Collaborative Problem Solving: Operationalizing Trauma Informed Care

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1 Collaborative Problem Solving: Operationalizing Trauma Informed Care April 25, 2017 ACRC s Portland, OR J. Stuart Ablon, PhD Collaborative Problem Solving Provides a common philosophy, language, and replicable structure with clear guideposts for adults to: Maintain authority and compliance via collaboration rather than power and control Help youth (and adults!) build skills Build a helping relationship Philosophy Kids do well if they can Conventional Wisdom The most common over-simplified understanding: Because of poor (passive, permissive, inconsistent) parenting, kids learn to use challenging behavior to get things (e.g., attention) or escape / avoid things (e.g., work). Logical Solution The most common over-simplified solution: Motivate compliant behavior through intensive, consistent programs of rewards, punishments and ignoring. Specific Components of Operant Approach List of Target Behaviors (priority is compliance) Menu of Rewards and Punishments (differential reinforcement) Currency System 1

2 Limits of Operant Strategies What Consequences Do and Don t Token economy systems have been mainstays of treatment in therapeutic programs for many years but There is very little empirical evidence to suggest they are effective in such programs and lots of evidence to suggest that they can actually be counter-productive Rewards, Punishments and Ignoring DO: Teach basic lessons & provide external motivation, increase power differential DON T: Teach complex thinking skills, build relationships, help kids stay regulated Why Traditional Discipline Doesn t Work with our Most Challenging Kids: Conventional wisdom is wrong! Challenging kids lack skill not will Unconventional Wisdom: It s a Learning Disability Research in neurosciences has shown these kids are delayed in the development of crucial skills or have significant difficulty applying these skills when they are most needed Unconventional Wisdom: It s a Learning Disability Which skills do these kids lack? flexibility/adaptability frustration tolerance problem-solving Challenging Behavior as Lagging Skills Explaining is not excusing! 2

3 The Shift in Thinking: Can t vs. Won t The philosophy of CPS helps us adults stay regulated ourselves The Shift in Thinking: Can t vs. Won t It is always safer to assume the problem is a result of lack of skill rather than lack of will Understanding that, like a learning disability, a child s challenging behavior is not intentional, goal-oriented, manipulative, or attention-seeking helps us adults stay regulated ourselves Problem to be Solved Assessment Sufficient Skill Lagging Skill Adaptive Behavior Challenging Behavior Planning: Three Options Plan A: Impose adult will Plan B: Solve the problem collaboratively Plan C: Drop it (for now, at least) Changing the Stress Response You can t change a neural network without activating that specific network You have to activate the stress response (stress the child) in order to change the stress response Dilemma: how do you activate the stress response safely? o With the right DOSE and PATTERN: predictable, moderate and controlled Planning: Three Options Plan A: Impose adult will Plan B: Solve the problem collaboratively Plan C: Drop it (for now, at least) 3

4 Three Plans Plan A: Impose adult will Activates stress response Dose often too intense for the child Increases power differential risking dysregulation Three Plans Plan C: Drop it (for now, at least) Decreases power differential Does not trigger child or activate stress response Three Plans Plan B: Work towards solving the problem in a mutually satisfactory and realistic manner Activates stress response Decreases power differential Dosing Stress Response Degree of Relationship And Stress Higher Tolerance Low You can work on harder Start with easier problems problems (low-hanging fruit) (harder = higher DOSE, more (easier = lower DOSE, More dysregulating) less dysregulating) Dosing Stress Response After you decide which problem will be a tolerable dose to work on first using Plan B, you will need to decide what Plan you will use for the other problems in the meantime You only have two other options: Plan A or Plan C o Plan A increases the power differential, risks dysregulation and developmental damage o Plan C avoids dysregulation and reduces power differential Changing the Stress Response You can t change a neural network without activating that specific network You have to activate the stress response (stress the child) in order to change the stress response Dilemma: how do you activate the stress response safely? o With the right DOSE and PATTERN: predictable, moderate and controlled 4

5 Plan B Pattern 1. EMPATHIZE: Clarify child concern 2. SHARE adult concern 3. COLLABORATE: Brainstorm, assess and choose solution Plan B Pattern Predictable Controlled Moderate Gives child control but not sole responsibility Plan B Pattern 1. EMPATHIZE: regulating 2. SHARE: dysregulating 3. COLLABORATE: regulating Empathy is Regulating THE TOOLS: Detective work to clarify concerns requires probing and drilling down using a combination of 4 tools: o clarifying questions * Regulating tools o educated guessing o reflective listening* o reassurance* THE FEELING: EMPATHIC, patient, open-minded listening Sharing Adult Concern is Dysregulating Sharing the adult concern provides a predictable dose of good stress Expect the child to experience some dysregulation Good Stress in Plan B What do you do if child escalates or shuts down? o o Go back to Empathy to re-regulate (using reflective listening and reassurance) If the child is not able to re-regulate with your assistance, default to Plan C 5

6 Collaborating is Regulating The Neurobiologic Sequence of Plan B Giving child first chance at generating a solution Ensuring solutions are mutually satisfactory Cortex REASON Limbic Region RELATE Collaborate: To create solution Share: The adults concern Empathize: Clarify the child s concern MidBrain /Brainstem REGULATE Reflective listening Reassurance Plan B: Skills Taught 1. EMPATHIZE: Clarify child concern Identifying, clarifying and expressing concerns, regulating emotions 2. SHARE adult concern Perspective-taking, recognizing impact on others, empathy 3. COLLABORATE: Brainstorm, assess and choose solution Generating solutions, reflecting on multiple thoughts, considering outcomes, moving off original idea Advantages of Experiential, Relational (vs. Didactic) Skills Training Doesn t require child s agreement that they lack certain skills or that they want you to be the one to train them! Doesn t require transfer of skills to real world (e.g., DuPaul et al., 1994;Gresham, 1985, 1998) Respects specificity principle of neuroplasticity: activates the specific neural network involved in applying skills (artificial circumstances don t recruit those specific systems) Advantages of Experiential, Relational (vs. Didactic) Skills Training Practices multiple skills at the same time and the integration of those skills Automatically focuses on the skills that need the most work Builds on prior successes All occurs in a relational context This is Hard for Us, Too! The bad news: we adults have lagging skills too! The good news: we practice our skills too every time we do Plan B Regulation or disregulation is contagious and Plan B fosters positive co-regulation by helping regulate both child and adult 6

7 The Relational Process More bad news: Plan B isn t magical and requires many repetitions! More good news: those repetitions, conducted in a relational context, are how skills are built and new neural networks in the brain are developed Rhythmic Repetitive Relational Rewarding Plan B Pattern Dosing of Plan B Neural networks change through repetition of small relational doses o Ideal dose of Plan B is many small attempts throughout the course of the day o Doesn t matter what the focus is as long as it activates the stress response o Therapist can t be the change agent o Small doses from the important adults in the child s life (i.e., parents, teachers, direct care staff) to create new default templates A Helping Relationship Regardless of therapeutic modality, the best predictor of success in helping people change is the relationship between helper and helpee Helping is messy and takes time Helping is a working alliance, a two-way collaborative process, a two-person team effort Helping is not something you do to kids; rather, it is a process that adults and kids work through together 7

8 Online at LEARN: About Think:Kids About the Collaborative Problem Solving (CPS) approach Research on effectiveness of CPS Blog Online at TRAIN: Trainings Certification Programs Implementation in Systems Materials Online at HELP: Our Clinic Certified Providers and Systems Support Groups Resources for Parents: Books, Videos, Music How You Can Help You Follow us! ThinkKidsCPS 8

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