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. NCSP Stacey Rice, M.A. email@example.com firstname.lastname@example.org Michelle Portell Angela Dobbins, M.Ed.email@example.com pore firstname.lastname@example.org u email@example.com 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.
Overview • Beginning 101 – Forming Counseling Groups • Three Methods • Psychoeducational, CBT, Solution-Focused • Screening/Progress Monitoring Strategies
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.
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
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
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
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)
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
School-wide Data Room Photo courtesy of Marissa Casamassino, Kimbell Elementary
Data Wall Sample Photo courtesy of Marissa Casamassino, Kimbell Elementary
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
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?
First Session – Introduction and Rapport Building • Member Introduction • Ice Breakers • Group Title and Goals • Confidentiality • Ground Rules • Introduce Format (e.g. 30 min weekly)
Insight and Awareness • Emotional vocabulary • Identify physiological “triggers” • Monitoring and using competing responses • Listening skills (Nelson III et al., 2006)
Feeling Wheel (Words – Iconic) Adapt by Age, Students Can Help Make this Wheel Happy Mad Sad Joy Shy Friendly Silly Bored 17
Social Skills Protocol:Psychoeducational Approaches • Teach & Model Skill (Knowledge Deficit) • Role Play w/Feedback (Performance Deficit) • Practice-Practice (Fluency Deficit) • Review • Generalization (NASP, 2004)
Lesson Example • Goal: • Outcomes: • Warm-up activity: • Review: • Teaching (modeling): • Main Activity: • Discussion and Summary: • Homework:
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)
NSLB (No School Psychologist Left Behind) Diving in Deeper Ready for CBT
CBT In Schools (Phillip Kendall)Temple University Child and Adolescent Anxiety Clinic
Cognitive-Behavioral Therapy (CBT) Feelings Thoughts/ Interpretations Behavior Thoughts predict feelings which predict behavior. (Christner, Forrest, Morley, & Weinstein, 2007; Kendall & Hedtke, 2006)
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)
Think Good – Feel Good Younger Students What I Do • The Negative Trap What I Think What I Feel (Stallard, 2002)
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 THEN (Stallard, 2002)
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?
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)
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
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
Changing perspectives: What is he thinking? Oh no!! I’m going to break my ankle!!! This is fun!!! I love skateboarding!
Changing perspectives: What are you thinking? Oh no!! Another RtI Pyramid This is fun!!! I’m Learning Tier II – III Counseling Techniques
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?
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
Behavioral Exposures • Habituation • Experience before explanation • Different types • Imaginal • In vivo “in life” • Sense of mastery/accomplishment
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
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)
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
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?
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
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)
Solution-Focused Brief Therapy (SFBT) • Focus on what want to achieve (not past) • Focus how to obtain goal • Positive stated goals, measurable (Sklare, 2005)
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)
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
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?”
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)