Behavioural awareness intervention

Assessment and evaluation

Case study – 6 weeks

J. B.

7/7/11

The following case study is a singular instance on a wide spread problem. The failure to identify issues regarding behavioural management has illustrated that certain education providers are falling short of their obligations in meeting the needs of the individual. These obligations far exceed the general pedagogic standards demonstrated by certain education providers. The student needs to have access to emotional, social, creative, academic, behavioural, cognitive and competitive environments that allow the individual to flourishthrough practice, insight and attainment.

The procedures will include numerous evaluative assessments which will establish a behavioural profile and baseline data for analysis and interpretation at the end the six weeks. Manyof the assessment procedures will be administered and analysedby hand, however, these will be documented and presented with the profile and impact data.

The obligatory ethical considerations will be discussed and agreed upon using the PCF-1 (signed 13/7/11) from the “Jig-saw” diagnostic tools will allow the facilitator to capture a valid measure of behaviour and any possible antecedents that trigger the behaviour.

Parental appraisal

The initial assessment (13/7/11) began with several parental reports on J.B. the first of which measured the strengths and difficulties of J. B. The strengths and difficulties questionnaire (SDQ) has five scales that measure behaviour, symptomatic affects (BQ1 data, section IV. Migraines;

Sumatriptan. Penicillin allergy – affects schooling) and peer/social relationships. These scales are:

Emotional symptom scale (ESS) = 4 – reflects a clinically significant problem (5-10)

Conduct problem scale (CPS) =7 – clinically significant problem (4-10)

Hyperactivity scale (HS) = 8 - clinically significant problem (7-10)

Peer problem scale (PPS) = 1 – Strength (0-2) Pro social scale (PSS) = 7 – Strength (6-10)

The SDQ also gives an overall total score and impact score that provides a specific benchmark for the interpretation of the data.

Total SDQ = 27 - clinically significant problem (17-40) SDQ Impact = 2 – interpretive denominator (Home life)

Then the researcher conducted a functional behavioural analysis (FBA - 13/7/11). The FBA consists of 15 questions that assess any possible functions of the behaviour. The analysis sheet illustrates who the behaviour is happening withand possible reason. These areas are:

Peers Adults Escape Attention Setting event

J. B. shows a greater need to avoid/escape peers than gain attention and on occasion may seek approval from his peers. Similarly, with adults, escape functions are evident, however,with less of an attention seeking function. Interestingly, thefunction at the stage is not identifiable to, or indicative of, a singular environmental setting.

Lastly, a functional assessment interview (FAI-f - 13/7/11) was administered to collect all the verbal response on J. B.

behaviour. The interview comprised of twelve questions that are designed to hone in on the specific observations and feedback the parent has received and documented over the past six months. The data will be presented and discussed in the summary, along with, the interpretive analysis of the remaining data.

The last document (16/7/2011) that formed part of the parentalappraisal was a behavioural questionnaire (BQ1) that evaluatedthe behavioural expression, frequency and regulation. The BQ1 assessed the following areas:

I. Acquiring and using informationII. Attending and completing tasks

III. Interacting and relating with othersIV. Moving and manipulating objectsV. Caring for themselves

VI. Medication/health/physical well-being

Behavioural diagnosis

The data has exposed numerous difficulties that J. B. occasionally expresses in a maladaptive way. The FAI-f conducted with the parents suggests that J. B. has difficulties expressing anger appropriately resulting in random outbursts. The possible reason for these flare ups could be a repression of emotion with opposition and defiance being an observable outcome.

The FBA illustrates a greater need for J. B. to avoid/escape peers than gain attention, although on occasion, may seek approval from his peers. Similarly, with adults, escape functions are evident, however, with less of an attention function. The FAI-f also identifies the possible triggers, situations and involvement dependence of the anger/frustrationlevel increases. J. B. responds negatively to being challengedby authority i.e. mother and head of year, especially when rules are imposed or enforced.

Despite the infrequency, the behaviour generally happens on a bi-monthly basis with the duration of the conflict lasting over a 6-8hr period. Unfortunately, J. B. manages this conflict in an unconstructive manner i.e. by escaping and displaying the classic signs of anger/frustration increase e.g. clenched teeth/fists.

This propensity for escaping the situation causes worry for the parent; diminishes opportunity for emotional disclosure and causes obvious safeguarding complications for the school. Also, the physical/symptomatic affects may be a probable contributor to the migraine headaches that J. B. suffers from (BQ1 data, section IV. Migraines; Sumatriptan. Penicillin allergy).

The data collected from the BQ1 highlights the areas of difficulty that J. B. experiences. The parents’ report suggests that J. B. has slight problems in many areas i.e. section II, III and V. However, there are only a few aspects of these sections that have any frequency. J. B. shows that hecannot follow rules; respect/obey adults in authority or use adequate vocabulary and grammar to express thoughts/ideas in general conversations on a monthly basis.

Also, J. B. has a difficulty using language appropriate to thesituation and listener which happens on a weekly basis. Furthermore, J. B. has obvious problems with handling frustration appropriately, responding appropriately to changesin his own mood and using appropriate coping skills to meet daily demands of school environments on a monthly basis.

The SDQ interpretation for the conduct and hyperactivity wouldfactor together as a causal dimension that illustrate a need to keep J. B. occupied on a regular basis as loss of focus, new situations and unexpected events exacerbate the feelings of anxiety. This is then translating into physical symptoms and expressed in behaviour. The impact is minimal, however, this, in isolation, is evident at home above all other environments. Hence, the behavioural expression has the potential of snowballing if left unchecked.

Student appraisal

After the PCF-1 was satisfied and signed off by the parent (13/7/11), governor (19/7/11) and behaviour manager (13/7/11) the initial assessment identified the behavioural output of J.B. However, the assessed impact from the parental appraisal isnot always congruent with J. B’s general experiences, cognitive processes and behavioural expression.

J. B. has identified that his conduct does hinder relationships within his friend circle, although, this is the extent of the impact as J. B. sees it (SDQ; CPS = 5, clinically significant problem (5-10)). Overall, the data results in what could be seen as a clinically significant problem without intervention (TSDQ = 27, clinically significant problem (20-40)). J. B’s motivations were also assessed with a questionnaire that has two factors split into six variables. These are:

Intrinsic motivation = 48/68

Challenge = 17/24

Curiosity = 16/24

Independent mastery = 15/20

Extrinsic motivation = 30/52 (reversed scores)

Easy work = 13/20

Pleasing sifu = 6/12

Dependent on sifu = 11/20

J. B. shows a high level of curiosity and prefers to be challenged if independent mastery of information is to be achieved. If J. B. is challenged academically with materials that inspire and stimulate creative thought then the extrinsicmotivation for hard work would increase alongside his overall interest in other subjects.

Development at this stage could reflect age specific progress with cognitive abilities being at a good level (coherence scale = 63%). J. B. also has a good sense of himself, his spiritual, moral, social and cultural development and personalidentity formation (actualization scale = 65.5%).

However, J. B. may be frustrated at friends and family by way of disappointment. J. B. sees himself as a solid friend, whichcould diminish his regulation when primary/secondary appraisals are conflicted by assumed violations leading to catastrophic evaluations of future interactions.

Behavioural diagnosis

Identity formation, at this stage, may be contingent on peer/group/friend circle idiosyncratic standards which conflict with personal identity formation. This creates a possible dissonance, a relative ambivalence towards own interests. J. B. is aware of his own actions and may compare that of his friends to his own, which could lead to repressionof feelings, morals and value code through fear of rejection. Furthermore, J. B. does not always recognise the affect that his actions and outbursts have on his home-life.

Root issue hypothesis

Identity formation is inhibited by rejection anxiety causing afailure in assertion of personal values and/or interests.

Diagnostic variables

Age specific – identity, individuality…

Displacement of emotion

Possible feelings of rejection

Private acceptance

Public reclusion of identity

Conflict and dissonance

Anxiety, loss and excessive behaviours e.g. smoking

Behavioural summary

The contributory factors for J. B. illustrate that emotional discussions between siblings, parents, friends and teachers are infrequent and repressed. This is leading to a lack of interest in most things that oppose or challenge him. Frustration level increases characterise the repression with the displacement of these emotions directed at those closest.

The rejection factor is threatening to his sense of belonging and acceptance, with the conflict of losing his affiliations predicating the ambivalence and dissonance towards honest expression whilst in their presence.

The initial data from both parties provides insight and solid evidence for demarcating the baseline diagnostic range. It also operationalizes the J. B. case study and individualised intervention that focus on student-centred learning environments that are embedded with their individual behavioural targets, development that is differentiated by progress, learning that is regulated by self-evaluation and refocused with biological monitoring.

United delivery format– Midas pilot workflow study

22/7/11

2 – 4pm

J. B.

Session 1

Introduction to programme and content over the six sessions

Introduction into assessing emotions and environmental influences on our emotions

Thematic therapy and apperception i.e. Yin Yang activity

Introduction to assertion and communication strategies i.e. physiology, tonality and words

Learning style inventory – Visual and kinaesthetic strength; Aural and reading weakness

Discussion material:

How personal, social and educational roles all require different aspects and disciplines to effectively participate

How people respond to assertiveness

How assertion can circumvent the general difficulties in our personal, social and educational lives

Session 1a

J. B. has a strong conviction in his choices and opinion’s, healso has a solitary way about him. Self-motivation is very evident and is willing to complete tasks and be challenged with extension material. Also evident is the high degree of self-discipline and quiet enthusiasm that J. B. has, however, the low boredom threshold is a point of contention if not monitored and catered to.

Session 1b

J. B. demonstrated an ability to identify characters and angertriggers from within a text and comment on these independently. He has a clear understanding of his own interests and dislikes. J. B. also demonstrates an exceptionalworking memory and can reiterate in detail from visual and auditory material with ease.

United delivery format– Midas pilot workflow study

27/7/11

2 – 4pm

J. B.

Session 2

Identifying triggers and resolution of anger

How we start to problem solve stressful situations

Challenging beliefs and changing expectations

Learning styles inventory – Active = 7; Sensing = 11; Visual =9; Sequential = 7

Identifying and communicating clearly his emotions and ideas about what he likes/dislikes and finds calming/frustrating

Applying the above to a written/visual piece of work with parameters and guidelines (related to GCSE English)

Discussion material

Feedback on the reflective practice of the thermometer rating upon his outward expressions of anger

How affective are the management mechanism supporting the regulation of his outward expressions of anger

How the combined use of the journal and thermometer are helping J. B. manage adaptively and appropriately to frustration/anger by providing an outlet

During the conversation about the assigned homework film (Hulk) J. B. began discussing Harry Potter and stated that hisfavourite part was the metamorphosis between teen/adult. This indicates that J. B. is very much aware of the transition he is personally going through at present i.e. metamorphosis

Session 2a

J. B. has a strong preference for logic and facts which are presented in a linear or stepwise fashion. The visual aspect of J. B’s preferences is still evident over time and place with the physical component being of a moderate strength. The

problem solving aspect of the first session exposed this sequential preference that J. B. has, in that, the Fox, Chicken and Grain algorithm was better suited to his learning preferences (visual and sequential) than the abstract hostage situation (removing barriers problem).

Session 2b

Identifying and communicating clearly his emotions and ideas about what he likes/dislikes and finds calming/frustrating andapplying this to a written/visual piece of work with parameters and guidelines.

United delivery format

29/7/11

11 – 1pm

J. B.

Session 3

Practical session – social roles, reciprocal norms and etiquette

History of Wing Chun

Terminology of Wing Chun techniques

Body mechanics: strengths and weaknesses in the human body structure

Discussion material

What is acceptable and what is unacceptable behaviour and language – context based

How martial arts is related to the environment (Fibonacci series) and how we apply those theories to everyday situations

Session 3b

Who am I?

Social roles and responsibilities

Identifying different job roles and responsibilities of that role

Grouping and role playing friends, family and teachers etc.

Identifying roles judged on behaviour traits and communicationdifferences

Acceptability in different social situations

Multi-roles

Homework; identify the multi-roles of a film character (King’sspeech)

Session 3a

J. B. seems to enjoy the physical/visual aspects of learning and displays a very good level of coordination. The history reiteration component proved difficult; however, J. B. did grasp the general outlines and the basic understanding of the system history. He also remembered 4 out the 17 keys to Wing Chun.

Session 3b

J. B. enjoyed the practical elements of the session and demonstrated his unique understanding of the roles that careerpeople have. However, the more abstract quality of multiple roles that humans have was less clear. Nonetheless, in session4a and 4b the abstract nature of multiple roles will be explored and expanded upon.

Parental feedback

After a brief discussion on the case file (29/7/11) with J. B’s father he recounted an incident where J. B. had appropriately responded to disappointment. The duration that J. B. would have usually escaped for normally lasted between 6– 8hrs, however, he did not feel that propensity to leave, wasonly upset for a short period (approx. 20mins) and summarily apologised for the opposition he displayed.

The frequency and intensity relating to J. B’s outbursts, defiance and oppositional nature and behavioural expression has also decreased over the two week period. This was demonstrated by J. B. after a disagreement with his mother (1/8/11). The normal outcome of such conflict would have resulted in escape (6 – 8hrs), frustration/anger increase and displacement.

However, J. B. managed his response to the disappointment muchmore adaptively with duration being 15 – 20mins and the zone of proximity of J. B’s avoidance/escape remaining to the boundary of the residence. Furthermore, J. B’s defiance and oppositional frequency have also diminished from what was twice-a-day to twice-a-week.

United delivery format

3/8/11

11 – 1pm

J. B.

Session 4

Aggression questionnaire and central dispersal – self-evaluation

I. Physical (24.3)II. Verbal (15.2)III. Anger (17)IV. Hostility (21.3)

Friendship circle activity

Assertion

Behaviour identity

Rules to assertion

Inter-relationships and applying social skills

Discussion material

What does the circle tell you about relationships in your life?

Was the exercise difficult?

What criteria did you use to allocate people to rings of the circle?

Were there any surprises for you in your decisions?

The difference between associates, colleagues and true friends

How our best friends are not the best people to be around as they do not always have our best interests at heart

How individuals have multiple roles i.e. brother, son, friend,father and husband

Session 4a

J. B. was a great deal more interactive this session and therehave been noticeable changes in his biological self-regulationratings i.e. thermometer from week one to week two. In the

mornings of week 1 (Mr1) J. B. was averaging Mr1 = 48.43ْF, however, in week 2 (Mr2) the average is Mr2 = 27.86ْF (see fig. 1). The questionnaire also illustrated that J. B’s hostile (21) and verbal aggression (16) are within the normal range with the anger (20) and physical (27) aspects only slightly elevated. However, the results from the questionnairecould be tainted by J .B’s retrieval of past consequence and recent conflicts rather than that of his overall progress. Hence, he might be judging himself too harshly and unduly punishing himself.

United delivery format

12/8/11

2 – 4pm

J. B.

Session 5

Means

Algebra and interpreting data

Recap and insight

Homework assignment – zones of proximity

Personality and assertion

Ideal/real-self exercise

Looking up definition of unknown vocabulary from a list of personality traits and characteristics using a dictionary

Introduction of a new self-monitoring system for reading and task focus using a stop-watch system.

J.B used a stop-watch to record the duration of focus on a reading task, and the duration of any self-opted ‘refocus’ breaks and the reason for braking from the task.

First to read chapters 1 – 3 of The Prince of Mist by Carlos Ruiz Zafon using written text and audio recording (45 mins)

5 minute break

To continue reading chapters 4 and 5 of the same text using written text and audio recording (28 minutes)

Discussion material

What will you take from your experience into awareness?

Are you confident about future events in your life?

Do you feel any change or difference in your attitudes, behaviour and emotions?

Are you happy with yourself?

Session 5a

J.B. demonstrated a sound understanding of a new monitoring concept for reading and focussing on a specific task, and executed the task with surprising ease despite his declarationthat he ‘hates reading’. Using the monitoring, along with an auditory and visual input of a translated written text, J.B. sat still and read first for 45 minutes and a subsequent 28 minutes with only one short (2 minutes) self-opted break for ‘re-focus’.

Session 5b

During the session J. B. chatted very openly about numerous subjects that orientated around himself, his upcoming activities and his future. The noticeable changes in J. B’s behaviour are having a positive outcome on his home-life; his mother commented on the infrequency of the outburst and conflict and could not remember any incident during the past 2weeks. Also, J. B. was able to calculate averages from a data sheet and then interpret and discuss the reasons for the results.

The ideal/real-self exercise not only gave an insight into J.B’s understanding of how the world sees him, but, how he would ideally like to be seen. Furthermore, this exercise allowed J. B. access to new vocabulary from which he specifically learnt the definitions of two new words with the understanding of use.

Session tutor report

Having worked closely with Garrie on effective holistic teaching programmes for the last year, I have become familiar with his methodologies and delivery strategies for young people with anger issues and a ‘disengaged’ label within the current UK education system.

Although I have been impressed by his ideas, and have seen reports as to their effectiveness, even I have to admit to being astounded by the speed at which change has arisen throughthis most recent case study.

In just four weeks J.B’s whole attitude and outlook on life has taken a positive turn simply by having become aware of himself, his own feelings and actions, what triggers these feelings and actions, and therefore how to prevent them and deal with them as they arise.

He has become engaged in his family/ home life and has shown real engagement in the education provided by Garrie and myself, even with activities that he openly admits having a dislike for in mainstream school. For example, after declaring that he ‘hates reading’, J.B. none-the-less proceeded to concentrate on a reading passage for 45 minutes, taking only one self-opted break of 2 minutes. After a set break, J.B continued with the task for a further 28 minutes without a break and even expressed ‘intrigue’ in the text. J.B was only able to achieve this from the mechanism put in place on the programme for this activity.

I recommend this programme and Garrie Steels to ‘re-engage’ any student who has been disengaged/excluded from the current UK education system.

United delivery format – final analysis

The methodology and session material that created the individual united delivery intervention is documented earlier in the case study and therefore will not be mentioned in the final analysis.

Case study report

The following a priori analysis (conducted 1/10/11) will demonstrate that the united delivery format, in conjunction with, the “Awareness” behavioural intervention programme impacts upon unacceptable behaviour and displacement of emotion. And as documented earlier in the case study, both theparents (1/8/11) and session tutor (26/8/11) remarked upon theobservable differences in J. B’s behaviour, the duration and frequency of outbursts.

During week one J. B. was asked to evaluate his biological responses to create a baseline of general emotional regulation(fig. 1; control week). This was to ascertain the degree of

self-awareness the client had and would this be different to, in this case, week five. Furthermore, the results should also show where the self-regulation methodologies began to impact.

Results

The data was subject to a paired-samples analysis and a subsequent Pearson’s r correlation matrix. The results show that after four weeks participation there have been significant anger/frustration reductions in the morning (t(6)=4.929, p<.003)), the afternoon (t(6)= 4.767, p<.003) and evening (t(6)= 4.443, p<.004)) from that of week one. Even as early as the morning of week two changes where evident (t(6)= 2.384, p<.05)) compared to how he felt in the morning of week one. These significantly different results continued into weekthree and four were all results range between a p<.006 and p<.001 level of significance.

Control week

Week 1

Week 2

Week 3

Week 4

0 10 20 30 40 50 60 70

Feeling thermometer ratings

EveningAfternoonMorning

Feeling rating C0

Fig. 1 The chart is showing the average temperature ratings during the control week and intervention weeks in the mornings, afternoons and evenings.

The Pearson’s r analysis was conducted to illustrate the impact of the united delivery format and consistency/perseverance in the positive emotional regulation of the client. The impact will be shown in the correlations between the mornings, afternoons and evenings from the five weeks of data collection.

The results show that during week two there is a strong relationship in emotional regulation in the mornings (r = .882; r2 = 78%), afternoons (r = .880; r2 = 77%) and evenings(r = .832; r2 = 69%) of week two. There is also a strong correlation between the mornings and afternoons of week three (r = .905; r2 = 82%)

Similarly, there exists a strong correlation between the mornings (r = .854; r2 = 73%) and afternoons (r= .772; r2 = 59%) of week four and the evenings of week five. Furthermore, the consistency in emotional regulation was also evident during the afternoons and evenings of week five (r = .825; r2 =68%).

Then the correlations between week one and week five ratings were analysed and there were none (p= NS). Interestingly, the majority of the results were either entering, or, had entered a potential negative relationship state, although, none of these were approaching significance. However, this observable negative state is what you would expect to see after four weeks.