Ct assessing and treating violent youth
Jul 10, 2015
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Assessment Of Highly Complex Cases
Dr Kathy Seifert
kseifertespsmdcom
ASSESSMENT
Targets of Assessment
Types of Assessment
Assessments inform treatment
OBJECTIVES
1 Participants will be able to state the purposes of
the three levels of assessment
2 Participants will be able to name 2 assessments
for risk of dangerousness to others
3 Participants will be able to name 5 risk factors for
violence
4 Participants will be able to explain how
assessments can inform treatment
THREE LEVELS OF ASSESSMENT ndash LEVEL 1
1) Initial screening with a psycho-social interview and review of records
using an Integrated Health Model
1) Be logical and systematic about your assessment
2) Define Types of problems across domains - physical mental family
school substance abuse environment stressors
3) Look at information from a variety of psychological paradigms
4) Assess level of severity and acuteness
5) List strengths of youth and family
6) Be culturally sensitive
7) Assess for smoking weight exercise physical symptoms family history
of chronic disease and refer to MD when needed
8) Determine need for further assessment and treatment needs
ASSESSMENT LEVEL 2
If there are problems a more in depth assessment is needed in that area
Areas might include Behavioral health substance abuse physical health
cognitive health safety
1 Get information from other systems such as schools when you can
2 Assessment may be done by a specialist in that area
3 Be methodical and organized
4 Assessment should determine types and intensity of treatment
5 A variety of tools are available
ASSESSMENT LEVEL 3
When problems are severe chronic acute dangerous immediate specialty
assessments are needed to determine immediacy of danger as well as type
and intensity of treatment needed
1 Get 3rd party information when possible
2 Psychological Testing may be needed
3 Interventions that meet the needs of the client and his or her family
4 Safety must be the number 1 priority You cannot help children if they are not safe
1 Dangerousness
2 Suicidality
3 Domestic violence
DANGER TO SELF
Suicide Risk vs Self Harm
DANGER TO SELF
Assessment of suicidal risk is complex
ldquothe assessment of suicidal risk should be made and documented
with frequency during ongoing treatment especially at times of
impending transition heightened stress or changes in environmental
supportsrdquo
Berman Alan L Jobes David A Silverman Morton M (2006)
Adolescent suicide Assessment and intervention (2nd ed) (pp
119-167) Washington DC US American Psychological Association
ix 456 pp doi 10103711285-009
TREATMENT
one-size treatment does not fit all ndash Berman et al
using more treatment options in a synthesized
manner is superior to rigidly adhering to only one or
two approaches ndash Berman et al
SAFE-T
httpstoresamhsagovproductSuicide-Assessment-Five-Step-
Evaluation-and-Triage-SAFE-T-SMA09-4432
Assess Risk factors especially those that can be changed
Assess resiliency factors especially those that can be increased
Conduct suicide inquiry
Determine risk level and intervention
Document
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
ASSESSMENT
Targets of Assessment
Types of Assessment
Assessments inform treatment
OBJECTIVES
1 Participants will be able to state the purposes of
the three levels of assessment
2 Participants will be able to name 2 assessments
for risk of dangerousness to others
3 Participants will be able to name 5 risk factors for
violence
4 Participants will be able to explain how
assessments can inform treatment
THREE LEVELS OF ASSESSMENT ndash LEVEL 1
1) Initial screening with a psycho-social interview and review of records
using an Integrated Health Model
1) Be logical and systematic about your assessment
2) Define Types of problems across domains - physical mental family
school substance abuse environment stressors
3) Look at information from a variety of psychological paradigms
4) Assess level of severity and acuteness
5) List strengths of youth and family
6) Be culturally sensitive
7) Assess for smoking weight exercise physical symptoms family history
of chronic disease and refer to MD when needed
8) Determine need for further assessment and treatment needs
ASSESSMENT LEVEL 2
If there are problems a more in depth assessment is needed in that area
Areas might include Behavioral health substance abuse physical health
cognitive health safety
1 Get information from other systems such as schools when you can
2 Assessment may be done by a specialist in that area
3 Be methodical and organized
4 Assessment should determine types and intensity of treatment
5 A variety of tools are available
ASSESSMENT LEVEL 3
When problems are severe chronic acute dangerous immediate specialty
assessments are needed to determine immediacy of danger as well as type
and intensity of treatment needed
1 Get 3rd party information when possible
2 Psychological Testing may be needed
3 Interventions that meet the needs of the client and his or her family
4 Safety must be the number 1 priority You cannot help children if they are not safe
1 Dangerousness
2 Suicidality
3 Domestic violence
DANGER TO SELF
Suicide Risk vs Self Harm
DANGER TO SELF
Assessment of suicidal risk is complex
ldquothe assessment of suicidal risk should be made and documented
with frequency during ongoing treatment especially at times of
impending transition heightened stress or changes in environmental
supportsrdquo
Berman Alan L Jobes David A Silverman Morton M (2006)
Adolescent suicide Assessment and intervention (2nd ed) (pp
119-167) Washington DC US American Psychological Association
ix 456 pp doi 10103711285-009
TREATMENT
one-size treatment does not fit all ndash Berman et al
using more treatment options in a synthesized
manner is superior to rigidly adhering to only one or
two approaches ndash Berman et al
SAFE-T
httpstoresamhsagovproductSuicide-Assessment-Five-Step-
Evaluation-and-Triage-SAFE-T-SMA09-4432
Assess Risk factors especially those that can be changed
Assess resiliency factors especially those that can be increased
Conduct suicide inquiry
Determine risk level and intervention
Document
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
OBJECTIVES
1 Participants will be able to state the purposes of
the three levels of assessment
2 Participants will be able to name 2 assessments
for risk of dangerousness to others
3 Participants will be able to name 5 risk factors for
violence
4 Participants will be able to explain how
assessments can inform treatment
THREE LEVELS OF ASSESSMENT ndash LEVEL 1
1) Initial screening with a psycho-social interview and review of records
using an Integrated Health Model
1) Be logical and systematic about your assessment
2) Define Types of problems across domains - physical mental family
school substance abuse environment stressors
3) Look at information from a variety of psychological paradigms
4) Assess level of severity and acuteness
5) List strengths of youth and family
6) Be culturally sensitive
7) Assess for smoking weight exercise physical symptoms family history
of chronic disease and refer to MD when needed
8) Determine need for further assessment and treatment needs
ASSESSMENT LEVEL 2
If there are problems a more in depth assessment is needed in that area
Areas might include Behavioral health substance abuse physical health
cognitive health safety
1 Get information from other systems such as schools when you can
2 Assessment may be done by a specialist in that area
3 Be methodical and organized
4 Assessment should determine types and intensity of treatment
5 A variety of tools are available
ASSESSMENT LEVEL 3
When problems are severe chronic acute dangerous immediate specialty
assessments are needed to determine immediacy of danger as well as type
and intensity of treatment needed
1 Get 3rd party information when possible
2 Psychological Testing may be needed
3 Interventions that meet the needs of the client and his or her family
4 Safety must be the number 1 priority You cannot help children if they are not safe
1 Dangerousness
2 Suicidality
3 Domestic violence
DANGER TO SELF
Suicide Risk vs Self Harm
DANGER TO SELF
Assessment of suicidal risk is complex
ldquothe assessment of suicidal risk should be made and documented
with frequency during ongoing treatment especially at times of
impending transition heightened stress or changes in environmental
supportsrdquo
Berman Alan L Jobes David A Silverman Morton M (2006)
Adolescent suicide Assessment and intervention (2nd ed) (pp
119-167) Washington DC US American Psychological Association
ix 456 pp doi 10103711285-009
TREATMENT
one-size treatment does not fit all ndash Berman et al
using more treatment options in a synthesized
manner is superior to rigidly adhering to only one or
two approaches ndash Berman et al
SAFE-T
httpstoresamhsagovproductSuicide-Assessment-Five-Step-
Evaluation-and-Triage-SAFE-T-SMA09-4432
Assess Risk factors especially those that can be changed
Assess resiliency factors especially those that can be increased
Conduct suicide inquiry
Determine risk level and intervention
Document
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
THREE LEVELS OF ASSESSMENT ndash LEVEL 1
1) Initial screening with a psycho-social interview and review of records
using an Integrated Health Model
1) Be logical and systematic about your assessment
2) Define Types of problems across domains - physical mental family
school substance abuse environment stressors
3) Look at information from a variety of psychological paradigms
4) Assess level of severity and acuteness
5) List strengths of youth and family
6) Be culturally sensitive
7) Assess for smoking weight exercise physical symptoms family history
of chronic disease and refer to MD when needed
8) Determine need for further assessment and treatment needs
ASSESSMENT LEVEL 2
If there are problems a more in depth assessment is needed in that area
Areas might include Behavioral health substance abuse physical health
cognitive health safety
1 Get information from other systems such as schools when you can
2 Assessment may be done by a specialist in that area
3 Be methodical and organized
4 Assessment should determine types and intensity of treatment
5 A variety of tools are available
ASSESSMENT LEVEL 3
When problems are severe chronic acute dangerous immediate specialty
assessments are needed to determine immediacy of danger as well as type
and intensity of treatment needed
1 Get 3rd party information when possible
2 Psychological Testing may be needed
3 Interventions that meet the needs of the client and his or her family
4 Safety must be the number 1 priority You cannot help children if they are not safe
1 Dangerousness
2 Suicidality
3 Domestic violence
DANGER TO SELF
Suicide Risk vs Self Harm
DANGER TO SELF
Assessment of suicidal risk is complex
ldquothe assessment of suicidal risk should be made and documented
with frequency during ongoing treatment especially at times of
impending transition heightened stress or changes in environmental
supportsrdquo
Berman Alan L Jobes David A Silverman Morton M (2006)
Adolescent suicide Assessment and intervention (2nd ed) (pp
119-167) Washington DC US American Psychological Association
ix 456 pp doi 10103711285-009
TREATMENT
one-size treatment does not fit all ndash Berman et al
using more treatment options in a synthesized
manner is superior to rigidly adhering to only one or
two approaches ndash Berman et al
SAFE-T
httpstoresamhsagovproductSuicide-Assessment-Five-Step-
Evaluation-and-Triage-SAFE-T-SMA09-4432
Assess Risk factors especially those that can be changed
Assess resiliency factors especially those that can be increased
Conduct suicide inquiry
Determine risk level and intervention
Document
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
ASSESSMENT LEVEL 2
If there are problems a more in depth assessment is needed in that area
Areas might include Behavioral health substance abuse physical health
cognitive health safety
1 Get information from other systems such as schools when you can
2 Assessment may be done by a specialist in that area
3 Be methodical and organized
4 Assessment should determine types and intensity of treatment
5 A variety of tools are available
ASSESSMENT LEVEL 3
When problems are severe chronic acute dangerous immediate specialty
assessments are needed to determine immediacy of danger as well as type
and intensity of treatment needed
1 Get 3rd party information when possible
2 Psychological Testing may be needed
3 Interventions that meet the needs of the client and his or her family
4 Safety must be the number 1 priority You cannot help children if they are not safe
1 Dangerousness
2 Suicidality
3 Domestic violence
DANGER TO SELF
Suicide Risk vs Self Harm
DANGER TO SELF
Assessment of suicidal risk is complex
ldquothe assessment of suicidal risk should be made and documented
with frequency during ongoing treatment especially at times of
impending transition heightened stress or changes in environmental
supportsrdquo
Berman Alan L Jobes David A Silverman Morton M (2006)
Adolescent suicide Assessment and intervention (2nd ed) (pp
119-167) Washington DC US American Psychological Association
ix 456 pp doi 10103711285-009
TREATMENT
one-size treatment does not fit all ndash Berman et al
using more treatment options in a synthesized
manner is superior to rigidly adhering to only one or
two approaches ndash Berman et al
SAFE-T
httpstoresamhsagovproductSuicide-Assessment-Five-Step-
Evaluation-and-Triage-SAFE-T-SMA09-4432
Assess Risk factors especially those that can be changed
Assess resiliency factors especially those that can be increased
Conduct suicide inquiry
Determine risk level and intervention
Document
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
ASSESSMENT LEVEL 3
When problems are severe chronic acute dangerous immediate specialty
assessments are needed to determine immediacy of danger as well as type
and intensity of treatment needed
1 Get 3rd party information when possible
2 Psychological Testing may be needed
3 Interventions that meet the needs of the client and his or her family
4 Safety must be the number 1 priority You cannot help children if they are not safe
1 Dangerousness
2 Suicidality
3 Domestic violence
DANGER TO SELF
Suicide Risk vs Self Harm
DANGER TO SELF
Assessment of suicidal risk is complex
ldquothe assessment of suicidal risk should be made and documented
with frequency during ongoing treatment especially at times of
impending transition heightened stress or changes in environmental
supportsrdquo
Berman Alan L Jobes David A Silverman Morton M (2006)
Adolescent suicide Assessment and intervention (2nd ed) (pp
119-167) Washington DC US American Psychological Association
ix 456 pp doi 10103711285-009
TREATMENT
one-size treatment does not fit all ndash Berman et al
using more treatment options in a synthesized
manner is superior to rigidly adhering to only one or
two approaches ndash Berman et al
SAFE-T
httpstoresamhsagovproductSuicide-Assessment-Five-Step-
Evaluation-and-Triage-SAFE-T-SMA09-4432
Assess Risk factors especially those that can be changed
Assess resiliency factors especially those that can be increased
Conduct suicide inquiry
Determine risk level and intervention
Document
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
DANGER TO SELF
Suicide Risk vs Self Harm
DANGER TO SELF
Assessment of suicidal risk is complex
ldquothe assessment of suicidal risk should be made and documented
with frequency during ongoing treatment especially at times of
impending transition heightened stress or changes in environmental
supportsrdquo
Berman Alan L Jobes David A Silverman Morton M (2006)
Adolescent suicide Assessment and intervention (2nd ed) (pp
119-167) Washington DC US American Psychological Association
ix 456 pp doi 10103711285-009
TREATMENT
one-size treatment does not fit all ndash Berman et al
using more treatment options in a synthesized
manner is superior to rigidly adhering to only one or
two approaches ndash Berman et al
SAFE-T
httpstoresamhsagovproductSuicide-Assessment-Five-Step-
Evaluation-and-Triage-SAFE-T-SMA09-4432
Assess Risk factors especially those that can be changed
Assess resiliency factors especially those that can be increased
Conduct suicide inquiry
Determine risk level and intervention
Document
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
DANGER TO SELF
Assessment of suicidal risk is complex
ldquothe assessment of suicidal risk should be made and documented
with frequency during ongoing treatment especially at times of
impending transition heightened stress or changes in environmental
supportsrdquo
Berman Alan L Jobes David A Silverman Morton M (2006)
Adolescent suicide Assessment and intervention (2nd ed) (pp
119-167) Washington DC US American Psychological Association
ix 456 pp doi 10103711285-009
TREATMENT
one-size treatment does not fit all ndash Berman et al
using more treatment options in a synthesized
manner is superior to rigidly adhering to only one or
two approaches ndash Berman et al
SAFE-T
httpstoresamhsagovproductSuicide-Assessment-Five-Step-
Evaluation-and-Triage-SAFE-T-SMA09-4432
Assess Risk factors especially those that can be changed
Assess resiliency factors especially those that can be increased
Conduct suicide inquiry
Determine risk level and intervention
Document
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
TREATMENT
one-size treatment does not fit all ndash Berman et al
using more treatment options in a synthesized
manner is superior to rigidly adhering to only one or
two approaches ndash Berman et al
SAFE-T
httpstoresamhsagovproductSuicide-Assessment-Five-Step-
Evaluation-and-Triage-SAFE-T-SMA09-4432
Assess Risk factors especially those that can be changed
Assess resiliency factors especially those that can be increased
Conduct suicide inquiry
Determine risk level and intervention
Document
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SAFE-T
httpstoresamhsagovproductSuicide-Assessment-Five-Step-
Evaluation-and-Triage-SAFE-T-SMA09-4432
Assess Risk factors especially those that can be changed
Assess resiliency factors especially those that can be increased
Conduct suicide inquiry
Determine risk level and intervention
Document
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
ONTARIO HOSPITAL ASSOCIATION GUIDEBOOK
httpwwwohacomKnowledgeCentreDocumentsFinal2020Sui
cide20Risk20Assessment20Guidebookpdf
Each client is assessed for risk of suicide at regular intervals or as
needs change
Clients at risk of suicide are identified
Clientrsquos immediate safety needs are addressed
Treatment and monitoring strategies to ensure client safety are
implemented
Treatment and monitoring strategies are documented in the
clientrsquos health record
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SELF-INJURY
Attempt to Cope with internal or external stressors
Generating endorphins
Managing emotions
Eliciting response from environment
Trigger dissociative state
Treatment issue based on the function of the behavior
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
DANGER TO OTHERS
Each client is assessed for risk of dangerousness at regular intervals
or as needs change
Clients at risk of dangerousness are identified and charted
Immediate safety needs of others are addressed
Treatment and monitoring strategies to ensure procedures for
safety of others are implemented
Treatment and monitoring strategies are individualized and
documented in the clientrsquos health record
Outcomes of strategies are charted
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
BASIC PRINCIPLES OF ASSESSMENT LEVEL 3 (VERY
COMPLEX CASES)
Assess for dangerousness Domestic Violence Abuse risk of
violence risk of sexual offending and suicidality and take
appropriate safety measures Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
33 and 16 respectively (CRIME amp DELINQUENCY Vol 52 No 1 January 2006 7-27
DOI 1011770011128705281756)
Assess developmental level of parents and child in a variety of skill
areas Behavior Objective Sequence (Braatan) Skills must be
taught in developmentally appropriate sequence
Assess systems for cooperation communication and mutual support
Determine types and levels of treatment needed
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
Instrument Risk of
Violence
Ages Case
Manag
ement
Can be
Administe
red
Unaided
Clinical
Judgement
r =12
AUC =51
Any No NA Many studies
SAVRY (Handbook of
Violence Risk
Assessment
By Randy K Otto)
R = 56-
67 AUC
= 77-80
12-
18
No Hand Structured
Professional
Judgment
CARE2 (The
Handbook of Forensic
Psychology
edited by Irving B
Weiner Allen K Hess)
r = 62
AUC = 876-18 Yes Hand or
online
Risk and Needs
1026 males and
females ages 6-18
LS-CMI (Int J
Offender Ther Comp
Criminol 2012
Feb56(1)113-33
Epub 2011 Feb 13)
r = 39
AUC =
75
16+ Yes Hand or
computer
Risk and Needs
250000 youth and
adult offenders in
US and Canada
PCL-YV (Int J
Law Psychiatry 2008
Jun-Jul31(3)287-96)
AUC =
73 males
50
females
12-
18
No Hand Measure of
Psychopathic traits (Kosson et al Psychol
Assess 2002 Mar14(1)97-
109)
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SAVRY
httpsavryfmhiusfedu (ranks as most accurate by Singh JP Grann M Fazel
S 2011) The SAVRY is composed of 25 items (Historical Clinical and Contextual)
drawn from existing research and professional literature in adolescent development and
on violence and aggression in youth An additional five Protective Factors are also
provided (Bartel Borum amp Forth 1999 Borum Bartel amp Forth 2000) Ages 12-18
years
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
LS-CMI ndash TREATMENT PLANNING FOR
DELINQUENCY
1 LS-CMI httpwwwmhscomproductaspxgr=safampprod=ls-cmiampid=overview
The Level of ServiceCase Management Inventory (LSCMI) is an assessment that measures the risk and need factors of late adolescent and adult offenders The LSCMI is also a fully functioning case management tool This single application provides all the essential tools needed to aid professionals in the treatment planning and management of offenders in justice forensic correctional prevention and related agencies (16 years +) Male and female norms
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
CARE2
httpcare2systemscom The CARE-2 (Child amp Adolescent Risk Evaluation)
Assessment by Dr Kathy Seifert works to identify youth who are at risk for
violence and determines specific interventions needed to prevent any
future risk of aggressive behavior Updated and enhanced this invaluable
tool examines every factor that may be affecting the youths development and
puts a plan in place for the youth to mature into a positively pro-social
functioning member of society (ages 6-19)
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
USING THE CARE2
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
CARE2
4 NORMS
Malefemale
Pre-teenTeen
Mark all that apply
Items with scores are added and resiliency scores
subtracted
risk scale are statistically derived on a sample of
1000+ youth and studies of subsets
Evidence based intervention plans
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
HISTORICAL FACTORS
Past behavior problems
Past Assaults
Chronicity
Severity
Escape from custody
Firesetting
Harmed
Animals
Early behavior problems
Enuresis
Delinquency
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES
Anger management
Runaway
Lacks remorse
Poor problem solving
Belief in the legitimacy of aggression
Social skill deficits
Bullying behavior
Deviant peer group
Limited association with pro-social peers
Paranoia
IQ below 80
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
RECENT MENTAL HEALTH AND BEHAVIORAL
HEALTH ISSUES II
School problems
Risk for placement
Impulsive
Emotions poorly regulated
Psychosis
Self-harm
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
RESILIENCY FACTORS
Average or better IQ
Positive experiences with caregivers
Positive school experience
Lack of untreated psychiatric or substance abuse
problems in caregivers
Positive future goals
Positive activities
Effective treatment
Pro-social peers
Modulates emotions well
Takes medication as prescribed
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
HISTORICAL FACTORS II
Attachment problems
Abuse and neglect
Family violence abuse neglect or criminality
Parental insufficientcy
Parental absense
Bullying
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
HISTORICAL SUBSTANCE ABUSE amp
NEUROLOGICAL PROBLEMS
Substance abuse
Neurological
Mental health
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
PCL-YV
httpwwwmhscomproductaspxgr=eduampprod=pclyvampid=overview (Ranks
as least accurate by Singh JP Grann M Fazel S 2011 meta-analysis)
Correlations with female violence is NS The Hare Psychopathy Checklist
Youth Version (PCLYV) is a 20- item rating scale for the assessment of psychopathic traits in male and female offenders aged 12 to 18 The PCLYV uses an expert-rater format that emphasizes the need for multidomain and multisource information Using a semistructured interview and collateral information the PCLYV measures interpersonal affective and behavioral features related to a widely understood traditional concept of psychopathy Ages 12-18
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SAVRY ndash BORUM BARTEL FORTH
The SAVRY is composed of 24 items in three risk domains (Historical
Risk Factors SocialContextual Risk Factors and IndividualClinical
Factors) drawn from existing research and the professional literature
on adolescent development as well as on violence and aggression in
youth Not designed to be a formal test or scale there are no assigned
numerical values nor are there any specified cutoff scores Based on
the structured professional judgment (SPJ) model the SAVRY helps
you structure an assessment so that important factors will be
emphasized when you formulate a final professional judgment about a
youthrsquos level of risk
httpwww4parinccomProductsProductaspxProductID=SAVRY
Ages 12 ndash 18
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SAVRY ITEMS SIMILAR ON 4 SCALES
Risk ItemFactorsItemsFactors included in the
SAVRY
Historical Risk Factors
- History of Violence
- History of Nonviolent Offending
- Early initiation of Violence
- Past SupervisionIntervention
Failures
- History of Self-Harm or Suicide
Attempts
- Exposure to Violence in the Home
- Childhood History of Maltreatment
- ParentalCaregiver Criminality
- Early Caregiver Disruption
- Poor School Achievement
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SAVRY ITEMS 2
Social and Contextual
Risk Factors
- Delinquency
- Peer Rejection
- Stress and Poor Coping
- Poor Parental Management
- Lack of PersonalSocial Support
- Community Disorganization
IndividualClinical
Risk Factors
- Negative Attitudes
- Risk TakingImpulsivity
- Substance-Use Difficulties
- Anger Management Problems
- Low EmpathyRemorse
- Attention DeficitHyperactivity
Difficulties
- Poor Compliance
- Low InterestCommitment to
School
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SAVRY ITEMS ndash PROTECTIVE FACTORS
Protective Factors
- Prosocial Involvement
- Strong Social Support
- Strong Attachments and Bonds
- Positive Attitude Toward
Intervention and Authority
- Strong Commitment to School
- Resilient Personality Traits
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
DEVELOPMENTAL
ASSESSMENT
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
6 CORE CONCEPTS OF CHILD
DEVELOPMENT
Children are always learning and development
has a sequence that must be followed and age is
not a determinate of developmental level (roll
over sit up crawl stand up walk)
Skill building usually follows developmental
sequences and be taught within the context of a
healthy nurturing dependable relationship
Attachment experiences (good bad or ugly) and
trauma change the brain
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
CHILD DEVELOPMENT - 2
Corrective developmental experiences and
healthy relationships can also change the brain
The balance between healthy and unhealthy
biology (including genes) environment and
experiences will determine the health of
development
Healthy skill development is necessary to
function effectively in the world of people
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
WHAT DEVELOPMENTAL AREAS ARE AFFECTED
BY TRAUMA
Problem solving
Self management
Moral reasoning
Logic
Affect regulation
Interpersonal relatedness
Task behavior
Concentration
Impulsivity
Effective Communication
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
THE MARSHMALLOW EXPERIMENT
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
Trauma Negatively Affects Moral Development Kohlberg 1969 (Expanded from Piaget)
Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
ERIKSONrsquoS STAGES
bull 1 Hopes Trust vs Mistrust (Oral-sensory Birth-2
years) (Safe Base)
bull 12 Will Autonomy vs Shame amp Doubt (Muscular-
Anal 2-4 years) (Exploration from Safe Base)
bull 13 Purpose Initiative vs Guilt (Locomotor-Genital
Preschool 4-5 years) (I can do things on my own)
bull 14 Competence Industry vs Inferiority (Latency 5-
12 years) (I am Competent)
bull 15 Fidelity Identity vs Role Confusion
(Adolescence 13-19 years) (Who am I)
bull 16 Love Intimacy vs Isolation (Young adulthood
20-24) (Establishing a family career)
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
TRAUMA CAN INTERRUPT THE SEQUENCES OF
DEVELOPMENT
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
ASSESS WHERE A CHILD IS ON A
DEVELOPMENTAL SCALE
Many are at immediate gratification and seeking a
safe base
Immediate gratification and needs of the self are
primary
Must learn perspective taking and reciprocity before
empathy
If the youth is still seeking a safe base that must be
established before exploration of the world and
information gathering
A safe environment is essential for healthy development
You need some type of developmental guide for use in
your treatment plan
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
ASSESSMENT OF CHILDREN ndash LEVEL 3
Level 3 is for children and teens with severe
behavioral disturbances
8 Symptom Categories
Traumatized Brain
3 or 4 Attachment Patterns
Holistic Assessment and Treatment Practices
Assessing Development Using the BOS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
LEVEL 3 8 SYMPTOM CATEGORIES OF DTDCPTSDRAD ndash
PAST amp PRESENT FREQUENCY DURATION AND SEVERITY WHAT
OTHER DISORDERS HAVE THESE SYMPTOMS
Behavior ndash Lack of eye contact enuresis violence
out of control behavior hoarding food lies steals
oppositional and defiant breaks the rules
impulsive destructive hyperactive self-destructive
harms animals irresponsible
Emotions ndash intense anger amp temper sad
depressed hopeless moody fearful anxious
irritable inappropriate emotional reactions
emotions not well regulated
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SYMPTOMS ndash 2
THOUGHTS ndash NEGATIVE BELIEFS ABOUT OTHERS AND RELATIONSHIPS LACKS
CAUSE AND EFFECT THINKING ATTENTION amp LEARNING PROBLEMS
negative beliefs about self
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
Symptoms 3
Relationships ndash lacks
trust controlling (bossy)
with children and
adults is not genuinely
affectionate with family
indiscriminately
affectionate with
strangers unstable
peer relationships
blames others for
misdeeds victimizes
others and is
victimized
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SYMPTOMS - 4
Physical - failure to thrive poor hygiene tactilely
defensive enuresis amp encopresis accident prone high
pain tolerance
MoralSpiritual ndash lack faith compassion remorse pro-
social values identification with evil or the ldquodark siderdquo
Development - delayed development
Core BeliefsInternal Working Model of self others and
world is Negative
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
HOLISTIC ASSESSMENT PRACTICES
Measure all areas of strengths stressors and
symptoms for youth and family
Anything you change within the system will affect
other subsystems but try to affect as many areas
as possible
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
THE BEHAVIOR OBJECTIVE SEQUENCE
By Sheldon Braatan
A developmentally sequenced group of skills in 6 Domains
Age is not the determiner of skill level
Youth must learn skills in appropriate developmental
sequence
Find out at what level they have mastered skills (can do it 90
of the time without prompting)
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
ADAPTIVE SKILLS
Responds in a developmentally appropriate manner to rules and expectations
AND
Changes those responses as the circumstances change
Example
I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy the youth is able to adapt to the different format and relate to peers in the group not just counselor
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
Adaptive Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SELF-MANAGEMENT SKILLS
Responds appropriately to challenging experiences
with self-control in order to achieve success
(E) Appear alert and able to focus attention on activities
Wait or take turns when directed without physical intervention ndash
verbal prompts may be use
Respond when angry without verbal threats or intent to harm
(M) Seek adult help in personal andor group crisis
Maintain personal control and routinely comply with established
procedures in group situations without reminders
(H) Maintain self-control when faced with disappointment frustration
or failure without adult intervention
Obey new or temporary authority figure without presence of other
permanent staff
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
COMMUNICATION
Ability to share with and receive information from
other people to meet a need or affect another
person in a positive way Speak using a volume appropriate to the situation
Wait until a speaker is finished before responding
Express feelings about self or others to an adult appropriately
Spontaneously participate in group discussions
Maintain appropriate social distance when speaking to another
Speak courteously to others using appropriate references with
no cues
Describe personal strengths that will enable success
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
INTERPERSONAL BEHAVIORS
Interacting with others in social and task situations
in ways that meet personal and interdependence
needs and contribute to a sense of belonging Respond to an adult when his or her name is called
Accept help from an adult when offered
Sit quietly for 15 minutes or more in a group listening activity
Develop positive relationships with more than 1 adult
Share materials and equipment with peers with minimal
reminders from adults
Physically or verbally come to the support of another student by
offering assistance in a difficult situation
Spontaneously resist negative peer pressure
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
TASK BEHAVIORS
Student engages in task or activity with or without
assistance Accept assistance from an adult on academic tasks
Refrain from inappropriate behavior when asked by an adult to
correct errors
Complete daily assignments
Choose and actively participate in elective classes
Ignore distractions of others while working
Self-chart progress in reading or math
Participate in structured role-playing activities
Complete and turn in assigned homework when due
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
PERSONAL BEHAVIORS
Student engages in a counseling dialogue with a
helping person permitting adult to help resolve
issues or solve problems or build self esteem Express negative feelings to an adult
Follow through with specific directions from an adult to modify
behavior in a given situation
Participate in determining a short term plan for dealing with an
immediate situation
Attend to a peer when a peer is speaking
Express feelings about self to peers
Seek counseling t avoid conflict
Contribute to group rule making and consequences
Verbally demonstrate knowledge of alternative coping strategies
for managing stress
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
ASSESSING PARENTS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
PARENTS
Attachmenttrauma history
Awareness of Emotional amp Environment Triggers
Parenting Attitudes and Competencies
The child needs a loving home with
nurturing affection routine structure and boundaries
There are skills to learn about anger management reframing the
meaning of behaviors teaching rather than punishing
Parent Mental Health Substance Abuse Offending
Behavior Dangerousness amp Stability
Parents must take care of their mental health to do this job effectively
Safety
Parenting knowledge and style
Parents need to learn about attachment and trauma and skills to help
their children
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
MARITAL RELATIONSHIP amp CO-PARENTING
THE CHILD WILL DO BEST IF THE CAREGIVERS TAKE CARE
OF THEIR RELATIONSHIP HEALTH AS WELL
DOES THE COUPLE NEED COUPLES THERAPY
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
ASSESSMENT OF FAMILY SYSTEM
Family backgrounds
Families of origin
Marital relationship
Relationships among siblings and between children
and parents
Structure ndash Family Systems Work
Ongoing Patterns (ldquofamily dancerdquo)
Support Systems
Stressors and Stress Management
Rules Roles and Boundaries
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
INTERVENTIONS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
EVIDENCE BASED TREATMENT FOR COMPLEX
CASES
EBP Case management
Multi-system integration
Family Therapy
Developmental approaches with skill building
CBT
Role playing
Dosage is important
Holistic approaches
Neuro-feedback amp CES
Wrap-around
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
PROMISING PRACTICES
Trauma and attachment work
Routine and structure
Healthy safe environments
Narrative Therapy
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
DEVELOPMENTAL INTERVENTIONS
WITH BOS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
BOS - Level 3 (skills typically mastered
during preschool years)
Focus Self Significance Success
Issues Trust Pleasure Security Support
Interventions Routines Repetitions
Modeling Concrete Rewards Limit Setting
Consistent and Planned Consequences
Continuous Supervision
Adult Role ldquoBenevolent Dictatorrdquo
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
Level 2 (skills typically mastered during elementary
years)
Focus Group membership Competence Sensitivity to
Others Awareness of Values Communication Skills
Issues Applying Skills in Groups Balancing Personal and
Group Needs Responding to New Settings and People
Managing Movement
Interventions Routines Repetitions Verbal Rewards
Limit Setting with Expanded Choices Consistency with
Group Consequences Natural and Logical
Consequences
Adult Role ldquoGroup Leaderrdquo
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
Level 1 (skills typically mastered during
adolescence and early adulthood)
Focus Belonging Cooperation Personal
ldquoPowerrdquo Individualtion
Issues Applying Skills in New Situations
Expanding and Reinforcing Competencies
Transitions to New Environments
Interventions ldquoNormalrdquo Expectations Social
Rewards Expanded Choices Group Problem
Solving Self Selected Goals
Adult Role ldquoGuideFacilitatorrdquo
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
SUMMARY
3 levels of assessment
Initial screening
Specialty assessment ie Addictions trauma
Assessment for dangerousness and types and intensity
of treatment
Assessment for dangerousness at Level 3
SAVRY amp CARE2
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
OTHER ASPECTS OF ASSESSMENT
Assessment of youth family family system
Developmental Assessment with BOS
Neurological Assessment
Medical Assessment
Educational Assessment
Assessment for intensity longevity and types of
treatment ndash EBP and Promising Practice
QUESTIONS AND ANSWERS
QUESTIONS AND ANSWERS
Related Documents
