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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
(Reviewed in Bloomquist & Schnell, 2002)
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
(Reviewed in Bloomquist & Schnell, 2002)
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
(Reviewed in Bloomquist & Schnell, 2002)
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)
(Reviewed in Bloomquist & Schnell, 2002)
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
(Reviewed in Bloomquist & Schnell, 2002)
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
Age Successful Child Struggling Child
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
Age Successful Child Struggling Child
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
Age Successful Child Struggling Child
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
Practitioner and Stages of Intervention in Struggling Child Model (continued)
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:_____________________________________________________________________________
Practitioner and Stages of Intervention in Struggling Child Model (continued)
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
Practitioner and Stages of Intervention in Struggling Child Model (continued)
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
Practitioner and Stages of Intervention in Struggling Child Model (continued)
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
(Chapter 4)(Chapter 4)
Success Plans
1. Teaching a Child Social Behavior Skills
2. Teaching a Child Social Problem Solving Skills
3. Promoting Positive Peer Affiliations
Developmental Age of Child
Younger
Older
Enhancing a Child’s Emotional Enhancing a Child’s Emotional DevelopmentDevelopment
(Chapter 5)(Chapter 5)
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
Developmental Age of Child
Younger
Older
Enhancing a Child’s Academic Enhancing a Child’s Academic DevelopmentDevelopment
(Chapter 6)(Chapter 6)
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
Developmental Age of Child
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
Developmental Age of Child
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
Developmental Age of Child
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
Developmental Age of Child
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
Step 4 - Practice with Charts
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
Step 7 - Practice with Charts
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
Developmental Age of Child
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
Parent Well-Being Success Plan 2:
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
Parent Well-Being Success Plan 3:
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