In just four months, this nine-year-old named Frank has transformed from acting impulsively, to being able maintain self-control and think about what his best action would be when interacting with others on his Home, Classroom, Friendship and Sports Teams. In this blog, Frank's mother shares her gratitude about the positive transformation her son has made since being involved in the Growing G.R.E.E.N. InterActions Program. Therapeutic approaches allowing for that transformation are also explained. The program has taught Frank to Think First before acting so he can think about 1) the Team he is with at the moment, 2) what goals he and the Team might want to accomplish, and 3) what mutually beneficial choices of words and actions he might make. His mother just gave him a "G.R.E.E.N. Action Report" to reinforce him for staying calm and using his words after having to wait for an hour in a doctor's office! We initially contacted Hein SLP regarding their new social communication skills intervention, “The Growing G.R.E.E.N. InterActions Program,” hoping it would help our son Francisco with his social skills challenges. Over the years, we had already tried multiple programs with minimal success; little did we know the immense impact the GREEN program would have on Francisco in just four months. The improvements we see in Francisco have been life changing for our family in such a positive way. We now even have weekly family meetings to discuss the new strategies Frank and I learn every week on our session with Herb. Before the GREEN program, Frank had a tough time taking ownership of his actions and recognizing the impact these had on others. He was not able to communicate well with peers since he would only talk about his preferred topic and would monopolize the conversation to the point that others lost interest in what he was saying. He lacked the flexibility to follow social rules and struggled to participate in group activities and play. He would become frustrated quickly. At this time, his challenges were negatively impacting both his school and family life. Since starting The GREEN program, Francisco has made impressive progress. He is not only able to identify how his words and actions impact how others feel about him but now knows how to transform them positively. His anxiety has decreased, and his behavior has improved since Frank is now able to recognize how he is feeling and express it adequately. He has learned to compromise with others and join both group activities and team sports. Frank no longer monopolizes a conversation but summarizes what he is saying and asks for the input of others. He is even able to engage when the conversation or activity is on a non-preferred topic. I believe the most significant change since he started has been his ability to analyze his actions, how these impacted his “team” and how these may help reach the “team goal.” I know we still have work to do, but Herb Hein and his Green Program have transformed my little boy to the point that other professionals that work with him have noticed the huge change. I am so glad and thankful that there is finally a program that can teach abstract social skills in a very logical and concrete way that makes sense to the brain of a child with ASD. , Karla Maldonado, parent and advocate Learning to Be on a Team and Act G.R.E.E.N. with the InterActive Lesson Book A critical component of Frank's transformation is that he learned that he is not on his own, but is on Teams with others with whom he lives, learns, works, and plays. He has been on a G.R.E.E.N. Team with his mother, together participating in learning lessons and strategies during weekly treatment sessions with me so Frank has had a Team partner at home to support, guide and reinforce his carrying over new ways of thinking and acting "in the moment". During the first two weeks of treatment, his mother read The Guide's Guide which provided her with an understanding of the key concepts of Growing G.R.E.E.N. InterActions® and important considerations for the guiding of program participants. Then, through the "Read and Discuss" sections of the Growing G.R.E.E.N. InterActions InterActive Lesson Book which Frank and his mother read together for "homework", they both developed a clearer understanding of the concepts involved in being on a Team and using their powerful brains to have the awareness of others, the self-control, and the criteria for making mutually beneficial choices in their actions and their words. By completing the "Survey the Scene" pages in the InterActive Lesson Book, they have had the opportunity to analyze the presented scenarios to decide whether the various positive or negative actions or words lead to positive or negative consequences. The focus has been making sure Frank understands the vocabulary involved and the reason why the positive action is a better choice. These analysis exercises have helped guide Frank to make his own best action choices. Learning to Act G.R.E.E.N. Through Explicit Instruction, Modeling and Practice During our G.R.E.E.N. sessions together, Frank has learned many new concepts that now make sense to him through explicit instruction. In addition to learning what it means to act in a thoughtful instead of an impulsive way, Frank has been learning what it means to act G.R.E.E.N. with others: Grateful, Respectful, Empathetic, Easygoing and Navigating. G.R.E.E.N. behavior is explained and G.R.E.E.N. actions and words are modeled. Frank has had the opportunity to act out some basic positive scripts with the program's motivating movie clapboard to help him become increasingly more comfortable in saying things with G.R.E.E.N. words in a G.R.E.E.N. tone of voice. (He has recently been motivated to write his own G.R.E.E.N. Scenes that demonstrated the prosocial concepts he was learning.) Increasing Awareness & Motivation for Acting G.R.E.E.N. Through Token Reinforcement Frank has been reinforced for displaying these prosocial behavior during our sessions by being given tokens on his G.R.E.E.N. Token Tracker. When he shows respectful and cooperative behavior, a token is placed on the Respectful and Easygoing circles. If he shows any kind of coping or navigating behavior, he gets a token placed on his Navigating circle. When he displays any behavior that shows he is caring about the other people on his G.R.E.E.N. Team, he gets a token on the Empathetic circle. When he says "thank you" or otherwise shows that he is grateful for something that happens during the lesson or something that has happened at home or at school, he gets a token on the Grateful circle. After a while, he has learned to independently act in these ways in order to get acknowledged for displaying his Grateful or Respectful or Empathetic or Easygoing or Navigating behavior. After getting all five tokens, he then gets a break to enjoy what he chooses to do for two or three minutes before continuing on with another aspect of our session. Guiding Higher Levels of Self-Control, Verbal Expression for Needs, and Cooperation I started working with Frank on Valentines Day, 2019. Initially, Frank was impulsively saying some rude, disrespectful, or sarcastic things during our sessions. He was told in those moments that there would be another choice of words that would be demonstrating one or more of the G.R.E.E.N. behaviors. The G.R.E.E.N. choice was explained and modeled. When Frank then showed any glimmers of stopping to Think First to then make a better choice for the Team, he was reinforced by being given a token. He began to increasingly self-monitor what he was saying, encouraging me to reinforce his emerging positive behavior. In addition to receiving the tangible tokens (token reinforcement), I provided a lot of verbal praise as eventually he was reinforced by my verbally acknowledging his respectful, empathetic or navigating behavior as much as by my giving him tokens. I made sure to keep using the G.R.E.E.N. Token Tracker as we would work through a segment of our lesson, providing him tokens periodically and then announcing he deserved a break before we moved on to something else. Initially, one of Frank's behaviors that did not show Respectful or Navigating skills was his impulsively going to sit under the table without saying anything, demonstrating that he was not aware how this behavior might be affecting his mother and me while also demonstrating his lack of use of his words to tell if he was overwhelmed by some aspect of the lesson or was feeling something else. Part of our treatment was to encourage him to initially use his words to signal that he felt he needed to take a break, and to briefly wait for permission to take one. Then, he was guided to choose a different spot in the room that would be a more appropriate place for a nine-year-old to take a break rather than under the table. Through this explicit, personalized guidance and reinforcement process, Frank gradually demonstrated a higher level of self-control, more frequent and effective use of his words, and increased tolerance for longer periods of attention and cooperation. Frank's mother reported that he was exhibiting improved behavior at home and in his school due to the development of his self-control, his ability to Think First, and his ability to use his words to express how he felt and what he needed to successfully cope and navigate "in the moment". Developing Self-Monitoring and Goal Setting Behavior with Common Team Goals & Personal Goals One other critically important aspect of Frank's treatment has been the understanding and development of Common Team Goals and Personal Goals. Frank and his mother, father, sister and brother had a family meeting in which Frank and his mother explained what it meant to have Common Team Goals so they could then generate goals that they would all want to achieve. They also developed Home Team Rules to help them achieve their goals. Frank was also guided to develop a Personal Goal that would help him develop his G.R.E.E.N. skills. On April 1st, he and his mother each completed a G.R.E.E.N. Actions Evaluation Chart to get a baseline of how well Frank was demonstrating G.R.E.E.N. behavior. It was determined by both of them that improving Respectful behavior would be what Frank should focus on since he was displaying this only "Half of the Time" instead of "Most of the Time". Frank was guided to develop a Personal Goal to help him in this area. We made sure that Frank's words were being used to describe his Personal Goal so he would have ownership of it. We also knew he would get very frustrated if he felt others were "putting words in his mouth". Frank's Personal Goal was "I consistently show my respect for people who help me." Frank was willing to add the word "consistently" after I explained what that meant and how important it could be. He determined that his baseline was that he showed respect for people who helped him 60% of the time. His mother agreed. By evaluating his level of goal achievement during subsequent treatment sessions, Frank and his mother had the opportunity to periodically stop, think about and discuss how he was doing. During these guided opportunities for self-assessment, Frank was asked to put into words how he was doing. This guidance to establish and review his Personal Goal allowed him to increase his focus on his behavior throughout this time period and assisted him in making overall progress. There were a couple of weeks when his performance dipped, but we were able to talk about what had happened and what could be improved. We discussed that we were all works in progress, able to learn from any mistake we made. Frank learned to accept feedback and use it in future interactions. He self-generated recently that he wanted to take fewer breaks when working with his teachers as this would show more self-control and show more respectful behavior at school! This showed that he is self-generating the process of self-improvement. The following are the comments Frank made regarding how he was doing on his Respectful Personal Goal. His mother also provided some feedback regarding his Respectful, Easygoing and Navigating behavior: 4/15/19 How am I doing? What am I doing well? What can help me do better? Frank answered these questions by saying, "Listen when other people are talking and show them you are paying attention by looking at them." 4/16/19 His mother wrote "Respectful in his classes. Respectful with brother by not waking him up. Dad reports he was very easygoing in the mornings. Keep it up." 4/17/19 His mother wrote- "Respectful-did not wake brother up and easy going with class work and getting ready for school" 4/19/19 His mother wrote-"Very Respectful in baseball game; struggle to keep personal space but was able to turn it around" 4/21/19 His mother wrote-"took turns explaining GREEN program to family; explained and listened to all questions" 5/10/19 -Frank evaluated himself with a significantly lower functioning level of 20% on this date. He said, "I was not feeling well. I was feeling frustrated. I was acting disrespectful. I was under the table even though my teachers said 'please go to a mutually agreeable place for a break!'" 5/13/19- Frank said, "I am respectful. I am taking breaks in an acceptable place." 6/19/19- Frank said, "I am telling how I am and how I am feeling. This keeps me from getting in trouble and I get more help from the teachers." 7/3/19- Frank said, "I am respectful everywhere. It is very uncommon for me to not be respectful. If I need to 'flip the switch', I do it. I should try to take fewer breaks at school." When Frank was asked to make comments about his progress on his Personal Goals, I wrote down what he said instead of having him write down his own thoughts. Since one of his other treatment needs was improving his reading and writing skills, I wanted to separately guide his focus on thinking about and choosing the words for his social emotional behavior goal rather than focusing on the possibly frustrating challenges involved in spelling and writing each of the words. For other treatment activities and for some homework assignments, Frank was encouraged and reinforced for writing out his responses as he developed his skills and tolerance for these tasks that had been extremely frustrating. In addition to talking about how he was doing on his goal, Frank and his mother were asked to evaluate how well he was doing on his goal by writing down a percentage number that they could then transfer to a bar graph progress sheet. There was a column for Frank (Evaluator A) and his mother (Evaluator B). Frank was motivated to improve his performance through this graphing activity. Initially, when Frank was asked what strategies he was using to meet his goal, he said, "belly breathing and counting 1,2,3" which were some of the self-calming strategies he was learning at school. When we were filling out his second goal progress sheet on 5/24/19, and he was asked what strategies he was using to meet his goal, he said, "I calm myself down. I'm expressing my feelings. I get help to solve problems." By learning this variety of strategies, Frank was able to move from a 60% level to a 95% level on his Respectful Personal Goal. Learning To Methodically Make Choices with the Civilized Choice Checker A strategy that helped Frank during one of his more challenging weeks was completing a Civilized Choice Checker. This is one of the Wise Action Tool visual strategies that are part of the Growing G.R.E.E.N. InterActions Program. Together we determined what two choices of behavior would be and which would be better because it showed: 1. It was a logical choice. 2. It was a safe choice. 3. It was a choice that was good for everyone. 4. It was a choice that uses good self-control to meet the goals. Choice A was:
Frank's social emotional transformation has been remarkable. More of Frank's progress on his Respectful Personal Goal and additional goals will be shared in future blogs along with explanation of the treatment strategies used to help guide his emerging G.R.E.E.N. behavior.
I am so proud of Frank and grateful to be on his G.R.E.E.N. Team!
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