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					    Collaborative Problem-
        Solving (CPS) SM




  Teaching Children with Social,
Emotional, and Behavioral Challenges

      J. Stuart Ablon, Ph.D.
  CPS Institute, Department of Psychiatry
    Massachusetts General Hospital
         Harvard Medical School
Your explanation guides your
        intervention...
      Conventional Wisdom

Because of inconsistent, noncontingent
parenting, the child has learned that
explosive/noncompliant behavior is an
effective means of seeking attention or
coercing adults into “giving in.”
           Logical Intervention

Train and motivate adaptive behavior through
an intensive, consistent program of contingent
consequences and ignoring.
 Specific Components of Operant Approach


• List of Target Behaviors
  (priority is compliance)

• Menu of Rewards and Punishments
  (differential reinforcement)

• Currency System
     Limits of Operant Strategies


What Operant Strategies Can Do:
 - teach basic lessons about right from wrong
 - facilitate extrinsic motivation
        Limits of Operant Strategies

• facilitate teaching/learning of basic lessons (right
  from wrong)
   – It is highly likely that the child already knows the
     basic lessons (don’t hit, don’t swear, don’t
     explode), and is already aware of the
     consequences for these behaviors
   – Reward and punishment programs don’t teach
     complicated skills well
         Limits of Operant Strategies

• facilitate extrinsic motivation (to perform behaviors
  one is already capable of consistently performing)
   – If a child does not yet have the skills to behave
     adaptively, adding incentives will not accomplish
     the mission
   – Motivational programs make the possible more
     possible, but they don’t make the impossible
     possible
   – It is highly likely that the child is already motivated
     (not to be miserable)
       Unconventional Wisdom:
       It’s a Learning Disability
The child is delayed in the development of
crucial cognitive skills -- often including
flexibility/adaptability, frustration tolerance,
and problem-solving -- or has significant
difficulty applying these skills when they are
most needed.
            Logical Intervention

Identify and teach the lagging skills setting the
stage for, and solve the problems precipitating,
maladaptive behavior (while maintaining adults
as authority figures).
                      CPS Overview

Because the CPS model views maladaptive behavior as the
byproduct of a learning disability, the emphasis is on entirely
different…
• assessment “raw material” (cognition, not behavior)
    – What’s going on in this kid’s head that we wish wasn’t?
    – What isn’t going on in this kid’s head that we wish was?
• goals of intervention (teaching lacking thinking skills and solving
problems, not teaching adults to be more effective at imposing their
will and ensuring that kids have the incentive to comply)
        CPS Treatment Ingredients

1. Answer the question, “What lagging thinking skills
   and unsolved problems are setting the stage for
   maladaptive behavior?”

2. Be aware of options for responding to problems/
   unmet expectations and of what each option
   accomplishes

3. Successfully execute Plan B
        Pathways:
The Hand You’ve Been Dealt

•   Executive skills
•   Language processing skills
•   Emotion regulation skills
•   Cognitive flexibility skills
•   Social skills
         Pathways:
 The Hand You’ve Been Dealt


How are all these skills assessed?
          Pathways:
  The Hand You’ve Been Dealt

Assessment Tools
  – Pathways Inventory
  – Situational Analysis
  – Formal Testing (sometimes)
               Pathways Inventory

• Provides a listing of the skills frequently found lagging
  in children with social, emotional, and behavioral
  challenges
• Meant to be used as a discussion guide for achieving
  a consensus - not simply a checklist
              Pathways Inventory

Prioritization will be necessary:
• Which lagging skills and/or triggers seem to be
  accounting for the child’s worst moments?
• Which lagging skills and/or triggers seem to
  contributing to maladaptive behavior most often?
• Prioritizing is a consensus-building process among
  key stakeholders
• Worst case scenario: your initial priorities are
  imperfect
            Situational Analysis
     (Clues to Triggers and Pathways)
Explosive outbursts provide rich information in two
  areas:
• Triggers
   – These are “problems that have yet to be solved”
     (e.g., homework, reading, recess, lunch, waking
     up in the morning, sensory hypersensitivities,
     sibling interactions, etc.)
   – The more specific the trigger the better
• Pathways
   – These are “skills that need to be trained”
    Pathways + Triggers



CHALLENGING BEHAVIORS ARE
   HIGHLY PREDICTABLE
      Limits of Operant Strategies

What Operant Strategies Can Do:
 - teach basic lessons about right from wrong
 - facilitate extrinsic motivation
What Operant Strategies Can’t Do:
 - identify and teach the lagging skills setting
     the stage for, and solve the problems
     precipitating, maladaptive behavior
      CPS Treatment Ingredients

1. Answer the question, ““What lagging thinking skills
and unsolved problems are setting the stage for
maladaptive behavior?”

2. Be aware of options for responding to problems/
unmet expectations and of what each option
accomplishes

3. Successfully execute Plan B
You’ve got expectations!
               Three Plans
            (Common Approaches to
         Problems/Unmet Expectations)

Plan A: Impose adult will

Plan B: Collaborative Problem Solving

Plan C: Drop it (for now, at least)
               Three Plans
            (Common Approaches to
         Problems/Unmet Expectations)

Plan A: Impose adult will
  (e.g., “No,” “You must,” “You can’t”)
               Three Plans
            (Common Approaches to
         Problems/Unmet Expectations)

Plan C: Drop it (for now, at least)
  (e.g., “OK”)
                Three Plans
            (Common Approaches to
         Problems/Unmet Expectations)

Plan B: Collaborative Problem Solving
 - pursue unmet expectations
 - identify and teach lagging thinking skills
 - solve problems
 - reduce likelihood of challenging behavior
                Why Plan B?

•   The child has shown he needs someone to
    serve as his “tour guide” for navigating
    problems and regulating emotions
•   Over time, teaches the child skills so he
    won’t need the help for the rest of his life
            Initiating the Plans

• Plan A: “No,” “You must,” “You can’t”

• Plan B: Empathy>Problem>Invitation

• Plan C: “OK”
                After the Plans

• Plan A: “He did what I said.”

• Plan B: “We worked it out…we solved the
  problem together.”

• Plan C: “I didn’t bring it up.”
         A Few Important Points


• Expectations are a good thing, but only the
  realistic variety
• The Plans are not a ranking system for
  expectations…each Plan represents a distinct
  way of responding to unmet expectations.
• Plan B is not the average of Plans A and C
• Plan B is not a “technique”
• Plan B is faster than Plan A
"You know, the problem with diplomacy: It
takes a long time to get something done.
If you're acting alone, you can move more
quickly."

--President George W. Bush, at a 2006 Chicago press conference, on
the challenges of multilateral foreign policy
       An Important Reminder:


“Any problem/unmet expectation that can be
     handled using Plan A can also be
          handled using Plan B.”
       What about safety issues?

The more severe or unsafe the behavior,
   the more important it is to solve the
    problem or teach the lagging skill
  causing the behavior in the first place.
      CPS Treatment Ingredients

1. Answer the question, “What lagging thinking skills
are contributing to this child’s learning disability in the
domains of flexibility, frustration tolerance, and
problem-solving?”

2. Be aware of options for responding to problems/
unmet expectations and of what each option
accomplishes

3. Successfully execute Plan B
        Reminder


CHALLENGING BEHAVIORS ARE
   HIGHLY PREDICTABLE
          Plan B Applications

EMERGENCY B
  Takes place in the midst of a maladaptive
  behavior occurring (yet again); can be useful for
  solving problems, but more useful for crisis
  management/de-escalation


PROACTIVE B
  Takes place well before a maladaptive behavior
  recurs (crisis prevention); more likely to solve
  problems durably
    Plan B Entry Steps


1. Empathy(+Reassurance)
2. Define the Problem
3. Invitation
      Plan B Entry Steps


1. Empathy(+Reassurance)
2. Define the Problem
3. Invitation
            Empathy (+Reassurance)

•    Helps keep the child (and adult) calm
•    Ensures that the child’s concern is on the table
    - Solutions are not concerns
    - If you don’t know what the child’s concern is, you’ll have to figure
         it out (“What’s up?”)
    - The more specific the concern the better (requires probing)
•   Emergency B: Reflective listening
    - Can be modified for adolescents
•   Proactive B: “I’ve noticed that…” (neutral observation)
•   Reassurance is sometimes needed for additional
    calming
•   Empathy is not a formality - be prepared to be
    surprised!
    Plan B Entry Steps


1. Empathy(+Reassurance)
2. Define the Problem
3. Invitation
                 Define Problem

•   Ensures that the adult’s concern is on the
    table
•   Definition of a problem: two concerns
    that have yet to be reconciled
•   Reminder: Solutions are not concerns
•   Dueling solutions = a power struggle
•   Good to contemplate: “What’s your concern
    about that?”
    –   What if child “doesn’t care” about your concern?
   Plan B Entry Steps

1. Empathy(+Reassurance)
2. Define the Problem
3. Invitation
                     Invitation

•   This is an invitation to brainstorm solutions together
•   Lets the child know this is something you’re doing
    with him rather than to him
•   Generic Examples: “Let’s think of how we can work
    that out;” “Let’s see if we can solve that problem”
•   Better Still: Should recap two concerns so as to
    reiterate problem to be solved
•   Child is given the first opportunity to generate
    solutions (“Do you have any ideas?”) – but resolution
    of the problem is a team effort (collaborative)
Invitation Mantra


Don’t be a genius
Definition of an Ingenious Solution

 Any solution that two parties agree
is realistic and mutually satisfactory
                    This is Hard!

- Early on, CPS can feel like slogging through mud
- Over time, a Plan B “rhythm” should develop
- Very difficult problems may require more than one
  discussion
- Sometimes it’s necessary to take a break from the
  discussion and return to it later, after both parties
  have had more time to think
- Initially, child is likely to propose solutions that are not
  realistic or mutually satisfactory
- The first solution seldom solves the problem durably
- “Talking with” a child is not the same thing as doing
  Plan B
    Additional Information/Resources



    www.ccps.info
-   web-based seminars
-   Advanced Trainings
-   E-newsletter
-   new books, DVDs, trainings
Additional Information/Resources




www.thinkkids.org

				
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posted:5/26/2010
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