Kimberly Lark's Presentation

Information about Kimberly Lark's Presentation

Published on August 5, 2014

Author: Ohtee_0424

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Emotional disturbances in school age children: By Kimberly Lark, MOTS Emotional disturbances in school age children Presentation outline: Background of emotional regulation & common diagnoses Social Emotional Learning (SEL) Frame of Reference as a tool to address emotions. Emotions Group Protocol Discussion & Conclusion Presentation outline What is emotional regulation?: The real time response to interactions with others and events that are met with responses deemed appropriate to society to address emotions elicited by interactions with others in accordance with each situation. Emotional regulation is achieved intrinsically through engaging in means to obtain the correct level of arousal and maintain physiological homeostasis. Emotional regulation is necessary to engage in tasks and establish relationships with others. Emotional regulation may also be achieved through the process of mutual regulation in which others are sought out for assistance in achieving emotional stability. This may include talking about one’s feelings Emotional regulation is a skill necessary to communicate with others and interpret information from society (Rubin, 2010). What is emotional regulation? Why does emotional Regulation & stability matter?: Individuals that develop the ability to communicate effectively and express themselves socially have more positive relationships while those that do not develop these skills are at a risk for developing anxiety and depression in the future (Rubin, 2010). Emotional stability and regulation supports social interaction and effective communication (Rubin, 2010). Emotional regulation is needed for successful social and communication skills which are positively associated with the establishment of positive relationships, performance in school, and achievement of future career goals (Rubin, 2010). Emotional regulation is of paramount value to prevent the occurrence of shootings and bullying within school systems. Why does emotional Regulation & stability matter? Emotional regulation & stability and areas of occupation: Emotional stability is a prerequisite for successful engagement in almost all areas of occupation described by the Occupational Therapy Framework (OTPF, 2014 ): - Work - Education - Play - ADLs - Leisure - IADLs Emotional regulation & stability and areas of occupation What diagnoses result in emotional disturbances?: According to the National Institute of Mental Health (NIMH), 10 to 15% of children experience emotional and behavioral dysregulation . Common Diagnoses with emotional regulation difficulties include: 1. Attention Deficit Hyperactivity Disorder (ADHD) 2. Autism Spectrum Disorder (ASD) 3. Bi-Polar Disorder 4. Anxiety Disorder What diagnoses result in emotional disturbances? Neurology of emotional regulation: Neurological studies have shown hypoactivity in the area of the fusiform gyrus of the brain in individuals with ASD-a diagnoses commonly associated with emotional regulation complications. The fusiform gyrus is responsible for processing the facial expressions, emotions, and potential future actions of others. This results in a sometimes decreased ability for these individuals to predict the behavior of others, sequence activities, and understand the purpose of activities which may result in increased stress. Furthermore, individuals with ASD typically have higher levels of the stress hormone cortisol furthering the anxiety. Individuals with ASD commonly report consistently feeling fear (Rubin, 2010). Neurology of emotional regulation How does the central nervous system cope with emotional dysregulation?: The central nervous system (CNS) must be physiologically regulated in order to engage socially, academically, and perform functional activities. The CNS will seek coping mechanisms including repetitive, rhythmical, or deep pressure motor behaviors in an attempt to achieve regulation. All behaviors have a function which may be an attempt at physiological regulation or engagement (Rubin, 2010). How does the central nervous system cope with emotional dysregulation ? Developmental milestones of coping behaviors: Coping behaviors change in accordance with development, but previous mechanisms of coping may still be utilized for self regulation (Rubin, 2010): Behavior Strategies: examples include rhythm & pressure, sensorimotor strategies including sucking thumb, or stress related eating. Language Strategies: Develop typically at 17 months plus and give the ability to mentally think through actions. Metacognition: “Thinking about thinking” starts at about 6 years of age in typical development and provides the ability to think about coping skills and strategies. Developmental milestones of coping behaviors Emotional Regulating behaviors:: These behaviors are important to recognize so that they can be addressed in therapy as they occur: Self Soothing behaviors: include mouthing, flapping, rocking, toe walking, making noises, and avoiding eye contact. Refusing and protesting: Drop to the floor, run away, pushing, verbal outbursts, and hitting (Rubin, 2010). Emotional Regulating behaviors: What can we do as occupational therapists to help?: Explain the purpose of activities since prediction may be difficult due to neurological differences. Utilize visual aids to show in steps the activities that will occur in advance to decrease anxiety and prevent the occurrence of emotional dysregulated behaviors. Tools commonly used include visual schedules, check off sheets, or pictures of common activities and emotions in accordance with developmental competencies or age. Model appropriate behaviors for effective communication to facilitate effective communication in the child (Rubin, 2010). Successful implementation of the Social Emotional Learning (SEL) framework that will be discussed in detail for the remainder of this presentation. What can we do as occupational therapists to help? What is social emotional learning (SEL)?: Classroom instruction of individuals to enhance their ability to process and adapt emotionally to changes in their environment by applying knowledge and making decisions leading to the establishment of positive relationships, goal attainment, and displaying the appropriate behaviors in accordance to the situation and location. The establishment of social and emotional skills are required for success in the workplace and school environments to facilitate learning and the achievement of productivity. Collaborative for Academic, Social, and Emotional Learning (CASEL) is the leading national organization focused on delivering evidence based research and tools for integrating SEL strategies into school districts (CASEL, 2013). What is social emotional learning (SEL)? Five components of SEL: CASEL (2013), has developed five competencies that culminate in social emotional learning (SEL) as follows: Self Awareness: Ability to assess internal emotions and thoughts and their impact on behavior-including the ability to realize ones own strengths and limitations. Self Management: Regulation of one’s emotions coupled with internal motivation to achieve goals. Social Awareness: Ability to adhere to social norms while bing able to understand the viewpoints of others. Relationship Skills: Maintenance of healthy relationships across a wide group of people that involves the integration of communication, conflict resolution, effective communication, and seeking and offering help as necessary. Responsible Decision Making: Ability to regulate one’s own behavior due to an internalized idea of right and wrong. Five components of SEL Implementation of sel: The SEL framework is implemented within school systems in various combinations of the following levels of intervention (AOTA, 2010): Tier 1 Universal: The SEL interventions are implemented at the level of the entire school and include strategies of displaying behaviors with visual supports, screenings for at risk behavior, and discussion of specific skills in classes. Tier 2 Targeted: Groups are developed for at risk students to emphasize social and emotional skills. Tier 3 Intensive: Activities and assignments are altered in accordance with each individual student. The implementation of SEL works best when started with very young students and continued through high school. Implementation of sel Evidence based sel: Extensive evidence exists in support of implementing SEL into the typical curriculum of public schools. As a result, the American Occupational Therapy Association (AOTA) mental health promotion fact sheet on SEL (2013), calls for occupational therapists working in schools to empower themselves within the following aspects of SEL: Research SEL Determine if the school district has adopted SEL, and if so implement strategies into therapy. Identify school committees participating in SEL and participate. Collaborate with other disciplines to strategize SEL strategic implementation The CASEL website can be visited at www.casel.org to access SEL research and implementation initiatives by state. The next component of this presentation will present evidence based research regarding SEL and the outcomes of SEL implementation. Evidence based sel “ruler” approach to sel & classroom quality Outcom: Hagelskamp , Brackett, Rivers, & Salovey (2013), conducted a 2 year randomized control trial (RCT) on the effectiveness of the RULER approach to SEL by testing and reporting the results of two hypotheses they derived. The RULER approach to SEL described in the study integrates the components of social and emotional learning into the curriculum of the entire school and involves training teachers on how to achieve this. The RULER approach addresses five key emotional skills including understanding emotions cause and consequences, correct labeling of emotions, and accurate expression and regulation of emotions. “ruler” approach to sel & classroom quality Outcom “Ruler” approach to sel : The RULER approach seeks to develop supportive environments that individuals are comfortable to express themselves including teachers. A balanced social and emotional environment is a requirement for effective teaching and learning and teachers that are able to regulate and respond to their own emotions are better equipped to maintain a balanced classroom over time. The idea behind implementation of this approach is the provision of a positive environment in the classroom provides that necessary needs are met of the individuals and as a result they are more motivated to learn and mentally available to learn once basic needs are met ( Hagelskamp , Brackett, Rivers, & Salvoy 2013). “Ruler” approach to sel SEL “Ruler” approach study: The study was limited to the effect of RULER approach on fifth and sixth grade classrooms over the course of two years. The study sought to answer the following two hypotheses: Classrooms that implemented the RULER approach enjoyed much enhanced emotional, instructional support, and organization compared to other schools. RULER impacts on emotional support by the first year are further exacerbated by the end of the second year. The study involved sixty two schools in New York that were recruited via district wide meetings. All recruited schools that agreed to participate were randomly placed in groups to participate in the RULER method or participate in the comparison condition. Following randomization, the effectiveness or randomization was determined by comparing current demographics at the school ( Hagelskamp , Brackett, Rivers, & Salvoy 2013). SEL “Ruler” approach study Data collection of “ruler” approach to sel study: Teachers submitted videotaped classroom sessions that were assessed by coders trained to utilize the CLASS observational method. CLASS coders attended a two day training and worked alongside a current coder until reliability was achieved. The CLASS observational method assesses emotional, instructional, and classroom organization ( Hagelskamp , Brackett, Rivers, & Salvoy 2013). Data collection of “ruler” approach to sel study Results of “ruler” approach to sel study: The first hypotheses tested that classrooms implementing the RULER approach result in a heightened emotional, instructional, and better classroom organization compared to traditional classrooms was found to be true. The individual category results were found to be as follows: Emotional support was 15% higher in classrooms implementing the RULER approach versus typical classrooms. Instructional support was 31% higher in classrooms implementing the RULER approach versus typical classrooms. Classroom organization was 24% higher in classrooms implementing the RULER approach versus typical classrooms ( Hagelskamp , Brackett, Rivers, & Salvoy 2013). Results of “ruler” approach to sel study Results of the “ruler” aproach to sel study cont’d: The second hypothesis tested investigated the impact of RULER on classroom instructional support and organization are determined by earlier impacts on classroom emotional supports-assessed one year after implementation of the RULER approach. This hypothesis was found to be true on two of three accounts. RULER approach resulted in an increase of classroom emotional support one year after implementation. Higher levels of emotional support evidenced at year one result in more instructional support at the end of the second year. The direct effect of RULER to the resultant increased instructional support evidenced at year two was found to not be statistically significant. Rather, the RULER approach indirectly affected the increased instructional support evidenced at year two ( Hagelskamp , Brackett, Rivers, & Salvoy 2013). Results of the “ruler” aproach to sel study cont’d Conclusion to the implementation to the “ruler” approach to SeL: This study furthers the previous research support that SEL intervention and the RULER approach enhance the quality of classroom experience in schools within the domains of emotional, instructional, and organizational delivery. Furthermore, independent observers blind to the study rated classrooms with the RULER approach on average higher on all three domains then typical classrooms lacking a SEL program. SEL programs are powerful interventions that can be utilized to enhance the quality of classroom instruction and learning. The results of this study should be held with particular esteem due to the study design of a randomized control trial (RCT) coupled with the control for demographic and socioeconomic factors ( Hagelskamp , Brackett, Rivers, & Salvoy 2013). Conclusion to the implementation to the “ruler” approach to SeL SEL in second grade “strong start” curriculum study: Caldarell , Christensen, Kramer, and Kronmiller (2009) conducted a quasi experimental control group study evaluating the effects of Strong Start curriculum implementation in 26 second grade students. The study divides emotional and behavior complications into two areas: Externalizing problems: described as anger problems including outbursts such as verbal and physical aggressions. Internalizing problems: include emotions such as sadness, fear, anxiety and depression that often go ignored because they are not disruptive, but if left untreated can manifest in emotional and behavioral disorders associated with unfavorable outcomes. SEL programs focus on teaching coping and understanding strategies to effectively eliminate not just manage potential emotional problems which lead to higher academic records and better peer relationships. SEL in second grade “strong start” curriculum study SEL in second grade “strong start” curriculum study cont’d: This study focused on “pro social” behaviors and capacity to understand and regulate emotions. “pro social behaviors” include helping, sharing, and caring to foster positive relationships. Inability to regulate emotions leads to internalizing and externalizing problems previously described. Strong Start is one of the few SEL programs designed to expose early elementary school children to the concepts embodied in SEL. The goal of the study was to determine if students that received the Strong Start curriculum demonstrated a decrease in externalizing and internalizing behavior ( Caldarell , Christensen, Kramer, & Kronmiller , 2009). SEL in second grade “strong start” curriculum study cont’d SEL in second grade “strong start” study methodology: This study was comprised of Utah elementary schools made up of 504 students that was selected based upon convenience due to a researcher being employed there. A limitation of the study was the former employment of a researcher at the elementary school utilized for the study. The study utilized two second grade classrooms that were randomly distributed to receive the Strong Start curriculum while the control group continued on with traditional instruction ( Caldarell , Christensen, Kramer, & Kronmiller , 2009). SEL in second grade “strong start” study methodology Sel in second grade “strong start” study methodology cont’d : The dependent variable in the study was the teacher ratings of students internalizing and externalizing problems and pro social behaviors. The teacher ratings were administered one week before the onset of the Strong Start program and one week after implementation of the Strong Start program. To complete ratings teachers utilized the School Social Behavior Skills (SSBS) which is a norm referenced and standardized instrument designed to determine social competence and antisocial tendencies of children age five through eighteen. The independent variable was implementation of Strong Start program. During Strong Start instruction, the control group classroom was participating in regular coursework( Caldarell , Christensen, Kramer, & Kronmiller , 2009). Sel in second grade “strong start” study methodology cont’d Sel in second grade “strong start” study results: The study accounted for differences between control group and treatment group by administering a pretest prior to implementation of the Strong Start curriculum and no statistical differences were found. The results of the study indicated that students receiving the Strong Start curriculum that were categorized as at risk and average both experienced increases in peer relations. Students in the at risk category had a significant decrease in internalizing behaviors. Neither group experienced a decrease in externalizing behaviors. The students completed a questionnaire about their experiences and comprised 74% positive responses including feedback suggesting the program taught them to be kind and learn about feelings. Sel in second grade “strong start” study results Sel in Second grade “strong start” discussion: The study findings support the use of SEL programs and the Strong Start program for use in school initiatives. The study found Strong Start to be a tool for achieving social and emotional competence by increasing peer relationships significantly as well as decreasing internalizing behaviors in students determined to be in the at risk category. Externalizing behaviors did not decrease with implementation of Strong Start as the program was not designed as a comprehensive measure to address behaviors. The results indicated that students in the control group experienced an increase in internalizing problems, decrease in pro social behaviors and provide evidence for SEL programs a mechanism for prevention( Caldarell , Christensen, Kramer, & Kronmiller , 2009). Sel in Second grade “strong start” discussion How can occupational therapists help with sel implementation?: According to the AOTA (2010) fact sheet on occupational therapists in school settings, eligibility of occupational therapy services in the school setting are determined upon the student’s eligibility for special needs instruction as determined through the IEP process. As a result, the OT will likely help implement SEL strategies within their group and individual sessions with special needs students rather then assist with SEL administration on a school wide level. The OT is likely to work with students that have one of the diagnoses discussed at the start of the presentation and can incorporate SEL trainings into other aspects of their intervention or conduct a group focused on SEL with the students receiving occupational therapy services ( Caldarell , Christensen, Kramer, & Kronmiller , 2009). How can occupational therapists help with sel implementation? Group Protocol: Students with emotional disturbances: The group will be an open group that would take place weekly in the OT room of an elementary school. Students participating in the group may have various diagnoses including ASD, ADHD, Bi-Polar Disorder and many others. The group format is open because new students may start the school throughout the school year or current students may become eligible for occupational therapy services in the school district. The group will last about forty five minutes to an hour. Group Protocol: Students with emotional disturbances Group Protocol: Students with emotional disturbances: The group will feature an introduction period which the facilitator will provide visual pictures of each activity in the plan as well as provide a brief purpose of the group to increase understanding and decrease anxiety. The group will also benefit from the use of checklists and checking off steps to better understand and predict sequencing. Following the facilitator introduction, the group will begin with an icebreaker activity. This activity is meant to engage peers with others in the group they are not familiar with and to introduce group members and get them working together to complete goals. The icebreaker activity would occur weekly for the group as a way to integrate possible new members into the group. Group Protocol: Students with emotional disturbances Group protocol: students with emotional disturbances: The group will utilize extensive visual aids, colors, and games to increase the desire to participate. The visual aids will include pictures of emotions that facilitate discussions of emotions and activities with emotions. Some diagnoses result in difficulty recognizing the emotions of others and visual aids help with emotion recognition and decrease anxiety. Activities during the group session include reading books about emotions and discussion about how emotions are experienced by everyone to increase the comfort level of the group. Other activities include working with peers to accomplish activity goals to enhance peer relationships. Other activities will include filling out worksheets and coloring-all activities in the group are focused on enhancing peer relationships while gaining an understanding of emotions. Group members will be eligible for small rewards for positive behaviors such as stickers in the hopes of streamlining internalization of right and wrong for development of behavioral self regulation. Group protocol: students with emotional disturbances conclusion: The SEL framework is typically utilized in a school based model, but it is a valuable tool that occupational therapy practitioners can utilize in the medical model as well to enhance clients’ emotional competencies. The SEL framework is a valuable tool that can be utilized to address emotions and feelings to address the role of emotional stability in successful participation in occupation. conclusion references: Foster, L. (2013, January 1). Occupational Therapy's Role in Mental Health Promotion , Prevention, & Intervention Social and Emotional Learning (SEL). . Retrieved July 30, 2014, from www.aota.org Kronmiller , K. Promoting Social And Emotional Learning In Second Grade Students: A Study Of The Strong Start Curriculum. Early Childhood Education Journal , 51-56. Occupational Therapy in School Settings. (2010, January 1). . Retrieved July 30, 2014 , from www.aota.org Occupational therapy practice domain & process. (2nd ed.). (2008). Bethesda , MD: American Occupational Therapy Association. Rubin, E. (Director) (2010, January 7). Emotional Regulation in Austism Spectrum Disorders . Lecture conducted from www.occupationaltherapy.com . Salovey , P. Improving Classroom Quality with The RULER Approach to Social and Emotional Learning: Proximal and Distal Outcomes . American Journal of Community Psychology , 530-543. What is SEL?. (2013, January 1). Retrieved July 30, 2014, from www.casel.org references

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