research concerning the implementation of life space crisis intervention and a multi-level token...

Research concerning the Research concerning the implementation of Life Space implementation of Life Space Crisis Intervention and a Crisis Intervention and a multi-level token economy multi-level token economy systemsystem

Ilse Goethals

Eline Spriet

Population Population Adolescents with EBD in Flanders (D’Oosterlinck et al., 2006)

DSM IV diagnose ‘attention deficit hyperactive disorder’ (ADHD), ‘conduct disorder’ (CD), ‘pervasive developmental disorder’ (PDD), problems related to physical or sexual abuse, ‘other disorders of infancy, childhood and

adolescence’ such as ‘separation anxiety disorder’ and ‘reactive attachment disorder’.

CBCL (Child Behavior Checklist) High levels of externalising and internalising problem

behaviour (aggression) and a lack of social competences

D’Oosterlinck, F., Broekaert, E., De Wilde, J., Bockaert, L.F. & Goethals, I. (2006). Characteristics and Profile of Boys and Girls with Emotional and Behavioural Disorders in Flanders Mental Health Institutes: A Quantitative Study. Child: Care, Health and Development, 32 (2), 213-224

School School HomeHome Teachers and other

staff-members (n=26) Average age: 41 Gender

female = 20 % male = 80 %

years of employment 1 - 12 years = 61 % 13 - 24 years = 26 % 25 - 37 years = 13 %

Educators and other staff-members (n = 38) Average age: 41 Gender

female = 54 % male = 46 %

years of employment 1 - 12 years = 58 % 13 - 24 years = 5 % 25 - 37 years = 37

%

Research aims of the project Research aims of the project

2006 - 20082006 - 2008 20062006

Aim 1: detect specific problem areas Aim 1: detect specific problem areas Aim 2: develop a test-battery to objectify the Aim 2: develop a test-battery to objectify the

problem areasproblem areas 20072007

Aim 3: evaluate the implementation of LSCI and Aim 3: evaluate the implementation of LSCI and the token economy level-systemthe token economy level-system

Aim 4: follow-up 2007Aim 4: follow-up 2007 20082008

Aim 5: follow-up 2008Aim 5: follow-up 2008

Aim 1: Detect problem Aim 1: Detect problem areasareas

Method Instruments

Observations in class-rooms and in the living-groups Analysis of documents Unstructured conversations

Subjects: Youngsters Teachers Educators Staff-members External partners

Analysis All interviews were tape-recorded and transcribed Content analysis with a qualitative software package

(WinMAX). Coding hermeneutic units by two groups Tree-structure of categories and subcategories

ResultsResults Main problem areas

Cooperation between school and the home

Not enough support Feeling of insecurity High amount of Truancy Disruptive behaviour Conflicts between youngsters

Aim 2: Aim 2: Objectify problem Objectify problem areasareas

Dawson, C. A. (2001). Crisis Intervention Training and Support for School Staff of Junior High School Special Education Students Emotional Disturbances. Unpublished dissertation. Nova South-Eastern University, Florida, U.S.A.

D’Oosterlinck, F., Goethals, I., Broekaert, E., Schuyten, G., De Maeyer, J. (2008).Implementation and effect of life space crisis intervention in special schools with residential treatment for students with emotional and behavioral disorders (EBD).Psychiatric Quarterly, 79(1), 65-79.

Aim 2: objectify problem Aim 2: objectify problem areasareas

Method Instruments

Administrative registrations Self-report scales Surveys

Administrative registrations during 22 days (April-May) Truancy suspensions Transfers to more or less restrictive settings

Instruments (2)Instruments (2) Administrative registrations

Conflicts time and place of conflict people involved nature of the conflict according to LSCI

Critical incidents Verbal aggression Physical aggression Complaint of parents Nursery visits because of fight Access to bus was denied Police interference To buzz a staff member during the weekend

Instruments (2)Instruments (2)

Self-report scales YSR (Youth Self Report; 11 to 18 years)

measuring problem behaviour Main scales

Internalising behaviour Externalising behaviour Total Problem Behaviour

MASC (Multidimensional Anxiety Scale for Children; 11 to 19 years) measurements of dimensions of anxiety Main scales:

Physical symptoms Harm avoidance Social anxiety Separation anxiety Total anxiety

Instruments (2)Instruments (2)

BDHI-D (Buss-Durkee Hostility Inventory - Dutch) Measurement of aggression and hostility

Indirect aggression Direct aggression Social desirability

Instruments (2)Instruments (2) Surveys

CBCL (Child behaviour Checklist) rated by educators concerning the boys in their living-

group TRF (Teacher Report Form)

rated by teachers concerning their students Safety on the job

Self-developed questionnaire 6 statements level of feeling insecure due to:

Delinquent behaviour Deviant behaviour Verbal assault Physical assault Criminal offences Insufficient support and recognition

Rated by teachers and educators (n = 64) 5pt Likert-scale: (very low– very high)

Results: Safety on the jobResults: Safety on the job

Most employees feel very insecure because of the verbal assaults of youngsters

Teachers experience higher levels of insecurity as a result of delinquent and aggressive behaviour, when compared to educators

Men, more than women, experience high levels of insecurity due to verbal assaults, aggressive and out of bound-behaviour of youngsters

‘Age’ and ‘years of employment’ is not specifically related to high or low levels of insecurity

Aim 3: LSCI & Level-Aim 3: LSCI & Level-SystemSystem

evaluation of the evaluation of the implementationimplementation

Method

Self-developed survey 20 statements

Knowledge and use of LSCI Knowledge and use of Level-System

Example: “I understand how a youngster can move from level 1 to level 2”

Crisis management team

Rating scale: ‘yes’, ‘no’, sometimes’

Result:

Most respondents (70%) have sufficiant knowledge on how to implement the Level-

System are un-afraid to confront a youngster when he has lost points for

inappropriate behaviour agree that an LSCI conversation can help the youngster support the basic assumptions of LSCI are pleased with the crisis team during school ours

70% of the respondents state they: are not having LSCI conversations with youngsters who lost

points due to inappropriate behaviour have insufficient knowledge about the rewards per level are unhappy with the crisis team (residential) do not register LSCI conversations have little knowledge on how to organise the follow-up of

youngsters who are in level 4 need more support to implement LSCI

Aim 4: follow-up 2007 Aim 4: follow-up 2007

Test-battery: Administrative registrations

Self-report scalessurvey

Results: Administrative registrations

01020304050607080

%

0-33 34-68 69-102

number of hours

Truancy

2006

2007


Number of suspensions: 2006 = 3 2007 = 2

Number of transfers to more restricted settings: 2006 = 1 2007 = 0


117

81

48

28

0

50

100

150

200

2006 2007

Number of conflicts

School

Home


Place and time in 2006: Most conflicts occurred: during classes (24%),

other situations (17%) at the play area (13%)

At the beginning of the week (60%)

due to problems with other peers (59%) and/or

due to problems with rules and boundaries (42%) and/or

problems related with negative self image (38%) and/or

Problems with adults (32%)(teachers/educators)

Place and time in 2007: Most conflicts occurred: at the play area (29%),

during meals (19%), during their free-time (17%)

at the end of the week (42%)

due to problems with other peers (69%) and/or

problems related with negative self image (15%) and/or

due to problems with rules and boundaries (11%) and/or

Problems with adults (11%) (teachers/educators)


Number critical incidents 2006: n = 147 2007: n = 65

Significant results: Day of the week: X²=16,3; p<0,001

In 2007, critical incidents occurred most at the end of the week (41%) whilst in 2006 most incidents occurred in the beginning of the week (60%)

School year: X²=7,92; p<0,05 In 2007, most incidents arose in the 1st and 2nd

school year (53%) compared to 2006 (43%) Type of critical incident: X²=23,38; p<0,001


Year

20072006

Co

un

t120

100

80

60

40

20

0

critical incidents

refer to nurse

complaint of parent

police intervention

verbal assault

physical assault

Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Internalising problem Average ‘Internalising problem

behaviour’ behaviour’

52

54

56

58

60

62

64

66

YSR CBCL TRF

2006

2007

Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Externalising problem Average ‘Externalising problem

behaviour’behaviour’

54

56

58

60

62

64

66

68

70

72

YSR CBCL TRF

2006

2007

Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Total problem Average ‘Total problem


52

54

56

58

60

62

64

66

YSR CBCL TRF

2006

2007

Results: MASCResults: MASCAverage anxietyAverage anxiety

MASC

4445464748495051

Fysic

al sy

mpt

oms

soci

al an

xiet

y

avoi

ding d

amag

e

sepa

ratio

n anx

iety

tota

l anxi

ety

2006

2007

Results: BDHI-D Results: BDHI-D hostility and aggressionhostility and aggression

0

2

4

6

8

10

12

14

direct aggression indirectaggression

social desirability

2006

2007

Aim 5: follow-up 2008 Aim 5: follow-up 2008

Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Internalising problem Average ‘Internalising problem

behaviour’ behaviour’

50

52

54

56

58

60

62

64

66

YSR CBCL TRF

2006

2007

2008

Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Externalising problem Average ‘Externalising problem


56

58

60

62

64

66

68

70

72

YSR CBCL TRF

2006

2007

2008

Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Total problem Average ‘Total problem


54

56

58

60

62

64

66

68

70

72

74

YSR CBCL TRF

2006

2007

2008

Results: MASCResults: MASCAverage anxietyAverage anxiety

MASC

363840424446485052

Fysica

l sym

ptom

s

socia

l anx

iety

avoid

ing da

mage

sepa

ratio

n anx

iety

tota

l anx

iety

2006

2007

2008

Results: BDHI-DResults: BDHI-Dhostility and aggressionhostility and aggression

0

2

4

6

8

10

12

14

directaggression

indirectaggression

socialdesirability

2006

2007

2008

Discussion

Administrative data 2008 will be collected in May and June

Limitations of this research: No experimental design No control on administrative registration No assurance on quality of LSCI conversations Self-report scales and social desirable answers

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