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Aggression Replacement Training for Youth and their Caregivers

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Title: Aggression Replacement Training for Youth and their Caregivers


1
Aggression Replacement Training for Youth and
their Caregivers
2
Overview of Edgewood and its A.R.T. Model
3
What is Edgewood?
  • Established in 1851 as an orphanage
  • 1960s Residential Treatment Center for Children
    with emotional problems or in need of fostering
  • 1970s added School/Day Treatment Center for
    latency aged children
  • Mid 1980s Began Community and School Based
    Services, which include Kinship Support
    Services, School Based Services, Mental Health
    Services, Child Abuse Treatment Programs,
    Advocacy and Prevention Services.
  • Currently 375 employees and up to 500 volunteers
    a year, and serve 5,000 children and families
    each year, through a continuum of care from early
    intervention thru intensive residential services.

4
Mission Statement
  • To strengthen children, youth, families and their
    communities through service, training, advocacy,
    and research.

5
Our Core Values
  • Community-Based and Accessible.
  • Programmatically Strength-Based.
  • Family and Culturally Centered.
  • Collaborative Framework.

6
What is our Model
  • Received a two- year grant from San Franciscos
    Mayors Office of Criminal Justice (MOCJ) which
    funds programs for youth in the Juvenile Justice
    system.
  • Goal of the project is to bring evidence based
    CBT programs to youth who are on Juvenile
    Probation, but remain in their communities,
    living at home (although we do have some group
    home youth in our program).
  • Reduce recidivism of youth on Juvenile Probation.
  • Consists of 4 cycles a year within our outpatient
    clinic and includes a parent component (to align
    with our core values, and mission).

7
What is our Model
  • How It Is Implemented
  • 10 week-cycle
  • Youth attend 2 times a week for 1.5 hours
    Tuesdays and Thursdays
  • Parents attend 1 time a week for 1.5 hours on
    Thursdays
  • Groups occur in the early evening, so all can
    attend 500 to 630pm
  • 3 Monthly Family Dinner on Thursdays following
    group

8
What is our Model
  • Who
  • All referrals come from Probation Officers or
    other programs working with Juvenile Offenders,
    i.e. Public Defenders, CARC, etc
  • Youth who have been placed on Probation but
    remain in the community with a parent/caregiver
  • Age range 14-18 years old
  • Parents and Caregivers of youth participating
  • All youth and caregivers must go through an
    intake process

9
What is our Model
  • Who are the Staff
  • 1 20 hour clinician who provides supervision to
    the Youth and Family Outreach Coaches, and runs
    the youth group with one Youth and Family
    Outreach Coach
  • 3 20 hour Youth and Family Outreach Coaches
    these are B.A. level position, who co- lead the
    youth group and the parent group, as well as are
    assigned a caseload of the current groups youth
    and provide case management and family
    conferencing.
  • 1- (approx 5 hours a week) Program Manager, who
    provides supervision and oversight of program and
    budget

10
Sample Schedule
  • SCHEDULE FOR ART GROUPS
  • Thursday, January 10 Thursday, March 20, 2008
  • (Please submit all referrals by Friday, January
    4, 2008)
  • Tuesday and Thursday groups will be from
    500pm-630pm
  • We will be discussing Anger Control on Tuesdays
    and Skill-streaming on Thursdays. A family
    dinner will be served once a month for all youth,
    adults and staff from 630-700pm following
    group.
  • Weekly schedule
  • Thurs Jan 10 ART Introduction Pre-test
  • Tues Jan 15 Introduction to Anger
  • Thurs Jan 17 Responding to Failure / Parent Group
    (Monthly Dinner)
  • Tues Jan22 Triggers
  • Thurs Jan 24 Understanding the Feelings of Others
    / Parent Group
  • Tues Jan 29 Cues
  • Thurs Jan 31 Moral Reasoning 1 / Parent Group
  • Tues Feb 5 Anger Reducers
  • Thurs Feb 7 Negotiating / Parent Group
    (Monthly Dinner)
  • Tues Feb 12 Reminders
  • Thurs Feb 14 Using Self-Control / Parent Group

11
A.R.T. as an Outpatient Model
12
Outreach
  • Importance of creating a Brand to distinguish
    your mission and model of ART
  • Letters outlining purpose What we do? Who we
    serve?
  • Flyers that provide contact information and
    schedule of groups
  • Presentations at community organizations to build
    awareness
  • Attendance at staff meetings to create
    relationships, provide information, and collect
    referrals

13
Referral Process
  • Keep it SIMPLE!
  • Referral form should
  • Outline contact information of guardian
  • Provide contact number of referrer
  • Describe reason for youth being placed on
    probation (include court order, if applicable)
  • List other agencies involved with family
  • State expectations of outcome

14
Intake Process
  • Sets precedent and expectation for active
    involvement of providers
  • Confirms engagement of parents/guardian
  • Assesses for familys needs

15
Setting the Precedent
  • The Key Factor in successful treatment is
  • COLLABORATION!
  • Contact referrer to inform them that referral was
    received and to check if additional information
    needs to be relayed
  • Explain that on-going weekly contact will be made
    to share attendance and participation of youth
  • Opens the dialogue for easy communication between
    programs and/or providers, and thus builds
    relationship
  • Increases opportunity for additional referrals!

16
Confirming Engagement
  • The Message we want to give is
  • A.R.T. is not solely a class to drop youth off
    at!
  • because
  • Parents are encouraged to attend too!
  • In order to
  • Foster skills and to support, learn, and grow!
  • ???

17
Confirming Engagement (cont)
  • Since this is the first contact with the parent,
    it is important to-
  • Simplify the process of the intake and all the
    consent forms.
  • Explain the set-up of the 10 week ART cycle and
    provide a written program description and
    schedule.
  • Allow them adequate time to provide relevant
    history and background information on their
    family.
  • Treat them as the EXPERT in knowing their child,
    so they feel heard and understood, rather than
    shamed due to youths behaviors and/or choices.

18
Assessing Needs
  • A.R.T is typically an adjunct to other services,
    so be cognizant of exploring additional options
  • Discuss strengths of the family first, so that
    the areas of concern may be easier to express.
  • Inquire about any previous experience with
    programs and/or providers to know what worked
    well and what didnt.
  • Openly ask questions pertaining to hardships,
    difficulties, and challenges that the family
    faces and NORMALIZE!
  • Offer ideas and examples of resources available!
  • Determine level of openness to receiving other
    services and explain process of how this will be
    done. No surprise contacts from other providers!

19
Assigning Outreach Coach
  • Family needs
  • System Dynamics
  • Personalities
  • are matched to a
  • Family Youth Outreach Coach

20
Structure of Caregiver Component
21
Overview of Parent/Caregiver Component
  • Parent group occurs 1 day a week for 90 minutes.
  • Format and agenda of parent group similar to
    youth group.
  • Family dinners once a month
  • Observation of family
  • Reinforcement of skills
  • Building relationships
  • Guest Speaker
  • Case Management

22
Philosophy of Caregiver Component
23
Why Parent/Caregiver Involvement is Important for
Youth and Families
  • Promotes awareness of skills.
  • Helps parents develop skills.
  • Encourages continuity between behavioral
    expectations and reinforcement schedules in group
    and at home.
  • Creates a feeling of cohesion within the family
    unit.
  • Facilitates transference of skills to siblings
    and other family members.

24
Statistics Related to Parent/Caregiver
Involvement for Youth and Families
  • An estimated 1,600 persons under age 18 were
    murdered in the U.S. in 2002. About two-thirds
    (64) of these juvenile murder victims were male
    (1).
  • Teens who believed that their parents cared about
    and supported them were less likely to be exposed
    to weapon violence or to commit violence with a
    weapon (2)
  • Teens whose parents demonstrate positive
    behaviors on a number of fronts are more likely
    to engage in those positive behaviors themselves
    (3).

1-Snyder, H.N., Sickmund, M., op.
cit. 2-Henrich, C.C., Brookmeyer, K.A., Shahar,
G. (2005) 3-hAckard, D., Neumark-Sztainer, D.,
Story, M., Perry, C. (2006)
1
25
How to Frame Parent/Caregiver Participation in
Group
  • Empowerment of parent/caregiver
  • Help parents/caregivers realize their role in
    childs development.
  • Maintain a non-critical perspective.
  • Position the group as an opportunity for parents
    to develop their own skills.
  • Emphasize the supportive components of group.

26
How to Build Relationship and Rapport with
Parent/Caregiver
  • Acknowledge parents commitment.
  • Maintain flexibility within the group structure.
  • Provide parents with an opportunity to vent and
    seek support.
  • Promote group interaction and facilitate
    supportive communication between group members.

27
Supporting Families and Linking Them to Other
Services
  • A.R.T. Case Management
  • Family Conferencing
  • Kinship Support Services
  • EPSDT/Mental Health Services
  • Ongoing collaboration with probation officers
  • Possible collaboration with other service
    providers if necessary

28
Case Examples of Working with Youth and Families
29
Case 1High Family Involvement
  • Janine and Rico

30
Successes
  • Regular attendance by Rico and Janine.
  • Additional extended family support.
  • Family was responsive to case management.
  • Supportive of A.R.T. curriculum and
    interventions.
  • Janine and Rico able to share experiences and
    insights with other group members.

31
Challenges
  • Family dynamics sometimes volatile.
  • History of violence in the home.
  • Rico temporarily lived with another family
    member.
  • Rico witnessed two fatal shootings.
  • Family lived in violent neighborhood.

32
Case Management
  • Collaborated with probation officer, school staff
    and football coach.
  • Assisted Janine with finding work.
  • Scheduled regular meetings and phone contact with
    family to support Rico in various settings.
  • Referred family to individual and family therapy
    at Edgewood.

33
Case 2High Parent InvolvementLow Youth
Involvement
  • Diana Mark

34
Successes
  • Regular parent attendance.
  • Responsive to case management.
  • Diana was open to services and supportive of
    A.R.T. interventions.
  • Diana was willing to share her perspectives and
    insights with other group members.

35
Challenges
  • Mark did not attend groups regularly.
  • Parent history of drug use and inconsistent
    parenting.
  • Family living in violent neighborhood.
  • Mark diagnosed with ADHD, ODD, and depression.

36
Case Management
  • Scheduled regular meetings with Diana to assess
    Marks needs.
  • Brainstormed about ways to engage Mark in groups.
  • Collaborated frequently with Probation Officer.
  • Supported Diana in personal and professional
    development.

37
Case 3High Youth InvolvementGradual Family
Involvement
  • Laura and Jamal

38
Successes
  • Jamal regularly attended group.
  • Laura increased her level of engagement
    throughout the cycle.
  • Family was responsive to case management.
  • Laura supported A.R.T. interventions at home.

39
Challenges
  • History of domestic violence.
  • Mother extremely anxious and reluctant to leave
    home.
  • Sibling with special needs.
  • Family living in dangerous neighborhood.
  • Family experienced communication challenges with
    probation officer.

40
Case Management
  • Provided family with food and clothing.
  • Assisted Laura with finding a job.
  • Collaborated with probation officer.
  • Transported family for safety reasons.
  • Referred family for additional mental health
    services.

41
Other Factors to Consider in Development of
Outpatient Model
42
Behavior Management
  • Clarify rules and expectations
  • Praise desired behaviors
  • Ignore unwanted behaviors
  • Use of reminders, prompts, and redirections
  • Arrange seating, if necessary
  • Provide needed materials, snacks, and breaks
  • Remove stimulating objects
  • Maintain calm and soothing classroom space
  • Involve parent/caregiver through phone calls and
    meetings

43
Impact of Community Violence on Families during
A.R.T Cycles
  • Multi-generational family history of trauma
    and/or crime
  • Fragmented families
  • Placed in group homes
  • AWOL and/or run-away youth
  • Involved in or living amidst turf wars
  • Verbally threatened and physically attacked in
    the community
  • Injured by gunshot and drive-bys
  • Witnessed serious crimes, violence, and death

44
Future Plans for Edgewood A.R.T.
45
Future Program Development
  • Parent Partner Hire a parent to co-facilitate
    the parent Group
  • Explore ways to have open enrollment
  • Bring ART groups to schools
  • How to include in existing curriculum
  • At all grade levels
  • Involve families

46
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