Tuesday, November 26, 2019

For all Children:


Ò These Foundational Setting Events can help put any of us on a trajectory for our “Best Life.”


Click here to continue.  As always, please feel free to ask questions or make comments.  If you would like to start at the beginning.  Please click on the "Home" button below and go to "What's causing the short?"

40 Developmental Assets - Success 2000


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Developmental Assets




Click here to continue, and learn just a little more on building assets.  The rest of the presentation will continue after this next page/video.





Children with Trauma


For some children, adolescents, and adults, who have experienced significant trauma:
Ò TraumaInformed therapy can be helpful.
Ò Playtherapy (not referring to P.L.A.Y.) can be helpful.
Ò Equinetherapy and yoga also have some good research supporting  it’s use for improved self-regulation.
Watch:  

Bessell van der Kolk: Overcome Trauma With Yoga


Click here to continue.  Click on "Home" below to go to the beginning.  (What's causing the short?)


Resilience


Ò Much of the early research on resilience was conducted by university extension in Hawaii. 

Ò From resilience has grown:
Ò Risk and Protective Factors &
Ò Developmental Assets 



You can learn about developmental assets which help children thrive here: https://www.search-institute.org/our-research/development-assets/developmental-assets-framework/

ÒMost children/youth/people with trauma, most children/youth/people with disabilities, most children/youth/people, CAN have spark, can thrive.  This is an important component of their “Best Life.”

Ò See:  

TEDxTC - Peter Benson - Sparks: How Youth Thrive.


Click here to continue.  Click "Home" below to go to the beginning. (What's causing the short?)


ACES


While this is an over simplification, the study found that the more adverse childhood experiences (ACES) a child had (risk factors) the more likely they were to have social, emotional, & cognitive impairment. 
This in turn increases the likelihood the child/adult will become involved with health-risk behaviors. 
This in-turn increases the risk of disease, disability, and social problems, and ultimately early death. 
However, well before early death, is poor quality of life.




What the pyramid does not demonstrate, is the importance of protective factors. 
Many people who have adverse childhood experiences go on to thrive. 
Quite often the difference is the presence of protective factors, strength, resilience, or developmental assets. 
Click here to continue.  Click on "Home" below to go to the beginning. (What's causing the short?)

Thursday, November 21, 2019

Maslow

What happens when you try to teach or help a child... or adult change/improve behavior when physiological needs have not been met?  What if there are safety concerns, how much progress can you make with behavior... or health?  How difficult is it if the child or adult does not have a good sense of love or belonging?


What happens when you try to do intervention and there are significant physiological or safety concerns for the child or family?

How difficult is it if there isn’t sound attachment?

Please feel free to answer or make comments below.
Have you ever heard of???  Click to continue.

Fundamental Setting Events


Therapists, educators, parents, should never underestimate the critical importance of fundamental, developmental building blocks,  experiences, and setting events. 

Too often we attribute the lack of progress to a lack of motivation or skills, when other critical, fundamental, issues are at play and must be addressed for significant improvement/progress to occur.

Ò Do you remember???



What caused the short.


Ò We kept a set of spare keys in the ash tray.
Ò When the car would jostle around, the keys would cause a short.
Ò Keys removed.  End of problem.
So...

Ò Before writing goals or objectives.  (Goals are where you want to go, objectives are how you will (or the steps you will take to) get there.

Ò Is there a need?
Ò Is there a problem?
Ò Is there a short? (are there setting events)
Ò What’s causing the short?
What are the:
Fundamental Setting Events?  (Click to learn more)

What's causing the short?


Ò Early in our marriage, my wife and I bought a Ford Escort.
Ò Soon we started having electrical shorts… over and over and over again. 
Ò It would get fixed and then would short out, again.
Ò Finally a mechanic discovered…
Any guesses?
Please make comments or ask questions below.

Foundational Setting Events These are the things, without which, the straw May not have broken the camel’s back. AND How to write: Contextually Mediated measurable behavioral objectives(MBOs)

Feel free to ask questions and make comments.




1980's Ford Escort: What's causing the short?

ACES


While this is an over simplification, the study found that the more adverse childhood experiences (ACES) a child had (risk factors) the more likely they were to have social, emotional, & cognitive impairment. 
This in turn increases the likelihood the child/adult will become involved with health-risk behaviors. 
This in-turn increases the risk of disease, disability, and social problems, and ultimately early death. 
However, well before early death, is poor quality of life.

How can adverse childhood experiences affect health, learning, habits, and behavioral change?  Can anything be done to help the healing?  What?  Please feel free to make comments or ask questions below.
Click here to go to the beginning.
This presentation will continue in a few days.

Thursday, June 6, 2019

Reinforcement and Crisis


Remember to reinforce what you only really want to reinforce.  Remember, “what we focus on, increases.”  This is not an invitation to bury your head in the sand.  Take care of safety, urgent issues quickly and efficiently, but find ways to reinforce the positive.
          Understand and effectively use:
1.     Redirection  
2.     Choices (3 is usually best and make them real choices)
3.     Consequences
Tantrums:
1.               Assure safety if there is a real potential safety hazard.
2.               Don’t over react.
3.               Allow children to lean they can self-calm
4.               Teach children appropriate ways to communicate and meet needs
5.               Teach delayed gratification

Parsimonious checklist for Family Centered Planning


For almost any child, the family is the first context within which all development occurs.
After family, typical comes school, religious organizations and support (for some), peers, culture, and environment.
To assure you are optimizing the context within the family, consider:
1.       Was information gathered about the child/youth in context of the family?  This would include the natural environment and natural routine.  Observation may be included if possible, but understand, behavior often changes when being observed.  Be aware of the “Hawthorne Effect.”
2.       Have you, are you carefully, and demonstratively listening to: comments, concerns, and observations, by parents/guardians? 
Understand that sometimes, in somethings, parents can be right and know more about their child than you.
3.       Are plans, goals, objectives, written in language easy for the parent/guardian to understand?
4.       Is the family a full partner in the plan?
5.       Whenever possible is the child/youth a full or to the degree possible, partial and active partner in the plan?
6.       Are outcomes meaningful and practical for the child/youth and family?
7.       Even when there is a behavior you wish to diminish or eliminate, have you included what you want the child/youth to do?  What is the replacement behavior?
8.       Be careful about ascribing motivation to parents/guardians.  Sometimes we do not even fully understand our own underlying motivations.  You can collect data, you can work to influence, but understanding “why” can be very elusive.
9.       Be a good partner with everyone involved.  Be considerate.  Don’t assume.

This book, like a well written objective, was meant to be parsimonious.  Hopefully, like a well written objective, it is also helpful.

Foundational Setting Events

I always appreciate good, thorough, meaningful assessment, if it informs and enhances good intervention/treatment.  Don’t shortcut assessment.
Evidence based interventions primarily fall into one of two categories: Developmental and Behavioral.  Over the past 10 – 20 years, these two approaches have come closer together. 
Typically, when looking at the “why,” or reason for a behavior, a good BCBA (behavioral) will look at the function of the behavior.  Is the child trying to avoid/escape/release, get something, or is it to fill a sensory need?  Skill and performance deficits will be considered.  Antecedents, Behavior, and Consequences, will all be considered, and they are all crucial and critical elements of an effective plan.
Developmental interventions work in a similar vein.  The interventionist and/or parent coach create the opportunity for the child to develop foundational developmental skills and then build upon those skills. The Greenspan Floortime ApproachTM is a good example.  Building upon the work of Dr. Greenspan, Dr. Richard Solomon developed The PLAY Project. See:  Autism: THE POTENTIAL WITHIN, The PLAY Project Approach to Helping Young Children with Autism. Richard Solomon, MD.  https://www.playproject.org/  (PLAY is an excellent evidence based and low-cost intervention for autism for many children and families. PLAY can significantly extend capacity for services for children with ASD at a relatively low cost.  It is not for all, but for some it can be a great boon.)
Therapists, educators, parents, should never underestimate the critical importance of fundamental, developmental building blocks and experiences.  Too often we attribute the lack of progress to a lack of motivation, or even simple skill building, when other critical issues are at play and must be addressed. 
Setting events will be considered as mentioned previously.  However, this appendix will take a much broader view of setting events, some of which are often overlooked or neglected, but which are fundamental for anyone, whether or not they have a disability or social/emotional difficulty.  Do not disregard the foundations of: physical, emotional, social, and mental health.
Let’s start with Maslow.  Almost anyone in the social sciences or education is familiar with Maslow’s Hierarchy of Needs.  It is something we learn about in Psychology or Social Work 101 and then we often forget it exists.  If the child, any child (or adult), does not have his/her basic physiological and safety needs met, you are unlikely to change or improve outcomes or behavior.  The same could be said for that child’s parent.  If you want to influence the parent as a partner for the good of the child, do not forget the parent also has basic needs.
For my purposes here, I only want to focus on the bottom three layers of Maslow’s Foundation.  Physiological includes physical needs (shelter, food, clothing, etc.), health and medical needs.  Safety would include adverse childhood experiences, which will be discussed next.  Safety also includes stability.  It is difficult to feel safe in instability.  Love and belonging are also essential and will be discussed after adverse childhood experiences.




Adverse Childhood Experiences

This model from the U.S. Substance Abuse and Mental Health Services Administration https://www.samhsa.gov/  refers to a large research project, the Adverse Childhood Experiences Study, sometimes referred to as ACES.  You can learn more about this study from many resources, including: https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/adverse-childhood-experiences
While this is an over simplification, the study found that the more adverse childhood experiences a child had (risk factors) the more likely they were to have social, emotional, & cognitive impairment.  This in turn increases the likelihood the child/adult will become involved with health-risk behaviors.  This in-turn increases the risk of disease, disability, and social problems, and ultimately early death.  However, well before early death, is poor quality of life.
What this pyramid does not demonstrate is the importance of protective factors.  Many people who have adverse childhood experiences go on to thrive.  Quite often the difference is the presence of protective factors, strength, or developmental assets.  You can learn about developmental assets which help children thrive here: https://www.search-institute.org/our-research/development-assets/developmental-assets-framework/
Though this may differ slightly from Maslow’s model, I always put safety first and immediate.  Resolving urgent, significant, immediate, safety concerns is always the priority.  In this context, I expect Maslow would agree.  While removing risk factors is important when possible, it is impossible to remove the past.  Inserting protective factors or developmental assets, especially those which fit the interest and/or need of the child can help ameliorate risk and reduce the negative effects of adverse childhood experiences. 
Additional intervention/therapy may also be needed.  Some children can benefit from trauma informed therapy and/or play therapy (not to be confused with P.L.A.Y.) provided by a well-trained, effective therapist able to build a positive rapport with the child and parent/guardian.





Please also consider the following pyramid model.


This is only part of The Pyramid Model from the Technical Assistance Center on Social Emotional Intervention for Young Children.  For more information go to: http://challengingbehavior.fmhi.usf.edu/do/pyramid_model.htm
Consider this pyramid, what do you think the outcome would be for the child and family if only the top and bottom levels of this pyramid were present?  The point of this model is the necessity of addressing each layer from the bottom up, before providing intensive individual intervention for the child, whenever possible.  While there may be some urgent situations where an immediate intervention may be warranted, in most situations, for most children with social-emotional needs, building the foundation can lessen or even resolve the need for intensive individual intervention.





Here’s another.  The Foundation for Personal, Optimal, Health.
          It can be very difficult to think clearly, feel well, and behave your best, when your body is fueled by crap and void of essential nutrients.  It is similar for a lack of sleep, exercise and/or significant chronic stress.
Our internal chemistry, how we think and how we feel is fueled or disrupted by what we put into our bodies; by the chemicals, liquids, and nutrients.
Do not underestimate the importance of this fact.



Personal Optimal Health
          Food Security is not about getting enough food to eat.  It is about getting the essential nutrients.  This is about getting all the nutrients your mind and body need to function well.  If you are food insecure, you will crave food.  Even if you were to eat a gallon of macaroni and cheese every single day, even two gallons of macaroni and cheese every single day, if that was all you ate, you would be food insecure.  I had a college roommate who tried that.  He became so sick he had to have vitamin shots to regain his health.  He was lucky, it could have been much worse.  For some it is.
          According to the World Health Organization, and perhaps for the first time in history, there are now more people in the world who are malnourished and obese than malnourished and underweight.  (See: http://weight-lossnewsandresearch.blogspot.com/2018/05/food-insecurity-paradox.html)
          Some believe it is too expensive to eat healthy, that is a myth, for most.  It is cheaper to eat healthy, and be healthy, even on food stamps, IF you know how.  Many can even eat more than they usually eat and still lose weight, if needed.  This is not something that can be remedied in one meal or one day.  If you or a child are seriously food insecure, it will take many weeks/months of good, well-balanced meals to rectify significant damage previously done.  In some cases, it may require medical intervention.  Occasionally it may be too late, but still important for personal optimal health, whatever that may be.   See: Food Addiction, Binge Eating, Addiction Recovery: Choose: Health, Life, and Love (with recipes) CR Petersen M.Ed.
          While only discussing a few aspects, all the pyramid is essential for anyone’s personal optimal health.
"With irrefutable evidence that children in low- and middle-income countries can be expected to develop optimally as long as basic needs for nutrition, safety and stimulation are met, policy makers and political leaders can now turn their attention to making it happen."



All of this speaks to the old metaphor comparing the fence at the top of the cliff to the ambulance at the bottom.  While we will always need the ambulance, these pyramids or foundations, bring attention to the need for a good strong fence.
Examples:
Many cases of autism and developmental disabilities can be prevented with nutrition before and during pregnancy.
Exercise and depression
This does not mean that exercise will eliminate depression.  In very few cases will it do that.  However; in many cases, it will ameliorate depressive symptoms.  Consult with your physician, take medication as needed.
Nutrition and mental illness
Again, good nutrition is not likely to eliminate mental illness, but in some cases, it may ameliorate symptoms. Consult with your physician, take medication as needed.
One other interesting article:
The road to Alzheimer's disease is lined with processed foods

According to the researchers at Vitalsmarts https://www.vitalsmarts.com/, we are influenced by both motivation and ability, and for both, at the levels of personal, socials, and environment.  At the personal motivational level, we might include: sensory needs, wanting something, and escaping from something.  These may include motivators pertaining to health, and internal feelings such as pain.   Personal ability may include other aspects of physical health and disability, as well as other areas of personal ability.
          Hopefully you are now well beyond only thinking about the basic motivators of avoiding or escaping, getting something desired, or sensory needs.  Those are important, even critical, but they are not the whole story. 
          You may be asking yourself how you can know about all these levels in multiple pyramids.  While not a complete answer, the CANS or The Child and Adolescent Needs and Strengths http://weight-lossnewsandresearch.blogspot.com/2018/05/the-child-and-adolescent-needs-and.html  can fill in many of the pieces which may missing and where you can build on strengths.
Not only will it provide an assessment, but it will tell you of specific needs which may need to be addressed, and areas of strength which can be further ameliorated.  These strengths can be used to minimize the impact of some needs.  This does not mean that some serious and significant needs do not need to be addressed with urgency.  Urgent needs, especially around safety and stability, must often be addressed immediately.
Many years ago, I was a MANDT http://www.mandtsystem.com/
instructor.  At the time I was a clinician in a mental health agency.  It was common on average, on a weekly basis, that we would restrain and put at least one youngster in time out.  I know practically nothing about MANDT now, but at that time, while physical restraint was taught, avoiding the need and prevention, were emphasized.  Quite often, when foundations are created as demonstrated in the foregoing pyramids, crises are adverted.  While the MANDT training did not address anywhere near everything addressed here in this appendix, it addressed enough to make a substantial difference.  After going through the training, myself, and then training the staff at the agency, as I remember, we only had to physically restrain one child, one time, during the following year and a half.  That is a substantial improvement over doing it weekly.


Working with parents and guardians

“There’s no such thing as a resistant client, only inflexible therapists.”  Becoming Solution-Focused in Brief Therapy 1st (first) Edition by Walter, John L., Peller, Jane E. Published by Brunner/Mazel Inc. (1992)
Why this quote?  Many therapists feel competent working directly with the child, but so much more is often required than “fixing the child.”  Many children lack the essential building blocks which they need to thrive, or even achieve their personal, basic, optimal health.  Expanding capacity for intervention almost always requires partnership with a parent/guardian.  This is the child’s first and often most important teacher.
Sometimes environments need to be altered, relationships need to be improved, basic needs need to be met.  Sometimes communication and interactions need to be adjusted or improved.  This does not necessarily mean that a parent is a bad parent, but the needs of some children are different from others.  Sometimes talents, strengths, assets, resilience, and interests, need to be developed.  Sometimes we forget to apply fundamental developmental information known for years, decades, generations, and in some cases, millennia.  This may require more than basic Interventional skills.  You may need to relate to, influence, and even teach a parent.
This may require flexibility, creativity, excellent communication skills, the ability to relate, demonstrate real empathy, as well as additional skills and knowledge not always common to the beginning or even many experienced therapists, interventionists, and/or teachers.
One must be very careful about telling a parent s/he is doing it “all wrong,” or that s/he must make substantial changes, unless there is a significant safety issue, to include those which must be reported to proper authorities.  Almost always the best way to help parents/guardians create healthier environments and more therapeutic supportive interactions for their children with special needs, is to praise what they are doing right, and give them slight nudges towards change.  Overtime this approach will almost always be more beneficial for both the parent/guardian, and the child.  Milton Erickson, a famous 20th century psychiatrist believes we are all in trenches pertaining to the way we think and behave.  It can be very difficult for many of us to see or act outside the deep trenches in which we are traveling.  His very effective practice was not (in almost all cases) to try to force people to make significant changes or see things completely differently, but to help them make very moderate changes.  This would allow them to make more healthy adjustments once they were outside their deep trenches.  Often the initial change was very slight.
In what I believe was his first professional position in the field, Milton Erickson worked in a psychiatric hospital.  There was a man who had been there many years and who believed he was Jesus Christ.  Many had tried to convince him he wasn’t.  Erickson said to the man, ‘I understand you are Jesus Christ.’  The man responded, “Yes.”  ‘I understand you used to be a carpenter.”  The man responded, “Yes.”  ‘I understand you like to help others.’  The man responded, “Yes.”  ‘Well,” Erickson asked, ‘they need help in the carpentry shop, would you be willing to help?’  What could the man say, but “Yes.”  Within about six months the man was released from the hospital.  Erickson’s entire career was filled with these types of interventions.  (See: Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. by Jay Haley) 
A little respect and positive rapport with a parent/guardian, the right amount of positive feedback, and gentle nudges in the right direction, along with patience, can usually go a long way.  Generally, you do not even need to make direct suggestions.  Well-crafted questions can be even more effective, most of the time.  How do you think you could???  What have you done in the past that has???  What has worked in the past???  What have you seen others do to???  What do you think might work???  And the last question, what do you think about trying???
Many years ago, my wife and I purchased a new car.  Repeatedly, part of the electrical system would short out.  We took it into the dealer and they would replace a fuse and try to figure out why it was shorting.  This continued for months.  The mechanics could not find the source of the problem.  Finally, on one visit a mechanic discovered a set of spare keys we kept in the ashtray.  Once the keys were removed, the electrical shorts stopped occurring.  Often, it is the same with setting events.  Once an underlying issue is resolved, the maladaptive or inappropriate behavior stops or is easily replaced with more appropriate, healthy behaviors.
The following is intended to only give you a glimpse of some of the fundamental, developmental, and general health needs of every child (and adult).  ALL the following CAN be significant setting events.  Some is essential, much is crucial… for optimal health and development.

More on Goals


Goals
Remember, a goal is where you want to go, objectives are how you are going to get there… or the steps to help you reach the goal.
Consider:
1.     Needs which need to be met.
2.     Issues which need to be resolved.
3.     Developmental stages which need to be met or achieved.
4.     Behaviors which need to be changed, developed, or replaced.
5.     Strengths and interests which can be developed or augmented.
6.     Setting Events, for child/family.
How to write a SMARTERR goal
Specific (with a baseline)
Measurable
Achievable/Attainable
Results-Focused
Time-Bound
Evaluate/Enhance/Adjust
Reporting/Accountability &
Reinforcement/Reward