm solutions –Choose one –Make an agreement Strategies –Deal making –Compromising –Discussing –Brainstorming

41. Sample – Solving People Problems

42. Lesson 10: Letting Go of Stress Self-awareness of stress level –physical & cognitive symptoms Relaxation techniques –Slow breathing –Muscle relaxation Cognitive techniques for dealing with stress –Talking to friends –Facing your fears

43. Lesson 11: Behavior Change - Setting Goals and Staying Active How to set and attain goals Increase engagement in positive activities Personal values as a critical component Connection between activity and mood

44. Lesson 12: Finishing Up! Review and re-teach where needed Post assessment (optional, but recommended) Booster Lessons Reminds students of main ideas Provide more opportunities to practice

45. General Evaluation Results Empirically evaluated in ~ 20 separate studies Treatment fidelity Emotion knowledge and social-emotional competence Negative behavioral and emotional symptoms Primarily at Tier 1 and Tier 2 Student and teacher satisfaction (social validity) http://strongkids.uoregon.edu/

46. Strong Start effects on teacher ratings of 26 second grade students internalizing symptoms & peer-related social skills Caldarella, P., Christensen, L., Kramer, T. J., & Kronmiller, K. (2009). The effects of Strong Start on second grade students’ emotional and social competence. Early Childhood Education Journal, 37, 51 – 56.

47. Strong Kids effects on teacher ratings of 22 at-risk elementary school students internalizing symptoms Marchant, M., Brown, M., Caldarella, P., & Young, E. (2010). Effects of Strong Kids curriculum on students at risk for internalizing disorders: A pilot study. Journal of Empirically Based Practices in Schools, 11(2), 123-143.

48. Strong Start Pre-K effects on teacher ratings of 52 preschool school students Gunter, L., Caldarella, P., Korth, B.B., Young, K. R. (2012). Promoting social and emotional learning in preschool students: A study of Strong Start Pre-K. Early Childhood Education Journal, 40 (3), 151-159.

49. Strong Start/Kids effects on teacher ratings of internalizing symptoms & social skills at treatment school (n = 348) vs. control school (n = 266) Kramer, T. (2013). Evaluating the effects of a social and emotional learning curriculum, Strong Kids, administered school-wide (Unpublished doctoral dissertation). Brigham Young University, Provo, Utah.

50. Strong Start/Kids effects on teacher ratings of at-risk (n = 48) and non- at-risk students (n = 300) internalizing symptoms & social skills Kramer, T. (2013). Evaluating the effects of a social and emotional learning curriculum, Strong Kids, administered school-wide (Unpublished doctoral dissertation). Brigham Young University, Provo, Utah.

51. Treatment Fidelity & Social Validity Teachers have been able to implement Strong Kids with fidelity –Most common areas missed: review of previous week’s lesson and wrap-ups Teachers, students, parents valued goals, procedures, and outcomes –Lesson length a bit long for younger students –More supplementary materials needed, particularly for Strong Start

52. Positive Teacher Comments “The strength of the curriculum was in providing students a way to talk about their issues using a common language” “Students seem to be doing better at inviting other people to play and joining in activities” “SEL is definitely necessary, since often the kids are coming to us in pieces, and they can’t focus.” “I had one boy...and he was really at risk and had behavior issues, but he really just thrived during the lessons and he was totally engaged in them. We would read a book and he would say, “I need that book. That’s me in that book!” “…we spend a lot of time teaching the students academics but we know for our students at this school the most helpful thing for them is emotional help…when you help them emotionally you’re empowering them for the rest of their lives. And seeing them use the things we have taught is very rewarding.”

53. Critical Teacher Comments “I would want more supplemental material. I would love to have photographs of people showing the emotions. The book had black and white pictures that were real, but they were small.” “More games and activities (in the manual) for the students, since this is supposed to be something that we don’t have to plan for very much.” “If there was a packet that came with it that had supplements with things to do I would be more inclined to go through the section. “(The lessons) were a little too long.” “I thought the (students’) attention span was the hardest thing... I think once I became more familiar with the format of it I got a little more comfortable shortening it to their attention span.”

54. Study in Residential Treatment Center Evaluate effectiveness of Strong Teens with adolescent girls One previous study in RTC (Isava, 2006) with mixed results omitted two of the lessons taught over the course of 5-weeks instead of 12 small sample In current study, Strong Teens administered to approximately 50 adolescent girls during weekly group therapy Wait-list control group design Data-analysis underway

55. Study in EBD classroom One study of Strong Kids implemented in a special education self-contained classroom 21 third thru fifth graders with EBD Results showed improvements in students’ emotional knowledge and self report, but no significant effects on teacher ratings Teachers planned to continue using Strong Kids More research with this population is needed Nakayama, N. J. (2008). An investigation of the impact of the Strong Kids curriculum on social-emotional knowledge and symptoms of elementary aged students in a self-contained special education setting. Unpublished doctoral dissertation, University of Oregon, Eugene.

56. Using Strong Kids: Getting Started Materials ready (paper, posters, transparencies, overhead projector) Familiarize yourself with the lesson, prepare for transitions and lesson length Incorporate classroom rules Reinforce appropriate participation Consider seating arrangements (desks, tables, etc.)

57. Additional Suggestions Consider a team approach to leading a Strong Kids group or for school-wide implementation: teachers, counselors, psychologists, etc. Use pre-post tests (knowledge & symptoms) to document effectiveness (with parent consent) Review Tips for Transfer Training at end of each lesson, for maintenance and generalization

58. Recommendations at Tier 3 Frequent reinforcement Consider small groups for activities Immediate feedback on written activities Incorporate school-wide behavior supports Allow opportunities to practice skills Break up lessons Use relevant, realistic examples specific to group Supplement and reinforce lessons throughout week Allow students to “show off” skills learned Shorten scripts when lengthy

59. paul_caldarella@byu.edu leslie_gunter@byu.edu http://education.byu.edu/pbsi/