Implementing DBT Skills in Schools at a Universal …...2015/05/05 · DBT Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) ©2002-2015 Marsha M. Linehan,

Implementing DBT Skills in Schools at a Universal Level Webinar | May 5, 2015

James Mazza, PhD & Elizabeth Dexter-Mazza, PsyD

© 2015 Marsha M. Linehan, Ph.D., ABPP For educational use only. Do not copy or distribute without permission.Behavioral Tech, LLC | 4746 11th Avenue NE, Suite 102 Seattle, WA 98105 | Ph. (206) 675-8588 | Fax 1-(206) 675-8590 | www.behavioraltech.org

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©2002-2015 Marsha M. Linehan, PhD, ABPP 5

James Mazza, Ph.D.

Elizabeth Dexter-Mazza, Psy.D.

BEHAVIORAL TECH WEBINAR

MAY 5, 2015

Implementing DBT Skills in Schools at a Universal Level


Webinar Objectives:

1. Identify how DBT STEPS-A is different than standard/comprehensive DBT

2. Discuss 1-2 potential challenges that may occur in schools when implementing DBT STEPS-A at a universal level

3. List 2-3 components of the DBT STEPS-A curriculum





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DBT: Starting upstream

DBT STEPS-A

School-Based: DBT

Outpatient DBT

Residential Treatment + DBT

Hospitalization + DBT

IOP/PHP + DBT

Program Evaluation and Research


When “I” is replaced by “WE” even ILLNESS becomes WELLNESS





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BACKGROUND & FOUNDATION

DBT

DBT STEPS-A


I. Background on DBT

B. Components of DBT

DBT

Individual Therapy *Skills Group

Consultation Team for Therapists

Mindfulness

Distress Tolerances

Emotion Regulation

Interpersonal Effectiveness


Phone Coaching




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DBT Skills Training for Emotional Problem Solving for Adolescents

(DBT STEPS-A)


I. What is DBT STEPS-A and why do we need it?

A. DBT STEPS-A is social-emotional learning (SEL) curriculum based on Dialectical Behavior Therapy DBT (Linehan, 1993, 2015) – an empirically-based comprehensive treatment for people with pervasive problems of emotion dysregulation.

1. One component of DBT is the skills groupa) Acquisition of emotion regulation and coping skillsb) Practice of the emotion regulation and coping skills





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I. DBT STEPS-A Goal: Balance academics & decision making/coping strategies

What is a Dialectic?

B. Balance of polar opposites1. Thesis, Antithesis, Synthesis2. Academics, Social-Emotional Skills, Education

C. Acceptance & Change



II. Social Emotional Learning (SEL) Curriculums

A. Balancing academics and decision-making skills1. Current school structure not balanced - ++ academics

a) Educ = Academic + Decision-Making/Coping strategies

B. Where could adolescents use these skills?1. Alcohol and drug use2. Relationships with peers, family, and romantic3. Suicidal behavior & Self-harming behavior4. Physically and/or sexually abused 5. Bullying victimization and perpetration6. Homeless youth7. Antisocial behavior8. Academic pressures





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Tier IUniversal Population

Tier IISelected Population

Tier IIIIndicated

Tier IIntensive Services

Intensified

Tier II

Tier III

Special Education Response to Intervention (RTI)

School-Based Mental Health (SBMH)

Within School Settings

Tier IIntensive Services

Intensified

Tier II

Tier III

Alternative School

Out of School Placement

Residential Treatment School + Integrated Mental Health

Residential Treatment Center + Integrated School Services

Tier IVHighly structured

Therapeutic services

Tier VResidential Treatment

Tier VIHospitalization

Outpatient TherapyTier IVHighly structured

Educational services

Should be talking to each other

MULTIPLE TIER SYSTEMS OF SUPPORT

General School-Based Setting


MULTIPLE TIER SYSTEMS OF SUPPORT

Applying DBT to School-Based Settings


(DBT STEPS-A)


(DBT STEPS-A +)

Tier IIIIndicated

(DBT STEPS-A ++)Tier I

Intensive Services

Intensified

Tier II

Tier III

Special Education Response to Intervention (RTI)

School-Based Mental Health (SBMH)

Within School Settings

Tier ISB-DBT

Rathus & Miller

SB-DBT +

Tier II

Tier III

Alternative School

Out of School Placement

Residential Treatment School + Integrated Mental Health

Residential Treatment Center including comprehensive DBT

Tier IVOutpatient DBTfor Adolescents

Tier VResidential Treatment

Tier VIHospitalization

Outpatient TherapyTier IVHighly structured

Educational services

SB-DBT ++

Should be talking to each otherSB-DBT + = Miller, Rathus, & Linehan

SB-DBT ++ = Comp DBT + & family




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(DBT STEPS-A)


(DBT STEPS-A +)

Tier IIIIndicated

(DBT STEPS-A ++)

GENERAL EDUCATION

School-Based Mental Health

Special EducationResponse to Intervention



DBT STEPS-A Class/Group

Short-term Goals

1. To provide students with a structured format to learn new skills in a nonjudgmental environment

2. To teach students a set of skills that apply to their own personal situationsA. Skill Acquisition

3. To provide ongoing support and coaching during skill development

Long-term Goals

1. To practice skills so they become automatic

2. To polish skills so they become more effective and can be used in different environmentsA. Skill Practice and Generalization

3. To create a school environment that supports students using DBT STEPS

Skill Acquisition Skill Practice & Generalization




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IMPLEMENTATION ISSUES


V. Implementation IssuesA. The DBT STEPS-A curriculum and group have some unique

characteristics that deserve further clarification

1. DBT STEPS-A lessons are structured with accountabilitya) What incentives do students have in completing the DBT

STEPS-A class or group work?b) What reporting mechanisms are in place @ XX School District?c) Decision rules for not doing well in DBT STEPS-A?

2. How to value DBT STEPS-A implementation and work completion within the school district?





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V. Implementation Issues

A. The DBT STEPS-A curriculum and group have some unique characteristics that deserve further clarification (cont)

3. Guidelines for attending class/groupa) Not under the influence of alcohol or drugs

1. Can increase the urges in othersb) No discussion of self-harming/suicidal behaviorc) No discussion of personal substance abused) Be mindful that what you share in class/group can be

communicated to the whole school



V. Implementation IssuesA. The DBT STEPS-A curriculum and group have some unique

characteristics that deserve further clarification (cont)

4. Issues of confidentialitya) Important for group cohesion, support & coaching

a) Helps with participation and self-disclosure1. No one wants their personal issues on web (i.e., Facebook or

school website) or spreading throughout the school

b) Yet not enforceable so need to be mindful of what you share





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CURRICULUM STRUCTURE


DBT STEPS-A

Structure

1. Designed for 50 minute periodsA. 30 lessons – standardB. Flexible curriculum

2. Format – similar to a class3. Covers the 4 domains4. Standardized with Rathus & Miller –

DBT for adolescents

Curriculum

1. Designed at the universal levelA. Ideal – Health teacherB. Profess. Staff – school psychs &

counselors, school social workers2. Manualized lessons AND provides

degree of flexibility3. Tests & test answers included 4. Teacher Manual & Student Workbook





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V. Curriculum StructureA. Lesson structure

1. Each lesson is structured similarly (50 minutes)a) Mindfulness (5 minutes)b) Homework Review (10 minutes)c) Teaching new lesson (30 minutes)d) Lesson summary & assignment of homework (5 minutes)

2. Each lesson provides:a) Main Pointsb) Materials neededc) Lesson Overview and Timelined) Detailed lesson plan (includes examples)e) Homework assignment






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Next paagewith examples




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V. Curriculum StructureB. Group format

1. Class size – Tier I level - 15-30 students2. Group size – Tier II & III – ideally 8-15 students

a. Rationale being maximizes opportunities for participation, self-disclosure, peer support, and peer coaching

b. Able to review and integrate diary card accomplishments and challenges into future lessons.

c. Facilitates group formation and trust



V. Curriculum Structure

C. Format Type (cont)2. Open format

a) New students can join the class/group at anytimeb) Advantages of open format

1. Allows students who move to join class/group mid-year 2. New students joining are more likely to adhere to established group

norms3. Students do not have to wait an entire year or more

c) Disadvantage of open format1. New members may disrupt class/group cohesion2. Depending on how late in the curriculum they start:

a. students may miss a significant number of skills





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V. Curriculum StructureC. Format Type (cont)

3. Closed formata) Once the class/group is established – closed to new students

(i.e., after 1 month)b) Similarly for students who dropout or are absent for a month

– out means outc) Advantages of closed format

1. Established group norms2. Fosters greater participation and self-disclosure

3. Helps with instructional planning

d) Disadvantage1. Student cannot be added after set time



V. Curriculum StructureD. Modular implementation

1. There are four modules plus orientation that comprise the STEPS-A curriculum

a) Core Mindfulness (interspersed throughout)b) Distress Tolerancec) Emotion Regulationd) Interpersonal Effectiveness

2. Standard curriculum is 30 lessonsa) Flexibility - Some lessons may take longer to teach among

certain adolescent groupsb) Choosing lessons for shorter time period





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Mindfulness

Mindfulness

Mindfulness

Distress Tolerance

Emotion Regulation

Interpersonal Effectiveness

Orientation

Tier II & III Students

1. Classroom Guidelines2. Principles of Dialectics

3. Wise mind4. What skills – Observe4. What skills – Describe4. What skills – Participate5. How skills – Nonjudgmentally5. How skills – One-Mindfully5. How skills – Effectively

6. ACCEPTS7. Self-Soothe and IMPROVE8. TIP9. Pros & Cons10. Accepting Reality & Radical

Acceptance11. Turning the mind & Willingness12. Mindfulness of Current Thoughts

15. Goals of Emotion16. Describe Emotions17. Check the Fact & Opposite Action18. Problem-Solving19. A of ABC PLEASE20. BC PLEASE21. Wave skill

25. Goal Setting26. DEAR MAN27. GIVE28. FAST29. Evaluating Options

1. Lesson #122. Lesson #223. Lesson #30

TESTS

*END*

START HERE Lessons #1-2

Lessons #13-14

Lessons #23-24

Recommended Sequence of the DBT STEPS-A Modules – Universal (Tier I)


Piloting DBT STEPS-A1. Lincoln High School – Portland, Oregon

2. Battle Ground School District – Battle Ground, Washington

3. Mastery Charter Schools – Philadelphia, Pennsylvania

4. Project GRAD - Los Angeles, California

5. Oakland Unified School District – Oakland, California

6. Manteca Unified School District – Manteca, California





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Responses from 8th grade students in the alternative school in WA

Class covered only Mindfulness and Distress Tolerance modules – 25 min. periods

Question Yes No Sometimes ?

(n=64)

Will you use STEPS-A? 51 (80%) 11 (17%) 1 (1.5%) 1 (1.5%)

Do you think this program can help others?

57 (89%) 4 (6.0%) 2 (3.0%) 1 (1.5%)

Anecdotal Data



Quote from an 8th grade teacher at an alternative school in WA

“This is a great program and a powerful program that gives students skills for life. I’ve been impressed in the retention of the students who I taught last year and that I’m seeing again this year. We have a YSPP (Youth Suicide Prevention Program) that……..focuses only on suicide. We have the SMART (School Mobilization Assistance Response Team) program that responds to trauma after it has happened. What STEPS-A does is fills in the gap and actually gives students skills to deal with stress that can lead to self-harm and other issues. A big “Thank You” to you and the rest who have developed this program.” (Jones, 2014)





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Intervention GroupControl Group

DERS: Total Score9th Graders

Fall SpringAcademic Year 2013-2014




(DBT STEPS-A)

Tier IISelected Population(DBT STEPS-A +)

Tier IIIIndicated

(DBT STEPS-A ++)

GENERAL EDUCATION

School-Based Mental Health

Special EducationResponse to Intervention





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TIER IDBT STEPS-A Curriculum

TIER II = TIER I Strategies +1. Smaller class/group sizes (10-15 students)2. 2 cycles with STEPS-A 3. Individual coaching by instructor

TIER III = TIER I + TIER II Strategies + 1. Designated Individual time (15-45 minutes)

A. Coaching, modeling, and mentoring2. Parent groups in the evening (1-2 per month)3. Team consultation

TIER II

TIER III

P

R

O

G

R

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S

S

M

O

N

I

T

O

R

I

N

G

TIER I

Gen. Ed., i.e., health teacher

Health teacher, SEL teacher, school counselor

School psychologist, school counselor, school social worker

SBMH: DBT Rathus & Miller

Implementing DBT Skills Tier I-III


BIG Take home Message!!





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James J. Mazza, Ph.D.

Miller Hall, Box 353600

University of Washington

Seattle, WA 98195-3600

(206) 616-6373

[email protected]

For More Information & Questions



Thank you for attending!For more training information, please visit

www.behavioraltech.org

Linehan Institute – Behavioral Tech | 4746 11th Ave NE Suite 102 | Seattle, WA 98105 | Phone 206.675.8588 | [email protected] Behavioral Tech, LLC is a wholly owned subsidiary of the Linehan Institute, a nonprofit organization.

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Live Webinar | May 5, 2015

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Linehan Institute – Behavioral Tech | 4746 11th Ave NE Suite 102 | Seattle, WA 98105 | Phone 206.675.8588 | [email protected] Behavioral Tech, LLC is a wholly owned subsidiary of the Linehan Institute, a nonprofit organization.

Information about the Instructors Elizabeth Dexter-Mazza, PsyD received her undergraduate degree from Florida State University and her doctoral degree from the School of Professional Psychology at Pacific University in 2004. She completed her predoctoral internship at the Albert Einstein College of Medicine/Montefiore Medical Center’s Adolescent Depression and Suicide Program under the directorship of Dr. Alec Miller. Dr. Dexter-Mazza completed her postdoctoral fellowship under the direction of Dr. Marsha Linehan at the Behavioral Research and Therapy Clinics (BRTC) at the University of Washington. While at the BRTC, Dr. Dexter-Mazza was the Clinical Director and a research therapist for Dr. Linehan’s research studies, which provided both individual DBT and DBT group skills training. Her clinical experience and training with DBT focuses on treatment for adult and adolescent populations along with family members. Dr. Dexter-Mazza’s primary research focuses on the development and evaluation of effective training programs for mental health professionals working with suicidal clients. She has published several book chapters and peer reviewed articles on DBT, Borderline Personality Disorder (BPD), and graduate school training in how to manage suicidal clients. Dr. Dexter-Mazza maintains a private practice in Seattle, providing individual DBT to people with BPD and skills based coaching and support to family members and friends of individuals with BPD. Additionally, Dr. Dexter-Mazza is a trainer for Behavioral Tech, LLC, a training company that provides DBT trainings to mental health professionals around the world. She is licensed as a psychologist in the state of Washington. James J. Mazza, PhD is a professor in the School Psychology Program at the University of Washington – Seattle where he has been for the past 20 years teaching and conducting research in the field of adolescent mental health. Dr. Mazza’s received his Masters and Ph.D. from the University of Wisconsin – Madison. His research examines the complex relationships of how mental health issues impact adolescent social emotional abilities and academic skills through a multitiered system of supports (MTSS). Dr. Mazza’s research has focused on school-based settings and has written extensively through peer-reviewed articles and book chapters on how to identify youth who are at-risk for suicidal behavior as well as developing social emotional learning (SEL) curricula to help all students learn emotion regulation skills.

*Faculty Disclosure Statement: Elizabeth Dexter-Mazza, PsyD is the author of STEPS-A SEL Curriculum. As the author, she retains intellectual property rights and receives royalties, consulting fees, and honoraria for its use. Dr. Dexter-Mazza is a contracted trainer with Behavioral Tech, LLC and receives compensation for her training activities.

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Implementing DBT Skills in Schools at a Universal …...2015/05/05 · DBT Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) ©2002-2015 Marsha M. Linehan,

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