The Tarnow Self-Management Approach to Behavioral Change: Building a Bridge to Success by W. Walker Peacock, Psy.D.

Example bf Suggested Target Behaviors Generated By SMART

  • Study space is kept clean and neat
  • Records all important assign-ment details in planner
  • Able to explain how his/her actions affect others
  • Waits until others are finished before talking – permitted one reminder
  • Allows friend to choose activity during playdate
  • Treats parents with respect
  • Able to transition to new situa-tion or task easily

The Self-Management approach to preparing a child for success is like building a bridge. The final goal is to establish a pathway in the brain between two previously disconnected locations. In the case of a bridge, it is a connection between two physical locations; in terms of behaviors, it is the connection between cause and effect.

When constructing our bridge, we don't know how long it needs to be and we don't know how long it will take to get there. We only know we've made the connection when we stop falling off the edge. In other words, we don't know how long it will take the child to learn the desired skills. This is important to remember because behavioral goals, like any goal, should focus less on "success" and more on "progress". A goal of "straight A's" can be overwhelming because success is an all-or-nothing demand. Each day without straight A's may be seen as a failure. It is important to break this long-term goal of "straight A's" down into smaller, short-term goals of "record assignments in planner" and "finishes homework by 7 pm". These smaller goals are less overwhelming, easier to measure, and they provide multiple opportunities for success. Additionally, each short-term success brings us closer to our long-term goal. With this thought in mind, we can begin to see that our bridge (long-term behav-ioral goal) is actually made up of individ-ual bricks (short-term behavioral goal).

Behavioral management plans act as the blueprint for how, where, and when these bricks need to be placed. An effective behavioral management plan will include:

  • Clear directions
  • Small, specific, & scheduled tasks, and
  • Immediate reward for completion of these tasks

With these components in place, behav-ioral management programs provide a detailed outline for: 1) What change needs to be seen, 2) Where these behav-iors need to be seen, 3) When these behaviors need to be seen, and 4) How much reward the child can earn for completion of these behaviors. The reward is a very important componenet of the plan. Research shows that children learn better when they are rewarded for doing the right thing, as opposed to being punished for doing the wrong thing. As such, effective behavioral management plans help to build a behavioral chain: small positive behaviors combined with positive reinforcement lead to complex behaviors driven towards long-term goals.

An effective behavioral blueprint requires people who will act as managers -parents and teachers - who will supervise and reward the child as each brick is put into place. Unlike a structural blueprint, the behavioral blueprint is a fluid design and requires constant evaluation and changes. It is not an easy task, to be firm and flexible at the same time. This is where psychoeducational training is helpful. In addition to teaching caregivers how to design and implement an effective behav-ioral management plan, these trainings serve several functions. The first function is to provide an education about self-management disorders: their neuro-biological roots, symptoms, and effective therapies. This process teaches caregiv-ers, and also helps them to teach the child. A second function of psychoeduca-tional training is to re-introduce the child to parents and teachers. It is important for caregivers to understand that the child is not "lazy, stupid, or crazy". After understanding is established, caregivers can begin to work towards a better understanding of how the child's brain works. Third, training can help parents and teachers focus on positive direction: reward instead of punishment. This allows them to, tell the child "Go!" instead of "No!"

Creating an external source of rules and rewards, combined with the application of this source across multiple settings, is a good start. But it may not be enough. Change is hard and it takes time, effort, and persistence from everyone involved. While parent and teacher training provides education and some preliminary structure, parents and teachers require more support as they encounter the obsta-cles that are common with behavioral plans. These roadblocks often follow a similar course. Plans that do not produce immediate improvement lead to frustra-tion from both parents and teachers. Frustration leads to poor communication within the home, between homes, or between home and school. A breakdown in communication often results in the "blame game", which only contributes to the chaos and takes focus away from effective parenting of the child. Another result of poor communication is that different caregivers have different expec-tations and definitions of "success". These inconsistencies make it difficult to measure progress or enforce conse-quences. The end result of these road-blocks is almost a collective "Why Bother?" from parents, teachers, and children alike.

Our experience at the Tarnow Center has been that most families, despite the best intentions, only follow a behavioral plan for a few weeks before becoming frustrated. These parents then either return to a drug-only treatment or drop out of treatment altogether. Such noncompliance is a serious issue: not only does dropout remove the family from treatment, but parental perception of treatment failure decreases the likelihood that this family will seek treatment in the future. To return to the bridge analogy, these families need a tool to help them be more effective behavioral construction managers. A team at the Center has worked together with a software developer to create this tool: a web-based behavioral management program that acts as surrogate self-manager for the entire family. The program, "SMART Family System", enables therapists and parents to work together to incorporate the principles of SMART (Specific, Measurable, Achiev-able, Rewardable, Trackable) goals. The program starts with a 200-item question-naire, which assesses the child's self-management skills. Responses to this questionnaire then generate a list of sug-gested target behaviors that specifically target the areas where the child's self-management breaks down. Parents and therapists work together to break these target behaviors down into SMART goals that are appropriate for the behavioral plan. SMART encourages families to sign contracts that clearly explain each person's (parents and Achievers) roles and expectations, and provides examples of such contracts online.

SMART includes two methods of positive reinforcement: privileges and rewards. Privileges are things that the Achiever may be accustomed to as part of his or her daily life. Examples of privileges include television time, telephone time, or use of the computer. Using SMART, these privi-leges are now unlocked as the Achiever's positive behaviors help them progress through the level system. Rewards are special treats or activities that would be "above and beyond" what an Achiever would expect on a daily basis. Examples of rewards would be a new video game, a movie night with friends, or a gift card to a favorite store. Rewards can be saved in SMART, and then purchased with tokens or money that the Achiever earns each time he or she completes a daily task.

Similar to training wheels on a bicycle, this model is designed to support the child as he or she practices and learns self-management. The goal being that by the time the child is ready to individuate and leave home, he or she can "ride alone".

A web-based application provides solutions to many of the problems families encounter with behavioral management plans. Parents and children are now able to check off completed behaviors together, and the computer provides instant feedback to the child about current number of tokens, current level, and current privileges. Target behaviors are entered into the program, where they can easily be broken down and edited in order to establish specific guidelines towards self-management. Online access opens up communication with divorced or traveling parents, and allows other significant caregivers like teachers and grandparents to have access to clear expectations and definitions for success. Finding the appropriate balance between challenge and reward will always involve a learning curve, but the computer makes it easier by maintaining the structure of the plan while individual variables such as tokens, points, or levels are adjusted. Finally, complex calcula-tions, storage of successful (and unsuc-cessful) plans, and detailed charts are all managed within the computer, taking care of the organization and tedious paperwork that so often send behavioral plans out the door.

Having a web-based tool like SMART helps us to resolve many of the difficul-ties inherent in starting and maintaining a behavioral management program. However, just as any tool requires a skilled hand in order to be effective, SMART requires a persistent family. A concern for many of our families is that the child and at least one of the parents struggle with self-management skills. Monitoring behaviors, calculating and giving rewards, and enforcing consequences are not immediately rewarding, making it less likely that parents who have their own self-management difficulties will stick with the plan once the novelty has worn off.

This is where the Self-Management model provides the final layer necessary to complete our behavioral bridge. One of the most important skills that we teach at the Tarnow Center is persistence. We provide this skill through family support sessions with a trained therapist. In the early stages, these sessions serve to provide training, structure, and encour-agement as the parents start to introduce a behavioral plan. Early sessions also help to support the parents, reducing the risk of dropout. As the child progresses through each developmental stage of self-management, ongoing support sessions help parents to redefine and update goals. The experience at the Center is that this practice helps parents develop the skill to use this technique as their child pro-gresses through each developmental stage.

We have been working with parents individu-ally since SMART was released in Novem-ber, and this summer we will be offering educational support sessions in a group format. Many of the parents we see have given us excellent ideas and feedback, and the groups were designed so that parents can share this creativity directly with each other. SMART groups will be available weekly on an "as- needed" basis. Parents can sign up for a group whenever they feel like they need to check in and get some support. For more information about how to get started with SMART or how to get involved with our summer groups, contact your clinician or call 713-621-9107 (ext. 253).