Effective Family-Focused Skills Training Interventions for Youth with Aggression and Conduct Problems Michael Bloomquist, Ph.D., L.P. Assistant Professor

Effective Family-Focused Skills Effective Family-Focused Skills Training Interventions for Youth with Training Interventions for Youth with Aggression and Conduct ProblemsAggression and Conduct Problems

Michael Bloomquist, Ph.D., L.P.

Assistant ProfessorDepartment of PsychiatryUniversity of Minnesota

August 22, 2006 Mental Health for Family Supportive Housing Seminar SeriesModel Cities St. Paul, Minnesota

Overview of Presentation

• Brief Description of Aggression and Conduct Problems in Youth and Evidence-Based Interventions

• Review of Parent and Family Skills Training Literature and Methods

• Illustrative “Struggling Child” Model of Parent and Family Skills Training

Possible DSM-IV-TR CategoriesPossible DSM-IV-TR CategoriesI. Oppositional Defiant Disorder (ODD)

II. Conduct Disorder (CD)

III. Attention Deficit Hyperactivity Disorder (ADHD)

IV. Possible Co-Morbid Conditions

A. ODD/CD/ADHD combinedB. Anxiety/Posttraumatic Stress Disorder C. Depression or Bipolar DisorderD. Pervasive Developmental DisorderE. Reactive Attachment DisorderF. Lower intelligenceG. Reading/academic delaysH. Substance use/abuse

Overt Aggression Reactive Aggression

Proactive Aggression Relational Aggression

Bullying Violence

Stealing/Fire Setting Truancy/Drug Use

Psychopathy Child Delinquency

Moodiness Anxiety

Social MaladjustmentUnderachievement

Possible Dimensions or Target Possible Dimensions or Target CharacteristicsCharacteristics

Developmental Progression of Children with Early Developmental Progression of Children with Early and Persistent Aggression and Conduct Problemsand Persistent Aggression and Conduct Problems

I. Infancy and Toddlerhood (0-2 years) - Difficult temperament, easily frustrated, and hard to soothe, or unresponsive

II. Preschool (3-5 years) - Tantrums, defiance, aggressive actions, and coercive interactions with parent

III. Early Elementary (6-8 years) - Coercive interactions with peers/teachers, academic and social problems (negative peer reputation and information processing biases/deficits)

IV. Later Elementary and Middle School (9-14 years) –Covert antisocial behaviors increase including substance abuse, and family problems are more pronounced

V. Adolescent and Adulthood (15+ years) - Covert actions are predominant, except for a subset of violent individuals, antisocial personality and/or lifetime functional problems

Gender DifferencesGender Differences

I. Boys > Girls – “Early Starter” aggressive

developmental pathway (more overt aggression and

covert behaviors)

II. Girls Exposed to Similar Risk Factors - Often

eventually end up on the same developmental

trajectory, but with somewhat later onset (more

relational aggression and covert behaviors)

Race/Ethnic DifferencesRace/Ethnic Differences

I. Few Differences - Prevalence rates across

race/ethnic groups when socioeconomic status is

controlled

Factors That Influence Children’s Behavior and AdjustmentFactors That Influence Children’s Behavior and Adjustment

Area of Influence

Risk Factors Associated with Problem Development

Assets and Protective Factors Associated with Positive Development

Child Early behavioral and/or emotional problems (implies possible biological cause)Poor social skills Academic difficulties

Early behavioral and emotional regulation capacity

Good social skillsAcademic skills and success

Parent/Family

Parent personal problemsParent-child child attachment or bonding problemsFamily lacks routines and rituals Negative (coercive) parent-child interactionsFamily problems and instability

Relationship with a stable adultSupportive and authoritative parentingFamily has predictable routines and rituals Positive parent parent-child interactionsPositive and stable family environment

Factors That Influence Children’s Behavior and Adjustment Factors That Influence Children’s Behavior and Adjustment (continued)(continued)

Area of Influence

Risk Factors Associated with Problem Development

Assets and Protective Factors Associated with Positive Development

Social/Peer Group

Rejected by positive influence childrenAssociations with negative influence children

Accepted by positive influence childrenAssociations with positive influence children

Commun-ity/Society

PovertyNeighborhood problemsCommunity violence and crime

Violent media influences

(Reviewed in Bloomquist & Schnell, 2002)

Attends effective schoolsSafe and organized neighborhoodsOpportunities for positive influence school, religious, and community activitiesNon-violent media influences

Intervention Report Card – Mike’s Intervention Report Card – Mike’s Grading Grading

I. Social Competence Training – B- II. Parent/Family Skills Training – AIII. Stimulant Meds – A-, Other Meds - CIV. Restrictive Mental Health Services - CV. Academic Skills Building - B

VI. School-Wide Interventions – B VII. Peer Mediation – B

VIII.Classroom Management – A-IX. Mentoring/Afterschool – C+X. Family Support – C+XI. Multidimensional Foster Care – B+XII. Multicomponent Interventions – A


Rationale for Family Focus

I. Ample research documents the link between aggression/conduct problems and family

A. Parent characteristics – Depression, distress/stress, substance abuse, parental cognitions (attributions, locus of control, etc.)

B. Parent-child attachment – InsecureC. Coercive parent/child interactions – Escape conditioning, poor

monitoring/supervision, etc.D. Family problems – Intimate partner separations and/or

violence, maltreatment, family “chaos,” etc.

II. Family socialization - Parents facilitate child development

III. Research about what works – Behavioral parenting and family interventions work


Parent and Family Skills Training (PFST)Parent and Family Skills Training (PFST)

I. Train Parent to Manage Child - Child management strategies and play/bonding strategies

II. Address Parent Problems - Training in coping strategies and other practical strategies

III. Train Parent to Facilitate Child – Promote child’s acquisition of

developmental skills

IV. Train Family Members - Family-wide interaction strategies


Research Supports This ApproachResearch Supports This Approach

I. Meta-analysis

II. Reviews of Research

III. "Proven" Intervention - according to APA guidelines (Patterson, Webster-Stratton Programs)

IV. Statistical and Clinical significance

V. Better Outcomes - With preschool/school age children than teens

VI. Multisystemic and Family-wide Skills Interventions - Work best with teens

VII. Negative Outcomes - Premature termination, poor treatment engagement, lack of maintained progress (occurs in some families)


Overview of PFST Best Practice Guidelines - Overview of PFST Best Practice Guidelines - DeliveryDelivery

I. Practitioner Establishes Relationships II. Training Methods

A. Use instruction, modeling (including video modeling), role-play, practice, feedback, reinforcement, discussion, and homework

B. Leads parents to “discover” new skillsC. Interventions can be delivered in small groups or with

individual families

III. Approximately 10-18 Sessions – To allow for mastery of content (up to 50 sessions for some families)

IV. Follow-up and Booster Sessions(Reviewed in Bloomquist & Schnell, 2002)

Overview of PFST Best Practice Guidelines - Overview of PFST Best Practice Guidelines - ContentContent

I. Observe and Track Child Behavior

II. Child-directed Play

III. Reinforce/Shape Positive Behavior and Ignore Mild Negative Behavior

IV. Defuse Power Struggles and De-escalate Parent-Child Conflict

V. Consistent and Firm Response for Non-compliance (e.g., time-out, removal of privileges, etc.)

VI. Standing or House Rules for Behavior

VII. Token System for Behavior Management

VIII. Monitor and Supervise Children

IX. Interventions for Stealing and Fire Setting

X. Address Parent Personal and Other Family Problems

XI. Teach Parents to Restructure “Unhelpful” Thoughts

XII. Teach Parents/Family Members to Improve Family-wide Interactions

XIII. Teach Parent to Coach Child Skill Development


Overview of PFST Best Practice Guidelines - Overview of PFST Best Practice Guidelines - ContentContent (continued)

Caveat 1: Challenges of Using “Evidence - Based” Interventions In the “Real World”

I. Programs – Use content and procedures within an evidence-based program

A. Insures adherence to protocolB. Less flexibility and individualization (one size fits all) and less

feasible in real world

II. Guidelines – Use content and procedures across evidence-based programs to create “empirically-informed” interventions

A. Not empirically validated, and may not reflect validated program B. More flexibility and individualization, and more feasible in real

world

III. Adaptive Interventions – Programs/guidelines should be tailored to the needs and/or choices of individual clients (for heterogeneous real world population)

A. Leveled-care - Practitioners or empirical decision making determines what and how much B. Client-directed care - Client determines what and how

much

Caveat 2: Preventing Treatment Dropout

(Kazdin, 1996; Nock et al., 2005)

I. 40 - 60% of families with ODD/CD youth drop out of treatment prematurely

II. Same risk factors that relate to problem development also predict dropout

III. Parents attributions/expectations predict dropout

IV. Perceptions of “burden of treatment” predicts dropout

V. Perceptions of cultural insensitivity predicts dropout

Integrative Illustrative Model: Integrative Illustrative Model: PFST for the “Struggling Child”PFST for the “Struggling Child”

((Bloomquist, 2006)

I. Provides Evidence - Based Guidelines derived from Parent/Family and Child Social Competence Training to be used Adaptively

II. Incorporates Knowledge in Child Development and Developmental Psychopathology

III. Focuses on Six Areas of Child and Parent/Family Skills Development

IV. Focuses on Behavioral Skills Training AND Family Engagement

V. Used at the University of Minnesota Attention and Behavior Problems Clinic and in Early Risers

Practitioner and Stages of Intervention in Struggling Child Model

I. “Practitioner” – High on relationship skills and structuring; focus on process; utilize behavioral training procedures

II. Assessment A. Diagnostic

B. Child developmental - Self-control, social, affective and academic

C. Parent stress and family stressD. Six functional domains (B&C above)

Self-Control Development

Age Successful Child Struggling Child

Infant/Toddler • Easy-going and responsive to parent

• Irritable/fussy and/or unresponsive to parent

• Manageable “terrible two’s” behavior

• Tantrums and whines

Preschool • Obeys caregiver’s directions • Disobeys caregiver’s directions

• Follows rules • Doesn’t follow rules

Elementary School • Usually reflective and thinks before acting

• Often impulsive and acts before thinking

• Gets upset but can calm down • Gets very upset and overreacts to stress

Adolescence • Continues to cope with strong emotions

• Frequent intense anger outbursts or anxiety

• Aware of own behavior and it’s impact on others

• Unaware of own behavior and it’s impact on others

Social Development


Infant/Toddler • Secure attachment or bond with parent • Insecure attachment or bond with parent

• Plays with others • Plays by self

Preschool • Mostly positive interactions with parents • Mostly negative interactions with parents

• Accepted by positive influence peers • Rejected or neglected by positive influence peers

Elementary School

• Good social skills (e.g., cooperative, sharing, expresses feelings)

• Poor social skills (e.g., uncooperative, pouting, stingy)

• Mostly positive interactions with peers and teachers

• Mostly negative interactions or withdrawn with peers and teachers

• Affiliates with positive influence peers • Often affiliates with negative influence peers

• Solves most social problems effectively • Ineffective in solving social problems

Adolescence • Thinks of other’s thoughts and feelings • Doesn’t think of other’s thoughts and feelings

• Engages in positive activities with peers (e.g., sports, music, arts, recreation)

• Often engages in negative activities with peers (e.g., drugs, truancy, promiscuity) or is withdrawn

• Teen “launches” from family, but maintains strong family ties

• Teen rejects family and has poor family relationships

•

Healthy romantic relationships • Unhealthy romantic relationships

Emotional Development


Infant/Toddler • Mostly content and happy • Mostly fussy and irritable

• Displays a wide range of basic emotions (e.g., anger, sadness, fear, happiness)

• Displays negative basic emotions (e.g., anger, sadness, fear)

• Expresses a wide range of emotions through play

• Expresses negative emotions through play

Preschool • Expresses simple emotions to others • Unexpressive and keeps feelings inside

• Fears are common (e.g., “bad guys”) • Fears are common (e.g., afraid of dark)

Elementary School

• Overcomes most fears • Fears persist

• Understands and expresses complex emotions (e.g., remorseful, pride)

• Doesn’t understand or express complex emotions (e.g., guilt, optimism)

• Positive self-concept emerging • Negative self-concept emerging

• Many positive and helpful thoughts about self and others

• Some negative unhelpful thoughts about self and others

Adolescence • Mostly positive and helpful thoughts about self and others

• Mostly negative and unhelpful thoughts about self and others

• Mostly happy and satisfied • Mostly depressed, anxious, or angry

Academic Development


Infant/Toddler • Explores Environment • Apprehensive about environment

• Is curious and inquisitive • Avoids new situations

Preschool • Enjoys looking at books • Excessive television and video games

• Good adjustment to school setting • Poor adjustment to school setting

• Excited about learning • Indifferent about learning

Elementary School

• Concentrates, stays on task, gets work done

• Inattentive, off-task, doesn’t complete tasks

• Organized with school materials and tasks

• Disorganized with school materials and tasks

• Enjoys school • Dislikes school

Adolescence • Consolidating special skills and interests • No particular special skills or interests

• Engaging in vocational or career planning and preparation

• No viable vocational or career plans

Parent Well-Being

Coping Parents

Managing everyday challenges and problems

Satisfactory marriage or intimate partner relationship

Keeping up with parenting responsibilities

Supportive family and/or friends

Stressed Parents

Overwhelmed by everyday challenges and problems

Marriage or intimate partner relationships problems

Overwhelmed by parenting responsibilities

Limited family or friend support system

Family Relationships

Coping Family

Close parent-child relationship

Predictable routines and rituals

Predominantly positive parent-child interactions

Predominantly positive family communication and ability to resolve conflict

Stressed Family

Distant parent-child relationship

Lack of routines and/or rituals

Predominantly negative (coercive) parent-child interactions

Predominantly negative family communication and inability to resolve conflict

Child Development and Family RatingChild Development and Family Rating

1 2 3Rarely Sometimes Often

___ 1. My child is struggling in self-control (behavior) development – He or she is defiant or doesn’t follow rules at home or school or gets too angry.

___ 2. My child is struggling in social development– He or she is aggressive or withdrawn from peers and/or siblings.

___ 3. My child is struggling in emotional development – He or she keeps feelings inside or thinks negative thoughts or feels unhappy or nervous.

Child Development and Family Rating (continued)Child Development and Family Rating (continued)

1 2 3Rarely Sometimes Often

___ 4. My child is struggling in academic development - He or she dislikes school or doesn’t like reading or has trouble completing school work.

___ 5. As a parent, I am stressed out - I feel overwhelmed with responsibilities/problems and/or feel unhappy.

___6. Our family is stressed out – We have more negative interactions than positive interactions in our family.

Practitioner and Stages of Intervention in Struggling Child Model (continued)

III. Engaging the Family – Enhance client motivation and change clients cognitions/behaviors that could impede change

A. Form collaborative relationship – Fully explain everything and use collaborative intervention planning dialoguing (i.e., 2:1 ratio of questions to statements)

1.Use a developmental frame to conceptualize child and family problems (“struggles”) and solutions (“get back on track”)

2.Use a family self-evaluation strategy to target “Areas of Focus”

3. Select “Success Plans” to target Areas of Focus


III. Engaging the Family (continued)

B. Plan for resistance and/or obstacles1. Employ cognitive restructuring 2. Simplify homework3. Allow emotional expression4. Deal with other family problems

through additional family support interventions

C. Continuously revisit engaging the family

LOW

AMinimal Emphasis

on Engaging Family

B Moderate

Emphasis on Engaging Family

CModerate Emphasison Engaging Family

DSignificant Emphasis on Engaging Family

HIGH

Parent Capacity and Motivation to Complete Intervention

A Framework for Conceptualizing Emphasis on Engaging FamilyA Framework for Conceptualizing Emphasis on Engaging Family

LOW HIGH

Family ProblemSeverity

Family Support: Strengths and Concerns FormFamily Name:_______________________________________________________Date:__________________________

Rate the family in these four domains in order to determine areas of focus in family support.

1 2 3 4

Strength No Concern Mild to Moderate Concern Serious Concern

Child Health/Support

Medical (Physical health) Nutrition/Exercise

Spiritual Extracurricular (Sports, camps, clubs, etc.)

Mental Health Other:____________________________________

Child School

Child’s Homework School Attendance

Academics Other:___________________________________

Parent Involvement at School (conferences, volunteering, attending school events).

Family Basic Needs

Financial/Economic Housing

Transportation Child Care

Employment Nutrition/Food

Other:_____________________________________________________________________________

Parent Health/Support

Medical (Physical Health) Nutrition/Exercise

Partner/Marital Substance Use

Spiritual Social Support (Friends/Family)

Mental Health Language (ESL)

Other:_____________________________________________________________________________


IV. Teach Parent and Child Selected Behavior or Skill

A. Explain and discuss the selected behavior or skill B. Demonstrate or model the behavior or skillC. Role-play using the behavior or skill


V. Coach and Reinforce Parent and Child for Using New Behavior or Skill

A. Remind, prompt and reinforce child and parent for using new behavior or skill

B. Plan to use new behavior or skill in “real life” situations

C. Use charts to promote behavior or skill development


VI. Continue Training Until Mastery is Achieved

A. Parent and child knows and employs skills routinely

B. The amount of time to accomplish

this varies

VII. Monitoring, Maintenance, and Booster Training

A. Follow-up as needed

Enhancing a Child’s Self-Control Enhancing a Child’s Self-Control Development Development

(Chapter 3)(Chapter 3)

Success Plans

1. Teaching a Child to Obey

2. Teaching a Child to Follow Rules

3. Teaching a Child to Manage Anger

Developmental Age of Child

Younger

Older

Enhancing a Child’s Social Enhancing a Child’s Social Development Development


Success Plans

1. Teaching a Child Social Behavior Skills

2. Teaching a Child Social Problem Solving Skills

3. Promoting Positive Peer Affiliations


Younger

Older

Enhancing a Child’s Emotional Enhancing a Child’s Emotional DevelopmentDevelopment


Success Plans

1. Teaching a Child to Understand and Express Feelings

2. Teaching a Child to Think Helpful Thoughts

3. Promoting a Child’s Self-Esteem


Younger

Older

Enhancing a Child’s Academic Enhancing a Child’s Academic DevelopmentDevelopment


Success Plans

1. Helping a Child Appreciate and Enjoy Reading

2. Teaching a Child Self-Directed Academic Behavior Skills

3. Being Involved in a Child’s Schooling


Younger

Older

Improving Parent Well-Being Improving Parent Well-Being (Chapter 7)(Chapter 7)

Success Plans

1. Improving Parent Stress Management Skills

2. Staying Calm with Stressful Children

3. Changing Unhelpful Parent Thoughts


All ages

Improving Family RelationshipsImproving Family Relationships(Chapter 8)(Chapter 8)

Success Plans

1. Improving Parent-Child Bond

2. Improving Family Interaction Skills

3. Developing Family Routines and Rituals


All ages

Illustration 1:Illustration 1:Enhancing a Child’s Self-Control Enhancing a Child’s Self-Control

Development Development (Chapter 3)(Chapter 3)

Success Plans

1. Teaching a Child to Obey

2. Teaching a Child to Follow Rules

3. Teaching a Child to Manage Anger


Younger

Older

Child Self-Control Development Success Plan 1:

Teaching a Child To Obey

Step 1 - Give Effective Commands

Step 2 - Use Effective Warnings

Step 3 - Give Positive or Negative Consequence for Behavior

Step 4 - Calm Down and Stay Cool

Step 5 - Stay with It

Step 6 - Practice with Charts

Vague command - Telling a child in vague terms what she is expected to do (e.g., “Shape up,” or “Knock it off”).

Question command - Asking a question in an attempt to gain a child’s compliance (e.g., “Would you please pick up your toys?”).

Rationale command - Explaining to a child why she needs to comply (e.g., “You need to get dressed now, because if you don’t we will be late for our appointment”).

Multiple commands - Telling a child to do too many things at once (e.g., “Pick up your toys, make your bed, wash your hands, and then come to dinner”).

Frequent commands - Repeating the same command over and over and over to a child.

Specific, one-step command - Stating a specific, one-step command in 10 words or less (e.g., “Turn off the TV now”).

Removing Privileges for DisobedienceRemoving Privileges for Disobedience1.1. Parent states a command to the child/teen.Parent states a command to the child/teen. The command should be

brief and clear as to exactly what is expected of the child/teen.

2.2. Give a warning.Give a warning. If the child/teen does not follow through with the command, then the child/teen should be given a warning. A warning is an ““if…thenif…then”” statement. The warning should be stated clearly and concisely. For example, “if you don’t (command), then (you will lose a privilege).” Privileges to remove may include TV time, access to the telephone, going outside, driving the car, games, and so forth. It may be helpful too count to 5 before going to the next step.

3.3. Loss of privilege.Loss of privilege.Option 1:Option 1: The child/teen is told that the privilege is lost until he/she complies with the original command.

Option 2:Option 2: The child/teen is told the privilege is lost for a specified period of time (e.g., 24 hours).

4.4. After compliance.After compliance. Once the child has complied with the original command, then the lost privilege is returned accordance with the specification of option 1 or 2 above.

Child Self-Control Development Success Plan 2:

Teaching a Child To Follow Rules

Step 1 - Designate Behavior Expectations

Step 2 - Designate Privileges to be Earned or Lost for Behavior

Step 3 - Specify How Behavior Expectations are Connected to Privileges


Rules for Family Rules

• List All the Rules

• Rank Order the Rules in Importance

• Select Top 3 – 5 Rules

• Write Down Rules

• Episodically Review the Rules

EXAMPLE: DAILY BEHAVIOR CHARTName: April Week of: November 6-12

Directions: Identify four (or fewer) target behaviors for your child to work on each day. Put a smiling face in the box if the behavior was completed. Put a frowning face in the box if the behavior was not completed. Always praise your child each time he or she gets a smiling face. At the end of the day, tally up smiling and frowning faces. Administer the reward or mild punishment sometime within 24 hours. There are two levels of rewards and one level of mild punishment.

BehaviorBehavior Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Up and dressed by 7:00 a.m.

Homework done before supper

Take dog out for a walk

In bed by 7:30 p.m. with lights out

Total smiling faces 0 3 2 4 4

Total frowning faces 4 1 2 0 0

Daily Rewards: Mild Punishments:

1-2 Smiling faces = Snack 4 Frowning faces = No computer for 24 hours

3-4 Smiling faces = Rent favorite DVD

Example: Weekly Behavior ChartName :__________________ Week of:_____________________________

Behavior Saturday Sunday Monday Tuesday Wednesday Thursday Friday

Help with dishes

Bathroom cleanup after shower

N/A Write in school planner N/A Cooperate with good attitude around the house Ask for permission to use internet Come home on time (9:00 on school nights and 11:00 on weekends)

Weekly Grade and Corresponding Rewards/Consequences (Determined on Friday Evenings)A = 36-40 (90%) - $10 and stay up late two weekend nights or sleep overB = 32-35 (80%) - $7 and stay up late one weekend nightC = 28-31 (70%) - $5F = 27 or less (below 69%) – grounded all weekend

Child Self - Control Development - Success Plan 3

Teaching a Child To Manage Anger

Step 1 - Determine if Child Is Ready to Learn Anger Management Skills (consider age and

resistance)

Step 2 - Define Anger

Step 3 - Teach Child to Recognize Anger Signals

Step 4 - Teach Child to Relax

Step 5 - Teach Child to Use “Helpful Self-Talk”

Step 6 - Teach Child to Take Action


Anger SignalsAnger SignalsBody signals Thought signals Action signals

• Breathing rate increased • “I hate myself” • Punch/hit

• Heart rate increased • “I feel like hurting myself” • Yell

• Sweating increased • “I hate her” • Cry

• Red face color • “I’m going to hit him” • Threatened

• Tense muscles • “I hate doing homework” • Faint

•

Body feels “hot” • “I want to break something” • Fidget

• “I am dumb” • Tremble

• “I can’t do anything right” • Run

• “I give up.” • Withdraw

Relaxation StrategiesRelaxation Strategies

Deep breathing

Visualization

Robot/rag doll technique

Muscle tension-release

Coping Self TalkCoping Self Talk

• “Take it easy.” • “It’s OK if I’m not good at this.”

• “Stay cool.” • “I’m sad Tanya doesn’t want to play with me, but many other kids like to play with me.“

• “Chill out.”

• “Take some deep breaths.”

• “I’m getting tense. Relax!” • “I’ll just try my hardest.”

• “Don’t let him bug me.” • “Try not to give up.”

• “I’m going to be OK.”

Illustration 2:Improving Parent Well-Being

(Chapter 7)

Success Plans

1. Improving Parent Stress Management Skills

2. Staying Calm with Stressful Children

3. Changing Unhelpful Parent Thoughts


All ages

Parent Well-Being Success Plan 1:

Improving Parent Stress Management Skills

• Learn to Relax • Take Time Away From Family Responsibility

• Time with Spouse/Partner • Spend Special Time with Your Child

• Seek Out Social Support • Schedule Pleasant Events

• Good Health Habits • Utilize Effective Problem Solving

• Think Accurately • Learn to Control Anger

• Stay Calm with Stressful Children


Staying Calm with Stressful Children

Step 1: Recognize when child’s behavior is causing stress

Step 2: Cope with that stress

Staying Calm1. Recognize Stress (i.e., aware of stress “signals”)

Body signals Thought signals Action signals

2. Relax Your Body - Do deep breathing, tense and release muscles, count to 10, and so forth

3. Use “Coping Self-Talk” – Examples of coping self-talk include the following: “Take it easy” “Stay cool

“Don’t let it bug you” “Relax” “I’m going to be ok”

“I can handle this” “I will try my best”

4. Taking Effective Action – Walk away, ignore it, take a walk, try to discuss it, express feelings, use problem solving, and so forth.

• Breathing/Heart rate increased

• Tense muscles

• Increased sweating

• face turns red

• Body feels hot

• “That brat!”

• “I am not going to take any more!”

• “I’m a worthless parent.”

• “I can’t handle this!”

• “I hate him/her.”

• Punch/hit

• Yell/threaten

• Cry

• Tremble

• Withdraw


Changing Unhelpful Parent Thoughts

Step 1 - Identify and Understand Unhelpful Thoughts

Step 2 - Counter with Helpful Thoughts

Unhelpful Parent ThoughtsUnhelpful Parent Thoughts 1 2 3 4 5

Not at all Sometimes Moderately often All the time Often

1. _____ My child acts up on purpose.

2. _____ My child is the cause of most of our family problems.

3. _____ It is my fault that my child has problems.

4. _____ It is his/her fault (other parent) that my child is this way.

5. _____ I GIVE UP. There is nothing more I can so for my child.

6. _____ I have no control over my child. I have tried everything, and so forth.

For each thought you rated a 3, 4, or 5, ask yourself the following questions:

1. What is unhelpful about this thought?

2. How would this thought influence my behavior toward my child?

3. How would my behavior, which relates to my thought, affect my child?

Helpful Thoughts for ParentsHelpful Thoughts for Parents1. It doesn’t matter whose fault it. What matters are solutions to the problems2. It is not just my child. I also play a role in the problem.3. It is not just my fault; my child also plays a role in the problems.4. It does not help to blame him/her (other parent). We need to work together.5. I have to parent my child. I have no choice. I need to think of new ways to

parent my child.6. My belief that I have not control over my child might be contributing to the

problem. Many things are in my control. I need to figure out what I can do to solve the problem.

Ask yourself the following questions about these helpful thoughts:

1. What is helpful about this thought?2. How would this thought influence my behavior toward my child?3. How would my behavior, which relates to my thought, affect my child?

“Success Plans” To Improve Six Areas of Focus

Twelve child-focused Success Plans1. Three for self-control development2. Three for social development3. Three for emotional development4. Three for academic development

Six parent/family-focused Success Plans5. Three for parent well-being6. Three for family interactions

Parents (and often children) are guided to select andimplement most relevant plan(s) that match child and/or parent/family struggles

MAINTAINING IMPROVEMENTS FOR YOUR CHILD AND FAMILY

• Pick the Right Skills to Work On • Realistic Thoughts

• Enlist the Help of Others • Goal Setting

• Self-Reinforcement • Practice Self-Awareness

• Conduct Periodic Reviews • Plan Relapse Prevention

• Don’t Give Up

PFST for the “Struggling Child”PFST for the “Struggling Child”ABP Clinic Quality Assurance Protocol ABP Clinic Quality Assurance Protocol

(adapted from Early Risers Quality Assurance Protocol)(adapted from Early Risers Quality Assurance Protocol)

I. Manual – Book

II. Training – Practitioners are trained

III. Technical Assistance - About this PFST model

IV. Clinical Supervision - About using this PFST model with specific clients

V. Fidelity Practitioner “Logs” - Progress notes

VI. Supervisor Observation Ratings – Direct observation of practitioner in action

Primary Sources for Presentation

August, G.J., Anderson, D., & Bloomquist, M. (1992). Competence enhancement training for children: An integratedchild, parent, and school approach. In S. Christenson and J. Conoley (Eds.). Home-school collaboration: Enhancing children’s academic and social competence (pp. 175-213). Silver Springs, Maryland: NationalAssociation of School Psychologists.

Bloomquist, M.L. (2006). Skills training for children with behavior problems: A parent and practitioner guidebook. (Revised Edition). New York: Guilford Press.

Bloomquist, M.L. August, G.J., Lee, S.S., Berquist, B., & Mathy, R.M. (2005). Targeted prevention of antisocial behavior in children: The Early Risers “Skills for Success” Program. In R.G., Steele, & M.C. Roberts (Eds.).

Handbook of mental health services for children, adolescents, and families (pp. 201-214). New York: Kluwer Academic/Plenum Publishers.

Bloomquist, M.L. & Schnell, S. (2002). Helping children with aggression and conduct problems: Best practices for intervention. New York: Guilford Press.

Dishon, T.J., & Kavanagh, K. (2003). Intervening in adolescent problem behavior: A family centered approach. New York: Guilford Press.

Henggeler, S.W., & Lee, T. (2003). Multisystemic treatment of serious clinical problems. In A.E. Kazdin & J.R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents. (pp. 301-324). New York: Guilford Press

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Effective Family-Focused Skills Training Interventions for Youth with Aggression and Conduct Problems Michael Bloomquist, Ph.D., L.P. Assistant Professor