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AGGRESSION REPLACEMENT TRAINING--IN ACTION

AGGRESSION REPLACEMENT TRAINING--IN ACTION. Rose Jenkins Conference Implementing Evidence-Based Practices: Early Lessons Learned October 3-4, 2006. Aggression Replacement Training Overview. Elijah McCauley, MA Clinical Training Specialist Stars Behavioral Health Group.

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AGGRESSION REPLACEMENT TRAINING--IN ACTION

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  1. AGGRESSION REPLACEMENT TRAINING--IN ACTION Rose Jenkins ConferenceImplementing Evidence-Based Practices: Early Lessons LearnedOctober 3-4, 2006

  2. Aggression Replacement TrainingOverview Elijah McCauley, MA Clinical Training Specialist Stars Behavioral Health Group Aggression Replacement Training--In Action

  3. Stars Behavioral Health Group • Starting in 1988, we now operate a wide variety of behavioral health programs for children, adolescents, and families. • Our programs include treatment –intensive programs provided in homes, at schools, and residential/ community-based centers. Aggression Replacement Training--In Action

  4. Our Clients Conduct Disorder • Aggression toward others • Destruction of Property • Deceitfulness, lying, or stealing • Serious violations of rules Aggression Replacement Training--In Action

  5. The 3 ART Components • #1. Skill-Streaming (behavioral) • #2. Anger Control Training (emotional) • #3. Moral Reasoning Training (values) Aggression Replacement Training--In Action

  6. Skill-Streaming 50 social skills: examples • Expressing a Complaint Constructively • Caring for Someone Who is Sad or Upset • Dealing w /(-) Peer Pressure • Keeping Out of Fights • Helping Others • Responding Constructively to Failure Aggression Replacement Training--In Action

  7. Skill-Streaming • Modeling • (Skill Demonstration by Trainers) • Role-Playing • (Skill Rehearsal by Youth) • Performance Feedback • (By Trainers and all Youth in Group) • Generalization Training • (To Increase Both Transfer and Maintenance) Aggression Replacement Training--In Action

  8. Anger Control Training • Identify triggers (internal & external) • Identify physiological cues of anger • Identify anger reducers • Reminders to decrease anger Aggression Replacement Training--In Action

  9. Problems I Had Today • Think bad about myself • Don’t care about others • Don’t care about myself • Problems with authority • Mess with other people • Get messed with alot • Make others mad • Steal stuff • Get mad easy • Want to use alcohol or drugs • Lie to people • “Punk” other people Aggression Replacement Training--In Action

  10. Thinking Problems • Self-Centered (me, me, me) • Blaming Others (you, you, you) • Assuming the Worst (biggie, biggie, biggie) • Minimizing (no biggie) Aggression Replacement Training--In Action

  11. Anger Reducers:Chill-Out Skillz • Deep Breathing • Count Backward from 10 • Put a “cool” picture in your head Aggression Replacement Training--In Action

  12. Moral Reasoning The strength of this UNIQUE approach comes from Positive Peer Influence Aggression Replacement Training--In Action

  13. Moral Reasoning We want our clients to develop-- Moral Maturity For this to occur they must develop mutual caring, respect & trust Aggression Replacement Training--In Action

  14. Anthony’s Problem Situation Anthony is walking along a side street w/his friend Raymond. Noticing a purse in the backseat of a parked car, Raymond says, “Look! The car’s unlocked, & there’s a purse in the backseat. Let’s grab it!” What should Anthony do? Aggression Replacement Training--In Action

  15. Anthony’s Problem Situation 1.Should Anthony try to persuade Raymond not to steal the purse? (circle one) Should persuade should let steal can’t decide 2. What if Raymond says to Anthony that the car owner can probably get insurance $ to cover the loss? (circle one) Should persuade should let steal can’t decide 3. In general, how important is it for people not to take things that belong to others? (circle one) Very important important not important 4. What if you found out the car belonged to your good friend Would Care a lot don’t care don’t know Aggression Replacement Training--In Action

  16. Santa Clara County Aggression Replacement Training Aggression Replacement Training--In Action

  17. Purpose • To implement an evidence based program into Juvenile Hall and the Ranch Programs in order to: • Enhance positive coping strategies • Reduce violence in custody and upon release • Increase in sociably acceptable behaviors Aggression Replacement Training--In Action

  18. Demographics • Average daily population: Juvenile Hall 250 / Ranches 101 • Number of minors admitted annually: Juvenile Hall 2893 / Ranches 420 • Minors screened for Mental Health issues annually: 2888 • minors open to MH services while detained: Juvenile Hall 1010 / Ranches 312 Aggression Replacement Training--In Action

  19. Accomplishments - Wave #1 • Seven Mental Health Therapists and Eleven Custodial Staff trained in ART Model. • Two ten week groups consisting of 8 male minors completed in Juvenile Hall. • Twelve minors complete ten weeks of training at the Boys Ranch. • Three additional groups 2 male and 1 female started in Juvenile Hall. • One additional group for males started at the Boys ranch. Aggression Replacement Training--In Action

  20. Comparison of Skillstreaming Checklist Average Score, Maximum possible = 50 Aggression Replacement Training--In Action

  21. Satisfaction Questionnaires Average score, Maximum possible = 30 Aggression Replacement Training--In Action

  22. Number of behavior Incident Reports For Youth Completing ART Curriculum Aggression Replacement Training--In Action

  23. Facilitator Viewed Strengths • Sessions build upon previous information. • Materials are easy for trainer to understand. • Materials are easy for minors to understand. • Different levels of material are given so that subject matter can be modified to fit group. • Use of week 0 to do pretest and set ground rules with minors. Aggression Replacement Training--In Action

  24. Facilitator Viewed Difficulties • Calls to master trainer not useful at the beginning • Scheduling meeting due to staff schedules can be challenging • Amount of staff time needed to prepare sessions, lead session and evaluate can place a burden on the staff • High attrition in Juvenile Hall groups. • Turnover in members = challenge to group dynamics Aggression Replacement Training--In Action

  25. Victor Community Support Services, Inc.Victor Treatment Centers, Inc.North Valley Schools, Inc. Observations and Conclusions of Victor Family of Programs’ Aggression Replacement Training Across 3 Settings: Community Mental Health Clinic Public and Non-Public School Environments Juvenile Hall Aggression Replacement Training--In Action

  26. Aggression Replacement Training Community Mental Health Clinic Setting Aggression Replacement Training--In Action

  27. Aggression Replacement Training--In Action

  28. Aggression Replacement Training School Settings Integrated Day Treatment Program in a Special Day Class Specialty MH Services in a Special Day Class Day Treatment Program in a Non-Public School Aggression Replacement Training--In Action

  29. Aggression Replacement Training Juvenile Hall Setting Five A.R.T. Group Curricula over 10 Months Aggression Replacement Training--In Action

  30. Aggression Replacement Training--In Action

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  33. Conclusions Client Demographics • ART seems most effective for youth with higher Cognitive Functioning • Single-sex groups assist with client focus and behavior management (other research indicates same gender groups also reduce female anti-social behavior) • Youth with high motivation at the onset of the ART groups increase effectiveness • ART seems appropriate for both moderate and higher level acuity Aggression Replacement Training--In Action

  34. Conclusions Client Demographics • ADHD symptoms seem to interfere with the acquisition of ART skills • The intensity of Anger may increase during ART sessions, however: • Anger intensity during sessions does not seem to increase aggression • Youth with intense anger experiences seem to apply ART skills • Youth are most engaged in the Role Plays • The application and sustainment of ART skills is greatly enhanced through collateral involvement (family members, teachers, milieu counselors) Aggression Replacement Training--In Action

  35. Conclusions Staffing Characteristics and Training • Increased supervision and fidelity monitoring appears to be as critical to ART efficacy as didactic training • Experience running groups and comfort level with youth anger appear to increase ART success • Group supervision and collegial support increase ART fidelity and efficacy • Staff attitude and enthusiasm seem to be more essential than formal education or years of experience Aggression Replacement Training--In Action

  36. Conclusions Staffing Characteristics and Training • Staff morale is consistently elevated through ART applications • ART provides a vehicle for staff creativity and application of their unique talents and skills • Staff must be comfortable with role plays; staff consistently love role plays • Use of humor seems to be a very helpful skill with ART • It seems to work best for support staff (milieu counselors) to remain outside of the group, due to the sensitivity of discussions Aggression Replacement Training--In Action

  37. Conclusions ART Design • ART is consistently reported as easy to learn and straightforward • Role Plays are consistently reported as the most engaging and effective element of ART • Skillstreaming seems most appropriate for environments with stable client populations and staffing, due to the need for youth to practice of their individualized plans Aggression Replacement Training--In Action

  38. Conclusions ART Design • Anger Control seems to have the most long term impact (numerous clients remember Anger Control language years later) • Moral Reasoning seems most appropriate for older youth (14 to 18) due to its cognitive demands • Maintaining fidelity with Moral Reasoning can be a challenge with consistent reports of insufficient content • ART enhancements assist with maintaining a fun atmosphere and youth engagement Aggression Replacement Training--In Action

  39. Sustaining ART in a Residential Program Sean Schoneman, Ph.D. Assistant Clinical Director of Training Casa Pacifica Aggression Replacement Training--In Action

  40. Steps to Sustaining Training Program Fidelity Staff Involvement Responsibility Accountability Support from Senior Management Results Setting Goals for the Future Aggression Replacement Training--In Action

  41. Training • Medical Model: Observe, assist, lead • Placed immediately into groups after 3 day training • “Expert Team” Meetings: • Training • Implementation • Support Aggression Replacement Training--In Action

  42. Training 3 Tiers of ART Training at Casa Pacifica Tier 1: Expert ART Team • 3 Day Training in Sacramento • Weekly Expert ART Team Meetings • Training New Hires & People from their Departments • Teleconferencing with National Trainer • Annual 3 Day Training from National Trainers Aggression Replacement Training--In Action

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