The document discusses the Collaborative Problem-Solving (CPS) approach for treating "explosive" children. CPS assumes these children have lagging skills that cause noncompliance, unlike traditional models that focus on parenting. CPS uses Plan B instead of imposing will (Plan A) or removing expectations (Plan C). Plan B involves the caregiver and child collaboratively solving problems to strengthen the child's skills. The therapist helps identify skills to train, facilitates CPS between family members, and ensures all concerns are addressed to change perceptions and establish therapeutic alliances for change.
The Explosive Child: Summary CPS by Dr. Ross GreeneKathy Gregory
This presentation is meant to summarize Dr. Ross Greene's book, "The Explosive Child". None of this work is original to me, all of this work is from the work of Dr Ross Greene.
The Explosive Child: Summary CPS by Dr. Ross GreeneKathy Gregory
This presentation is meant to summarize Dr. Ross Greene's book, "The Explosive Child". None of this work is original to me, all of this work is from the work of Dr Ross Greene.
Understanding How 'Screen Time' Affects Learning Lisa Guernsey
Presented in parts with Faith Rogow at NAEYC 2013, the annual meeting for the National Association for the Education of Young Children, in Washington, DC on November 23, 2013.
Complex developmental disability in infancy and early childhood, sign and symptom, its treatment via therapist approaches across the child's daily life
Attention deficit hyperactivity disorder is a lifelong neurodevelopmental disorder that affects the brain and results in a variety of inappropriate and maladaptive behaviors. ADHD is not a disease (Kajander 1995) but is a processing deficit that results in children having difficulty with inhibitory control. That is, children with ADHD lack self-control, something they cannot help. In children with ADHD, the parts of the brain that control attention and stop inappropriate behavior are underdeveloped (Barkley 1996; Kajander 1995). ADHD occurs three times more frequently in male students than female students (Reeve et al. 1995) and commonly occurs with other disorders. For example, ADHD occurs in 20 percent to 50 percent of the students with learning disabilities, in 65 percent of the students with oppositional defiant disorder, and in 20 percent to 30 percent of the students with conduct disorder (Reeve et al. 1995; Barkley 1990).
Carol Dweck & Ross Greene - Framing How Kids Learnkawilson68
The mindset theories of Carole Dweck are presented in addition to the collaborative problem solving model promoted by Ross Greene. Both honour the idea that 'kids are doing the best with what they've got'. These are translated to the classroom and how feedback and assessment and help frame behaviours and help kids want to learn.
Understanding How 'Screen Time' Affects Learning Lisa Guernsey
Presented in parts with Faith Rogow at NAEYC 2013, the annual meeting for the National Association for the Education of Young Children, in Washington, DC on November 23, 2013.
Complex developmental disability in infancy and early childhood, sign and symptom, its treatment via therapist approaches across the child's daily life
Attention deficit hyperactivity disorder is a lifelong neurodevelopmental disorder that affects the brain and results in a variety of inappropriate and maladaptive behaviors. ADHD is not a disease (Kajander 1995) but is a processing deficit that results in children having difficulty with inhibitory control. That is, children with ADHD lack self-control, something they cannot help. In children with ADHD, the parts of the brain that control attention and stop inappropriate behavior are underdeveloped (Barkley 1996; Kajander 1995). ADHD occurs three times more frequently in male students than female students (Reeve et al. 1995) and commonly occurs with other disorders. For example, ADHD occurs in 20 percent to 50 percent of the students with learning disabilities, in 65 percent of the students with oppositional defiant disorder, and in 20 percent to 30 percent of the students with conduct disorder (Reeve et al. 1995; Barkley 1990).
Carol Dweck & Ross Greene - Framing How Kids Learnkawilson68
The mindset theories of Carole Dweck are presented in addition to the collaborative problem solving model promoted by Ross Greene. Both honour the idea that 'kids are doing the best with what they've got'. These are translated to the classroom and how feedback and assessment and help frame behaviours and help kids want to learn.
Most people believe personality traits are fixed characteristics that are present at birth and persist throughout an individual’s lifetime. Recent research, however, indicates these “fixed” traits are simply the symptoms of a person’s belief system. These beliefs can be so strong, in fact, that they positively or negatively influence every aspect of an individual’s life: sports, business, relationships, parenting, teaching, and coaching.
According to Carol S. Dweck, one of the world’s leading researchers in the field of motivation, there are two main belief systems, or mindsets, that people can possess. These mindsets strongly influence the way individuals respond to success and failure, and in Mindset, Dweck uses research, examples of well-known business and sports leaders, and specific scenarios to demonstrate how changing one’s mindset can profoundly affect the outcome of almost every situation. Dweck also explains how understanding the basics of mindsets can help in accepting and understanding relationships and the people who comprise them
Mindsets are your beliefs and they affect your life and your success in business and your life.
Do you let failure or success define your life, or do you view them as opportunities? Do you view your qualities carved in stone and that you will have to prove yourself over and over and over or that the view you adopt for yourself profoundly affects the way you lead your life.
Do you view your life as a test or as a journey.
This session will look at how to encourage a problem-solving approach which permeates all the outcomes rather than as a separate element. It will look at strategies to promote collaborative learning and how this can be used to create an atmosphere of achievement to promote the four capacities.
http://www.ltscotland.org.uk/slf/previousconferences/2007/seminars/aproblemsolvingapproachinthecollaborativeclassroom.asp
Mindset (The Growth Mindset vs. the Fixed Mindset) for Kindergarten through F...Chris Shade
Asked to talk to a group of our kindergarten through fifth grade students about the growth (versus fixed) mindset, I created a presentation to support my message. Content is based on the book, Mindset: The New Psychology of Success by Carol Dweck. For more info, visit http://mindsetonline.com/whatisit/about/index.html. To purchase your copy, go to http://www.amazon.com/Mindset-The-New-Psychology-Success/dp/0345472322. See the presentation caught on video at https://www.youtube.com/watch?v=qPk2kq14rGw.
A one-page summary of the key differences between the fixed mindset and the growth mindset (concepts developed by Prof Carol Dweck from Stanford University).
Growth mindset has been shown to be significantly predictive of long-term success in a variety of areas, including acedemic success.
Presentation materials for an educator inservice on growth mindsets. Includes background information, historical perspectives, a self-assessment, and strategies for assisting students in developing growth mindsets.
A critique is an analysis of and a commentary on another piece .docxaryan532920
A critique is an analysis of and a commentary on another piece of writing. It generally focuses on technique as well as on content. A critical response essay (or interpretive essay or review) has two missions: to summarize a source’s main idea (briefly) and to respond to the source’s main ideas with reactions based on your synthesis. This critical response also incorporates counterpoint, or a counterargument. As a critic you are taking a skeptical or even opposing position – does the essay convince you?
I. Summarizing
The first step to writing is to read actively and thoughtfully, seeking answers to the following questions as you go:
What are the main points, ideas, or arguments of the work (book, article, play essay, etc.)?
How is the work organized?
What evidence/support does the author give?
What is the primary purpose of the work?
II. Analyzing (interpretation and evaluation)
To help you generate content for your analysis, consider the following questions:
Does the work achieve its purpose? Fully or only partially?
Was the purpose worthwhile to begin with? Or was it too limited, trivial, broad, theoretical, etc.?
Is any of the evidence weak or insufficient? In what way? Conversely, is the evidence/support particularly effective or strong?
Can I supply further explanation to clarify or support any of the main points, ideas, and arguments?
Are there sections you don’t understand? Why?
Was there any area where the author offered too much or too little information?
Is the organization of the work an important factor? Does its organization help me understand it, hinder my understanding, or neither?
Is anything about the language or style noteworthy?
III. Counterargument
Consider the above questions in those two sections as a foundation to argue your point (and please don’t assume that there is no other position – that is a narrow ideological view). Your goal in the final section is to take the two previous sections (summary/synthesis, and analysis/evaluation/interpretation) as an opportunity to posit (make, state, etc.) an argument or position that undermines, problematizes, debunks or otherwise causes a problem for the argument you are assessing. This sort of analysis that resists glazing over potential problems in favor of a complimentary review provides an opportunity (a vital one) to strengthen the original argument, amend it, or otherwise take into consideration something that was omitted or misstated.
Organization
The length or your essay and whether you respond to a single passage or to an entire work will vary with the assignment. Regardless of length and breadth, all critical responses include the following basic elements:
Introduction:
Body:
o Summary
o Transition
o Analysis: Evaluate the evidence: sufficient (enough evidence, examples), representative (large enough pool/sample), relevant (accurate correlations), accurate, claims fairly qualified
o Transition
o Response: base ...
Running head DEVELOPMENTAL DELAY1DEVELOPMENTAL DELAY.docxsusanschei
Running head: DEVELOPMENTAL DELAY 1
DEVELOPMENTAL DELAY
Developmental Delay
Obinna Okwara
Southern New Hampshire University
Developmental Delay
Each kid unique and each grows in his or her particular pace and style. You may be concerned if your child is not yet slithering or strolling when numerous companions are as of now showing this ability. In any case, recall that there are varieties in common improvement. Is your newborn child or youngster demonstrating noteworthy postponements or diverse examples of accomplishing significant turning points? This could be an indication of a development issue. These are illustrations: children who cannot keep up sitting by the tenth month or a tyke whose legs get solid each time he tries to move over. Older children may also display atypical development if they are not ready to eat with utensils or dress or disrobe, or on the off chance that they experience difficulty cutting with scissors or drawing (Estes et al., 2009).
Developmental delay alludes to a youngster who is not accomplishing breakthroughs inside of the age scope of that typical variability. 'There are five key identifiers for the development issue that make up the formative points of the milestone. A youngster might have a formative postponement in one or a greater amount of these ranges:
Gross motor: utilizing a vast group of muscles to sit, stand, walk, and run, and so on. Keeping adjust and evolving positions.
Fine motor: using hands and fingers to have the capacity to eat, draw, dress, play, compose and do numerous different things.
Language: talking, using non-verbal communication and emotions, conveying and understanding what others say.
Cognitive: Thinking abilities including learning, understanding, critical thinking, thinking and recalling.
Social: Interacting with others, having associations with family, companions, and instructors, coordinating and reacting to the sentiments of others
Ways to identify child development delay
Development Screening: A developmental screening test is a rapid and general estimation of abilities. Its aim is to distinguish kids who need further assessment. A screening test is just intended to identify children who may have an issue. The screening test might either over-distinguish or under-recognize kids with delay (Estes et al., 2009).
Developmental Evaluation: A developmental evaluation is a long, inside and out the appraisal of a child's aptitudes and ought to be managed by an exceptionally prepared proficient, for example, a therapist. Evolution tests are used to make a profile of a child's qualities and shortcomings in every single development range (Estes et al., 2009).
Population
Commonly, there is an age extent of an entire where a child is required to take in these new capacities. In case, the customary age range for walking is 9 to 15 months, and a child still is not walking around 20 months, this would be seen as a developmental deferral. Parent of the influenced childr ...
Running Head LIFE SPAN PARENTING PROJECT1LIFE SPAN PARENTING.docxwlynn1
Running Head: LIFE SPAN PARENTING PROJECT 1
LIFE SPAN PARENTING PROJECT 2
Student's name: Emmanuel Domenech
Professor's name: Dr. Suzi Hundemer
Class: BEHS 343
Topic: Chapter 2: Theoretical Perspectives on Parenting (trait theory) Chapter 3: Approaches to parenting research(Group counseling and psychotherapy with children and adolescents)
Institution: University of Maryland University College
Date: June 9, 2019
Life Span Parenting Project
Children ought to be evaluated when it comes to their entire environment with the inclusion of whatever negative or positive parental influences that could exist, this is according to Group counseling and psychotherapy with children and adolescents. I have learned that one of the most refreshing impacts concerning parents is because mainly we work with their kids who are reaching the adolescent stage in regions of their personal/social, academic success, career development, and realm. Their work comprises of working in intervention and prevention (Denno et al., 2015). Counselors help students like who undergo rough times, for instance, in adolescent and help them in enlightening their skills of resilience to be equipped better in case of hitting tough times in the future.
The adolescent stage is characterized by uneven and dramatic integration of changes that are developmental into the day to day lives of young persons. Simultaneously, teenagers experience growing independence from their families, mood swings, and at times, rapidly increasing sexuality. The tasks of talking to them usually start within the units of the family. Often, as guardians, we tend to view our teens as fragile thus visit our pediatricians or doctors since we see them as people whom to seek advice from regarding both behavioral and physiologic issues (Shechtman, 2017). The ongoing relationship with the pediatrician and the family gives for enough prospects to offer support and guidance that is anticipated as our kids get into and move through the stage of adolescence.
Determinants of Parenting
As we all know, the parent-child relationship has a massive influence on most aspects of the development of a child. When behaviors, parenting skills, and optimal capabilities have a positive effect on the school achievement or self-esteem of a child, there is positive behavior and development on the kids.
Fig: Family-Based Therapy
Some other treatment programs that can be used to work in families include family therapy, family-centered therapy, or family-based therapy. These programs change from one to the other. These are effective when it comes to family counseling and help in coming to terms with the stage or any disorder that could arise in the process.
As far as I am concerned, therapy is vital when looking at parenting approaches. This is because when an individual is a child, through adolescent to when they mature to being adults, they require guideline on being better per.
This poster depicts the parenting book by Dr. Thomas Gordon, P. E. T. Parent Effectiveness Training. It gives a summary of the book, as well as provides recommendations to future parents.
Characteristics of Effective Prevention ProgramsAn ounce of p.docxbissacr
Characteristics of Effective Prevention Programs
"An ounce of prevention is worth a pound of cure."
–Benjamin Franklin
Mental health services can target families and couples already experiencing severe problems, those couples and families experiencing common life stage transitions, and even couples and families that have not yet shown any signs of difficulty at all. Primary prevention seeks to intervene with the latter group on a mass scale with the goal of impacting the greatest number of couples and families as possible. As attractive as primary prevention sounds, and equally common-sensical and time-honored, the development and implementation of primary preventative interventions and programs proves difficult. For instance, it is difficult to measure the impact of an intervention or program that seeks to forestall some future outcome that may be one or more years away. Fortunately, much research has been conducted on what constitutes an effective, or good, preventative intervention or program. The dilemma for mental health professionals as a whole, and for you as a future marriage, couple, and family counselor, is how to carve out space in your professional work for the creation and development of prevention programming. This is challenging because in clinical practice, the majority of time and money may be spent on tertiary prevention or remedial counseling.
To prepare for this Discussion, use the Internet to find a prevention program for an area of professional interest. Consider how this program is effective or ineffective using the characteristics of effective programs outlined in the Learning Resources.
Reply
Primary Prevention Program
Example Educating the young about Health Safety
In this week I will discuss Primary prevention, and different characteristics that this program successful produce. Primary prevention is actively involved and aimed at high-risk groups that are not affected by a condition of prevention (Albee, George W., Ryan, Kimberly,1998). In the following reading of preventive care: Sanders, Thompson, and Bidwell use a population approach relating to children making transitions in a primary effort of research (Sanders, M. R., Ralph, A., Sofronoff, K., Gardiner, P., Thompson, R., Dwyer, S., & Bidwell, K. ,2008). One strong characteristic was multilevel planning, execution, and evaluation relating to the study of comparison communities and Targeted population (Sanders, M. R., Ralph, A., Sofronoff, K., Gardiner, P., Thompson, R., Dwyer, S., & Bidwell, K.,2008). One example of a primary prevention program would first involve educating one of or exposure to that may occur (case teaching the young adolescents about health and the safety of good health such as using good hygiene or eating right or working out daily).In the several characteristics that may relate to primary prevention may involve risk factors, protective factors, and Variable Risk factors relating to culture, .
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
1. Treating Explosive Kids
Part 2
The Collaborative
Problem-Solving Approach
Drew Burkley Psy.D.
Center of Excellence
Clinical Psychology Fellow
Andrew.Burkley@Cherokeehealth.com
2. Authors
Ross W. Greene, PhD
Director of the Collaborative Problem Solving Institute
Associate Professor in the Department of Psychiatry, Harvard
Medical School
J. Stuart Ablon, PhD
Director of Think:Kids, Department of Psychiatry,
Massachusetts General Hospital,
Associate Professor in the Department of Psychiatry, Harvard
Medical School
3. Location
Collaborative Problem Solving Institute
Department of Psychiatry of Massachusetts General
Hospital
http://www.explosivechild.com
4. Thanks to...
Gloria Jones, Psy.D.
Sasha Ahmed, M.S.
Scott Browning, Ph.D.
6. “Explosive” children and
adolescents?
The term “explosive” will be used in this presentation
because it is a common theme among all the
descriptions and diagnoses
7. What makes CPS different?
Assumes that explosive children are poorly
understood and are often poorly addressed by
available therapies
For close to fifty years, conceptualization and
treatment of explosive children have been
significantly influenced by the coercion or social
interactional model.
There has been a focus on patterns of parental
discipline
Inconsistent discipline
Irritable explosive discipline
Low supervision and involvement
Inflexible rigid discipline
8. The Plans
When a problem arises, there are three ways
to deal with it
Plan A: Imposing of parents Will
Plan C: Removing Expectations
Plan B: Collaborative Problem Solving.
9. Why Plan B?
Parents often chose Plan A.
Works for about 95% of children
Doesn’t account for lagging skills
Lagging skills, such as poor frustration
tolerance, poor executive functioning, etc.
may be influencing compliance
Typically seen in the “explosive” children
Plan B helps address skills and increase child
compliance
11. Plan B Basics
Plans A and C do not help children learn
needed skills
Developmentally, children are not equipped to
handle explosive episodes alone.
Two types of Plan B: Proactive and
Emergency
Parent does thinking for the child
12. Surrogate Frontal Lobe
Frontal lobes
Executive functioning
Impulse Control
Planning
Not fully developed until mid 20’s
Caregiver becomes surrogate frontal lobe
Thinks for child
13. Surrogate Frontal Lobe
The caregiver functions as a surrogate frontal
lobe by:
Walking child through the situation
Precipitating explosive episodes
After multiple repetitions, child will increase their
thinking-through ability
Something Caregivers already do
Teaching baseball or how to cross the street
Models creativity and flexibility
14. Rudimentary Plan B
Key Ingredients for a
successful Plan B
are
Both parties (are at
a place at which
they can begin
calm and rational.
Ensure concerns
of are clearly
defined
Brainstorm
All Ideas considered
Creative problem
solving for all concerns
Steps Necessary for
Successful execution
of Plan B
Empathy (plus
reassurance)
“I’ve noticed you’ve
had problems with
X, what’s up?”
Define the problem
Invitation
15. Step 1: Empathy
Empathy
Information Gathering to Understand
Acknowledges the concerns of the child and
defines that concern
Starts with “I’ve noticed”
Highly specific definition is essential for
successful empathy
Feeling heard helps people feel understood
16. Step 2: Define the Problem
Plan A: The concern of the adult
Plan C: The concern of the child
Plan B: Reconciling the concerns of
the child with that of the adult
To Main purpose adult get’s their concern on
the table.
Recognize the pathways that are interfering with the
ability to the child to respond to Plan A
Clearly define the concerns of the child through
Empathy
Clearly define the concerns of the ADULT through
appropriate investigation
17. Step 3: The Invitation
Invite the child to brainstorm.
For example:
Let’s think about how we can solve this problem together.
Let’s see what we can figure out or do about this together.
Assess the ability of the child to develop alternative
solutions.
Do they have the skills to generate alternative solutions? Do
these solutions take both adult and child concerns into account?
If not, the care giver may have to serve as the surrogate frontal
lobe.
18. Step 3: The Invitation
The burden is upon both members (child and
adult) of the problem solving team to solve the
problem. What matters now is that a solution is
developed that is feasible and mutually
satisfactory.
The invitation appears to many parents to be a
dissolution of their power rather than a sharing
and development of responsibility with their
child.
The Litmus test for a good solution is that it is
realistic, doable, and mutually satisfactory.
19. Emergency Plan B
Versus Proactive Plan B
Emergency Plan B
De-escalation technique.
Most parents and caregivers don’t realize
that the problems are highly predictable
Proactive Plan B
Solve the problem before it occurs
Teaching tool
Helps child ID triggers
Know for future occurences
20. Easy Living Through Plan B
Prior to explaining Plan B to caregivers, we
should:
Explain the pathways that are causing issues
identify the triggers (i.e., problems that have yet
to be solved) that commonly precipitate
explosive episodes.
21. Easy Living Through Plan B
Two forms of Plan B:
Focusing on resolving the triggers for the
explosion (Problem-focused Plan B)
Focusing on developing the lagging skills that
are causing the explosions (Skills-focused Plan
B)
22. Common Mistakes
Forgetting to Invite the child to problem
solve
Skipping steps
Not clearly identifying the two concerns
Providing alternative solutions (two
Plan A’s or a Plan A and a Plan C)
23. Common Mistakes
As a clinician, forgetting to examine and
identify ADULT pathway problems before
entering this step.
Caregivers trying to make Problem
Solving Unilateral rather than
collaborative.
Caregivers trying to make Plan B a clever
form of Plan A!
Relying too much on Emergency Plan B
and not using Proactive Plan B
25. Skills Needed for Plan B
Identify and articulate concerns
Consider these generating alternative
solutions
Anticipate outcomes of potential solutions
26. Therapist Roles
Identify lagging skills
Assist family in strengthening them
Facilitate therapeutic process
27. Therapist Roles
Establish alliances with each participant
Maintain neutrality
Prevent discussion from spinning out of
control
Be vigilant to hindrances to full investment
28. Therapist Roles
Help participants stay on track during
discussions
Identify any impediments to progress
Address within the family system
29. What is the single
greatest predictor
of therapeutic
change?
31. Establishing Alliances
Therapeutic relationship is vital
Communication of empathy is key
Validate
Convey understanding
32. Establishing Alliances with Adults
Adults need:
To be heard and understood
To see the clinician as competent
To see the clinician has the capacity to help relieve
distress
33. Establishing Alliances with Children
Children need to know:
Things may be better this time around
That the clinician does not believe that
negative behaviors are intentional
That the clinician views the situation as a
“family problem”
34. Maintaining Neutrality
Ensure that all participants’ concerns make it
into the discussion
Remaining focused
Understanding
Clarifying
35. Maintaining Neutrality
Remain focused on process vs.
outcome
***HOWEVER***
Solutions need to be“mutually
satisfactory”
36. Taking Control of the Case
Therapist Roles
Mediate
Assess “temperature”
Remain vigilant
37. Taking Control of the Case
Therapist Roles (cont...)
Actively calculates the pace of therapy
Keeps the discussion on track
Remains mindful of other treatments being
delivered
38. Pathways Extended
The Therapist as a Salesperson
Beginning therapy focused on child skill deficits:
Maintains congruence with many parents’ expectations
about the process of therapy
Helps alter/reframe parent perceptions of their child’s
outbursts
39. Pathways Extended
The Therapist as a Salesperson
A Good “Pitch”
from original definition of the referral problem to more
systemic perception.
Address both child and parent skill deficits
Feasible when therapeutic alliance is secure.
40. Pathways Extended
Defining the problem
Executive struggles
Generating alternative solutions
Disorganized/unsystematic approach
Language-processing issues
Emotional regulation deficits
Concrete thinkers
42. Identifying &Articulating Concerns and
Problems
Language Processing Skills
– Using and Practicing Adaptive Vocabulary
– Using Reminders
– Talking about the incident later, away from
the heat of the moment.
– Teach Pragmatic vocabulary with problem
identification
Video Clip
43. Considering Possible Solutions
Mutual process between parent and child
Some children have never been given the
opportunity
Repetition and exposure to adults showing
this skill helps to build it in some cases
In other cases a structured model can help
44. Reflecting on Likely Outcomes and How
Feasible/Satisfactory They Are
Therapist may express skepticism about
solutions that may not be realistic/feasible
model for the family
Child may not develop a solution based on both
concerns
difficulty with perceptive taking
45. Parent’s Execution of Plan B
Step 1- Empathy
Calming affect
Acknowledge their concern
Step 2 Defining Problem
Help child to take your concern into account when working toward a
solution
State concern in a calm, tentative manner
Reminder of problems solved prior
46. Final Thoughts
Advantages of Plan B:
Training can occur in the environments in which the skills are to be utilized
Collaborative in nature
Child is more likely to think about a problem
More likely to take ownership of the problem and the solution
Teaching adaptive social functioning is built in
Neither Plan A nor Plan C teaches the child how to negotiate their world using their lagging cognitive skills.
Parents and clinicians must first recognize and be aware of the lagging cognitive skills of their child and how they are attributed to the explosive episodes before they are able to move from Plan A or C to Plan B.
Neither Plan A nor Plan C teaches the child how to negotiate their world using their lagging cognitive skills.
Parents and clinicians must first recognize and be aware of the lagging cognitive skills of their child and how they are attributed to the explosive episodes before they are able to move from Plan A or C to Plan B.
Neither Plan A nor Plan C teaches the child how to negotiate their world using their lagging cognitive skills.
Parents and clinicians must first recognize and be aware of the lagging cognitive skills of their child and how they are attributed to the explosive episodes before they are able to move from Plan A or C to Plan B.
The Frontal Lobes of the brain are the areas in the brain that function to implement executive planning, motor planning, and impulse control.
In Plan B, the parent or care giver is doing the thinking (i.e. frontal lobe activity) for the child due to lacking cognitive skills or relative inexperience in performing the acts.
Similar to parents or care givers who teach their child or children how to ride a bike, hit a baseball, or learn to read (all frontal lobe activities), parents and care givers using Plan B will teach their child the crucial skills of flexibility, frustration tolerance, and problem solving.
Walking a child through a frustrating situation in the present (thereby preventing explosive episodes in the present).
Solving problems routinely precipitating explosive episodes in a durable way
After multiple Plan B repetitions, training lacking thinking skills so that the child won’t need the surrogate frontal lobe for the rest of their life.
Ensure concerns of are clearly defined and are at least considered
Entertain the wide range of possibilities that could address BOTH sets of concerns.
being aware of, and being sensitive to the feelings, thoughts, and experiences of another without actually sharing the feelings and experiences of another.
Observations have to be neutral. Not “I’ve noticed your trying to ruin my life”. I”ve noticed you’ve been terrorizing your brother lately, what’s up? I’ve noticed you’re being disruptive lately, what’s up? Shuts kid up.
Coming to a highly specific definition of the concern of the child is absolutely essential for this model and successful empathy.
Many adults or care givers will need specific models of how to empathize and what is not empathy. Many caregivers make an educated guess at this stage, but need instead to patiently work with their child.
Some parents have difficulty with the first step of Plan B (Empathy) because they fear that they are about to capitulate to the wishes of their child. In fact, what you are doing is clearly defining the problem.
What are your concerns about this specific behavior?
A common mistake at this step is that many caregivers attempt to provide TWO SOLUTIONS instead of defining TWO CONCERNS that Define the Problem.
Both child and adult concerns must be clearly specified before we can define the problem and an effective collaboration can begin! Usually adult’s concern’s fit into 1 of 3 categories Learning, Safety, how beh affects themselves or others.
The child must be invited in to a collaborative brainstorming session in a way that is feasible and mutually satisfying
--End point
help the child learn how to develop alternative solutions to their problems
Most parents and caregivers do not think about outbursts in situational terms so they don’t realize that the problems are highly predictable and wait until they are in the throes of a problem before attempting Plan B.
Emergency Plan B is when you are waiting until you are right in the middle of a disagreement or a problem to use Plan B. It is then a de-escalation technique.
We find that most outbursts tend to occur repetitively in response to the same circumscribed set of problems or triggers.
This is Emergency Plan B and it is the least opportune time to attempt a durable solution, but it can be a productive form of crisis intervention.
Over-reliance on Plan B as a de-escalation technique will decrease its effectiveness as a teaching technique because repeated crises and explosions have now become associated with the steps of Plan B (e.g., Empathy, Defining the Problem, Invitation).
Proactive Plan B is when you are trying to solve a predictable problem before it returns. Proactive Plan B is a teaching tool.
Proactive Plan B serves to help the child identify triggers to their explosive behaviors without shame to help them learn to solve the problem before it happens again.
explain the pathways (i.e., skills that need to be trained) that may be interfering with the capacity of the child for flexible frustration tolerance and problem solving
We should also have achieved an informal sense of the ability of the caregiver to digest and absorb this alternative view toward their problem with their child.
Care givers must agree that it is crucial to teach their child their lacking thinking skills through collaborative solutions to problems and that consequence based programs are unlikely to accomplish these goals.
The level of hostility between the caregiver and the child must be at a SAFE level prior toward the implementation of any of these steps.
If a majority of episodes deal with getting ready for school or doing homework, then therapist might consider a Problem focused Plan B
If outbursts are due to lagging skills, then Plan B might focus on skill building.
WARNING: IT IS VERY COMMON FOR ADULTS TO SUCCESSFULLY MAST ER THE FIRST TWO STEPS (EMPATHY AND DEFINING THE PROBLEM) BUT NEVER INVITE THEIR CHILD INTO THE PROBLEM SOLVING DEPARTMENT.
like Assessing Pathways, Empathy, Defining the problem, or giving the Invitation along the way. Also, not buying in.
(adult and child) and clearly defining the Problem but instead providing two Alternative solutions (e.g., Two Plan A’s or a Plan A and a Plan C).
For Plan B to be utilized and implemented effectively both parents and their children need to possess certain skills.
These are intricate skills that are not always developed in the families we serve. But Plan B discussions can provide us with meaningful (directly observable) information about each family member’s relational skills in these areas and others.
(((Read Slide First!!!!)))
The goal of facilitating is that Plan B can be modeled, practiced, fine-tuned, and eventually implemented by the family without assistance
To achieve these goals, therapist must first [next slide]
((Read first two lines))
CPS requires hard work and a shift in mindset for participants
Things often get worse before getting better
Validate where the parent is coming from– ask questions that communicate an understanding of explosive children.
vs. “child’s problem”
Solutions eventually developed are not as important as the process (family interaction) by which they were developed.
Solutions, or outcomes....Family decides what is “mutually satisfactory” not the therapist.
Mediates between family members in conflict
Can predict when family may not be capable of direct interactions with each other
Remain vigilant during direct discussions of family members’ ability to remain emotionally regulated.
especially if conflicting guidance is being offered.
Child- primarily focused on up to now; while parent may interfere with the implementation of plan B
The above are some potential parental pathway difficulties
Exec- refers to anticipation of problems before they occur
A.V.- using emotion words- happy sad angry, instead of saying “this sucks” identify emotion
Reminder- When a child say’s I don’t want to, or has an outburst- it is helpful to remind them of the feeling that surfaces. EG. “you’re feeling frustated, or angry.”
In this clip, we’ll see an example of a child with some difficulty with language processing and how the therapist approaches that. start at 3:35 End at 7:47
So at this point, the therapist is trying to work with the family to develop an outcome which addresses everyone’s concerns.
never given..... and need parent/therapist to suggest solutions.
Structured model --- Ask for help, Meet halfway/give a little, Do it a different way
(((Watch clip from 8:30....)) parent’s try to work plan b with therapist as a support...
(((Stop when needed for time!!))) probably around 12:00 minutes....
Isn’t easy. Realistically, kids are not going to immediately change their perspective and regulate, however; this approach truly improves family discussion, problem solving, and healthy approaches.....