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Anger Management Training:What they didn’t teach you in
Graduate School!
Presented byRance L. Harbor, Ph.D.
School PsychologistHillsborough County Public Schools
University of South FloridaSchool Psychology ProgramEmail: [email protected]
FASP 2010
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Overview
In addition to providing traditional School Psychology services, School Psychologists are increasingly being asked to provide counseling with elementary, middle and high school students.
These services are often being requested for both special education and regular education students.
Deciding who receives counseling, how often, what format, and if the counseling is having a positive impact can be as challenging as providing the counseling itself.
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Overview
The goal of this workshop is to provide the practitioner with skills on how to plan, implement, and manage counseling sessions effectively.
Information presented will include both literature based material and knowledge gained from personal experience.
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• Take it slow-don’t feel the pressure to rush!
• Make out your plan ahead of time
• Discuss it with your administrator and all parties involved.
• Discuss with other support staff what you will be providing and how to interface with them.• Guidance Counselors• Administrators• School Social Worker• School Nurse
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Areas to be covered….
How to select students for your AMT using a RtI based referral process that includes various individuals and/or resources within the school setting.
How to decide between individual or group sessions.
How to select what model, format and/or curriculum to use for the counseling sessions.
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Areas to be covered…. How to monitor progress in the school
setting using the Response to Intervention model.
How and when to access additional resources.
Following the model that good assessment leads to good intervention, the participant will be exposed to several assessment tools and strategies that are available to help identify appropriate treatment goals.
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Definition of Anger (Novaco )
Anger vs. AggressionNot all acts of aggression are
preceded by anger, nor are all instances of anger
necessarily followed by overt aggression,
However…it is true that very frequently anger leads to overt aggression.
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Definition of Anger (Novaco )
Anger is thought to consist of a combination of : physiological arousal and cognitive labeling of that arousal as
anger. Anger arousal results from
particular appraisals of aversive events.
External circumstances provoke anger only as mediated by their meaning to the individual.
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Types of Anger Instrumental
The anger is occurring in order to achieve some goal that the student feels cannot be achieved without the anger or aggression.
This anger often comes from a history of using anger successfully to achieve goals and is often learned through observation of others (peers, family).
It is more likely to be -planned- and based upon a history of reinforcement of its use.
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Types of Anger Instrumental (cont…)
Often, these students have both knowledge of and skill in alternative (more acceptable) behaviors.
However, the use of anger is more powerful, results in more immediate gratification, and has a high stimulation value.
It is often difficult to find alternative choices for the student that have a reinforcing value as great or greater than the use of instrumental anger.
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Types of Anger Reactive
The anger is in response to some act of provocation or a specific situation. Usually the student is attempting to avoid or escape with this type of response. This anger is most likely the result of
(a) over labeling of arousal as anger and being overly sensitive to hostile cues
(b) limited repertoire of solutions to and alternatives for anger and aggression
(c) limited or nonexistent training (parenting) in anger control and limited or nonexistent models demonstrating that control
(d) intense levels of arousal during interpersonal conflict situations
(e) usually present in students described as "impulsive".
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Characteristics of Aggressive Students Social- Cognitive Appraisals
Overly Sensitive to Hostile Cues Bias in Attributing Hostile Intention to Others Underestimate Own Aggressiveness
Social Problem Solving Limited Repertoire of Non-Aggressive Solutions Aggressive Back-Up Solutions
Appraisal of Internal Arousal Over labeling of Affective Arousal as Anger Low Levels of Empathy
Cognitive Operations Difficulty in Sustaining Attention Commission of Errors in Short Term Memory
Arousal System Intense Levels, Labeled as Anger Anxiety Component, Preceding Anger Episode Inhibitions to Appropriate Expression of Anger
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Characteristics of Non-aggressive Students Social- Cognitive Appraisals
Perspective Taking Skills Attributing Non-hostile Intention likely
Social Problem Solving Wide Range of Social Skills in Areas of Verbally Mediated
Solutions Appraisal of Internal Arousal
Able to Label Affective Arousal Across a Number of Dimensions, Including: Anxiety, Fear, Frustration, as well as Anger.
Perspective Taking Cognitive Operations
Reflective Productive Self-Guiding Private Speech
Arousal System Lower Levels, Wider Labeling Appropriate Expression of Anger Acceptable
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Referral Sources
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• Administrators• Guidance Counselors• School Nurses• School Social Workers• Behavior Specialist• Intervention Specialists• Speech/Language Therapist• Teachers• Parents• IEP
Who are our referral resources?
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Who are our referral resources?
STUDENTS!
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Tier III: Intensive Interventions( Few Students)
Students who need Individual Intervention
Tier II: Targeted Group Interventions
(Some Students)Students who need more support in
addition to school-wide positive behavior program
Tier I: Universal Interventions
All students; all settings
17
The Problem Solving/RtI Process with AMTThe Problem Solving/RtI Process with AMTThe Problem Solving/RtI Process with AMTThe Problem Solving/RtI Process with AMT
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Tier 1 IdentificationScreening
Level 1 Screener (Harbor)
Teacher Report Form (Harbor)
Parent Feedback Form (Harbor)
Discipline ReportsTimeout Reports
Tier 1
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Student Survey
Behavior Not at All
Some Very Much
1. How motivated are you to stay in school? 1 2 3
2. Do you believe you will be able to graduate? 1 2 3
3. Do you think you can pass Algebra? 1 2 3
4. Do you think you will pass the FCAT Math? 1 2 3
5. Do you think you will pass the FCAT Reading? 1 2 3
6. Do you think you think you will pass the ACT or SAT? 1 2 3
7. How well do you understand your teachers when they are teaching?
1 2 3
8. How well do you understand what you read in your text books? 1 2 3
9. Do you think you can make all A, B, or C grades? 1 2 3
10. How much do things at home interfere with you being successful at school?
1 2 3
11. How much do things in your neighborhood interfere with you being successful at school?
1 2 3
12. How safe do you feel at school? 1 2 3
Please rate how much the following questions apply to you by circling the appropriate number.
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Student Survey
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Who do you feel comfortable going to for help if another student, or an adult at school, was harassing or bullying you? (Check all that apply and write a specific name of the person if you want.)
Teacher(s) _________________ Administrator _________________ School Resource OfficerSchool Psychologist School Social Worker Guidance Counselor School Nurse A Friend Parent (s) ______________ Nobody
Student Survey
What things about school worry you the most? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What things could we do to help you do better in school? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Teacher SurveyPlease rate this student’s behavior by circling the appropriate number.
Current Grade (estimate): A B C D F Academic Concerns, if any: ___________________________________________Behavior Concerns, if any: ____________________________________________
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Parent Survey
Never occurred
Present within the past year
Present for over a year.
1. Difficulties with reading. 2. Difficulties with math. 3. Difficulties with writing. 4. Failing/low grades. 5. Has been in Special Education. 6. Difficulties with behavior. 7. Difficulties with attendance. 8. Difficulties with skipping class. 9. Difficulties with anger. 10. Difficulties with fighting. 11. Difficulties with teachers. 12. Difficulties with peers. 13. Frequent school changes. 14. Victim of being bullied 15. Bulling Others 16. Accused of Sexual Harassment 17. Other:
SCHOOL HISTORYFill in the circle that best describes the events in school that the student has experienced.
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Parent Survey
Never Within the past year
Prior to the past year
38. Parent divorce
39. Parent separation
40. Parent remarriage
41. Change in parental custody
42. Placement in a group/foster home
43. Serious illness of a parent or sibling
44. Death of a parent or sibling
45. Moved to a different home
46. Incarceration of a parent
47. Incarceration of a sibling
48. Other
Fill in the circle that best describes any events that have occurred within the family.
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Parent Survey
Never Within the past year
Prior to the past year
54. Allergies
55. Asthma
56. Diabetes
57. Ear Infections/Hearing loss
58. Heart Condition
59. Seizures
60. Serious head injury
61. Vision problems
62. Other:
Fill in the circle that best describes any health events experienced by the student.
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Parent Survey
None Occurred some
Occurred often
64. Prenatal exposure to tobacco.
65. Prenatal exposure to alcohol.
66. Prenatal exposure to drugs.
67. Complications during pregnancy.
68. Complications during birth.
69. Complications/ concerns after birth.
70. Developmental delays.
Fill in the circle that best describes any pre/post-natal events that MAY
have occurred.
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Tier 1 Interventions Have School-Based Social Skills
Program in Place Include AMT Interventions
Add AMT to the Peer/Social Classes Look for curriculum AMT via TV (morning show format)
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Tier 2 Identification
Lack of Progress with Tier 1 Interventions Break into subgroups
Reg & ESE Look at Intensity and Frequency
Teacher Timeout logs Principal Office Sign In Teacher Feedback Parent Feedback/Input
When to use parent feedback and how
Tier 2
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Tier 2 Interventions Add AMT to ISS
(via TV/Worksheets) Computer Software Programs
ABE Software (http://abeintervention.com)
Have mentors learn AMT Group Therapy Based Interventions
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Tier 2 Interventions Group Therapy Based Interventions
Prepare Curriculum (http://www.researchpress.com/product/item/5063)
Arnold Goldstein, Ph.D
Project Achieve (http://www.projectachieve.info) Howard Knoff, Ph.D.
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Tier 2 Interventions Group Therapy Based Interventions• RETHINK E. Fender• RETHINK is an acronym and stands for:
R - recognizing when you are angry E - empathizing and seeing other's point of view T - thinking about what gets you angry H - hearing where the other person is coming from I - integrating anger with love and respect N - noticing what your body feels like when you're angry
K - keeping the conversation in the present
Defusing Anger and Aggression Video/Manual Geoffrey Colvin, Ph.D.
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Tier 2 Interventions Group Therapy Based Interventions• Second Step http://www.cfchildren.org/programs/ssp/overview
Defusing Anger and Aggression Video/Manual Geoffrey Colvin, Ph.D.
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• Interpersonal Problem Solving Model• Spivack and Shure
• Alternatives to Violence Project• Quaker Peace Center
• http://www.quaker.org/visalia/AVP/index.html
Tier 2 Interventions
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• Factors to consider• Purpose of the intervention• Age of the student• Severity or Frequency of the Situation• ESE (IEP Driven) • Letter of intent/passive consent• Consultation Referral• Permission Letter• Consultation Referral or Referral for ESE
What about permission to see the student?
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Do I do Group or Individual Sessions?
Age Grade Gender Social skill level Level of understanding Background/Past experiences Number of students in need Presenting problem Underlying issues Psychological factors
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Do I need to provide extra incentives?
• Games (tie in to AMT)• Prizes (Tie in to Positive Praise)• Letters to Home, Teacher, Court• Food• Parties• Verbal Praise• Extra Time with
Therapist/Teacher/Administrator• Other
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How much do I communicate?
• Student/Client• Teacher• Peers• Parent• Courts• SRO• Agencies, HKI, Group Home
• How do I communicate with others about the sessions, goals, progress, expectations?
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Specifics on AMT “Groups”
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Who do we include as co-facilitator or do we? (Advantages and Disadvantages)
• Teacher• Administrator• Other support staff • Older student• Parent/Volunteer• Intern/Practicum Student
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How do we make up the group?Advantages and Disadvantages
• Males, Females or co-ed.• Homogenous vs. Heterogeneous groups based on:
• type of problem• severity of problem• past experiences• reaction style.
• Age/Grade differences.• Regular Ed, ESE, or Mix.• Similar demographics.
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How many in the Group?Advantages and Disadvantages
• Intensity, Frequency, Duration of presenting problem.
• Past experience in groups• Past experience with you• Motivating factors
• Court ordered, LRE, internal desire• Type of Problem • Minimum #, Maximum #
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Where do we meet for group?Advantages and Disadvantages
• Classroom where the problem exists?• Empty classroom• Your office• Conference Room• Guidance Suite• Peer classroom• Auditorium• Cafeteria• Stage• Others
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Group SpecificsAdvantages and Disadvantages
• How many sessions for the group?• 4-6• 8-12• 9 wks• 1 semester• all year• Set start and stop date vs. Students entering
as the year progresses.
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Group SpecificsAdvantages and Disadvantages
• When to have the group?• What day of the week
• Mon, Tue, Wed, Thu, Fri• What time of the day
• HR/1st period, Lunch, Free Time, PE, Last period
• How much time for group?• Full Class period• Hour• 30 Minutes• Other?
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Issues for both Individual or
Group Sessions
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What model do I use?
Cognitive Behavioral Interpersonal Problem Solving Model Behavioral Humanistic Freudian Free-styling
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Types of Models/CurriculumsAdvantages and Disadvantages
• Cognitive Behavioral • Models/ Individual Sessions
• Child and Adolescent Therapy: Cognitive- Behavioral Interventions (Philip Kendall)
• Cognitive Therapy with Children and Adolescents: A casebook for clinical practice (Reinbeck, Dottily, & Freeman)
• Curriculum for Groups• E. Fender (RETHINK)• A. Goldstein (PREPARE CURRICULUM) • Second Step
• http://www.cfchildren.org/programs/ssp/overview/
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What type of CurriculumAdvantages and Disadvantages
• Look at the curriculum and match to your group.• Elementary, Middle School, High School
• Examine what model and if it fits your belief.• Many authors will allow you to examine the curriculum.
• Is it evidence based?• Read closely and do independent research to find out.
• Has it been used with your population and topic/concern?
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What type of CurriculumAdvantages and Disadvantages• Do you follow it by script or make your own
changes?• Do you make your own curriculum?• Do you mix your curriculum?• Do you mix Didactic Group with Process
Group?• What does it require your client to do?
• Read• Write• Role Play• Home work assignments.• Watch video tapes• Playing Games
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Components of Cognitive-Behavioral
Anger Management Training Cognitive Preparations
The student is taught about the cognitive, physiological and behavioral aspects of anger, its positive and negative functions, and especially its antecedents.
Skill Acquisition The student learns alternative coping skills to utilize in
response to provocations.
Application Training Makes use of imagination and role-play inductions of anger
and homework assignments to facilitate proactive of the coping skills acquired-- particularly skills in self-instruction (Novaco).
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Components of Anger Management Training
Modeling use at least two examples for each demonstration select scenarios that are relevant to students scenarios should result in positive outcomes,
never negative ones main actor should be portrayed as a person
reasonably similar in age, socioeconomic background, verbal abilities, and other salient characteristics to the people in the group.
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Components of Anger Management Training
Role Play just before beginning, remind the students of their
parts; the main actor must use the anger control techniques and the co-actor should try to stay in his or her described role in the scenario.
instruct the observing group members to pay attention to whether the anger control techniques are being used properly by the main actor .
as the role play unfolds, if either actor "breaks role", stop the scene and encourage him or her to get back into role.
if the role play is clearly departing from the anger control techniques to be practiced, stop the role play, give whatever instructions are needed and then restart the role play.
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Components of Anger Management Training
Role Play the role playing should continue until each
student has had the opportunity. to be the main actor and practice using the
techniques in a situation he or she has really encountered or is about to encounter.
role play is optional and voluntary.
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Components of Anger Management Training
Performance Feedback feedback always comes from the peers
first. provide reinforcement for those aspects
of the role play that were performed properly.
provide reinforcement to the co-actor for his or her help and cooperation.
provide reinforcement for specific behaviors in the role play.
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The Chain of Behavior that Students Learn
Cues the physiological and kinesthetic sensations that signal to
the individual his or her level of anger arousal. Reducers
techniques that in combination with reminders may reduce anger arousal--for example--deep breathing, counting backwards, imagery, considering consequences, etc.
Triggers external events and internal appraisals that serve as
provocations to anger arousal. Reminders
self-instructional statements that may function to reduce anger arousal. This model uses the "stop and think" sequence.
Self-Evaluation the opportunity to self-reinforce and/or self-correct
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Tier 3 Identification
Lack of success at Tier 2 Progress Monitoring from Groups
Teacher Feedback Teacher Feedback Sheet
Behavior Observation FBA results Discipline Referrals
Tier 3
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Tier 3 Interventions Individuall Therapy Sessions
With Psychologist, Social Worker, Guidance Counselor, Mentors
May need more than just regular AMT lessons/skill development Need to address additional factors
Family Academic Psychological
Anxiety, Psychosis Drug Use
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Tier 3 Interventions• Cognitive Behavioral Models for Individual
Sessions• Child and Adolescent Therapy: Cognitive-
Behavioral Interventions (Philip Kendall)
• Cognitive Therapy with Children and Adolescents: A casebook for clinical practice (Reinbeck, Dottily, & Freeman)
• Adapt Group Sessions to Individual Sessions (i.e., Prepare Curriculum)
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Outcome Measurement/RTIData Resources
•Behavior Observations•Behavior Checklists (teacher, parent, student)
CBCLBASCCONNERSCDISSRS
•Discipline Referrals•Timeout Logs•Teacher Notes•Customized Brief Rating Scales /Progress Reports*
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How can I do ALL THAT?
Remember… Past data can become baseline for
intervention!
Use it when you can
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RtIFor Elementary
Time on TaskReading (Fair)DisciplineAttendance
What Progress Monitors do we need to monitor?
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RtIFor Middle School
Reading (Fair)GPADisciplineAttendance
What Progress Monitors do we need to monitor?
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RtIFor High Schools
GPACreditsDisciplineAttendance
What Progress Monitors do we need to monitor?
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Discipline/Behavioral Data
Discipline History
0 0 0 2 0
18
10
16
0 0 0 2 0
26
18
53
0
10
20
30
40
50
60
1999-00(1st)
2000-01(2nd)
2001-02(3rd)
2002-03(4th)
2003-04(5th)
2004-05(6th)
2005-06(6th)
2006-07(7th)
Year/GradeReferrals OSS
Elementary School Middle School
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Discipline/Behavioral Data
Discipline HistoryReferrals for Aggressive Behaviors
4 4
2
4
2 2
1
3
0 0 0
1
0 00
1
2
3
4
5
BW1 BW2 BW3 BW4 AMTW1 AMTW2 AMTW3 AMTW4 AMTW5 AMTW6 AMTW7 AMTW8 FW1 FW2
Week #Referrals OSS
Baseline Post- TxAMT
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How and when to access additional resources.
Family Need to get the family involved
Medical Anxiety, Headaches, Health Concerns, etc.
Pharmacological Anxiety, Depression, ADHD, etc.
Tutoring Intensive Therapy
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How and when to access additional resources.
211http://www.211atyourfingertips.org
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For more information and/or materials contact:
Rance L. Harbor, Ph.D.School Psychologist
Hillsborough County Public Schools