Presentation on theme: "Contributors: Maria Wojtalewicz, Ph.D., NCSP, Lindsey Tropf, B.A.,"— Presentation transcript:
1 Contributors: Maria Wojtalewicz, Ph.D., NCSP, Lindsey Tropf, B.A., Counseling Skills for School Psychologists Delivering Tier II-III RtI Interventions NASP Conference, San Francisco, CA; February, 22, 2011University of FloridaDiana Joyce, Ph.D. NCSP Stacey Rice, M.A.Michelle Portell Angela Dobbins, M.Ed. pore uContributors: Maria Wojtalewicz, Ph.D., NCSP, Lindsey Tropf, B.A.,Presentation Materials and the Sample Report are Available atCase examples have been altered to mask student identity and for educational purposes.Hilton San Francisco Union Square, Tuesday, Feb 22nd, 2011, Continental 2 (Ballroom Level, Tower 3), Capacity 100, 10am-11:50amABSTRACTThis presentation will review entry-level Tier II-III counseling skills for providing RTI interventions. Three methods; psychoeducational, cognitive-behavioral therapy, and solution-focused will be reviewed. Applications for small group and individual counseling will address anger management, problem-solving, anxiety, and social skills. The format emphases practical applications with sequential steps in designing sessions and measuring outcomes. Resources will include curricula, session activities, progress monitoring options, and sample reports.Diana Joyce Dr. Diana Joyce is a faculty member of the NASP approved and APA accredited School Psychology Program at the University of Florida. She has taught numerous graduate courses including developmental psychopathology, social-emotional assessment, consultation, cognitive assessment, and learning disabilities assessment. As a dual licensed psychologist and school psychologist, she administers the practica program and supervises 40+ graduate students per year in four county school systems and nine clinical sites. Clinical sites include a child morbid obesity clinic, an adolescence diabetes treatment compliance clinic, a hospital psychiatric unit, a juvenile residential treatment facility, a behavioral health center, a university ADA office for college students with disabilities, and a child forensics law clinic. Her research interests include professional development issues and behavioral/conduct disorders. Her publications include one book, seven chapters and numerous peer-referred articles. Over the past few years, as co-principal investigator she has been awarded approximately $830,000 in professional development grants to research training models for Response-to-Intervention (RtI). Her national service includes; program reviewer for the National Association of School Psychologists and site accreditation reviewer for the American Psychological Association.Stacey Rice Stacy is an advanced doctoral student with the University of Florida School Psychology program. She holds a master’s in child advocacy as well as certifications in suicide prevention, trauma response, and Baker Act training. She has provided both clinic outpatient and school-based CBT therapy for children and youth.Michelle Portell Michelle is a school psychologist pursuing her doctorate with a primary focus on school-based service delivery.Angela Dobbins is an Advanced Doctoral student in the School Psychology program at the University of Florida. She obtained her M.Ed. in Developmental Counseling from Vanderbilt University, as well as a B.A. in Psychology. Angela is a National Certified Counselor (NCC) and has provided counseling services in various settings (e.g. schools, substance abuse facilities, and medical clinics).
2 Overview Beginning 101 – Forming Counseling Groups Three Methods Psychoeducational, CBT, Solution-FocusedScreening/Progress Monitoring Strategies
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 (c)(2)Counseling services means services provided by qualified social workers, psychologists, guidance counselors, or other qualified personnel.
4 NASP Counseling Workshops Solution-Focused Group Counseling, Leslie Cooley, Friday 2:00-3:50pm, MS064Cognitive-Behavioral Interventions for Students With Obsessive-Compulsive Disorder; Doug Jones, Thursday, 12:00-1:50pm, MS163Treating Obsessive Compulsive Disorder With Exposure Response Prevention, Robert Wingfield, Friday, 9:30-11:00am, PO253Counseling Techniques to Promote Social Competency, Laurie Harrier, Thurs 8:00-9:50am, MS192Child Abuse and Neglect School Based Prevention, Intervention, and Counseling, Amy Patenaude, Wed 2:30-4:20, MS067School-Based Group Counseling for Autism Spectrum Disorders, Julie Herbstrith, Thurs 4:00-5:50pm, MS154
5 Effective Tier II-III Counseling Precursors Tier I Social-emotional SupportsPBS: e.g., clear expectations, schedules posted, recognition for appropriate behaviorsClassroom management (e.g., Kagan Structures, Responsive Teaching)Embedded Social Curriculum (e.g., Second Step, FLPBS website)
6 Social-Emotional Benchmarks Florida - http://www. fldoe Social-Emotional Benchmarks Florida - National – Early Childhood - (with videos)K-34-5Self-ManagementPersonal Safety/SpaceAppropriate Task BehaviorInterpersonal SkillsAwareness How to Express FeelingsAwareness How to Work in GroupRespect/DiversityAwareness Different CulturesAwareness of Stereotype and Negative ImpactSelf-ManagementEffective Study HabitsEffective Time ManagementInterpersonal SkillsSelf-Identify Appropriate Ways to Express FeelingsWell Developed Skills in Group Collaborative WorkRespect/DiversityKnowledge and Appreciation of Different CulturesRecognition of One’s Own Bias, Self-correction
7 Tier II – III Counseling Intervention Features (Batsche et al., 2005, Griffiths et al., 2007)Tier II SupplementalShort-termMay use protocol (e.g., social skills training, problem-solving curricula)Often small groupTier III IntensiveIndividualizedIncreased frequency and/or durationIdentify support networkMulti-faceted servicesMulti-agency - Coordinate w/outside service providers (e.g., physicians, psychiatrists)
8 Sample Counseling Groups Grade KCounseling Skill Targets & CurriculaTier IIInternalizing: gives up easy, often seeks help, socially awkward, whines, poutsSkill Building: self-initiation, prosocial peer communication, appropriate expression of needsTools: 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 vocabularyExternalizing: poor impulse control, self-regulation, low frustration toleranceSkill 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 IIIExternalizing: Angry outbursts, inappropriate touching, gross body noisesSkill Building: self-regulation, boundaries, social etiquetteTools: anger management curricula, personal space respect rules, grossology book
9 Creating Counseling Groups Begin by sorting students according to their needsSmaller groups for similar short term (yellow)Individuals for intensive, longer term (red)Pictures of teachers sorting data at Knights elementary – consent to share photo from Marissa CasamassinoPhotos courtesy of Marissa Casamassino, Kimbell Elementary
10 School-wide Data RoomThe next few slides illustrate several different kinds of data wallsPhoto courtesy of Marissa Casamassino, Kimbell Elementary
11 Photo courtesy of Marissa Casamassino, Kimbell Elementary Data Wall SamplePhoto courtesy of Marissa Casamassino, Kimbell Elementary
12 Three Counseling Approaches PsychoeducationalEasy to implement! Addresses skill acquisition and performance deficits (e.g., social/friendships skills, boundaries)CBTAddresses the thinking, feeling, and behavior relationship. Strong evidence for anxiety and depression, anger management, grief management.Solution-FocusedCentered around personal goals to address conflicts
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?There is a sample letter in the supplemental handouts file.
14 First Session – Introduction and Rapport Building Member IntroductionIce BreakersGroup Title and GoalsConfidentialityGround RulesIntroduce Format (e.g. 30 min weekly)
15 Insight and Awareness Emotional vocabulary Identify physiological “triggers”Monitoring and using competing responsesListening skills(Nelson III et al., 2006)
17 Feeling Wheel (Words – Iconic) Adapt by Age, Students Can Help Make this Wheel HappyMadSadJoyShyFriendlyActivity – For young children, let them help make wheel from magazine pictures, for older students take digital photos of the group to use.SillyBored1717
18 Social Skills Protocol: Psychoeducational Approaches Teach & Model Skill (Knowledge Deficit)Role Play w/Feedback (Performance Deficit)Practice-Practice (Fluency Deficit)ReviewGeneralization(NASP, 2004)
19 Lesson Example Goal: Outcomes: Warm-up activity: Review: Teaching (modeling):Main Activity:Discussion and Summary:Homework:
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)(NASP, 2004)
21 Diving in Deeper Ready for CBT NSLB (No School Psychologist Left Behind)Diving in DeeperReady for CBT
22 CBT In Schools (Phillip Kendall) Temple University Child and Adolescent Anxiety Clinic 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.CHILDRENKendall, P. C. & Hedtke, K. (2002). The coping cat workbook (2nd ed). Ardmore, PA: Workbook Publishing.Kendall, P. C. & Hedtke, K. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual (3rd ed). Ardmore, PA: Workbook Publishing.Depression – Impulse ControlKendall, P. C. (2007). Cognitive-behavioral therapy for impulsive children: Therapist manual (3rd 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.
24 CBT Protocol Thoughts, Feelings, and Actions The Magic CircleWhat were you doing?What were you Thinking?Think about something you did that you really enjoyed. Write or draw in the circleselementary example of a Thoughts Bubble activityExample: Thinking that no one likes you makes you feel sad-which may make you stay at homeLearning to break the cycleHow did you feel?(Stallard, 2002)
25 Think Good – Feel Good Younger Students What I DoThe Negative TrapWhat I ThinkWhat I Feelelementary example of the Negative Trap exercise. Mention that with younger children need to incorporate more drawings, diagrams, and manipulative, hands-on activities to reinforce concepts. These must be adapted for older students (i.e., more sophisticated).-CBT should be adapted to be more concrete with younger children, and can be more abstract with older children and adolescents(Stallard, 2002)
26 If – Then Brain Teaser Example CBT Exercise for Older Students IF I make a mistake THEN IF I feel hurt THEN IF I am mad THEN IF I let people down THENadolescent example of If/Then thinking and catastrophizing-Explain the difference between CBT with elementary age/adolescent age (developmental and higher order thinking)(Stallard, 2002)
27 Think Good Feel Good Tracking your thoughts Helps identify automatic thoughts and when they happen“Hot” thoughtsWhat were you thinking when you started feeing this way?What did you think was going to happen?How did you think it would end?
28 Main CBT components Relaxation training Cognitive strategies Diaphragmatic (deep) breathingProgressive muscle relaxation (PMR)Cognitive strategiesReducing negative self-talkChallenging unrealistic and dysfunctional thoughtsConsidering different perspectivesBehavior strategiesBehavioral exposuresSuccessive approximationProblem-solving techniques(Kendall & Hedtke, 2006)
29 CBT Protocol Relaxation Training Deep BreathingBreathe from the stomach rather than from the lungsTeach students to breathe in slowly through the nose, and out through the mouthChildren should breathe in to the count of 5, and out to the count of 5
30 CBT Protocol Relaxation Training Progressive Muscle RelaxationTension AwarenessTense Muscles to the Count of Five then Relax to the Count of FiveIdentify areas of tensionModeling the ExerciseThere is a relaxation script in the supplemental handouts file
31 Changing perspectives: What is he thinking? Oh no!! I’m going to break my ankle!!!This is fun!!! I love skateboarding!
32 Changing perspectives: What are you thinking? Oh no!!Another RtI PyramidThis is fun!!!I’m LearningTier II – IIICounselingTechniques
33 Cognitive Therapy: 1) What’s 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?
34 Changing Perspectives Create ambiguous scenariosBe creative!Use magazine cutoutsWatch TV and guess what characters are thinkingReinforce the opposite of what seems most obvious
35 Behavioral Exposures Habituation Experience before explanation Different typesImaginalIn vivo “in life”Sense of mastery/accomplishment
36 Case Study-Sophia17 year old female with Obsessive Compulsive Disorder (OCD)Contamination issues and obsessive fears of disappointing peopleOften had distressing cognitive distortions such as “I’m stupid” “I’m going to disappoint everyone”Imaginal exposures, as well as in vivo exposures completed to habituate anxietyThere is a CBT sample report in the supplemental handouts file.
37 Case Study-Sophia Skills Hierarchy SUDS Level (1-10) Holding sticky core of an air freshener3Touching a sticky substance (syrup)5Raising hand when not completely sure of an answerRaising hand more than twice in a row during class6Turning in a paper that’s not “perfect”7Purposely asking for feedback or constructive criticism from a teacher8Working on a group project and not taking the “leader” rolePurposely answering a question incorrectly during class9
38 Case Study-Sophia Tracked obsessions and compulsions with a daily log Addressed cognitive distortions by looking at worst case scenariosExercise: How likely is this situation to happen? (percentage)
39 Successive Approximation Reward what you want to seeWork on one thing at a timeStep by stepKeep the long-term goal in mindKeep it fun
40 Problem Solving Define the problem List possible solutions What is the problem?List possible solutionsWhat are all the things I could do about it?What will happen if I do those things?List possibilitiesWhat solution is best?What happened when I tried it, how did I do?
41 What if ? The basics if a student is suicidal Be aware of your school’s crisis plan/protocol for suicidal students!Keep this plan in mind when counseling any student that may be suicidalThis should include a protocol for who to contact (at minimum-the student’s parents/guardian, and the administration)Always have community crisis resources on handCrisis hotlines, mobile crisis units, facilities handling students in crisis
42 What if ? The basics if a student is suicidal Assess immediate threat of harmAssess other risk factorsContact administration/parents of studentIf threat is imminent-contact police/mental health facilities (with parents and/or student if possible)
43 Solution-focused Brief Therapy Reaching for the Goal
44 Solution-Focused Counseling in Schools (Sklare, 2005) Sklare, G. B. (2005). Brief counseling that works: A solution-focused approach for school counselors and administrators . Thousand Oaks, CA: Corwin Press.
45 Solution-Focused Brief Therapy (SFBT) Focus on what want to achieve (not past)Focus how to obtain goalPositive stated goals, measurableThere is a sample case report for solution-focused therapy in the supplemental handouts file.(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 1st sign miracle occurred?What would be different?3. If we videotaped you after the miracle happenedWhat would you be doing?(Sklare, 2005)
47 SFBT Cont’d Miracle = Areas needing remediating First sign of miracle = guides goal developmentDiscussed when the “miracle” has occurredBuilds positive thinking and reflection on when the student made behavioral changes
48 SFBT Cont’d Scaling Questions: Coping Questions: Rate progress of goals on Likert scaleUse scaling as discussion pointWhen 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?”
49 Progress Monitoring How to Show Positive Outcomes
50 Best Practices in Behavioral Progress Monitoring Critical Features (Chafouleas, Volpe, Gresham & Cook, 2010; Christ, Riley-Tillman & Chafouleas, 2009)Defensible evidence of validity for interpretationFlexibility across situationsEfficiency (reasonable, flexible)Repeatability (time series data)Progress Monitoring DevelopmentTreatment 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 LimitationsBehavior/emotion is mood/state dependent thus less stableBenchmarks are not well-definedMore bound to the environmentSuccess is often extinguishing a behaviorRating Scales most CommonBASC-2 Progress Monitor (Externalizing & ADHD; Internalizing, Social Withdrawal; Adaptive Skills)Social Skills Improvement System
54 Progress MonitoringIdentifying feelings (e.g., sad, anxious, angry, etc.,)Normalize the experience of fears and anxietyAnxiety can be a good thing!Role-play feelingsMake a Feelings ThermometerVarious formats and purposes:(Subject Units of Distress Scale [SUDS])From very strong (10) to very weak (1)
59 Resources Easy Progress Monitoring Data Graphing On-Line Graphing Resources (ChartDog)Intervention IdeasTools for Educators
60 Resources for School Application CBT Manuals Free Manual https://trialweb.dcri.duke.edu/tads/manuals.htmlChorpita, 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 (3rd 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 (3rd ed). Ardmore, PA: Workbook Publishing.Kendall, P. C. & Hedtke, K. (2002). The coping cat workbook (2nd 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.
61 Resources for School Application Brief Solution-Focused Therapy Solution-Focused ManualsMetcalf, L. (2008). Counseling toward solutions: A practical solution-focused program for working with students, teachers, and parents (2nd 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.
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 TrainingI Can Problem Solve, Myrna Shure, Aggression, Emotionality, Withdrawal, RejectedIntervention Central, Jim Wright, ADHD, Bullying, DefianceLife 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 RejectionPeace 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, SharingUniversity of California at Los Angeles (2010). School-based mental health resources
63 ReferencesBatsche, 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),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,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,Fuchs, L. (2004). The past, present, and future of curriculum-based measurement research. School Psychology Review, 33,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),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.
64 ReferencesNational 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,