The HAVEN Program Dialectical Behavior Therapy to Organize

The HAVEN Program Dialectical Behavior Therapy to Organize Educational Support for Adolescents with Emotional Needs Brian Drelicharz, LCSW and Claudia Kelly, LCSW Hinsdale High School District #86 Paul Holmes, Psy. D. School of Social Services Administration, University of Chicago

The HAVEN Program • Purpose • Overview of Contextually-focused Dialectical Behavior Therapy (C-DBT) • Dialectical Behavior Therapy • Psychological Flexibility Model • Description of Program • Program Structure • Targets of Intervention • Moment-to-moment interactions • Preliminary Findings

The HAVEN Program • Dialectical Behavior Therapy • A third wave behavioral therapy • Inclusion of acceptance strategies • Focus on secondary change • Emphasis on a participant's future and their values • Focus on what is organizing a participant's behavior • Emotions, thoughts, memories and bodily sensations or things valued

The HAVEN Program • Dialectical Behavior Therapy • DBT has one foot in the 2 nd wave and other in the 3 rd wave. • Includes both Cognitive Restructuring and Mindfulness Cognitive Restructuring ● Assumption about content of mind Mindfulness ● Assumption about content of mind ○ Content is the problem. ○ Content is NOT the problem. ○ Counter or challenge it. ○ Openness and acceptance.

The HAVEN Program Acceptance and Commitment Therapy Psychological Rigidity Loss of Vitality

The HAVEN Program Acceptance and Commitment Therapy Psychological Flexibility

The HAVEN Program Form versus Function of Behavior Form of behaviors vary and share few topographical characteristics Suggests divergence in treatment approaches Function of the various behaviors is to escape from and/or avoid aversive private experiences. Suggests convergence on one approach 7

The HAVEN Program • Dialectical Behavior Therapy • Originally developed for persons who struggle with suicide and para-suicidal behaviors. • One of only a few empirically supported therapies for individuals who present with multiple problems. • Now considered appropriate for anyone who engages in behavior where the purpose of the behavior is to change/control aversive private responses.

The HAVEN Program • Dialectical Behavior Therapy • Biosocial Model of Affect Dysregulation • Neurobiological Processes • High sensitivity, low threshold for responsivity and slow return to baseline. • Invalidating Environment • Environments that protect from, reinforce or punish person for their private responses.

The HAVEN Program Dialectics The middle path suggests that truth is discovered, develops and emerges. It is dynamic, changing and evolving. It is practicing the both/and rather than the either/or in our interactions with participants. 10

The HAVEN Program DBT Basic Assumptions • Students are doing the best they can. • Students want to improve. • Students need to do better, try harder, and be more motivated to change. • Students may not have caused all of their own problems, but they have to solve them anyway. • The lives of affectively dysregulated individuals are unbearable as they are currently being lived. • Students must learn new behaviors in all relevant contexts • Students cannot fail in therapy. • Staff working persons with affective dysregulation need support.

The HAVEN Program What is DBT? • DBT problem behavior prevention program. • Do not want participants to define themselves by their problem behaviors. • Target behaviors are the student’s solution to the pain associated with the problem. • The goal is to teach new solutions that do not distract everyone from the problem. • The goal of DBT is to assist students who are committed to developing a meaningful life.

The HAVEN Program What is DBT? Skills Training Individual Therapy Phone Coaching Consultation Group

The HAVEN Program The Synergy of DBT • Students learn skills in the skills group. • Therapist assists students in applying the skills they learned in group to prompts that have occasioned education-interfering behaviors. • Staff present and available to students for skills coaching in the moments that matter. • Staff receive support from and are held accountable by the consultation team in order to optimize their efficacy.

The HAVEN Program Skill Areas • Mindfulness • Observing thoughts and emotions rather than responding to them. • Distress Management • Rather than reacting in ways that make things worse. • Emotion Regulation • Every emotion is appropriate, how you respond to it is more or less effective. • Interpersonal Effectiveness • Observing limits with others and doing so in a way that respects their limits.

The HAVEN Program Milieu Consultation ● One of the main functions of skills coaching is to teach students that they do not have to engage in educationinterfering behavior in order to obtain assistance. ● Staff available in the moments that matter in order to provide skills coaching, increase motivation and reinforce effective coping.

The HAVEN Program Impetuses Behind the HAVEN Program Political Environment New District Leadership Mainstream Related Service Workload Financial Savings Coordination of Services Local Hospital Programs Student Transitions to Mainstream Academic Standards Access to Extra-curriculars

The HAVEN Program DBT in Clinical Setting DBT in School Setting • Skills Training = Applied Social Communication Class, • Individual Counseling = 1: 1 social work sessions • Skills Coaching = Parent Group, milieu interactions • Consultation Group = Certified & non-certified staff weekly meetings with Paul Holmes

The HAVEN Program Structure of Program • • • Online Courses & Live Instruction Classes Group, Elective Credit Para-Educator Support Point Sheet Level System Home Room/Primary Student & Staff Movement In & Out of HAVEN Program Consultation with Paul Holmes Capacity for Home Visits Transportation

The HAVEN Program 2015 -2016 1 LBS 1, 1 LCSW, 2 paraprofessionals, Adaptive PE: 8 -15 students 2016 -2017 2 LBS 1, 2 LCSW, 5 paraprofessionals, Adaptive PE, Gen. Ed Math Support, Gen. Ed Elective Offering: 19 -22 students 2017 -2018 2 LBS 1, 2 LCSW, 5 paraprofessionals, Program Coordinator, Gen. Ed Math Support, 2 Gen. Ed Elective Offerings: 18+ students 2018 -2019 3 LBS 1, 3 LCSW, 7 paraprofessionals, Program Coordinator, External Supports TBD: 22+10 students

The HAVEN Program Challenges Solutions 2015 -2016 Stigma Staff Education Limited Movement Adaptive PE Online Math Gen. Ed Support Few Live Offerings Second Classroom, Gen. Ed Electives Limited Groupings, Coverage, and Crisis Capacity Double Clinical Team Paraprofessional Turnover Increased Wages Lack of DBT Training Summer DBT Training (Certified Staff) 2016 -2017 Poor Student Fit, Motivation Intake/Outplacement Criteria Course Sectioning Clinical Coordinator Limited Administrator Availability Clinical Coordinator Intake Procedure, Outside Tours Clinical Coordinator Research Capacity, Paraprofessional Turnover, Limited Parent Engagement TBD

The HAVEN Program Preliminary Data • • Credits Earned Disciplinary Referrals Attendance Clinical Scales

Credits Earned = HAVEN Graduates

Disciplinary Referral Data Increase in Referrals Decrease in Referrals Means Comparison Test Pre-HAVEN Referral Mean = 1. 66 HAVEN Referral Mean = 0. 26 t = 2. 114 p = 0. 041

Attendance Data Mean % Change > 0 t = 2. 26 p = 0. 016 (+) Change Increase in Full Attendance Days (-) Change Decrease in Full Attendance Days

Clinical Scale Data • Child & Adolescent Mindfulness Measure (CAMM) • Assesses the degree to which students act with awareness and observe and accept internal experiences (thoughts, memories, and physical sensations) • Avoidance & Fusion Questionnaire for Youth (AFQ-Y) • Assesses (1) the ways adolescents attach thoughts, feelings, memories, and physical sensations to their life experiences (2) accept or avoid internal experiences that they do not like (3) how the presence of unwanted internal experiences impacts behavioral effectiveness • Acceptance & Action Questionnaire (AAQ-II) • Measures psychological inflexibility, or experiential avoidance

The HAVEN Program What’s Next • Expansion to Out of District Students • Research and Publication • Documentary • Ongoing tension between clinical DBT purpose vs school-based outcomes

Contact Information Brian Drelicharz, bdrelich@hinsdale 86. org Claudia Kelly, ckelly@hinsdale 86. org Paul Holmes, eholmes@uchicago. edu