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Handouts

The TIP Model Participant Handout is available on the website. It contains an outline of information you will cover during the presentation of each module as well as a “toolkit” section for ongoing use by TFs.

Trainer Notes

The purpose of videos & activities is included in the notes section for the trainer. It is important to understand how every video or activity is designed as a learning anchor & connects to the content in some way.
If any of the embedded videos do not play, you will likely need additional software that will play various file formats. You can Google “K-Lite Codec Pack” & download it for free.
The information in the notes section is meant to give additional content knowledge & guidance for elaborating on the slides. It is not meant to be read entirely verbatim. You will need to read the notes before you present the module & paraphrase the information. This will help demonstrate that you understand the content.
You are also encouraged to use your own experiences & stories to enhance the delivery of information.

Virtual Format

Our recommendation for delivering engaging & interactive training is to use the Zoom platform with access to breakout rooms & annotation. Microsoft Teams has breakout room access but does not have a feature to annotate on predesigned slides. If you must use MS Teams, you can do some of the annotation activities using chat and/or the whiteboard feature.

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What’s Up?�Prevention Planning Method�

Hewitt B. “Rusty” Clark, Ph.D., BCBA Coral Huntsman, LMFT

Wayne Munchel, LCSW

TIP Model Practices for Improving Outcomes with Youth & Young Adults with EBD

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Please click HERE

to be directed to the “Don’t You Just Wish” video

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W

What is your concern? (about RB/RS)

How does RB fit in with future plan/values?

Ask about pros/cons of RB

Talk about options/Elicit Change Talk

See the stage of change

Understand ambivalence

Plan for next steps

H

A

T

S

U

P

Incorporates Motivational Interviewing &

Harm Reduction strategies

Put this in your own words.

WHAT’S UP? - A tailored approach to reducing and eliminating risk behaviors and risky situations among youth and young adults with emotional and behavioral difficulties. This approach is collaborative and seeks to have Y/YA decide if/when change is needed. We support them as they work through the stages of change. WHAT’S UP? incorporates Motivational Interviewing (MI) and harm reduction strategies.

Unlike SODAS and SCORA, this acronym is less of a step-by-step, looping process, and more of a “use-as-needed” approach. It is meant to help the TF stay connected with the concepts of Motivational Interviewing, harm-reduction, person-centered planning, and the TIP Guidelines.

A TF would use this acronym as a guide for prevention planning interventions that would be used based on the needs of the Y/YA, the stage of change, rapport with Y/YA, etc.

Trainer note: You do not need to elaborate on each letter as you will be presenting the details of each letter in later slides.

Supplemental Information

Generally, Prevention Plans should:

Maximize the Y/YA’s input
Maximize use of the Y/YA’s strengths and natural supports, rather than relying on professionals
Place the ambitions and goals of the Y/YA rather than the TF or the program in the forefront
Be well-integrated with the overall strengths-based, person-centered plan

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What is your concern about the RB/RS?

Leave Traditional Approaches in the Past

Use ENGAGERS/OARS & LISTEN!

Resist the Righting Reflex

Seek Understanding & Build the Relationship

Guideline # 1-Engage Young People

Our task is to avoid approaching Y/YA in the typical and traditional way. By showing empathy and allowing the Y/YA to set the pace for addressing risky behavior, we have an opportunity to better understand the them as a whole person.

Main focus of this step: TFs should seek to understand the Y/YA rather than trying to direct or remind them that their behaviors are dangerous. Build the relationship (Guideline #1) with the Y/YA by:

Using OARS
Using info from Strength-Discovery and Futures Planning to enhance engagement
Avoiding the righting reflex
Asking if the Y/YA has concerns about risky behaviors/risky situations rather than directly addressing them before the Y/YA has acknowledged that they exist

Supplemental Information:

The Righting Reflex

This is that strong urge to tell Y/YAs the solution to their problem because we feel we know what would work. It’s that urge to “right” a situation that we feel should be fixed. It is a common response to want to “make things right” when we see a problem. In Motivational Interviewing, the TF does not persuade, cajole, inform, prod, or in any way try to change the Y/YA’s behavior. Change must come from the Y/YA’s intrinsic motivation.

Not resisting the “righting reflex” can set up a dynamic where the TF is arguing for change and the Y/YA is arguing against it. Instead, what is preferred, and what is most likely to receive the desired outcome, is when the Y/YA is verbalizing their own reasons for change that may also be associated with their attitudes, beliefs, and values.

There are times when we witness our youth making choices that we believe are not in their best interests and will not support them in reaching their desired goals. In many cases, it can be extremely challenging to allow these behaviors to continue without wanting to “step in” and help them see a different path. When we, as TFs, want to steer our Y/YA in a direction that we believe will serve them “better” and will reduce any additional suffering or stress, we should recognize the righting reflex at work and resist giving in to it.

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The ENGAGERS

Qualitative Features of Interactions for Engaging Youth & Young Adults

Encourage sharing of thoughts, feelings, & ideas

Neutralize your own judgmental reactions

Gesture with eye-contact, facial expressions, & body language

Ask Open-ended questions

Give Affirmations & descriptive praise

Express empathy, care, & encouragement

Reflect understanding

Summarize & offer assistance

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Can you repeat the part about the stuff where you said all of the things?

OARS

Optional review of OARS if necessary.

If you are not doing the poll below, ask participants to give examples or definitions of each letter and discuss. OARS are part of the ENGAGERS which support the concepts of the “W” in WHAT’S UP?

For virtual format, consider adding a Zoom poll. You can cut and paste the following questions to create a poll for each of the OARS. If you use the “meeting template” feature in Zoom, you will only need to do this once and it will be available for all future trainings.

OARS Review Poll – Create a poll for each and review participant responses. The correct answers are in bold, explanations of answers are in parenthesis.

O - Which is the best open-ended question?

1. Are things going well at school? (yes or no answer)

2. How do you feel about being part of our program? (possible one-word answer or “I don’t know”)

3. What are your thoughts on using the drop-in center?

4. Is there any news on your housing application? (yes or no answer)

5. Has the time you've spent in your new home been good? (yes or no answer)

A - Which is the best affirmation for a youth who passed the GED test?

1. You did a great job!

2. I knew you could do it.

3. You studied regularly for months and kept a positive attitude, great job! (this is the only statement with specific, unarguable facts, and descriptive praise, which defines affirmations)

4. It was a struggle at first, but you got through it.

5. You should be so proud of yourself for passing a very difficult test.

R - Which is the best reflection? Y/YA says: Sometimes they push a little too much in this program. Like I always have to know exactly what my goals are.

1. It's good to have goals even if you feel a little pressure to figure out what they are. (persuasive comment about creating goals rather than just reflecting)

2. Say a little more about feeling pushed into creating goals. (good open-ended request for more information, but no reflection)

3. Sometimes there's a bit too much pressure and you're not always sure what you want.

4. You're feeling pressured about goals, let’s explore what you have so far? (not a bad reflection at first, but launches into a question and action about the very thing the Y/YA feels pressure from, reviewing goals)

S - Which is the best use of summaries?

1. At the end of a session. (good time to use them, but not the best answer)

2. After a long conversation about a particular topic. (good time to use, but not the best answer)

3. As needed throughout the session to check in and keep conversation focused.

4. When the TF needs more control over the conversation. (TF should not control the conversation)

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How does concern (RB/RS) match up w/ �Futures Planning/Goals/Values?

Gently Develop Discrepancies (don’t Confront)

Avoid arguing

Resist the “Righting Reflex”

Guideline #3-Acknowledge & Develop Personal Choice & Social Responsibility

Put this in your own words.

Motivation for change can be enhanced when people perceive discrepancies between their current situation and their hopes for the future. Our task is to help focus our Y/YA's attention on how current behavior differs from behavior necessary to achieve goals .

Gently developing a discrepancy can help them see the conflict between current behavior, personal goals, and values (such as health, family, financial stability, happiness, etc.). Asking how the current behavior matches up with future goals should be genuine and nonconfrontational.

Slide 8-10 are all related to “H” in WHAT’S UP?

It is critical that discrepancies are stated in a non-confrontational, non-judgmental way.

Use the vignettes in the next slide for an activity on developing discrepancies.

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Develop a Discrepancy Example

Darren has been using speed recently and states that he needs it to stay focused because he “has a lot on his plate.” It has made him feel nervous, edgy and quick to anger. He has been getting in a lot of arguments with his girlfriend and mother. Darren currently lives with his mother, but his plan is to get a job, car and move in with his girlfriend. He is very bright, is a good communicator and is likable.

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Develop Discrepancies Vignettes

1. Kris (they, them) discloses that they cut when feeling lonely & afraid. They show multiple superficial cuts & scars on their wrists when asked, some of which look infected. They talk frequently about their desire to become a nurse. They are compassionate & look out for others.

2. Ari is living in transitional housing. Recently she started allowing a few new acquaintances to come over & party. She has had noise complaints & has been warned to respect the other tenants or she will have to leave. Ari wants to find a PT job and regain custody of her infant son. She is very goal-oriented & is good at interviewing.

3. Elvira reports that she stopped her anti-psychotic meds because they were causing weight gain. She was recently hospitalized for a week after she began hearing voices. Before the hospitalization, she had been taking her meds intermittently. Elvira has stated that she wants to be a singer. She has an involved, caring family & gets along with others.

4. Malik mentions that he drinks a lot when he becomes depressed. He says it helps him sleep and relax when he’s around his “noisy” family. Once he obtains employment and saves some money, he desperately wants to get his own apartment and some peace and quiet. Malik is smart, likes to read, and enjoys drawing.

These vignettes are also in the Participant Handout.

Develop Discrepancy Activity (in-person or virtual)

Form pairs & read the vignette together (use breakout rooms for virtual format).
Person 1 – verbalize the discrepancy from the vignette to person 2 as if you are speaking to the youth.
Person 2 does not need to respond. The point of the activity is to practice actually saying a discrepancy out loud. Participants can often identify a discrepancy but have a difficult time saying it the way they would to a Y/YA.
Participants can take turns working through the 4 vignettes.
Ask a few participants to share the discrepancies they developed. Provide constructive feedback and praise for responses accordingly.

Virtual format: Share this screen to the breakout rooms. Alternatively, if you can’t use this feature, you can cut and paste the vignettes below into chat (before you send them to breakout rooms) and/or ask them to take a quick pic of the slide to take into the breakout room. You might need to paste 1 and 2 first, then paste 3 and 4 separately into the chat.

If people struggle to give examples when you process the activity, you will need to give an example. Responses will vary. Sample discrepancies to listen for and/or provide:

1. Wynona, I know you’ve talked about ways in which cutting can help you cope, I also know you want to be a nurse and care for others, what do make of those two things?

2. I know you love hanging out with your friends and having them over, I also know you love your son and want to have him back home. Is there any way that some of your time with friends might affect getting your son back?

3. You’ve explained how your meds are having some negative effects on you and I totally understand your hesitation with taking them. At the same time, I know you really want to develop your singing. What are your thoughts on how these two things might work or not work together?

4. Malik, you’ve said that drinking helps you manage the noise at home a little better, you’ve also said that you can’t wait to get a job and move into your own place. Is there any way you see one getting in the way of the other?

Purpose of activity: To allow participants to practice how they would articulate a discrepancy without sounding judgmental or confrontational.

To cut and paste into chat if needed

1. Wynona discloses that she cuts herself when she feels lonely & afraid. She shows multiple superficial cuts & scars on her wrists when asked, some of which look infected. She talks frequently about her desire to become a nurse. She is a compassionate & looks out for others.

2. Ari is living in transitional housing. Recently she started allowing a few new acquaintances to come over & party. She has had noise complaints & has been warned to respect the other tenants or she will have to leave. Ari wants to find a PT job and regain custody of her infant son. She is very goal-oriented & is good at interviewing.

3. Elvira reports that she stopped her anti-psychotic meds because they were causing weight gain. She was recently hospitalized for a week after she began hearing voices. Before the hospitalization, she had been taking her meds intermittently. Elvira has stated that she wants to be a singer. She has an involved, caring family & gets along with others.

4. Malik mentions that he drinks a lot when he becomes depressed. He says it helps him sleep and relax when he’s around his “noisy” family. Once he obtains employment and saves some money, he desperately wants to get his own apartment and some peace and quiet. Malik is smart, likes to read, and enjoys drawing.

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Ask about good/not so good aspects of the RB

Try to understand the function of the RB

Affirm that continuing the

RB/RS is an Option

(Acceptance is not approval)

Decisional Balance might help with exploring this

The focus of this component is to understand the possible function(s) that a RB or RS is serving for the YA, rather than focusing on an original cause.

By asking about the good things and the not so good things about a RB or RS, the TF starts to get a sense of what the YP might be gaining or jeopardizing through the RB or RS.

It is okay to express empathy and acknowledge how the risky behavior makes sense to the Y/YA (acceptance is not approval).

Rather than focusing on the cause of a behavior, it’s good to know the function of a behavior and how it may or may not benefit the Y/YA.

Optional Discussion Topics:

How might finding out when the RB occurs and does not occur help the TF get a sense of its function?

Similarly, how does knowing with whom the RB is occurring or not occurring help the TF understand its possible function?

How does information of this sort assist the TF in thinking about a possible Option(s) for reducing risk (harm Reduction)?

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To Help Explore Good/Not So Good Aspects “A”

Decisional Balance Tool

Change

No Change

Advantages

Disadvantages

Janis and Mann (1977)

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Talk About Options/Elicit Change Talk

“Only when people feel free to stay the way they are, do they feel free to change” -Unknown

Watch for opportunities to elicit Options

Explore incremental / Harm Reduction changes.

Explore YA’s Advantages & Disadvantages of Options.

Talk About Options

Discussing options that the Y/YA identifies can help combat feelings of hopelessness. Generating options can help the Y/YA develop a mental habit of risk behavior alternatives. It is important for a TF to acknowledge or suggest that changing nothing is an option. We must be willing and ready to accept that the Y/YA may choose to maintain the status quo.

Elicit Change Talk

Change talk in general refers to statements about desire, ability, reasons and need for change. Research shows that change talk is associated with enhanced motivation for change, and motivation is associated with increased likelihood of actual change. This supports the importance of listening for-and eliciting-change talk (Miller & Rollnick, 2013; Moyers et al., 2009).

The next 2 slides continue this step and contain more tools and guidance on how to do this.

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Readiness Ruler:

Help Elicit Change Talk/Lead to Options

Importance of making a change

Willingness to change

Commitment for taking action

Confidence to change/take action

Readiness to change

Avoid asking what it would take to get to a higher number.

Validate by asking why the number isn’t lower.

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Please Click HERE

to be directed the “WHATS UP - Contemplation Stage” video

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Preparation

Contemplation

Precontemplation

Action

See the Stage of Change to Stay Youth Centered

Prochaska &

DiClemente (1984)

Maintenance

Relapse

Ask participants to call out the stages before you show them. This allows for acknowledgement & validation of the experience in the room and helps keep participants engaged. How much time you put into the Stages of Change depends on how knowledgeable the participants are on this concept.

Put this in your own words

One of the best-known approaches to change is the Stages of Change (SOC) model. The SOC model has been found to be an effective aid in understanding how people go through a change in behavior. In this model, change occurs gradually, and relapses are an inevitable part of the process. Recognizing the Y/YA’s SOC helps guide a TF’s application of the WHAT’S UP? process.

Remind participants that, in this step, TFs observe what SOC their Y/YAs are in. Emphasize that these stages are fluid, and it often takes multiple tries before lasting changes are achieved.

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Helpful Support

Not Helpful Support

SOC Type of Support Activity

SOC Activity if time permits (virtual or in-person):

Ask participants to think about something they want to change but haven’t changed yet. This will not be shared.
Next, ask them to think about the stage of change they are in for this behavior. Give them a moment for this.
Ask them to write on scratch paper, post in chat, or annotate the kind of approaches from others that would be helpful/not helpful for them keeping their SOC in mind.
Ask if anyone is willing to share the SOC they are in and the helpful/not helpful approaches.
Again, no one shares their behavior unless they want to.

Purpose of activity: Applying concepts to one’s personal challenges can be a powerful way to connect to this material and help enhance participants’ understanding of how the Stages of Change can drive our approach(es) with Y/YA to truly “meet them where they are at.”

Note: The following 6 slides are optional, and the information is in the Participant Handout. Show participants the breakdown of SOCs only if you feel that they need an additional review/discussion. Be sure to build in time if you choose to review them.

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Pre-Contemplation

Validate lack of readiness for change

Acknowledge decision is theirs

Encourage self-exploration, not action

Establish rapport

Express concern and keep the door open

Educate only w/ permission

No intention of changing behavior

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Contemplation

Normalize Ambivalence

Validate lack of readiness

Help tip decisional balance toward change

Encourage evaluation of pros & cons of change

Listen for & elicit change talk

Aware a problem exists,

no commitment to action

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Preparation

Encourage initial small steps

Clarify goals

Identify and explore possible actions visualize what change would look like

Identify/Enlist social support

Remind about skills/strengths for change

Intent upon taking action

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Action

Bolster self-efficacy

Revisit long-term benefits of change

Identify high-risk situations

Focus on social support

Reinforce Y/YAs reason(s) for change

Acknowledge difficulties in early SOC

Actively making changes

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Maintenance

Reinforce internal rewards

Support lifestyle changes

Affirm the Y/YAs resolve & self-efficacy

Practice new skills

Review long-term goals

Reframe relapse as part of recovery

Sustained change

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Relapse

Fall back into old patterns

of behavior

Normalize & explore recurrence as a learning opportunity

Evaluate triggers

Re-assess motivation & barriers

Commend any willingness to reconsider positive change

Review/revise coping strategies

Maintain supportive contact

Do not confront, criticize or punish

Convey a hopeful vision

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��Understand / Normalize Ambivalence�

Acknowledge Change is Difficult

Reframe Unsuccessful Tries as Common

Express

Encouragement & Hope!!

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Plan next steps

Match step to

Stage of Change

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WHAT’S UP?

WHAT’S UP? Components & Tools

What is your concern about RB/RS? (Use OARS/avoid the righting reflex)

How does RB fit w/future plan/values? (Develop a discrepancy)

Ask about pros/cons of RB (Decisional balance)

Talk about options/elicit change talk (Readiness ruler)

See the stage of change

Understand ambivalence

Plan for next steps

WHAT’S UP? Components Activity (virtual or in-person):

For virtual format you will need to cut and paste the components from this slide (also listed below) before they go into breakout rooms. Once they are in breakout rooms, share the next slide (vignettes) to the rooms. Ask participants to take pics of both slides if you can’t share to the rooms.

Form small groups of 3-5.
Assign one vignette to each group (vignettes are in the Participant Handout for in-person)
Person #1 from the group will role-play the situation in the vignette based on the SOC.
Person #2 will be the TF who talks with person #1 about their situation. Person #2 will use components of WHAT’S UP? based on what they hear from person #1.
Person #3 (scribe) will check off any components/tools (listed on this slide) they notice the TF is using.
Any additional people can separately note the components they notice are being used.
For in-person format, leave this slide up and refer to the Participant Handout for the vignettes.

To cut and paste into chat:

What is your concern about RB/RS? (Use OARS)

How does RB fit w/future plan/values? (Develop a discrepancy)

Ask about pros/cons of RB (Decisional balance)

Talk about options/elicit change talk (Readiness ruler)

See the stage of change

Understand ambivalence

Plan for next steps

Process questions:

What did the TFs do particularly well?
As a TF, what did you find most challenging? E.g., OARS, ENGAGERS, avoiding the Righting Reflex.
As the YP, what did the TFs do that was most helpful?
How was this process similar to or different from how you usually handle RBs with a YP?

Purpose of activity: To allow participants to practice the application of the content of this module.

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WHAT’S UP? Vignettes

1. Kris (they, them) discloses that they cut when feeling lonely & afraid. They show multiple superficial cuts & scars on their wrists when asked, some of which look infected. They talk frequently about their desire to become a nurse. They are compassionate & look out for others. SOC is Contemplative.

2. Ari is living in transitional housing. Recently she started allowing a few new acquaintances to come over & party. She has had noise complaints & has been warned to respect the other tenants or she will have to leave. Ari wants to find a PT job and regain custody of her infant son. She is very goal-oriented & is good at interviewing. SOC is Precontemplative.

3. Elvira reports that she stopped her anti-psychotic meds because they were causing weight gain. She was recently hospitalized for a week after she began hearing voices. Before the hospitalization, she had been taking her meds intermittently. Elvira has stated that she wants to be a singer. She has an involved, caring family & gets along with others. SOC is Preparation.

4. Malik mentions that he drinks a lot when he becomes depressed. He says it helps him sleep and relax when he’s around his “noisy” family. Once he obtains employment and saves some money, he desperately wants to get his own apartment and some peace and quiet. Malik is smart, likes to read, and enjoys drawing. SOC is contemplative.