Plan B

Report
Collaborative
Problem Solving
An Approach to Helping
Explosive Students with
Challenging Behaviour
By Ron Teffaine, M.Ed., CSC
Agenda for Today
What Would You Do?
• Read over the two scenarios in your handout.
• Briefly write down what you would do if you
were the teachers of those students.
• Be prepared to share an idea or two with the
rest of the class.
Ross W. Greene, Ph.D.
• Director of the Collaborative Problem Solving
Institute at Massachusetts General Hospital,
• Associate professor of Psychiatry at Harvard
Medical School.
Wrote two popular books about CPS
CPS for parents
CPS for teachers
Who was CPS Designed for?
Explosive children and adolescents:
• Severely resistant to adults
• Have explosive outbursts
• A heterogeneous group, with a
variety of diagnoses:
e.g., ADHD, ODD, CD, IED,
Dysthymia, Bipolar Disorder,
Temper Dysregulation Disorder,
Asperger’s Disorder, FASD, etc.
Why A New Model?




The Coercion Model dominated the conceptualization &
treatment of explosive behaviour for 45 years prior to CPS.
It says that 4 patterns of discipline contribute to coercive adultchild interactions:
(1) Inconsistent
(2) Irritable explosive
(3) Low supervision/involvement
(4) Inflexible or rigid
Children learn that arguing and tantrums coerce adults to give in
to their wishes.
The solution has been Parent Training (PT).
PT has limitations:
• Many parents give up or drop out
• 30-40% of parents report behaviour problems at follow-up
• 50% of treated children never reach normal
Parent Training books
based on Coercion Model
Two popular books for teachers
based on the coercion model:
William Jensen & Ginger Rhode
Coercion Model in School
Asking
Ignoring
Begging
Stalling
Threatening
Arguing
Aggressive
Demanding
Verbal
&/or Physical
Aggression
Gives in
Wins
Loses
Three Conceptual Models:
(1) Main Effect
• Child’s outcome is product of either adult or child
characteristics
The solution is
Parent Training!
Poor
parenting
skills
Adult
or
Has a disorder,
(e.g., ADHD)
Child
Explosive
Outcome
The solution
is Medication!
A or C = Outcome
Three Conceptual Models:
(2) Interactional
• Child’s outcome depends on the
combination of adult & child characteristics
(A-1)
+
(C-1)
=
(O-2)
Severe
(A-1)
+
(C0)
=
(O-1)
Moderate
Adult
+
Child
A + C = Outcome
Outcome
Three Conceptual Models:
(3) Transactional
• Child’s outcome depends on degree
of “fit” or “compatibility” between adult
& child characteristics
CPS is based on this model
Unique Fit
Goal of
treatment
Is not to fix the
adult or the
child, it is to
improve the
“compatibility”
between adult
and child.
How well does CPS work?
Subjects - 50 children (ages 4-12) with ODD
Conclusion: CPS resulted in better outcomes than PT.
Journal of Consulting and Clinical Psychology 2004, Vol. 72., No. 6, 1157-1164
CPS Philosophy:
Suggests kids would do
well if they had the right
skills to appropriately
adapt to the
environmental demands
“Children do well
if they can.”
VS.
Suggests explosive
kids are
attention-seeking,
manipulative, limittesting, or poorly
motivated
“Children do well
if they want to.”
Explosive kids have a Learning
Disability in three global domains:
(1) Flexibility / adaptability
(2) Frustration tolerance
(3) Problem solving
 These disabilities hinder a child’s ability to adapt
to changes or demands, and internalize standards
of conduct.
 As a result, explosive children find it difficult to
comply with adults’ imposed goals and standards.
Different parts of the brain contribute to the LD in
flexibility/adaptability, frustration tolerance, &
problem solving:
Prefrontal Cortex –
executive functioning
Limbic System – emotions
Left Brain –
Right Brain –
routine,
sequential,
analytical,
linguistic
processing
novel,
holistic,
analogical,
spatial
processing
Problems in Five Cognitive Pathways
contribute to the LD in the 3 domains
1. Executive skills:
•
Impulsivity, perseveration, trouble remembering things, enmeshed
thoughts & feelings, weak forethought, and disorganization
2. Language-processing skills:
•
Trouble comprehending, weak grammatical expression, slow
verbal fluency, difficulty labeling feelings, poor pragmatics
3. Emotion regulation skills:
•
Chronic irritability, depression, and/or anxiety
4. Cognitive flexibility skills:
•
Concrete, literal, black-and-white thinkers, who are rigid and
detail-oriented
5. Social skills:
•
Cognitive distortions, inaccurate interpretations, lacks empathy,
poor self-monitoring, lacks interpersonal skills
Exploring the Cognitive Pathways
The
Pathways
Inventory
is an
excellent tool
for exploring
skill deficits
among the 5
pathways
Exploring “Pathway” skill deficits
• As you observe a student’s explosive behaviour
over time, think about which pathways are needed
to meet the demands of the problem situations.
•
e.g., If John gets upset every time you tell him
to get a partner or join a group, he may lack the
necessary social skills.
• e.g., If John gets nervous and upset just before
show-and-tell time, he may have language
processing deficits and/or excessive anxiety
because of poor emotional regulation.
Exploring “Triggers” – Unsolved Problems
• Triggers – are “problems that have yet to be solved.”
These are situations that precipitate or increase the
likelihood of explosive episodes.
• e.g., telling a student to do some written work, telling
a student to put materials away, when a student loses
a game, when criticized for being late, when
accidentally bumped, asking for homework, etc.
• By identifying triggers and pathway deficits,
explosive episodes become more predictable.
 can help with generating possible solutions,
 can anticipate what adaptations can be used to
prevent and reduce explosive episodes.
High Probability Triggers
Exploring Triggers & Pathways
Two other tools can be used to explore common triggers and
lagging skills among the 5 pathways:
The ALSUP Checklist
The ALSUP Rating Scale
Exploring Triggers & Pathways
The ALSUP Rating Scale
Individual Exercise
Use one ALSUP Rating
Scale for each student
scenario presented at the
beginning of the workshop
to identify the “Triggers” &
“Pathways” likely involved.
Prioritize Triggers & Pathways
 Examine the collected data using the Pathways
Inventory, ALSUP Checklist or Rating Scale.
 Transfer the problems to the Prioritizing Triggers
& Cognitive Pathways form.
 Determine which Triggers are the most frequent or
interfere the most.
 Observe which Pathway lagging skills are affected
most often.
 Rank order the problems in order of priority, so
that each can be worked through.
Prioritize Triggers & Pathways cont’d…
Impact
on
Triggers
(Unsolved
Problems)
When other
kids push
ahead of him
Asked to
correct his
written work
Asked to
work with a
new partner
Freq
Per
Day
6
Often
Executive
Skills
The
Teacher
3
3

2
3

2
2
1
Sometimes
(from the ALSUP)
Other
Kids
4
Sometimes
Cognitive Pathways Affected
Language
Skills

EmotionRegulation
Skills
Cognitive
Flexibility
Skills
Social
Skills
R
A
N
K



1

2

3



Prioritize Triggers & Pathways cont’d…
• Use the CPS PLAN form to categorize items into High
Priority unsolved problems and lagging skills, as well as
Low Priority unsolved problems/accommodations.
Document Plan B Sessions
Three plans for handling problems
1. Plan A – imposition of adult will. Insisting that
expectations be met. Adult assumes motivation is
the problem, so may offer incentives or threaten
punishment.
• Entry phrases: “No,” “You must..,” “You have
to…” “You can’t..,” etc.
• Escalating insistence:
“Look, if you __, I’ll give you ___.” REWARD
“If you don’t __, you’ll miss __!” PUNISHMENT
Three plans for handling problems
2. Plan C – involves reducing or
removing expectations, at least
temporarily.
• Adults signal this when they say nothing, or do
not object to a student’s request or behaviour.
• When Plan C follows Plan A, it could be
interpreted as “giving in” to a child’s explosive
behaviour. This may increase it.
• However; starting with Plan C simply means
you’re choosing not to impose an expectation
just yet.
Three plans for handling problems
3. Plan B – engaging the student in a
collaborative attempt at problem solving to
achieve a mutually satisfying (win-win)
resolution of whatever concerns or factors
are interfering with expectations being met.
• Although Plan A seems quicker, it can
precipitate explosive episodes, which are more
time consuming than solving the problems
durably with Plan B.
Criteria for an Effective Intervention
1. Create a helping relationship
2. Solve the problems (triggers)
precipitating explosive episodes
3. Teach lagging skills within the 5
cognitive pathways
4. Reduce the frequency, intensity, and
duration of challenging behaviour
5. Help pursue adult expectations
How well does each plan achieve the goals of
an effective intervention?
Goals Achieved by Each Plan
Create
Helping
Relationship
Plan A
Teach
Skills
Solve
Problems
(triggers)
With
FBA
With
FBA
?
temporarily
Pursue
Expectations


Plan C
Plan B
Reduce
Outbursts





How Does Plan B Teach Skills?
 Executive skills:
• Organized, planful (nonimpulsive) thinking develops
as adults guide students’ thinking with Plan B.
• Separation of affect develops as kids learn that
solutions to problems take their concerns into account.
• Shifting cognitive set develops as students learn to
anticipate triggers and agree to solutions (e.g., teacher
reminders, visual schedules, social stories, etc.).
 Language-Processing skills:
• Expressing frustration in a socially acceptable manner
(e.g., “I’m frustrated” vs. “Screw you!”) can develop
based on teacher suggestions during brainstorming.
How Does Plan B Teach Skills?
 Emotion Regulation skills:
• Reduction of anxiety & irritability occurs as chronic
problems associated with these feelings are resolved
using Plan B.
• Dispelling cognitive distortions (e.g., labeling,
overgeneralizing, catastrophizing, etc.) associated with
anxiety & depression can occur as Plan B identifies them
and provides disconfirming evidence for them.
 Cognitive Flexibility skills:
• Thinking becomes more flexible as anxiety is
decreased through the “Empathy” step & reassurance.
• Considering another’s perspective develops through
the “Defining the Problem” step.
How Does Plan B Teach Skills?
Plan B
Two main types:
– this is preferred!
This is a proactive procedure, done at a time
when each person is calm and able to think well
(e.g., before/after school, lunchtime, recess, etc.)
1. Proactive Plan B
•
2. Emergency Plan B
•
•
This is done at the start of challenging behaviour
or after an explosive episode.
If done too often, this is called “Perpetual Plan B”
and signals the urgency for Proactive Plan B.
What if student starts to Escalate?
(From “No More Meltdowns”- Jed Baker, Ph.D).
•
•
•
•
Use the student’s interests or passions
Ask student to deliver a message
Send to designated “comfort zone”
Go for a walk with the student & allow venting
What if student continues to Escalate?
Emergency Plan B
or
Proactive Plan B
Three steps or ingredients:
1. Empathy
B
• Gather information about and achieve a clear
understanding of the student’s concern or
perspective on the unsolved problem.
2. Define the problem
• Enter the adult’s concern for consideration.
3. Invitation
• Brainstorm ideas that are realistic and mutually
satisfactory (i.e., win-win solutions).
Proactive Plan B in Action
Proactive Plan B
STEP 1 – Empathy
Plan B
Step 1. Empathy
You tend to ___ when…
___ occurs when you…
Words to use:
 Initial inquiry
• “I’ve noticed that …(insert unsolved problem)
… what’s up?”
 Drilling for Information
• Ask W4 (who, what, where, when) & How
questions about the unsolved problem.
• Explore facts, thoughts, beliefs, feelings,
physical reactions, relationships, choices, etc.
• Investigate the conditions under which it occurs,
& those under which it doesn’t. What’s the
difference to the student?
• Use active listening, reflect & summarize ideas.
•
Take your time; don’t rush this step.
Plan B
Step 1. Empathy
More Help:
 If you’re not sure what to say next, say:
•
“How so?” “I’m confused.” “I don’t quite understand.”
“Can you tell me about that?” “Let me think about that for
a second.”
 If the student doesn’t talk or says, “I don’t know,”
try to figure out why. Maybe…
• your observation wasn’t very neutral
• the problem was too vague
• you’re using Plan A
• he/she really doesn’t know – give time, break down
problem
Plan B
Step 1. Empathy
?
What You’re Thinking:
 Am I using a concerned, caring, and
respectful tone of voice?
 What don’t I yet understand about the kid’s
concern or perspective?
 What doesn’t make sense to me yet?
 What do I need to ask to understand it
better?
Plan B
Step 1. Empathy
Don’t…
• Skip the Empathy step
• Assume you already know the student’s
concern
• Rush through the step without sufficient drilling
– “Perfunctory Empathy”
• Leave the Empathy step before you completely
understand the kid’s concern or perspective
• Talk about solutions yet
Plan B - Empathy Step
– Drilling for Information
Teacher
Student
Observer
Group Work Time
Plan B exercise: Step 1 - Empathy
•
•
•
•
•
•
•
•
Break up into groups of 3.
One person will be the student (1), one the teacher
(2), and one the observer (3).
Each group member will get a “Role-Play Sheet” that
lists two unsolved problems.
The teacher (2) will try out Step 1 of Plan B with one
problem.
The teacher and observer use the “Cheat Sheet.”
The teacher may also use the CPS “Deciding on
Solutions” form if desired.
The observer will use the “Feedback Form” to record
what went well under step 1 of Plan B, and a helpful
comment or two under the suggestions column.
Once step 1 is completed, rotate so that each group
member has a turn.
Proactive Plan B
STEP 2 – Define The Problem
Step 2. Define The Problem
Well,…
Words:
Adult’s
Concern
 “The thing is (insert adult concern)…”
 “My concern is (insert adult concern)…”
More Help:
 Most adult concerns fall into 2 categories:
•
•
How the problem is affecting the student
How the problem is affecting others
What You’re Thinking:
 Have I been clear about my concern?
 Does the student understand what I said?
Step 2. Define The Problem
Don’t…
•
•
•
•
•
Start talking about solutions yet
Sermonize
Judge
Lecture
Use sarcasm
Teacher
Student
Observer
Group Work Time
Plan B exercise:
Step 2 – Define the Problem
•
•
•
•
•
•
•
Stay in your groups.
Decide who will be the student (1), teacher (2), and the
observer (3).
Continue using the “Role-Play Sheet” that lists two
unsolved problems.
The teacher (2) will try out Step 2 of Plan B with one
problem.
The teacher and observer use the “Cheat Sheet.”
The observer will use the “Feedback Form” to record
what went well under Step 2 of Plan B, and a helpful
comment or two under the suggestions column.
Once step 2 is completed, rotate so that each group
member has a turn.
Proactive Plan B
STEP 3 – Invitation
Plan B
Step 3. Invitation
Words to use:
 Restate the concerns, usually beginning with:
•
•
•
•
•
“I wonder if there is a way we can…”
“Let’s see if we can figure that out”
“Let’s see what we can do about that”
“Do you have any ideas?” (Let the student go first!)
“Well, I have a few ideas… would you like to hear
them?”
Plan B
Step 3. Invitation
More Help:
Brainstorming
 Stick closely to the identified concerns
 Let the student go first, but remember it’s a team
effort
 Consider the odds of a solution actually working:
• If they’re below 60-70%, talk about what is
making you skeptical
 Try the CPS “Deciding on Solutions” form
 At the end, agree to return to Plan B again if the
first solution doesn’t work
Plan B
Step 3. Invitation
?
What You’re Thinking:
 Have I summarized both concerns accurately?
 Have we truly considered whether both of us can
do what we’ve agreed upon?
 Does the solution address both of our concerns?
 What are the odds of this solution working?
Plan B
Step 3. Invitation
Don’t…
 Rush through this step
 Enter this step with pre-ordained,
“ingenious” solutions
 Agree to solutions that both you and the
student can’t actually perform
 Agree to solutions that don’t truly address
both your concerns
Plan B - Invitation Step
– “Ingenious Solutions”
Teacher
Student
Observer
Group Work Time
Plan B exercise: Step 3 – Invitation
•
•
•
•
•
•
•
Stay in your groups.
Decide who will be the student (1), teacher (2), and the
observer (3).
Continue using the “Role-Play Sheet” that lists two
unsolved problems.
The teacher (2) will try out Step 3 of Plan B with one
problem.
The teacher and observer use the “Cheat Sheet.”
The observer will use the “Feedback Form” to record
what went well under Step 3 of Plan B, and a helpful
comment or two under the suggestions column.
Once step 3 is completed, rotate so that each group
member has a turn.
Plan B in Groups
Plan B in Groups
Plan B in Groups
Questions
or
Final Comments?
Please fill out the
Workshop Evaluation form
Thank You
For more information about CPS,
visit the
“Lives In the Balance”
website at:
http://www.livesinthebalance.org

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