Intro the Clinical and School Psych Final

"Scared Straight" Programs for Preventing Juvenile Delinquency

-"Scared Straight" Programs for Preventing Juvenile Delinquency: more harmful than helpful. "Results of this review indicate that not only does it fail to deter crime, but it actually leads to more offending behavior. Government officials permitting this program need to adopt rigorous evaluation to ensure that they are not causing more harm to the very citizens they pledge to protect."

Modification vs. Accommodation

-Accommodation: changes how a student learns the material -Modification: changes what a student is taught or expected to learn

Alcoholics Anonymous for the Treatment of Alcoholism

Alcoholics Anonymous for the Treatment of Alcoholism: effectiveness not demonstrated. "The available experimental studies did not demonstrate the effectiveness of AA . . . in reducing alcohol use and achieving abstinence compared with other treatments, but there were some limitations with these studies."

Dodo Bird Verdict

Many outcome studies have pitted one therapy against another. Again and again, the surprising result, one disappointing to adherents, has been that the results are usually a virtual tie

Crisis Preparedness

-Crisis Preparedness: (1) Have school emergency/crisis plan (for school personnel, students, and families) (2) Conduct drills in the school to ensure students are familiar with process (3) Train all staff in crisis management (4) Improve security and safety in schools (5) Develop crisis communication system (for school personnel, as well as students, families) (6) Utilize strong mental health prevention and intervention strategies to build up coping skills and protective factors prior to a crisis occurring -Adults and Crisis Response: (1) Let children know that it is okay to feel upset (2) Observe children's emotional state (3) Tell children the truth and answer the questions they may have honestly (4) Stick to the facts (5) Keep your explanations developmentally appropriate (6) For all children, encourage them to verbalize their thoughts and feelings (7) You may need extra help for those with special needs -School Psychologists and Crisis Response: (1) Flight Team (coordinated among professionals in 2 counties; receive phone call when there has been an event leading to the need for additional support in a school; respond to call and go to school in crisis) (2) Help guide other professionals (3) Consult on how to speak to media (4) Consult on how to deliver news to student body (morning announcements, assembly, homeroom teachers) (5) Set up room in building for students (6) Provide space and materials for students to work on memorial activity (cards, poster, drawings, banner) (7) Have office space available for individual students who are especially impacted (create list of students to check-in with: the significant other, the best friends, the first responder) (8) If there was an accident scene, be aware of location and of students congregating there (9) Think about what to do with student's desk, locker, and belongings Parents and Crisis Recovery: (1) Focus on your child over the week following the tragedy and offer extra reassurance about their safety (2) Spend extra time reading or playing quiet games before bed (3) Make time to talk with your children each day (4) Let children express their emotions (5) Give plenty of hugs! Many children will want actual physical contact (6) Safeguard your child's physical health (7) Maintain a "normal" routine... but don't be inflexible (8) Consider thinking and expressing hopeful thoughts (9) Limit or stop TV viewing of these events, particularly if they impact your child or you; be aware if the TV or radio is on in the background (10) Monitor Internet and social media, Twitter, and text messages -Teachers and Crisis Recovery: (1) Maintain structure and stability...Routine is good! (2) Provide information directly to students in a calm factual way and dispel rumors (3) Seek support from school psychologists, school counselors, school social workers, and school nurses (4) Be aware of students who may have recently experienced a personal tragedy or have a connection to the victim(s) in some way (5) Be mindful of children who exhibit extreme anxiety, fear, or anger (6) Be aware of those who appear too distant or quiet, which is "not their typical self" Know what community resources are available (7) Conduct age appropriate classroom discussions and activities (8) Provide an outlet for students' desire to help (e.g., letters of support to the impacted community, fundraising if appropriate, etc.

Cultural Competence

-APA Ethical Guidelines require us to be knowledgeable in different identities of children (age, race, etc.) -Awareness: assumptions, values, biases -Understanding: our worldview, worldview of others, including those that are culturally and linguistically diverse (CLD) -Knowledge: cultural differences, assessment, and intervention strategies -Skills: providing counseling, assessment, and intervention services

Achievement Gap

-Achievement Gap: the disparity in academic performance between groups of students -Grades, standardized-test scores, course selection, dropout rates, & college-completion rates -Achievement gap between SES group, race, disability vs. no disability, English language proficiency vs. CLD -Those who are members of racial minority groups are overwhelmingly concentrated in the lowest-achieving schools -By age 3, children in poverty have smaller vocabularies and lower language skills than children from middle-income families -Children who both live in poverty and read below grade level by 3rd grade are three times as likely to not graduate from high school as students who have never been poor -Outside of School Factors: (1) "Opportunity gaps" in the resources available to poor versus wealthy children (2) Fewer educational resources at home (3) Poorer health (4) Poorer nutrition

Roles of Clinical Psychologists (and Comparing to Other Professions)

-Activities of clinical psychologists: psychotherapy (the treatment of mental disorder by psychological rather than medical means), diagnosis/assessment, teaching, clinical supervision, research/writing, consultation, administration -Counseling psychology: overlaps with clinical psychology. Traditionally worked with normal or moderately maladjusted individuals. Historically have done a lot of vocational and educational counseling. -Psychiatry: Has M.D. degree plus 4-year residency. Can prescribe medication. Declining in popularity among medical residents. -Social Work: Has MSW degree. Historically worked with social forces and outside influences that impacted individuals. Recently moved more into delivery of psychotherapy. A fast-growing profession, currently 60% of licensed mental health providers. -Professional Counselor: Generally a 2-year master's. Focus on counseling. Little emphasis on testing or research. -Marriage and Family Therapist: Generally a 2-year master's. Trained in psychotherapy and family systems and treat problems within the context of relationships. -Who can prescribe psychotropic medication? Psychiatrists -Who can do psychotherapy? Psychologists, Psychiatrists, Social Workers -Who can do testing? Psychologists

Adverse Event vs. Traumatic Event

-Adverse Event: event where something tragic occurs but the student does not retain trauma from that experience -Traumatic Event: event where something tragic occurs and the student does retain trauma, or some type of harm, from that experience and it affects the student

Thinking Traps

-Catastrophizing: overestimating the negative consequences of an event (e.g. if I get contaminated, I will get sick and die) -Overgeneralization: drawing conclusions on a single incident (e.g. I got sick that one time I ate that food, so all foods like it must be toxic) - -Arbitrary Inference: drawing a conclusion that is not supported by evidence. -Dichotomous Thinking: All or Nothing; "If I'm not a total success, I'm a failure" -Disqualifying: Disregard positive experiences or qualities as without value ("I got lucky.") -Mind Reading: Belief that you know what others are thinking to the exclusion of other likely possibilities

Affect Regulation & Window of Tolerance

-Affect regulation: the ability of an individual to modulate their emotional state in order to adaptively meet the demands of their environment (the ability to maintain or increase positive feelings and states of well-being and to minimize or regulate stress feelings and defensive states) -It is the ability to keep affective arousal within tolerable limits, neither escalating to states of hyperarousal or becoming numb or frozen in states of hypoarousal (in between the window of tolerance which is the optimal arousal zone) -Bringing the frontal lobes back online can be a key strategy in moving someone out of states of dysfunctionally high arousal. Therapies of a variety of orientations are increasingly focusing on this ability to shift state, to bring the arousal down and the person more in possession of the abilities of their whole brain -Emerging as a powerful common ground among many approaches to psychotherapy -Integrates knowledge of the brain and how it can become dysregulated, how infant-caregiver attachment affects our capacities to self-soothe, and how neurobiological systems can aid in affect regulation and self-regulation -Provides a less pathologizing and more compassionate way of conceptualizing a lot of human troubles. Problems with affect regulation are common to most mental health disorders -Provides a way of understanding both what happens in the treatment room and what we would increasingly want clients to be able to do for themselves -In the therapy room: (1) The therapist him or herself is an affect regulator (2) The presence of an attuned other can be very regulating (3) We accomplish this by many of the basic skills we have discussed already: empathy, the tone of our voice, our posture, the quietness of the space we provide -Outside the therapy room: (1) Mindfulness Meditation (many therapists highly recommend this, CAPS has a workshop available for students) (2) Breathing Techniques (for example four-square breathing) (3) Exercise (4) Guided Imagery (for example half-smile technique) (5) Hypnosis and Self-Hypnosis (6)Computer Training Programs like Heartmath

Testing vs. Assessment

-Assessment: a more broad term, seen as a procedure -Testing: a specific part of assessment, a "product" that measures a particular behavior or set of objectives

Different Roles of School Psychologist

-Assessment: primary role of school psychologist. Federal & state laws require assessments before students are placed in special education. An ongoing process of data collection according to a problem-solving model, is broader than psychological testing. Usually is a multi-method process. -Consultation: collaborate with teachers to help them identify classroom-based problems and implement data-based interventions. Support implementation of effective instruction and behavior management at the classroom level. Assist parents to develop skills to help their children succeed at home and in school. Collaborate with admin and other school personnel to identify systemic concerns and promote systems-level change. -Prevention: Implement programs to build positive connections between students and adults. Support early identification of potential academic skill deficits and/or learning difficulties. Create safe, supportive learning environments. Promote wellness and resilience by reinforcing communication and social skills, problem solving, anger management, self-regulation, self-determination, and optimism. Enhance understanding and acceptance of diverse cultures and backgrounds. Foster tolerance and appreciation of diversity. -Intervention: work directly with children, teachers, administrators, and families. Develop individualized, classroom, and school-wide interventions for learning and adjustment. Design and implement crisis response plans. Provide counseling, social skills training, and academic and behavioral interventions. -Staff, Parent, and Student Education: School psychologists provide teachers and parents training in teaching and learning strategies and interventions, discipline and behavior management techniques, strategies to address substance abuse, risky behaviors, or mental illnesses that affect students, and crisis prevention and response. -Research and Program Development: recommend and implement evidence-based programs and strategies. Conduct school-based research to inform practice. Evaluate effectiveness of programs and interventions independently and as part of a school-based evaluation team. -Mental Health Care: deliver school-based mental health services such as group, individual, and crisis counseling. Coordinate with community resources and health care providers to provide students with complete, seamless services. Partner with parents and teachers to create healthy school environments. Provide counseling, instruction, and mentoring for those struggling with social, emotional, and behavioral problems. -Advocacy: school psychologists encourage and sponsor Appropriate educational placements, education reform, etc. School psychologists and teachers can work together to advocate for the needs of students at the school, local, state, and national level. -Systems Change: promote change at different levels in a system. Focus on more than one area of an individual's life. Constantly look to improve the environments where they work and their clients operate.

Types of Cognitions

-Automatic Thoughts: quick thoughts that often pass through awareness when triggered by situation ("I don't understand this assignment. I suck at math") -Intermediate Beliefs: attitudes, rules, sssumptions about the world ("If I don't get it the first time, I never will") -Core Beliefs: fundamental truths about the self, the world, and the future; lenses through which information is filtered ("I'm a failure")

Top-down vs. Bottom-up Processing

-Bottom-up processing: processing sensory information as it is coming in (built up from the smallest pieces of sensory information) (1) Survival responses: under threat, the thalamus receives the sensory input, relays threat information to the amygdala (the smoke alarm of the brain) that initiates sympathetic nervous system responses. The frontal lobes shut down to ensure instinctive responding -Top-down processing: perception that is driven by cognition. Your brain applies what it knows and what it expects to perceive and fills in the blanks (1) Mediated by the Frontal Lobes (2) Mindfulness (3) Cognitive Processing (4) Meaning Making (5) Modulates our Emotions

Current Treatments for Trauma

-CBT Treatments for PTSD: (1) Prolonged Exposure Therapy: imaginal exposure to traumatic memory with emphasis on "hot spots", in vivo exposure to avoided situations, some cognitive restructuring, breathing retraining, psychoeducation, 10-12 sessions (cBt) (2) Cognitive Processing Therapy: written exposure to traumatic memory, cognitive restructuring with emphasis on "stuck points", Psycho-education, 10-12 sessions (Cbt) (dropout rates with PE/CPT can be high: 25%) (3) Written Exposure Therapy: repetitive written exposure to traumatic memory, psycho-education, 5 sessions; designed to be easily disseminated and well tolerated, promising early results (4)Virtual Reality Exposure Therapy: augments imaginal exposure with VR technology (visual stimuli, audio, vibrations, smells); virtual worlds created for Vietnam, Iraq/Afghanistan, 9/11 -Medication Treatments for PTSD: (1) SSRI's most frequently prescribed. May help with some symptoms, but less helpful for resolution. (2) Experimental and Under Study: MDMA (Ecstasy) and LSD (and other Hallucinogens) (3) Drugs that affect memory -Experiential Treatments: (1) Eye Movement Desensitization and Reprocessing (EMDR): is an eight-phase treatment. Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, the client is asked to hold different aspects of that event or thought in mind and to use his eyes to track the therapist's hand as it moves back and forth across the client's field of vision. The eyes are moving in the way they do in (REM) sleep. Internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, "I survived it and I am strong." Unlike talk therapy, the insights clients gain in EMDR result not so much from clinician interpretation, but from the client's own accelerated intellectual and emotional processes. (2) Sensorimotor Psychotherapy (Pat Ogden) and Somatic Experiencing (Peter Levine - Body focused approaches (3) Accelerated Experiential Dynamic Psychotherapy (Diana Fosha) - Emotion and Relationship focused approaches

Child Study Team

-Child study team (CST): New Jersey specific. Multi-disciplinary team mandated in every public school. Members - School Psychologist, Social Worker, Learning Disabilities Teacher Consultant (LDTC). Primarily responsible for Special Education eligibility determination and case management

Databases to Aid in Evidence-Based Practice

-Cochrane Collaboration: promotes evidence-based healthcare for the purpose of enabling patients and doctors to make informed decisions about treatment and care. -National Institute of Clinical Excellence: set up in 1999 in England to standardize services offered within the National Health Service. The are guidelines that take into account both efficacy and effectiveness. -The National Registry of Evidence-based Programs and Practices (NREPP): a searchable online registry of mental health and substance abuse interventions that have been reviewed and rated by independent reviewers. -The Substance Abuse and Mental Health Services Administration (SAMHSA): created this registry to improve access to information on tested interventions and to reduce the lag time between the creation of scientific knowledge and its practical application in the field -Many professional organizations (e.g., APA) have developed systems to classify interventions by the evidence base. -Agency for Healthcare Research and Quality (AHRQ): health services research arm of the US Department of Health and Human Services

Cognitive Behavior Therapy (CBT)

-Cognitive Behavior Theory: a short-term, present-focused treatment that focuses on solutions and doesn't aim to change the past. Utilizes learning principles (classical and operant conditioning) -Goal of CBT: Reduce symptoms through increased cognitive flexibility and behavior modification -First Wave (1940's/1950's): behavior therapy: learning principles (operant/classical conditioning) drive all behavior -Second Wave (1970's): integrated cognitive-behavioral therapy: unobservable cognitive and emotional processes also affect behavior; the world is filtered through our interpretation -Third Wave (1990's): mindfulness and value-based (still cognitive-behavior therapy but new names like DBT and ACT) -With CBT to treat a disorder we must: (1) Understand learning principles: "All behavior is lawful" (2) Recognize the role of cognitions in psychopathology (3) Take a Top-down approach to treating psychopathology: present versus past focused -CBT Triangle: (1) Thought (what we think affects how we act and feel) (2) Emotion (what we feel affects how we think and do) (3) Behavior (what we do affects how we think and feel) -To understand behavior in context, look for: (1) Immediate triggers (stimulus antecedents) (2) Factors that make client more vulnerable to triggers (setting conditions) (3) Short and long term consequences (consequent variables; reinforcement) -In CBT the target of treatment becomes not what the client "has" but what he/she "does"

Explanations as to why Different Types of Therapies Lead to Similar Results

-Common Factors: this stresses that all effective therapies have certain factors in common and that outcome may have more to do with the presence or absence of these than with the specific model or protocol followed (may account for more variance in outcome than models/techniques)

Consultation

-Consultation: process in which consultant works with consultee (parent, teacher, administrator) with the goal of bringing about a positive change in the client (child). It is an indirect service delivery model and consultation can be done on every level of the Tier Model. -Consultation model: consultant, consultee, client -The client is not always the child -Benefits of consultation: (1) School psychologists can impact many students by consulting with teacher or administrator (greater impact (2) Teach skills to reduce your workload -Challenged of consultation: (1) Relationships (2) Generating buy-in (talk the talk when you don't walk the walk) (3) Delivery of information

School-Based Counseling

-Counseling Models: (1) Individual Counseling (anxiety, depression, tics, emotion regulation, coping strategies) (2) Group Counseling (social skills, topic specific, classroom or program wide) (3) Problem solving (discipline referrals) (4) School based programs (The Haven, The Teen Center, BRIDGE Center) (5) Life Skills Programs (career development program) -Advantages of counseling in schools: (1) Greater access to individuals than outpatient setting (2) Can receive immediate feedback from teachers (3) Can coordinate a variety of services in the school (4) Long term follow up is possible (5) You are readily accessible in the event of a crisis (6) Barriers exist that often prevent people from getting counseling. These barriers don't exist in schools (examples of barriers: cost/lack of insurance and transportation) -Challenges of counseling in schools: (1) Confidentiality (teachers, administrators, parents) (2) Time (3) Space (4) Resources (5) Continuity (6) Creating groups (7) Does the student really need counseling? (educational impact and cost of missing class)

Cultural Competence

-Cultural competence: the ability to understand, communicate with and effectively interact with people across cultures -Changing demographics: As of now, 39% of U.S. residents is non-white minority status. Persons of color will be majority by 2045, this includes African-Americans, Latinos, Asian-Americans, Arab-Americans, Southeast Asian-Americans, and immigrants from various countries in the developing world -Ethics and treatment effectiveness: there are disparities in mental health care for minorities. Cultural Competence is essential to treatment process & outcome. Culturally insensitive therapy is a barrier to treatment and is damaging -Four main multicultural practice competencies: (1) Cultural Self-Awareness: provider's sensitivity to her or his personal values and biases and how these may influence perceptions of the client, client's problem, and the therapeutic relationship (What are the lenses through which I see the world?) (2) Cultural Knowledge: the therapist's knowledge of the client's culture, worldview, and expectations for the therapeutic relationship (What are the lenses through which my client sees the world?What is their experience? What are they going through?) (3) Culture-Specific Expertise: the therapist's ability to intervene in a manner that is culturally sensitive and relevant (This may involve educating oneself about the specific cultures of the clients with whom one works.It may also involve understanding the stressors of the environment on them) (4) Culture-Sensitive Advocacy: the process through which clinicians become aware of social or cultural barriers that clients face and work with clients to constructively address these barriers (Discrimination is disempowering. At a minimum, therapists need to display empathy and not attribute experiences to individual dynamics when it is more likely systemic. This may be macro abuses like racial profiling or more subtle ones like micro-aggression. Therapists need to NOT be neutral in the face of these injuries) -Therapeutic alliance: there is increasing concern over the effects of cultural misunderstandings and drop-out rates in relation to ethnic minorities (numerous studies have found high drop-out rates for ethnic minorities). Analogue research find that weak therapeutic alliances are predictive of drop-out. It has been hypothesized that cultural misunderstandings and microaggressions between patient and therapist lead to patients feeling misunderstood and uncertain about the positive effects of psychotherapy, resulting in premature termination -Research suggests that when client's perceive their therapists as ignorant, dismissive, or hostile toward their culture, this corrodes the therapeutic alliance, leading to poorer treatment outcomes -When therapists are able to: (1)Notice and address conflicts... (2)Remain non-defensive... (3)Acknowledge and take responsibility for their mistake... (4)Validate and explore the patient's cognitive and emotional responses... ...then the therapeutic alliance is repaired and treatment can continue.

Prevention of Discipline

-Culturally Responsive Pedagogy (CRP): Make instruction culturally relevant. Communication of high expectations. Learning within the context of culture -School-wide positive behavior supports -School connectedness - foster inclusive environments -Presence of teacher/adult that expresses belief in abilities, capacity for hard work -Evidence-based disciplinary practices (restorative practices, behavioral theory) -Improve early healthcare and exposure to educational material (Sesame Street, prenatal care and parenting support, head Start programs—improve literacy) -Increase exposure to educational materials (studies have found that children in poverty whose parents provide engaging learning environments at home do not start school with the same academic readiness gaps seen among poor children) -Universal preschool programs becoming more common

PTSD as a Diagnostic Category

-DSM-III in 1980 was the first time PTSD was specifically included as an officially recognized diagnosis. -This was despite the long-obvious effects on humans of traumatic events. -This was a turning point in our advancement of knowledge in this area, providing a point of entry to more rigorous study of diagnosis and treatment and of the impact of trauma in general. -As useful as the inclusion of PTSD in DSM has been, its focus on a set of symptoms can sometimes keep us from recognizing what a complex, multidimensional entity it is.

DSM

-DSM: Diagnostic and Statistical Manual of Mental Disorders. -DSM represents... the remedicalization of psychiatry -To be a diagnosable mental disorder, DSM requires evidence of...distress or disability -Taxonomy: "The process or system of describing the way in which different living things are related by putting them in groups." "The study of the general principles of scientific classification." -Categorical Model: A disorder is either present or absent. You are in the category or not based on whether you "meet criteria." -Dimensional Model: There is a continuum between normal and abnormal behavior, and a person can be anywhere along it (DSM-5 has some disorders on a spectrum) -DSM-5 introduces more dimensional elements into its primarily categorical system by use of...severity indexes -DSM-III: Watershed (not based on theory but based on describing symptoms, make agreements possible, universal language, common system); to increase reliability of diagnosis; to create diagnostic system that was atheoretical (not based on theories); to match up better to insurance companies and their demand to be paying only for diagnosed illnesses; make diagnosis an objective, descriptive, rule governed process; match treatment to diagnosis

Three Adolescent Risk Pathways

-Deviance proneness: linked to impulsivity -Trauma/stress/negative-affect: linked to external factors like trauma or a dysfunctional family, leading to negative affect and potentially self-medicating the pain -Pharmacological effects: linked primarily to genetics, i.e., that different individuals have more or less sensitivity to the effects of alcohol, with the somewhat counter-intuitive finding that less sensitivity to effects may put one at higher risk

Dialectical Behavior Therapy for Borderline Personality Disorder

-Dialectical Behavior Therapy for Borderline Personality Disorder: highly effective. "The results indicate Dialectical Behavior Therapy is helpful for people with borderline personality disorder. Effects included a decrease in inappropriate anger, a reduction in self-harm and an improvement in general functioning."

Direct vs. Indirect Service Delivery

-Direct service delivery is when information is delivered directly to the client. -Indirect service delivery is when information is delivered to the client's parent/guardian or teacher and not the client.

Discipline Gap

-Discipline Gap: "instances when students who belong to specific demographic groups (e.g., race/ethnicity, sex, disability status) are subjected to particular disciplinary actions...at a greater rate than students who belong to other demographic groups." Focused on in-school and out-of-school suspensions -African American adolescents have been found to be more commonly perceived as defiant and uncooperative by their teachers, lacking contextual considerations -White children are often disciplined for objective offenses (e.g. vandalism), and Black children are often disciplined for subjective offenses (e.g.disrespect) -The discipline gap between Black and White students starts in pre-kindergarten & gets larger throughout the school years -Suspension: Punitive discipline can have negative consequences. After accounting for demographics, attendance, and course performance, each additional suspension further decreases a student's odds of graduating high school by 20%. Segregation of students who break rules with students who also break rules can increase negative behavior

Discrepancy Model

-Discrepancy model: How does a child's IQ scorecompare to their educational achievement scores? (1)A child with a high IQ and low academic achievement can qualify for special education services (2)A child with a low IQ and even lower academic achievement can qualify for special education (3) A child with a low IQ and low academic achievement, would NOT qualify for special education because there is no discrepancy between IQ and achievement

Bronfenbrenner's Ecological Model

-Ecological systems model: This model provides an organizing framework from which to view individuals. Allows us to consider variables inside and outside of the individual (can help prevent the fundamental attribution error and self serving bias). Provides ideas for multiple layers of intervention. Encourages comprehensive assessment (microsystem, mesosystem, exosystem, macrosystem, chronosystem). -Microsystem: people that child has direct contact with (family, friends, classmates, teachers, neighbors, etc.). -Mesosystem: relationships, interconnections, interactions between microsystems. -Exosystem: environmental elements that influence child's development, even though child is not directly involved with them (parents' work environment, mass media, school boards, etc). -Macrosystem: attitudes and ideologies of the culture (laws, history, SES, ethnicity, geographic location, etc.). -Chronosystem: time dimension such as major life transitions or events in a child's life and historical events (parent divorce, relocation, natural disasters, etc.).

Electroconvulsive Therapy for Schizophrenia

-Electroconvulsive Therapy for Schizophrenia: somewhat effective. "The evidence suggests that courses of ECT can, in the short term, result in an increase in global improvement for some people with schizophrenia."

Three Stage Model of Trauma Treatment

-Establishing safety (stabilization work): (1) May be brief if trauma is single-incident or may be longer if a lifetime of trauma (2) Premise is traumatized people are often quite deficient in managing their psychological resources and are often in states of overwhelm. (3) Many of the techniques we discussed in our affect regulation unit can apply here. There needs to be enough basic safety in the person's life, and they need to have some resources for affect regulation, as well as a good therapeutic alliance to proceed to the work of processing the trauma. (4) This stage can be fairly short in a person with a good support system who is in many ways functioning fairly well. Or it can be fairly long if there is a long history of multiple traumas and the person is precarious in their everyday life and has little current support. -Treatment of the Trauma Itself (1) A variety of current treatment techniques -Restoring the connection between the survivor and his/her community

Underlying Principles of our Ethical Code

-Ethical principles: (1) Respecting the Dignity and Rights of all Persons (2) Competence and Responsibility (3) Honesty and Integrity in Professional Relationships (4) Responsibility to Schools, Families, Communities, the Profession, and Society -NASP's Principles of Professional Ethics are based on 2 assumptions: (1) School psychologists will act as advocates for their students/clients (2) At the very least, school psychologists will "do no harm" (school psychologists demonstrate respect for the autonomy of persons and their right to self-determination, respect for privacy, and a commitment to just and fair treatment of all persons)

New Jersey Bullying Law

-Every public school, including higher education institutions, report all cases of bullying or teasing to the state. -Verbal reports must be given to principals on the day of an observed incident and a written report must be provided within two days. -Families must be notified, as well as the superintendent of schools, and an investigation must take place within ten days of the incident. -Schools must also have a plan that outlines how they will address bullying and all teachers and administrators must be trained to identify and respond to bullying. -The first week in October has been designated as the "Week of Respect." During this week, schools are asked to teach about intimidation and harassment in order to make students more aware of the causes and effects of bullying. -Personnel Required - These individuals must work to provide a safe and welcoming environment for all students (1) District Anti-bullying Coordinator (ABC) (2) School Anti-bullying Specialist (ABS) (3) School Safety Team (SST) in each school building

Evidence-Based Practice (EBP) vs. Empirically-Supported Treatments (EST)

-Evidence-Based Practice (EBP): an approach to treatment that integrates "best research evidence with clinical expertise" within the context of client characteristics, culture and preferences (APA, 2005). It is an ongoing, decision making process (the evidence-based movement originated in the attempt to differentiate between scientific medicine and irrational treatments). -Empirically-Supported Treatments (EST): interventions found to be effective by research. Often classified by levels of support -EBP will use ESTs whenever they are appropriate

The Developmental Pathway of Addiction

-For a variety of substances, including alcohol, we see peak rates around the late teens and early 20s, with subsequent declines beginning in the mid-20s. It's especially important to note, in the context of this presentation, that these declines are not limited to young adulthood, but rather continue throughout later stages of the adult lifespan. -Heterogeneity in developmental trajectories: there are maturing out group, persistent abstainers / light drinkers and persistent risky drinkers. Persistent risky drinkers drink more often when they grow in age compared to maturing out groups and abstainers / light drinkers which drink less when they grow in age

Demographics of School Psychologists

-Gender demographic of school psychologists: 83% Female, 16% Male, .10% Agender -Median age of school psychologists: 42.4 -Race demographic of school psychologists: 87% White, 5% Black/Af.Am., 2.8% Asian, 6% Hispanic -Language demographic of school psychologists: 86% Speak only English, 7% Spanish, 1.3% ASL, 5.3% Other (27 different languages), 7.9% provide multilingual services -Mean age went down, field still White and female (but more diverse, more female than in the past). Still there is a discrepancy between the demographics of this field and of the students school psychologists work with (for example: male and colored students). -School psychologists mean salaries: 60k-75k (depending on area) -School psychologists contracts: 50% 164-191 days (9 months), 25% 192-206 days (10/11 months), 25% 207+ days (12 months)

Ethics Code

-General principles: the guiding aspirational ideals of the profession (respects our overall aspirations): Beneficence, Fidelity, Integrity, Justice and Respect for People's Dignity. -Ethical standards: give guidance on specific do's and don'ts, specifying things like confidentiality, record keeping, maintaining competence. -Specific ethical standards: (1) Confidentiality: keeping information during therapy private. There are certain exceptions, mandated by law, where society has decided that other goods outweigh that of confidentiality, e.g. child abuse, suicidal or homicidal risk. (2) Dual relationships: any situation where there are multiples roles between therapist and client, i.e., that in addition to the therapist/client relationship, another relationship also exists. Burden is on the therapist to minimize harm and to be sure the dual relationship does not interfere with objectivity and competent functioning (sometimes unavoidable). (3) Informed consent: In all their services (therapy, research, assessment), psychologists obtain the informed consent of those whom they serve in language that is understandable.In situations where this is not legally a requirement (children, forensic settings), psychologists attempt at least to gain assent (4) Boundaries of competence: Psychologists have an obligation to develop and maintain competence in their field. They should practice within the boundaries of that competence. They should be aware of personal issuesthat may interfere with their ability to work and address them. (5) Conflicts of interests: a situation in which a person or organization is involved in multiple interests, financial or otherwise, and serving one interest could involve working against another.

Psychodynamic Theory

-Goal of psychodynamic psychotherapy: To loosen the bonds of past experience to create new life possibilities -Unconscious: Much thinking and feeling goes on outside conscious awareness. Modern cognitive science has much support for this, often calling it implicit or procedural memory. Psychodynamic theory focuses on the ways in which we do not know our own mind, and may not WANT to know our own mind, how we look away from what frightens us or threatens us -The Mind in Conflict: We are of two minds about many things. Psychodynamic theory places a great deal of emphasis on ambivalence, that we can have positive and negative feelings, approach and avoidance tendencies, towards the same thing. The more torn we are in different directions, the more of our energy we have to spend dealing with the conflict. There are different systems in the brain, evolving at different times for different purposes that may find themselves in conflict -The Past is Alive in the Present: Our past is important, not just as a history, but because it becomes a template through which we view current reality. The goal of psychoanalytic psychotherapy is to loosen the bonds of past experience to create new life possibilities -Transference: In one sense, transference is no more than this seeing the past in the present. When we first meet someone, we try to navigate the new situation be seeing it through the lens of our past experiences. Old scripts, expectations, desires, etc. are activated and become alive in the therapy relationship -Defenses: Psychological ways of protecting ourselves from anxiety. Mechanisms that deny, distort or minimize reality (denial, projection, intellectualization, sublimation) -Central features of psychodynamic theory: (1) Focus on the unconscious (2) Emphasizes the subjective, individual experience of the client (affective, or emotional, life) (3) Focus on life history to view current experience (4) Focus on therapist/client relationship (transference and countertransference) (5) Focus on defense mechanisms in relation to reducing anxiety

Types of Psychotherapy

-Humanistic psychotherapy: "The romantic vision is fundamental to humanistic psychotherapy...it emphasizes the cultivation of emotional sensitivity and expressiveness and seeks to develop in clients spontaneity, creativity, authenticity, agency and experiential intensity." Values living authentically in the moment. Adjustment to society not a prime goal. People are fundamentally good, unfallen. -Cognitive-Behavioral Therapy (CBT): Seen as more allied with Comic vision."In CBT, conflict may be ascribed to external situations or internal forces that can be mastered through application of therapeutic technology. CBT therapists are more interested in the direct alleviation of suffering than in the exploration of internal struggles." -Psychoanalytic psychotherapy: More allied to the tragic and the ironic visions. "The outcome of psychoanalytic treatment is not ... all obstacles overcome, but the fuller recognition of what one's struggles are about." The focus in multiple meanings and an underside to every upside (and vice versa) owes a lot to an ironic perspective.

IDEA (IDEIA)

-IDEIA: children are eligible if they have one of the 13 IDEA disabilities and who need special education services (receives an IEP- individualized education program). -IDEIA provides: (1)Free Appropriate Public Education (FAPE) (educational program that is individualized to a specific child, that meets that child's unique needs, provides access to the general curriculum, meets the grade-level standards established by the state, and from which the child receives educational benefit) (2)Least Restrictive Environment (LRE) (children should spend as much time as possible with peers who do not receive special education) (3)Guidelines and criteria for special education (accommodations/modifications) and related services -The IDEIA Is documented in an Individualized Education Plan (IEP). Parts of the IEP: Present Levels of Academic Achievement and Functional Performance (PLAAFP), measurable annual goals and short-term objectives, progress reporting, list of accommodations/modifications, supplementary aids and services, consent. Many people contribute to this document but ultimately it is the case manager's responsibility to ensure that the document is complete and correct. -School psychologists and IDEIA: eligibility determination (identification and classification), case management, development and implementation of IEP, consultation and support. -IDEIA disability categories: Autism, Deaf-Blindness, Deafness, Emotional Disturbance, Hearing Impairment, Intellectually Disabled, Multiple Disabilities, Orthopedic Impairment, Other Health Impaired, Specific Learning Disability, Speech or Language Impairment, Traumatic Brain Injury, Visual Impairment -IDEA = Services & Supports through SPECIAL EDUCATION

Implicit Bias

-Implicit Racial Bias: implicit social cognition is the process by which the brain uses "mental associations that are so well-established as to operate without awareness, or without intention, or without control." -Despite the consistent and extensive research that shows African American males being disproportionately overrepresented in discipline referrals, no significant studies support the claim that African American boys are actually more disruptive than their non-African American peers

APA's New Multicultural Guidelines

-In August of 2017, the APA adopted new multicultural guidelines for psychologists. Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality (2017). It offers 10 guidelines with accompanying case studies. The goal is to provide a framework for multiculturally competent services -Intersectionality: the interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage -Intersectionality is a key concept in the new guidelines, not present in the preceding 2003 guidelines, that tries to highlight the complexity of contexts, and the fluidity of identity, that we should be aware of in our clients

"Maturing Out" of Problem Drinking

-Maturing out often attributed to adult-role transitions: E.g., marriage, parenthood, full-time employment -Developmental personality maturation: personality has been traditionally viewed as a stable characteristic. Research has only recently acknowledged/emphasized ways that personality "matures" with age -A series of important studies linked young-adult problem drinking reductions to... (1) Increases in conscientiousness (2) Decreases in "impulsivity" (3) Decreases in neuroticism

Micro-Aggression

-Micro-aggressions: the "brief and commonplace daily verbal, behavioral, and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial, gender, sexual-orientation, and religious slights and insults to the target person or group" -Derald Wing Sue argues that microaggressions are largely unconscious, since "[p]erpetrators are usually unaware that they have engaged in an exchange that demeans the recipient of the communication"

Mindfulness

-Mindfulness: paying attention in a particular way on purpose, in the present moment and non-judgmentally -Numerous studies are demonstrating the power of mindfulness to promote wellbeing -Some recent, exciting work indicates that there are measurable biological benefits. Mindfulness raises telomerase levels, reflecting an increase in our ability to heal ourselves on a cellular level -Traits of mindfulness: (1) Aware of what is happening as it is happening (2) Nonjudgmental (3) Nonreactive (4) Ability to name what is going on inside of you - ability to describe in words the internal world (5) Self-observation -Relationship of "presence" to happiness -Recent study found a strong relationship between being present and happiness as well as a relationship between unhappiness and "mind-wandering," not being in the present. Even positive mind-wandering was linked with lower happiness

NJ 6A:14 Disability Categories

-N.J.A.C.6A:14: specific special education law in New Jersey which slightly differs in disability categories. Student eligibility: it is determined that the student has one or more of the disabilities defined in (c)1 through 14 below. The disability adversely affects the student's educational performance. AND the student is in need of special education and related services. -Auditorily Impaired (An inability to hear within normal limits due to physical impairment or dysfunction of auditory mechanisms characterized by: "Deafness"--The auditory impairment is so severe that the student is impaired in processing linguistic information through hearing, with or without amplification and the student's educational performance is adversely affected. and "Hearing impairment"--An impairment in hearing, whether permanent or fluctuating which adversely affects the student's educational performance) -Autistic (A pervasive developmental disability which significantly impacts verbal and nonverbal communication and social interaction that adversely affects a student's educational performance. Onset is generally evident before age three. An assessment by a certified speech-language specialist and an assessment by a physician trained in neurodevelopmental assessment are required), -Intellectually Disabled (Significantly below average general cognitive functioning existing concurrently with deficits in adaptive behavior; manifested during the developmental period that adversely affects a student's educational performance. Mild, moderate, severe), -Communication Impaired (Language disorder in the areas of morphology, syntax, semantics and/or pragmatics/discourse which adversely affects a student's educational performance and is not due primarily to an auditory impairment. When the area of suspected disability is language, assessment by a certified speech-language specialist and assessment to establish the educational impact are required. The speech-language specialist shall be considered a child study team member), -Emotionally Disturbed (Condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a student's educational performance due to: An inability to learn that cannot be explained by intellectual, sensory or health factors; An inability to build or maintain satisfactory interpersonal relationships with peers and teachers; inappropriate types of behaviors or feelings under normal circumstances; A general pervasive mood of unhappiness or depression; or A tendency to develop physical symptoms or fears associated with personal or school problems), -Multiply Disabled (The presence of two or more disabling conditions, the combination of which causes such severe educational needs that they cannot be accommodated in a program designed solely to address one of the impairments. Multiple disabilities includes cognitively impaired-blindness, cognitively impaired-orthopedic impairment, etc. The existence of two disabling conditions alone shall not serve as a basis for a classification of multiply disabled. Multiply disabled does not include deaf-blindness) -Deaf/Blindness (Concomitant hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational problems that they cannot be accommodated in special education programs solely for students with deafness or students with blindness), -Orthopedically Impaired (A disability characterized by a severe orthopedic impairment that adversely affects a student's educational performance. The term includes malformation, malfunction or loss of bones, muscle or tissue. A medical assessment documenting the orthopedic condition is required), -Other Health Impaired (disability characterized by having limited strength, vitality or alertness, including a heightened alertness with respect to the educational environment, due to chronic or acute health problems, such as attention deficit disorder or attention deficit hyperactivity disorder, a heart condition, tuberculosis, rheumatic fever, nephritis, asthma, sickle cell anemia, hemophilia, epilepsy, lead poisoning, leukemia, diabetes or any other medical condition, such as Tourette Syndrome, that adversely affects a student's educational performance. A medical assessment documenting the health problem is required), -Preschool Child with a Disability (3-5 years old. Has a developmental delay in Physical, including gross motor, fine motor and sensory (vision and hearing); Intellectual; Communication; Social and emotional; or Adaptive. 33% delay in 1 developmental area, or a 25 % delay in 2 or more developmental areas. OR Has an identified disabling condition that adversely affects learning or development. Requires special education and related services), -Social Maladjustment (A consistent inability to conform to the standards for behavior established by the school. Such behavior is seriously disruptive to the education of the student or other students and is not due to emotional disturbance as defined in (c)5 above), -Specific Learning Disability(SLD) (A disorder in one or more of the basic psychological processes involved in understanding or using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. Can be determined when a severe discrepancy is found between the student's current achievement and intellectual ability in one or more of the following areas: Basic reading skills; Reading comprehension; Oral expression; Listening comprehension; Mathematical calculation; Mathematical problem solving; Written expression; and Reading fluency. The term severe discrepancy does not apply to students who have learning problems that are primarily the result of visual, hearing, or motor disabilities, general cognitive deficits, emotional disturbance or environmental, cultural or economic disadvantage. A specific learning disability may also be determined by utilizing a response to scientifically based interventions methodology as described in N.J.A.C. 6A:14-3.4(h)6.), -Traumatic Brain Injury (An acquired injury to the brain caused by an external physical force or insult to the brain, resulting in total or partial functional disability or psychosocial impairment, or both. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual and motor abilities; psychosocial behavior; physical functions; information processing; and speech), -Visually Impaired (An impairment in vision that, even with correction, adversely affects a student's educational performance. The term includes both partial sight and blindness. An assessment by a specialist qualified to determine visual disability is required. Students with visual impairments shall be reported to the Commission for the Blind and Visually Impaired)

Need for Standardization of Assessment

-Need for standardization: standardization makes it so that all confounding variables are not present, only retains true scores to compare

Dr. Terry Wilson of GSAPP Interview

-Participated in the Eating Disorders Workgroup for DSM-5, there were 12 people (5 psychiatrists, 5 clinical psychologists, 1 Pediatrician, 1 PhD nurse, one from UK, one from Netherland). Dr. Wilson notes there were efforts to be consistently transparent through the process (having subgroups for constant feedback from all perspectives). -DSM-IV: had diagnosis of Anorexia Nervosa, Bulimia Nervosa and Eating Disorders NOS (served as a residual category but problem was that about 70% of people were getting Eating Disorders NOS). Efforts were therefore made to be more precise in defining anorexia nervosa and bulimia nervosa in DSM-5. -Main changes in DSM-5 (1)Bulimia (included criteria "The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months." DSM-IV had previously included "at least twice a week for 3 months (2)Anorexia Nervosa (took out the menstrual criteria which had always been criticized) (3)Creation of a new diagnosis Binge Eating Disorder -Decision not to add obesity as a disorder: many people think that people who are obese necessarily binge eat but this is not the case. Differences between BED and obesity include the following: (1)Those with BED report higher distress (2)Those with BED are more likely to have other psychiatric disorders (depression very common, substance abuse to some extent, anxiety, personality disorders) (3)Treat implications are very different (4)There are effective methods for treating BED - there are not effective long term treatments for obesity (relapse occurs regularly) -The future: (1) Dimensional approach: attempt was made in DSM-5 to include a dimensional approach. Instruction throughout the DSM-5 note that clinicians can adapt criteria based on level of severity (clinical judgment (2)Research Diagnostic Criteria (RDOC) approach: goal is to try and figure out etiology and causes of disorders. Our knowledge in this area is still very limited (3)Transdiagnostic approach: the argument is that all eating disorders have far more in common with each other than differences. If we focus on common mechanisms maintaining the disorders we can impact treatment.

Polyvagal Theory

-Polyvagal Theory: Three Neural Circuits that regulate our relationship with the world - deciding whether the environment is safe or dangerous, whether other humans are safe or dangerous -Immobilization: Feigning death, shutdown (imagine the limp mouse in the mouth of the cat). Most primitive component. Dependent on the oldest branch of the vagus nerve -- the unmyelinated dorsal vagal -Mobilization: Fight or Flight behaviors. Dependent on the sympathetic nervous system -Social Engagement System: Facial expression, vocalization, listening. Dependent on the myelinated vagus. It fosters calm behavioral states by inhibiting the influence of the sympathetic nervous system on the heart. We can only access this system when we are not in disturbed states of hyper or hypoarousal

Psychological Debriefing Prevention

-Psychological Debriefing for the Prevention of PTSD: effectiveness not demonstrated. "There is no evidence that single session individual psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease. A more appropriate response could involve a 'screen and treat' model."

Disproportionality

-Race Interaction and SES: 2016 Census: Median household income for Whites ($65,041) was higher than for Hispanics ($47,675), which was higher than for African Americans ($39,490). According to spatial assimilation theory, these numbers alone should result in racial segregation, even if no discrimination was present. Children are then born into these families and attend schools in these segregated neighborhoods, where different education is provided due to a difference in funds -Inequality in School Funding: Schools are primarily funded at the LOCAL level. This leads to different areas having vastly different funds available, and hence vastly different resources and educational opportunities for students. Many schools with fewer funds have eliminated arts programs and decimated athletic opportunities (some people have argued for schools be primarily funded at the state level since it would allow funds to be distributed equally among schools) -Inequality: African American and Latino students are more likely to attend high-poverty schools than Asian American & Caucasian students. High-achieving African American and Latino students may be exposed to less rigorous curriculums, attend schools with fewer resources, & have teachers who expect less of them academically than they expect of similarly situated Caucasian students -Disproportionality is an issue of equity and access in general and special education. It refers to "the extent to which membership in a given...group affects the probability of being placed in a specific disability category." Underlying premise: all groups should be represented in special education at same rate as in general population. If not, bias could be present. But compared to white students, black students have been persistently overrepresented in special education nationally, along with Native American students. Hispanic and Asian/Pacific Islander students are underrepresented. -Disproportionality in SE: (1) Differences in early learning and school readiness (2) Inequitable opportunities due to tracking, poor resources and limited teacher training (3) Lack of culturally relevant curriculum (4) Limited family involvement and advocacy in schools (5) Funding which favors special education (6) Racism and systemic bias that all CLD youth require special education -How does disproportionality happen: (1) Vague and inconsistent state criteria for classification (2) High degree of subjective professional judgment due to vague disability definitions (3) Bias in referral, assessment, and placement (4) Interpersonal bias and lower expectations (5) Failure to effectively create pre-referral interventions

Identity and Background

-Race: Biologically determined traits. Members of a racial group may comprise different ethnicities and cultures -Ethnicity: Group that shares a common history, culture, values, behaviors. These features cause members to have a shared identity. Definition is similar to culture but members of same ethnic group may have different cultural experiences depending on degree of acculturation -Culture: "An integrated pattern of human behavior that includes thoughts, communications, languages, practices, beliefs, values, customs, courtesies, rituals, manners of interacting and roles, relationships and expected behaviors of a racial, ethnic, religious or social group; and the ability to transmit the above to succeeding generations." -Socioeconomic Satus (SES): Our social and economic position based on income, education, occupation. Low SES is related to poorer physical health, poorer housing, fewer educational and sports/extracurricular opportunities

Adverse Childhood Experiences (ACE) Study

-The ACE Study looked at Adverse Childhood Experiences of abuse, neglect and other traumatic stressors in relation to health outcomes. Subjects were given an "ACE score" for the total number of events reported in 7 categories. They found a strong and graded relationship between the score and health outcomes in adulthood. -There is a cumulative effect of early abuse, neglect and household disfunction as one proceeds through the life cycle. Somone with a high ACE score is more likely to have social, cognitive and emotional impairments in childhood, later to engage in riskier behavior, and more likely to have chronic illnesses and to die earlier from many causes.

Challenges to Psychotherapy as a Humanistic Enterprise, McWilliams

-Redesign of DSM: (1) The aim to be more useful to researchers had great impact on clinicians as well (2) Diagnostic criteria went from contextual and dimensional models to externally defined and described criteria -Rise of Managed Care: (1) Funding healthcare in what is "essentially a venture-capitalist model." (2) Creating an incentive system to deny care (3) Use (and abuse) of empirically supported treatment movement to assist in that denial of care -Role of Pharmaceutical Industry: (1) Their profitability depends on making human problems into chemically treatable disorders (2) Their ability to market directly to the public has made the "better living through chemistry" approach much more visible than our much less Madison Avenue savvy position -Estrangement Between Academic Researchers and Clinicians in Psychology: (1) Academics and clinicians lead such different lives that they are often out of touch with each other (2) Contempt of one side for the other leads to inability to work together to solve the problems confronting us

Consent

-Respect for Autonomy of Persons (Consent): school psychologists respect the right of persons to participate in decisions affecting their own welfare -Unless otherwise ordered by court, parent or legal guardian is authorized representative consenting to treatment (they sign any authorization to consent to treatment and release information) -If child is 14 years old or more, they also sign authorization ("dual consent") (obtain "assent" for kids under 14) -At least one parent or guardian must provide consent. Other parent may object, but minor can still be treated. Divorce: parent with legal medical decision making rights must provide consent

Confidentiality

-Respect for Privacy (Disclosure): school psychologists respect the right of persons to choose for themselves whether to disclose their private thoughts, feelings, beliefs, and behaviors -Start treatment with explanation of limits of confidentiality -Developmentally appropriate language -Therapeutic contracts spell out limits and give examples -Legal guardian has the right to minor's records (most information does not need to be disclosed to parents) -Not required to release info related to STD's, abortion, substance use -Exceptions to confidentiality are imminent risk of harm to self or others and child abuse -If know of imminent risk or harm to self or others, required to take steps: (1) Protect from harming others (2) Protect child from suspected harm by others (3) Protect from harming self -School psychologists (an in NJ all people) are mandated reporters (must practice within the boundaries of their competence, use scientific knowledge from psychology and education to help clients and others make informed choices, and accept responsibility for their work)

Requirements to be a School Psychologist

-School psychologists address those variables that impact a child's educational performance, whether internal to the child or part of the various systems (home, school, etc.) that the child functions in. Work with student, families, teachers, community providers, medical providers, and other stakeholders important in the child's life. -School psychologists have graduate training (coursework and experience and a specialist-level degree program or a doctoral degree); hold a certificate to practice school psychology (state specific, but can also be nationally certified). -In schools only school psychologists can administer assessments and reports (IQ, ACH, RISK).-School psychologists enhance the educational performance and emotional well-being of children and learners in all types of educational settings. They also address those variables that impact a child's educational performance, whether internal to the child or part of the various systems (i.e. home, school, etc.) in which the child functions.

Section 504

-Section 504: children are eligible when they have physical or mental impairments that substantially limit a major life function (receives a 504 plan, not an IEP). -Section 504 covers qualified students with disabilities who attend schools receiving Federal financial assistance. To be protected under Section 504, a student must be determined to: (1) have a physical or mental impairment (such as physiological disorder or condition, cosmetic disfigurement, anatomical loss, etc.) that substantially limits one or more major life activities (such as hearing, walking, taking care of oneself, etc.); or (2) have a record of such an impairment; or (3) be regarded as having such an impairment. Section 504 requires that school districts provide a free appropriate public education (FAPE) to qualified students in their jurisdictions who have a physical or mental impairment that substantially limits one or more major life activities. -As of January 1, 2009, school districts... must NOT consider the ameliorating effects of any mitigating measures that student is using. The mitigating measures are as follows: medication; medical supplies, equipment or appliances; prosthetics; hearing devices, etc. -504 plan common accommodations: presentation accommodations (listen instead of read, lesson outline instead of notes), response accommodations (oral instead of writing, type instead of write), setting accommodations (small group, sensory tools- chair band), timing accommodations (extended time, frequent breaks), scheduling accommodations (more time for projects, take tests in am vs. pm) organizational skills accommodations (highlight texts, timer to stay on task). -Section 504 = Services & supports through GENERAL EDUCATION

Social-Emotional Learning (SEL)

-Social-emotional learning (SEL) Programs: aim to reduce a wide array of risk factors, while fostering many protective and resilience factors -Research suggests SEL programs are effective at all grade levels and in all community settings -Areas of SEL Programs: (1) Self-Awareness (2) Self-Management (3) Responsible Decision-Making (4) Social Awareness

Suicide Assessment

-Suicide Assessment: (1) Ideation/desire (2) Intent (3) Plan (4) Means (5) Access (6) Rehearsal (7) Substance use, risky behaviors (8) Reasons for living, reasons for dying (9) Level of impulsivity (10) Risk factors (burdensomeness, prior attempts, family history of suicide, access to firearms), protective factors (family/community support, adaptive coping skills, religious/cultural beliefs discourage suicide)

Neuroplasticity

-The concept that the brain can change as a result of experience, that it is "plastic" and changeable -Replaces the older belief that the brain could not change after crucial developmental periods -We can use this knowledge to help people change in therapy: "Neurons that fire together, wire together" -Much of this neuroplasticity is experience-dependent. The brain changes with experience and we get better at what we practice. Whatever the brain does most, it devotes more resources to. Examples of the hippocampus of taxi drivers, the amygdala of trauma survivors -The neural networks we use frequently get stronger, while those we use less frequently get weaker -One way of assessing the strength of a network is the speed with which it can be accessed -->Experiment where you lose your eyes and think of something you don't like about yourself. Notice how long it took for something to come to mind. Next, close your eyes and think of something you like about yourself. Notice how long it took for something to come to mind -->Most of us are far better at accessing the negative rather than the positive about ourselves. -->Focusing on those negative aspects strengthens them, while focusing on developing opposite qualities strengthens them

Multicultural Wave

-The multicultural wave in therapy adds: (1)Attention to culture (2)Attention to systems (3)Attention to power and privilege (4)Attention to who is telling the story

The Three-Legged Stool of EBP

-Three-Legged Stool: (1) Best Research Evidence: depends on the question to be answered (different research designs are needed to answer different types of questions). Treatment efficacy gold standard is randomized clinical trials, but multiple strands of evidence of necessary for effective practice. The Spring article talks about how psychology programs may overemphasize this aspect, with relatively less focus on clinical expertise and patient values. (2) Clinical Expertise: relates to the therapist's skill and competence in employing interventions. Has generated the most controversy because it is the hardest in many ways to specify. A solid empirical literature demonstrates that "nonspecific factors" like warmth and the ability to establish a relationship accounts for substantial variance in outcome. A standard approach in training programs is to try to operationalize and train these competencies. (3) Patient Values: least developed of the three. Aims for shared decision making with client. Requires respect for the client's preferences, values and cultural context

Tier Model

-Tier Model: one way to conceptualize how we deliver prevention and intervention services in schools. It can be applied to key areas of functioning that are addressed in schools -Tier 1: Primary - Supports all students in a school (try to prevent issues from developing through whole-group interventions) -->Universal screening (data collection, flag problems early, depression screening for freshmen in health, sociogram) -->School/classroom wide behavior plans; Recess/physical engagement; Mindfulness; School connectedness strategies (greeting kids by name); Restorative practices --> 80-90% schoolwide interventions -Tier 2: Secondary - Provides additional support for smaller groups of students (try to prevent even further development of issues and provide more targeted help through interventions) -->Check ins with at risk students (new students); Lunch social groups; Targeted academic groups (instructional support, basic skills) -->5-10% targeted interventions -Tier 3: Tertiary - Provides intensive interventions and support for individual students not successful with Tier 1 and Tier 2 interventions -->Individual counseling; Individualized academic interventions; Wraparound services; Specialized programs; OOD schools --> 1-5% intensive specialized interventions -Common mistakes with tiered model: (1)Jump to Tier 3 (2) Inconsistent interventions across Tiers (3) Lacking sufficient supports across all Tiers

Multiple Relationships

-To foster and maintain trust, school psychologists must be faithful to the truth and adhere to their professional promises. They are forthright about their qualifications, competencies, and roles; work in full cooperation with other professional disciplines to meet the needs of students and families; and avoid multiple relationships that diminish their professional effectiveness

Trauma

-Trauma: "Exposure to actual or threatened death, serious injury, or sexual violence" either personally, by witnessing it, learning about its occurring to a family member or friend or repeated exposure to aversive details (first responders). -When a traumatic or disturbing event happened, the natural system for processing a memory was interrupted because of high arousal and/or encoded as survival information (information that occurred at the time of the upsetting event is stuck or frozen in the memory) Present day triggers or experiences can activate the feelings and responses in the stored memory

Visions of Reality

-Visions of Reality: refers to assumptions about the nature and content of human reality Has been used to illuminate the way in which different kinds of theories highlight different dimensions of human experience -Romantic: "Life is an adventure or quest in which each person is a hero who transcends the world of experience, achieves victory over it, and is liberated from it." "The romantic vision idealizes individuality and what is 'natural.' It advocates free, uninhibited, and authentic self-expression." -Ironic: Antithetical to the romantic view. An attitude of detachment, of keeping things in perspective, of recognizing the fundamental ambiguity of every issue that life present to us. Each aspect of behavior may represent something else. Life cannot be fully mastered or understood -Tragic: "Tragedy, unlike irony, involves commitment." In a tragic drama, the hero has acted with purpose and has committed an act causing shame or guilt. He suffers by virtue of a conflict, e.g., between passion a duty, and after considerable inner struggle, arrives at a state of greater self-knowledge. Limitations of life are accepted - not all is possible, not all is redeemable -Comic: "In comedy the direction of events is from bad to better, or even best. Although there are obstacles and struggles in a comedy, these ultimately are overcome and there is a reconciliation between hero and antagonist, between the person and his or her social world. Harmony and unity, progress and happiness prevail."

Under Stress

-We are designed for bottom-up processing under stress. "Bottom-up hijacking" is triggered by a "false alarm," responding as if threatened when there is no danger. Cognitive processing is inhibited

Psychotherapy

-We tend to think of physical interventions like medication as things that change the brain, but we are realizing more in more, in study after study, that psychotherapy also changes the brain -- with fewer side effects and often with longer-term results -Different approaches to psychotherapeutic treatment are based in different ways of conceptualizing human problems and difficulties and the path to healing. Different "visions of reality" as described by Messer as an example of this. There is no one "right" or "correct" way that lines up with objective reality, though there may be approaches that are a better or worse fit for a particular therapist, client or problem

What Works in Therapy

-What works according to clients: (1) Listen to client (2) Privilege the client's experience (3) Request feedback on the therapy relationship (4) Avoid critical or pejorative comments (5) Ask what has been most helpful in this therapy -What works in general: (1) Empathy (2) Alliance (measured as agreement on therapeutic goals, consensus on treatment tasks, and a relationship bond - relationship is broader than this alone) (3) Cohesion (groups) (4) Goal Consensus and Collaboration (5) Positive Regard (6) Congruence/Genuineness (7) Feedback (8) Repair of Alliance Ruptures (9) Self-Disclosure - Research suggests that therapists should disclose infrequently, to validate reality, normalize experiences, strengthen the alliance or offer alternative ways to think or act. Therapists should avoid self-disclosures for their own needs or that move focus from client. (10) Management of our own feelings towards clients - not acting it out (11) Quality of Relational Interpretations -What works for particular clients: (1) Reactance: refers to being easily provoked and responding oppositionally to external demands. Highly reactant clients do better with low directiveness and more self-control. Low reactant clients do better with high directiveness (2)Functional Impairment: refers to the severity of the client's subjective distress as well as reduced behavioral functioning. More functionally impaired clients have worse outcomes. Greater impairment in clients may indicate greater benefit from more intensive therapy and multiple modalities (adding group, medication, increased support) (3)Stages of Change: stages (precontemplation, contemplation, preparation, action, maintenance). Therapist's optimal stance depends on stage of change, aligning the relationship to the stage and adjusting tactics as the clients moves through the stages -What does not work: (1) Confrontations (2) Negative Processes (3) Assumptions (4) Therapist Centricity (5) Rigidity (6) Ostrich Behavior (7) Procrustean Bed

Trauma

Trauma: any event that is a threat to a child or another person's safety that results in a child experiencing strong feelings of terror and helplessness (child's usual coping ability is overwhelmed) -Adverse Childhood Experiences: abuse, neglect, household dysfunction