Monday, June 28, 2010

Social Skills Training with Children and Adolescents: Interview with Craig LeCroy, Ph.D.

[Episode 60]Today’s Social Work Podcast is on social skills training with children and adolescents. My guest, Craig Winston LeCroy defines social skills as “a complex set of skills that facilitate the successful interactions between peers, parents, teachers, and other adults” (LeCroy, 2009, 653). Social skills include everything from dress and behavior codes, to rules about what, when, and how to say or not to say something. Social skills training is a form of behavior therapy, and as such focuses on behaviors, rather than thoughts or feelings, as the targets for change. Traditional behavior modification is often thought of in terms of task completion, for example, using star charts to get kids to clean their rooms or do homework. But in social skills training, behavior modification principles are used to teach people skills that help them to be successful in social situations.

Download MP3 [28:42]


I encountered an example of social skills training last week with my 2 1/2-year-old daughter. My daughter’s daycare is really good about letting us know what the kids did during the day. My wife and I often use that information as the basis for conversations with our daughter. During dinner, we’ll ask questions like, “Did anyone plant flowers today?” to which my daughter has typically has yelled out an enthusiastic, “me!” Last week we were playing this game and I asked, “Did anyone pretend to be a train today?” For the first time since she could talk, my daughter sat there in silence. Was she ignoring my question? No. She was answering my question non-verbally. She was raising her hand. My wife and I were shocked. You’re probably not shocked to learn that at home, my wife and I don’t raise our hands in response to questions. So, who is teaching her to raise her hand? The next day, I went to pick her up from preschool, a classroom that she transitioned into about three weeks ago. The class was sitting in a circle and her teacher was asking the class questions. My daughter and her little friends were all answering by raising their hands. Clearly, this is where she had learned this very specific social skill – that you answer questions by raising your hand, not by shouting. I don’t know how her teacher did it, but I suspect that she used basic behavior modification strategies such as explaining the new behavior, modeling it, and consistently reinforcing it by rewarding those who did it, and punishing (either by calling out or ignoring) those who did not. I also suspect that my daughter learned by watching her older classmates do it. While part of me was sad to see that my daughter’s enthusiastic “me” had been converted into a very calm, silent, and socially acceptable raised hand, another part of me understood that becoming Horshack from Welcome Back Kotter was not in her best interest.

Now, I can tell you that when I was working with kids who were getting expelled for talking back to their teachers, arrested for provoking the cops, or getting beaten up because they managed to say exactly the wrong thing to the wrong person, hearing a parental anecdote about a toddler raising her hand would have left me wanting just a little bit more. So I asked one of social work’s leading experts, Craig Winston LeCroy, professor of social work at Arizona State University, to talk with us about social skills training for children and adolescents. Professor LeCroy has developed and tested social skills prevention and intervention programs, including a social skills-based prevention program for adolescent girls (“Empowering Adolescent Girls”), a social skills program for training home visitors (LeCroy & Whitaker, 2005), and an empirically based treatment manual outlining a social skills program for middle school students (LeCroy, 2008). In today’s interview, Craig defines social skills training and emphasizes fit between social skills training and the ecological and strengths orientation of social work. He talks about the how social workers can effectively train youth in social skills, giving particular emphasis to the concepts of overlearning, role-playing and modeling. He talks about providing skills training in groups, as well as an alternative to traditional expressive play therapy - individual child skill therapy. Craig emphasizes that successful social skills training requires knowledge of specific situations and can, therefore, be very culturally responsive. He talks about how early social skills training programs focused on juvenile delinquency, and discusses some of the existing evidence, particularly around modeling, to support social skills training as an effective intervention. Craig talks about his current research on using social skills in a universal prevention program with adolescent girls called “Empowering Adolescent Girls.” We finish our conversation with a discussion of resources around social skills training.

Interview questions:
  • What is social skills training?
  • Who are some of the folks that it is used with – who are the target populations?
  • Could you give some examples of what it is and how it’s done?
  • Are the skills that you work on specific to a given diagnosis, or is it not diagnosis specific?
  • How are social skills taught and how would one go about learning how to teach them?
  • What research is out there that supports social skills training as an effective intervention for working with kids?
  • We’ve talked about some resources in the last couple of minutes – your Handbook of Evidence-Based Treatment Manuals for Children and Adolescents (LeCroy, 2008), and the Empowering Adolescent Girls (LeCroy, 2001) manual through W.W. Norton. Are there other resources that you think listeners should know about?
One quick word about today’s social work podcast: I recorded it using a Zoom H2 recorder on location at the Society for Social Work and Research (SSWR) annual conference. If you listen closely you can hear the sounds of San Francisco in the background: a clock chiming, busses loading and unloading passengers, and even some pigeons congregating outside of the interview room. They don’t detract from the interview, but I wanted to give fair warning in case you were listening to this podcast anywhere were those sounds might be cause for alarm.

So, without further ado, on to Episode 60 of the Social Work Podcast, Social Skills Training with Children and Adolescents: Interview with Craig LeCroy, Ph.D.

Download MP3 [28:42]



Bio

Craig Winston LeCroy, Ph.d. is Professor of Social Work at Arizona State University. He is the author of over 100 scholarly publications including 10 previous books. Professor LeCroy has developed and tested social skills interventions in both prevention and intervention programs. For example, he developed a social skills based prevention program for adolescent girls (LeCroy, Empowering adolescent girls, W. W. Norton), a social skills program for training home visitors (LeCroy & Whitaker, 2005), and developed an empirically based treatment manual outlining a social skills program for middle school students (Social Skills Training in LeCroy, Handbook of Evidence Based Treatment Manuals, Oxford University Press). Professor LeCroy has directed numerous child and adolescent projects including an NIMH Training Grant, a substance abuse prevention grant, and a universal prevention program for adolescent girls. He is currently directing an evaluation project of home visitation services for at-risk families

Contact
Craig Winston LeCroy, Ph.D.
Arizona State University
School of Social Work Tucson Component
340 N. Commerce Park Loop Suite
250 Tucson, AZ 85745
office (520) 884-5507 xt. 15
fax (520) 884-5949
craig.lecroy@asu.edu
http://ssw.asu.edu/portal/about-us/faculty-staff/faculty-profiles/craig-w-lecroy  

Transcript

Interview
[06:09]
Jonathan Singer:  So Craig, thanks so much for being here today and talking with us about Social Skills Training. First question: What is Social Skills Training?

Craig LeCroy:  Well, thanks for inviting me.  Social Skills Training is a strategy that has been around for a long time that focuses on teaching individuals very explicit new skills. And it’s a behavioral approach. So the very fundamental assumption behind social skills training is that behavior and skills are pre-eminent and that’s what we need, and that’s what we need to emphasize to create change. So that’s the big focus: how do we teach somebody some new skills so they can address some difficult situations or environments and make those environments work better for them?

[06:53]
Jonathan Singer: So, who are some of the folks who are targeted? Who is it used with?

Craig LeCroy:  It’s a pretty broad-based program.  It’s been used a lot with adults, in particular seriously mentally ill populations, but also for adults in general. For example, the assertiveness training strategies that have been used are really good, solid programs for adults with a variety of kinds of difficulties and issues that they’re struggling with, is a great example of Social Skills Training. And in my work with children and adolescents, Social Skills Training can be used quite a lot as a fundamental treatment strategy for working with a wide range of issues.

[07:42]
Jonathan Singer: I’m just wondering if you have any examples of what it is and how it’s done.

Craig LeCroy:  One of the things I like to emphasize is how easy it is to use as a strategy; and when I’m teaching my class with Children and Adolescents I try to get my students to try and think about how they can take any particular problem and translate [them] into skills that might be helpful in working with their kids. For example, you could have a kid who’s feeling lonely and isolated. Most of the time what we emphasize are, you know, the negative kinds of things that are going on. The skills approach is to say, “What kinds of skills would help this person function better?” If they’re lonely and isolated, they need to learn better conversational skills, or social greeting skills, or those kinds of things. If you have a kid that has anger problems, obviously anger management skills come to mind. The point is, take any kind of difficulty or problem and think about what kind of skills could I teach this person that would help them function better, to address their difficulty. And so sometimes you can even have a whole template of different kinds of skills that would be quite helpful.

[08:55]
Jonathan Singer: With Social Skills Training – is it specific around a diagnosis, or is it not related to specific diagnoses?

Craig LeCroy:  Well ultimately, I think it ends up being a little bit of both. Some social skills strategies can be directed towards the kinds of skills that kids need [who] have very specific diagnoses. But it’s also useful for a variety of different kinds of issues as well.

I think the Social Skills Model is the primary strategy behind most prevention programs.  So if you think about prevention programming -- teen sexuality, substance abuse – all of those programs really boil down to good use of skills training. Let’s just take teen sexuality. We know that teens are likely to get into trouble with their sexuality if they don’t have good communication skills. Communicating clearly with somebody about sex is very important. We know for example that lots of girls get pressured into having sex when they don’t feel they’re ready for it. Well then obviously that’s a situation for learning assertive skills and refusal skills.

So it becomes really, I think, quite predominant in prevention; and it’s one of the reasons I like to emphasize Social Skills Training in my class, because a lot of social workers are engaged in prevention strategies. And so I feel they should really know this strategy.

[10:25]
Jonathan Singer: So it sounds like, especially for folks who work with children and adolescents, that this is something key that everybody should really know, and know how to do it.

Craig LeCroy:  Exactly, and your point reminded me (with the diagnoses), a good example is with ADHD. They’ve found that Social Skills Training (Henshaw’s done a lot of work on this), where that’s a really good population where you can do some really specific Social Skills Training, because you take kids who have ADHD – they lack planning skills; they lack organizational skills. Helping them get planful and organized is really important for them to be able to function well.  So even if you’re doing other kinds of treatment strategies (let’s say one of your other treatment strategies is parent management training; you’re working with the parents); it can also be quite helpful to work individually with these kids and help them acquire some of those specific skills. 

It can also be really creative. I’ll give you an example of some creative application, where sometimes I’ll work with individual kids, and I can help them change the way other people respond to them. People don’t often think about this as a strategy. So let’s say you have an ADHD kid in the classroom and he’s having some problematic interactions with the teacher or he has a personality style that’s bothersome to the teacher.  Well that might lead the teacher to not attend to him very much. I might teach that kid to reinforce the teacher for responding to him; teach him some skills to say to the teacher, “I really appreciate it when you come over and give me some additional attention and focus on this work, because then I get through it more easily.” So now that kid is actually changing the environment that is problematic for him.

[12:11]
Jonathan Singer: So how are social skills taught, and how would one go about learning how to teach them?

Craig LeCroy: The basic strategy is to take a situation or a context and then break down the skills. So part of the challenge in doing successful social skills training is taking something complicated breaking it down and (as much as you can) in different steps, and then teaching the different steps. The more that you think about human behavior the more you realize how complicated it is. So just like initiating a conversation for an early adolescent, sometimes they’re not very skillful at that—from a Social Skills training point of view, you would break that down into really simple steps. I’m going to go introduce myself. I’m going to ask a question. I’m going to ask another question. And that’s how you actually get a conversation starting. So sometimes it seems overly simple, but the fact is those interactions are really quite complicated. It’s kind of like teaching a husband and wife to engage in more thorough conversation, when sometimes one of the best things you can do is teach one of them to ask two questions, because usually, someone says something, and they just want to talk about what’s going on for them, and they don’t feel very listened to. So this simple skill – ask two questions – becomes actually quite useful and helpful. And it’s quite easy to learn; so that’s a nice piece of it as well.

So in terms of training with social skills, it’s really important to use over-learning: take a particular skill, and make sure the person learns the skill and practice it several times. And that’s one of the things practitioners fail to do. And when you do that, there are a lot of additional benefits. You build a person’s confidence; there’s sense of self-efficacy. So it’s got a lot of these other additional outcomes that I think are really important in the general change process that you’re trying to work towards. That’s really important. Defining the skill very explicitly – breaking it down so that it’s clear when they’re meeting that skill, when they’ve performed mastery of the skill -- that’s important. And of course, general Social Skills Training focuses a lot on modeling and role-playing, so that’s why in groups it’s often best used. And you can develop some models, and that can be helpful.

Now I want to talk a little bit about how you can do this individually as well, because I’ve found that in some clinical situations people end up working with kids individually. And while I do think that is often limited as an intervention because I’m much more oriented to the parent management models and family models but it does sometimes make sense to work individually with kids. And rather than do kind of a traditional play therapy (which I think is not that effective), I prefer to have a focus on child skills therapy, if you will. So, really teaching the kid very specific skills that they’re going to learn and be able to apply in different situations.

[15:28]

And one other thing I wanted to mention about the skills training that I think is useful is that it puts a lot of emphasis on the situational context and understanding the situations. So that I think is a really good part of the model. So when you’re trying to learn about what skills should I teach, you’re also trying to figure out what situations does the person need the skills for. So you’re finding out what the situations are and then you’re matching the skills to those situations. And in that way, sometimes I like the model because it can be very culturally responsive.

I’ll give you an example.  We were doing some research with American Indian youth. So the question there is, what kind of situations do they wind up in where they are more likely to be pressured into getting into drug use (because we were studying prevention).  So we tried to study that by talking to kids, doing focus groups, gathering different ways of gathering data, and construct situations. And then when we construct the situations and give them back to the kids and then get feedback, we kind of get this set of situations that actually becomes very useful for skills training. So with the Native American kids one of the things we found is that they actually get initiated into drug use in family situations. Well that was kind of new to us. And then we said, well we have to come up with situations where there are like, family circumstances and then teach them resistance skills in that context. 

So then it becomes really responsive that way. And that’s one of the great benefits, is trying to figure out what those situations are. The mistake a lot of people make is that they just assume that certain skills are the right skills. But how do you know that? You need to go back and look at the situations. What kinds of skills are the situations demanding? It’s very ecological that way, and so it has a good fit for Social Work because of that.

[17:27]
Jonathan Singer: Talking about Social Skills Training I’m reminded of when I would work as an outpatient therapist. I would have kids who would get into residential treatment. And I might visit them and one of the things kids in residential would always do is they would come up to me, and say, “Hi, my name is ‘so-and-so;’ welcome to our cottage.” And that would be an example of some Social Skills Training. They’ve been taught how to introduce themselves; be polite; shake my hand, and then ask me a question like, “Would you like something to drink?”

Craig LeCroy: Yeah, absolutely, and you know what this reminds me of is that some of the original research that initiated a lot of focus on Social Skills Training was done with juvenile delinquents. And one of the things that they found is that those kids did not have very good skills at interacting with authority figures, like police. And even when they didn’t want to get in trouble, they often ended up getting in trouble, because of the way they interacted with the police.  And so they started developing skills training programs and starting teaching them how to interact with people in authority in ways where they wouldn’t get in trouble. And it was successful. It was a big part of the early initiation of kind of a skills-oriented approach.

[18:52]
Jonathan Singer:   So that brings up the question of what research is out there to support Skills Training as an effective intervention in working with kids?

Craig LeCroy: Yeah, it’s a complicated question, but I think in general there’s quite a lot of research support for Skills Training and we could look to some very specific programs where they’ve been able to show that Skills Training helped individuals learn necessary skills. It is often used a supplement to other treatments, so it’s often not the exclusive strategy in and of itself. And the other thing about the research support I would say is that social skills depends very heavily on modeling, and there’s so much research supporting how modeling influences behavior. So I would draw upon all of that research on modeling and suggest that there’s a lot of foundation for that for Skills Training.

One of the early studies I did was a primary prevention model comparing Social Skills Training and Problem-Solving with early adolescent kids. One of the interesting things I found in that study is that we found good outcomes from Social Skills Training; but when we compared it with Problem Solving Strategies, which are more cognitive (there were also some good outcomes). But what we found is that when we taught kids different ways to handle different situations, their problem-solving skills got better as well. So the Problem-Solving intervention wasn’t any better than the Social Skills intervention. So I think that’s interesting and it suggests that if we keep getting kids to focus on trying new skills in different situations, they can learn how to think about those situations as well.

[20:44]
Jonathan Singer:   That’s really interesting. So you’re saying it’s a complicated question, and the answer is complicated in part because the theoretical foundation for Social Skills Training has a lot of research behind it already, in terms of modeling and in terms of the behavioral techniques, and because it seems to work best when there are discrete situations. It’s not like you could say, “Oh yeah, Social Skills Training is effective…period. You would have to say, “This particular set of skills has been found to work with these kids around this situation.”

Craig LeCroy:  Exactly. And I think a good example of this is to go back to the kid with ADHD. I think it wouldn’t be appropriate to just prescribe Social Skills Training for that kid. It wouldn’t be enough; it wouldn’t work. You really need to have Parent Management Training. You may need to have medication or at least an assessment for that. And then you might want to supplement all of that with some Social Skills Training. And lots of times in treatment, that’s where we always fall short: we offer such a small dose of something and then assume it’s going to have an impact. And what we need lots of times is a big dose of this.

Recently I was reviewing some National Institute of Mental Health grants. And one of the proposals that I really liked was this very, very intensive program. And even though you could see that it would be very hard to implement, the idea made sense. It was for ADHD kids. It included Parent Management Training, included a summer program, included classroom management issues. They were taking all of these strategies and saying, now let’s see if we can have an impact. And for sure one of the limitations would be, how many parents can actually get their kids through all of that? That would still be a significant issue. But, if we could show a big impact with all of those things, it might be interesting. The question they were trying to answer was, can we change these kids’ behavior without medication? And I thought that was a really interesting question, because a lot of parents don’t want to put their kids on medication. And the answer to that question, we didn’t really know – can we provide them with some real benefits if they were that motivated to do all of these things?

[23:13]
Jonathan Singer:   That’s very interesting. Are you working on any projects right now that have to do with Social Skills Training or where you’re using Social Skills Training?

Craig LeCroy:  Yeah, one of the interesting programs I have going now is a prevention program for adolescent girls. And what we did, when we looked at a lot of issues, developmental issues for adolescent girls, you can identify a number of critical things: like gender role identification, body image difficulties. And you know there’s a lot in the popular press, like peer relationships, the whole “mean girls” thing, all of that kind of stuff. And so we looked at all of that and we realized there wasn’t really a prevention program that tried to address all of those things. So we rolled up our sleeves and tried to design a prevention program that was very specific to addressing all of these issues, and we built a lot of skills training into that, and kind of built a universal program, that’s like a 10-session program that we implement in the schools for adolescent girls.

[24:19]
Jonathan Singer:   What’s that program called?

Craig LeCroy:  That’s called the “Empowering Adolescent Girls” program. And a couple years ago we worked on that. We have a book that we published with W.W. Norton that’s called “Empowering Adolescent Girls” and it outlines the program, and it’s very prescriptive so it has all of the curriculum in there that says what are the step-by-step process to implement this program.  And we found some good preliminary outcomes from that program as well.

[24:48]
Jonathan Singer:   So it sounds like if somebody’s listening to this podcast, thinking, “Wow, it sounds like a really good thing to implement in the schools that I work in,” or “I’d like to know more about this,” they could go to the book as a way of learning more about skills training, Social Skills Training specifically.

Craig LeCroy:  Exactly, because one of the things I’ve always been interested in is trying to specify and manualize treatment. And so in this book, it’s a very prescriptive program. And we tried to make it so that you could literally pick up the book and implement the program.  And lots of people have been able to do that pretty successfully, from what we’ve heard.

[25:29]
Jonathan Singer:   That’s great. And I know that you have a chapter in the book that you edited on treatment manuals for children and adolescents on Social Skills Training. And that’s something I actually used in a class I taught a number of years ago for students on how to think about working on something over time. Because I think that one of the challenges in Social Work Education is that we teach that there’s a beginning, a middle, and an end; but we’re pretty fuzzy about what that looks like. So the treatment manual that you wrote on Social Skills Training for kids was a really excellent example and I really think it made it easier for the students to get an idea of what exactly they should do, when, even if it would be difficult to have it work exactly like that in a real-world situation every time.

Craig LeCroy:  Yeah, exactly, I think it’s really important to specify, and it gives students and practitioners a good place to start. It’s not always the end of the road, but it’s like -- here’s exactly what I could do to teach this specific skill in this situation. Here are the steps; here’s how I would organize this group.

[26:43]
Jonathan Singer:   So we’ve sort of talked about a couple of resources for folks, just in the last couple of minutes. There’s your handbook of treatment manuals for children and adolescents, the book that you did through Norton. Are there other resources for folks who are listening to this podcast and saying, “I’d like to know more about how to learn about Social Skills Training, or programs or things like that?

Craig LeCroy:  Yeah, there are. And I can send you an additional list that you can link. But one additional thing I wanted to mention is there is one publishing company called Research Press and for years they’ve been very involved in creating books that were extremely practitioner-friendly, that specified how to implement different strategies, and many of them were very,  very skill-oriented. Some people might be familiar, for example, with Goldstein’s book Skill-Streaming the Adolescent. So you can see that’s published by Research Press.  In that book he outlines some very specific skills strategies. And they also publish a book for working with juvenile offenders that, again, is very detailed, prescriptive kind of book – exactly the kind of book that practitioners love because it spells out, step to step, how to implement treatment. So yeah, I think people would enjoy looking at that.

[28:02]
Jonathan Singer:   Well Craig, thanks so much for being here and talking with us today about Social Skills Training for children and adolescents.

Craig LeCroy:  Great, thanks for having me.

[28:11]
Jonathan Singer:   I’m Jonathan Singer and thanks for being with me for another episode of the Social Work Podcast. If you missed an episode, or have suggestions for future episodes, please visit socialworkpodcast.com. If you’d like to support the podcast, please visit our online store at cafepress.com/swpodcast. To all the Social Workers out there – keep up the good work. We’ll see you next time at The Social Work Podcast.



Transcription generously donated by: Ian M. Danielsen, L.C.S.W., Assistant Professor, Social Work Program, Longwood University, Farmville, VA; former Director, Greater Richmond SCAN (Stop Child Abuse Now) Child Advocacy Center, Richmond, VA. 

References and resources

These references were provided by Craig LeCroy.


APA (6th ed) citation for this podcast:
Singer, J. B. (Host). (2010, June 28). Social skills training with children and adolescents: Interview with Craig Winston LeCroy, Ph.D. [Episode 60]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://www.socialworkpodcast.com/2010/06/social-skills-training-interview-with.html

3 comments:

LBSW said...

Very interesting stuff. I am so glad I discovered this podcast. Thanks for all the interesting interviews and discussions you have about all things social work. I am an MSW student as well as a hospice social worker, and I drive around a lot for work, school, and my practicum. It is so nice to have something this enlightnening to listen to during my day. Keep it up.

socialworkhelps.blogspot.com

Darsan clincia said...

Wow, really very interesting about social skills and clinical trainings. Thank yous o much for sharing this nice information with us. Good stuff....

Darsan clincia said...

Wow, really very interesting about social skills and clinical trainings. Thank yous o much for sharing this nice information with us. Good stuff....