Your “ Do Now ” Activity

1. Your “Do Now” Activity • Have you ever attempted to “change your ways” or “break a bad habit”?(Smoking, drugs, drinking diet soda, finding fault in others, nail biting, over-eating, checking phone too often, etc.) • If so, what was the hardest part of changing? • If so, did you ever “forget”, or “backslide”? • If so, are you fully free of that habit today? • If not, think of a youngster with a persistent misbehavior who is resistant to your interventions. • Which factors keep him/her from changing? • How can the likelihood of change be increased?

2. Assessing & SupportingReadiness ForPositive Behavior Changein Intervention-Resistant Youth Tom McIntyre, Ph.D. www.BehaviorAdvisor.com

3. Why do our interventions work well with some kids, but fail miserably with others? One’s Willingness to Change 1. How (dis)satisfied is the youth with his/her present ways? & 2. Is there the promise of increased benefits accruing from displays of the new ways (Motivation A better “payoff”)

4. What’s the BIG “reason”behind all behavior? ^ • All (repeated) behaviors bring benefits. • Brings something desirable to us (positive reinforcement) • Allows us to avoid or escape something undesirable (negative reinforcement) • If a behavior brings no “payoff”, it is discontinued. • Our kids are using the best strategies they’ve found so far for meeting their needs.

6. Intervention Resistant Kids

7. Which factors influence a youngster’s willingness to engage in new ways? • Recognition of the need to change. • Seeing a better “payoff” to the proposed behavioral pattern. • Strength of personal character traits such as “self-restraint”, “ability to delay gratification”, etc. • Agreeing with the behavior-change procedures that will be used. • History of past failures. • Trust in the person(s) leading the effort. • OTHERS? ? ? ? ?

8. “Change your thoughtsand you change your world.”Norman Vincent Peale

9. Change is the end result of all true learning. Change involves three things: First, dissatisfaction with self -- a felt void or need; second, a decision to change to fill the void or need; and third, a conscious dedication to the process of growth and change -- the willful act of making the change, doing something.Leo Buscaglia

10. “TransTheoretical Model of Change”AKA: “Stages of Change Model”

11. Typical Stages of Behavior Change ^ 1. Pre-contemplation: No interest in changing present ways. 2. Contemplation: Considers trying to change to other ways 3. Preparation:Decides to make a change in life habit(s) & lays the groundwork for it. Perhaps in 2 separate stages: • Make a decision without a plan yet devised • Work on a plan of action 4. Action: Takes a definitive step toward change. Shows a different, more appropriate (re)action pattern with progressively greater frequency & facility. 5. Maintenance: Continues to strengthen & stabilize the new behavior pattern to avoid a return to the previous ways. 6. Relapse: Returns to the old action/pattern for a length of time. Support needed to build desire to re- engage.

12. Stages of Change

13. Pre-Contemplation "Faced with the choice between changing one's mind and proving that there is no need to do so, almost everyone gets busy on the proof.“John Kenneth Galbraith • Disinterest due to: • Payoff for present pattern of behavior • Demoralized by a history of past failures • Characteristics? • Denies need to change • Argumentative • Uncooperative • Feeling incapable of changing despite desire to do so • How do we spur interest in changing when attempts to confront & convince are ineffective? Handout

14. How do we move them forward?

15. Yagotta like the messengerif you’re gonna listen to the message. How do we develop “trust bonds” with relationship resistant kids?

16. Pre-Contemplation Stage:Questions to Ask ^ • “What would you like to make different about your present situation?” • “Why do you think others are so concerned about your actions? Why do they care about what you do?” • What are the benefits to your present way of doing things? What’s the pay-off? • “What will happen if you don’t change? What do you think that your life be like 3 years from now if you continue your way of reacting to situations?”

17. More questions • “Do you ever wonder if there might be a better way?” • “What would be the payoffs & benefits if you changed from your present ways of acting to what we ask?” • “What would have to happen for you to know that your present behavior is a problem?” • “What would be some warning signs that would let you know that this is a problem?” • Others?

18. Someone who oncewalked in those shoes… • “Would you be willing to talk with someone who once believed as you do, but doesn’t feel that way anymore?” • (If the offer is declined) “If you’re confident in your beliefs right now, why not talk with someone who once felt your way? What’s the threat?”

19. Contemplation Stage • The thought of changing has entered the mind. • The pros & cons are being weighed • How do we get involved? • What is our role? • Questions to ask? • “Why are you thinking about change at this time? • “What are the reasons for not changing?” • “What are the barriers to you changing today?” • “In the past, what things helped you in your change effort?” • “What do you need in order to feel more confident in your ability to change things?” • What do you think that you need to learn about changing?”

20. Strategies to Move Our Kid Forward? The 1st stage of change is recognizing that it’s needed. • Engage in a problem solving meeting to talk about the pros & cons of changing. • Inform him/her • about the usual stages of change • that change comes gradually • that change often involves set-backs. • Sketch out some ideas for how to go about preparing for change.

21. For use with student in pre-contemplation or contemplation stages. From TherapistAid.com Found in your Handout.

22. From TherapistAid.com Found in your Handout.

23. Page 2 of the form on previous slide Found in your Handout.

24. Our Approach 1. Validate the youth’s experience: "I hear that you’re thinking about trying a new way of doing things, but you’re not ready yet to take action." 2. Acknowledge youngster’s control of the decision: "I won’t preach to you because I recognize that you’re a capable young wo/man. You’ll be the one to decide if and when you’re ready.” 3. Clarify the boy/girl’s perceptions of the pros and cons of changing to a new way: “So what do you imagine as nice outcomes; some benefits to doing things like we’ve been talking about? What could be a drawback of leaving your usual ways of handling things?" 4. Encourage further self-exploration: "These questions are very important to beginning a successful change in your life. Give them some more thought and we’ll talk again another day. 5. Restate your position that it is up to them: "It’s totally up to you to decide whether a change is right for you. Whatever you choose, I’m here to support you. Let me know if you want to talk." 6. Leave the door open for moving to the preparation stage: "After talking about this, if you feel you would like to make some changes, we can begin with some planning, and see what you think about it."

25. Preparation Stage • Decision has been made to engage in change • How do we get involved? What is our role? • Conduct a Functional Behavior Assessment • Help the youngster sketch out a plan of action. • Identify & assist in problem solving re: obstacles to success. • Help the youngster identify social supports. • Determine whether s/he possesses the underlying skills to be successful with the plan for behavior change. • Encourage small initial steps that are “in the ball park” of what we hope will develop.

26. “Have no fear of perfection -- you'll never reach it.”Salvador Dali, Spanish painter Preparation Stage: Questions to Ask? • Goal: Get the student thinking about change. • “Have you ever tried to make the change before?” • “Can you share what you’ve got so far in your plan?” • “Are there any things getting in the way of starting your plan?” • “What’s the biggest obstacle to the success of your plan?” • “Would you like to partner with me to tweak your plan, and give it greater chances of success?” • “Who else should we recruit to work with us on the plan?” • “How will you know when it’s time to begin?” • “Once you begin, how can we support your efforts?”

27. Our Approach During the Planning Stage 1. Praise the decision to change the present behavior responses with reasons why it is a good choice. 2. Ask how we can help (and suggest some ways such as…?) Identify other support people. 3. Encourage small initial steps. 4. If multiple changes are involved, prioritize by level of difficulty or importance. 4. Identify and discuss obstacles. 5. Role play increasing realistic and varied situations in order to….?

29. Preparation stage discussion starter. TheCentersOhio.org Found in your Handout.

30. MOVING AHEAD:What can we do to help the student prepare for the action stage? • Social skills & anger management • “Circle of Courage” or other character education • Part time practice of new behavior during selected time periods. • Practicing the new way in parts • Task analysis • Shaping • Honest feedback on practice performance • “Criticism sandwich” • With encouragement • Instruction in self monitoring • Awareness of “Differential reinforcement”(to be implemented during the action stage)

31. Action Stage • “The journey of a thousand miles begins with a single step.”Lao-tzu • Undertakes the plan on an range of enthusiasm from: Uncertainty/Hesitation Enthusiasm/Vigor • How do we support the effort?

32. Action Stage: Questions to Ask? • “How’s it going?” • “How can I help?”

33. Action Stage • Assign/encourage the youngster to enter into situations where the new skill can be demonstrated (perhaps with us providing support before entry, or being by his/her side to offer hints, etc.) • If accompanying the youth, engage in frequent in-the-moment debriefings with immediate role play. • Focus on restructuring cues and social support. • Combat feelings of loss (at the trappings & benefits of the old behavior) and the reiterate long-term benefits.

34. Maintenance Stage • The youngster continues to engage in the new action/behavior pattern. • How do we help him/her “Stay on the right track”?

35. MOVING AHEAD: What can we do to help the student maintain success? • Self monitoring • Differential reinforcement • Honest feedback • “Criticism sandwich” • With encouragement • “Problem solving” meeting if run across road blocks

36. Questions to Ask: Maintenance Stage • “What’s keeping it going?” • “What’s the key to your success?” • “What do you need in order to continue being successful?” • What struggles do you still face? • “Put your feet in the right place. Then stand firm.” Abraham Lincoln, 16th U.S. president

37. Relapses:A Stage? A Return to a Previous One? “When one door closes, another opens; but we often look so long and so regretfully upon the closed door that we do not see the one which has opened.” Alexander Graham Bell • Common among those striving to change. • Often brings on demoralization. • How do we help them to get “back in the game”?

39. MOVING AHEAD:What can we do to help the student prepare for another attempt? • “I’ve learned much more from my failures than my successes.”Bernard Baruch

40. RelapseThe Resumption of Old Behaviors • Investigate the trigger for relapse; what & why • Reassess the motivations to try. • Identify the barriers being faced. • Identify & teach stronger, more effective coping strategies.

41. Looking Back in Order to Move Forward Questions to Ask: Relapses? • “You did it for _____ days. How did you manage to do it for so long?” • “What lessons have you learned that will help you succeed in the future?” • “What do you need to succeed for a longer time?” • “What do you need to get re-energized to try again?”

45. Pre-ContemplationStage(“I don’t need to change.”)

46. Contemplation Stage(Considering Change to Other Ways)

47. PreparationStage(Giving it a try-out)

48. Action Stage(Actively trying)

49. The question sheet for each stage is followed by this likert scale “ruler”. . Found in your Handout.

50. Does the youngster ready to change? • Let’s look at the “Readiness Ruler”