Collaborative Problem Solving

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

2. 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? Jot down an idea, and be prepared to share it.

3. 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.

4. Ross W. Greene, Ph.D. Originator of the Collaborative Problem SolvingApproach • Director of the Collaborative Problem Solving Institute at Massachusetts General Hospital, • Associate professor of Psychiatry at Harvard Medical School.

5. Wrote two popular books about CPS CPS for parents CPS for teachers

6. 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.

7. 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

8. Parent Training books based on Coercion Model

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

10. Coercion Model in School Ignoring Asking Stalling Begging Arguing Threatening Verbal &/or Physical Aggression Aggressive Demanding Gives in Wins Loses

11. Three Conceptual Models: • Main Effect • Child’s outcome is product of either adult or child characteristics The solution is Parent Training! Adult Poor parenting skills Explosive Outcome or Child Has a disorder, (e.g., ADHD) The solution is Medication! A or C = Outcome

12. Three Conceptual Models: (2) Interactional • Child’s outcome depends on the combination of adult & child characteristics (A-1) (O-2) (C-1) = + Severe (A-1) (C0) (O-1) = Moderate + Outcome Adult Child + A + C = Outcome

13. 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 Goal of treatment Is not to fix the adult or the child, it is to improve the “compatibility” between adult and child. Unique Fit

14. 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

15. 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. “Children do well if they want to.” Suggests explosive kids are attention-seeking, manipulative, limit-testing, or poorly motivated

16. Explosive kids have a LearningDisability 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.

17. 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, sequential, analytical, linguistic processing Right Brain – novel, holistic, analogical, spatial processing

18. 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

19. Exploring the Cognitive Pathways The Pathways Inventory is an excellent tool for exploring skill deficits among the 5 pathways

20. Exploring “Pathway” skill deficits • As you observe a student’s explosive behaviour over time, think about which pathways are neededto 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.

21. 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.

22. High Probability Triggers

23. Exploring Triggers & Pathways Two other tools can be used to explore common triggers and lagging skills among the 5 pathways: The ALSUP Rating Scale The ALSUP Checklist

24. Exploring Triggers & Pathways The ALSUP Rating Scale Individual Exercise Use oneALSUP Rating Scale for each student scenario presented at the beginning of the workshop to identify the “Triggers” & “Pathways” likely involved.

25. 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.

26. Prioritize Triggers & Pathways cont’d…

27. 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.

28. Document Plan B Sessions

29. 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

30. 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.

31. 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.

32. 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

33. How well does each plan achieve the goals of an effective intervention?

34. 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.

35. 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.

36. 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.

37. 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.

38. What if student starts to Escalate? • Use Non-violent Crisis Intervention • 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 • 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).

39. 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. QuestioningGive info., redirect • 2. Refusal Set limits (+ then -) • 3. ReleaseAllow venting • 4. IntimidationGet help, keep hands off • 5. Tension Reduction Therapeutic rapport Emergency Plan B or C.O.P.I.N.G.

40. Proactive Plan B Three steps or ingredients: 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

41. Proactive Plan B in Action

42. Proactive Plan B STEP 1 – Empathy

43. Step 1. Empathy Plan B 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.

44. Step 1. Empathy Plan B 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

45. Step 1. Empathy Plan B ? 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?

46. Step 1. Empathy Plan B 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

47. Plan B - Empathy Step – Drilling for Information

48. Group Work Time Plan B Practice Teacher Student Observer Step 1

49. 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.

50. Proactive Plan B STEP 2 – Define The Problem