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How to Solve Behavioral Problems Together
Corrie A. Goldberg, Ph.D., Postdoctoral Fellow
Family Service CenterWilmette, Glenview, Northbrook & Kenilworth
NAMI Illinois Conference: Creating a Community of Support
October 12, 2018
Introduction
• Who am I?• What is the Family Service
Center?• What is the Plan for This
Morning?
Learning Objectives
• Understand the philosophy of the Collaborative and Proactive Solutions (CPS) model
• Learn common pathways to common problems with emotion regulation
• Learn the steps of the CPS model• Learn resources to support the continued
practice of the CPS model
Evolution of the CPS Model
• Developed by Dr. Ross Greene• Initially targeted children with “explosive
behaviors” in outpatient and hospital settings.• Expanded to include all children who at times
lack the capacity to meet certain demands.• May meltdown, explode, shut down, etc.
Key Principles• KIDS DO WELL IF THEY CAN• Problem behaviors not due to lack of motivation,
rather represent a skill deficit; incompatibility between child’s characteristics and the demands and expectations placed upon them.
• Offering “carrots” or threatening “sticks” may not help; may exacerbate problem behavior.
• Rather than assuming that adult knows why problem is occurring and how to solve; investigate, collaborate, and solve together.
Paradigm Shift
• Challenging behavior is not due to defiance, willfulness, or lack of motivation. It is not attention-seeking, manipulation, or limit-testing.
• Challenging behavior is the byproduct oflagging cognitive skills.
• Disconnect between the expectation and the individual’s ability to meet that expectation, in that moment, under those circumstances.
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Pathways to Problems
• Executive Function Skills• Language Processing Skills• Emotion Regulation Skills• Cognitive Flexibility Skills• Social Skills
Triggers (for Maladaptive Behaviors)
• Situation or event in which child regularly has difficulty meeting the expectation
• An unsolved problem• Examples: Difficulty getting ready for school in
the morning; difficulty doing science homework, etc.
Assessment of Lagging Skills and Unsolved Problems (ALSUP)
• Available at: www.livesinthebalance.org/paperwork
• Discussion guide to help identify lagging skills and the specific unsolved problems that result from those lagging skills.
• Example: Difficulty stopping iPad play to get ready for school; Difficulty transitioning from recess to social studies.
• ALSUP can help with “paradigm shift.”
UNSOLVED PROBLEMS GUIDE: Unsolved problems are the specific expectations a child is having difficulty meeting. Unsolved problems should be free of maladaptive behavior; free of adult theories and explanations; “split” (not “clumped”); and specific.
LAGGING SKILLS UNSOLVED PROBLEMS
q Difficulty handling transitions, shifting from one mindset or task to another
q Difficulty doing things in a logical sequence or prescribed order
q Difficulty persisting on challenging or tedious tasks
q Poor sense of time
q Difficulty maintaining focus
q Difficulty considering the likely outcomes or consequences of actions (impulsive)
q Difficulty considering a range of solutions to a problem
q Difficulty expressing concerns, needs, or thoughts in words
q Difficulty managing emotional response to frustration so as to think rationally
q Chronic irritability and/or anxiety significantly impede capacity for problem-solving or heighten frustration
q Difficulty seeing “grays”/concrete, literal, black & white, thinking
q Difficulty deviating from rules, routine
q Difficulty handling unpredictability, ambiguity, uncertainty, novelty
q Difficulty shifting from original idea, plan, or solution
q Difficulty taking into account situational factors that would suggest the need to adjust a plan of action
qInflexible, inaccurate interpretations/cognitive distortions or biases (e.g., “Everyone’s out to get me,” “Nobody likes me,” “You always blame me, “It’s not fair,” “I’m stupid”)
q Difficulty attending to or accurately interpreting social cues/poor perception of social nuances
q Difficulty starting conversations, entering groups, connecting with people/lacking other basic social skills
q Difficulty seeking attention in appropriate ways
q Difficulty appreciating how his/her behavior is affecting others
q Difficulty empathizing with others, appreciating another person’s perspective or point of view
q Difficulty appreciating how s/he is coming across or being perceived by others
q Sensory/motor difficulties
HOME EXAMPLES• Difficulty getting out of bed in the morning in time to get to school • Difficulty getting started on or completing homework (specify assignment)• Difficulty ending the video game to get ready for bed at night• Difficulty coming indoors for dinner when playing outside• Difficulty agreeing with brother about what TV show to watch after school• Difficulty with the feelings of seams in socks • Difficulty brushing teeth before bedtime
SCHOOL EXAMPLES• Difficulty moving from choice time to math• Difficulty sitting next to Kyle during circle time• Difficulty raising hand during social studies discussions• Difficulty getting started on project on tectonic plates in geography• Difficulty standing in line for lunch
ASSESSMENT OF LAGGING SKILLS & UNSOLVED PROBLEMS
CHILD'S NAME _______________________________________________________________ DATE ________________
INSTRUCTIONS: The ALSUP is intended for use as a discussion guide rather than as a freestanding check-list or rating scale. It should be used to identify specific lagging skills and unsolved problems that pertain to a particular child or adolescent.
If a lagging skill applies, check it off and then (before moving on to the next lagging skill) identify the specific expectations the child is having difficulty meeting in association with that lagging skill (unsolved problems). A non-exhaustive list of sample unsolved problems is shown at the bottom of the page.
ALSUP
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Prioritize Problems
• We want to “fix” everything all at once, but we can’t.
• Plan A (discouraged): Unilateral. Adult decides solution and imposes it. Not the same as communicating an expectation or concern.
• Plan C: Not choosing the battle right now.
Plan B: The Goal of CPS
• Collaborative and Proactive Solutions• Both parties’ concerns are of equal legitimacy• Both parties’ concerns are addressed• Problem solve around a predictable problem
during a time that the problem is not occurring.
• Goal is to generate a solution so that the problem does not reoccur.
Brain Basics• Left Brain: helps think logically,
organize thoughts into language, helps with sequencing and order.
• Right Brain: helps experience emotions, interpret nonverbal cues.
• “Upstairs Brain”: helps with thoughtful consideration of actions
• “Downstairs Brain”: handles instinctual, split-second decisions; “fight, flight, or flee.”
Upstairs and Downstairs Brain• “Downstairs Brain”-fully formed at
birth. Controls basic body functions like breathing and heart rate
• “Upstairs Brain”-does not complete development until mid-twenties. Responsible for planning, emotion-control, empathy, etc.
• Amygdala-housed in the downstairs brain. Makes split-second decisions; act before thinking.
Whole Brain Integration• Integration: helps bring together aspects of brain to allow
for whole brain coordination. Happens through experience.
“We aren’t held captive for the rest of our lives by the way the brain works in this moment-we can actually rewire it so
that we can be healthier and happier. This is true not only for children and adolescents, but also for each of us across
the life span.”
The Whole-Brain Child Daniel Siegel, M.D. & Tina Payne Bryson, Ph.D.
Plan B Step 1: Empathy
• Gather information about the problem from the child’s point of view.
• Kids have information that we badly need to solve the problem.
• Solving a problem begins by hearing a person’s concern, BUT the problem still needs to be solved.
PROBLEM SOLVING PLAN
CHILD'S NAME ______________________________________________________________________________________________________________________________ DATE ________________
UNSOLVED PROBLEM #1
Adult taking the lead on Plan B:
Kid concerns identified: (Empathy step)
DATE____________
Adult concerns identified: (Define the Problem step)
DATE____________
Solution agreed upon: (Invitation step)
DATE____________
Problem Solved?YES? _____ DATE___________
NO? _____ COMMENT:
UNSOLVED PROBLEM #3
Adult taking the lead on Plan B:
Kid concerns identified: (Empathy step)
DATE____________
Adult concerns identified: (Define the Problem step)
DATE____________
Solution agreed upon: (Invitation step)
DATE____________
Problem Solved?YES? _____ DATE___________
NO? _____ COMMENT:
UNSOLVED PROBLEM #2
Adult taking the lead on Plan B:
Kid concerns identified: (Empathy step)
DATE____________
Adult concerns identified: (Define the Problem step)
DATE____________
Solution agreed upon: (Invitation step)
DATE____________
Problem Solved?YES? _____ DATE___________
NO? _____ COMMENT:
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Drilling Strategies
• Reflective listening and clarifying statements• Ask the child what they are thinking in the
midst of an unsolved problem• Summarize & ask for more concerns• For more tips, see Drilling Cheat Sheet at
www.livesinthebalance.org/paperwork
DRILLING CHEAT SHEET
The goal of the Empathy Step is to gather information from the child about his/her concern or perspective on the The goal of the Empathy Step is to gather information from the child about his/her concern or perspective on the unsolved problem you’re discussing (preferably proactively). For many adults, this is the most diunsolved problem you’re discussing (preferably proactively). For many adults, this is the most diffifficult part of Plan cult part of Plan B, as they often find that they are unsure of what to ask next. So here’s a brief summary of different strategies for “drilling” for information:
REFLECTIVE LISTENING AND CLARIFYING STATEMENTSReflective listening basically involves mirroring what a child has said and then encouraging him/her to provide additional information by saying one of the following:• “How so?” • “I don’t quite understand” • “I’m confused” • “Can you say more about that?” • “What do you mean?”
Reflective listening is your “default” drilling strategy…if you aren’t sure of which strategy to use or what to say next, use this strategy.
ASKING ABOUT THE WHO, WHAT, WHERE/WHEN OF THE UNSOLVED PROBLEMEXAMPLES:• “Who was making fun of your clothes?”• “What’s getting the way of completing the science project?”• “Where is Eddie bossing you around?”
ASKING ABOUT WHY THE PROBLEM OCCURS UNDER SOME CONDITIONS AND NOT OTHERSEXAMPLE: “You seem to be doing really well in your work group in math…but not so well in your work group in social studies…what’s getting in the way in social studies?”
ASKING THE CHILD WHAT S/HE’S THINKING IN THE MIDST OF THE UNSOLVED PROBLEMNotice, this is different than asking the child what s/he is feeling, which doesn’t usually provide much information about the child’s concern or perspective on an unsolved problem.EXAMPLE: “What were you thinking when Mrs. Thompson told the class to get to work on the science quiz?”
BREAKING THE PROBLEM DOWN INTO ITS COMPONENT PARTSEXAMPLE: “So writing the answers to the questions on the science quiz is hard for you…but you’re not sure why. Let’s think about the different parts of answering questions on the science quiz. First, you have to understand what fferent parts of answering questions on the science quiz. First, you have to understand what ffthe question is asking. Is that part hard for you? Next, you need to think of the answer to the question. Is that part hard? Next, you have to remember the answer long enough to write it down. Are you having trouble with that part? Then you have to actually do the writing. Any trouble with that part?”
DISCREPANT OBSERVATIONThis involves making an observation that differs from what the child is describing about a particular situation, and it’s the riskiest (in terms of causing the child to stop talking) of all the drilling strategies.EXAMPLE: “I know you’re saying that you haven’t been having any difficulty with Chad on the playground lately, but I recall a few times last week when you guys were having a big disagreement about the rules in the box-ball game. What do you think was going on with that?”
TABLING (AND ASKING FOR MORE CONCERNS)This is where you’re “shelving” some concerns the child has already expressed so as to permit consideration of other concerns.EXAMPLE: “So if Timmy wasn’t sitting too close to you, and Robbie wasn’t making noises, and the floor wasn’t dirty, and the buttons in your pants weren’t bothering you…is there anything else that would make it difficult for you to participate in Morning Meeting?”
SUMMARIZING (AND ASKING FOR MORE CONCERNS)This is where you’re summarizing concerns you’ve already heard about and then asking if there are any other concerns that haven’t yet been discussed. This is the recommended strategy to use before moving on to the Define Adult Concerns step.EXAMPLE: “Let me make sure I understand all of this correctly. It’s hard for you to do your social studies worksheet for homework because writing down the answers is still hard for you…and because sometimes you don’t understand the question…and because Mrs. Langley hasn’t yet covered the material on the worksheet. Is there anything else that’s hard for you about completing the social studies worksheet for homework?”
Prepared with the assistance of Dr. Christopher Watson
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Plan B Step 2: Define Adult Concerns
• Allows adult to voice their concerns and perspective.
• Gives child opportunity to listen, reflect, perspective-take, show empathy, and consider how their behavior affects another person.
PROBLEM SOLVING PLAN
CHILD'S NAME ______________________________________________________________________________________________________________________________ DATE ________________
UNSOLVED PROBLEM #1
Adult taking the lead on Plan B:
Kid concerns identified: (Empathy step)
DATE____________
Adult concerns identified: (Define the Problem step)
DATE____________
Solution agreed upon: (Invitation step)
DATE____________
Problem Solved?YES? _____ DATE___________
NO? _____ COMMENT:
UNSOLVED PROBLEM #3
Adult taking the lead on Plan B:
Kid concerns identified: (Empathy step)
DATE____________
Adult concerns identified: (Define the Problem step)
DATE____________
Solution agreed upon: (Invitation step)
DATE____________
Problem Solved?YES? _____ DATE___________
NO? _____ COMMENT:
UNSOLVED PROBLEM #2
Adult taking the lead on Plan B:
Kid concerns identified: (Empathy step)
DATE____________
Adult concerns identified: (Define the Problem step)
DATE____________
Solution agreed upon: (Invitation step)
DATE____________
Problem Solved?YES? _____ DATE___________
NO? _____ COMMENT:
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Plan B Step 3: Invitation Step
• Collaborate on a solution that is realistic and mutually satisfactory.
• Solution must logically and durably address the concerns of both parties.
• Both parties are learning how to resolve disagreements without conflict.
• *Review and repeat as-needed.
PROBLEM SOLVING PLAN
CHILD'S NAME ______________________________________________________________________________________________________________________________ DATE ________________
UNSOLVED PROBLEM #1
Adult taking the lead on Plan B:
Kid concerns identified: (Empathy step)
DATE____________
Adult concerns identified: (Define the Problem step)
DATE____________
Solution agreed upon: (Invitation step)
DATE____________
Problem Solved?YES? _____ DATE___________
NO? _____ COMMENT:
UNSOLVED PROBLEM #3
Adult taking the lead on Plan B:
Kid concerns identified: (Empathy step)
DATE____________
Adult concerns identified: (Define the Problem step)
DATE____________
Solution agreed upon: (Invitation step)
DATE____________
Problem Solved?YES? _____ DATE___________
NO? _____ COMMENT:
UNSOLVED PROBLEM #2
Adult taking the lead on Plan B:
Kid concerns identified: (Empathy step)
DATE____________
Adult concerns identified: (Define the Problem step)
DATE____________
Solution agreed upon: (Invitation step)
DATE____________
Problem Solved?YES? _____ DATE___________
NO? _____ COMMENT:
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But, wait….
• So, you’re saying that adults don’t get to be in charge anymore, right?
No, individuals (adults) get to communicate their expectations. If the other party consistently has difficulty meeting them, the two collaborate to find mutually-agreeable, durable solutions.
But it sounds hard, time consuming, and I’m not sure that it would even work
• Learning a new skill can be challenging.• It takes some time to become comfortable
with the model.• You will likely spend less time engaging in Plan
B discussions than Plan A battles, and you will teach skills over time.
Research Findings• CPS model found to be as effective, or better than
parent training in reducing symptoms of Oppositional Defiant Disorder in a pediatric population (Greene, Ablon, et al., 2004; Ollendicket al., 2015).
• Significantly reduced the number of restraintsand injuries in child/adolescent inpatient hospital (Greene, Ablon, & Martin, 2006; Martin et al., 2008).
• Successes in Maine Juvenile Justice System and Public Schools (Greene, 2016).
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Questions?
