Counseling Skills for School Psychologists Delivering Tier II-III

RtI InterventionsNASP Conference, San Francisco, CA; February, 22, 2011

University of FloridaDiana Joyce, Ph.D. NCSP Stacey Rice, M.A. djoyce@coe.ufl.edu stacrice@ufl.edu

Michelle Portell Angela Dobbins, M.Ed. portellm@ufl.edu pore dobbinad1@ufl.edu u portellm@ufl.edu 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. 1

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)

5http://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 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

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

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Tier II – III Counseling Intervention Features

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

Sample Counseling GroupsGrade K

Counseling Skill Targets & Curricula

Tier II Internalizing: 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 vocabulary

Tier II Externalizing: 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 III

Externalizing: Angry outbursts, inappropriate touching, gross body noisesSkill Building: self-regulation, boundaries, social etiquetteTools: anger management curricula, personal space respect rules, grossology book

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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

School-wide Data Room

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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

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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) 15

Feeling Vocabulary

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MAD ? SAD ?

Upset Mischievous - Silly Disappointed

Apprehensive - Worried

Frustrated Smug - Better Upset Confused - Puzzled

Disgusted Disoriented - Shocked

Wounded Ashamed - Embarrassed

Angry Jealous - Envy Hurt Abandoned - Alone

Enraged Suspicious - Distrust

Helpless Remorseful - Guilty

Furious Betrayed - Harmed Hopeless Overwhelmed - FrozenHappy – Confident, Hopeful, Excited, Love-Struck,

Exhilarated, Ecstatic, Serene

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

Mad

Sad

Bored

Shy

Silly

Friendly

Joy

Happy

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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

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(NASP, 2004)

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)

20(NASP, 2004)

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Diving in Deeper

Ready for CBT

NSLB (No School Psychologist Left Behind)

CBT In Schools (Phillip Kendall)

Temple University Child and Adolescent Anxiety Clinic

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Thoughts/Interpretations

Feelings

Behavior

Thoughts predict feelings which predict behavior.

Cognitive-Behavioral Therapy (CBT)

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

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CBT ProtocolThoughts, Feelings, and Actions

The Magic Circle

What were you Thinking?

What were you doing?

How did you

feel?

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

(Stallard, 2002) 24

Think Good – Feel GoodYounger Students

The Negative Trap

What I Think

What I Do

What I Feel

(Stallard, 2002)

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If – Then Brain TeaserExample CBT Exercise for Older Students

IF I make a mistake THENIF I feel hurt THENIF I am mad THENIF I let people down THEN

(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 trainingDiaphragmatic (deep) breathingProgressive muscle relaxation (PMR)

Cognitive strategiesReducing negative self-talkChallenging unrealistic and dysfunctional thoughtsConsidering different perspectives

Behavior strategiesBehavioral exposuresSuccessive approximation

Problem-solving techniques

28(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

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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-SophiaSkills Hierarchy SUDS Level (1-10)

Holding sticky core of an air freshener

3

Touching a sticky substance (syrup)

5

Raising hand when not completely sure of an answer

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Raising hand more than twice in a row during class

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Turning in a paper that’s not “perfect”

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Purposely asking for feedback or constructive criticism from a teacher

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Working on a group project and not taking the “leader” role

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Purposely answering a question incorrectly during class

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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?40

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)

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Solution-focused Brief Therapy

Reaching for the Goal

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

45(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?

46(Sklare, 2005)

SFBT Cont’d

1. Miracle = Areas needing remediating

2. First sign of miracle = guides goal development

3. 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

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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)

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 Sample1=Rarely, 2=Occasionally 3=Sometimes 4=Often5=Always

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 SampleSUDS

(Storch, 2006)

41 Time

Progress Monitoring Samples

Baseline

Baseline Intervention

Intervention

Withdrawal

Single Subject

Design

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Progress Monitoring Data

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Baseline

Intervention

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

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) 58

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. 60

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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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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References