Aggression Replacement Training for Youth and their Caregivers

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Aggression Replacement Training for Youth and
their Caregivers
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Overview of Edgewood and its A.R.T. Model
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What is Edgewood?

• Established in 1851 as an orphanage
• 1960s Residential Treatment Center for Children
  with emotional problems or in need of fostering
• 1970s added School/Day Treatment Center for
  latency aged children
• Mid 1980s Began Community and School Based
  Services, which include Kinship Support
  Services, School Based Services, Mental Health
  Services, Child Abuse Treatment Programs,
  Advocacy and Prevention Services.
• Currently 375 employees and up to 500 volunteers
  a year, and serve 5,000 children and families
  each year, through a continuum of care from early
  intervention thru intensive residential services.

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Mission Statement

• To strengthen children, youth, families and their
  communities through service, training, advocacy,
  and research.

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Our Core Values

• Community-Based and Accessible.
• Programmatically Strength-Based.
• Family and Culturally Centered.
• Collaborative Framework.

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What is our Model

• Received a two- year grant from San Franciscos
  Mayors Office of Criminal Justice (MOCJ) which
  funds programs for youth in the Juvenile Justice
  system.
• Goal of the project is to bring evidence based
  CBT programs to youth who are on Juvenile
  Probation, but remain in their communities,
  living at home (although we do have some group
  home youth in our program).
• Reduce recidivism of youth on Juvenile Probation.
• Consists of 4 cycles a year within our outpatient
  clinic and includes a parent component (to align
  with our core values, and mission).

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What is our Model

• How It Is Implemented
• 10 week-cycle
• Youth attend 2 times a week for 1.5 hours
  Tuesdays and Thursdays
• Parents attend 1 time a week for 1.5 hours on
  Thursdays
• Groups occur in the early evening, so all can
  attend 500 to 630pm
• 3 Monthly Family Dinner on Thursdays following
  group

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What is our Model

• Who
• All referrals come from Probation Officers or
  other programs working with Juvenile Offenders,
  i.e. Public Defenders, CARC, etc
• Youth who have been placed on Probation but
  remain in the community with a parent/caregiver
• Age range 14-18 years old
• Parents and Caregivers of youth participating
• All youth and caregivers must go through an
  intake process

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What is our Model

• Who are the Staff
• 1 20 hour clinician who provides supervision to
  the Youth and Family Outreach Coaches, and runs
  the youth group with one Youth and Family
  Outreach Coach
• 3 20 hour Youth and Family Outreach Coaches
  these are B.A. level position, who co- lead the
  youth group and the parent group, as well as are
  assigned a caseload of the current groups youth
  and provide case management and family
  conferencing.
• 1- (approx 5 hours a week) Program Manager, who
  provides supervision and oversight of program and
  budget

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Sample Schedule

• SCHEDULE FOR ART GROUPS
• Thursday, January 10 Thursday, March 20, 2008
• (Please submit all referrals by Friday, January
  4, 2008)
• Tuesday and Thursday groups will be from
  500pm-630pm
• We will be discussing Anger Control on Tuesdays
  and Skill-streaming on Thursdays. A family
  dinner will be served once a month for all youth,
  adults and staff from 630-700pm following
  group.
• Weekly schedule
• Thurs Jan 10 ART Introduction Pre-test
• Tues Jan 15 Introduction to Anger
• Thurs Jan 17 Responding to Failure / Parent Group
  (Monthly Dinner)
• Tues Jan22 Triggers
• Thurs Jan 24 Understanding the Feelings of Others
  / Parent Group
• Tues Jan 29 Cues
• Thurs Jan 31 Moral Reasoning 1 / Parent Group
• Tues Feb 5 Anger Reducers
• Thurs Feb 7 Negotiating / Parent Group
  (Monthly Dinner)
  
• Tues Feb 12 Reminders
• Thurs Feb 14 Using Self-Control / Parent Group
  

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A.R.T. as an Outpatient Model
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Outreach

• Importance of creating a Brand to distinguish
  your mission and model of ART
• Letters outlining purpose What we do? Who we
  serve?
• Flyers that provide contact information and
  schedule of groups
• Presentations at community organizations to build
  awareness
• Attendance at staff meetings to create
  relationships, provide information, and collect
  referrals

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Referral Process

• Keep it SIMPLE!
• Referral form should
• Outline contact information of guardian
• Provide contact number of referrer
• Describe reason for youth being placed on
  probation (include court order, if applicable)
• List other agencies involved with family
• State expectations of outcome

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Intake Process

• Sets precedent and expectation for active
  involvement of providers
• Confirms engagement of parents/guardian
• Assesses for familys needs

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Setting the Precedent

• The Key Factor in successful treatment is
• COLLABORATION!
• Contact referrer to inform them that referral was
  received and to check if additional information
  needs to be relayed
• Explain that on-going weekly contact will be made
  to share attendance and participation of youth
• Opens the dialogue for easy communication between
  programs and/or providers, and thus builds
  relationship
• Increases opportunity for additional referrals!

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Confirming Engagement

• The Message we want to give is
• A.R.T. is not solely a class to drop youth off
  at!
• because
• Parents are encouraged to attend too!
• In order to
• Foster skills and to support, learn, and grow!
• ???

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Confirming Engagement (cont)

• Since this is the first contact with the parent,
  it is important to-
• Simplify the process of the intake and all the
  consent forms.
• Explain the set-up of the 10 week ART cycle and
  provide a written program description and
  schedule.
• Allow them adequate time to provide relevant
  history and background information on their
  family.
• Treat them as the EXPERT in knowing their child,
  so they feel heard and understood, rather than
  shamed due to youths behaviors and/or choices.

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Assessing Needs

• A.R.T is typically an adjunct to other services,
  so be cognizant of exploring additional options
• Discuss strengths of the family first, so that
  the areas of concern may be easier to express.
• Inquire about any previous experience with
  programs and/or providers to know what worked
  well and what didnt.
• Openly ask questions pertaining to hardships,
  difficulties, and challenges that the family
  faces and NORMALIZE!
• Offer ideas and examples of resources available!
• Determine level of openness to receiving other
  services and explain process of how this will be
  done. No surprise contacts from other providers!

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Assigning Outreach Coach

• Family needs
• System Dynamics
• Personalities
• are matched to a
• Family Youth Outreach Coach

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Structure of Caregiver Component
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Overview of Parent/Caregiver Component

• Parent group occurs 1 day a week for 90 minutes.
• Format and agenda of parent group similar to
  youth group.
• Family dinners once a month
• Observation of family
• Reinforcement of skills
• Building relationships
• Guest Speaker
• Case Management

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Philosophy of Caregiver Component
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Why Parent/Caregiver Involvement is Important for
Youth and Families

• Promotes awareness of skills.
• Helps parents develop skills.
• Encourages continuity between behavioral
  expectations and reinforcement schedules in group
  and at home.
• Creates a feeling of cohesion within the family
  unit.
• Facilitates transference of skills to siblings
  and other family members.

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Statistics Related to Parent/Caregiver
Involvement for Youth and Families

• An estimated 1,600 persons under age 18 were
  murdered in the U.S. in 2002. About two-thirds
  (64) of these juvenile murder victims were male
  (1).
• Teens who believed that their parents cared about
  and supported them were less likely to be exposed
  to weapon violence or to commit violence with a
  weapon (2)
• Teens whose parents demonstrate positive
  behaviors on a number of fronts are more likely
  to engage in those positive behaviors themselves
  (3).

1-Snyder, H.N., Sickmund, M., op.
cit. 2-Henrich, C.C., Brookmeyer, K.A., Shahar,
G. (2005) 3-hAckard, D., Neumark-Sztainer, D.,
Story, M., Perry, C. (2006)
1
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How to Frame Parent/Caregiver Participation in
Group

• Empowerment of parent/caregiver
• Help parents/caregivers realize their role in
  childs development.
• Maintain a non-critical perspective.
• Position the group as an opportunity for parents
  to develop their own skills.
• Emphasize the supportive components of group.

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How to Build Relationship and Rapport with
Parent/Caregiver

• Acknowledge parents commitment.
• Maintain flexibility within the group structure.
• Provide parents with an opportunity to vent and
  seek support.
• Promote group interaction and facilitate
  supportive communication between group members.

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Supporting Families and Linking Them to Other
Services

• A.R.T. Case Management
• Family Conferencing
• Kinship Support Services
• EPSDT/Mental Health Services
• Ongoing collaboration with probation officers
• Possible collaboration with other service
  providers if necessary

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Case Examples of Working with Youth and Families
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Case 1High Family Involvement

• Janine and Rico

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Successes

• Regular attendance by Rico and Janine.
• Additional extended family support.
• Family was responsive to case management.
• Supportive of A.R.T. curriculum and
  interventions.
• Janine and Rico able to share experiences and
  insights with other group members.

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Challenges

• Family dynamics sometimes volatile.
• History of violence in the home.
• Rico temporarily lived with another family
  member.
• Rico witnessed two fatal shootings.
• Family lived in violent neighborhood.

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Case Management

• Collaborated with probation officer, school staff
  and football coach.
• Assisted Janine with finding work.
• Scheduled regular meetings and phone contact with
  family to support Rico in various settings.
• Referred family to individual and family therapy
  at Edgewood.

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Case 2High Parent InvolvementLow Youth
Involvement

• Diana Mark

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Successes

• Regular parent attendance.
• Responsive to case management.
• Diana was open to services and supportive of
  A.R.T. interventions.
• Diana was willing to share her perspectives and
  insights with other group members.

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Challenges

• Mark did not attend groups regularly.
• Parent history of drug use and inconsistent
  parenting.
• Family living in violent neighborhood.
• Mark diagnosed with ADHD, ODD, and depression.

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Case Management

• Scheduled regular meetings with Diana to assess
  Marks needs.
• Brainstormed about ways to engage Mark in groups.
• Collaborated frequently with Probation Officer.
• Supported Diana in personal and professional
  development.

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Case 3High Youth InvolvementGradual Family
Involvement

• Laura and Jamal

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Successes

• Jamal regularly attended group.
• Laura increased her level of engagement
  throughout the cycle.
• Family was responsive to case management.
• Laura supported A.R.T. interventions at home.

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Challenges

• History of domestic violence.
• Mother extremely anxious and reluctant to leave
  home.
• Sibling with special needs.
• Family living in dangerous neighborhood.
• Family experienced communication challenges with
  probation officer.

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Case Management

• Provided family with food and clothing.
• Assisted Laura with finding a job.
• Collaborated with probation officer.
• Transported family for safety reasons.
• Referred family for additional mental health
  services.

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Other Factors to Consider in Development of
Outpatient Model
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Behavior Management

• Clarify rules and expectations
• Praise desired behaviors
• Ignore unwanted behaviors
• Use of reminders, prompts, and redirections
• Arrange seating, if necessary
• Provide needed materials, snacks, and breaks
• Remove stimulating objects
• Maintain calm and soothing classroom space
• Involve parent/caregiver through phone calls and
  meetings

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Impact of Community Violence on Families during
A.R.T Cycles

• Multi-generational family history of trauma
  and/or crime
• Fragmented families
• Placed in group homes
• AWOL and/or run-away youth
• Involved in or living amidst turf wars
• Verbally threatened and physically attacked in
  the community
• Injured by gunshot and drive-bys
• Witnessed serious crimes, violence, and death

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Future Plans for Edgewood A.R.T.
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Future Program Development

• Parent Partner Hire a parent to co-facilitate
  the parent Group
• Explore ways to have open enrollment
• Bring ART groups to schools
• How to include in existing curriculum
• At all grade levels
• Involve families

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