1. Counseling Techniques for School Psychologists Delivering RtI Interventions NASP Conference, Chicago, IL: March 3rd 2010
Diana Joyce, Ph.D. NCSP Douglas Jones, B.A Angela Dobbins, M.Ed.
University of Florida
Hyatt-Crystal Ballroom, 280 Capacity, Wed March 3rd, 9:30-10:30am
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2. RtI Tiered Behavioral Interventions Counseling Applications
Tier I
Universal – All Students
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)
Tier II
Supplemental, Targeted, Short-Term
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
Tier I: Focus on PREVENTION
SOS = Signs of Suicide program
SSIS = Social Skills Improvement System Rating Scales, 2008, Gresham & Elliott
BESS = Behavioral and Emotional Screening System, 2007, Kamphaus & Reynolds
Behavior Plans & Counseling Therapy: Individualized, greater frequency
and intensity, often addressing multiple issues simultaneously
Multi-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
Tier III
Intensive, Individual, Long-Term

3. Internalizing Externalizing
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
(Kendall & Hedtke, 2006)

4. 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

5. Basic Protocol Formats
First Session
Intro, Rapport-Building, Confidentiality, Rules
Core Sessions Targeted Skills Curriculum
Last Session, Closure
Booster or Follow-up

6. Progress Monitoring Data Sources (Pre/Post/Weekly)
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

7. Solution-Focused Brief Therapy (SFBT)
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
(Sklare, 2005)

8. 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 happened
What would you be doing?
(Sklare, 2005)

9. SFBT Cont’d Miracle = Areas needing remediating
First sign of miracle = guides goal development
Discussed when the “miracle” has occurred
Builds positive thinking and reflection on when the student made behavioral changes
(Sklare, 2005)

10. SFBT Cont’d Scaling Questions: Coping 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?”
(Sklare, 2005)

11. Progress Monitoring Data

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

13. Social Skills Protocol: Select Skill Deficits for Core Sessions
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)

14. Second-Step Program Unit I: Empathy Training
Focus on building feeling vocabulary
Identifying physical and situational cues
Unit II: Emotion Management
Focus on three strategies:
Self-coaching (“Stay Calm”)
Deep (Belly) Breathing,
Cognitive Distractions (Counting)
Steps in the problem solving approach:
How do I feel?
What is the problem?
What can I do?

15. Second-Step Program 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

16. Case Example 3 Kindergarten Males Identified Referral Concerns:
Impulsive
Inattentive
Oppositional
Pre-intervention Data
BASC-2 Behavioral and Emotional Screening System (BESS) Parent Rating Scales
Teacher Interviews

17. Case Example Group Focus: Weekly, 30 Minute Sessions Empathy Training
Impulse Control
Problem-Solving
Weekly, 30 Minute Sessions

18. Case Example Progress Monitoring Data: Calming Strategies
During imaginal exposure, each of the students can identify and correctly use belly breathing as a strategy at the end of the intervention, but Student 1 is able to identify an additional way to calm himself (counting backwards).
Qualitative data: student 1 has shown growth in his ability to wait his turn and adjust when things are not going his way ( no more tantrums). Has the ability to apply self-calming strategies during real life situations and can assist others in doing these. (Deep breathing and counting). Making gains, but still could benefit from more sessions in order to promote generalization across settings.
Student 2 has shown limited growth in regulation of behaviors. Concerns with influencing/distracting other group members. Student 2 often causes Student 3 to loose focus during the sessions. Teacher reports seeing limited improvement for this student. Can identify deep breathing as a strategy, but does not actively use it during situations. Make gains, but could benefit from higher level of service.
Student 3 has shown moderate growth in using cues to identify feelings of others and himself, but still lacks the generalization of skills from imaginal exposure to classroom. Has ability to identify deep breathing as a strategy, but does not generalize from imaginal/role play to real situations. Teacher reports social skills/ peer interactions have shown positive improvements. Make gain, but needs higher level of service.

19. Main CBT Components Relaxation Training Cognitive Strategies
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

20. CBT for Childhood OCD

21. Anxiety-Reductive Compulsive Disorders
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

22. The Obsessive-Compulsive Cycle
Obsessions
Fear/Anxiety
Reduction in
Distress
Compulsions
Negative Reinforcement
(Piacentini et al, 2006) 22

23. Ritual Cycle SUDS = Subjective Units of Distress (0-100) S U D
Storch, 2006 23

24. CBT Treatment Strategies
Psychoeducation
Conceptualization of OCD
Rationale for Treatment
Creation of Symptom Hierarchy
Exposure plus Response Prevention
Addressing Obsessions
Contingency Management
if the child has an urge to perform a compulsion, the child would be prompted to recognize
that those urges are the ‘‘OCD talking.’’
‘‘Leave me alone OCD’’ or ‘‘I am not going to let OCD control my life’’
(Piacentini et al, 2006)

25. Symptom Hierarchy Step SUDS 10. Bathing with toilet water 10
9. Putting hand in public toilet w/o washing – 1 day 9
8. Flushing public toilet w/o washing – 12 hr 8
7. Flushing public toilet w/o washing – 30 min 7
6. Standing near urinal w/o washing 6
5. Flushing home toilet w/o washing 5
4. Touching public sink w/o washing
3. Touching sink in house w/o washing 4
2. Touching floor w/o washing 3
1. Touching doorknob w/o washing 2
Storch, 2006 25

26. OCD Thermometer
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

27. Exposure and Response Prevention
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)
if the child has an urge to perform a compulsion, the child would be prompted to recognize
that those urges are the ‘‘OCD talking.’’
‘‘Leave me alone OCD’’ or ‘‘I am not going to let OCD control my life’’

28. Relevance of ERP in the schools
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,

29. Case Example 10 yr-old male Referral concerns: Frustration
Learning Disorder
ADHD
Autism Spectrum Disorder
OCD
Referral concerns:
Frustration
Compulsive Behaviors
Touching / Retouching
Cloth Picking

30. Case Example Weekly CBT Sessions Coping Strategies Role Plays
Frustration Exposures
ERP for OCD symptoms
Graduated Exposures
Behavioral Management
Compliance Training
Contingency Reinforcement

31. Touching Exposures

32. Questions? ? ? ? ? ?

33. Resources: CBT Manuals CBT Free Online Treatment Manuals
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,
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.

34. Resources Counseling Interventions & Curricula
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,
On-Line Graphing Resources
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,
Second Step Prevention Curriculum, Committee for Children
Skill Streaming, A. Goldstein & E. McGinnis, Prosocial Skills, Stress Coping, Friendship Building, Sharing

35. References
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,
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,
Storch, E. A.(2006). Treatment of a patient with Obsessive-Compulsive Disorder. Journal of Family Practice, 55,