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Therapeutic Learning Classroom (TLC)
Hillcrest Family Services
Article from Hillcrest Family Services
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Theraplay® Approaches and Group Work in a
Therapeutic
Classroom Special Education Setting
Thomas M. Ottavi, Ph.D., Cindy Olsen, M.S., Mary Kate Bristow, M.A.
Presentation at the 1st Annual International Theraplay® Conference. Chicago IL June 26, 2003.
The classroom will being going into its 5th year in 2003-2004 school year. We have had wonderful support from Hillcrest Family Services and the Dubuque Community School District. Our referrals must have an emotional psychiatric diagnosis (Depression, PTSD, Bipolar Disorder) in addition to behavior disorders or problems. Students have typically been unsuccessful or unable to handle Behavior Disordered placements or other public school programming. Children receive 9 hours of day treatment therapy work during the week and a therapeutic approach to all instruction and interaction.
The classroom is always developing and has advanced the ideas described below over the years. Dedication, creativity and hard work have been wonderful to observe in our Therapist Cindy Olsen, M.S., teachers Donna Bardon and Tim Widmeier and the highly committed and skilled associates. We have worked to be creative and student focused during our education, therapy and consultation services. The most major help has been the direct staff commitment to relationship building approaches and the individual care and time that students receive.
Theraplay ® group training and consultation have been extremely important and we are most grateful for all the help. Cindy Olsen and the teachers and associates have developed many ways to work together and make the crucial adjustments and refinements in group approaches and interventions on an individual and group level. Below is some general description of the program.
GUIDING BELIEFS:
Therapeutic interaction and relationship building need to be a major education focus for children with significant mental health issues. Therapeutic interaction through play activities and playful relating should be consistent and constant part of learning, skill building, and social activities in the school setting.
Children with developmental psychological disorders benefit from both a structured and predictable environment with limits. It is also important to have more open and spontaneous opportunities to work out relating and emotional issues. Play and Theraplay® activities provide opportunities for both of these approaches.
Drawing from group Theraplay® approaches and general Theraplay® principles can significantly and uniquely help in addressing the students' early unmet needs, severe developmental delays, and engrained negative behavior, and negative cognitive beliefs. Theraplay® approaches along with individualized education programming can have major impact across social, emotional, behavioral, learning, and relating domains.
Verbal praise to children and relationship positives in play activities are emphasized more than any material rewards. This is modeled with a low amount of object or token incentives and a high emphasis on student responsibilities and mutual respect.
Trauma issues are often over looked in the school setting. We believe that the therapy takes place in multiple settings.
INTEGRATED INTERVENTION:
Given that children typically have a wide range of problem and strength areas, we have found in necessary and useful to draw from a variety of approaches. This allows us to be flexible, responsive and in tune with individual student and classroom community needs.
The Therapeutic Classroom at Hillcrest Family Services has significant variation in the specific diagnostic, functional, relational needs of students. Over the last four years, we have drawn from and adapted a wide-range of discipline, therapy, and education styles and strategies.
APPROACHES INCLUDE:
EVALUATION EMPHASIS:
Children with significant mental health disorders need ongoing functional and diagnostic assessment. Mental health disorder symptoms and traits may be minimized, masked, misdiagnosed, magnified, and missed all together. We work to look carefully and critically at symptoms and histories of problems, not jumping to conclusions or assumptions, and in the end thoughtfully setting intervention priorities is crucial. We work to recognize that additional or substitute problems may come up as progress is made with initial problems.
The psychological and relational needs of children may change and cycle rapidly. Therapeutic evaluations need to have a broad base and be adaptable.
The focus areas of children's relational needs across the Theraplay® domains of Structure, Nurture, Engagement, and Challenge can be an excellent guide to their needs in the classroom setting. Play activities present excellent opportunities to assess progress and problem areas.
We use the input from all staff working with the students and have regular meetings to compare clinical assumptions with day-to-day functioning.
COORDINATION COMMITMENT
Initial and ongoing communications are an expectation of the program. Extensive efforts will be made to connect with parents and support their concerns for their children.
Parents will be helped to integrate school programming and discipline approaches with home discipline and parenting approaches.
Input from parents, home support, and parent assistance are crucial to therapeutic and educational progress.
Ongoing input from therapists, psychiatrists, physicians and all providers is vital to advancing therapeutic and educational progress.
Frequent meetings and staffing are needed to make adjustments and coordinate interventions.
STUDENTS DESCRIPTIONS AND BACKGROUND:
Common DSM-IV Diagnoses for Both Classrooms:
ADHD, Bi-polar Disorder, PTSD, Depression, Anxiety Disorders, Oppositional Defiant Disorder, Tourette's Syndrome, Intermittent Explosive, Reactive Attachment Disorder, Asperger's Syndrome, Pervasive Developmental Disorder NOS, Communication Disorders, Obsessive Compulsive Disorder, Learning Disorders, Borderline Intellectual Functioning, Mild Mental Retardation; Trichotillamania.
TLC 1 Students in Grades K - 4th
Percentages are estimates over the last 4 years.
Currently Residential Treatment (10%)
On the verge of Residential Treatment Placement (75%)
History of Sexual Abuse/Trauma (approx. 80%)
History of Physical Abuse or Trauma (30%)
History of Verbal Abuse or Domestic Violence (10-15%)
History of Sexual Perpetrator Issues (5%)
Termination of Parent Rights (20%)
Failed foster-homes; Failing or Failed Adoptions (20%)
Attachment Issues (75%)
Attachment Disorder (20%)
Ongoing suspicions of neglect or maltreatment (20%)
Limited parent involvement (25%)
Highly Aggressive upon referral (75%)
TLC 2 Students in Grades 5th - 9th
** notes a major difference from TLC1
Currently Residential Treatment (60%) **
On the verge of Residential Treatment Placement (35%)**
History of Sexual Abuse/Trauma (approx. 80%)
History of Physical Abuse or Trauma (30%)
History of Verbal Abuse or Domestic Violence (10-15%)
History of foster-placements or RT placements (25%)
History of Sexual Perpetrator Issues (20%) **
Termination of Parent Rights (20%)
Failed foster-homes; Failing or Failed Adoptions (30%)
Attachment Issues (75%)
Attachment Disorder (20%)
Ongoing suspicions of neglect or maltreatment (20%)
Limited parent involvement (55%)**
Highly Aggressive upon referral (80%)
REFERRAL SOURCES:
Failed Behavioral Disorders Placement Local or Regional School Districts
Major incident resulting in removal from Local or Regional School Districts
Failed Behavioral Disordered Placement at Hillcrest On-grounds School.
Residential Treatment Houses at Hillcrest Family Services
STAFF / Hours
Teacher (1:6) Full time
Associates (1:1 and 1:2) Full time
Therapist (1:6) 9 contact hours per week
Psychological Consultant 3-4 consult and contact hours per week
Social Work Consultant 2-4 consult and contact hours per week
Above team meets 2.5 hours per week of Staffing.
Assistant Principal: School Administration, Major incident
interventions, contact with Parents
Practicum Students: Associate and Therapist roles
School Nurse: Medication administration and monitoring
Psychiatry: Per clients case or Staff RTC psychiatrist
In-home services: Per DHS funding
DAILY SCHEDULE:
ARRIVAL - via bus, parents or van (many have 45-90 minute rides)
GROUP TIME 2-3 Hours in the Mornings Tuesday, Wednesday, Thursday.
RECREATION TIME - Break
ACADEMICS .5 - 1.5 Morning and 1.5-2.5 hours in the Afternoon
LUNCH Family style meal, working on social behaviors and relationship building, students prepare some parts of meals or entire meals for holidays. Also time taken for story time (students or staff reading), food share at the end, sometime do "hurts" from Theraplay® approaches.
SPECIALIST INSTRUCTION - music, PE, Art, Multicultural
OUTINGS TO THE PUBLIC LIBRARY- these usually go quite well and students have
good interest.
FIELD TRIPS
OVERVIEW OF GROUP TIME AND INSTRUCTION TIME
TYPICAL GOALS FOR BOTH GROUP TIME AND INSTRUCTION
Build a sense of safety.
Build healthy relationships and trust.
Adults seek attunement to the child's needs.
Helping students be receptive to relating and learning.
Build Relationship and Social Skills.
Establish a sense of regulation through structure and nurturing
Improve Genuine Emotional Connection and Expression.
Contain and re-work historical patterns of failure and rejection.
Contain and re-work replaying past or home dysfunction.
Expression of Negative Beliefs and Negative Self into activities.
Re-shape aggressive or rage-filled energies.
Increase sense of self as special and competent.
Have student see no need for severe power-struggling or disconnecting.
Build ability to be tolerant of differences and cooperate.
GROUP TIME FOCUS:
ACADEMIC INSTRUCTION FOCUS:
Instruction is individualized for each students level.
Teachers and associates on generally equal basis of leadership.
Structure and teaching classroom procedures is a must.
Significant 1:1 help from associates is often needed and at times hard to get.
Attachment Disordered or Level I Trauma/Attachment issues students need some highly structured approaches to establish acceptance of authority. (see sheets for Student Responsibility Plan)
Attempts are made to have independent work.
Meeting resistance or power struggles with supportive and relationship building approaches.
Playfulness, Acceptance, Curiosity, Empathy (PACE) approaches of Dan Hughes, Ph.D.
Many attempts made to have students remain in the classroom.
Removals are made to a Student Intervention room for issues of safety.
"Processing:" of aggression or extreme misbehavior is done in a variety of ways. Accountability and apology are included.
Calming and sensory assistance is often given.
ATTUNMEMENT WITH STUDENTS:
We draw from many parts of the approaches and philosophy of Bruce Perry, M.D., Ph.D.
and Dan Hughes, Ph.D. Below are quotes from these two major contributors to psychological theory and approaches to children who have experienced trauma and/or disturbances in attachment.
"This is why the core of good teaching is attunement. Attunement is being
aware of, and responsive to, another. How does this child feel? Is she
interested, engaged, capable of listening to what I want to say? What is
the best way to communicate this idea, fact, concept, or principle to her
in this moment? What will engage, encourage and excite her about this
subject? What will be heard, perceived, felt and learned - in short, what
the teacher will communicate - depends upon how receptive the child is.
And how well a teacher reads a child's receptivity depends upon an
understanding of how humans communicate without words."
Bruce Perry, M.D., Ph.D.
From Attunement: Reading the Rhythms of the Child
Dan Hughes, Ph.D. Dyadic Developmental Psychotherapy
"I have chosen to call this model of treatment Dyadic Developmental Psychotherapy because it is based on the premise that the development of children and youth is dependent upon and highly influenced by the nature of the parent-child relationship. Such a relationship, especially with regard to the child's attachment security and emotional development, requires ongoing, dyadic (reciprocal) experiences between parent and child. Such experiences are affectively and cognitively matched to the developmental, age-appropriate needs of the child. The parent is attuned to the child's subjective experience, makes sense of those experiences, and communicates them back to the child. This is done nonverbally as well as verbally. It is done with playfulness, acceptance, curiosity, and empathy." From Dan Hughes' Website
For more information about the Therapeutic Learning Classroom, program development or consultation possibilities please contact Tom Ottavi, Ph.D. email: Tom.
More information from Hillcrest Family Services
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