pc-care2018/08/01 · e.1 pc-care video review worksheet this worksheet for each pc-care session...
TRANSCRIPT
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript.
PC-CARE
• Session 2 Protocol • Video Review Worksheet • Session 2 Coding Sheet & Checklist • Session 2 Strategies to Manage Behaviors • Calming Strategies for Young Children • Calming Strategies for Older Children • Co-regulation Techniques Handout • Daily CARE Handout • Session 2 Strategies Questionnaire • Session 2 What Worked Last Week Questionnaire
Weekly Assessment
• WACB-N
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript.
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE:
Course of Treatment Manual. Unpublished Manuscript. V
PC-CARE PROTOCOL
SESSION 2 GOALS: Teach Selective Attention, Modeling, Redirect, Calming, PRIDE Skills
CHECK-IN (7 min)
• Find out how parent and child are doing • Collect Daily CARE handout- find out how
transitions went, whether parent changed the environment and how it worked, what kinds of changes PRIDE skills made. Review PRIDE skills if needed.
• Administer and review WACB-N & “Last Week’s Strategies: What worked?” questionnaire
• Choose child behavioral focus for session.
Listen, but bring discussion back to how PC-CARE skills might help. If parent/ child issues are outside the scope of PC-CARE, offer to call later to discuss more thoroughly.
MINI-DIDACTIC* (10 min)
• Show parent Strategies to Manage Behavior handouts and teach about SELECTIVE ATTENTION as a way to cut down low-level negative child behaviors, possibly accompanied by MODELING and REDIRECTING the child’s attention to more appropriate play.
• Talk about the need for parents to keep CALM during SELECTIVE ATTENTION. Talk about the importance for kids of keeping calm (emotionally regulated). Show parent & child coping handout and teach them one or two CALMING strategies. Show parent & child COREGULATION handout and encourage them to try 1 or 2 skills at home.
Forms needed: • Strategies to Manage
Behavior • Calming Strategies for
young children • Calming Strategies for
older children • Coregulation handout * Make sure to involve child in the didactic if age appropriate. Child can use selective attention with sibs
CODE & FEEDBACK (5 min)
• Conduct 4- minute behavioral observation. Code using PC-CARE coding.
• Give parent feedback on behavior observation: point out child’s response to PC-CARE skills parent used, improvements in child behavior
Use PC-CARE Coding Sheet
COACH (20 min)
• Coach parent to play with child and practice PRIDE skills.
• Have a plan for when to coach selective attention, modeling, redirecting, and calming, and also look for opportunities to coach them as situations arise.
• Have parent give a transitional warning for switching toys half way through session; ask parent to model a CALMING skill. Switch toys; if child whines or protests, have parent ignore
Pick toys the child is interested in. Make sure child is happy to switch toys- make sure the parent makes it sound REALLY fun! If you haven’t had enough time with the first toy (for one reason
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE:
Course of Treatment Manual. Unpublished Manuscript. VI
[SELECTIVE ATTENTION] and point out cool qualities of new toy [REDIRECT] and MODEL putting away first set of toys.
or another), don’t switch toys.
CHECK OUT (5-7 min)
Discuss when the parent (and child, if appropriate) can use selective attention, redirecting, and calming at home or school. Work out plans with them to try it. (Use the “Using Strategies at Home” questionnaire.)
Present graph of PC-CARE Progress.
• Remind parent and child about Daily CARE. Discuss toys they like to play with and what time of day they like to play.
• If they did Daily CARE in Week 1, praise, talk about what a big difference it makes.
• If no Daily CARE or little buy in, talk about how this is an important part of the child’s therapy, foundation of their commitment to change, and supports healthy development. Consider having the parent tell you where they would have Daily CARE, what time of day they were thinking about having it, what toys they’d use, to help them visualize what it would be like.
Daily CARE Week 2: • 5-minutes of Special Playtime daily • PRIDE skills • Selective attention & Redirect as planned • Calming
Make sure to leave some toys on the table for child to play with. Remember to include child if age appropriate.
Session # _____
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., Königs, M., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.1
PC-CARE Video Review Worksheet
This Worksheet for each PC-CARE session was constructed to help you think critically about each PC-CARE session and should help you during all your sessions dealing with PC-CARE.
Write down the main things the therapist asked about and discussed during check-in: It is essential that the didactic stays within the 10 minute timeframe. For each skill, identify how many ways the therapist defines it, how many explanations are given, and how many examples are given.
Did the caregiver seem anxious and/or overly talkative? If so, describe how the therapist redirected him/her.
Note how the therapist included the child in check-in and didactic (and makes it fun):
Mention pros and cons of the child being involved in the didactic this week. Pros: Cons:
Session # _____
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., Königs, M., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.2
Look at your coding of the caregiver. Are there areas where the caregiver might improve? Describe how the therapist uses coding results to inform coaching. Write at least two Level 3 coaching statements (i.e., explanations, observations of parent and/or child, interpretations) the therapist used during coaching that stood out for you. Note why they stood out (briefly):
Identify each skill taught this week and how the therapist coached each of them:
1) 2) 3) 4) Note instances where the therapist did a good job being gently corrective during coaching. Describe moments when coaching seemed to shift the caregiver’s performance and understanding of skills. Write down how the therapist introduces the graph at the end of session and describes the family’s progress:
Note how Daily Care is presented and encouraged:
PC-CARE – Session 2
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.3
WEEKLY CODING AND CLINICAL NOTES
4 min. Coding Instructions: “Tell your child that it’s playtime. Use all the skills you’ve learned while you follow along with [HIS/HER] play.”
CLIENT NAME DATE START TIME STOP TIME TOYS USED
CAREGIVER GOAL FOR SESSION
PARENT’S STATEMENTS: POSITIVE TALLY CODES TOTAL
NEUTRAL PARENT TALK
PRIDE (PRAISE, REFLECT, IMITATE, DESCRIBE, ENJOY)
AVOID TALLY CODES TOTAL QUESTIONS
COMMANDS
NEGATIVE TALK (NTA)
STRATEGIES USED TO MANAGE BEHAVIOR – circle all strategies present during 4 minutes of coding
TRANSITIONS REDIRECT CHANGE ENVIRONMENT RULES
MODELING CALMING REMOVAL OF PRIVILEGE WARNING CHOICES
IGNORE WHEN-THEN/IF-THEN RE-DO HAND-OVER-HAND RECOVERY
PARENT-CHILD INTERACTION QUALITY INDEX
During 4 minutes of coding: Not at all Somewhat Very much
Parent is covertly hostile. 1_____2_____3_____4_____5
Parent is bossy or intrusive. 1_____2_____3_____4_____5
Parent is withdrawn and quiet. 1_____2_____3_____4_____5
Child was easily upset and hard to soothe. 1_____2_____3_____4_____5
Child ignored parent. 1_____2_____3_____4_____5
Child was bossy or tried to control play. 1_____2_____3_____4_____5
Child was aggressive or rude to parent. 1_____2_____3_____4_____5
PC-CARE Session 2 Checklist
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.4
Goals: Assess, reinforce PRIDE concepts, use Selective Attention, Modeling, Redirect, & Calming
Check-in (7 min.): Start Time_________________ Assessment measures and feedback (WACB, etc.) Daily CARE handout collected, reviewed, discussed barriers to completion if applicable Discussed objectives and goals (related to child behaviors) for session Complete “Last Week’s Strategies: What worked?” questionnaire
Mini-Didactic (10 min.): Start Time_________________ Present Session 2 Strategies handout Explain, model, and/or role play Selective Attention, Modeling, Redirect Present and explain Calming Strategies handout (choose handout for Younger or Older child)
4-minutes Coding (5 min.): Start Time_________________ Lead in statement given Reliable coding Gives feedback to caregiver Give coaching strategy for session, connect with session plan
Coaching (20 min.): Start Time_________________ Uses 3 levels of coaching: sufficient quantity, timing, pace, tone, and variety
Coach Coding (tally up coaching levels used in 5 minutes)
Start Time: End Time:
Level 1 (Lead)
Level 2 (Follow & Praise)
Missed Opp. Errors
Level 3 (Explain and Rapport)
Explanations Observations Generalizations
Coached to stated objectives of session: a. Selective Attention __________ b. Modeling __________ c. Redirect __________ d. Calming __________
Used exercises to achieve coaching goals if needed Gave warning (1, 2, 5 minute) before end of session
Closing the session (12 min.): Start Time_________________ Reviews accomplishments of session related to child behaviors Complete “Using Strategies at Home” questionnaire Shows graph of parent progress, connect with treatment goals Gives Daily CARE handout, connect with parent performance and treatment goals: Selective
Attention, Modeling, Redirect, Calming at home Asks if caregiver will be able to come to session next week Tells caregiver plan for next week
CLINICAL NOTES:
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.5
PC-CARE
SESSION 2 Skill Reason Example
Selective Attention
Ignore inappropriate behavior (unless it’s
dangerous or destructive)
• Helps child notice differences between your responses to good and bad behavior.
• Helps parents stay calm. • Avoids increasing negative,
attention-seeking behavior by only rewarding good behavior with your attention.
• Child: (plays roughly with toys) • Parent: (says nothing about it,
turns focus to own toys; making it fun) “I’m going to make some cookies. Oh these are so tasty!
• Allows child to know what behavior you want.
• Helps to correct difficult behaviors by showing child the positive opposite behavior.
• “I am putting my toys away gently.”
• “I am going to slow down and think about what to do next.”
• Child: (shouting loudly) Parent: (quietly) “I’m going to use my indoor voice.”
• Gets child to focus on another toy, behavior, or activity without use of strict discipline.
• Provides opportunity to praise good behavior and create positive interaction.
• If the child wants another sibling’s toy, the parent can redirect the child by showing them a different yet equally fun toy.
• “Wow, I have a space station. It is really fun to get the rockets ready for blastoff.”
Calming
• Gives parents the opportunity to model skills and calm themselves.
• Gives child some skills in learning how to calm.
• “I feel really upset. I am going to calm down. I am going to take a deep breath and count to 10.”
• “I feel nervous. I am going to tighten my shoulders and then relax them.”
Redirect
Modeling
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.6
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.7
TECHNIQUE DESCRIPTION
Label Feelings
Help your child identify big feelings by labeling your child’s feelings in a neutral tone of voice.
For example, “It seems like that really frustrated you,” or “I can see it made you feel sad when . . .”
Breathe Together
Calmly take deep breaths so your child can see you practicing self-calming. If it does not make your child more upset, sit next to or hold your child while you breathe deeply
so your child can feel the rhythm of breathing.
Body Calming
Slowly and rhythmically rub your child’s back, feet, etc, when they are recovered. Connecting like this lets them know that you will be
there when they are ready to talk or interact.
Back
Stories
Tell your child a story while drawing on the top half of your child’s back. For example, draw a circle with rays for the sun,
draw triangles for mountains, tap your fingers to walk up the mountain, and brush your hand back forth to make wind.
Then, switch places and let your child tell a story on your back.
Sing or play relaxing songs. Model how to sing/dance/play an instrument.
Your child will learn to use music as an active calming tool.
Creating a soothing environment can reduce distress. Try lowering lights and turning off noisy toys and devices.
Weighted blankets or other objects that children can touch or feel can help them focus and calm down.
A cold washcloth over the eyes can reduce visual stimulation and calm an overly stressed system.
Sensory Activities
Music
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.8
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished
Manuscript. E.9
Pretend you are holding a ball of Play-Dough.
SQUEE-EEEZE it as hard as you can!
Then, let it go.
Make your body rigid like a robot.
Then, relax your body, like a ragdoll.
Pretend you are smelling a beautiful flower.
Then, pretend you are blowing out
candles on a birthday cake.
Make your back very straight,
And make your stomach very hard, So that you can squeeze between two trees.
Then, relax and shake it all out!
Silly Face Contest! Make a face: A puffer fish
A turtle A friendly puppy A goofy monkey
Take a deep breath,
and blow into the bubble wand
while thinking of what you want to say.
Your words go into the bubble
and float away!
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished
Manuscript. E.10
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of
Treatment Manual. Unpublished Manuscript. E.11
Snowman/Puddle: Make your body tense like a snowman.
Then, slowly melt your body down to the ground in a puddle.
Robot/Ragdoll: Make your body rigid like a robot. Then, relax your body, like a ragdoll.
Turn it into a game!
Flower/Birthday Cake:
Pretend you are smelling a beautiful flower. Then, pretend you are blowing out
candles on a birthday cake.
Down Dog:
Rest on your hands and knees. Curl your toes under and
make an upside-down ‘V’ with your body. Press through your fingers and your heels.
Feel your body stretch.
Sit & Breathe:
Find a quiet place to sit on the floor. Sit cross-legged, with a straight back,
looking at the ground about two feet in front of you. As you breathe, feel the cool air coming into your nose,
then feel the warmed-up air going out of your nose. If it helps, count the breaths: one, two, three . . .
Imagine a Rainbow:
Imagine you are walking down a beautiful path. A storm is clearing and you see a rainbow. Stand under it and let its warm, bright light fill you with
happiness. You are a rainbow too. Red: You are strong and safe. Orange: You are happy and playful. Yellow: You are proud and confident. Green: You are
kind and caring. Blue: You are honest and truthful. Indigo: You are clever and creative. Violet: You are a good friend.
Color/Art:
Coloring, painting, playing with playdough, and other arts and crafts are also
great ways to relax. Focus on what you are making, noticing the colors, the way the materials feel, and the shapes you are forming. Notice how your big
emotions get smaller as you create new things.
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of
Treatment Manual. Unpublished Manuscript. E.12
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.13
Child’s Name: _____________________________________ Therapist – Session #: _____
Parent Name: _____________________________________ Date Returned: __________
During 5 Minutes Throughout the day
DATE
5-minute Special Play
Time!
What toys did you play
with?
Circle PRIDE skills used today
List strategies to manage
behavior used today
Overall, how was your child today?
(circle one)
__________ YES NO
Praise Reflect
Imitate Describe
Enjoy
__________ YES NO
Praise Reflect
Imitate Describe
Enjoy
__________ YES NO
Praise Reflect
Imitate Describe
Enjoy
__________ YES NO
Praise Reflect
Imitate Describe
Enjoy
__________ YES NO
Praise Reflect
Imitate Describe
Enjoy
__________ YES NO
Praise Reflect
Imitate Describe
Enjoy
__________ YES NO
Praise Reflect
Imitate Describe
Enjoy
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Forte, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.14
SPECIFIC SKILLS TO PRACTICE DAILY
Use your Relationship Enhancement Skills (PRIDE)
P Praise!
R Reflect!
I Imitate and model!
D Describe!
E Enjoy out loud!
Use “physical positives” such as smiles, eye contact, hugs, kiss, sitting closely Reduce questions and commands Avoid “NO”, “DON’T”, “STOP”, “QUIT”, & “NOT”
Use your Strategies to Manage Behaviors
Transitions between activities. Compliance-friendly environment: Help
child to succeed. Ignore unwanted behaviors that are mild. Redirect & Model appropriate behavior. Keep Calm! When-then, if-then, & choices to
encourage compliance. Set up Rules. Effective commands: Praise compliance,
remove privilege for non-compliance. Redo and hand-over-hand to practice
positive behaviors. Recovery by using PRIDE skills after
compliance.
Increase the behaviors you want to see by using key words:
Unwanted behaviors:
Dawdling, stalling, delaying
Misbehaving at meal times
Disobeying, acting defiant
Acting angry or aggressive
Words to encourage appropriate behaviors:
Quickly Complying (first
time) Focusing
Right away
Quietly Waiting
Hands to self Sitting in seat Using manners Polite words
Good attitude Calmly
Following directions
Cooperative Complying
Using calming skills Softly Gently
Carefully Calmly
Thinking things over
Screaming, yelling
Destroying or being rough with
things
Provoking others, picking fights
Interrupting, seeking attention
Trouble paying attention, overactive
Using nice words Big boy/girl voice
Indoor voice Using calming
skills Speaking softly Talking calmly
Safely Calmly Gently Softly
Carefully Hands to self
Hands to self Polite words
Saying nice things Cooperative
Sharing
Letting others talk
Listening Waiting Patiently
Taking turns
Listening Focusing
Concentrating Waiting Patiently
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.15
PC-CARE
Today we learned the following strategies. Please rate how well you think each strategy will work for you and your family by circling the appropriate number on a scale of 1 (not at all well) to 5 (extremely well). Selective Attention/Ignore
Not at all Slightly Well Somewhat Very Well Extremely well well well
1 2 3 4 5 Modeling
Not at all Slightly Well Somewhat Very Well Extremely well well well
1 2 3 4 5 Redirect
Not at all Slightly Well Somewhat Very Well Extremely well well well
1 2 3 4 5 Calming
Not at all Slightly Well Somewhat Very Well Extremely well well well
1 2 3 4 5
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.16
SESSION 2
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.17
PC-CARE
Last session, we practiced the following strategies. Please rate how well these strategies worked since the last session on a scale of 1 (not at all well) to 5 (extremely well). Circle the number that reflects how well each strategy worked.
PRIDE Skills
Not at all Slightly Well Somewhat Very Well Extremely well well well
1 2 3 4 5 Avoid Skills
Not at all Slightly Well Somewhat Very Well Extremely well well well
1 2 3 4 5 Transitions
Not at all Slightly Well Somewhat Very Well Extremely well well well
1 2 3 4 5 Compliance Friendly Environment
Not at all Slightly Well Somewhat Very Well Extremely well well well
1 2 3 4 5
SESSION 2
Copyright © 2016 by University of California, Davis. Timmer, S., Hawk, B., Lundquist, K., Armendariz, L., Aviv, R., Boys, D., & Urquiza, A. (2016) PC-CARE: Course of Treatment Manual. Unpublished Manuscript. E.18
Forte, L., Boys, D., & Timmer, S. (2012) The use of brief child behavior assessments for weekly check-ins in PCIT: WACB-N and WACB-P. Poster presentation at the 12th Annual PCIT Conference for Traumatized Children, Davis, CA. Updated 8/01/18
WACB – N (Weekly Assessment of Child Behavior – N)
Admin Use Only: Check if administered by therapist Session # __________________
Your Name __________________________ Relationship to Child _______________ Today’s Date ___/___/___
Child’s Name _________________________ Child’s Gender _______________ Child’s Age ___________
Directions Please fill out the whole form by circling one number per sentence. For each sentence:
a) Please circle the number that shows how often your child behaved that way in the last week. b) Circle either “yes” or “no” to show whether you need that behavior to change.
For example: If your child rarely cried at bedtime (once or twice) last week, you might choose 2 and circle “NO.” How often does your child… Never Sometimes Always Change? 1. Cry at bedtime? 1 2 3 4 5 6 7 YES NO
STEP 1:
In the past week…. Not at all Sort of Very Does this need to change?
How stressful was it to parent this child? 1 2 3 4 5 6 7 YES NO
STEP 2:
How often does your child…. Never Sometimes Always Does this need to change?
1. Dawdle, linger, stall, or delay? 1 2 3 4 5 6 7 YES NO
2. Have trouble behaving at meal times? 1 2 3 4 5 6 7 YES NO
3. Disobey or act defiant? 1 2 3 4 5 6 7 YES NO
4. Act angry, or aggressive? 1 2 3 4 5 6 7 YES NO
5. Scream and yell when upset and is hard to calm?
1 2 3 4 5 6 7 YES NO
6. Destroy or act careless with others’ things? 1 2 3 4 5 6 7 YES NO
7. Provoke others or pick fights? 1 2 3 4 5 6 7 YES NO
8. Interrupt or seek attention? 1 2 3 4 5 6 7 YES NO
9. Have trouble paying attention or is overactive?
1 2 3 4 5 6 7 YES NO
Total Score
(items 1 through 9 ONLY)
/63 /9 (1 per YES)
Forte, L., Boys, D., & Timmer, S. (2012) The use of brief child behavior assessments for weekly check-ins in PCIT: WACB-N and WACB-P. Poster presentation at the 12th Annual PCIT Conference for Traumatized Children, Davis, CA. Updated 8/01/18