They don

1
They dont understand! Helping students with
emotional and mental health disorders succeed in
the classroom

• Richard Van Acker, Ed.D.
• University of Illinois at Chicago (M/C 147)
• 1040 W. Harrison
• Chicago, Illinois 60607
• [phone]
• vanacker_at_uic.edu

2
Mental Health Disorders

• Mental health problems cause major changes in a
  persons thinking, emotional state, and behavior.
  Mental health disorders disrupt a persons
  ability to work and to carry out their usual
  personal relationships. These problems impede
  the individuals ability to accurately perceive
  and/or process information (sensory input,
  language, etc.)

3
Functions of the Brain impacted by mental health
disorders
THINKING OR COGNITION
BEHAVIOR
PERCEPTION OR SENSING
PHYSICAL OR SOMATIC
EMOTION OR FEELINGS
SIGNALING (BEING RESPONSIVE AND REACTING TO THE
ENVIRONMENT)
4
Mental Distress vs. Disorder

• Distress
• A response to environmental challenges
• May be adaptive
• Usually short-term does not significantly
  impair functioning
• Should not be diagnosed.
• Usually does not require professional
  intervention
• Usually responds well to typical support and
  positive life-style activities

• Disorder
• Onset not tied to environmental challenges
• Frequently long-term and impairs functioning
• Must meet recognized diagnostic criteria
• Frequently requires professional intervention
• Usually responds well to evidence-based
  interventions
• Usually helped by appropriate supports and
  positive life-style activities

5
Seriousness of the Problem
Prevalence of Emotional Behavioral Disturbance
(EBD)
Population Proportions (9 to 17 year-olds)
5-9 Youth with EBD extreme functional
impairment 9-13 Youth with EBD, with substantial
functional impairment 20 Youth with any
diagnosable disorder
5-9
9-13
20
20
6
Common Mental Health Concerns

• Population as a Whole
• Depression 6
• Psychosis 1
• Anxiety Disorders 10
• ADHD - 4
• Anorexia Nervosa 0.2
• Total - 15 20

• Translation to the average classroom
• Depression 2 students
• Psychosis rare
• Anxiety Disorders 3 students
• ADHD 1 student
• Anorexia Nervosa rare
• Total 4 5 students

7
Four Most Problematic Disorders for School
Personnel

• Reactive Attachment Disorder
• Bi-Polar Disorder
• Attention Deficit Hyperactivity Disorder
• Oppositional Defiant Behavior

8
Time of Initial Occurrence for Common Behavior
Problems
Learning Disorders
Emotional and Behavioral Disorders
Conduct Disorder
Oppositional Defiant Disorder
Attention Deficit-Hyperactivity Disorder
Compliance Problems
Bi-Polar
Schizophrenia Drug abuse Bulimia Anorexia nervosa
Language Disorders
Depression Autism Rett Syndrome Aspergers
Syndrome Reactive Attachment Disorder
Birth 6 years
12 years 18 years
Wicks-Nelson Israel, 2003
9
Time of Initial Occurrence for Common Behavior
Problems
Learning Disorders
Emotional and Behavioral Disorders
Conduct Disorder
Oppositional Defiant Disorder
Attention Deficit-Hyperactivity Disorder
Compliance Problems
Bi-Polar
Schizophrenia Drug abuse Bulimia Anorexia nervosa
Language Disorders
Depression Autism Rett Syndrome Aspergers
Syndrome Reactive Attachment Disorder
Birth 6 years
12 years 18 years
Wicks-Nelson Israel, 2003
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Reactive Attachment Disorder

• Reactive attachment disorder (RAD) is a condition
  found in children who have received grossly
  negligent care and do not form a healthy
  emotional attachment with their primary
  caregivers -- usually their mothers -- before age
  5.
• This can occur for many reasons, including
• Persistent disregard of the child's emotional
  needs for comfort, stimulation, and affection
• Persistent disregard of the child's basic
  physical needs
• Repeated changes of primary caregivers that
  prevent formation of stable attachments (for
  example, frequent changes in foster care)

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There are two types of RAD inhibited and
disinhibited.

• Common Symptoms of Inhibited RAD Include
• Detached
• Unresponsive or resistant to comforting
• Excessively inhibited (holding back emotions)
• Withdrawn or a mixture of approach and avoidance
• Common Symptoms With Disinhibited RAD Include
• Indiscriminate sociability
• Inappropriately familiar or selective in the
  choice of attachment figures

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Why IS Attachment Important?

• Attachment is essential for the formation of a
  healthy personality which includes
• Development of a conscience
• Ability to become self-reliant
• Ability to think logically
• Ability to cope with frustration and stress
• Ability to handle fear or threat to self
• Development of relationships

13
Symptoms Displayed by Individuals with RAD

• Lack of self-control / impulsive
• Speech and language delays
• Lack of conscience / shows no remorse
• Indiscriminately affectionate with strangers
• Avoids physical contact
• Hyperactive

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Symptoms (Cont.)

• Aggressive
• Destructive towards self, property, and others
• Food issues hordes, gorges, refuses to eat,
  and/or hides food
• Often on guard anxious, wary
• Prefers to play alone
• Inhibition or hesitancy in social situations

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School Implications

• Children with RAD have difficulties
  self-regulating emotions and behaviors
• These children struggle to form typical,
  reciprocal relationships with peers and adults
• Self-regulatory and social skills are important
  prerequisites for school readiness and academic
  achievement

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The Unique School Challenge for Children with RAD

• While the school setting is meant to educate,
  children with RAD are primarily concerned with
  internal feelings of safety, security, and trust
• Greater degree of dependency on the teacher due
  to past disruptions in attachment (learned
  helplessness, and difficulty shifting between
  teachers)

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How can Teachers Help

• Be consistent, predictable, and repetitive
• Set clear, concise expectations
• Set and follow a classroom routine
• Model and teach appropriate social behaviors
• Maintain realistic expectations
• Ignore junk behaviors behaviors that are not
  harmful to the child, others ot to property

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How Teachers Can Help (Cont.)

• Be patient with the child (and yourself)
• Understand behaviors attempt to promote and
  reinforce desired behaviors punishment per se
  is ineffective
• Help the child learn to regulate his/her feelings
  and actions
• Utilize other resources for support (related
  services providers, the internet, etc)

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Bi-polar Disorder

• Bipolar disorder can be described as a
  psychiatric diagnosis of mood disorders. 
• The condition is defined by presence of 1 or more
  episodes that results from elevated energy
  levels, cognition, and mood imbalance such as
  depression episodes.

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Bipolar Disorder

• Symptoms of bipolar disorder include
• mania,
• hypomania,
• depression,
• racing thoughts,
• sleep disturbances,
• delusional or grandiose thinking,
• hypersexuality and
• risky behavior with no regards for the
  consequences.

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Accommodations for Individuals with BI-Polar
Disorder (Lesley, 2009)

• Delivering praise and positive reinforcement
• Provide counseling to them or referring them to
  counselors for assistances
• Offering peer assistance incentives and programs
• Decreasing distractions in school
• Provide frequent breaks when working
• Provide them with self-paced instruction,
  chunked assignments, and flexible  scheduling
• Provide clear, simple choices for desired
  behavior
• Keeping open channels of communication with them.

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School Accommodations (Cont.)

• Provide Structured Classroom Settings Students
  with Bipolar Disorder need to be in classrooms
  with high structure and predictability. This
  helps offset their cognitive and emotional
  impairments. The educational atmosphere of
  organization allows them to feel safe and
  accepted within their environments.
• Accommodations For short attention span, high
  activity level, organizational difficulties
  (e.g., frequent breaks movement built into the
  classroom schedule use of fidgets, lap buddies,
  etc. highly structured routines predictability
  visual supports, such as visual schedules, visual
  organizers for writing use of computer
  technology, software/keyboarding.
• Stress Management Help the student to recognize
  internal states, use stress reduction techniques.
  
• Problem Solving Skills Focus on teaching
  effective strategies for dealing with frustration
  and negative thinking. Help them develop a plan
  such as establishing a "cool down" or safe place
  to go when feeling upset

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Attention Deficit Hyperactivity Disorder

• ADHD is a disorder characterized by the symptoms
  of hyperactivity, inattention, and/or impulsivity
  that are more frequent and severe than is
  typically seen in one's peers

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ADHD - Inattentive Symptoms

• Fails to give close attention to details or makes
  careless mistakes in schoolwork
• Has difficulty keeping attention during tasks or
  play
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails
  to finish schoolwork or chores and tasks
• Has problems organizing tasks and activities
• Avoids or dislikes tasks that require sustained
  mental effort (such as schoolwork)
• Often loses toys, assignments, pencils, books, or
  tools needed for tasks or activities
• Is easily distracted
• Is often forgetful in daily activities

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ADHD - Hyperactivity Symptoms

• Fidgets with hands or feet or squirms in seat
• Leaves seat when remaining seated is expected
• Runs about or climbs in inappropriate situations
• Has problems playing or working quietly
• Is often "on the go," acts as if "driven by a
  motor"
• Talks excessively

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ADHD- Impulsivity Symptoms

• Blurts out answers before questions have been
  completed
• Has difficulty awaiting turn
• Interrupts or intrudes on others (butts into
  conversations or games)

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ADHD and the Brain

• Cortex of the brain is significantly thinner in
  people with ADHD especially in the frontal lobe
  areas of the brain.
• Less risk inhibition
• Poor attention
• Immaturity in specific brain structures in the
  limbic system - the inhibitory system regulating
  arousal and reward.

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Accommodations for ADHD

• Helping children with ADD/ADHD follow directions
  means taking measures to break down and reinforce
  the steps involved in your instructions, and
  redirecting when necessary.
• Seat the child with ADD/ADHD away from doors and
  windows. Put pets in another room or a corner
  while the student is working.
• Alternate seated activities with those that allow
  the child to move his or her body around the
  room. Whenever possible, incorporate physical
  movement into lessons.
• Write important information down where the child
  can easily read and reference it. Remind the
  student where the information can be found.
• Divide big assignments into smaller ones, and
  allow children frequent breaks.
• Reducing the interruptions of children with
  ADD/ADHD should be done carefully so that the
  childs self-esteem is maintained, especially in
  front of others. Develop a secret language with
  the child with ADD/ADHD. You can use discreet
  gestures or words you have previously agreed upon
  to let the child know they are interrupting.

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In children with Oppositional Defiant Disorder
(ODD),

• there is an ongoing pattern of uncooperative,
  defiant, and hostile behavior toward authority
  figures that seriously interferes with the
  youngsters day to day functioning. Symptoms of
  ODD may include
• Frequent temper tantrums
• Excessive arguing with adults
• Often questioning rules
• Active defiance and refusal to comply with adult
  requests and rules
• Deliberate attempts to annoy or upset people
• Blaming others for his or her mistakes or
  misbehavior
• Often being touchy or easily annoyed by others
• Frequent anger and resentment
• Mean and hateful talking when upset
• Spiteful attitude and revenge seeking

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ODD and the Brain

• The development of oppositional defiant disorder
  is associated with changes in the
  neurotransmitters of the brain.
• Neurotransmitters are chemical transmitters of
  impulses between nerve cells.
• Raising or lowering the level of
  neurotransmitters (i.e., deviation from the norm)
  leads to a sudden change in mood and changes in
  the thinking process because of impaired
  transmission of nerve impulses.
• Thats why people with ODD have
• a sense of irritation,
• they have no fear of punishment,
• they often cannot adequately perceive the reality
  and communicate normally,

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External Factors Impacting the Development of ODD

• The major familial external factors that
  contribute to the development of ODD disorder
• domestic violence,
• abuse (physical or sexual abuse),
• indifference of parents,
• disastrous financial situation (poverty), or poor
  quality of life,
• drug and alcohol use by parents.
• The major school-based external factors include
• excessive punishment or punishment for behavior
  outside the control of the student,
• abuse by adults and peers, and/or
• Indifference on the part of teachers

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Treatment

• Typically multimodal treatment involving
• Medication (e.g., anti-depressants, mood
  elevators, anti-anxiety medications, stimulant
  medications).
• Behavioral Interventions clear expectations and
  predictable contingencies designed to reduce
  problem behaviors and to facilitate student
  success.
• Cognitive Behavioral Interventions (e.g.,
  self-regulation, attributional retraining,
  cognitive restructuring)

33
World Health OrganizationModel for School Mental
Health Promotion
3-12
Students needing Additional Help
20-30
Whole School Environment
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Failure of school personnel to understand the
complex nature of behavior
Disability
Habit
Needs and Desires
Culture
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The Functional Assessment of Behavior

• The identification of the target behavior
• An informed hypothesis as to function of the
  behavior
• Data collection
• Indirect data collection
• Direct data collection
• Verification -
• Triangulation of data
• Functional analysis of behavior
• Developing the behavior intervention plan
• Program to decrease undesired behavior
• Program to increase desired alternative behavior
• Monitoring the implementation and evaluation

36
Behavior Problems can Occur for many different
reasons

• Attention
• Escape
• Tangible reward
• Peer Affiliation
• Justice or Revenge
• To communicate intent - if language impaired
• Indicate physical discomfort
• Indicate frustration or need for help
• Sensory/Perceptual Needs
• Stereotypic or self-injurious
• Sensory input needs

• Knowledge deficits
• Does not know what is expected
• Not enough practice of skill
• Has not learned to generalize skill

(Modified from Neal Cessna, 1993)
37
Maslows Hierarchy of Needs
38
Common Motives for Escape and Avoidance
Responding Behaviors
Fear
Safety
Threat Reduction
39
Common Motives for Escape and Avoidance
Responding Behaviors
Fear
Frustration
Safety
Self-Esteem or Competence
Threat Reduction
Lend Control
40
Common Motives for Escape and Avoidance
Responding Behaviors
Fear
Frustration
Safety
Self-Esteem or Competence
Threat Reduction
Lend Control
The need for AUTONOMY can also trigger escape or
avoidance.
41
Careful Observation to Identify Triggers

• Often as one of the people who spends the most
  time directly interacting with a student, you may
  quickly become aware of when a student moves away
  from his or her typical or baseline behavior.
• This may be signaled by an increase or a decrease
  in behavior.
• A critical skill in working with children like
  Robbie is to be good at observing triggers that
  may serve to move a student into a potential
  crisis situation.

42
Understanding the Crisis
Crisis
De-escalation
Escalation
Agitation
Trigger
Hangover/Recovery
Adapted from Managing the Cycle of Acting-Out
Behavior in the Classroom By Dr. Geoff Colvin
43
Understanding the Crisis
Crisis
De-escalation
Escalation
Agitation
Trigger
Hangover
Student Cognition
44
Understanding the Crisis
Crisis
De-escalation
Escalation
Staff Movement Away from Self Control
Agitation
Trigger
Hangover
Student Cognition
45
Understanding the Crisis
Crisis
De-escalation
Escalation
Staff Movement Away from Self Control
Agitation
Trigger
Hangover
Staff Cognition
Student Cognition
46
Understanding the Crisis
Crisis
De-escalation
Escalation
Agitation
Trigger
Hangover
Area of Greatest Influence
47
Lets Think About a Student

• Randy is a freshman
• Randy and his family have recently moved into the
  school district from another urban school
  district (Dade County Florida Miami).
• Randy is a very reluctant learner.
• At times, Randy can become disruptive to the
  classroom setting.
• Randy seldom completes the assigned work and
  almost never does homework

48

• The classroom teacher has assigned the class to
  read the next 6 pages in the Social Studies text
  and to answer the questions at the end of the
  chapter.
• Randy starts to try and do the lesson. He begins
  to look upset. He is displaying increased
  movement and he is starting to look around the
  room and to divert his attention from the task.
  He mumbles to himself and starts to actively
  protest that, This shit is stupid. Nobody cares
  about this crap.
• The teacher moves towards Randy and asks if
  everything is okay?
• Randy says, I dont know why we cant do this as
  a class or with partners. This is really
  boring!
• The teacher says, I know you can do this if you
  try just do your best
• Randy says, I hate this shit!
• The teacher says. Randy you need to watch your
  language. You can not cuss in this classroom.
• Randy says, Dont tell me what I can and can not
  do. You arent my boss!
• The teacher says, Randy, we have to all get
  along and do what is asked of us otherwise the
  classroom just wont work.
• In a loud voice, Randy says, Im tired of this
  bullshit. I hate this f___king class. Randy
  starts to get up to exit the classroom.
• The teacher steps in his way (to block his exit)
  and says, Sit down right now and do what I have
  asked you to do! Stop swearing!
• Randy says, F__k you! I am out of here!
• The teacher moves towards Randy and grabs his arm
  attempting to move him back to his seat.
• Randy shakes her hand off of his arm and pushes
  past her exiting the classroom.

49
Additional Information

• Randy is a student with both learning and
  emotional disorders (Anxiety Disorders).
• He can become overwhelmed very easily and often
  becomes frustrated and will either simply shut
  down or he will become argumentative (loud
  protests and threats to hurt others or to leave
  the instructional area).
• The text is written at the 9.4 grade level. Randy
  has 4.3 grade level decoding skills and even
  lower levels of reading comprehension.

50
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options









51
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read








52
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid







53
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?







54
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?







55
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring.






56
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best






57
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best






58
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit.





59
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss





60
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss





61
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss
Dont tell me what to do you are not my boss




62
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss
Dont tell me what to do you are not my boss We have to get along or school wont work




63
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss
Dont tell me what to do you are not my boss We have to get along or school wont work




64
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss
Dont tell me what to do you are not my boss We have to get along or school wont work
Tired of this bullsh_t, I hate this f_cking class



65
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss
Dont tell me what to do you are not my boss We have to get along or school wont work
Tired of this bullsh_t, I hate this f_cking class Stop swearing Sit down right now Blocks exit



66
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss
Dont tell me what to do you are not my boss We have to get along or school wont work
Tired of this bullsh_t, I hate this f_cking class Stop swearing Sit down right now Blocks exit



67
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss
Dont tell me what to do you are not my boss We have to get along or school wont work
Tired of this bullsh_t, I hate this f_cking class Stop swearing Sit down right now Blocks exit
F_ck you! I am out of here starts to exit


68
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss
Dont tell me what to do you are not my boss We have to get along or school wont work
Tired of this bullsh_t, I hate this f_cking class Stop swearing Sit down right now Blocks exit
F_ck you! I am out of here starts to exit Teacher grabs his arm and attempts to guide him to seat


69
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss
Dont tell me what to do you are not my boss We have to get along or school wont work
Tired of this bullsh_t, I hate this f_cking class Stop swearing Sit down right now Blocks exit
F_ck you! I am out of here starts to exit Teacher grabs his arm and attempts to guide him to seat


70
Debriefing
Student Behavior Staff Behavior Escalate Neutral Reduce Options
Teacher assigns 6 pages to read
Starts to look agitated This shits stupid Is everything ok?
Why not do this as a class, partners This stuff is boring. Try Do your best
I hate this shit. Watch your language cant cuss
Dont tell me what to do you are not my boss We have to get along or school wont work
Tired of this bullsh_t, I hate this f_cking class Stop swearing Sit down right now Blocks exit
F_ck you! I am out of here starts to exit Teacher grabs his arm and attempts to guide him to seat
Shakes her arm off - He pushes past teacher - exits

71
Understanding the Crisis
Teacher grabs his arm
Crisis
De-escalation
Teacher blocks escape
Need to do what is asked
Watch your language
You can do it if you try
Escalation
Reading Level
Agitation
Trigger
Hangover
72
Looking for a Win-Win
Crisis
De-escalation
Escalation
Agitation
Trigger
Hangover
What would have been some options to help engage
Jason in study of cell structure? 1. 2. 3.
73
Does anyone speed when you drive?

• Are there places you dont tend to speed?
• Generally has more to do with the likelihood of
  being caught than the nature of the fine.

74
Simple Consequence to Reduce High Rate Behaviors
75
Library Envelope System

• Make one library pocket card for each student

Number of cards based on baseline data student
need.
Joe
Sarah
Aaron
Mary
Lashika
Anita
Scott
Randy
Lashonda
Free ticket
2-3 minute delay to recess or passing
Detention loss of recess
76
Selecting Consequences

• Should develop, maintain, or maximize the
  relationship between the student and teacher.
• Should allow student to learn an alternative
  pro-social behavior.
• Should allow student to practice the alternative
  behavior.
• Should be rather quick and simple to apply.
• Should minimize student resistance.

77
Cognitive Behavioral Intervention

• CBI focuses on two general areas
• Cognitions target the students private speech
  about himself, the environment, and his future.
  Explores beliefs and attitudes.
• Behaviors targets specific behaviors that tend
  to reinforce or trigger maladaptive,
  dysfunctional or irrational thoughts, beliefs and
  attitudes.
• Cognitions Behaviors

Strives to have the student intervene on his or
her own behavior.
78
Self-Regulation/Self-Control

• Self-monitoring the ability to collect data or
  otherwise identify ones own thoughts and
  behavior.
• Self-evaluation to be able to judge ones
  performance accurately against some standard of
  performance.
• Self-reinforcement the ability to deliver
  self-praise or a reward contingently on the
  display of a specified desired behavior.

79
Commonly used materials and resources

• Cognitive techniques
• Emotion thermometer

10
9
8
7
6
5
4
3
2
1
0
Really scared or upset
Ask for help. Take a break. Count to 10
slowly. Take a few deep breaths. Self-praise
Pretty scared or upset
A little bit scared or upset
Not at all scared or upset
80
Student Recommended for CICO
CICO Implemented
CICO Coordinator Summarizes Data For Decision
Making
Morning Check-in
Parent Feedback
Regular Teacher Feedback
Bi-weekly Meeting to Assess Student Progress
Afternoon Check-out
Graduate Program
Revise Program
81
Student ___________________ Teacher
________________ Date________
Subject Area Subject Area Subject Area Subject Area Subject Area Subject Area Subject Area
Behavior Scoring Rubric Soc Stud Math Science Reading
Uses Kind words and actions Displays kind and welcoming behavior towards others Teases, taunts or displays rude or disrespectful behavior towards others Threatens harm or displays verbal/physical aggression towards others 4 1 0 4 1 0 4 1 0 4 1 0 4 1 0 4 1 0 4 1 0
Active Task Engagement On-task more than 85 of the interval On task more than 50 but less than 85 of the interval On-task more than 10 but less than 50 of the interval On-task less than 10 of the interval 3 2 1 0 3 2 1 0 3 2 1 0 3 2 1 0 3 2 1 0 3 2 1 0 3 2 1 0
Follows Teacher Directives Spontaneously complies to at least 90 of teacher directives Verbally protests but complies to at least 90 of directives Fails to comply to at least 25 of directives but does not engage in problem behavior Fails to comply to at least 25 of directives and engages in problem behavior 4 2 1 0 4 2 1 0 4 2 1 0 4 2 1 0 4 2 1 0 4 2 1 0 4 2 1 0
Stays in the Assigned Area Exits the classroom without permission (any time during interval) Out of seat or assigned area and fails to comply with initial request to return Remains in the seat or assigned area throughout the interval Out of seat or instructional area but returns the first time asked 4 2 1 0 4 2 1 0 4 2 1 0 4 2 1 0 4 2 1 0 4 2 1 0 4 2 1 0
Work Completion Work completed with reasonable level of effort (Not concerned with accuracy or neatness at this time) Effort expended at a reasonable level but work not completed Little or no work attempted 4 2 0 4 2 0 4 2 0 4 2 0 4 2 0 4 2 0 4 2 0
Comments
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Self-Instruction Training
(Meichenbaum Goodman 1971)

• Cognitive Modeling the teacher performs a task
  while talking aloud the student observes.
• Overt External Guidance The student and teacher
  both perform the task while talking aloud
  together.
• Overt Self-Guidance The student performs the
  task using the same verbalizations as the teacher
  (talk together).
• Faded Self-Guidance The student whispers the
  instructions (often in an abbreviated form) while
  going through the task.
• Covert Self-Guidance The student performs the
  task, guided by self-speech.

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Five Common Irrational /Dysfunctional Thoughts

• Arbitrary Inference the drawing of a conclusion
  when evidence is lacking or actually supports a
  contrary conclusion.
• Magnification exaggeration of the meaning of an
  event.
• Cognitive deficiency disregard for an important
  aspect of a life situation.
• Dichotomous Reasoning overly simplified and
  rigid perception of events as good or bad, right
  or wrong.
• Overgeneralization taking a single incident
  such as a failure as a sign of total incompetence
  and in this way generalizing a fallacious rule.

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Ethical Dilemma of Teachingin Todays Classroom

• The rise in the demand for greater accountability
  for student academic excellence has increased the
  anxiety level of both teachers and students.
• Increase in the display of mental health symptoms
  within the school setting.
• Increased levels of frustration and fear.
• Increased levels of student failure.

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Schools as Mental Health Service Providers
Service Provider Arrangement School Relationship Provider Type Services Barriers
Special Education Hired by school or school district School Psychologists Special Education Testing, IDEA implementation Time spent on testing, not accessible to all students
Stand Alone School Program School or school district hires providers or program Social Workers, child psychologists, teachers Counseling, Interventions for specific mental health issues Stigma, Time, Program cost
Community Linked School or school district contracts with organization for the provision of services Social Workers, child psychologists, psychiatrist, crisis counselors Varied crisis/ as needed to comprehensive mental health services Not linked to other school services, providing as needed does not address issue of lack of services
Other Service Provider Options May occur on school premises but not during school hours Varied Varied Not always linked to school services, may not reach all needy children
School Based Health Centers Located at or near schools Varied Varied Funding and space
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Mental Health Problems are Real!

• They impact the students ability to process
  information and to make rational decisions when
  disorder is displayed.
• Most teachers have no problem understanding that
  the nature of the demands they place on a student
  change when he is physically ill (e.g., having
  just thrown up or displaying a high fever).
• These same teachers often do not understand the
  need to address the student in a different manner
  when their mental health disorder is impacting
  the students behavior.

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Embedding Cognitive Behavioral Strategies Across
the School Day
Common Practices Common Opportunities Examples
Direct instruction of cognitive behavioral strategy along with an academic lesson (Double Dipping) Language Arts History/Social Science Physical Education Bibliotherapy selecting a book with a key social theme to teach language arts and social problem solving
Provide students with opportunities to practice strategies by carefully sabotaging an instructional or social situation. Physical Education Recess Science Keyboarding/Computer Lab Art Class Selecting teams that must share limited materials. Placing students in very close proximity to one another.
Incidental teaching Recess/Lunch Free time/ Transitions Solving social problems on the playground.
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Mental Health Problem Sample Components of CBI
Aggression Poor self control Impulsivity Guiding self statements ("Stop, Think Act") Positive self statements ("You can solve this problem") Verbal self-instructions ("What are all of my options to solve this problem?") Relaxation training (controlled breathing, progressive muscle relaxation) Reinforcement for using skills
89
Mental Health Problem Sample Components of CBI
Nighttime fears School refusal Separation anxiety Generalized anxiety Specific phobias Social phobia Obsessive Compulsive Disorder Recognition of faulty cognitions ("I can't go in that elevator" "Everyone will laugh at me when I give my talk") Positive self statements ("I can handle this" "I know that's just my anxiety telling me lies") Relaxation training Modeling, role playing, reinforcement for using CBT skills Exposure to a hierarchy of anxiety-producing situations
90
Linking Literature to Social Skill Development in
Students with Behavioral ChallengesBonnie
McCarty Gyneth Slygh (2004)

• Rationale for using bibliotherapy
• System to analyze literature for use with
  students
• Annotated bibliographies
• Sample lesson plans
• http//dpi.wi.gov/sped/doc/ebdlitsosk.doc-418.5K
  B

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Information Source

• The Wisconsin Department of Public Instruction
  has developed
• A Look at the Mental Health Needs of
  Children in an Educational Setting
• This resource lists the risk factors,
  symptoms, and possible school intervention
  strategies for a number of mental health
  disorders in children and youth. Including
• Anxiety Disorders
• Bipolar Disorder
• Borderline Personality Disorder
• Depression
• Obsessive Compulsive Disorder
• Oppositional Defiant Disorder
• Post Traumatic Stress Disorder, and
• Schizophrenia
• www.dpi.wi.gov/sped/doc/ebdmhfacts.doc

92
Questions?
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For More Information

• The Center for Health and Health Care in Schools
  www.healthinschools.org
• Center for Mental Health Serviceshttp//www.menta
  lhealth.org/cmhs/
• Mental Health The Surgeon General's Report
  http//www.surgeongeneral.gov/library/mentalhealth
  /toc.htmlchapter3
• National Institute of Mental Health
  http//www.nimh.nih.gov
• University of Maryland Center for School Mental
  Health Assistance http//csmha.umaryland.edu/
• School Mental Health Projecthttp//smhp.psych.ucl
  a.edu