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Counseling Skills for School Psychologists Delivering Tier II-III RtI Interventions NASP Conference, San Francisco, CA; February, 22, 2011 PowerPoint PPT Presentation


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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 Florida Diana Joyce, Ph.D. NCSPStacey Rice, M.A. [email protected] [email protected]

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

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Counseling Skills for School Psychologists Delivering Tier II-III RtI InterventionsNASP Conference, San Francisco, CA; February, 22, 2011

University of Florida

Diana Joyce, Ph.D. NCSPStacey Rice, M.A.

[email protected] [email protected]

Michelle PortellAngela Dobbins, [email protected] pore [email protected] u [email protected]

Contributors: Maria Wojtalewicz, Ph.D., NCSP, Lindsey Tropf, B.A.,

Presentation Materials and the Sample Report are Available at http://www.nasponline.org/

Case examples have been altered to mask student identity and for educational purposes.


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Overview

  • Beginning 101 – Forming Counseling Groups

  • Three Methods

    • Psychoeducational, CBT, Solution-Focused

  • Screening/Progress Monitoring Strategies


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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) http://idea.ed.gov

    • Counseling services means services provided by qualified social workers, psychologists, guidance counselors, or other qualified personnel.


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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


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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)

http://flpbs.fmhi.usf.edu/teaching_lession_plans.asp


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Social-Emotional Benchmarks Florida - http://www.fldoe.org/workforce/pdf/guidance.pdfNational – http://ascamodel.timberlakepublishing.com/files/NationalStandards.pdfEarly Childhood - http://illinoisearlylearning.org/standards/socemodev.htm (with videos)

K-3

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 One’s Own Bias, Self-correction

  • 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


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Tier II – III Counseling Intervention Features

(Batsche et al., 2005, Griffiths et al., 2007)

  • 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)


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Sample Counseling Groups


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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


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School-wide Data Room

Photo courtesy of Marissa Casamassino, Kimbell Elementary


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Data Wall Sample

Photo courtesy of Marissa Casamassino, Kimbell Elementary


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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


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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?


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First Session – Introduction and Rapport Building

  • Member Introduction

  • Ice Breakers

  • Group Title and Goals

  • Confidentiality

  • Ground Rules

  • Introduce Format (e.g. 30 min weekly)


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Insight and Awareness

  • Emotional vocabulary

  • Identify physiological “triggers”

  • Monitoring and using competing responses

  • Listening skills

(Nelson III et al., 2006)


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Feeling Vocabulary


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Feeling Wheel (Words – Iconic) Adapt by Age, Students Can Help Make this Wheel

Happy

Mad

Sad

Joy

Shy

Friendly

Silly

Bored

17


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Social Skills Protocol:Psychoeducational Approaches

  • Teach & Model Skill (Knowledge Deficit)

  • Role Play w/Feedback (Performance Deficit)

  • Practice-Practice (Fluency Deficit)

  • Review

  • Generalization

(NASP, 2004)


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Lesson Example

  • Goal:

  • Outcomes:

  • Warm-up activity:

  • Review:

  • Teaching (modeling):

  • Main Activity:

  • Discussion and Summary:

  • Homework:


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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)


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NSLB (No School Psychologist Left Behind)

Diving in Deeper

Ready for CBT


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


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Cognitive-Behavioral Therapy (CBT)

Feelings

Thoughts/

Interpretations

Behavior

Thoughts predict feelings which predict behavior.

(Christner, Forrest, Morley, & Weinstein, 2007; Kendall & Hedtke, 2006)


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CBT ProtocolThoughts, Feelings, and Actions

  • The Magic Circle

What were you doing?

What were you Thinking?

  • Think about something you did that you really enjoyed. Write or draw in the circles

How did you feel?

(Stallard, 2002)


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Think Good – Feel GoodYounger Students

What I Do

  • The Negative Trap

What I Think

What I Feel

(Stallard, 2002)


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If – Then Brain TeaserExample CBT Exercise for Older Students

IFI make a mistakeTHEN

IFI feel hurtTHEN

IFI am madTHEN

IFI let people downTHEN

(Stallard, 2002)


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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?


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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

(Kendall & Hedtke, 2006)


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CBT ProtocolRelaxation 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


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CBT ProtocolRelaxation 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


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Changing perspectives: What is he thinking?

Oh no!! I’m going to break my ankle!!!

This is fun!!! I love skateboarding!


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Changing perspectives: What are you thinking?

Oh no!!

Another RtI Pyramid

This is fun!!!

I’m Learning

Tier II – III

Counseling

Techniques


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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?


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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


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Behavioral Exposures

  • Habituation

  • Experience before explanation

  • Different types

    • Imaginal

    • In vivo “in life”

  • Sense of mastery/accomplishment


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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 “I’m stupid” “I’m going to disappoint everyone”

  • Imaginal exposures, as well as in vivo exposures completed to habituate anxiety


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Case Study-Sophia


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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)


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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


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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?


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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 suicidal

    • This should include a protocol for who to contact (at minimum-the student’s parents/guardian, and the administration)

  • Always have community crisis resources on hand

    • Crisis hotlines, mobile crisis units, facilities handling students in crisis


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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)


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Solution-focused Brief TherapyReaching for the Goal


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Solution-Focused Counseling in Schools (Sklare, 2005)


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Solution-Focused Brief Therapy (SFBT)

  • Focus on what want to achieve (not past)

  • Focus how to obtain goal

    • Positive stated goals, measurable

(Sklare, 2005)


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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)


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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


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SFBT Cont’d

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?”


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Progress MonitoringHow to Show Positive Outcomes


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Best Practices in Behavioral Progress Monitoring

  • 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)


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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


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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


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Progress Monitoring Sample

1=Rarely, 2=Occasionally 3=Sometimes 4=Often

5=Always


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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)


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Progress Monitoring Sample

SUDS

Time

(Storch, 2006)

41


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Progress Monitoring Samples

Single Subject

Design

Baseline

Baseline

Intervention

Withdrawal

Intervention


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Progress Monitoring Data

Baseline

Intervention


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(Kendall & Hedtke, 2006)


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ResourcesEasy Progress Monitoring Data Graphing

  • On-Line Graphing Resources (ChartDog)

    • http://www.interventioncentral.org

      • Intervention Ideas

      • Tools for Educators


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Resources for School ApplicationCBT Manuals Free Manual https://trialweb.dcri.duke.edu/tads/manuals.html

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 (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.


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Resources for School ApplicationBrief Solution-Focused Therapy

  • Solution-Focused Manuals

    • Metcalf, 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.


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ResourcesCounseling Interventions Websites

  • ACHIEVE: A Collaborative School-based Reform Process, Howard Knoff, Social Skills, Conflict Resolution, Self Regulation, Positive School Climate, www.stopandthinksocialskills.com

  • Aggression Replacement Training, Mark Amendola, Anger Control, Aggression, Moral Reasoning Training

  • www.aggressionreplacementtraining.org

  • I Can Problem Solve, Myrna Shure, Aggression, Emotionality, Withdrawal, Rejected www.researchpress.com

  • Intervention Central, Jim Wright, ADHD, Bullying, Defiance http://www.interventioncentral.org/

  • Life Skills Training, Gilbert Botvin, Self-esteem, Social Skills, Substance Abuse, Social Anxiety, Peer Pressure, www.lifeskillstraining.com

  • PeaceBuilders, Michael Krupnick, Positive School Climate, Prosocial Behaviors, Conflict, Sibling Fighting, School Attachment, Peer Rejection www.peacebuilders.com

  • Peace Education Foundation, Conflict Resolution Programs, Peer Mediation, Crisis Management, http://www.peaceeducation.com/

  • Primary Mental Health Project, Deborah Johnson, Mild Aggression, Withdrawal, Shyness, Anxious, Poor Classroom Adjustment, www.childrensinstitute.net

  • Skill Streaming, A. Goldstein & E. McGinnis, Prosocial Skills, Stress Coping, Friendship Building, Sharing http://www.skillstreaming.com/

  • University of California at Los Angeles (2010). School-based mental health resources http://smhp.psych.ucla.edu/


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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.


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References

  • 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. http://www.uoregon.edu/~ivdb/powerpoint/jeff/jeff_pwrpt/hsipp/rti.pdf

  • 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.


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