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AGGRESSION REPLACEMENT TRAININGIN ACTION

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Title: AGGRESSION REPLACEMENT TRAININGIN ACTION


1
AGGRESSION REPLACEMENT TRAINING--IN ACTION
  • Rose Jenkins ConferenceImplementing
    Evidence-Based Practices Early Lessons
    LearnedOctober 3-4, 2006

2
Aggression Replacement TrainingOverview
  • Elijah McCauley, MA
  • Clinical Training Specialist
  • Stars Behavioral Health Group

3
Stars Behavioral Health Group
  • Starting in 1988, we now operate a wide variety
    of behavioral health programs for children,
    adolescents, and families.
  • Our programs include treatment intensive
    programs provided in homes, at schools, and
    residential/ community-based centers.

4
Our Clients
  • Conduct Disorder
  • Aggression toward others
  • Destruction of Property
  • Deceitfulness, lying, or stealing
  • Serious violations of rules

5
The 3 ART Components
  • 1. Skill-Streaming (behavioral)
  • 2. Anger Control Training (emotional)
  • 3. Moral Reasoning Training (values)

6
Skill-Streaming
  • 50 social skills examples
  • Expressing a Complaint Constructively
  • Caring for Someone Who is Sad or Upset
  • Dealing w /(-) Peer Pressure
  • Keeping Out of Fights
  • Helping Others
  • Responding Constructively to Failure

7
Skill-Streaming
  • Modeling
  • (Skill Demonstration by Trainers)
  • Role-Playing
  • (Skill Rehearsal by Youth)
  • Performance Feedback
  • (By Trainers and all Youth in Group)
  • Generalization Training
  • (To Increase Both Transfer and Maintenance)

8
Anger Control Training
  • Identify triggers (internal external)
  • Identify physiological cues of anger
  • Identify anger reducers
  • Reminders to decrease anger

9
Problems I Had Today
  • Think bad about myself
  • Dont care about others
  • Dont care about myself
  • Problems with authority
  • Mess with other people
  • Get messed with alot
  • Make others mad
  • Steal stuff
  • Get mad easy
  • Want to use alcohol or drugs
  • Lie to people
  • Punk other people

10
Thinking Problems
  • Self-Centered (me, me, me)
  • Blaming Others (you, you, you)
  • Assuming the Worst
  • (biggie, biggie, biggie)
  • Minimizing (no biggie)

11
Anger Reducers Chill-Out Skillz
  • Deep Breathing
  • Count Backward from 10
  • Put a cool picture in your head

12
Moral Reasoning
  • The strength of this UNIQUE approach comes from
  • Positive Peer Influence

13
Moral Reasoning
  • We want our clients to develop--
  • Moral Maturity
  • For this to occur they must develop mutual
    caring, respect trust

14
Anthonys Problem Situation
  • Anthony is walking along a side street w/his
    friend Raymond. Noticing a purse in the backseat
    of a parked car, Raymond says, Look! The cars
    unlocked, theres a purse in the backseat.
    Lets grab it!
  • What should Anthony do?

15
Anthonys Problem Situation
  • 1.Should Anthony try to persuade Raymond not to
    steal the purse? (circle one)
  • Should persuade should let steal
    cant decide
  • 2. What if Raymond says to Anthony that the car
    owner can probably get insurance to cover the
    loss? (circle one)
  • Should persuade should let steal
    cant decide
  • 3. In general, how important is it for people not
    to take things that belong to others? (circle
    one)
  • Very important important not
    important
  • 4. What if you found out the car belonged to your
    good friend
  • Would Care a lot dont care dont
    know

16
  • Santa Clara County
  • Aggression Replacement Training

17
Purpose
  • To implement an evidence based program into
    Juvenile Hall and the Ranch Programs in order to
  • Enhance positive coping strategies
  • Reduce violence in custody and upon release
  • Increase in sociably acceptable behaviors

18
Demographics
  • Average daily population Juvenile Hall 250 /
    Ranches 101
  • Number of minors admitted annually Juvenile
    Hall 2893 / Ranches 420
  • Minors screened for Mental Health issues
    annually 2888
  • minors open to MH services while detained
    Juvenile Hall 1010 / Ranches 312

19
Accomplishments - Wave 1
  • Seven Mental Health Therapists and Eleven
    Custodial Staff trained in ART Model.
  • Two ten week groups consisting of 8 male minors
    completed in Juvenile Hall.
  • Twelve minors complete ten weeks of training at
    the Boys Ranch.
  • Three additional groups 2 male and 1 female
    started in Juvenile Hall.
  • One additional group for males started at the
    Boys ranch.

20
Comparison of Skillstreaming Checklist
Average Score, Maximum possible 50
21
Satisfaction Questionnaires
Average score, Maximum possible 30
22
Number of behavior Incident Reports
For Youth Completing ART Curriculum
23
Facilitator Viewed Strengths
  • Sessions build upon previous information.
  • Materials are easy for trainer to understand.
  • Materials are easy for minors to understand.
  • Different levels of material are given so that
    subject matter can be modified to fit group.
  • Use of week 0 to do pretest and set ground rules
    with minors.

24
Facilitator Viewed Difficulties
  • Calls to master trainer not useful at the
    beginning
  • Scheduling meeting due to staff schedules can be
    challenging
  • Amount of staff time needed to prepare sessions,
    lead session and evaluate can place a burden on
    the staff
  • High attrition in Juvenile Hall groups.
  • Turnover in members challenge to group
    dynamics

25
Victor Community Support Services, Inc.Victor
Treatment Centers, Inc.North Valley Schools, Inc.
Observations and Conclusions of Victor Family of
Programs Aggression Replacement Training Across
3 Settings Community Mental Health Clinic Public
and Non-Public School Environments Juvenile Hall
26
  • Aggression Replacement Training
  • Community Mental Health Clinic Setting

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  • Aggression Replacement Training
  • School Settings
  • Integrated Day Treatment Program in a Special Day
    Class
  • Specialty MH Services in a Special Day Class
  • Day Treatment Program in a Non-Public School

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  • Aggression Replacement Training
  • Juvenile Hall Setting
  • Five A.R.T. Group Curricula over 10 Months

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Conclusions
  • Client Demographics
  • ART seems most effective for youth with higher
    Cognitive Functioning
  • Single-sex groups assist with client focus and
    behavior management (other research indicates
    same gender groups also reduce female anti-social
    behavior)
  • Youth with high motivation at the onset of the
    ART groups increase effectiveness
  • ART seems appropriate for both moderate and
    higher level acuity

42
Conclusions
  • Client Demographics
  • ADHD symptoms seem to interfere with the
    acquisition of ART skills
  • The intensity of Anger may increase during ART
    sessions, however
  • Anger intensity during sessions does not seem to
    increase aggression
  • Youth with intense anger experiences seem to
    apply ART skills
  • Youth are most engaged in the Role Plays
  • The application and sustainment of ART skills is
    greatly enhanced through collateral involvement
    (family members, teachers, milieu counselors)

43
Conclusions
  • Staffing Characteristics and Training
  • Increased supervision and fidelity monitoring
    appears to be as critical to ART efficacy as
    didactic training
  • Experience running groups and comfort level with
    youth anger appear to increase ART success
  • Group supervision and collegial support increase
    ART fidelity and efficacy
  • Staff attitude and enthusiasm seem to be more
    essential than formal education or years of
    experience

44
Conclusions
  • Staffing Characteristics and Training
  • Staff morale is consistently elevated through ART
    applications
  • ART provides a vehicle for staff creativity and
    application of their unique talents and skills
  • Staff must be comfortable with role plays staff
    consistently love role plays
  • Use of humor seems to be a very helpful skill
    with ART
  • It seems to work best for support staff (milieu
    counselors) to remain outside of the group, due
    to the sensitivity of discussions

45
Conclusions
  • ART Design
  • ART is consistently reported as easy to learn and
    straightforward
  • Role Plays are consistently reported as the most
    engaging and effective element of ART
  • Skillstreaming seems most appropriate for
    environments with stable client populations and
    staffing, due to the need for youth to practice
    of their individualized plans

46
Conclusions
  • ART Design
  • Anger Control seems to have the most long term
    impact (numerous clients remember Anger Control
    language years later)
  • Moral Reasoning seems most appropriate for older
    youth (14 to 18) due to its cognitive demands
  • Maintaining fidelity with Moral Reasoning can be
    a challenge with consistent reports of
    insufficient content
  • ART enhancements assist with maintaining a fun
    atmosphere and youth engagement

47
Sustaining ART in a Residential Program
  • Sean Schoneman, Ph.D.
  • Assistant Clinical Director of Training
  • Casa Pacifica

48
Steps to Sustaining
  • Training
  • Program Fidelity
  • Staff Involvement
  • Responsibility
  • Accountability
  • Support from Senior Management
  • Results
  • Setting Goals for the Future

49
Training
  • Medical Model Observe, assist, lead
  • Placed immediately into groups after 3 day
    training
  • Expert Team Meetings
  • Training
  • Implementation
  • Support

50
Training
  • 3 Tiers of ART Training at Casa Pacifica
  • Tier 1 Expert ART Team
  • 3 Day Training in Sacramento
  • Weekly Expert ART Team Meetings
  • Training New Hires People from their
    Departments
  • Teleconferencing with National Trainer
  • Annual 3 Day Training from National Trainers

51
Training
  • 3 Tiers of ART Training at Casa Pacifica
  • Tier 2 All Additional ART Group Facilitators
  • Annual 3 Day Training from National Trainers
  • Quarterly Refresher Trainings
  • Supervision During Groups from Expert ART Team
    Co-leaders
  • 2-Hour New Hire Training

52
Training
  • 3 Tiers of ART Training at Casa Pacifica
  • Tier 3 All other staff
  • 3 Day Training from National Trainers and/or
    2-Hour New Hire Training

53
Program Fidelity Strategies
  • Expert Team Leader Observations of Groups using
    ART Checklists
  • Quarterly Refreshers for all ART Participants
  • New ART Trainings by Department
  • Weekly Expert Team Meetings
  • Video Taping
  • Teleconferencing with National Trainer

54
Advantages to Being Part of Multi-agency
Implementation
  • Great Support in Getting Started
  • Able to Get ART Resources Cheaper
  • Other Agencies are Available to Share Information
  • Data Base
  • Assistance with Creating Own Data Base
  • Access to Aggregate Data from all Participating
    Agencies
  • Program Fidelity

55
Recent Changes to Our Expert ART Team
  • Leadership Responsibilities within the Team
  • Back-Up Leader
  • Program Leaders
  • Paperwork Czar
  • Treasurer
  • Four Trainer have been recognized as Proficient
    and will begin training ART on campus

56
Recent Changes to Our Expert ART Team
  • Leadership Responsibilities within the Team
  • Back-Up Leader
  • Program Leaders
  • Paperwork Czar
  • Treasurer
  • Four Trainer have been recognized as Proficient
    and will begin training ART on campus

57
Future Challenges
  • Budget
  • 96 of our current budget Stipends
  • Team wants to keep their stipends
  • Increasing our funding
  • Grants
  • Lobbying for a larger budget
  • Producing revenue via teaching
  • Keeping the Team Together
  • Opening a site in Santa Barbara, CA

58
Future Goals for ART in Our Agency
  • Trainer of Trainers Training
  • . Providing In-House Training of ART
  • . Providing Training for Other Agencies
  • Traveling to Learn and Teach
  • Live Supervision via bug-in-the-ear
  • Every Current Expert Team Member has the
    Opportunity to be a Trainer of Trainers
  • Increased Collaboration with our LSCI Team

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