Ecobehavioral Consultation in the Schools: Models, Tools and Techniques

1. Ecobehavioral Consultation in the Schools: Models, Tools and Techniques Steven W. Lee, Ph.D. School Psychology Program University of Kansas Mini-skills workshop presented at the annual meeting of the National Association of School Psychologists convention, March, 2010

2. Goals of the Presentation • Knowledge • Overview of history of consultation. • Foundation and rationale for ecobehavioral consultation (EBC). • Operationalize the EBC model. • Materials • Distribute EBC forms and procedures. • Practice • Skill development in EBC.

3. Agenda • Ecobehavioral Consultation (EBC) IQ • Definition and emergence of consultation • Rationale for EBC • Assumptions of EBC • EBC implementation materials • EBC demonstration and practice

4. Why Consultation? • Consultation skills are used in: • Interviewing teaching staff for assessments • Interviewing parents for assessments • Consulting individually with teachers, parents and principals • IEP meetings • Multi-disciplinary staffings • Problem-solving with students • Student assistance teams

5. Ecobehavioral Consultation IQ • Score • 2 points for each "yes" ; 1 point for each "somewhat" or "sometimes“; 0 for each "no“ • I have an entry plan for my schools. • I have implemented my entry plan. • I use a structured approach to consultation. • I successfully manage consultee resistance. • I am familiar with various models of consultation. • Communication skills are my strength. • I can conduct a complete functional behavior assessment (FBA). • I make adjustments during consultation to address the needs and cultural values of my consultee. • I have skills in crisis consultation. • I know and use a mini-experiment method with my consultation cases. • I assist the consultee in collecting information on treatment integrity. • I use a variety of data collection methods as part of consultations. • Goal setting is an integral part of my consultations. • Both the consultee's AND my ideas are used in developing interventions through consultation. • I assist the consultee in developing socially valid interventions. • I regularly follow-up in at least 4-6 weeks to check for effectiveness of the consultation intervention. • I plan for generalization of consultation-based interventions into other settings. Whiz in Ecobehavioral Consultation (Ask me anything)= >16 Semi-Expert (I want questions in writing) = 12-15 Neophyte (Don’t ask me anything) = 8-11 Aren't you glad this wasn't a real test = <8

6. “Consultation involves an indirect problem-solving process between a specialist (e.g., special educator, psychologist, mental health worker) and one or more persons (e.g., parents, teachers) to address concerns presented by a client (e.g., child/student, classroom, system; Gutkin & Curtis, 1990; Medway, 1979)”Consultation includes:1. Indirect service.2. Problem-solving emphasis.3. Collegial and voluntary nature.4. Attention to process and outcome. What is consultation?

7. Historical Emergence of Consultation • Four trends • The Sage and the medical model • Professionalism in school psychology • Manpower • Legislative

8. The Sage, Clinical Consultation and the Medical Model • The Sage - experts due to age, education, experience • Medieval Germany - "Freir beruf" independent professional who declares and practices a certain expertise. • Old World physicians introduce concept into America - AMA Code of Ethics (1847) "the physician's role is to unite tenderness with firmness and condescension with authority, so as to inspire the minds of the patients with gratitude, respect and confidence"

9. The Sage, Clinical Consultation and the Medical Model • Specialized knowledge and status generalization • Doctor-patient model of consultation • Diagnostic-prescriptive approach • Clinical consultation • First indirect approach • Two doctors discussing the case • Advanced the second opinion model of consultation.

10. Traditional Medical Service Delivery Model for Psychology Neighbors Relatives Other Parent Siblings Child Parents (Teachers) Daily Interaction 1 2 Referral Assessment Report 4 Psychologist 3 Treatment

11. Collaborative/Ecological Consultation Service Delivery Model for Psychology Neighbors Relatives Other Parent Siblings Child Parents (Teachers) Daily Interaction Treatment 4 1 Assessment 2 Referral 2 Assessment Collaborative Consultation Psychologist 3 Assessment 2

12. Problems with the Medical Model for Mental Health Service Delivery • Philosophical Problems - Is mental illness really internal to the individual. - Context independent vs. context dependent. - Definition of mental illness. • Effectiveness - Assessment - Diagnosis - Treatment • Impractical - Remediation vs. prevention. - Manpower

13. Professionalism • Boulder Conference (1949) • Scientist- practitioner model emerges • Thayer Conference (1954) • Credentialing and roles emerged • Spring Hill Symposium (1980) • Olympia Conference (1981) • Further development of roles including consultation • NASP Standards (2000) • Include consultation and collaboration as a key training domain

14. Professionalism • Research on consultation • Mannino & Shore (1975) - Consultee, client and/or system changes were reported in over 50% of the available studies. • Medway (1979) - Positive changes in 78% of the studies. • Medway (1982) - 84% of studies found positive changes in consultee or client. • Gresham & Kendell (1987) - Meta-analytic study found differential positive effects for behavior consultation over other consultation models.

15. Professionalism Research on consultation • Sheridan, Welch & Orme (1996) • 76% of studies (n=46) found positive effects on “some measures” (consumer satisfaction; social validity; process integrity; follow-up & generalization). • 46% of studies used experimental designs; studies mainly used BC and it produced the most favorable results. • Reddy, Barboza-Whitehead, Files & Rubel (2000). • 34 outcome studies • Effect size (client) by consultation model • Behavioral Consultation (n=29 studies) = 1.36 • Organizational Consultation (n=3 studies) = 2.43 • Mental Health Consultation (n=2 studies) = .53 • Large effect for; 1) externalizing child behavior problems; 2) consultee skill acquisition and 3) increased use of services (org. development). • Medium effect for; 1) academic problems; 2) social problems; 3) increased consultee knowledge; 4) attitude change – consultee; 4) decreased referrals – system. • Larger effect sizes for older versus younger children

16. Manpower • Mental Health Needs • Prior to Civil War - moral deficiencies • Late 1800's - Social Darwinism • Late 1800's - Public institutions created to control and contain mentally-ill - "bedlams". • Salvation Army, YMCA - rehabilitation • Institutions and agencies needed specialists, outside help. • Albee (1968) Medical model for mental health has led us to a serious shortage of personnel; “we can never produce the number of ‘doctors’ to meet mental health needs” - “psychology should not be a care delivery field” • Caplan and Mental Health Consultation • Post WWII - Caplan's Child Guidance Centers in Israel - more referrals than professionals available.

17. Legislative • Formed in 1955, Joint Commission on Mental Illness and Health - called for mental health consultation (1961). • Late 1950's 1960's growing dissatisfaction with traditional mental health services. Szasz (1960) Called for the locus of psychotherapy to change from the human psyche to the relationship between society and people. • Social Movement of the 1960's - Kennedy (1963) “Bold new approach” to fight mental illness resulted in CMHC act.Consultation the primary intervention approach.

18. Legislative • Public Law 94-142 • IEP was born • Related services (includes school psych.) • Consultation • Student Assistance Team • Section 504 (ADA) • Evaluation and re-evaluation • Educational services that allow for equal participation • IDEA & IDEIA • Psychological services (consulting) • Functional behavior assessment • Classroom observation • Manifestation determination • Positive behavioral interventions

19. Psychohistory and the Emergence of the Ecobehavioral Model for Consultation • Contributing Forces • Ecological psychology • Behaviorism • Problem-solving

20. Ecobehavioral Consultation (EBC) Roots of EBC: Ecological Psychology • Confucius believed one’s development occurs as one interacts with family, friends and the social order. • Titchener'sstructuralism and reactions against it - functionalism • Kurt Lewin (1951) advanced his field theory. • Roger Barker (1968) posited that the unit of focus should be on molar behavior and the ecological context within which it exists.

21. Ecobehavioral Consultation (EBC) Roots of EBC: Ecological Psychology • Urie Bronfenbrenner (1979) offered a dynamic ecological systems theory. • Robinson, G. ( Science, 2004) • “DNA is destiny” or not • Gene is expression in the brain occurs as an interaction of heredity and environment. • Not just over generations but WITHIN THE LIFETIME OF THE INDIVIDUAL

22. Ecobehavioral Consultation (EBC) Roots of EBC: Behaviorism Here come the behaviorists………………………………………………… • Francis Bacon’s empirical-inductive method. • John Watson warned against introspection in psychology as a unreliable method and argued in favor of stimulus-response relationships and the prediction and control of behavior. • B.F. Skinner’s operant conditioning articulated the three-term contingency as the stimulus, response and reinforcing stimulus. • Albert Bandura’s social learning theory emphasized that learning can take place through modeling or vicarious exposure. Reciprocal determinism identifies the relationship between the environment behavior and the person. • Kantor’s interbehavioral psychology.

23. Ecobehavioral Consultation (EBC) • Problem Solving • Four stage model (Bergan, 1995) • Problem identification • Problem analysis • Plan implementation • Problem evaluation • Problem solving research (Heppner 1975; Davidson & Sternberg, 2003) • Inferred predisposition • Problem definition and formulation • Generating alternatives • Decision-making

24. Ecobehavioral Consultation (EBC) The Rationale for Ecobehavioral Consultation • Willems - ecosystemic factors and response covariation. • Gutkin (1993) • argued for a paradigm shift in school-based consultation from a behavioral to an ecobehavioral perspective. • traditional behavior analysis has much to offer but is too narrow to fully account for the variation in behavior that we see in a school environment. • Why hasn’t it happened sooner? • Too many variables? • Lack of training? • Lack of tools? • Theoretical orientation?

25. Ecobehavioral Consultation (EBC)

26. Ecobehavioral Consultation (EBC) Assumptions of EBC • Hypothetical-inductive approach. • Functional relationship of the behavior in it’s current context that include the proximal and distal variables in its ecosystem as well as the historical context. • Inter-dependency of the person-behavior-environment. • The ecosystem includes both the structural elements of the environment but also cultural and behavioral expectations. • Multiple causation resulting in multiple effects. Dynamic, ever-changing interplay of causes of the person, behavior and the environment that when viewed through the lens of reciprocal determinism. • Multi-dimensional and probabilistic view of behavior function. • Behavior is viewed within the context in which it occurs and has little or no meaning or is incongruous in other settings. • Action research with “mini-experiments”. • Biological structure of the organism.

27. Ecobehavioral Consultation Process Sheet School:________________________ Consultee Name:________________ Student:_______________________ Date:___________________ Page ____ of ______ PHASE 1: Interview #1 with Consultee • MAKE THE PROCESS OVERT (Describe your steps and those to come) Notes: • 1. CREATE A CALM ATMOSPHERE • Downplay crisis and avoid immediate solution. • Be empathetic, use active listening and non-verbals. • 2. DEFINE ANDS CLARIFY THE PROBLEM • Gain breadth (What are the problems?). • Prioritizethe problem list. • Divide #1 problem into component parts (if necessary) • Define the problembehaviorally. (Does it pass the video camera test?) • When did it begin? (What is approximate starting date?) • What started it? (Was there an identifiable event that started it?) • Antecedents (What happens immediately before the target problem that triggers it? • Consequences (What happens immediately after the target problem?) • Frequency/duration? (How frequently does the target problem occur per day? Week?) • Short-term goal? (What is a reasonable short term goal?) • Long term goal? (What is a reasonable long term goal?) • 3. ASSESS SETTING EVENTS AND SYSTEMS INFLUENCES • What situations or settings that make the problem better? Worse? • During what days or times of the week is the problem is better? Worse? • Are there other people that make the problem better? Worse? Who are they? In what way do they affect the target problem? • Are there other systems (e.g., home, peers) that influence the target problem? If so, in what way? • To what extent does the way the client thinks or feels influence the target problem? Describe.

28. EBC Student/Client Problem Oriented Interview Name_______________________ Date__________ School___________________ Page ___ of ___ Problems Occurrence Triggers % of time trigger causes problem Consequences % of time conseq. follows problem Goals (targets for change & what could be done) (list of all problems, define behaviorally where possible) (frequency, duration, etc) (home, peers, school, teacher, demands, etc) (actions/feelings of self and others) Consultee Targeted Problem (if not mentioned above)

29. EBC Student/Client Problem Oriented Interview Instructions • Complete the identifying information on the form. • RAPPORT BUILDING - Introduce yourself and spend time building rapport. • PROBLEMS - Ask the student, ”What problems are you having (school, home, peers)?” Lists these problems in the “problems” box in the EBC Problem Oriented Interview. Operationally define each problem behaviorally when and where possible. Use additional sheets if necessary. This general problem-oriented interview gives the student/client to identify the highest priority problems for them without being influenced by the adults in his/her life. It also provides the consultant with insight on the congruence on the problem(s) between the consultee and the student/client. • OCCURRENCE – For each problem, ask the student, “How often does the problem occur?” Attempt to ascertain the current frequency or duration of each problem using a timeframe such as, per week, per day, per hour, depending upon the frequency or duraction of occurrence. • TRIGGERS – For each problem, ask the student, ”What triggers or starts this problem?” Use an ecobehavioral approach to identify proximal environmental, people, settings or demand characteristics that trigger (from the student/client’s perspective) each problem. Ecobehavioral queries may include the following, “What situations seem to trigger this problem?” or “Are there people who trigger this problem, if so, in what way?” For each identified trigger, ask the student/client to identify the percent of time or the conditional probability that each trigger causes the problem. For a problem that occurs exclusively at school, more specific setting or task demands must be identified to ascertain a conditional probability. For example, a student having identified arguments as a problem may predict that arguments occur 50% of the time when the student is required to interact with another, specific student. Estimates for the probability that a trigger will cause a problem should be developed for each identified trigger. Also included here should be queries of distal events that may have started or given rise to the problem. These distal events should be identified as such and included in the “Triggers” column for the problem. • CONSEQUENCES –Use an ecobehavioral approach to identify the proximal events that occur immediately after the problem. The consultant may ask the student, “What happens immediately after the problem occurs?” These consequences include actions of others, feelings or thoughts that the student may have or environmental changes to name a few. Follow-up questions may include, “What did the teacher do immediately after the problem occurred?” or “What did you think or feel immediately after the problem occurred?” Distal consequences may be queried as such, “Were there any permanent changes that took place after the problem occurred?” For each identified consequence, ask the student to estimate the percent of time that consequence occurs after each occurrence of the problem. • GOALS – Ask the student/client to identify desirable goals for change for each problem. The consultant may ask, “What would be a reasonable short-term and long-term goal for changing this problem?” Estimate the degree to which the student/client wants to contribute to changing the problem. The consultant may ask, “What will you do to change the problem?” • CONSULTEE TARGETED PROBLEM – If the student/client does not identify the same problem posed by the consultee, use the bottom row on the interview form to complete the problem oriented interview focusing on that problem.

30. Behavior Setting: _____________________________________________ Behavior Setting: _____________________________________________ Behavior Setting: _____________________________________________ Function/Plan Function/Plan Function/Plan Antecedents/Triggers Antecedents/Triggers Antecedents/Triggers Consequences Consequences Consequences EBC Phase 2 Multiple Setting-Based Solution Form Name_______________________ Date__________ School___________________ Page __/__ Target Problem/Behavior_______________________________________________________________________

31. Monday Date __/__/__ Student Name_____________________ Behavior/Problem__________________ ________________________________ 0 0 0 0 0 10 10 10 10 10 20 20 20 20 20 30 30 30 30 30 40 40 40 40 40 50 50 50 50 50 Zero Anchor Below write-in the “0” side anchor the worst problem or behavior ever. 60 60 60 60 60 70 70 70 70 70 80 80 80 80 80 90 90 90 90 90 100 100 100 100 100 Best Anchor Below write-in the “100” side anchor the best the problem or behavior has ever been (or no problem).. Friday Tuesday Thursday Wednesday EBC Weekly Individual Behavior Rating Form Teacher/Consultee___________________ Grade____ School___________________ Page ___/___ Instructions: Below are scales for rating a week of a problem/behavior. Begin by filling in the anchors. On the “Zero Anchor” or “0” side, write in a descriptor for the worst (most severe or most frequent) day of the problem you have ever experienced. On the “Best Anchor” or “100” side, write-in a description of the best (or no occurrences) day of the problem you have ever experienced. Fill in the starting date for the Monday when you begin rating. At the end of each day or period, make a summary rating of the severity/frequency of the problem/behavior by placing an “X” on the scale. Use the space on the right to note features of the problem or situations in which in occurred that you deemed noteworthy. These features may include important triggering events, the severity of the problem or observed controlling consequences. Graph the data weekly on the EBC Behavior Rating Chart. Notes: May include triggering events, new features of the problem/behavior, the severity of the problem or observed controlling consequences. Monday: Tuesday: Wednesday: Thursday: Friday:

33. EBC Phase 2 (FBA) Summary and Interpretation Form Name_______________________ Date__________ School___________________ Page __/__ Notes: Target Problem/Behavior______________________________________ __________________________________________________________ Estimated Frequency Results Source Possible Function(s) (e.g. Triggers, Consequences, Trials)

34. EBC Phase 2 Hypothesis/Solution Form Name_______________________ Date__________ School___________________ Page __/__ Target Problem/Behavior_______________________________________________________________________ Hypotheses Possible Solution(s)

35. Ecobehavioral Consultation Process Sheet: Phase 3 & 4: Interview and Follow-up Phase 3: Interview • 1. FEEDBACK AND HYPOTHESIS GENERATION • Analyze and interpret data together. • Generate tentative hypothesis(Consider possible functions and collaboratively obtain agreement on hypothesis). FEEDBACK AND HYPOTHESIS GENERATION Notes: GENERATION SOLUTIONS LIST: • 2. GENERATING SOLUTIONS • Brainstorm possible solutions based on hypothesis (No criticism, freewheeling, quantity desired, use structure). • Use visual aid to share solution list. • 3. CHOOSE SOLUTION AND SPECIFY RESPONSIBILITIES • Discuss solutions in relation to hypothesized function. • Consider the Best Available Solution (BAS). • Consider the ecology of the environment on the for implementation of the solution and vice versa. • Identify the chosen solution as a “trial intervention”. • Make responsibilities explicit. • Include ongoing data collection for progress monitoring. TRIAL INTERVENTION W/RESPONSIBILITIES: • 4. IMPLEMENT SOLUTION(S) • Develop strategies to promote implementation. • Arrange to treatment fidelity checks. • Use a “mini-experiment” design for implementation. SOLUTION IMPLEMENTATION FIDELITY AND DESIGN NOTES: Phase 4: Follow-up Interview FOLLOW-UP NOTES: • 1. EVALUATE SOLUTION EFFECTIVENESS • Collect and summarize the data. • Examine the data together(Consider goal attainment). • Consider generalization/fading/maintenance. • Restart the process (if needed).