AGGRESSION REPLACEMENT TRAININGIN ACTION

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AGGRESSION REPLACEMENT TRAINING--IN ACTION

• Rose Jenkins ConferenceImplementing
  Evidence-Based Practices Early Lessons
  LearnedOctober 3-4, 2006

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Aggression Replacement TrainingOverview

• Elijah McCauley, MA
• Clinical Training Specialist
• Stars Behavioral Health Group

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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.

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Our Clients

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

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The 3 ART Components

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

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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

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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)

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Anger Control Training

• Identify triggers (internal external)
• Identify physiological cues of anger
• Identify anger reducers
• Reminders to decrease anger

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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

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Thinking Problems

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

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Anger Reducers Chill-Out Skillz

• Deep Breathing
• Count Backward from 10
• Put a cool picture in your head

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Moral Reasoning

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

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Moral Reasoning

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

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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?

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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

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• Santa Clara County
• Aggression Replacement Training

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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

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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

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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.

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Comparison of Skillstreaming Checklist
Average Score, Maximum possible 50
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Satisfaction Questionnaires
Average score, Maximum possible 30
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Number of behavior Incident Reports
For Youth Completing ART Curriculum
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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.

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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

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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
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• 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

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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)

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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

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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

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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

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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

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Sustaining ART in a Residential Program

• Sean Schoneman, Ph.D.
• Assistant Clinical Director of Training
  
• Casa Pacifica

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Steps to Sustaining

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

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Training

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

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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

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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

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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

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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

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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

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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

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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

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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

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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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