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A Model for School Psychology Practice: Addressing the Needs of Students with Emotional and Behavioral Challenges through the Use of an In-School Support Room and Reality Therapy

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Title: A Model for School Psychology Practice: Addressing the Needs of Students with Emotional and Behavioral Challenges through the Use of an In-School Support Room and Reality Therapy
Language: English
Authors: Passaro, Perry D., Moon, Michael, Wiest, Dudley J.
Source: Adolescence San Diego. Fall 2004 39(155):503-503.
Availability: Libra Publishers, 3089C Clairemont Drive, Suite 383, San Diego, CA 92117. Web site: http://www.abe.pl/html/english/detailsj.php?id=0001-8449.
Peer Reviewed: Y
Page Count: 15
Publication Date: 2004
Document Type: Journal Articles
Reports - Descriptive
Descriptors: Psychotherapy, School Psychology, Intervention
ISSN: 0001-8449
Abstract: This article describes a treatment approach for students with emotional and behavioral challenges. The approach involves conducting reality therapy in an in-school support room. Data from this pilot study indicate that the treatment assists in developing more effective choices and in turn promotes cognitive and behavioral change in most students, while reducing the number of disciplinary actions for these students.
Abstractor: Author
Entry Date: 2005
Accession Number: EJ696859
Database: ERIC
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  Value: <anid>AN0015618884;ado01sep.04;2005Jan24.09:18;v2.2.460</anid> <title id="AN0015618884-1">A MODEL FOR SCHOOL PSYCHOLOGY PRACTICE: ADDRESSING THE NEEDS OF STUDENTS WITH EMOTIONAL AND BEHAVIORAL CHALLENGES THROUGH THE USE OF AN IN-SCHOOL SUPPORT ROOM AND REALITY THERAPY </title> <sbt id="AN0015618884-2">ABSTRACT</sbt> <p>This article describes a treatment approach for students with emotional and behavioral challenges. The approach involves conducting reality therapy in an in-school support room. Data from this pilot study indicate that the treatment assists in developing more effective choices and in turn promotes cognitive and behavioral change in most students, while reducing the number of disciplinary actions for these students.</p> <cn>INTRODUCTION</cn> <p>Students identified as having an emotional disturbance present a significant challenge for school psychologists. This article describes an in-school treatment approach for school psychologists serving students with emotional disturbance and behavioral disorders. It involves a simple and practical model of mental health services provided at the school site by the school psychologist.</p> <p>The model described utilizes both a specialized setting and a specific methodology to help students identify and evaluate their behaviors and choices, while reducing the number of disciplinary actions. The intervention then assists the student to develop a plan for improvement which, if successful, results in a return to the classroom. The setting for this intervention is an in-school support room (ISSR), which in this case is a small classroom which has become the school psychologist's office, and the methodology is reality therapy (RT).</p> <p>Review of the Literature</p> <p>Behavioral strategies such as time out have been utilized for many years, for students with disabilities (Brown, Nesbitt, Purvis, & Cossairt, 1978)and without (Flanagan, Adams, & Forehand, 1979), at home (Gardner, Forehand, & Roberts, 1976), and school (Clarke, Rowbury, Baer, & Baer, 1973). Time out has been described by Clarke et al. (1973) as time away from positive reinforcement. Parents are often advised by professionals to employ a time-out technique when children require removal from a situation or setting (Olson & Roberts, 1978). Teachers are also encouraged to utilize time way from their classrooms in the form of office referrals which are designed to change the students' behavior before returning to the classroom (Axelrod, 1983).</p> <p>These office referrals traditionally result in a visit to the school principal or assistant principal. However, for students with emotional and behavioral challenges, traditional discipline methods are generally not effective in reducing problem behavior (McConaughy & Ritter, 1995; Bear, 1998; Miller, Grehm, & Whitehouse, 1998).</p> <p>A more therapeutic intervention is required for students with an emotional disturbance, and the school psychologist is a resource who could provide it. One form of intervention that can be utilized by the school psychologist is RT.</p> <p>RT was developed in the 1960s by psychiatrist William Glasser. It provides a conceptually simple yet effective method for working with emotionally challenged youth. It requires those working with the student to develop a positive, friendly relationship, especially with those who do not want such a relationship. RT is different from some psychological models because it encourages everyone who works with the student to enter into a counseling relationship with them, not just the psychologist.</p> <p>Research on the use of RT and an ISSR for students with emotional disturbances conducted by Coats (1991) has demonstrated a positive effect on student behavior, as measured by teacher perceptions. However, Coats (1991), in his recommendations for future research, suggests that additional studies should be conducted on the integrated use of RT and ISSR, using student outcome indicators to evaluate the effectiveness of the interventions.</p> <p>If the school psychologist were to provide this service on a school campus it would be an extension of their current, primarily regulatory responsibilities. The most appropriate roles and functions of school psychologists have been a topic of considerable discussion within the profession for many years. Gutkin and Conoley (1990), Tapasak and Keller (1995), and Sheridan and Gutkin (2000) state that school psychology practice has not kept up with the times and recommend that the field undergo a broad reconceptualization-and soon. Others recommend expanded roles for school psychologists such as teaching social and emotional intelligence (Quinn & McDougal, 1998), offering various prevention and treatment programs (Adelman & Taylor, 1998), and ongoing teacher consultation and collaboration (Wiest & Kreil, 1995, 1997).</p> <p>The school psychologist is therefore faced with the dilemma of increasing direct services to students, providing more assistance to teachers and staff, and assuring regulatory compliance. While it is easy to suggest expanded roles for school psychologists, few authors offer practical and school-tested models of how more can be done with less.</p> <p>Hypothesis</p> <p>This study theorized that several measurable behavioral changes would occur as a result of the use of RT and an ISSR: positive changes in average daily behavior of students served in the program over the school year; a reduction in the number of out of school suspensions compared to the previous academic year; and increases in the amount of time students' participate in general education courses compared to the previous school year and within the current school year.</p> <cn>METHOD</cn> <p>Students Served</p> <p>Ten male students in grades six through eight, all residents of a suburban school district in southern California, participated in this study. Each student met the State of California Educational Code criteria for an emotional disturbance: "A condition exhibiting one or more behavioral characteristics, which exist over a long period of time and to a marked degree, which in turn adversely affects educational performance." Each of these students were served in a special day class, at the start of the intervention; however, some where later transitioned to a less restrictive setting (resource specialist program).</p> <p>All of the students within this study were diagnosed outside of the school setting by licensed mental health professionals using DSM-IV-TR criteria. Each of the ten students was identified as having multiple psychological disorders, in addition to their classification according to special education criteria.</p> <p>Student 1 met the DSM-IV-TR criteria for an attention deficit disorder with hyperactivity (ADHD) and oppositional defiant disorder (ODD), as well as depression. Students 2 and 4 were diagnosed with ADHD and ODD; however, at the conclusion of this study, student 4 was re-evaluated and diagnosed with a conduct disorder (CD). Student 3 was identified with ADHD, ODD, intermittent explosive disorder, and Tourette's syndrome. Student 5 was diagnosed with mild deficit to borderline intellectual functioning, attention deficit disorder without hyperactivity (ADD), and ODD. Student 6 met the criteria for both ADD and depression. Student 7 was primarily depressed in addition to being diagnosed with ODD. Student 8 met the criteria for ADHD, ODD, and depression. Student 9 was diagnosed with ODD, and student 10 was diagnosed with ADHD, bipolar disorder, and intermittent explosive disorder.</p> <p>Setting</p> <p>A comprehensive middle school housed the district's middle school program for students with emotional disturbance (ED). These students are primarily served in a special day class (SDC) program. The SDC described in this study housed a teacher and one or two instruction assistants. However, when students required greater individualized support, they were referred by staff or self-referred to a second, smaller classroom, which serves as the school psychologist's office.</p> <p>This setting provides a place and an individual to help solve a problem. Given that few school psychologists serve a single campus, it is essential for the school psychologist to train other staff members to serve students in the ISSR.</p> <p>The primary purpose of the ISSR is to temporarily remove the student from a problem situation, not to punish. The message is: 'We need to work this out." The atmosphere of the classroom and ISSR is positive and noncoercive to increase the likelihood that the student will evaluate the behavior that he is choosing, learn that he is responsible for his choices, and to help him develop the skills to make more effective choices. This cognitive approach is employed to help the student engage in a more effective set of coping behaviors by focusing on choices.</p> <p>The school psychologist's office/ISSR is a comfortable place with both individual student desks and a large conference table surrounded by six padded chairs. Here the student can calm down, think about the situation, and develop a plan to return to class. As in sports, the ISSR is used to break the momentum, evaluate the situation, and formulate a plan.</p> <p>Reality Therapy</p> <p>Glasser (1988) states: "Counseling is just one human being helping another with a problem. This is not hard to do, if the person with the problem wants to be counseled." Students with emotional disturbances, may be resistant to counseling and defensive. Given this need for the student to want to solve the problem (counseling), and the innate resistance of most students with emotional disturbances, the school psychologist's job is to motivate them to participate in counseling and to persuade them to want to learn/change.</p> <p>RT consists, at its most fundamental level, of four questions. These are: What do you want? What are you doing? Is what you are doing getting you what you want? Do you want to figure out a better way?</p> <p>Reality therapy works most effectively when students do not perceive themselves as being questioned by a policeman, but instead by a facilitator. The psychologist's tasks are to refocus students toward their goals, and then to help them observe the problem behavior which is keeping them from reaching those goals. Next, the students and psychologist review the students' goals, stressing the alignment, or lack thereof, between goals and behaviors. Finally, once an agreement is reached that what the students are currently doing is not working, other, more appropriate ways for the students to achieve their goals are openly discussed.</p> <p>Plan for Improvement</p> <p>The plan for improvement (PFI) form was adapted from a similar form developed by Glasser. It is utilized to help students apply the principles of RT to their lives. The PFI is used when students are placed in the school support room and utilizes the principles of RT in an individualized manner. It can be completed by students while the psychologist/staff conducts other tasks. After the PFI form is completed, it is reviewed with students before they return to the classroom. The plan is used to focus students on the underlying RT principles of behavioral choices, natural consequences, and the alignment between what students desire and their behavior to reach that goal. The questions used in the plan are as follows: What happened in the class? How does my behavior affect the class? What is my level of cooperation in class (on a scale from 1 to 10)? What am I willing to do? Who can help and support me with this plan?</p> <p>As in many other interventions for at-risk youth, conflict is an opportunity for growth and development. In the model described here the school psychologist spends the very limited time available for student counseling focused on a specific and current problem, instead of group-based counseling interventions, which are extremely difficult with groups of students who are often oppositional and defiant.</p> <p>Dependent Measures</p> <p>Daily behavior of students served in the program over the school year was assessed using a 4-point Likert scale (4 = excellent, 3 = good, 2 = fair, 1 = poor). The scale measures staff members' subjective assessment of the behavior for that day. Behavioral assessment was closely aligned to specific student behavioral goals and objectives with each student's individualized education plan (IEP). Behaviors typically included were, compliance, task completion, verbal and or, physical aggression.</p> <p>The number of out-of-school suspensions compared to the previous academic year (2000-2001) was measured through school records and student confidential files.</p> <p>The change in the amount of time students' with ED participated in general education courses compared to previous school year and within the current school year was assessed by daily student attendance records within classes outside the ED/SDC setting in which students were primarily served.</p> <p>Interobserver Agreement</p> <p>Each day, prior to the departure of the students, staff conferred and achieved consensus regarding the feedback that would be delivered to the students and their parents. Prior to the numeric assignment, students were questioned about their behavior and asked what they thought their behavioral ranking should be on the 5-point scale.</p> <cn>RESULTS</cn> <p>The ISSR/RT intervention described was evaluated during the 2001-2002 school year. Results were measured in three domains: changes in daily behavior ratings of students over the school year; changes in the number of out-of-school suspensions compared to the previous academic year (2000-2001); and changes in the amount of time students participated in general education courses, within the current school year.</p> <p>General Trends</p> <p>The average daily behavior rating of students served improved on average by 42% over the 2001-2002 school year.</p> <p>At the start of the school year, average student behavior was assessed by staff as being in the lowest range 36% of the time, while average student behavior reached the highest level (excellent) only 19% of the time. However, within one semester this trend was reversed. At the end of the school year, average student behavior was assessed in the highest range 38% of the time, while average student behavior was reported in the lowest level (poor) only 13% of the time.</p> <p>The amount of time for all students' combined participation in general education courses, increased dramatically to over 62% by the spring of the school year.</p> <p>In addition to the changes in behavior and general education participation there was a decrease in the total number of out-of-school suspensions by 12% from the previous academic year for all students combined.</p> <p>There was a successful transition from the most restrictive public school setting (ED/SDC) to a less restrictive environment for 40% of the original students combined. However, unfortunately, two students were determined to be inappropriately placed and required a more restrictive environment, which in both cases was a non-public school (NPS). Both of the students' sent to an NPS met the criteria for residential placement.</p> <p>Individual Findings</p> <p>Figure 1 contains the behavioral ratings of the ten individual students served in the program over the course of the school year, as well as their frequency of participation in general education classes.</p> <p>Student 1 and student 2 made continual behavioral and academic progress. By the end of the academic year they were transitioned from full-time placement in an ED/SDC to 3 periods in a resource specialist program (RSP), and general education classes for the remainder of the school day.</p> <p>Student 3 made limited progress in this program or placement. His parents were dissatisfied with the rate of progress and requested a more restrictive placement after five months. At that time he was transitioned to an NPS, and then to a residential program.</p> <p>Student 4 was making behavioral and academic improvement after being placed on probation in November; however, once he was released from probation, in April his behavior and academics returned to baseline.</p> <p>Student 5 began the program with significant academic, intellectual, and behavioral challenges. He was the most physically aggressive of the students. In spite of these limitations he made rapid progress when placed in the program. However, his overall improvement was limited.</p> <p>His placement into general education classes was restricted to certain elective courses and physical education, due to academic and ability deficits. He therefore continued to spend the majority of his instructional day in an ED/SDC setting.</p> <p>Student 6 was one of the most successful in the program. After six years in an ED/SDC program, this student was able to transition to a maximum RSP and then to only a single period of RSP before his promotion and transfer to high school. His successes were significantly related to medication changes made throughout the year. School staff worked collaboratively with the student's family and psychiatrist to provide feedback regarding his behavior.</p> <p>Student 7 was without question the most disturbed and disturbing student in the program. His case was also the most complex. He was the most intellectually and academically gifted of the ten students in the study. As the data in Figure 1 indicate, this student made limited behavioral progress, but could easily succeed in general education classes from an academic standpoint. His behavior, however, negatively impacted his success in general education. In spite of his limited behavioral progress, he continued to participate in, and even increased his general education participation. This contradiction was due to the fact that decisions regarding the student were made during a series of legal proceedings. This continued until he was transferred to an NPS.</p> <p>Students 8 and 9 made strong behavioral improvement, but each had very limited motivation to participate in general education. Therefore, in spite of numerous efforts to encourage and support their increased participation in general education, they continued to spend the majority of their instructional time in the ED/SDC.</p> <p>Student 10 was placed into the program late in the school year after multiple interventions in and out of school. However, once he was ineligible to transition to further general education during the study, but as a footnote, he did transition to a full-time general education program in the next two semesters.</p> <cn>DISCUSSION</cn> <p>The results of this study provide positive indicators for the use of RT and an ISSR for middle school students with emotional disturbances. However, there are three significant limitations which should be carefully considered. These include the subjective nature of behavioral measures, student mortality within the study, and the unfortunate fact that if what a student wants is get out of school, he can easily achieve that result. Each of these limitations is discussed below.</p> <p>Given the subjective nature of the daily student behavioral ratings, there can certainly be a large standard error within the measurement system employed. The positive results could be influenced by decreased sensitivity of the staff to disturbing behaviors and other factors related to increased tolerance. Furthermore, the results can be related to subject mortality and a change in the student population.</p> <p>The removal of two students from the program to a more restrictive environment clearly indicates that the program could not assure the success of all students in the program.</p> <p>Finally, the decrease in the number of out-of-school suspensions, while positive for the majority of the students, does not accurately capture and explain this data. The student suspension data are not generally reflective of the entire sample of students. In fact, the data most accurately describe three students. Two of them were placed in NPS settings during the course of the school year. The third student, with an extensive juvenile criminal history, including two cases of assault on teachers and staff, accounted for most of the suspensions for the remainder of the school year.</p> <cn>CONCLUSIONS</cn> <p>Given the regulatory demands of school psychologists, it is extremely difficult for them to find the time to provide interventions to reduce problem behaviors at their school sites. Meanwhile, the number of students with emotional and behavioral problems continues to increase in schools throughout the nation.</p> <p>The simple and practical model offered here-RT and an ISSR-has demonstrated that it is possible to accomplish psycho-educational assessment and other demands placed upon school psychologists while also providing mental health services at the school site to students in greatest need of behavioral change.</p> <p>GRAPH: Figure 1 Student Behavior During the Intervention Program</p> <ref id="AN0015618884-3"> <title> REFERENCES </title> <blist> <bibl id="bib1" type="bt"></bibl> <bibtext>Adelman, H. S., & Taylor, L. (1998). Mental health in the schools: Moving forward. School Psychology Review, 27(2), 175-190.</bibtext> </blist> <blist> <bibl id="bib2" type="bt"></bibl> <bibtext>Axelrod, S. (1983). Behavior modification for the classroom teacher. New York: McGraw-Hill.</bibtext> </blist> <blist> <bibl id="bib3" type="bt"></bibl> <bibtext>Bear, G. G. (1998). School discipline in the United States: Prevention, correction, and long-term social development. School Psychology Review, 27(1), 14-32.</bibtext> </blist> <blist> <bibl id="bib4" type="bt"></bibl> <bibtext>Brown, L., Nesbitt, J., Purvis, G., & Cossairt, A. (1978). The control of severe tantrum behavior through the use of a one-minute time out procedure. In R. V. Hall & R. G. Fox (Eds.), Instructor's manual for responsive teaching-parenting model transparency kit. Lawrence, KS: H & H Enterprises.</bibtext> </blist> <blist> <bibl id="bib5" type="bt"></bibl> <bibtext>Clarke, H. B., Rowbury, R., Baer, A. M., & Baer, D. M. (1973). Time out as a punishing stimulus in continuous and intermittent schedules. Journal of Applied Behavior Analysis, 6, 443-455.</bibtext> </blist> <blist> <bibl id="bib6" type="bt"></bibl> <bibtext>Coats, K. I. (1991). The impact of RT in a school for emotionally disturbed youth. (ERIC Document Reproduction Service No. ED 355690).</bibtext> </blist> <blist> <bibl id="bib7" type="bt"></bibl> <bibtext>Flanagan, S., Adams, H. E., & Forehand, R. (1979). A comparison of four instructional techniques for teaching parents the use of time out. Behavior Therapy, 10, 94-100.</bibtext> </blist> <blist> <bibl id="bib8" type="bt"></bibl> <bibtext>Gardner, H. L., Forehand, R., & Roberts, M. (1976). Time-out with children: Effects of an explanation and brief parent training on child and parent behaviors. Journal of Abnormal Child Psychology, 4, 277-287.</bibtext> </blist> <blist> <bibl id="bib9" type="bt"></bibl> <bibtext>Glasser, W. (1960). Reality therapy. New York: Harper & Row.</bibtext> </blist> <blist> <bibl id="bib10" type="bt"></bibl> <bibtext>Glasser, W. (1976). Schools without failure. New York: Harper & Row.</bibtext> </blist> <blist> <bibl id="bib11" type="bt"></bibl> <bibtext>Glasser, W. (1988). Choice theory in the classroom. New York: HarperCollins.</bibtext> </blist> <blist> <bibl id="bib12" type="bt"></bibl> <bibtext>Gutkin, T. B., & Conoley, J. C. (1990). Conceptualizing school psychology from a service delivery perspective: Implicaions for practice, training and research. Journal of School Psychology, 28, 203-223.</bibtext> </blist> <blist> <bibl id="bib13" type="bt"></bibl> <bibtext>McConaughy, S. H., & Ritter, D. R. (1995). Best practices in multidimensional assessment of emotional and behavioral disorders. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology (Vol. 3, pp. 865-873). Washington, DC: NASP.</bibtext> </blist> <blist> <bibl id="bib14" type="bt"></bibl> <bibtext>Miller, G. E., Brehm, K., Whitehouse, S. (1998). Reconceptualizing school-based prevention for antisocial behavior within a resiliency framework. School Psychology Review, 27(3), 364-379.</bibtext> </blist> <blist> <bibl id="bib15" type="bt"></bibl> <bibtext>Olson, R. L., & Roberts, M. W. (1978). Alternative treatments for sibling aggression. Behavior Therapy, 18, 243-250.</bibtext> </blist> <blist> <bibl id="bib16" type="bt"></bibl> <bibtext>Quinn, K. P., & McDougal, J. L. (1998). A mile wide and a mile deep: Comprehensive interventions for children and youth with emotional and behavioral disorders and their families. School Psychology Review, 27(2), 191-203.</bibtext> </blist> <blist> <bibl id="bib17" type="bt"></bibl> <bibtext>Sheridan, S. M., & Gutkin, T. B. (2000). The ecology of school psychology: Examining and changing our paradigm for the 21st century. School Psychology Review, 29, 485-502.</bibtext> </blist> <blist> <bibl id="bib18" type="bt"></bibl> <bibtext>Tapasak, R. C., & Keller, H. R. (1995). A reaction to "Where will...?' and suggestions for "How to': A need to address systems-level variables in school psychology role/function change efforts. Journal of School Psychology, 33, 201-208.</bibtext> </blist> <blist> <bibl id="bib19" type="bt"></bibl> <bibtext>Wiest, D. J., & Kreil, D. A. (1995). Transformational obstacles in special education. Journal of Learning Disabilities, 28, 399-407.</bibtext> </blist> <blist> <bibl id="bib20" type="bt"></bibl> <bibtext>Wiest, D. J., & Kreil, D. A. (1997). In T. Jennings (Ed.), Restructing for integrative education (pp. 53-77). Westport, CT: Bergin and Garrey.</bibtext> </blist> </ref> <aug> <p>By Perry D. Passaro, Santa Ana Unified School District; Michael Moon, Santa Ana Unified School District; Dudley J. Wiest, California State University, San Bernardino and Eugene H. Wong, California State University, San Bernardino</p> <p></p> <p>Requests for reprints should be sent to Dr. Perry Passaro, 1940 W. Orangewood Ave, Suite 101, Orange, CA 92868.</p> </aug>
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  Data: This article describes a treatment approach for students with emotional and behavioral challenges. The approach involves conducting reality therapy in an in-school support room. Data from this pilot study indicate that the treatment assists in developing more effective choices and in turn promotes cognitive and behavioral change in most students, while reducing the number of disciplinary actions for these students.
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            – Type: issn-print
              Value: 0001-8449
          Numbering:
            – Type: volume
              Value: 39
            – Type: issue
              Value: 155
          Titles:
            – TitleFull: Adolescence San Diego
              Type: main
ResultId 1