Collaborative Problem Solving An Approach to Helping Explosive Students with Challenging Behaviour By Ron Teffaine, M.Ed., CSC

Agenda for Today 9:00 am - 10:15 am CPS (theory, research, tools) 10:15 am - 10:20 am Nutrition Break 10:20 am - 11:30 am CPS (Plan A, C, B) 11:30 am - 1:15 pm Lunch & HTA AGM 1:15 pm - 2:30 pm CPS (videos & practicing the Plan B steps in groups) 2:30 pm – 2:50 pm Nutrition Break 2:50 pm – 3:45 pm CPS (group practice, questions, fill out evaluation form) What do I want from this workshop today? Please share your thoughts.

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.

Originator of the Collaborative Problem Solving Approach 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 adult-child interactions: Inconsistent Irritable explosive Low supervision/involvement 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 For the last 45 years, the coercion model written about by Dr. Gerald Patterson at the Oregon Social Learning Center has dominated conceptualization & treatment of explosive behaviour.

Parent Training books based on Coercion Model These are two popular parent training books based on the Coercion Model.

Two popular books for teachers based on the coercion model: William Jensen & Ginger Rhode

Coercion Model in School Asking Ignoring Begging Stalling Arguing Threatening Aggressive Demanding Verbal &/or Physical Aggression Escalating power struggles in which the teacher finally gives negatively reinforces aggression in the student and makes them worse in the long run. Gives in Wins Loses

Three Conceptual Models: Main Effect Child’s explosive behavior is assumed to be the product of either adult or child characteristics The solution is Parent Training! Adult Poor parenting skills Explosive Behavior Sameroff (1975) described 3 conceptual models that trace the evolution of how researchers have tried to understand developmental outcomes for children with explosive behaviour. These models helped to show the limitations of PT, and provided the impetus for developing the CPS method. In the Main Effect model, only one standard treatment is provided either for the adult or the child. Standard (canned) treatments do not always fit either the adult of the child. or Child Has a disorder, (e.g., ODD) The solution is reinforcement! A or C = Outcome

Three Conceptual Models: (2) Interactional Child’s explosive behavior depends on the combination of adult & child characteristics (A-1) + (C-1) = (O-2) Severe (A-1) (C0) = (O-1) + Moderate Explosive Behavior Adult Child The Interactional Model treats the outcome as something of a math equation, with the combination of bad adult and child characteristics producing bad outcomes. The model expands the treatment options by including standard interventions for both adults and child simultaneously. However, this model doesn’t explain those circumstances in which “good” adult and child characteristics still produce “bad” outcomes. + A + C = Outcome

Three Conceptual Models: (3) Transactional Child’s behavior depends on degree of “fit” or “compatibility” between adult & child characteristics CPS is based on this model Goal of treatment Is not to fix the adult or the child, it is to improve the “compatibility” between adult and child. With the Transactional Model, explosive behavior is viewed as only one of many possible manifestations of incompatibility. Other manifestations might include child maltreatment, anxiety (in adult or child), depressed mood (in adult or child), social withdrawal (in adult or child), or substance abuse (in adult or child). The treatment involves unique (NOT STANDARD) solutions to handle the compatibility between the adult and child in specific situations. Unique Fit

How well does CPS work? Figure 1. Scores based on the Oppositional-Defiant Disorder Rating Scale (ODDRS). The ODDRS is a 5-point scale that measures the frequency & severity of ODD behaviors. Figure 2. The Parent CGI stands for Clinical Global Impression. The CGI is a 7-point scale from Very Much Improved to Very Much Worse. 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

“Children do well if they can.” CPS Philosophy: “Children do well Suggests kids would do well if they had the right skills to appropriately adapt to the environmental demands CPS Philosophy: “Children do well if they can.” VS. “Children do well if they want to.” Suggests explosive kids are attention-seeking, manipulative, limit-testing, or poorly motivated The CPS philosophy assumes a problem exists within the child that is misunderstood and/or mismanaged by the adult, while the latter assumes that the problem is merely lack of motivation or a simple choice.

Explosive kids have a Learning Disability in three global domains: Flexibility / adaptability Frustration tolerance 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. Explosive kids have a Developmental Delay or Learning Disability of sorts in 3 global domains.

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 – routine, logical, rigid, sequential, analytical, linguistic Right Brain – creative, Intuitive, flexible holistic, analogical, spatial

Problems in Five Cognitive Pathways contribute to the LD in the 3 domains Executive skills: Impulsivity, perseveration, trouble remembering things, enmeshed thoughts & feelings, weak forethought, and disorganization Language-processing skills: Trouble comprehending, weak grammatical expression, slow verbal fluency, difficulty labeling feelings, poor pragmatics Emotion regulation skills: Chronic irritability, depression, and/or anxiety Cognitive flexibility skills: Concrete, literal, black-and-white thinkers, who are rigid and detail-oriented Social skills: Cognitive distortions, inaccurate interpretations, lacks empathy, poor self-monitoring, lacks interpersonal skills CPS places a high value on analyzing 5 cognitive pathways that contribute to a LD in the 3 domains of (1) flexibility/adaptability, (2) frustration tolerance, and (3) problem solving. Understanding these helps make explosive behaviour more predictable and manageable. A Sensory Pathway is something I would have added. This is often seen in children with Asperger’s, FASD, and Tourtette Syndrome.

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 Two helpful forms are the Assessment of Lagging Skills & Unsolved Problems (ALSUP) and an ALSUP Rating Scale. These help to explore common triggers, as well as deficits in the 5 pathways that may set the stage for explosive behaviour.

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. Participants will need 2 ALSUP Rating Scale forms to complete this exercise.

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 Cognitive Pathways Affected (from the ALSUP) Triggers (Unsolved Problems) Freq Per Day Other Kids The Teacher Executive Skills Language Emotion-Regulation Cognitive Flexibility Social R A N K When other kids push ahead of him 6 Often 3  1 Asked to correct his written work 4 Some-times 2 Asked to work with a new partner

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 In high schools, you might have something like this on the Maplewood or PowerSchool Counselling Notes so others dealing with the student can see what’s being worked on, and what’s been resolved. Another alternative, is to have a template form like this on the school’s network under the student’s name, for the same purpose.

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. 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. 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. Although Plan A may seem quicker on the front end, explosive episodes precipitated by Plan A can be more time consuming than solving the problems durably with Plan B.

Criteria for an Effective Intervention Create a helping relationship Solve the problems (triggers) precipitating explosive episodes Teach lagging skills within the 5 cognitive pathways Reduce the frequency, intensity, and duration of challenging behaviour Help pursue adult expectations Dr. Greene argues that any intervention for challenging kids should to achieve 5 specific goals to be effective.

Goals Achieved by Each Plan How well does each plan achieve the goals of an effective intervention? Goals Achieved by Each Plan Create Helping Relationship Teach Skills Solve Problems (triggers) Reduce Outbursts Pursue Expecta-tions Plan A With FBA With FBA ? temporarily  Plan C Plan B It is only Plan B that helps to achieve all 5 goals of an effective intervention. Plan A may reduce outbursts temporarily, unlike Plan B which is more durable.

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. By implementing Plan B, many lagging skills are gradually improved.

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? Social Skills: Some skills are trained simply by using Plan B: e.g., Assertiveness, cooperation, problem solving, etc. Other skills may need to be trained directly using strategies similar to published social skills training programs: e.g., Skillstreaming – Dr. Arnold Goldstein & Dr. Ellen McGinnis Social skills are taught in a collaborative fashion, so there’s a better chance the info. will be heard. Plan B often teaches social skills in the natural environment, therefore, there’s better generalization.

Plan B Two main types: 1. Proactive Plan B – 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.) 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? Use Non-violent Crisis Intervention Anxious Student: Noticeable change from usual behaviour (e.g., quieter, louder, fidgety, etc.); student has a problem Offer assistance; be nonjudgmental, caring, empathic, and supportive Try Distraction (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? Use Non-violent Crisis Intervention Defensive Student: Agitated – now we have the problem Starting to lose rationality; challenging 1. Questioning Give info., redirect 2. Refusal Set limits (+ then -) 3. Release Allow venting 4. Intimidation Get help, keep hands off 5. Tension Reduction Therapeutic rapport Psychological Needs vs. Lagging Skills Abstract Beliefs vs. Concrete Reasons Although Dr. Greene says that Emergency Plan B can be done when kids are starting to show challenging behaviour, he admits it’s not the best way to do Plan B, and other models do not support this idea either (e.g., NVCI, WEVAS), because kids can’t think as well when they are becoming defensive. Emergency Plan B or C.O.P.I.N.G.

Proactive Plan B Three steps or ingredients: 2. Define the problem 1. Empathy 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). B

Proactive Plan B in Action

Proactive Plan B STEP 1 – Empathy

Plan B Step 1. Empathy Initial inquiry Words to use: Initial inquiry “I’ve noticed that (insert unsolved problem)… what’s up?” Drilling for Information Ask W4 (who, what, where, & when) questions about the unsolved problem. Investigate the conditions under which it occurs, & those under which it doesn’t. What’s the difference? 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: 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 and treat it like a formality 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 Enter into the Empathy Step with an open mind. Treat assumptions only as hypotheses, not as a foregone conclusions.

Plan B - Empathy Step – Drilling for Information

Plan B Practice Teacher Observer Student Group Work Time Step 1

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. Re: CPS Deciding On Solutions form - Write down the problem and adult’s concerns before meeting with the student. Briefly summarize the student’s concerns on the form after the Empathy Step is completed.

STEP 2 – Define The Problem Proactive Plan B STEP 2 – Define The Problem

Step 2. Define The Problem Well,… Words: “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? Adult’s Concern Ask the student if they understood what you said.

Step 2. Define The Problem Don’t… Start talking about solutions yet Sermonize Judge Lecture Use sarcasm

Plan B Practice Teacher Observer Student Group Work Time Step 2

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: 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”

Plan B Practice Teacher Observer Student Group Work Time Step 3

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.

Questions or Final Comments?

Workshop Evaluation form 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