THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF SOCIAL WORK OPEN ONLY TO STUDENTS IN A CHILD-SERVING FIELD PLACEMENT COURSE NUMBER: COURSE TITLE: SEMESTER & YEAR: INSTRUCTOR: SOWO 751 Behavioral Intervention with Children Spring, 2013; room 102 Jean Livermore, MSW, LCSW 335C Tate Turner Kuralt Phone: (919) 962-6529 Fax: (919) 962-3384 Email: jlivermo@email.unc.edu OFFICE HOURS: Tuesdays 12:15 – 1:45pm, or by appointment COURSE DESCRIPTION: This course teaches basic principles of behavior theory and intervention, current applications, and how to assess behavior, design and implement behavior plans for children COURSE OBJECTIVES: At the end of the course students will: 1. Know current applications of behavior theory with children, including individual behavior management, Positive Behavior Intervention in school settings, and parent training. 2. Know the research on effectiveness of behavioral interventions with children and on parent training programs. 3. Be able to conduct an individual behavioral assessment of a child using a Functional Behavioral Assessment framework. 4. Be able to create an individual intervention plan for a child using a Positive Behavioral Intervention framework, and know how to evaluate the effectiveness of such plans. 5. Have knowledge of other behavior intervention strategies with children such as token economies. 6. Know the application of behavioral interventions to some specific disorders of childhood, such as Attention Deficit/Hyperactivity Disorder. 7. Identify diversity and ethical issues regarding the use of behavioral interventions with children. EXPANDED DESCRIPTION: This course builds on the introduction to behavior theory that is presented in the Integrated Practice course. It will review the history, theoretical foundations and basic principles of clinical behavior therapy and teach the application of these principles to child behaviors. Students will practice assessing specific child behaviors and designing and evaluating individualized intervention plans, consistent with the Functional Behavioral Assessment/Positive Behavioral Intervention approach used in schools. Students will be introduced to additional behavioral intervention strategies such as social skills training, self-management programs and token economies. The appropriate application of behavioral intervention to some specific disorders of childhood including Attention Deficit Hyperactivity Disorder and anxiety disorders will be reviewed. Research on effectiveness of behavioral interventions with children and on groupbased parent training programs will be presented. Diversity considerations and ethical issues regarding the use of behavioral interventions with children will be considered and discussed. REQUIRED TEXTS/READINGS: There is no textbook for this class; required readings can be obtained via Sakai or the UNC electronic library. RELATED READINGS: Supplemental recommended readings are noted for specific classes. TEACHING METHODS This course will use a variety of teaching and learning methods, including lecture, group discussions, role plays and student presentations. Discussions will draw upon work and field experiences, readings and assignments; participation by each student is essential and expected. For discussions to be lively and enthusiastic, the development of a supportive learning environment, in which all contributions are valued, is essential. A supportive learning environment is fostered by listening to the ideas and views of others, being able to understand and appreciate a point of view which is different from your own, articulating clearly your point of view, and demonstrating interest and engagement in the contributions of classmates. CLASS ASSIGNMENTS Assignments are described below, and assignments, expectations and grading criteria will be discussed in more detail during the first class session. All written assignments should use references following APA format and be typed or word processed using correct grammar, punctuation and spelling. Class participation (20%) In a seven week course, missing class has a significant impact on participation and learning opportunities. Students are expected to attend all classes, to be on time, and to stay for the duration of the class. Points will be deducted for missing class, arriving late or leaving early. It is the student’s responsibility to notify the instructor in advance if unable to attend class. Students are expected to contribute regularly to classroom discussion, including being prepared to discuss readings and assignments; asking questions; initiating topics; offering ideas, examples and comments; and responding to contributions of other students. Students are expected to demonstrate engagement in discussions by listening respectfully to others and through other verbal and nonverbal behaviors. First Paper: Brief report of experience using positive social reinforcement (10%) A one-two page paper presenting details of a two-week behavioral observation and brief intervention. Students will be required to define the behavior, record baseline measurements, describe and justify the positive social reinforcer, measure and report results of the intervention. A detailed description of the assignment and a form for recording data are available on Sakai. Brief Quiz on definitions of basic principles and terms (10%) SoWo 751; Spring, 2013 2 Second paper: Review of behavioral instructional programs for parents and caregivers (25%) A four-five page paper reviewing a book or guide for teaching behavior management skills to parents or caretakers. Choices will include self-help books, curricula for use individually with parents or in group Behavioral Training Programs, and manuals or guides for therapists to use in working with parents. These books and manuals will be available from the instructor. With permission, you may purchase or utilize your own material but this material must be approved by the instructor. A concise summary of your review to hand out to classmates (5%) A one page handout summarizing the main points of the material reviewed. Handout should describe target audience, identify strengths and any concerns, and make recommendations to classmates regarding how and with whom this material would best be used. Third paper: A comprehensive Functional Behavioral Assessment (FBA) and Positive Behavioral Intervention (PBI) plan for a specific, problematic behavior (30%) Through their field placements, students will identify a child with a specific behavior that is problematic either at home or in school. Students will be required to conduct a comprehensive functional assessment of the behavior in context and to develop a positive intervention plan for behavior change. The approximately 5-6 page paper will present the details of a Functional Assessment and Positive Behavioral Intervention plan, following a format provided for the assignment. EVALUATION: Class Attendance and Participation 20% First Paper on Social Reinforcement 10% Quiz 10% Second Paper on Review of Parent Training Material 25% Summary Handout for Classmates on Reviewed Material 5% Third Paper \Consisting of a Complete Behavior plan, including FBA/PBI 30% 100% GRADING SYSTEM H = 94-100 P = 80-93 L = 70-79 F = 69 and below POLICY ON LATE ASSIGNMENTS AND INCOMPLETES Written assignments are due at the beginning of class on their due date, as noted in the course outline. Points will be deducted for late assignments. A grade of Incomplete is given on rare occasions when there is sufficient reason to warrant it. It is the student’s responsibility to initiate a conversation with the instructor to request an Incomplete—instructors have no responsibility to give an Incomplete without such a request. SoWo 751; Spring, 2013 3 POLICY ON ACADEMIC DISHONESTY Please refer to the APA Style Guide, The SSW Manual, and the SSW Writing Guide for information on attribution of quotes, plagiarism and appropriate use of assistance in preparing assignments. All written assignments should contain a signed pledge from you stating that, "I have not given or received unauthorized aid in preparing this written work." In keeping with the UNC Honor Code, if reason exists to believe that academic dishonesty has occurred, a referral will be made to the Office of the Student Attorney General for investigation and further action as required. POLICY ON ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES Students with disabilities that affect their participation in the course and who wish to have special accommodations should contact the University’s Disabilities Services. Disabilities Services will notify the instructor that the student has a documented disability and may require accommodations. Students should discuss the specific accommodations they require (e.g. changes in instructional format, examination format) directly with the instructor. POLICY ON THE USE OF ELECTRONIC DEVICES The use of electronic devices in the classroom is prohibited. Exceptions will be made only for students with written documentation of a disability. For these students the use of electronic devices for non-class related activities (e.g. checking email, playing games) is strictly prohibited. COURSE OUTLINE AND READINGS The class format is based on the expectation that you are prepared and active learners. Reading the assigned materials prior to the date they are due is a prerequisite to getting the most out of class sessions and successfully meeting the course objectives. NOTE: THE FOLLOWING GLOSSARY OF TERMS IS AVAILABLE ON SAKAI Kazdin, A. E. (2005). Glossary. In Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents (pp. 373-383). New York: Oxford University Press. WEEK 1: FOUNDATIONS OF BEHAVIOR THERAPY JANUARY 15, 2013 Origins of behavior therapy, early behaviorists, experimental psychology Classical and operant conditioning, social learning theory Basic principles and assumptions about human behavior in behavior theory Defining and analyzing behavior: context, antecedents, consequences, contingencies, reinforcement schedules WEEK 2: BASIC PRINCIPLES, APPLIED JANUARY 22, 2013 Additional concepts: extinction, generalization, chaining, shaping, and others School-wide and classroom approaches to positive behavior The functional perspective SoWo 751; Spring, 2013 4 IDEA: Functional Behavioral Assessment and Positive Behavioral Intervention plans Ethics of behavior therapy Readings Required for Week 2: Maag, J. W. (2004). Introduction to behavior management. In Behavior management: From theoretical implications to practical applications (2nd. ed., pp. 1-20). Toronto: Wadsworth/Thompson. (Available on Sakai) Sugai, G. & Lewis-Palmer, T. (2004). Overview of a function-based approach to behavior support within schools. Assessment for Effective Intervention, 30(1), 1-6. (Available via UNC electronic Library at http://aei.sagepub.com/content/30/1/1.full.pdf+html. Weiss, N. R., & Knoster, T. (2008). It may be nonaversive, but is it a positive approach? Relevant questions to ask throughout the process of behavioral assessment and intervention. Journal of Positive Behavior Intervention, 10(1), 72-78. (Available on Sakai) Recommended Supplemental Reading: Maag, J. W. (2001). Rewarded by punishment: Reflections on the disuse of positive reinforcement in schools. Exceptional Children, 67(2), 173-186. (Available via UNC electronic Library) Steege, M. W., & Watson, T. S. (2009). Introduction to functional behavioral assessment. In Conducting school-based functional behavioral assessments: A practitioner's guide (2nd ed., pp. 1-17). New York: Guilford Press. (Available on Sakai) WEEK 3: BEHAVIORAL PARENT TRAINING JANUARY 29, 2013 Parenting and culture History of parent education Training for compliance using time out In-class Quiz on Definitions of Behavior Principles and Terms First paper due Readings Required for Week 3: Shriver, M. D., & Allen, K. D. (2008). Cultural issues in parent training. In Working with parents of noncompliant children: A guide to evidence-based parent training for practitioners and students (pp. 117-138). Washington, DC: American Psychological Association. (Available on Sakai) Danforth, J. S. (1998). The behavior management flow chart: A component analysis of behavior management strategies. Clinical Psychology Review, 18(2), 229-257. (Available via UNC electronic Library) Ducharme, J. M. (2007). Success-based, noncoercive treatment of oppositional behavior. In J. M. Briesmeister & C. E. Schaefer (Eds.), Handbook of parent training: Helping parents prevent and solve problem behaviors (3rd ed.) ( pp. 268-304). Hoboken, NJ: John Wiley & Sons. (Available on Sakai) SoWo 751; Spring, 2013 5 Recommended Supplemental Reading: Warzak, W. J., & Floress, M. T. (2009). Time-out training without put-backs, spanks, or restraint: A brief report of deferred time-out. Child and Family Behavior Therapy, 31, 134-143. (Available via UNC electronic Library) Barker, C. H., Cook, K. L., & Borrego, J. (2010). Addressing cultural variables in parent training programs with Latino families. Cognitive and Behavioral Practice, 17(2), 157-166. (Available via UNC electronic Library) Kotchick, B. A., & Grover, R. (2008). Implementing evidence-based treatments with ethnically diverse clients. In R. G. Steele, T. D. Elkin & M. C. Roberts (Eds.), Handbook of evidence-based therapies for children and adolescents: Bridging science and practice (pp. 487-504). New York: Springer. (Available on Sakai). Calzada, E. J. (2010). Bringing culture into parent training with Latinos. Cognitive and Behavioral Practice, 17, 167-175. (Available via UNC electronic Library) McMahon, R. J., & Kotler, J. S. (2008). Evidence-based therapies for oppositional behavior in young children. In R. G. Steele, T. D. Elkin & M. C. Roberts (Eds.), Handbook of evidence-based therapies for children and adolescents: Bridging science and practice (pp. 221-240). New York: Springer. (Available on Sakai) WEEK 4: COLLABORATING WITH PARENTS AND FAMILIES FEBRUARY 5, 2013 Engaging parents, overcoming barriers Collaborating to develop basic behavior plans Teaching behavioral principles and time out Readings Required for Week 4: Webster-Stratton, C. (2009). Affirming diversity: Multi-cultural collaboration to deliver the incredible years parent programs. International Journal of Child Health and Human Development, 2(1), 17-32. (Available on Sakai). Shriver, M. D., & Allen, K. D. (2008). How to teach parents. In Working with parents of noncompliant children: A guide to evidence-based parent training for practitioners and students (pp. 117-138). Washington, DC: American Psychological Association. (Available on Sakai) Shriver, M. D., & Allen, K. D. (2008). Beyond noncompliance: Developing evidence-based parent training interventions. In Working with parents of noncompliant children: A guide to evidence-based parent training for practitioners and students (pp. 159-186). Washington, DC: American Psychological Association. (Available on Sakai) Recommended Supplemental Reading: Budd, K. S., Hella, B., & Hyo, B. (2011). Delivering parent-child interaction therapy in an urban community clinic. Cognitive and Behavioral Practice, 18, 502-514. (Available via UNC electronic Library) SoWo 751; Spring, 2013 6 WEEK 5: INTERVENTIONS WITH OLDER CHILDREN AND ADOLESCENTS FEBRUARY 12, 2013 Interventions with adolescents Working with parents of adolescents Second Paper and Handout Due Readings Required for Week 5: Miltenberger, R. G. (2001). The token economy. In Behavior modification: Principles and procedures (2nd ed.) (pp. 412-433). Belmont, CA: Wadsworth/Thompson. (Available on Sakai) Cavell, T. A. (2001). Updating our approach to parent training. I: The case against targeting noncompliance. Clinical Psychology: Science and Practice, 8(3), 299-318. (Available via UNC electronic Library) Recommended Supplemental Reading: Barry, L. M., & Messer, J. J. (2003). A practical application of self-management for students diagnosed with Attention-Deficit/Hyperactivity Disorder. Journal of Positive Behavior Interventions, 5(4), 238-248. (Available via UNC electronic Library) WEEK 6: COMPLEX FAMILIES, DIFFICULT BEHAVIORS FEBRUARY 19, 2013 RACHEL GALANTER, MPH, GUEST SPEAKER Program Manager of the Family Support Program Exchange Club Family Center of Durham Additional factors impacting behavioral interventions Working with multi-problem families Attention-Deficit/Hyperactivity Disorder: Multimodal interventions Children with serious behavior disorders Readings Required for Week 6: Cavell, T. A. (2000). Therapeutic alliance and parenting goals. In Working with parents of aggressive children (pp. 69-97). Washington, D.C.: American Psychological Association. (Available on Sakai) Levac, A. M., McCay, E., Merka, P., & Reddon-D'Arcy, M. L. (2008). Exploring parent participation in a parent training program for children's aggression: Understanding and illuminating mechanisms of change. Journal of Child and Adolescent Psychiatric Nursing, 21(2), 78-88. (Available via UNC electronic Library) Pham, A. V., Carlson, J. S., Kosciulek, J. F. (2010). Ethnic differences in parental beliefs of Attention-Deficit/Hyperactivity Disorder and treatment. Journal of Attention Disorders, (13)6, 584-591. (Available via UNC electronic Library) SoWo 751; Spring, 2013 7 Recommended Supplemental Reading: Cavell, T. A. (2000). A framework for intervening: responsive parent therapy. In Working with parents of aggressive children (pp. 49-67). Washington, D.C.: American Psychological Association. (Available on Sakai) Baker-Ericzén, M. J., Jenkins, M. M., & Brookman-Frazee, L. (2010). Clinican and parent perspectives on parent and family contextual factors that I pact community mental health services for children with behavior problems. Child Youth Care Forum 39(6), 397-419. Antshel, K. M., & Barkley, R. A. (2008). Psychosocial interventions in Attention Deficit Hyperactivity Disorder. Child and Adolescent Psychiatric Clinics of North America, 17(2), 421-437. (Available via UNC electronic Library) Schachter, D., Tharmalingam, S., & Kleinman, I. (2011). Informed consent and stimulant medication: Adolescents’ and parents’ ability to understand information about benefits and risks of stimulant medication for the treatment of Attention-Deficit/Hyperactitiy Disorder. Journal of Child and Adolescent Psychopharmacology, 21(2), 139-148. WEEK 7: OTHER BEHAVIORAL INTERVENTIONS, WRAP-UP AND EVALUATIONS FEBRUARY 26, 2013 Social skills groups, other interventions Behavioral interventions with specific childhood disorders Case Consultation and Practice Third Paper Due Readings Required for Week 7: Hautmann, C., Eichelberger, I., Hanisch C., Pluck, J., Walter, D., & Dopfner, M. (2010). The severely impaired do profit most: Short-term and long-term predictors of therapeutic change for a parent management training under routine care conditions for children with externalizing problem behavior. European Child & Adolescent Psychiatry, 19(5), 419430. Recommended Supplemental Reading: Shirk, S., & McMakin, D. (2008). Client, therapist, and treatment characteristics in EBTs for children and adolescents. In R. G. Steele, T. D. Elkin & M. C. Roberts (Eds.), Handbook of evidence-based therapies for children and adolescents (pp. 471-486). New York: Springer. (Available via UNC electronic Library) Ducharme, J. M., Folino, A., & DeRosie, J. (2008). Errorless acquiescence training: A potential "keystone" approach to building peer interaction skills in children with severe problem behavior. Behavior Modification, 32, 39-60. (Available via UNC electronic Library) Pelham, W. E., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for attentiondeficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 37(1), 184-214. (Available via UNC electronic Library) SoWo 751; Spring, 2013 8 WRITTEN ASSIGNMENTS—EXPANDED DESCRIPTIONS ASSIGNMENT ONE Using Positive Social Reinforcement to Change Behavior (10%) Due January 29, 2013 A one-two page paper presenting details of a two-week behavioral observation and brief intervention. This experience is directed toward applying positive social reinforcement within a social context. The assignment is not to be conducted with clients, or to be an intervention directed problematic behavior; the intention is to practice using social reinforcement to increase desired (adaptive) behavior. Enjoy! Choose an adult you see often (ideally someone you see daily) in a social or family setting. Choose a socially appropriate behavior that this person performs at least fairly often, which you would like to increase in frequency, duration or intensity. For example, smiling; talking with you; saying something funny; cooking dinner; emptying the dishwasher; asking about your day, etc. Complete the Behavior Observation Data Sheet (available on Sakai). During the first five days simply keep daily record of the frequency of the behavior. During the next five days practice using positive social reinforcement to ‘reward’ the behavior, and continue to keep daily records of the frequency of the behavior. In one-two pages, write up and analyze your behavioral experiment. Include observations of any additional variables that may have been relevant. How successful was your intervention? Why do you think you achieved these results? What changes might you make to increase the frequency/duration/intensity of this behavior? What do you think will happen if your social reinforcement is withdrawn? Attach your Behavior Observation Data Sheet Alternative Assignment If there is no adult with whom you interact almost daily, for the next 10 days use every opportunity to apply positive social reinforcement with adults in multiple situations (minimum of five). For example: in a restaurant engage your wait person in conversation; encourage them to talk about themselves; positively reinforce good service; observe the frequency of their attendance at your table compared to other tables compliment your regular bus driver, engaging him or her in brief conversation; notice the driver’s interactions with you on subsequent days smile and speak positively to a classmate who seems unusually quiet and somber thank someone for any assistance offered, such as holding a door open, etc. In one-two pages write up and analyze your behavioral experiments, discussing your opportunities and your observations. What social reinforcement did you use? When might it have had an impact, and when was there no apparent change in the other person’s behavior? What might have been mediating factors when you observed no changes? SoWo 751; Spring, 2013 9 ASSIGNMENT TWO Review of Behavioral Instructional Programs For Parents And Caregivers (25%) Due February 12, 2013 A four-five page paper reviewing a book or guide for teaching behavior management skills to parents or caretakers. Choices will include self-help books, curricula for use individually with parents or in group Behavioral Training Programs, and manuals or guides for therapists to use in working with parents. These books and manuals will be available from the instructor. With permission, you may purchase or utilize your own material but this material must be approved by the instructor. Students are to describe the primary target audience; assess the ‘user friendliness’ of the information or program; identify the specific behavioral principles that are presented (directly or indirectly) and assess and discuss the presentation of basic behavioral principles including accuracy, thoroughness and clarity; identify parenting knowledge and skills represented in the material that is in addition to strictly behavioral interventions (such as child development information); identify in what ways (if any) parents and caregivers are encouraged and supported for following the recommendations (beyond by being successful in changing their child’s behaviors if they continue with the program); describe the strengths of the material or program and identify any weaknesses or concerns; justify why or why not they would use the material/program with parents or caregivers. Rubric: Review of Behavioral Instruction Programs for Parents and Caregivers The Review should: (1) describe the primary target audience; (2 pts) (2) assess the ‘user friendliness’ of the information or program; (2 pts) (3) identify the specific behavioral principles that are presented (directly or indirectly); (3 pts) (4) assess and discuss the presentation of basic behavioral principles including accuracy, thoroughness and clarity; (3 pts) (5) identify parenting knowledge and/or skills represented in the material that are in addition to strictly behavioral interventions (such as child development information); (2pts) (6) identify in what way (if any) parents and caregivers are implicitly or explicitly reinforced for following the parenting guidelines; (2 pts) (7) describe the strengths of the material or program and identify any weaknesses or concerns; (5 pts) (8) justify why or why not you would use the material/program with parents or caregivers; (3 pts) (9) Use correct grammar, punctuation and spelling; any additional references in APA format; (3 pts) ASSIGNMENT THREE Handout: Summary of Reviewed Behavioral Instruction Material (5%) Due February 12, 2013 SoWo 751; Spring, 2013 10 A concise (one page) handout summarizing the main points of the material reviewed to be distributed to classmates. Handout should describe target audience, identify strengths and any concerns, and make recommendations to classmates regarding how and with whom this material would best be used. ASSIGNMENT FOUR Comprehensive Functional Behavioral Assessment (FBA) and Positive Behavioral Intervention (PBI) Plan (30%) Due February 26, 2012 Through their field placements, students will identify a child with a specific behavior that is problematic either at home or in school. Students will be required to conduct a comprehensive functional assessment of the behavior in context and to develop a positive intervention plan for behavior change. The approximately 5-6 page paper will present the details of a Functional Assessment and Positive Behavioral Intervention plan, following a format provided for the assignment. Rubric: Comprehensive Funcation Behavioral Assessment and Positive Behavioral Intervention Plan Your plan should include: 1. Description (5 pts) describe the child (suitably disguised) and the child’s situation; describe the problematic (target) behavior; explain why this behavior was selected; define the behavior in objective, measurable terms 2. Assessment (6 pts) describe the assessment process including a thorough analysis of the context (environment) and identifiable antecedents and the sources of information; identify ways the problematic behavior is reinforced and other variables that may influence the behavior; 3. Hypothesis (3 pts) based on this assessment, develop your hypothesis regarding the function of the behavior for the child; (use format in available forms) 4. Behavior Intervention Plan (6 pts) develop an intervention plan to reduce/eliminate the problematic behavior; provide an explanation and justification of changes to be implemented including choice of consequences and persons involved in implementing the plan; 5. Adaptive alternative behavior (5 pts) include a description of the alternative, socially appropriate skill SoWo 751; Spring, 2013 11 include details regarding how this skill will be taught or increased and how the adaptive behavior will be reinforced; 6. Evaluation (2 pts) describe how the success of the PBI will be evaluated. 7. Correct Terminology (3 pts) terms must be used accurately and correctly. 8. Good Grammar, punctuation and spelling are expected. Points may be taken off for poorly written material Sample FBA and PBI forms, adapted from the Public School systems, are available on Sakai; these forms may be useful to structure assessment and plan development. They are not required but, if completed, these forms should be attached to the paper. An alternative, less structured format is also available on Sakai if the forms utilized by the Public Schools are not suitable. SoWo 751; Spring, 2013 12