Running head: THE SCARE PROGRAM; AN INTEGRATIVE APPROACH

The SCARE Program; An Integrative Approach Kimberly Barber, Jaylene Bettcher, Marsha Hamilton, Mindy Seto, and Rhonda Williams APSY 674 Dr. Barb Bryden April 12, 2012

THE SCARE PROGRAM; AN INTEGRATIVE APPROACH The SCARE Program; An Integrative Approach Background Information (Jaylene Bettcher) Background information was obtained from an interview with Joey Harper and his mother, Carol Young. Additional information was obtained from copies of his previous report cards and a previous psychoeducational assessment. Joey is 14-years old and currently lives with his mother and her new boyfriend, Brian, in Calgary, Alberta. Although Joey has no biological siblings, Brians three young children, recently moved in with them. Joey is not fond of this new change, causing some tension within the household. Ms. Young has been separated from Joeys father, Jeff Harper, for nearly four years. Mr. Harper lives in Toronto, Ontario, with his new wife who is expecting a baby. Joey does not speak highly of his father as he feels that he abandoned him, and since the divorce they have only seen each other five times. Ms. Young is currently unemployed, as she does not have her high school diploma and finds it challenging to find a stable and well paying job. Brian currently works as a truck driver, and although he provides financial assistance for Ms. Harper, he works long hours and is only home on weekends. Because of financial difficulties, Joey was unable to continue with competitive hockey, which he excelled at and referred to as his passion. Developmental and Medical History Pregnancy and birth were unremarkable. Although Ms. Young could not recall the exact time that Joey achieved his developmental milestones, she reported that she does not remember him being delayed and that his doctor had no concerns. When Joey was 7-years old, his pediatrician diagnosed him with Attention-Deficit/Hyperactivity Disorder, Combined Type. Ms. Young and Mr. Harper felt that Joey was too young for medication, and throughout the years

THE SCARE PROGRAM; AN INTEGRATIVE APPROACH they continued to refrain from it. Concerns regarding Joeys hearing and vision were not reported. Educational Information Joey is currently in grade 8 at St. Abracadabras Middle School. According to Ms. Young, Joey has been experiencing difficulties in school since grade 2. His teachers have reported academic concerns, specifically in the areas of math and writing. A recent psychoeducational assessment indicated that Joeys math skills are at a grade-3 level and his writing skills are at a grade-4 level, despite Average cognitive abilities. In grade 6 Joey took part in a Success Math Program at his school, however, he was removed from this program after a physical altercation with a peer. Previous report cards indicate that Joey has difficulties attending to and respecting his teachers, as he is often argumentative and foul-mouthed. Joey reported that he does not enjoy school and that he often skips classes. He further acknowledged that he does not get along with many of his teachers as they are stupid and out to get him. Ms. Young reported that Joey does not have many friends at school, and according to his teachers, Joey frequently belittles his classmates and is occasionally physically aggressive towards them. Ms. Young explained that Joey had a best friend; however, they are no longer friends because Joey stole numerous valued items from him. Joey reported that his peers provoke him, and that he spends the majority of his school day in the principals office because of his rash behaviour. Present Personality and Behaviours Ms. Young described Joey as a defiant and emotional young man who is both smart and witty. She reported that Joey does not follow her household rules (e.g., curfew, being respectful to Brian and the kids), and that he constantly has an excuse for his actions. At home, Joey

THE SCARE PROGRAM; AN INTEGRATIVE APPROACH spends the majority of his time playing violent video games, despite his mothers wishes to participate in family activities (e.g., supper, games night, movies). Joey also stated that he enjoys hanging out at the skate park with some older friends; however, Ms. Young explained that he is no longer able to do so after he was caught spray painting houses and smoking marijuana. Ms. Young reported that she and Brian are unable to control Joey, and she fears that without an intervention he will soon face criminal charges. Goals and Target Behaviours (Jaylene Bettcher) Attention-deficit hyperactivity disorder (ADHD) is characterized by problems with attention, impulsivity, and hyperactivity, and is often found to co-occur with oppositional defiant disorder (ODD), whereby youth exhibit negative, hostile, and defiant behaviour (Linseisen, 2008). According to Marshal and Molina (2006), ADHD and ODD symptoms place youth at greater risk for academic failure, social isolation, and affiliation with deviant peer groups. Furthermore, these symptoms often have negative implications in the home setting; presenting parenting challenges and strain on the family system (Teasley, 2008). Seeing as Joey has been diagnosed with ADHD and displays many externalizing behaviours, our intervention aims to target self-regulation and anger and aggression, as well as appropriate familial interactions. In accordance with Barkley (1997), ADHD is a disorder of self-regulation in that individuals with ADHD demonstrate impairments in their ability to respond to their environment. Joey has difficulties attending to and respecting his teachers, and consequently he spends the majority of his time outside of the classroom, which is negatively impacting his math and writing skills. DuPaul, Arbolino, and Booster (2009) explain that youth with ADHD who exhibit disruptive behaviours may experience academic deficits, as their behaviour often interferes with classroom activities. Furthermore, Joeys mother reported that he does not have

THE SCARE PROGRAM; AN INTEGRATIVE APPROACH many friends at school, as he frequently engages in inappropriate verbal and physical behaviour. This is consistent with Salmerons (2009) finding that youth with ADHD often display inappropriate classroom behaviours that may peers find both offensive and intolerable. Joeys impulsive behaviour needs to be targeted in both the school and home setting, as Joey needs to consistently learn to monitor, evaluate, and reinforce his own behaviour (DuPaul et al., 2009). Alongside self-regulation, it is imperative that Joey learns how to cope with his anger, which in turn, may decrease his aggressive and defiant behaviour. Joey reported that his peers provoke him, resulting in anger and aggression. Nelson III and Schultz (2009) explicate that the strongest predictor of violence and affiliation with deviant peers groups in adolescence and adulthood is a history of aggressive behaviour as a child. Instead of engaging in positive peer groups and family activities, Joey is associating with older friends who encourage deviant behaviours. Thus, Joeys anger and aggression needs to be targeted in the school, home, and communal setting, as Joey needs to learn how to appropriately deal with his anger and increase his social competence and self-esteem (Nelson III & Schultz, 2009). Student Created Aggression Replacement Education (SCARE) Program (Jaylene Bettcher) The Student Created Aggression Replacement Education (SCARE) program is an evidence-based intervention created to target violence, aggression, and anger from late childhood through to early adolescence (Herrmann & McWhirter, 2003). The SCARE program was developed, in part, by students who are affected by violence, as their formal and informal experiences allowed them to formulate advice and suggestions to deter violence (Herrmann & McWhirter, 2003). In addition, the SCARE program was based on empirical literature of best practices for decreasing violent and aggressive behaviour in both children and adolescents, and it was also formulated on sound theoretical position that adapts a multi-modal approach

THE SCARE PROGRAM; AN INTEGRATIVE APPROACH (Herrmann & McWhirter, 2003). Finally, various empirically based journals have published standardized methodological studies on the efficacy of the SCARE program, making it a leading evidence-based school intervention program (Office of Juvenile Justice and Delinquency Prevention, 2012). SCARE Goals and Target Behaviours (Jaylene Bettcher) The SCARE program was regarded as a suitable intervention for Joey because it is an evidence-based school intervention that targets violence, and anger and aggression through selfregulation (Herrmann & McWhirter, 2003). To ensure consistency throughout our intervention plan it is imperative to define key constructs; namely anger and aggression. According to Nelson III & Schultz (2009) anger may be defined as a subjective emotional state that is often difficult for others to discern, while aggression is an observable behaviour that is typically mediated by anger. The SCARE program targets anger and aggression by educating youth about emotions and alternative coping mechanisms and responses, and by encouraging youth to make sound decisions in adverse situations (Herrmann & McWhirter, 2003). Thus, we aspire to find (postintervention) that Joey will display a significant improvement in his ability to self-regulate and cope with anger and aggression, which may allow him to improve his academic and social skills, and ultimately develop a relationship with his family. Implementation (Marsha Hamilton) Treatment for youth with anger and aggression can be implemented in various contexts, for example, schools, communities, residencies or secure-care institutions (Feindler & Engel, 2011). However, school based interventions are important to reduce or prevent aggressive behaviors since the school setting has the most interpersonal aggression amongst children and the only setting with universal access to children (Wilson & Lipsey, 2007, p.130).

THE SCARE PROGRAM; AN INTEGRATIVE APPROACH "Early adolescence is potentially one of the best times for prevention and intervention targeting at risk youth" (Herrmann & McWhirter, 2003, p.275). The SCARE program focuses on anger management and coping skills beginning in adolescence to young adulthood that are at risk of anger and aggression related problems (p. 276). For instance, a study using the SCARE program, Herrmann and McWhirter (2003) used participants in grades 7 through to 9 who displayed academic, behavioral and disciplinary (p. 279). School personnel were integral in identifying sample population of students that are at risk of aggressive behaviours since these children had school records with their histories of emotional and behavioral problems (Herrmann & McWhirter, 2003). Consequently, SCARE program is an ideal intervention for the case of Joey, since it is school based and aimed at targeting youths at risk for anger and aggression problems in the school setting. Group Intervention To implement the intervention in Joeys school, the SCARE program will utilize theoretical approaches based on cognitive, behavioral and social skills strategies. Wilson and Lipsey (2007) reported that programs may utilize several intervention approaches in the implementation phase, including cognitively oriented programs, behavioural programs, social skills training, and counselling/therapy. In addition, groups will be organized to facilitate the treatment process of the SCARE program at Joeys school. School personnel will be integral in identifying students like Joey who are at risk of anger and aggression, and consequently could benefit from this treatment. The importance of this group treatment was discussed by Franklin, Harris and Allen-Meares (2008). They explained that group treatment can be an effective modality for the youth and schools, because schools have limited resources to provide mental

THE SCARE PROGRAM; AN INTEGRATIVE APPROACH health services and schools provide the peer group interaction that is important to their development (p. 41). Group sessions The SCARE intervention at Joeys school will be organized into 15 sessions. Theoretically, the 15 lessons will be clustered under 3 sections, namely recognizing anger and violence in the community, managing and reducing anger in the self, defining anger and violence in others (Herrmann & McWhirter, 2003, p.277-278). Each section will have a specific objective which targets behavioural and cognitive changes in participants. Recognizing anger and violence in the community. The objectives of this section is to provide clear definition to the youths of anger and violence, and secondly to present the topic in an attractive format so the youths in the group would have an interest in acquiring anger management and coping skills. Therefore for lessons 1 and 2 Joey will learn strategies on recognizing anger and violence, and family/ friend tree. Managing and reducing anger in the self. The objective of this section is to educate the youths on effective prosocial strategies. The theoretical framework of this section is based on Novaco's adaptation of Michenbaum's stress inoculation model. The stress inoculation model is a therapeutic process of learning to manage and respond to stressful life events before it occurs (Herrmann & McWhirter, 2003, p. 277). For lessons 3-7 Joey will be presented with activities to educate them on internal responses to anger, reducing arousal through positive self-statements, systematic deep breathing, progressive relaxation and exercise. Diffusing anger and violence in others.

THE SCARE PROGRAM; AN INTEGRATIVE APPROACH The objective of this section is to give tools to students who are routinely not at risk for violence and aggression, to empower them to manage and diffuse the hostile intentions of others. The theoretical framework of this section is based on eclectic model involving "skills and techniques preventing situations involving anger and violence and promoting peaceful resolutions to handle hostile situations" (p. 277). During lessons 8-15 the group will learn creative alternatives to violence, paraverbal techniques, "I" instead of "you", reflections, proxemics, kinetics, appreciating diversity, and no violence contracting. Booster sessions for SCARE program Booster sessions are proposed by some researchers as valuable in extending positive treatment gains over time, particularly for youth treatment and prevention (Bundy, McWhirter & McWhirter, 2011). Consequently, Bundy et al. designed a study to evaluate the effectiveness of booster sessions on youths that had previously been in the SCARE program. The results of indicated that use of booster session six months after the completion of SCARE program with youth has proven to be effective in maintaining and increasing treatment effects. Therefore, booster sessions has the potential to enhance efficacy of intervention to reduce youth violence and aggression. Therefore to increase efficacy of the intervention with Joey, booster sessions will be arranged for youths that are involved in the group. Group sessions. Booster program will be implemented about six months after the original SCARE program. The sessions will be implemented for five weeks. The five week booster program will utilize some of the original SCARE session themes, but incorporate new activities and additional discussion items. The configuration of the booster program will be to have one session of the booster program taken from part one of the original SCARE program. This session will focus on

THE SCARE PROGRAM; AN INTEGRATIVE APPROACH educating youths on defining anger and aggression. In addition, two sessions will be taken from part two of the original SCARE program, and will teach the youths to reduce anger in the self. Finally, two lessons will be taken from part three of the original SCARE program and youths will focus on learning how to recognize and minimize anger in others. Pre and Post Intervention Assessments (Rhonda Williams) Prior to beginning the SCARE program, a battery of pre-intervention measures will be completed by students, parents and teachers to assess levels of both aggression and anger. The assessment battery will again be administered to all students, teachers and parents involved in the SCARE program upon its completion and statistically evaluated for significance. A follow-up battery of assessments will be conducted after the completion of five booster sessions six months after the initial completion of the SCARE program. Aggression and anger are two distinct constructs, requiring a multi-method, multi-person and multi-setting approach that includes behaviour observation, clinical interview, standardized testing, self-monitoring and ratings forms (Nelson & Schultz, 2009). Parents will be required to complete the Child Behaviour Checklist (CBCL; Achenbach, 2001) to measure aggressive behaviour. The CBCL also provides valuable information regarding attention problems, anxious/depressed, somatic complaints, delinquent rule-breaking behaviour, social problems, thought problems, withdrawal, externalizing and internalizing behaviours. Students will complete the Child Behaviour Checklist Youth Self-Report (CBCL-YSR; Achenbach, 2001) while teachers will also complete the Child Behaviour Checklist Teachers Report Form (CBCL-TRF; Achenbach, 2001) measuring the same constructs listed above. This will provide an overall emotional and behavioural assessment with specific measures focused on aggression. The psychometric properties of the CBCL are strong with a test-retest value ranging from .95 to

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH 1.00, inter-rater reliability ranging from .93 to .96 and a range of internal consistency from .78 to .97. Criterion validity was also addressed and found to be acceptable (Achenbach, 2001). Other aggression and anger measures to be completed by each student include the Aggression Questionnaire (AQ; Buss & Perry, 1992), Multidimensional School Anger Inventory (MSAI; Smith, Furlong, Bates & Laughlin, 1998) and a hassle log (Feindler & Engel, 2011). The AQ is a 29 item self-report questionnaire designed to measure four dispositional subtraits of physical and verbal aggression (involves hurting or harming others), anger (emotional or affective component to behaviour) and hostility (feelings of ill will and injustice component to cognition; Buss & Perry, 1992; Bryant & Smith, 2001). The range of internal consistency reliability coefficients for the four AQ subscales range from .79 to .93 for Physical Aggression, .52 to .64 for Verbal Aggression, .58 to .71 for Anger and .6 to .68 for hostility (Buss & Perry, 1992). The MSAI is a 36 item self-report designed to measure the emotional affect, behavioural expression and cognitive hostility-cynicism components of anger in adolescents (Smith et al., 1998). Specifically scores for Anger Experience, Hostility, Destructive Expression and Positive Coping subtests are derived. The range of internal consistency for the MSAI ranges from .67 to .84 with test-retest range of .5 to .62. The final measure that will be used by students is the completion of an individual hassle log. The hassle log is a self-monitoring tool that can be used to quantify a number of variables associated with both antecedent and consequence conditions surrounding incidents of aggression and/or aggression. This important clinical and educational tool allows the school psychologist to help determine individual triggers, setting events, responses and self-evaluations. This can also provide real-life examples to re-enact in role plays during SCARE program sessions with peers, teach self-observational and awareness skills and self-reinforcement for anger situations that were well managed (Feindler & Engel, 2011).

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH In addition to the CBCL, parents will be participate in a clinical interview with the school psychologist facilitating the SCARE program to discuss the students behavioural and emotional functioning levels, focusing on anger and aggression concepts. Teachers will also be given a tracking form to complete to record incidents of aggression or angry outbursts within the classroom on a daily basis. Tracking forms will be collected weekly by the school psychologist and content will be incorporated into role plays and discussions during SCARE program sessions. Referrals to the office for disciplinary measures will also be tracked by the students teachers through the schools computerized communication activity log program. Ensure Treatment Integrity (Mindy Seto) To establish the treatment integrity, several actions were taken. First, a checklist will be developed before the implementation of the SCARE program at Joeys school to include all the components of the treatment fidelity such as those related to the design of the implementation, the training of the staff and the delivery of the intervention. Second, training sessions for the staff at Joeys school will be conducted to assure that staff understand the program and those delivering the interventions are proficient in the administration procedure. Specifically, the training will include an overall summary of the SCARE program and an overview of each of the SCARE lessons and sessions. Furthermore, there will be opportunities to practice session administrations and a time for questioning. Thirdly, the facilitators will be provided with written training manuals as guidelines to follow in implementing the program. Fourthly, during the program implementation period, there will be a weekly review of the facilitators logbooks, brief weekly meetings and longer monthly meetings to ensure the intervention is consistent with the program goals and that the activities conducted comply with the SCARE procedures such as the set number sessions, the timing of the lessons and the materials used to deliver the lessons.

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH Emails will also be sent out to inform staff the events taking place and the progress of the program. Fifthly, specialists knowledgeable of the SCARE program will conduct regular observation sessions and random spot checks during the program implementation to ensure that interventions conducted adhere to the designated protocol. Sixthly, feedback from the specialists will be provided to program administrators and the staff delivering the program immediately to avoid miscommunication and intervention integrity. Finally, evaluations using checklists and rating scales will be given to the staff, the students and the parents to gather data on the effectiveness of the intervention. Classroom-based Strategies (Mindy Seto) Researchers, school psychologists and teachers seem to agree that the combination of medication and behavioral interventions is most likely to produce the best improvement in ADHD learners academic performance and social skills (DuPaul & White, 2006; Zentall, 2005). Successful classroom-based strategies to support Joey should begin with the formation of an IPP (Individualized Program Plan) identifying when and how Joey becomes inattentive, impulsive and hyperactive and then selecting the best educational practices with 1) academic instruction, 2) behavioral interventions and 3) classroom accommodations that are appropriate to meet Joeys needs at school. Here are some classroom-based strategies teachers can use to support Joey. Academic Instruction Examples of academic strategies include modifications to teacher instruction, setting up peer tutoring, using peer-mediated strategies and employing computer-assisted instruction (DuPaul & Weyandt, 2006; Raggi & Chronis, 2006). Because ADHD students can get bored

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH easily, finding ways to present lessons to Joey can help him to stay focused and become more interested in learning. Use PowerPoint presentations and computer-assisted instruction. The use of technology will make the instruction more visual and it will allow Joey to participate more actively. Use a variety of teaching activities that allow for multi-sensory learning experiences and use interesting pictures and sounds that are relevant to the materials being presented. Adapting these techniques can make the lessons more engaging and help Joey to stay focused. Set learning expectations and encourage Joey to participate in the classroom. Taking parts and participating in classroom activities will help Joey to stay on task. Check on Joeys performance by asking him questions related to the lesson to making sure he has understood the material presented. Break down class work into smaller work units so the tasks are less complicated and more manageable. For example, give Joey one or a few math problem(s) at a time instead of giving him the entire worksheet so he does not get frustrated. Highlight keywords on worksheets in advance before presenting them to Joey will help him to pay attention to the important concepts or instructions. Also, Joey should learn how to highlight important information when reading new materials. Behavioral Interventions Examples of behavioral interventions are teaching choice making, reduction in the size of tasks, active teaching of classroom rules, consequent-based strategies such as using the token reinforcement program where students earn immediate reinforcers, and the teaching of selfmanagement strategies (DuPaul & Weyandt, 2006; Reiber & McLaughlin, 2004).

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH Teach Joey to learn to slow down before he says things that he will later regret and encourage Joey to learn to think before he talks or acts. Rewards or praises should be as immediate as possible. Joey needs to know what are appropriate behaviors and be encouraged to repeat them. Identify the common problematic social issues for Joey, then discuss and help Joey to self explore ways to solve these problems. This will allow Joey to learn problem solving and social skills that may help him to make some friends and build a network of peer support. Form a behavioral plan together with Joey that is workable for both Joey and the classroom teachers. Joey needs to know how to self monitor his behavior and develop skills to exercise self-control. A simple behavioral plan can help set boundaries and guidelines for Joey to follow. Another intervention that can be useful on an individual, classroom or school-wide level is the introduction of 20 minutes of daily physical activity at the beginning of the school day. Engaging in 20 minutes of aerobic activity can have a great impact on overall brain functioning. Specifically, exercise improves learning by improving alertness, attention, cognitive flexibility and motivation. It also prepares and encourages nerve cells to bind to one another which is the cellular basis for creating and storing new information (Ratey & Hagerman, 2008). Because Joey is athletic and enjoys physical activity, this could be motivating and potentially improve his attendance and provide opportunities to engage with teachers and peers in a more prosocial way, creating opportunities for success. Classroom Accommodations Modifying the classroom setting can help students with ADHD to optimize their concentration to learn and prevent them from being distracted and easily bored during a lesson.

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH Furthermore, being disorganized is one of the biggest problems of students with ADHD; therefore, it is also important to make classroom accommodations to help students with ADHD to be organized. Have Joey sit where the teacher can easily keep eye contact with him. It is best to have Joey sit where he can hear and see the directions given and not be distracted. Avoid placing Joey into seats near a hallway, a window or in the back of the room. When giving directions or teaching a lesson, stand close to Joey and also involve Joey as much as possible. For example, when creating a sample problem in math, use Joeys name. Remind Joey the due date for assignments each day and write homework timeline on the board. This strategy will help Joey to be caught up with his homework and not fall behind in submitting his assignments. Break large assignments into smaller sections and assign each section with frequent homework check dates or section due dates for the completion of each smaller component of the assignment. Frequently monitor if Joey is off-task and redirect him back to his work and reward him with an encouragement as soon as he is on-task. Research strongly support the effective use of interventions in the classroom can reduce the academic impairment characteristics and it also suggests that a combination of intervention strategies such as using behavioral and environmental techniques combined with the use of medications is the best or the most effective treatment program for those with ADHD (Goldstein & Naglieri, 2008; Reiber & McLaughlin, 2004). Thus, proper education,

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH accommodations and interventions alongside with the support of medication are the best ways to support ADHD Joey to succeed academically at school and socially. Parent Support and Intervention (Kim Barber) The SCARE program intervention used for Joey targets his oppositional behaviour. The parent/ in-home interventions will focus on Joeys ADHD as well as the attachment issues surrounding the parent-child relationship. Suggested interventions are to be used in combination with the SCARE program. Joey has been previously diagnosed with ADHD- combined type. Due to his age, medication was refused at a previous point in time. Now that Joey has advanced in age, he may be ready to participate in a medication trial. Psychotropic medications have been found to be very effective for ADHD, and could alleviate many of the symptoms he experiences. Using both methylphenidate and amphetamine have shown improvements in ADHD symptoms (Faraone & Buitelaar, 2010), as has atomoxetine (Weiss, Tannock, Kratochvil, Dunn, Velez-Borras, Thomason, Tamura, Kelsey Stevens, and Allen, 2005). A medication trial should be discussed with a physician or psychiatrist and should be chosen based on their professional opinion. The medication trial should then be conducted under their care until an appropriate medication and dosage have been found. Mautone, Lefler, & Power (2011) describe key target interventions to promote overall home and school success in children with ADHD. Strengthening the parent-child relationship and changing behaviour is important. Teaching parents to apply punishment effectively will help this. Supporting children with homework and improving their study skills will encourage success. And finally, changing school behaviour and improving family-school collaboration and problem solving can be essential components as well.

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH Joeys parents may benefit from a parent training program to manage his behaviour. Chronis, Chacko, Fabiano, Wymbs, and Pelham (2004) discuss the behavioural parent training (BPT) model for ADHD and well as ODD/CD. BPT uses social learning principles to teach parents behaviour modification techniques. It has been shown to be very effective with ADHD, ODD and CD (Chronis et al., 2004, Mah & Johnston, 2008). BPT is found to be effective when delivered on an individual basis by a qualified therapist, but the cost-effectiveness is greater when delivered in a group format. BPT can take anywhere from 8 to 16 sessions (Pelham & Fabiano, 2008). A typical BPT curriculum would begin with an overview of the childs disorder, as well as social learning theory and behavioural management principles. A home/school daily report card is then discussed in combination with rewarding home and school behaviour. Parents are then trained how to attend to appropriate behaviour and ignore minor inappropriate behaviour. Giving effective commands and reprimands is taught as well as establishing and enforcing rules. When.then contingencies are discussed as an effective technique. Time-out procedures are taught based on age appropriateness and a home point system (reward and response cost) is discussed. Parents then learn about planning ahead for misbehaviour outside the home and how to enforce contingences when away from home. Different problem solving techniques are gone over with parents for situations that may arise with their child. Finally, the therapist will discuss with the parents how to maintain the program after weekly therapist contact has ended (Chronis et al., 2004). In Joeys situation, attachment issues may also be present. In order to foster positive attachment, parents should respond to acts of cooperation with love, appreciation, emotion, and the need for proximity. When responding to misbehaviour, parents should make efforts to

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH maintain firm, positive attachment while calmly carrying out the consequence to the misbehaviour (Scott & Dadds, 2009). Community Resources (Kim Barber) Joey and his family would benefit from participating in both individual and family therapy. Calgary offers a number of opportunities for counselling. Many of these organizations charge fees based on a sliding scale dependent on household income. If Joeys family cannot afford counselling services, they can use take advantage of this type of fee schedule where families pay what they can, or in some cases, nothing at all. There are a number of counselling programs to choose from in Calgary, such as Calgary Counselling Centre http://www.calgarycounselling.com/counselling.htm, Calgary Family Services http://www.calgaryfamily.org/youthfamily/, and the Calgary Family Therapy Centre http://www.familytherapy.org/. There are also several organizations that offer specialized counselling based on religious affiliation or belief systems such as, Catholic Family Service http://www.cfs-ab.org/counselling-services, Native Counselling Services of Alberta http://www.ncsa.ca/online/, and Jewish Family Service Calgary http://www.jfsc.org/programs__services/counselling/counselling.html. Joeys family may also appreciate assistance from a family support resource as well. The Eastside Family Counselling Centre http://www.woodshomes.ca/index.php?page=eastsidefamily-centre offers walk-in counselling services, no-cost legal advice and outreach services. The North Central Community Resource Centre http://www.weconnectyou.ca/resource_centre/index.htm assists individuals and families in accessing resources in their community by providing information and referrals for basic needs such as food, clothing, housing, employment and transportation.

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH In the past, Joey has benefited from being involved in sports programs, specifically hockey. There are programs within Calgary that provide funding for sports for families that cannot afford the costs involved. This opportunity may be an appropriate outlet for Joey to be involved in an active hobby that also has a social component. The programs that will provide financial aid to families to enroll their children in sports are KidSport Calgary http://www.kidsportcalgary.ca/ and Jumpstart http://jumpstart.canadiantire.ca/. Follow-up (Kim Barber and Rhonda Williams) For Joey and his family, follow-up will be important to be sure he has received appropriate treatment. Either Joeys family physician or psychiatrist will follow up with the medication trial. This will ensure Joey is taking the best medication for his symptoms in the most effective dosage. In order to encourage the continued use of skills learned during the interventions, booster sessions could be offered to Joey and his family. Joey could receive additional sessions of the SCARE curriculum six months after the completion of the program. The booster sessions would consist of five sessions over a five week period, containing five of the original themes that were identified as the most engaging and impactful for the youth (Bundy, McWhirter & McWhirter, 2011). The same assessment battery used in the pre and post-treatment SCARE intervention would be implemented after the completion of the booster sessions and statistically compared to previous results. Joeys parents could receive sessions reviewing the BPT program. The number of BPT booster sessions required would be determined by the success of the initial intervention as well as the improvement in Joeys behaviour and the overall family functioning. To support schools with the implementation and follow up with the Positive Behaviour Support (PBS) intervention, the team should clearly identify target behaviours and interventions.

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH A clear and streamlined data collection process and assessment plan should also be identified to gather and analyze data for future planning for positive supports. To increase fidelity, the PBS team should keep the process of monitoring and evaluating ongoing by reflecting on how the implementation is doing, comparing earlier measures with current data, modify or eliminate what is not working and celebrate and communicate successes with the school and team members. The team should also create a flexible action plan for school change that promotes continuous improvement by developing a core team and assessing the schools culture, strengths and needs. Building staff consensus, choosing a focus, developing action plans, communicating the plan effectively and implement, monitor and evaluate results of the action plan are also important steps. Schools should access the resource from Alberta Education called Supporting Positive Behaviour in Alberta Schools as a guide and support (Alberta Education, 2008). PBS teams could also use of the School-Wide Evaluation Tool (SET) as a fidelity measure to assess the schools implementation of the school-wide positive behaviour support (Vincent, Spaulding & Tobin, 2010). School-wide/Universal Intervention Program (Rhonda Williams) In schools, the key to effective preventative measures is the development of strategies that impact adult behaviour and school environment in a positive way (Scott, Alter, Rosenberg & Borgmeier, 2010). Universal school interventions such as Positive Behaviour Supports (PBS) generally facilitate success for approximately 80% of the student population. The PBS framework provides school staff with effective strategies to improve behavioural outcomes in their school while further facilitating academic and social development in a safe and supportive environment (Alberta Education, 2008). While disruptive student behaviours can negatively impact learning, social climate and personal relationships, PBS is well suited for helping students

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH with emotional and behavioural difficulties adapt their behaviour to general education classrooms so that emotional, social and intellectual growth can occur (Alberta Education, 2008; Hieneman, Dunlap & Kincaid, 2005). The PBS framework facilitates the inclusion of students with emotional and behavioural difficulties by establishing a proactive and solution-oriented approach with consistent expectations and approaches across classrooms and throughout the school. PBS also reduces the systemic strain by allowing more time, energy and resources to address the individual needs of students as they arise (Hieneman et al., 2005). One of the strengths of PBS is its flexibility to include a wide range of interventions to best meet the needs of students on a school-wide, classroom and individual level (Alberta Education, 2008; Scott et al., 2010). The main goal of SWPBS is to change the school environment to increase student exposure to protective factors and reduce exposure to common risk factors (McIntosh et al., 2010, p. 7). School personnel can use several practices to prevent problem behaviour and promote positive school cultures. The focus of the PBS approach is to support students and teachers within the learning environment by establishing, maintaining and reinforcing the positive behaviour of the majority of students by providing clear and consistent school-wide behavioural expectations, also addresses problem behaviours as they arise. Consequences should be fair and predictable and positive reinforcement should be used as frequently as possible to shape desirable behaviour (Alberta Education, 2008; McIntosh et al., 2010; Scott et al., 2010). In addition, modifications to the environment (e.g. hallways, lunch rooms) can be made to reduce opportunities for negative behaviour (McIntosh et al., 2010; Scott et al., 2010). To support students academically, differentiated instruction should be used to increase engagement and create opportunities for success (Alberta Education, 2008; Hieneman et al., 2005; McIntosh et

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH al., 2010). Teaching and reinforcing prosocial behaviour and social skills throughout the school setting allows students the opportunity to practice positive skills with adults and peers within a safe and predictable environment (Alberta Education, 2008; McIntosh et al., 2010). In addition, interventions need to be tracked and assessed for effectiveness, making data-driven decisions and an action plan for school change (Alberta Education, 2008; Scott et al., 2010). The most common methods for collecting data and identifying patterns include interviewing or surveying stakeholders (students, teachers, parents and other relevant individuals), tracking office referral and attendance records and conducting observations across activities, people and times of day to utilize the perspectives of multiple sources (Alberta Education, 2008; Hieneman et al., 2005). Another key component to the PBS framework is the use of building and maintaining interpersonal relationships within the school culture. Positive authentic relationships between students and teachers help to reduce negative behaviours within the school setting. Teachers can initiate and sustain meaningful relationships by exhibiting warmth, caring and trust while directing positive attention towards each student. This strength-based approach and interest into the lives of each student creates a sense of belonging while demonstrating active listening (Alberta Education, 2008; Scott et al., 2010). A comprehensive school-wide PBS approach involves identifying and engaging all participants in a collaborative, stakeholder-driven process which consists of students, teachers, parents, administrators as well as related service providers as part of a collaborative team (Hieneman et al., 2005). Creating a safe and caring environment requires an effectively communicating team that is solution-focused (Alberta Education, 2008). Effective PBS teams are characterized by open, honest and respectful communication, shared goals and responsibilities, a willingness to address conflicts and utilize consensus-based decision making as well as a long

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH term commitment to problem solving and support. Specifically, it is important that teachers are committed to PBS and agree to consistently implement interventions in the same manner across time and across school personnel. This requires the use of simple interventions with effective communication throughout the entire school team in order to create a safe and predictable environment (Scott et al., 2010). In addition, PBS teams often determine and address training and resource needs (reallocation of staff, time, specific resources) to promote sustained behavioural improvement from students (Alberta Education, 2008; Hieneman et al., 2005). Recommended Resources (Rhonda Williams) Individual Resources Because Joey was heavily involved in organized sports and formed friendships with his teammates, several resources can be accessed throughout the city that are free or have subsidized enrollment. Organized sports such as basketball, baseball, football, hockey and soccer can be accessed throughout the city at varying levels of ability and competition (http://www.calgaryarea.com/calgary_basketball.htm). The YMCA also provides memberships at a reduced cost and there are several across the city to access. (http://www.ymcacalgary.org/en/documents/programs/opportunity-fund.pdf). The Calgary Teen Zone (http://www.calgaryteenzone.com/programs.htm) and the Boys and Girls Club also provide a variety of free activities for youth to participate it. This would provide Joey with an opportunity to socialize with his peers in a more positive way. Parent and Family Resources Parent and family resources can provide support through groups for parents, adults and children. The Community Parent Education Program (Cpep) is a resource for families with children from ages five to seventeen years old. Cpep offers parenting skills, youth social skills

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH and problem-solving groups. This resource is free and can be accessed through Hull Child and Family Services. The Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD) organization also provides family resources through information and support for parents, children, and adults in and around the Calgary area, who are affected by and struggle with Attention Deficit Hyperactivity Disorder. This resource has good psycho-education materials for parents and teachers in addition to support meetings for parents. (http://members.shaw.ca/chaddcalgary/). Joeys parents could also access the Parent Support Association (PSA) of Calgary for a results-based parenting program to help parents develop stronger relationships with their teens. The PSA program focuses on establishing mutual respect, taking responsibility and putting issues in perspective for parents of an adolescent (http://www.psa.calgary.ab.ca/). School Resources In order to support Joey in the best way possible, school administration and teachers can access a resource called Individualized Program Planning (Alberta Education, 2006) through the Alberta Education website to provide structure and support for writing meaningful measurable goals to target specific behavioural and academic goals (http://education.alberta.ca/media/511715/ipp.pdf). A trilogy of Positive Behaviour Support (PBS) resources called Supporting Positive Behaviour in Alberta Schools (Alberta Education, 2008) provides excellent information and templates to implement PBS within a school setting and focuses on school-wide, classroom and intensive individualized interventions. These resources can be ordered or accessed through the Learn Alberta website for teachers and is available in Alberta only

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH (http://www.learnalberta.ca/Search.aspx?lang=en&search=supporting+positive+behaviour&grad e=&subject=&audience=&language=&format=&type= ). Another positive resource for schools that can be implemented on an individual, classroom or school level is the engagement in daily physical activity. Twenty minutes of daily aerobic which increases the heart rate of 85% has been found to increase brain function and overall physical fitness (Ratey & Hagerman, 2008). In the book Spark: The Revolutionary New Science of Exercise and the Brain, Ratey and Hagerman (2008) describe how exercise can be a positive influence and an agent for change in overall functioning, learning, stress, anxiety, depression, attention deficit hyperactivity disorder, additions, hormonal changes and aging.

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH References Achenbach, Thomas M. & Rescorla, Leslie A. (2001). Manual for the ASEBA School-Age Forms & Profiles. Burlington, VT: University of Vermont , Research Center for Children, Youth, & Families. Alberta Education (2008). Supporting positive behaviour in alberta schools: A classroom approach. Retrieved from http://www.learnalberta.ca/Search.aspx?lang=en& search = supporting+positive+behaviour&grade=&subject= Alberta Education (2008). Supporting positive behaviour in alberta schools: An intensive individualized approach. Retrieved from http://www.learnaberta.ca/Search.aspx?lang= en&search=supporting+positive+behaviour&grade=&subject= Alberta Education (2008). Supporting positive behaviour in alberta schools: A school-wide approach. Retrieved from http://www.learnalberta.ca/Search.aspx?lang=en& search = supporting+positive+behaviour&grade=&subject= August, G. J., Winters, K. C., Realmuto, G. M., Fanhorst, T., Botzet, A., & Lee, S. (2006). Prospective study of adolescent drug use among community samples of ADHD and NonADHD participants. American Academy of Child and Adolescent Psychiatry, 45, 824832. doi:10.1097/01.chi.0000219831.16226.f8 Barkley, R. A (1997). ADHD and the nature of self-control. New York: Guilford Press. Bryant, F. B. & Smith, B. D. (2001). Refining the architecture of aggression: A measurement model for the Buss-Perry aggression questionnaire. Journal of Research in Personality, 35, 138-167. doi:10.1006/jrpe.2000.2302 Buss, A.H. & Perry, M. (1992). The aggression questionnaire. Journal of Personality and Social Psychology, 63, 452-459. doi: 10.1037/0022-3514.63.3.452

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH Hieneman, M., Dunlap, G. & Kincaid, D. (2005). Positive support strategies for students with behavioral disorders in general education settings. Psychology in Schools, 42(8), 779794. doi:10.1002/pits.20112 Linseisen, T. (2008). Effective interventions for youth with oppositional defiant disorder. In C. Franklin, M. B. Harris, & P. Allen-Meares (Eds.). The school practitioners concise companion to mental health (pp. 35-50). New York, NY: Oxford University Press. Mah, J. W. T., & Johnston, C. (2008). Parental social cognitions: Considerations in the acceptability of and engagement in behavioral parent training. Clinical Child and Family Psychology Review, 11, 218-236. doi: 10.1007/s10567-008-0038-8 Marshal, M. P., & Molina, B. S. (2006). Antisocial behaviors moderate the deviant peer pathway to substance use in children with ADHD. Journal of Clinical Child and Adolescent Psychology, 35, 216-226. doi:10.1207/s15374424jccp3502_5 Mautone, J. A., Lefler, E. K., & Power, T. J. (2011). Promoting family and school success for children with ADHD: Strengthening relationships while building skills. Theory into Practice, 50, 43-51. doi: 10.1080/00405841.2011.534937 McIntosh, K., Filter, K. J., Bennett, J. L., Ryan, C & Sugia, G. (2010). Principles of sustainable prevention: Designing scale-up of school-wide positive behaviour support to promote durable systems. Psychology in Schools, 47(1), 5-21. doi: 10.1002/pits20448 Nelson III, W. M. & Schultz, J. R. (2009). Managing anger and aggression in students with externalizing behavior problems: Focus on exemplary programs. Mayer, M. J., Van Acker, R., Lochman, J. E. & Gresham, F. M. (Eds.), Cognitive-Behavioural Interventions for Emotional and Behavioral Disorders: School-Based Practice (pp. 111142). New York, New York: The Guilford Press.

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH Office of Juvenile Justice and Delinquency Prevention (2012). Prevention: SCARE program. Retrieved from http://www.ojjdp.gov/mpg/SCARE%20Program-MPGProgramDetail419.aspx Pelham, W. E., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for attentiondeficit/ hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 37(1), 184-214. doi: 10.1080/15374410701818681 Raggi, V. L., & Chronis, A. M. (2006). Interventions to address the academic impairment of children and adolescents with ADHD. Clinical Child and Family Psychology Review, 9 (2), 85-111. http://dx.doi.org.ezproxy.lib.ucalgary.ca/10.1007/s10567-006-0006-0 Ratey, J. J. & Hagerman, E. (2008). Spark : The revolutionary new science of exercise and the brain. New York, NY : Little, Brown and Company. Reiber, C., & McLaughlin, T.F. (2004). Classroom interventions: Methods to improve academic performance and classroom behavior for students with Attention-Deficit/Hyperactivity Disorder. International Journal of Special Education, 19 (1), 1-13. http://www.eric.ed.gov/contentdelivery/servlet/ERICServlet?accno=EJ852038 Salmeron, P. A. (2009). Childhood and adolescent attention-deficit hyperactivity disorder: Diagnosis, clinical practice guidelines, and social implications. Journal of the American Academy of Nurse Practitioners, 21, 488-497. doi:10.1111/j.1745-7599.2009.00438.x Scott, S., & Dadds, M. R. (2009). Practitioner review: When parent training doesnt work: Theory- driven clinical strategies. Journal of Child Psychology and Psychiatry, 50 (12), 1441-1450. doi: 10.1111/j.1469-7610.2009.02161.x

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THE SCARE PROGRAM; AN INTEGRATIVE APPROACH Scott, T. M., Alter, P. J., Rosenberg, M. & Borgmeier, C. (2010). Decision-making in secondary and tertiary interventions of school-wide systems of positive behavior support. Education and Treatment of Children 33(4), 513-535. doi: 10.1353/etc.2010.0018 Smith, D. C., Furlong, M., Bates, M. & Laughlin, J. D. (1998). Development of the multidimensional school anger inventory for males. Psychology in the Schools, 35(1), 115. doi: 0033-3085/98/010001-15 Teasley, M. (2008). Effective interventions for students with ADHD. In C. Franklin, M. B. Harris, & P. Allen-Meares (Eds.). The school practitioners concise companion to mental health (pp. 19-34). New York, NY: Oxford University Press. Vincent, C., Spaulding, S. & Tobin, T. J. (2010). A re-examination of the psychometric properties of the school-wide evaluation tool (SET). Journal of Positive Behavior Interventions, 12(3), 161-179. doi:10.1177/1098300709332345 Weiss, M., Tannock, R., Kratochvil, C., Dunn, D., Velez-Borras, J., Thomason, C., Tamura, R., Kelsey, D., Stevens, L., & Allen, A. J. (2005). A randomized, placebo-controlled study of once-daily atomoxetine in the school setting in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 44 (7), 647-655. doi: 10.1097/01.chi.0000163280.47221.c9 Wilson, S.J. & Lipsey, M.W. (2007). School-based interventions for aggressive and disruptive Behavior. Update of a meta-analysis. American Journal of Preventative Medicine, 33(2S). doi: 10.1016/j.amepre.2007.04.011 Zentall, S. (2005). Theory and evidence-based strategies for children with attentional problems. Psychology in the Schools, 42 (8), 821-836. http://dx.doi.org.ezproxy.lib.ucalgary.ca/10.1002/pits.20114

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