Important Questions

Why (are challenging kids challenging)?

When (are challenging kids challenging)?What (do challenging kids do when they’re

challenging?)What (are we going to do differently now that

we know why challenging kids are challenging)?

Key Theme #1:Key Theme #1: CPS Philosophy/Mentality

Kids do well if they can

If they’re not doing well, If they’re not doing well,

we adults need to figure out why, we adults need to figure out why,

so we can help.so we can help.

Key Theme #2:Key Theme #2: Definition of “Good Parenting,” “Good Teaching,” and “Good Treatment”

Being responsive to the handBeing responsive to the hand

you’ve been dealtyou’ve been dealt

Key Theme #3:Key Theme #3:

Your explanation guides yourYour explanation guides your

intervention…intervention…

Traditional Answer to Why?:Challenging Behavior Is Working

Because of passive, permissive, inconsistent, noncontingent parenting, the kid has learned that challenging behavior is an effective means of getting something (e.g., attention) or escaping or avoiding something (e.g., homework).

““First pass” definition of function: It’s workingFirst pass” definition of function: It’s working (leads to interventions aimed at ensuring that kids have the incentive to do well)

Important Questions

If the kid has the skills to go about getting, escaping, and avoiding in an adaptive fashion, then why is he going about getting, escaping, and avoiding in such a maladaptive fashion?

Doesn’t the fact that the kid is going about getting, escaping, and avoiding in a maladaptive fashion suggest that he doesn’t have the skills to go about getting, escaping, and avoiding in an adaptive fashion?

Mantra

Doing well is always preferable to not doing well

(Prerequisite: skills)

Unconventional Answer to Why?:Challenging Kids are Lacking Skills

Challenging kids are challenging because they’re lacking the skills not to be challenging…they are delayed in the development of crucial cognitive skills -- often including flexibility/ adaptability, frustration tolerance, and problem-solving.

““Second pass” definition of function: Second pass” definition of function: challenging behavior communicates that the kid challenging behavior communicates that the kid doesn’t have the skills to respond to problems doesn’t have the skills to respond to problems more adaptivelymore adaptively (leads to interventions aimed at solving problems and teaching lagging cognitive skills)

Unconventional Answer to When?:The Clash of the Two Forces

Lagging Skills

Demands ofEnvironment

Challenging episodes occur when the cognitive Challenging episodes occur when the cognitive demands being placed upon a person outstrip demands being placed upon a person outstrip the person’s capacity to respond adaptivelythe person’s capacity to respond adaptively..

The Clash of the Two Forces

Lagging Skills

Demands ofEnvironment

Unsolved Problems

Unsolved Problems: the specific conditions in which the demands being placed upon a person exceed the person’s capacity to respond adaptively

The Little What?:

The Spectrum of Looking Bad: a person may exhibit any of a variety of challenging behaviors when the clash of forces occurs, distinguished primarily by their severity

Mantra

Behind every challenging episode is a lagging skill and a demand for that skill (i.e., an unsolved problem)

Mantras

Challenging behavior is about delayed development, not poor motivation.

Challenging behavior cannot be viewed outside the context of development.

The goal of intervention is to move development forward.

Can’t Versus Won’t:

Motivation YES NO

YES Adaptive Maladaptive Skills

NO Maladaptive Maladaptive

Unconventional Wisdom:General Goals of Intervention

- Focus on the lenses:Focus on the lenses: - Make sure that caregivers understand why

challenging behavior occurs (lagging skills and demands for those skills)

- Get organized:Get organized: - Identify the specific situations in which

challenging episodes occur (unsolved problems) - Create mechanisms for communication,

continuity, and proactive intervention

- Get busy:Get busy: - Solve problems and teach skills

Focus on the Lenses: Categories of Skills

• Executive skills• Language processing skills• Emotion regulation skills• Cognitive flexibility skills• Social skills

Focus on the Lenses and Get Organized:Lagging Skills and Unsolved Problems

How are all these lagging How are all these lagging skills skills

and unsolved problems and unsolved problems assessed?assessed?

The Assessment of Lagging Skills and Unsolved (ALSUP)

• The ALSUP is meant to be used as a discussion guide for achieving a consensus - not simply a checklist or mechanism for quantifying

• The ALSUP helps caregivers focus on things they can actually do something about and avoid the “correlation equals causation error”

• If you only focus on things you can’t do anything about, you are likely to come to the conclusion that you can’t do anything

• You’re looking for “actionable” information

The ALSUP: Lagging Skills Section• This section contains a representative list of the skills

frequently found lagging in challenging kids• Goal is to have a meaningful (not perfunctory) discussion

about the degree to which each lagging skill applies to a particular child (don’t just check or circle and move on)

• If an item applies, more information is needed:– Examples of times when the lagging skill is seen

(examples = unsolved problems)– Degree to which unsolved problems are setting in

motion challenging episodes• Expect “Wow” moments

– When caregivers come to recognize that a kid is, indeed, lacking many skills

– When caregivers come to recognize why prior interventions have been ineffective

– When caregivers begin to regret the manner in which they’ve been interacting with a kid based on incorrect assumptions

– When caregivers begin pondering where they’re going to find the time to do things the right way

Dead-End Information:“He has bipolar disorder”“She has bad wiring”“He had a forceps delivery”“She was conceived out of wedlock”“He from that neighborhood”“Her mother’s crazy”“He’s a middle child”“She just wants attention”“He just wants his own way”“She just wants control”“He’s manipulating us”“She has a bad attitude”“He’s making bad choices”“She has a mental illness”

Useful Explanation Litmus Test: Useful Explanation Litmus Test: If our explanation guides our intervention, what would we do If our explanation guides our intervention, what would we do

next?next?

The ALSUP: Unsolved Problems Section

• Other ways to identify unsolved problems:– Ask the kid– Stories can help

• embedded within every story of a challenging episode is the unsolved problem that set the episode in motion

• adults tend to start at the end of the story, so they may need to rewind the tape

– Keep a log for a week• Goal is to be as specific as possible about unsolved

problems (with whom, over what, where, and when are challenging episodes occurring?)

• Unsolved problems should provide an explicit description of the conditions in which the clash of the two forces occurs

• Focusing on specific problems helps make the general situation less ambiguous and less overwhelming

Lagging Skills + Unsolved Problems:

CHALLENGING EPISODES CHALLENGING EPISODES

ARE HIGHLY PREDICTABLEARE HIGHLY PREDICTABLE

(good, then we can start intervening (good, then we can start intervening proactively)proactively)

(“predictable” doesn’t mean every (“predictable” doesn’t mean every time)time)

Focus of a Productive Meeting:

- Identify lagging skills- Identify lagging skills- Identify unsolved problems - Identify unsolved problems - Prioritize unsolved problems (because you - Prioritize unsolved problems (because you

can’t work on everything at once):can’t work on everything at once):– those unsolved problems contributing to the

kid’s worst moments or safety issues?– those unsolved problems contributing to

maladaptive behavior most often?– those unsolved problems that would be most

conducive to successful Plan B?

Plan B FlowchartPlan B Flowchart

- Specify high-priority unsolved problemsSpecify high-priority unsolved problems- Designate person primarily responsible Designate person primarily responsible

for solving the problem with the childfor solving the problem with the child- Follow the remaining sequence to a Follow the remaining sequence to a

successful resolutionsuccessful resolution- Add new unsolved problems as old ones Add new unsolved problems as old ones

are solvedare solved

Concepts from Developmental Psychopathology:

Equifinality: Disparate routes may lead to a common outcome

Multifinality: A given risk factor can lead to disparate outcomes during the course of development across different individuals

Probabilistic epigenesis: risk factors have a probabilistic rather than causal influence

Symphonic causation: psychopathology is multi-determined, complex, transactional, and nonlinear…individuals are neither unaffected by earlier experiences nor immutably controlled by them

“Pathological conditions are best understood as adaptational failures”

Limits of Operant Strategies:

What Operant Strategies What Operant Strategies CanCan Do: Do:- teach basic lessons about right from wrong - provide extrinsic motivation- useful for shaping adaptive behavior in cognitively “low-functioning” kids

Major downside when applied to challenging kids:- punishment, and failure to achieve an anticipated reward, often trigger challenging behavior- kids (and adults) over-focus on consequences and often lose track of the specific problems and skills the kid is working on

What Operant Strategies What Operant Strategies Can’tCan’t Do: Do:

- identify lagging skills and unsolved problems- help adults change their lenses- collaboratively and durably solve problems - teach lagging skills- re-examine and adjust environmental demands

Why is the focus on unsolved problems and not lagging skills?

• Lagging skills are identified primarily for the purpose of ensuring that adults are wearing the right lenses

• You’re working on lagging skills when you’re using Plan B to solve the problems that are byproducts of those lagging skills

• Lagging skills take a while to teach…better to get a lot of problems solved (and reduce challenging behavior) on the way

Three OptionsThree Options(Common Approaches to Handling Unsolved Problems)

Plan A:Plan A: Impose adult will (unilateral problem solving)

Plan B:Plan B: Collaborative Problem Solving

Plan C:Plan C: Drop it for now (prioritizing)

Three OptionsThree Options(Common Approaches to Handling Unsolved Problems)

Plan A:Plan A: Impose adult will (unilateral problem solving) - e.g., “No,” “You must,” “You can’t,” - e.g., “No,” “You must,” “You can’t,”

“ “1-2-3”1-2-3”

Plan A Plan A causescauses challenging behavior in challenging behavior in challenging kidschallenging kids

Plan A provides no information whatsoever Plan A provides no information whatsoever about the factors making it difficult for the about the factors making it difficult for the kid to meet a given expectationkid to meet a given expectation

Get Busy:Timing is Everything

CHALLENGING EPISODES ARE CHALLENGING EPISODES ARE

HIGHLY PREDICTABLEHIGHLY PREDICTABLE

Crisis Management:Crisis Management: Intervention is Intervention is reactive and occurs emergently, in the reactive and occurs emergently, in the heat of the moment heat of the moment

Crisis Prevention:Crisis Prevention: Intervention is Intervention is planned and occurs proactively, well planned and occurs proactively, well before highly predictable challenging before highly predictable challenging episodes occur againepisodes occur again

Three OptionsThree Options(Common Approaches to Handling Unsolved Problems)

Plan C:Plan C: Drop it for now (prioritizing)- Emergency C: “OK”- Proactive C: an agreed-upon

interim plan

Three OptionsThree Options(Common Approaches to Handling Unsolved Problems)

Plan B: Plan B: Collaborative Problem Solving- Emergency B: more useful for

de- escalation- Proactive B: more useful for

working toward durable solutions (make an appointment)

Get Busy:Entry Steps for Plan B

1. Empathy 2. Define the Problem3. Invitation

Get Busy:Empathy Step of Plan B

• The goal of the Empathy step is to gather information so as to achieve the clearest possible understanding of the kid’s concern or perspective on a given unsolved problem

• Proactive B: – Begins with a neutral observation (“I’ve noticed

that…”), about an unsolved problem, along with an initial inquiry (“What’s up?”)

– Usually requires being as specific as possible– The neutral part is important, too (you want the kid

to talk, right?)– After “What’s up?” one of six things is going to

happen• The kid says something• The kid says nothing• The kid says “I don’t know”• The kid says, “I don’t have a problem with that”• The kids says, “I don’t want to talk about it”• The kid responds defensively

Empathy Step (cont.):Drilling for Information

Drilling strategies:• Ask about the who, what, where, and when of the

unsolved problem• Ask about why the problem occurs under some

circumstances and not others• Break the problem down into its component parts• Ask the kid what s/he’s thinking in the midst of the

unsolved problem (more important than feeling)• Use clarifying statements: “How so?” “I don’t quite

understand” “I’m confused” “Can you say more about that?” “What do you mean?”

– Don’t be a genius – you’re shooting for your “aha!” moment

– What you’re thinking: “What don’t I understand yet about his/her concern or perspective? What part of the picture is still incomplete? What do I need to ask next so that I understand it better? (you shouldn’t be thinking about solutions yet)

Empathy Step (cont.):Drilling/Additional Guidance

• Remember, “drilling” isn’t “grilling”…it involves “listening” not “lessoning”

• Stay neutral, non-defensive throughout…suspend your emotional response…the Empathy step isn’t about you

• Don’t rush – the Empathy step is not a mechanical formality…you’re really curious…you really want to know!

• You’re not ready to leave the Empathy step until you have a clear understanding of the kid’s concern or perspective

• The Empathy step is a “Solution-Free Zone”

Empathy Step (cont.):He Didn’t Talk: I Don’t Know/Silence

Goal #1: Don’t freakGoal #1: Don’t freakGoal #2: Make sure you’re using Proactive Plan B (instead Goal #2: Make sure you’re using Proactive Plan B (instead

of Plan A or Emergency Plan B)of Plan A or Emergency Plan B)Goal #3: Make sure the observation is truly neutral…and Goal #3: Make sure the observation is truly neutral…and

specific!specific!Goal #4: Figure out what kind of “I don’t know” or silence it Goal #4: Figure out what kind of “I don’t know” or silence it

isis• He doesn’t trust you yet• He has a lot of experience with Plan A• He really doesn’t know

– Maybe he’s never thought about it before– Maybe you’ve never asked before– Maybe he needs the problem broken down into its

component parts• Maybe he needs time to think (better get

comfortable with silence)• Useful strategy: educated guessing/hypothesis Useful strategy: educated guessing/hypothesis

testingtesting

Empathy Step (cont.):He Didn’t Talk: Other Patterns

- “I don’t have a problem with that”- that’s the beginning of his concern or perspective…

start drilling!

- “I don’t want to talk about it”- he probably has a good reason…we need to respect

that- sometimes kids need permission not to talk- don’t do anything today that will reduce the

likelihood of the kid talking to you tomorrow

- Defensiveness (“I don’t have to talk to you!”)- he may need reassurance that you’re not using Plan

A - “I’m not telling you what to do” - “You’re not in trouble” - “I’m not mad at you” - “I’m just trying to understand”

Get Busy:Define the Problem Step of Plan B

• The goal of this step is to ensure that the adult’s concern or perspective is entered into consideration (possibly beginning with, “The thing is…” or “My concern is…”)

• Definition of a problem: two concerns that have yet to be reconciled

• Common adult concerns: – How the problem is affecting the kid (e.g., health, safety,

learning)– How the problem is affecting others (e.g., health, safety,

learning)• What’s the score? The first two steps are reserved

exclusively for concerns• If there are two solutions instead of two concerns on the table

at the end of this step, you’re engaged in a power struggle• This step is a Solution-Free Zone, too• What if the kid “doesn’t care” about your concern? • What you’re thinking: “Have I clearly articulated my

concerns? Does the kid understand what I’ve said?”

Get Busy:The Invitation Step of Plan B

• Goal of this step is to brainstorm solutions that will address the concerns of both parties

• Lets the kid know this is something you’re doing with with him rather than toto him

• Crucial to prove to the kid that you’re as invested in getting his concern addressed as you are in getting your own concern addressed

• Should recap two concerns so as to summarize the problem to be solved (Starts with: “I wonder if there’s a way…”)

• Stick as closely as possible to the concerns uncovered in the first two steps – not a good time for assumptions, creativity, or vague summaries

The Invitation Step (cont.)

• The kid is given the first opportunity to generate solutions (“Do you have any ideas?”), but resolution of the problem is a team effort (collaborative)

• Don’t be a genius (you don’t know where the plane is landing)

• Definition of a good solution– Realistic– Mutually Satisfactory

• What you’re thinking: “Have I summarized both concerns accurately? Have we truly considered whether both parties can do what they’re about to agree to? Does the solution truly address the concerns of both parties? What’s my estimate of the odds of this solution working?”

• If the odds are below 60-70 percent, figure out why and modify/refine the solution or continue brainstorming

• The Invitation ends with an agreement to return to Plan B if the first solution doesn’t stand the test of time

You’re Ready!But this is Hard!

Next Ingredients:

- Bravery: - It’s not as easy as it sounds- Inaugural Plan B: just do the Empathy step (save

the next two ingredients for the next day)- Persistence:

- You don’t get good at Plan B without practicing Plan B (the first 20 are for practice)

- Continuity: - Solving problems tends to be incremental- The first solution seldom solves the problem

durably…most problems require more than one discussion

- Solutions that don’t stand the test of time:- weren’t as realistic and mutually satisfactory as first

thought- didn’t address concerns that hadn’t yet been identified

Get Busy: Front-Loading Key Elements (embedding, not tasting)

• Leadership commitment (to time, continuity, participation)

• Formation of Core Group/CPS Team– Game plan/timeline/benchmarks (helps ward off

“implementation dip”) – Creation of mechanisms for training, coaching,

spreading– Integration of paperwork (ALSUP, Plan B

Flowchart) into existing systems– Creation of new mechanisms for communication,

follow-up– Commitment to proactive intervention; debriefing– Tracking/monitoring systems, data collection– Establishing goals for dramatic reductions in

detention, suspension, restraint, seclusion• Staff development: Helping those who are having

trouble• Revisiting/revising existing policies/procedures

Get Busy: What Do We Do While We’re “Waiting for Plan B to Work”?

- By By achieving a clearachieving a clear understandingunderstanding of the kid’s of the kid’s lagging skills, challenging episodes are reduced lagging skills, challenging episodes are reduced (don’t lose sight of the big picture by being too (don’t lose sight of the big picture by being too “technical”)“technical”)

- By By decreasing the use of Plan Adecreasing the use of Plan A, challenging , challenging episodes are reduced furtherepisodes are reduced further

- By By increasing the use of Plan Cincreasing the use of Plan C, challenging , challenging episodes are reduced furtherepisodes are reduced further

- By By increasing the use of Plan Bincreasing the use of Plan B, many problems , many problems are being solved and skills being trained…and are being solved and skills being trained…and challenging episodes are reduced furtherchallenging episodes are reduced further

Is Plan B Relevant for Kids with Very Limited Communication Skills?

• Components of Plan B– Identifying unsolved problems– Identifying concerns– Understanding concerns of another party– Generating alternative solutions and choosing

• Important Questions:– Which components are we working on right now?– Can the child communicate about these components

verbally?– If not, how is the child communicating about other things

now?– Adults may need to apply excellent observation skills (OK

to be a genius…just this once)– Pictures can help (along with creativity)

Medication?

1. What does medication treat well? What does medication not treat well?

2. Does the kid present with any issues that medication would be expected to treat well?

- inattention/disorganized thinking

- hyperactivity-impulsivity- irritability/obsessiveness- extremely short fuse- general anxiety- sleep- tics

More Questions:

What about the real world?Aren’t you putting the kid in a “Plan B

Bubble”?Aren’t you setting him up for a fall?When will the kid learn to “take

responsibility”? How will s/he be “held accountable”?

How does one “set limits” using the CPS model?

Additional Information/Resources

www.livesinthebalance.org

Advocacy/supportCare PackagesBill of RightsAction Plan B

Web-based radio programs/Listening LibraryStreaming video

www.cpsconnection.comAdvanced trainings

Certification trainings