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Research concerning the Research concerning the implementation of Life Space implementation of Life Space Crisis Intervention and a Crisis Intervention and a multi-level token economy multi-level token economy systemsystem
Ilse Goethals
Eline Spriet
Population Population Adolescents with EBD in Flanders (D’Oosterlinck et al., 2006)
DSM IV diagnose ‘attention deficit hyperactive disorder’ (ADHD), ‘conduct disorder’ (CD), ‘pervasive developmental disorder’ (PDD), problems related to physical or sexual abuse, ‘other disorders of infancy, childhood and
adolescence’ such as ‘separation anxiety disorder’ and ‘reactive attachment disorder’.
CBCL (Child Behavior Checklist) High levels of externalising and internalising problem
behaviour (aggression) and a lack of social competences
D’Oosterlinck, F., Broekaert, E., De Wilde, J., Bockaert, L.F. & Goethals, I. (2006). Characteristics and Profile of Boys and Girls with Emotional and Behavioural Disorders in Flanders Mental Health Institutes: A Quantitative Study. Child: Care, Health and Development, 32 (2), 213-224
School School HomeHome Teachers and other
staff-members (n=26) Average age: 41 Gender
female = 20 % male = 80 %
years of employment 1 - 12 years = 61 % 13 - 24 years = 26 % 25 - 37 years = 13 %
Educators and other staff-members (n = 38) Average age: 41 Gender
female = 54 % male = 46 %
years of employment 1 - 12 years = 58 % 13 - 24 years = 5 % 25 - 37 years = 37
%
Research aims of the project Research aims of the project
2006 - 20082006 - 2008 20062006
Aim 1: detect specific problem areas Aim 1: detect specific problem areas Aim 2: develop a test-battery to objectify the Aim 2: develop a test-battery to objectify the
problem areasproblem areas 20072007
Aim 3: evaluate the implementation of LSCI and Aim 3: evaluate the implementation of LSCI and the token economy level-systemthe token economy level-system
Aim 4: follow-up 2007Aim 4: follow-up 2007 20082008
Aim 5: follow-up 2008Aim 5: follow-up 2008
Aim 1: Detect problem Aim 1: Detect problem areasareas
Method Instruments
Observations in class-rooms and in the living-groups Analysis of documents Unstructured conversations
Subjects: Youngsters Teachers Educators Staff-members External partners
Analysis All interviews were tape-recorded and transcribed Content analysis with a qualitative software package
(WinMAX). Coding hermeneutic units by two groups Tree-structure of categories and subcategories
ResultsResults Main problem areas
Cooperation between school and the home
Not enough support Feeling of insecurity High amount of Truancy Disruptive behaviour Conflicts between youngsters
Aim 2: Aim 2: Objectify problem Objectify problem areasareas
Dawson, C. A. (2001). Crisis Intervention Training and Support for School Staff of Junior High School Special Education Students Emotional Disturbances. Unpublished dissertation. Nova South-Eastern University, Florida, U.S.A.
D’Oosterlinck, F., Goethals, I., Broekaert, E., Schuyten, G., De Maeyer, J. (2008).Implementation and effect of life space crisis intervention in special schools with residential treatment for students with emotional and behavioral disorders (EBD).Psychiatric Quarterly, 79(1), 65-79.
Aim 2: objectify problem Aim 2: objectify problem areasareas
Method Instruments
Administrative registrations Self-report scales Surveys
Administrative registrations during 22 days (April-May) Truancy suspensions Transfers to more or less restrictive settings
Instruments (2)Instruments (2) Administrative registrations
Conflicts time and place of conflict people involved nature of the conflict according to LSCI
Critical incidents Verbal aggression Physical aggression Complaint of parents Nursery visits because of fight Access to bus was denied Police interference To buzz a staff member during the weekend
Instruments (2)Instruments (2)
Self-report scales YSR (Youth Self Report; 11 to 18 years)
measuring problem behaviour Main scales
Internalising behaviour Externalising behaviour Total Problem Behaviour
MASC (Multidimensional Anxiety Scale for Children; 11 to 19 years) measurements of dimensions of anxiety Main scales:
Physical symptoms Harm avoidance Social anxiety Separation anxiety Total anxiety
Instruments (2)Instruments (2)
BDHI-D (Buss-Durkee Hostility Inventory - Dutch) Measurement of aggression and hostility
Indirect aggression Direct aggression Social desirability
Instruments (2)Instruments (2) Surveys
CBCL (Child behaviour Checklist) rated by educators concerning the boys in their living-
group TRF (Teacher Report Form)
rated by teachers concerning their students Safety on the job
Self-developed questionnaire 6 statements level of feeling insecure due to:
Delinquent behaviour Deviant behaviour Verbal assault Physical assault Criminal offences Insufficient support and recognition
Rated by teachers and educators (n = 64) 5pt Likert-scale: (very low– very high)
Results: Safety on the jobResults: Safety on the job
Most employees feel very insecure because of the verbal assaults of youngsters
Teachers experience higher levels of insecurity as a result of delinquent and aggressive behaviour, when compared to educators
Men, more than women, experience high levels of insecurity due to verbal assaults, aggressive and out of bound-behaviour of youngsters
‘Age’ and ‘years of employment’ is not specifically related to high or low levels of insecurity
Aim 3: LSCI & Level-Aim 3: LSCI & Level-SystemSystem
evaluation of the evaluation of the implementationimplementation
Method
Self-developed survey 20 statements
Knowledge and use of LSCI Knowledge and use of Level-System
Example: “I understand how a youngster can move from level 1 to level 2”
Crisis management team
Rating scale: ‘yes’, ‘no’, sometimes’
Result:
Most respondents (70%) have sufficiant knowledge on how to implement the Level-
System are un-afraid to confront a youngster when he has lost points for
inappropriate behaviour agree that an LSCI conversation can help the youngster support the basic assumptions of LSCI are pleased with the crisis team during school ours
70% of the respondents state they: are not having LSCI conversations with youngsters who lost
points due to inappropriate behaviour have insufficient knowledge about the rewards per level are unhappy with the crisis team (residential) do not register LSCI conversations have little knowledge on how to organise the follow-up of
youngsters who are in level 4 need more support to implement LSCI
Aim 4: follow-up 2007 Aim 4: follow-up 2007
Test-battery: Administrative registrations
Self-report scalessurvey
Results: Administrative registrations
01020304050607080
%
0-33 34-68 69-102
number of hours
Truancy
2006
2007
Results: Administrative registrations
Number of suspensions: 2006 = 3 2007 = 2
Number of transfers to more restricted settings: 2006 = 1 2007 = 0
Results: Administrative registrations
117
81
48
28
0
50
100
150
200
2006 2007
Number of conflicts
School
Home
Results: Administrative registrations
Place and time in 2006: Most conflicts occurred: during classes (24%),
other situations (17%) at the play area (13%)
At the beginning of the week (60%)
due to problems with other peers (59%) and/or
due to problems with rules and boundaries (42%) and/or
problems related with negative self image (38%) and/or
Problems with adults (32%)(teachers/educators)
Place and time in 2007: Most conflicts occurred: at the play area (29%),
during meals (19%), during their free-time (17%)
at the end of the week (42%)
due to problems with other peers (69%) and/or
problems related with negative self image (15%) and/or
due to problems with rules and boundaries (11%) and/or
Problems with adults (11%) (teachers/educators)
Results: Administrative registrations
Number critical incidents 2006: n = 147 2007: n = 65
Significant results: Day of the week: X²=16,3; p<0,001
In 2007, critical incidents occurred most at the end of the week (41%) whilst in 2006 most incidents occurred in the beginning of the week (60%)
School year: X²=7,92; p<0,05 In 2007, most incidents arose in the 1st and 2nd
school year (53%) compared to 2006 (43%) Type of critical incident: X²=23,38; p<0,001
Results: Administrative registrations
Year
20072006
Co
un
t120
100
80
60
40
20
0
critical incidents
refer to nurse
complaint of parent
police intervention
verbal assault
physical assault
Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Internalising problem Average ‘Internalising problem
behaviour’ behaviour’
52
54
56
58
60
62
64
66
YSR CBCL TRF
2006
2007
Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Externalising problem Average ‘Externalising problem
behaviour’behaviour’
54
56
58
60
62
64
66
68
70
72
YSR CBCL TRF
2006
2007
Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Total problem Average ‘Total problem
behaviour’behaviour’
52
54
56
58
60
62
64
66
YSR CBCL TRF
2006
2007
Results: MASCResults: MASCAverage anxietyAverage anxiety
MASC
4445464748495051
Fysic
al sy
mpt
oms
soci
al an
xiet
y
avoi
ding d
amag
e
sepa
ratio
n anx
iety
tota
l anxi
ety
2006
2007
Results: BDHI-D Results: BDHI-D hostility and aggressionhostility and aggression
0
2
4
6
8
10
12
14
direct aggression indirectaggression
social desirability
2006
2007
Aim 5: follow-up 2008 Aim 5: follow-up 2008
Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Internalising problem Average ‘Internalising problem
behaviour’ behaviour’
50
52
54
56
58
60
62
64
66
YSR CBCL TRF
2006
2007
2008
Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Externalising problem Average ‘Externalising problem
behaviour’behaviour’
56
58
60
62
64
66
68
70
72
YSR CBCL TRF
2006
2007
2008
Results: YSR/CBCL/TRFResults: YSR/CBCL/TRFAverage ‘Total problem Average ‘Total problem
behaviour’behaviour’
54
56
58
60
62
64
66
68
70
72
74
YSR CBCL TRF
2006
2007
2008
Results: MASCResults: MASCAverage anxietyAverage anxiety
MASC
363840424446485052
Fysica
l sym
ptom
s
socia
l anx
iety
avoid
ing da
mage
sepa
ratio
n anx
iety
tota
l anx
iety
2006
2007
2008
Results: BDHI-DResults: BDHI-Dhostility and aggressionhostility and aggression
0
2
4
6
8
10
12
14
directaggression
indirectaggression
socialdesirability
2006
2007
2008
Discussion
Administrative data 2008 will be collected in May and June
Limitations of this research: No experimental design No control on administrative registration No assurance on quality of LSCI conversations Self-report scales and social desirable answers