Anger Management Training: What they didn’t teach you in Graduate School! Presented by Rance L. Harbor, Ph.D. School Psychologist Hillsborough County.

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

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.

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.

• 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

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.

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.

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.

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.

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.

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.

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".

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

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

Referral Sources

• Administrators• Guidance Counselors• School Nurses• School Social Workers• Behavior Specialist• Intervention Specialists• Speech/Language Therapist• Teachers• Parents• IEP

Who are our referral resources?

Who are our referral resources?

STUDENTS!

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

Tier 1 IdentificationScreening

Level 1 Screener (Harbor)

Teacher Report Form (Harbor)

Parent Feedback Form (Harbor)

Discipline ReportsTimeout Reports

Tier 1

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.

Student Survey

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? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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: ____________________________________________

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.

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.

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.

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.

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)

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

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

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.

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.

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.

• 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

• 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?

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

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

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?

Specifics on AMT “Groups”

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

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.

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 #

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

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.

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?

Issues for both Individual or

Group Sessions

What model do I use?

Cognitive Behavioral Interpersonal Problem Solving Model Behavioral Humanistic Freudian Free-styling

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/

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?

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

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).

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.

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.

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.

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.

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

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

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

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)

Outcome Measurement/RTIData Resources

•Behavior Observations•Behavior Checklists (teacher, parent, student)

CBCLBASCCONNERSCDISSRS

•Discipline Referrals•Timeout Logs•Teacher Notes•Customized Brief Rating Scales /Progress Reports*

How can I do ALL THAT?

Remember… Past data can become baseline for

intervention!

Use it when you can

RtIFor Elementary

Time on TaskReading (Fair)DisciplineAttendance

What Progress Monitors do we need to monitor?

RtIFor Middle School

Reading (Fair)GPADisciplineAttendance

What Progress Monitors do we need to monitor?

RtIFor High Schools

GPACreditsDisciplineAttendance

What Progress Monitors do we need to monitor?

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

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

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

How and when to access additional resources.

211http://www.211atyourfingertips.org

For more information and/or materials contact:

Rance L. Harbor, Ph.D.School Psychologist

Hillsborough County Public Schools

[email protected]