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Counseling Skills for School Psychologists Delivering Tier II-III RtI Interventions NASP Conference, San Francisco, CA; February, 22, 2011 University of.

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Presentation on theme: "Counseling Skills for School Psychologists Delivering Tier II-III RtI Interventions NASP Conference, San Francisco, CA; February, 22, 2011 University of."— Presentation transcript:

1 Counseling Skills for School Psychologists Delivering Tier II-III RtI Interventions NASP Conference, San Francisco, CA; February, 22, 2011 University of Florida Diana Joyce, Ph.D. NCSPStacey Rice, M.A. Michelle PortellAngela Dobbins, M.Ed. pore u Contributors: Maria Wojtalewicz, Ph.D., NCSP, Lindsey Tropf, B.A., Presentation Materials and the Sample Report are Available at Case examples have been altered to mask student identity and for educational purposes. 1

2 Overview Beginning 101 – Forming Counseling Groups Three Methods Psychoeducational, CBT, Solution-Focused Screening/Progress Monitoring Strategies 2

3 Counseling Competencies NASP Ethics Principle II.1. Competence (NASP 2010) To benefit clients, school psychologists engage only in practices for which they are qualified and competent. NASP Comprehensive Model School Psychological Services Domain 4 Have knowledge of biological, cultural, developmental, & social influences on behavior & mental health, behavioral & emotional impacts on learning & life skills, & evidence based strategies to promote social emotional functioning and mental health to provide interventions and mental health services to develop social and life skills. IDEIA Definition Part 300 A, Section 300.34 (c)(2) Counseling services means services provided by qualified social workers, psychologists, guidance counselors, or other qualified personnel. 3

4 NASP Counseling Workshops Solution-Focused Group Counseling, Leslie Cooley, Friday 2:00-3:50pm, MS064 Cognitive-Behavioral Interventions for Students With Obsessive-Compulsive Disorder; Doug Jones, Thursday, 12:00-1:50pm, MS163 Treating Obsessive Compulsive Disorder With Exposure Response Prevention, Robert Wingfield, Friday, 9:30-11:00am, PO253 Counseling Techniques to Promote Social Competency, Laurie Harrier, Thurs 8:00-9:50am, MS192 Child Abuse and Neglect School Based Prevention, Intervention, and Counseling, Amy Patenaude, Wed 2:30-4:20, MS067 School-Based Group Counseling for Autism Spectrum Disorders, Julie Herbstrith, Thurs 4:00-5:50pm, MS154 4

5 Effective Tier II-III Counseling Precursors Tier I Social-emotional Supports PBS: e.g., clear expectations, schedules posted, recognition for appropriate behaviors Classroom management (e.g., Kagan Structures, Responsive Teaching) Embedded Social Curriculum (e.g., Second Step, FLPBS website) 5

6 Social-Emotional Benchmarks Florida - National – Early Childhood - (with videos) K-3 Self-Management Personal Safety/Space Appropriate Task Behavior Interpersonal Skills Awareness How to Express Feelings Awareness How to Work in Group Respect/Diversity Awareness Different Cultures Awareness of Stereotype and Negative Impact 4-5 Self-Management Effective Study Habits Effective Time Management Interpersonal Skills Self-Identify Appropriate Ways to Express Feelings Well Developed Skills in Group Collaborative Work Respect/Diversity Knowledge and Appreciation of Different Cultures Recognition of Ones Own Bias, Self-correction 6

7 Tier II – III Counseling Intervention Features Tier II Supplemental Short-term May use protocol (e.g., social skills training, problem-solving curricula) Often small group Tier III Intensive Individualized Increased frequency and/or duration Identify support network Multi-faceted services Multi-agency - Coordinate w/outside service providers (e.g., physicians, psychiatrists) 7 (Batsche et al., 2005, Griffiths et al., 2007)

8 Sample Counseling Groups Grade K Counseling Skill Targets & Curricula Tier II Internalizing: gives up easy, often seeks help, socially awkward, whines, pouts Skill Building: self-initiation, prosocial peer communication, appropriate expression of needs Tools: problem-solving curriculum, social skills curriculum (e.g., how to enter a conversation, join a group, reciprocity), and teach I statements with a feeling words vocabulary Tier II Externalizing: poor impulse control, self-regulation, low frustration tolerance Skill Building: pause to think before acting, self-awareness/monitoring, Tools: stop & think strategies, teacher cueing/prompting to self-check w/iconic representation, self-calming techniques (e.g., deep breathing, turtle) Tier III Externalizing: Angry outbursts, inappropriate touching, gross body noises Skill Building: self-regulation, boundaries, social etiquette Tools: anger management curricula, personal space respect rules, grossology book 8

9 Creating Counseling Groups Begin by sorting students according to their needs Smaller groups for similar short term (yellow) Individuals for intensive, longer term (red) Photos courtesy of Marissa Casamassino, Kimbell Elementary

10 School-wide Data Room 10 Photo courtesy of Marissa Casamassino, Kimbell Elementary

11 Data Wall Sample Photo courtesy of Marissa Casamassino, Kimbell Elementary

12 Three Counseling Approaches Psychoeducational Easy to implement! Addresses skill acquisition and performance deficits (e.g., social/friendships skills, boundaries) CBT Addresses the thinking, feeling, and behavior relationship. Strong evidence for anxiety and depression, anger management, grief management. Solution-Focused Centered around personal goals to address conflicts 12

13 Basic Considerations: Forming a Group – Pre-Planning What are the objectives? Which students will I include? Models, Circle of Friends? Size of group? How often will we meet? How long? Where? Materials, cost? Booster sessions? Communicate with parents, teachers? Some students are not successful in group settings (e.g., bullies). What counseling method? 13

14 First Session – Introduction and Rapport Building Member Introduction Ice Breakers Group Title and Goals Confidentiality Ground Rules Introduce Format (e.g. 30 min weekly) 14

15 Insight and Awareness Emotional vocabulary Identify physiological triggers Monitoring and using competing responses Listening skills (Nelson III et al., 2006) 15

16 Feeling Vocabulary 16 MAD?SAD? UpsetMischievous - SillyDisappointedApprehensive - Worried FrustratedSmug - BetterUpsetConfused - Puzzled DisgustedDisoriented - ShockedWoundedAshamed - Embarrassed AngryJealous - EnvyHurtAbandoned - Alone EnragedSuspicious - DistrustHelplessRemorseful - Guilty FuriousBetrayed - HarmedHopelessOverwhelmed - Frozen Happy – Confident, Hopeful, Excited, Love-Struck, Exhilarated, Ecstatic, Serene

17 Feeling Wheel (Words – Iconic) Adapt by Age, Students Can Help Make this Wheel Mad Sad Bored Shy Silly Friendly Joy Happy 17

18 Social Skills Protocol: Psychoeducational Approaches Teach & Model Skill (Knowledge Deficit) Role Play w/Feedback (Performance Deficit) Practice-Practice (Fluency Deficit) Review Generalization 18 (NASP, 2004)

19 Lesson Example Goal: Outcomes: Warm-up activity: Review: Teaching (modeling): Main Activity: Discussion and Summary: Homework: 19

20 Social Skills Protocol: Select Skill Deficits for Core Sessions (Skillstreaming, Goldstein 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) 20 (NASP, 2004)

21 21 Diving in Deeper Ready for CBT NSLB (No School Psychologist Left Behind)

22 CBT In Schools (Phillip Kendall) Temple University Child and Adolescent Anxiety Clinic 22

23 Thoughts/ Interpretations Feelings Behavior Thoughts predict feelings which predict behavior. Cognitive-Behavioral Therapy (CBT) (Christner, Forrest, Morley, & Weinstein, 2007; Kendall & Hedtke, 2006) 23

24 CBT Protocol Thoughts, Feelings, and Actions The Magic Circle What were you Thinking? What were you doing? How did you feel? Think about something you did that you really enjoyed. Write or draw in the circles (Stallard, 2002) 24

25 Think Good – Feel Good Younger Students The Negative Trap What I Think What I Do What I Feel (Stallard, 2002) 25

26 If – Then Brain Teaser Example CBT Exercise for Older Students IFI make a mistakeTHEN IFI feel hurtTHEN IFI am madTHEN IFI let people downTHEN (Stallard, 2002) 26

27 Think Good Feel Good Tracking your thoughts Helps identify automatic thoughts and when they happen Hot thoughts What were you thinking when you started feeing this way? What did you think was going to happen? How did you think it would end? 27

28 Main CBT components 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 28 (Kendall & Hedtke, 2006)

29 CBT Protocol Relaxation Training Deep Breathing Breathe from the stomach rather than from the lungs Teach students to breathe in slowly through the nose, and out through the mouth Children should breathe in to the count of 5, and out to the count of 5 29

30 CBT Protocol Relaxation Training Progressive Muscle Relaxation Tension Awareness Tense Muscles to the Count of Five then Relax to the Count of Five Identify areas of tension Modeling the Exercise 30

31 Changing perspectives: What is he thinking? Oh no!! Im going to break my ankle!!! This is fun!!! I love skateboarding! 31

32 Changing perspectives: What are you thinking? Oh no!! Another RtI Pyramid This is fun!!! Im Learning Tier II – III Counseling Techniques 32

33 Cognitive Therapy: 1) Whats the evidence for that belief? 2) What are the advantages/ disadvantages of believing X? 3) What does believing X do for you? 4) Are there other ways of viewing the situation? 33

34 Changing Perspectives Create ambiguous scenarios Be creative! Use magazine cutouts Watch TV and guess what characters are thinking Reinforce the opposite of what seems most obvious 34

35 Behavioral Exposures Habituation Experience before explanation Different types Imaginal In vivo in life Sense of mastery/accomplishment 35

36 Case Study-Sophia 17 year old female with Obsessive Compulsive Disorder (OCD) Contamination issues and obsessive fears of disappointing people Often had distressing cognitive distortions such as Im stupid Im going to disappoint everyone Imaginal exposures, as well as in vivo exposures completed to habituate anxiety 36

37 Case Study-Sophia Skills HierarchySUDS Level (1-10) Holding sticky core of an air freshener3 Touching a sticky substance (syrup)5 Raising hand when not completely sure of an answer 5 Raising hand more than twice in a row during class 6 Turning in a paper thats not perfect7 Purposely asking for feedback or constructive criticism from a teacher 8 Working on a group project and not taking the leader role 8 Purposely answering a question incorrectly during class 9

38 Case Study-Sophia Tracked obsessions and compulsions with a daily log Addressed cognitive distortions by looking at worst case scenarios Exercise: How likely is this situation to happen? (percentage) 38

39 Successive Approximation Reward what you want to see Work on one thing at a time Step by step Keep the long-term goal in mind Keep it fun 39

40 Problem Solving Define the problem What is the problem? List possible solutions What are all the things I could do about it? What will happen if I do those things? List possibilities What solution is best? What happened when I tried it, how did I do? 40

41 What if ? The basics if a student is suicidal Be aware of your schools crisis plan/protocol for suicidal students! Keep this plan in mind when counseling any student that may be suicidal This should include a protocol for who to contact (at minimum-the students parents/guardian, and the administration) Always have community crisis resources on hand Crisis hotlines, mobile crisis units, facilities handling students in crisis

42 What if ? The basics if a student is suicidal Assess immediate threat of harm Assess other risk factors Contact administration/parents of student If threat is imminent-contact police/mental health facilities (with parents and/or student if possible)

43 43 Solution-focused Brief Therapy Reaching for the Goal

44 Solution-Focused Counseling in Schools (Sklare, 2005) 44

45 Solution-Focused Brief Therapy (SFBT) Focus on what want to achieve (not past) Focus how to obtain goal Positive stated goals, measurable 45 (Sklare, 2005)

46 Solution Focused Brief Therapy (SFBT) 1. Miracle Question: If you woke up & miracle happened, all of your problems were fixed… 2. What is 1 st sign miracle occurred? What would be different? 3. If we videotaped you after the miracle happened What would you be doing? 46 (Sklare, 2005)

47 SFBT Contd 1. Miracle = Areas needing remediating 2. First sign of miracle = guides goal development 3. Discussed when the miracle has occurred Builds positive thinking and reflection on when the student made behavioral changes 47

48 SFBT Contd 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? 48

49 Progress Monitoring How to Show Positive Outcomes 49

50 Best Practices in Behavioral Progress Monitoring 50 Critical Features (Chafouleas, Volpe, Gresham & Cook, 2010; Christ, Riley-Tillman & Chafouleas, 2009) Defensible evidence of validity for interpretation Flexibility across situations Efficiency (reasonable, flexible) Repeatability (time series data) Progress Monitoring Development Treatment sensitive measures from comprehensive scales (Gresham et al., 2010) Three stages: Yield static score, level/trend feature, instructional utility (Fuchs, 2004)

51 Progress Monitoring Options Limitations Behavior/emotion is mood/state dependent thus less stable Benchmarks are not well-defined More bound to the environment Success is often extinguishing a behavior Rating Scales most Common BASC-2 Progress Monitor (Externalizing & ADHD; Internalizing, Social Withdrawal; Adaptive Skills) Social Skills Improvement System 51

52 Pre-Planning: Progress Monitoring Data Sources (Pre/Post/Weekly) Records Data Discipline Referral Rates Absence/Tardy Rates Improved Grades Classroom Data Behavioral Observations FBA Data Work Completion Rates Daily Behavior Report Cards Teacher Rating Scales Single Subject Design Self-Report Data SUDS Knowledge Surveys Self-report rating scales Parent Data Parent ratings Parent behavior plan log 52

53 53 Progress Monitoring Sample 1=Rarely, 2=Occasionally 3=Sometimes 4=Often 5=Always

54 Progress Monitoring Identifying feelings (e.g., sad, anxious, angry, etc.,) Normalize the experience of fears and anxiety Anxiety can be a good thing! Role-play feelings Make a Feelings Thermometer Various formats and purposes: (Subject Units of Distress Scale [SUDS]) From very strong (10) to very weak (1) 54

55 Progress Monitoring Sample SUDS (Storch, 2006) 41 Time

56 Progress Monitoring Samples Baseline Intervention Withdrawal Single Subject Design 56

57 Progress Monitoring Data 57 BaselineIntervention

58 DisorderEffective Interventions Internalizing AnxietyCBT, family anxiety management DepressionCBT, coping skills training, behavioral self-control therapy Fears/ PhobiasGraduated exposure, modeling, reinforced practice, In-vivo exposure, CBT, imaginal desensitization, self-calming techniques OCDCBT with exposure and response prevention Externalizing ADHDBehavior modification, reinforcement of other behaviors, organizers, parent training, medication ODD/CDBehavioral modification, anger management, CBT, REBT, time-out, problem-solving training, parent-child therapy, parent training (Kendall & Hedtke, 2006) 58

59 Resources Easy Progress Monitoring Data Graphing On-Line Graphing Resources (ChartDog) Intervention Ideas Tools for Educators 59

60 Resources for School Application CBT Manuals Free Manual Chorpita, B. F. (2007). Modular cognitive behavior therapy for childhood anxiety disorders. New York: Guilford Press. Kendall, P. C. (2007). Cognitive-behavioral therapy for impulsive children: Therapist manual (3 rd ed). Ardmore, PA: Workbook Publishing. Kendall, P. C., Choudhury, M. A., Hudson,J, & Webb, A. (2002). The C.A.T. project manual: For the cognitive behavioral treatment of anxious adolescents. Ardmore, PA: Workbook Publishing. Kendall, P. C., Choudhury, M. A., Hudson,J, & Webb, A. (2002). The C.A.T. project workbook: For the cognitive behavioral treatment of anxious adolescents. Ardmore, PA: Workbook Publishing. Kendall, P. & Hedtke, K. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual (3 rd ed). Ardmore, PA: Workbook Publishing. Kendall, P. C. & Hedtke, K. (2002). The coping cat workbook (2 nd ed). Ardmore, PA: Workbook Publishing. Stark, K., Kendall, P. C., McCarty, M., Stafford, M., Barron, R., & Thomeer, M. (1996). Taking action: A workbook for overcoming depression. Ardmore, PA: Workbook Publishing. Stallard, P. (2002). Think good- Feel good: A cognitive behavioral therapy workbook for children and young people. Hoboken, NJ: John Wiley & Sons. 60

61 Resources for School Application Brief Solution-Focused Therapy Solution-Focused Manuals Metcalf, L. (2008). Counseling toward solutions: A practical solution-focused program for working with students, teachers, and parents (2 nd ed.). Hoboken, NJ: Wiley. Metcalf, L. (2008). The field guide to counseling toward solutions: The solution-focused school. Hoboken, NJ: Wiley. Sklare, G. B. (2005). Brief counseling that works: A solution- focused approach for school counselors and administrators. Thousand Oaks, CA: Corwin Press. 61

62 Resources Counseling Interventions Websites ACHIEVE: A Collaborative School-based Reform Process, Howard Knoff, Social Skills, Conflict Resolution, Self Regulation, Positive School Climate, Aggression Replacement Training, Mark Amendola, Anger Control, Aggression, Moral Reasoning Training I Can Problem Solve, Myrna Shure, Aggression, Emotionality, Withdrawal, Rejected Intervention Central, Jim Wright, ADHD, Bullying, Defiance Life Skills Training, Gilbert Botvin, Self-esteem, Social Skills, Substance Abuse, Social Anxiety, Peer Pressure, PeaceBuilders, Michael Krupnick, Positive School Climate, Prosocial Behaviors, Conflict, Sibling Fighting, School Attachment, Peer Rejection Peace Education Foundation, Conflict Resolution Programs, Peer Mediation, Crisis Management, Primary Mental Health Project, Deborah Johnson, Mild Aggression, Withdrawal, Shyness, Anxious, Poor Classroom Adjustment, Skill Streaming, A. Goldstein & E. McGinnis, Prosocial Skills, Stress Coping, Friendship Building, Sharing University of California at Los Angeles (2010). School-based mental health resources 62

63 References Batsche, G. et al. (2005). Response to intervention: Policy considerations and implementation. Alexandra, VA: National Association of State Directors of Special Education. Chafouleas, S. M., Volpe, R. J., Gresham, F. M., & Cook, C. R. (2010). School-based behavioral assessment within problem-solving models: Current status and future directions. School Psychology Review, 39(3), 343-349. Christ, t. J., Riley-Tillman, T. C., & Chafouleas, S. M. (2009). Foundation for the development and us of direct behavior rating (DBR) to assess and evaluate student behavior. Assessment for Effective Intervention, 34, 2-1-213. 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. Fuchs, L. (2004). The past, present, and future of curriculum-based measurement research. School Psychology Review, 33, 188-192. Gresham, F. M., Cook, C. R., Collins, T., Rasethwane, K., et al., (2010). Developing a change-sensitive brief behavior rating scale as a progress monitoring tool for social behavior: An example using the Social Skills Rating System – Teacher Form. School Psychology Review, 39(3), 364-379. Griffiths, A., Parsons, L., Burns, M., VanDerHeyden, A. & Tilly, D. (2007). Response to intervention: Research for Practice. Alexandria, VA: National Association of State Directors of Special Education. 63

64 National Association of School Psychologists. (2004). Social skills: Building skills for success in school and life. Bethesda, MD: Author. 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. Sklare, G. B. (2005). Brief counseling that works: A solution-focused approach for school counselors and administrators. Thousand Oaks, CA: Corwin Press. Sprague, J. (2007). Response to intervention and positive behavioral support: Yes we get to do it here. Stallard, P. (2002). Think good- Feel good: A cognitive behavioral therapy workbook for children and young people. Hoboken, NJ: John Wiley & Sons. Storch, E. A.(2006). Treatment of a patient with Obsessive-Compulsive Disorder. Journal of Family Practice, 55, 329-333. 64 References

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