Brief Therapy in Schools
Brief Therapy in Schools
Brief Therapy in Schools
Series Advisory Board
Rebecca K. Oliver, LMSW, School Social Work Association of America
Timothy Schwaller, MSSW, LCSW, University of Wisconsin–Milwaukee
Tina Johnson, MSSW, MPA, MA, University of Louisville
Cassandra McKay-Jackson, PhD, LCSW, University of Illinois at Chicago
Laurel E. Thompson, PhD, MSW, Broward County Public Schools
Christine Anlauf Sabatino, PhD, LICSW, C-SSWS, The Catholic University
of America
Michelle Alvarez, MSW, EdD, Southern New Hampshire University
Kevin Tan, PhD, MSW, University of Illinois at Urbana–Champaign
Kate M. Wegmann, PhD, MSW, University of Illinois at Urbana–Champaign
Evidence-Based Practice in School Mental Health
James C. Raines
The Domains and Demands of School Social Work Practice:
A Guide to Working Effectively with Students, Families, and Schools
Michael S. Kelly
Solution-Focused Brief Therapy in Schools:
A 360-Degree View of Research and Practice
Michael S. Kelly, Johnny S. Kim, and Cynthia Franklin
A New Model of School Discipline:
Engaging Students and Preventing Behavior Problems
David R. Dupper
Truancy Prevention and Intervention:
A Practical Guide
Lynn Bye, Michelle E. Alvarez, Janet Haynes, and Cindy E. Sweigart
Ethical Decision Making in School Mental Health
James C. Raines and Nic T. Dibble
Functional Behavioral Assessment:
A Three-Tiered Prevention Model
Kevin J. Filter and Michelle E. Alvarez
School Bullying:
New Perspectives on a Growing Problem
David R. Dupper
Consultation Theory and Practice:
A Handbook for School Social Workers
Christine Anlauf Sabatino
School-Based Practice with Children and Youth Experiencing Homelessness
James P. Canfield
Solution-Focused Brief Therapy in Schools:
A 360-Degree View of the Research and Practice Principles, Second Edition
Johnny S. Kim, Michael S. Kelly, Cynthia Franklin
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1
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
1 3 5 7 9 8 6 4 2
Printed by WebCom, Inc., Canada
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We dedicate this book to the pioneers of school social work, who started
this profession in the early 20th century as a solution to the challenge of
building school/home/community linkages; to the 30-plus national and
state associations that carry on this work today; and to our school social
work students, who are eager to become the next generation of strengths-
based school social work practitioners.
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Contents
Contributing Authors ix
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Index 197
viiiContents
ix
Contributing Authors
Chapter 9: SFBT in Action: Substance Use
Adam Froerer, PhD
The Connie Institute &
Mercer University School of Medicine
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Introduction
A 360-Degree View of Solution-Focused Brief Therapy
in Schools
Johnny S. Kim, Michael S. Kelly, & Cynthia Franklin
Since its creation in the 1980s, solution-focused brief therapy (SFBT) has
gradually become a common treatment option accepted by many men-
tal health professionals (MacDonald, 2007). With its emphasis on client
strengths and short-term treatment, SFBT appears to be well suited for
school mental health contexts given the wide array of problems present-
ing in school settings and the large caseloads of most school social workers
(Franklin, Biever, Moore, Clemons, & Scamardo, 2001; Newsome, 2005).
This second edition is part of the Oxford Workshop Series and presents a
“360-degree” view of SFBT in school settings from meta-analytic, interven-
tion research, and practice perspectives.
All the chapters from the previous edition have been updated, and
we have added new chapters to further expand the clinical examples
demonstrating SFBT techniques. Since publication of the first edition
in 2006, research on SFBT in schools has produced several advances
that we cover here, including updates on recent systematic reviews and
discussion about SFBT listed on national evidence-based registries. This
second edition also expands some of the original chapters by adding a
Response to Intervention (RtI) framework for schools that may want to
use the SFBT approach. And we have added several new clinical chap-
ters called “SFBT in Action.” Selected based on results from the Second
National School Social Work Survey, which identified the most common
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Like Bonita, schools themselves are going through their own transition
in relation to the utilization of mental health services. Some policy makers
and educational leaders call for schools to become “full-service operations,”
giving students and parents the mental health, vocational, and English-
language training that external community agencies are not adequately
providing. Still others claim that school-based mental health is an “extra”
service and supportable only to the degree that it produces demonstrable
differences in student academic achievement and thus allows students to
compete successfully in the global economy. One of our colleagues remem-
bers being told by a local superintendent that he would support our col-
league’s SFBT research project only if it made a measurable positive impact
on “bottom-line” education issues for his K-8 district (in his case, this meant
higher GPAs and increased attendance).
School leaders and parents are right in wanting more from school-based
mental health services, and the profession itself has only begun to recognize
the need for more transparency with community stakeholders about the
SFBT Is Strengths Based
The SFBT approach posits that people have strengths; moreover, SFBT says
that those strengths are active, right now, in helping clients manage their
situation. The issue is not that clients cannot solve their problem without
additional training or somehow submitting to the school social workers’
view of the problem. Rather, their own inherent strengths will ultimately be
what they use to resolve their problem.
● SFBT is portable
● SFBT is adaptable
By not presuming that all clients are inherently in need of some treat-
ment for a particular pathology or dysfunction, strengths-b ased school
social workers are free to see their clients do a variety of things well and
to ask questions that help their clients mobilize those inherent strengths
to do something about the particular problems they face. In addition,
school social workers usually have to document their work with cli-
ents by writing reports and case summaries: SFBT gives them ample
opportunities not only to focus on their client’s strengths but also to
incorporate those strengths into their written assessments and other
paperwork.
SFBT Is Portable
Though SFBT started as and remains a set of techniques rooted in clini-
cal psychotherapy, it can make a difference in numerous other nonclinical
school settings. Almost anywhere in a school is a potential site for applying
SFBT techniques or ideas: the class meeting where students scale their own
behavior and then talk about what they would have to do differently for
them to rate themselves higher the next week; the special education staffing
conference where parents and teachers describe exceptions when a student
does not display a problem behavior in an effort to discover what the learn-
ing environment (and student) might do differently to avoid repeating the
problem behavior; the playground mediation where students think about
how doing one thing differently might change a conflict they are having.
All these examples (and many more that you will read about in this book)
underline the various ways that school social workers can bring SFBT into
their diverse settings and adapt SFBT ideas to their multiple roles within
their schools.
SFBT Is Adaptable
SFBT can be folded or nested into other techniques being used by clinicians.
Most experienced school social workers we have worked with have charac-
terized their practice approach as “eclectic.” One of the best features of SFBT
as a maturing practice approach is its ability to be integrated into other such
approaches. Clearly, elements of SFBT fit nicely within a cognitive or behav-
ioral treatment framework. Even practitioners who tend to favor approaches
that are based more on discovering how the past impacts a student’s cur-
rent functioning will appreciate the aspects of SFBT where clients set goals
for their own progress and gauge how well they are doing based on scaling
questions.
processes. The nature of SFBT (the thinking that change is possible and
constant) does not mean that clients who have more long-term treatment
plans, such as those students in schools who have individualized education
plans (IEPs) requiring a year of social work services, cannot benefit from
the strengths-based approach inherent to SFBT. In our practice experience,
some students we saw on a long-term basis wound up having several distinct
SFBTs over the course of the year. The process of helping them was similar,
but the issues changed as students learned how to manage one problem and
then faced a new one.
IEP. SFBT, along with CBT, is well suited to helping school social workers
write those goals and collaborate with their clients to meet those goals suc-
cessfully. By identifying discrete changes and applying scaling questions,
school social workers can easily integrate SFBT thinking into their IEP
goals. So far, this area has not been studied empirically, but our conten-
tion, from our own school experience, is that the very process of creating
IEP goals with students, teachers, and parents in a solution-focused manner
enhanced the eventual achievement of those goals by motivating the client
system to move toward solutions rather than remain stuck at only talking
about the problem.
Summary
SFBT is well suited to school social work practice and school contexts.
A solution-focused school social worker can help students, particularly
those who are harder to reach, focus on what’s working and how they can
change their lives in positive ways. Although not originally created for appli-
cation in a school context, SFBT is clearly an adaptable, portable practice
philosophy that, as we will see, can be used in many diverse school contexts
at multiple levels of intervention.
References
Delpit, L., & Kohl, H. (2006). Other people’s children: Cultural conflict in the classroom (2nd
ed.). New York: New Press.
Ferguson, R. (October 21, 2002). What doesn’t meet the eye: Understanding and address-
ing racial disparities in high-achieving suburban schools from The Tripod Project
Background. Retrieved August 1, 2007, from http://w ww.tripodproject.org/uploads/
file/ What_doesnt_meet_the_eye.pdf
Fong, R. (2004). Immigrant and refugee children and families. In R. Fong (Ed.),
Culturally competent social work practice with immigrant children and families.
New York: Guilford Press.
Franklin, C., Biever, J., Moore, K., Clemons, D., & Scamardo, M. (2001). The effective-
ness of solution-focused therapy with children in a school setting. Research on Social
Work Practice, 11(4), 411–434.
Franklin, C., Trepper, T., Gingerich, W., & McCollum, E. (2012). Solution-focused brief
therapy: A handbook of evidence-based practice. New York: Oxford University Press.
Kim, J. S. (2014). Solution- focused brief therapy: A multicultural approach. Thousand
Oaks: CA: Sage Publications.
MacDonald, A. J. (2007). Solution-focused therapy: Theory, research and practice. London:
Sage Books.
McGoldrick, M., Giordano, J., & Pearse, J. K. (1996). Ethnicity and family therapy
(2nd ed.). New York: Guilford Press.
Newsome, S. (2005). The impact of solution-focused brief therapy with at-risk junior
high school students. Children & Schools, 27(2), 83–90.
Tripod Project. (2007). Background of Tripod research project. Retrieved August 1, 2007,
from http://w ww.tripodproject.org/index.php/about/about_background/
Wing Sue, D., & McGoldrick, M. (2005). Multicultural social work practice. New York:
Wiley.
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The History
In the late 1970s, psychotherapy in the United States was at its zenith. The
evidence for this high point was everywhere: mental health services had
gone mainstream, self-help books topped the best-seller lists, and perhaps
most important, economic conditions had created a high degree of health
insurance support for mental health services (Cushman, 1995; Moskowitz,
2001; Wylie, 1994). The insurance money for psychotherapy usually was
not time limited and was also generous, allowing therapists from psychia-
try, psychology, and social work to earn six-figure incomes. A review of the
popular and academic literature of that time reveals that three main schools
of psychotherapy were popular then: psychodynamic therapy, cognitive-
behavioral therapy (CBT), and humanistic psychology (Norcross &
Goldried, 2003). Therapy was available, usually open ended or long term, to
almost anyone who knew where to find it.
By the early 1990s, things had changed dramatically. Self-help books
continued to crowd American bookstore shelves, but psychotherapy
had become a profession that was largely dominated by managed care.
Although still readily available to many people who needed it, psycho-
therapy was now time limited, often restricted to no more than 20 sessions
a year. Fees for therapists had been capped as well, and the golden days of
lucrative therapy practices had begun to fade (Duncan, Hubble, & Miller,
1999; Lipchik, 1994; Wylie, 1994). To a psychoanalytically informed prac-
titioner used to seeing patients for a decade or more, this new era was
dreary indeed.
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works and may be used in future research studies to examine change pro-
cesses within SFBT.
Under the broaden-and-build theory, positive emotions further elicit
thought-action repertoires that are broad, flexible, and receptive to new
thoughts and actions, whereas negative emotions elicit thought-action rep-
ertoires that are limited, rigid, and less receptive. The broadening aspect
of this theory posits that after someone experiences a positive feeling, that
person is more open and more receptive. This may be the key step in helping
students observe exceptions, make new meanings, and do something different
that is touted in SFBT practice literature (de Shazer, 1991). In addition to
broadening, this theory also posits that positive emotions help build durable
resources that can be drawn upon for future use. Students experiencing psy-
chological problems like depression or anxiety commonly to dwell on nega-
tive thoughts and beliefs about themselves or a particular situation, which
then leads to dysfunctional behaviors and further perpetuates a downward
spiral of psychopathology (Garland, Fredrickson, Kring, Johnson, Meyer, &
Penn, 2010). With positive emotions, the opposite can occur: upward spirals
of positive emotions help students build enduring resources of new thoughts,
perspectives, and options (Fitzpatrick & Stalikas, 2008b). But to counter-
act the negative emotions students experience, a greater number of positive
emotions must be experienced. Research suggests that, at minimum, a 3-to-
1 ratio of positive emotions experienced to negative emotions is necessary
to help generate sustained positive changes and undo the impact of nega-
tive distress (Garland et al., 2010). Therapeutic techniques for increasing
positive emotion are fairly new to positive psychology and are still being
developed. However, techniques for increasing client strengths and posi-
tive emotions are not new to SFBT; they have existed for many years and
have been successfully applied in diverse practice settings (Kim & Franklin,
2015). Formulating answers to solution-focused questions requires students
to think about their relationships and talk about their experiences in dif-
ferent ways, turning their problem perceptions and negative emotions into
positive formulations for change.
The Skills
As the Solution-Focused Brief Therapy Association (SFBTA) makes clear,
“[SFBT] should be characterized as a way of clinical thinking and interacting
with clients more than a list of techniques” (SFBTA, 2006, p. 2). By viewing
a client as being engaged in a constant process of change, solution-focused
clinicians are poised to tap into that client’s natural ways of healing and exist-
ing ways of viewing change (Tallman & Bohart, 1999). In July 2013, the sec-
ond edition of the Solution Focused Therapy Treatment Manual for Working with
Individuals was published on the SFBTA website for clinicians to learn more
about the clinical practices and research relevant to SFBT. It is free to down-
load at www.sfbta.org and a great resource for learning more SFBT techniques.
at a significantly lower rate, than MI and CBT counselors. This study also
showed how a SFBT approach differs from other, similar approaches like MI
by highlighting the sustained focus on listening for what the clients want,
what’s important to the clients, and how clients can achieve their desired
version of themselves (Bavelas et al., 2013).
When school social workers meet with students, much of the counsel-
ing session is centered around questions or problem-solving discussions.
Typically, the types of questions asked are:
in the way you’re behaving in her class?” On the basis of any changes that
the client identifies, the solution-focused school professional moves on to
amplify those positive changes and sees what ideas the student might have
about maintaining such changes into the future. Box 2.2 describes questions
typically used in SFBT.
Looking for Solutions
● What small change will you notice when things are
different?
● How would you know if our talk make a big difference?
Relationship Questions
● What will your teacher notice about your behavior when
things have changed?
● How would your parents know you were at your best?
better?
Moving Forward
● What will you do instead of cutting class to smoke?
● What will be a small sign that you are no longer depressed?
might be able to start bringing into being. For the miracle question, students
are asked to imagine that when they go to bed that night, a miracle takes
place, and when they wake up, their problem is solved and they feel better
and more hopeful about their day. The solution-focused school social worker
then asks, “What would be the first thing you would notice about your new
situation that told you the miracle had taken place?” This opens up the pos-
sibilities that students can see changes happening in their lives and identify
first steps at achieving more of the changes they want (Berg, 1994). Scaling
questions can be used for a variety of subjects, asking clients to rate their
ability to manage their problem on a scale of 1 to 5, with 1 being “not able
to handle my problem at all” and 5 being “fully able to handle my problem.”
Assuming a student rates the problem as being at a 2, a solution-focused
school social worker can ask what the student would be doing differently
if he or she is able to give a rating of 3 or 4 when they meet the next week.
With the scales, students can be asked to imagine what they would need to
do to raise (or lower, depending on the way the scale is framed) their score,
and exceptions where they may have already been doing things more in line
with their goals can be identified.
Likewise, the focus on exception questions helps the student use the past
pragmatically. By identifying times when the problem was not affecting the
student, or when the student was more able to handle a similar situation
successfully, the solution-focused school social worker invites the student
to view his or her current reality as being less stuck and hopeless. It also
encourages the student to imagine that the “exceptions” could more easily
become the future reality because, as one student told us, “Hey, now that
I realize that it’s already been a problem I was able to beat before, why can’t
I do it again?”
Students can change as much or as little as they want, and they are given the
freedom by the SFBT process to set goals they can achieve. In some ways, this
goal-setting process mirrors some of what CBT school social workers do as
they set treatment goals with clients based on specific problematic thinking
or behavior. The difference between CBT and SFBT here is that students are
not required to adopt a particular approach to their behavior or adopt new
ways of thinking about how their emotions are affected by their cognitions.
In CBT, the school social worker typically assigns tasks and makes recom-
mendations for behavioral or thought changes, whereas an SFBT approach
encourages students to do more of their own previous exception behaviors
in an effort to achieve their preferred future self (Bavelas et al., 2013).
Compliments Count
Anyone watching a videotape of a clinician doing SFBT will be immediately
struck by how often the clinician compliments the client over the course
of a regular session (Berg, 1994). Because in SFBT so much effort is spent
identifying student resiliency and setting goals based on strengths that stu-
dents have demonstrated in the past, it’s understandable that students begin
to self-report the times between sessions that they have made at least small
gains in solving their problems. Rather than take credit for helping the stu-
dent make this change (or expressing frustration the student is not pro-
gressing more quickly), solution-focused school social workers are quick to
highlight client gains and give compliments about their progress.
These compliments are not meant to be patronizing. Good solution-
focused school social workers know how to convey genuine pride and
excitement at a student’s progress, often saying things like “That’s great;
tell me how you did that?” or “I am so impressed! What did you figure
out that helped you deal with your problem so successfully?” Students take
that feedback and are motivated to make more changes, either for the same
problem or for a different problem that the solution-focused school social
worker may not even be aware of yet (De Jong & Berg, 2002; Metcalf, 1995;
Selekman, 2005).
Coping Questions
One persistent critique of SFBT has been that it is too optimistic and
does not allow clients to have deep emotional experiences in therapy
(Lipchik, 1994; Nylund & Corsiglia, 1994). This has been acknowledged
what hidden capacities the student has for managing and potentially over-
coming problems.
respectful, patient way, we have found that the ideas in SFBT allow us not
only to find some workable goal for most students in a school setting but
also to avoid labeling our students as being “in denial” about their problems.
The Application
The later “SFBT in Action” chapters provide more concrete case examples of
how to use SFBT with five of the most common issues or problems school
social workers encounter. In the present chapter, we also include an example
of a solution-focused handout developed by Franklin and Streeter (2004)
to help students set goals using SFBT techniques (see Box 2.3) and a form
developed by Garner (2004) to help practitioners evaluate their school’s
readiness to adopt SFBT ideas (see Box 2.4).
The Research
In Chapter 3, we share more information about the effectiveness of SFBT
in schools and other mental health settings obtained since the first edi-
tion of this book. In our work employing meta-a nalytic techniques to
analyze the extant intervention studies on SFBT, we have found that this
therapy has a small to medium treatment effects on behaviors and prob-
lems typically found in a school setting. This outcome is only slightly
smaller than the typical effect of other psychotherapeutic treatments
for some of the same behaviors and problems experienced by students
(Kim, 2008).
As we note in the next chapter, in keeping with our efforts to be trans-
parent and rigorous in this book, we can highlight the claims of SFBT’s
effectiveness but also caution against overstating that, as a technique, SFBT
outperforms all other approaches to therapy. In some ways, SFBT may be best
viewed as an important technique to use with students because it facilitates
What were your goals for the previous semester? Check the goals that
were fully met.
When it comes to meeting your goals, what are the obstacles that get
in your way?
● Attendance
● Number of assignments completed
● Quality of work done
What are 3 goals that you will set for the next semester?
1.
2.
3.
Describe what it will look like, sound like, and feel like when you are
meeting all of the goals you have set for yourself.
Source: Garner (2004).
The Future
School settings and SFBT are in some ways a natural fit. School social work-
ers are constantly struggling with large caseloads and limited time to serve
all the students who need help, and SFBT’s emphasis on rapid engagement
and change for students can help school-based professionals meet more stu-
dents and make a difference for them quickly. The goal-setting process of
SFBT (involving scaling questions and asking teachers to observe behav-
iors that students are working on improving) can be easily adapted to the
outcome-based education paperwork of Medicaid and special education to
help school social workers document their effectiveness (Lever, Anthony,
Stephan, Moore, Harrison, & Weist, 2006).
The challenge of finding ways to bring a solution-focused perspective
using student, family, and teacher strengths into a variety of school con-
texts (e.g., special education staffing, disciplinary meetings, or teacher con-
sultations) is significant, however, and sometimes even daunting. This is
particularly true as educators increasingly favor “problem-talk” using diag-
nostic categories derived from special education classification and psycho-
pathology language found in the Diagnostic and Statistical Manual of Mental
Disorders (Altshuler & Kopels, 2003; House, 2002). More research on SFBT
in schools (as well as collaboration between SFBT researchers and practitio-
ners in schools) remains essential to help continue the work that Insoo Kim
Berg and Steve de Shazer envisioned three decades ago.
Summary
SFBT is an approach that started in the American Midwest and has now
spread throughout the world, heavily influencing the last two generations of
practitioners. Its main ideas—that client strengths matter, that client change
is constant, and that clients can be trusted to devise solutions to their own
problems—are a welcome alternative to many of the deficit-based diagnos-
tic and treatment approaches prevalent in schools today. Solution-focused
school social workers can use techniques like the miracle question, coping
questions, and scaling questions to identify student goals and strengths to
help them make changes in their lives.
References
Altshuler, S. J., & Kopels, S. (2003). Advocating in schools for children with disabili-
ties: What’s new with IDEA? Social Work, 48(3), 320–329.
Bavelas, J., De Jong, P., Franklin, C., Froerer, A., Gingerich, W., Kim, J., Korman, H.,
Langer, S., Lee, M. Y., McCollum, E. E., Smock Jordan, S., & Trepper, T. S. (2013, July 1).
Solution-focused therapy treatment manual for working with individuals, 2nd ver-
sion. Retrieved from http://w ww.sfbta.org/researchdownloads.html
Berg, I. K. (1994). Family-based services. New York: W. W. Norton.
Berg, I., & Dolan, Y. (2001). Tales of solutions: A collection of hope- inspiring stories.
New York: W. W. Norton.
Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psycho-
therapy. Reading, MA: Addison-Wesley.
De Jong, P., & Berg, I. (2001). Instructor’s resource manual of interviewing for solutions.
New York: Brooks/Cole.
De Jong, P., & Berg, I. (2002). Interviewing for solutions (2nd ed.). New York: Brooks/Cole.
De Jong, P., & Berg, I. (2008). Interviewing for solutions (3rd ed.) Belmont, CA: Brooks/
Cole-Thomson Learning.
de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.
de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: W. W. Norton.
de Shazer, S. (1991). Putting difference to work. New York: Norton.
Duncan, B., Hubble, M., & Miller, S. (Eds.). (1999). Heart and soul of change: What works in
therapy. Washington, DC: American Psychological Association Press.
Fitzpatrick, M. R., & Stalikas, A. (2008a). Integrating positive emotions into theory,
research, and practice: A new challenge for psychotherapy. Journal of Psychotherapy
Integration, 18, 248–258.
Fitzpatrick, M. R., & Stalikas, A. (2008b). Positive emotions as generators of therapeutic
change. Journal of Psychotherapy Integration, 18, 137–154.
Franklin, C., & Streeter, C. L. (2004). Solution-focused accountability schools for the 21st cen-
tury. Austin, TX: Hogg Foundation for Mental Health, University of Texas at Austin.
Franklin, C., Biever, J., Moore, K., Clemons, D., & Scamardo, M. (2001). The effective-
ness of solution-focused therapy with children in a school setting. Research on Social
Work Practice, 11(4), 411–434.
Fredrickson, B. L. (1998). What good are positive emotions? Review of General Psychology, 2,
300–319.
Garland, E. L., Fredrickson, B., Kring, A. M., Johnson, D. P., Meyer P. S., & Penn, D. L.
(2010). Upward spirals of positive emotions counter downward spirals of negativity:
Insights from the broaden-and-build theory and affective neuroscience on the treat-
ment of emotion dysfunctions and deficits in psychopathology. Clinical Psychology
Review, 30, 849–864.
Garner, J. (2004). Creating solution-building schools training program. In C. Franklin &
C. L. Streeter (Eds.), Solution-focused accountability schools for the 21st century. Austin,
TX: Hogg Foundation for Mental Health, University of Texas at Austin.
House, A. (2002). DSM-I V diagnosis in the schools. New York: Guilford.
3
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Introduction
SFBT has become a popular therapy model for social work practice, espe-
cially within school settings. Part of the model’s appeal to social workers
lies in its strengths-based focus. De Jong and Miller (1995) note that social
work history is rooted in the principles of the strengths perspective but has
lacked specific tools and techniques to put strengths-based practice into
action. Building on Saleebey’s (1992) summary of strengths-based assump-
tions and principles, De Jong and Miller (1995) argue that SFBT can advance
social work’s tradition of using strengths-based principles by providing spe-
cific intervention skills and change techniques with similar philosophical
assumptions.
Practitioners from many disciplines, but especially social work, have
embraced SFBT because of the ease in implementing the model and its flexi-
bility for different practice settings. In an era of accountability and evidence-
based practice, however, the effectiveness of SFBT is important for social
workers to consider. The chapter summarizes the research support for, and
addresses the state of research on, the SFBT model compared to other inter-
vention models. Particular emphasis is given to a meta-analysis of SFBT and
to a review of SFBT studies conducted in school settings.
Although SFBT undoubtedly is popular among social workers in the
United States and around the world, the research on its effectiveness is
still limited in relation to its growing popularity (Gingerich & Eisengart,
2000; Triantafillou, 1997; Zimmerman, Prest, & Wetzel, 1997). This poses
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32
problems both for social workers who have embraced the SFBT model and
for the schools of social work teaching SFBT as part of their curriculum.
Fortunately, research studies are showing that SFBT is an effective interven-
tion, and research on this model continues to grow by the year.
Systematic Reviews
Gingerich and Eisengart (2000) conducted the first systematic, qualitative
review of the 15 controlled outcome studies on SFBT up to 1999. All of these
studies used either a comparison group or single-case, repeated-measures
design to evaluate various client behaviors or functioning. The studies were
divided into three groups according to the degree of experimental control
employed. Five studies met the well-controlled standard, four studies met
the moderately controlled standard, and six studies met the poorly con-
trolled standard.
Recently Gingerich and Peterson (2013) updated this previous systematic
review (Gingerich & Eisengart, 2000) and looked at 43 controlled outcome
studies on SFBT conducted internationally. Studies were grouped into six
different categories: child academic and behavior problems, adult mental
health, marriage and family, occupational rehabilitation, health and aging,
and crime and delinquency. Overall, results showed that 74% of the studies
reported significant positive benefits for those clients receiving SFBT inter-
vention. Of particular interest to school social workers are the 14 studies
that looked at child academic and behavior problems. Table 3.1 provides a
detailed looked at these studies.
Of the 14 studies that looked at this subgroup, 11 were conducted in
school settings, mostly in the United States. Overall, 12 of the studies found
improvement in the SFBT group after intervention on all or most outcomes.
Only two studies (Cook, 1998; Leggett, 2004) reported no difference in
the SFBT group after intervention for most or all outcomes. When exam-
ining how the SFBT group compared with the control group, three of the
studies (Cepukiene & Pakrosnis, 2011; Franklin, Moore, & Hopson, 2008;
Froeschle, Smith, & Ricard, 2007) showed statistically significant differ-
ences on all or most outcomes over those students in the control group. An
additional three studies (Daki & Savage, 2010; Newsome, 2004; Springer,
Lynch, & Rubin, 2000) showed changes in the desired direction for the SFBT
group on all or most outcomes. Six studies (Cook, 1998; Corcoran, 2006;
Kvarme et al., 2010; Leggett, 2004; Littrell, Malia, & Vanderwood, 1995;
Wilmshurst, 2002) did not report any difference between the SFBT and con-
trol groups on all or most outcomes. Two studies (Fearrington, McCallum, &
Skinner, 2011; Yarbrough, 2004) did not report between- group results
because they used a single-group design and did not have a comparison
group. Taken together, these studies continue to show the diversity in SFBT
application as well as the promising results when using SFBT with children
and youth.
Meta-Analysis
The good news is that since Gingerich and Eisengart’s (2000) review, more
research studies have examined the effectiveness of SFBT. To advance the
(Continued)
36
Table 3.1 (Continued)
Note. 0 = no difference; + = positive trend in desired direction; +* = statistical significant positive change; ≈ = approximately equal; n/a -not applicable.
37
with SFBT research as well. To illustrate, the small effect sizes calculated in
the SFBT meta-analysis are only slightly smaller than the effect sizes calcu-
lated for psychotherapy. For example, psychotherapy’s mean overall effect
size on adolescent depression, when including dissertations and using more
rigorous effect size calculations than previous meta-analyses on this subject,
was a moderate .34, with a range of −.66 to 2.02 (Weisz, McCarty, & Valeri,
2006). In addition, studies on the effectiveness of psychotherapy on adoles-
cent depression that were conducted in real-world settings had a small over-
all weighted mean effect size of .24. Similarly, Babcock, Green, and Robie
(2004) cite other meta-analyses on psychotherapy with small effect size
results due to difficulties in treating externalizing problem behaviors like
aggression (Loesel & Koeferl, 1987; Weisz, Weiss, Han, Granger, & Morton,
1995). Therefore, while Kim’s (2008) study found small treatment effects for
SFBT, other meta-analyses on psychotherapy have found only slightly better
or equal results, depending on the research study setting.
Corcoran (2006) Quasi- Conners Parent Rating 86 Students aged No significant differences between
experimental Scale; Feelings, 5–17 years groups, with both improving at
Attitudes, and posttest. This lack of difference
Behaviors Scale for may be because the comparison
Children group received treatment as usual,
which had many CBT compo-
nents that have been empirically
validated.
Franklin Biever, Single case Conners Teacher Rating 7 Middle school Five of seven (71%) improved per
Moore, Clemons, Scale students aged teacher reports.
& Scamardo 10–12 years
(2001)
(Continued)
42
Table 3.3 (Continued)
(Continued)
44
Table 3.3 (Continued)
students reduce the intensity of their negative feelings, manage their con-
duct problems, improve academic outcomes like credits earned, and posi-
tively impact externalizing behavior problems and substance use (Kim &
Franklin, 2009). Although at present there may not be enough studies to
draw definitive conclusions about the effectiveness of SFBT, the use of rigor-
ous research designs in real-world settings with increased sample sizes and
statistical power does provide support for looking upon it as a promising
therapy model. In fact, all the studies described in Table 3.3 use either an
experimental or quasi-experimental design, which helps reduce threats to
internal validity (Rubin & Babbie, 2005). The more recent outcome studies
on SFBT have moved beyond follow-up survey studies of the past and begun
to employ more rigorous, well-controlled study designs, lending even more
credibility to interpretations of the results obtained. In fact, viewed practi-
cally, SFBT is offered with only a few clinical sessions and has been shown
to perform in a manner similar to other therapeutic approaches conducted
in community settings with longer therapy sessions.
have extensive training in the SFBT model, will help ensure confidence in
the results obtained from the primary study.
To confidently determine the effectiveness of SFBT through a
meta-a nalytic review, more primary studies with larger sample sizes
and rigorous research designs are required. In addition, studies using
experimental designs need to utilize standardized measures that are
sensitive enough to measure brief intervention changes and that pos-
sess satisfactory clinical sensitivity, especially for internalizing behav-
ior problems. To help reduce the number of studies excluded from
meta-a nalysis, reported studies should include enough statistical infor-
mation to calculate effect sizes, such as means and standard deviations,
for both pretest and posttest groups as well as experimental and control
groups.
Summary
This chapter summarized the research support for SFBT and addressed
the state of the research on SFBT as compared to other intervention mod-
els. Particular emphasis was given to reviewing a meta-analysis on SFBT
conducted by Kim (2008) as well as other, more recent systematic reviews
of SFBT studies conducted in school settings. The research on SFBT has
steadily grown over the years, and this therapy model is now viewed as
evidence based. The studies that exist consistently demonstrate that SFBT is
a promising, effective approach that is useful for students in school settings
and for community service providers.
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4
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52
53
Tier 1 Approach
Over the past 15 years, campuses have utilized a three-tier system to meet
the needs of their diverse student populations: universal (Tier 1), selec-
tive (Tier 2), and intensive (Tier 3) interventions. The majority of students
(95% or more) have their needs meet by the first two tiers (Sabatino, Kelly,
Moriarity, & Lean, 2013). For a school considering the three-tier RtI system,
it is important to understand all the tiers while keeping in mind that the
most students will respond to the first two levels of intervention. Tier 1 is
particularly important because, after receiving the first tier of the RtI, 85% of
students will not require any higher level of intervention. The success of Tier 1
is due to the high-quality instruction students received in the classroom,
which is designed to prevent future problematic behaviors. The behaviors
taught inside the classroom are reinforced throughout the entire school by
a variety of staff members. While thought of mainly as an approach to be
implemented in primary prevention within all schools, the practices embed-
ded within Tier 1 can also be implemented to create effective school pro-
grams that may target one or more groups of students such as those at high
risk of dropout.
Graduating students with high-risk profiles requires a team that oper-
ates across the entire school to create a safe environment with a climate and
culture that will make interventions effective. Teachers, counselors, social
workers, or other school-based professionals normally implement Tier 1 in
classrooms. This classroom-based implementation helps Tier 1 be campus-
wide and reach each student. Although qualified school-based professionals
lead the instruction in the classroom, the entire school staff is invested in
implementing the interventions. A solution-focused approach can be incor-
porated into a Tier 1 intervention because SFBT engages all of the adults
surrounding the student and uses SFBT change processes to support the
student’s goals. This campuswide dedication is linked to the fidelity of a Tier 1
intervention’s implementation. Research suggests campuses that imple-
ment Tier 1 interventions with high fidelity have fewer behavioral referrals
and, overall, more positive campus climates (Allen-Meares, Montgomery, &
Kim, 2013). To maintain the high quality of instruction, assessment, and
both staff and students (Jones et al., 2009). Administrators and counselors
were further encouraged to institutionalize these practices into the school’s
academic instruction and programs (e.g., daily scaling and goals sheets) and
even a special graduation ceremony, called a Star Walk, which is described
in more detail later in this chapter.
As noted, the process of learning the philosophy of change and practic-
ing SFBT techniques at Garza High School went on for two years, but in
actuality, the professional development and learning about SFBT has never
stopped. Once the initial two-year training was accomplishment, ongoing
consultations, usually once or twice a semester, continued the transdisci-
plinary team approach toward adaptation of the solution-focused model
to the entire school. At the beginning of training, the original experts on
SFBT served as trainers, consultants, evaluators, and scribes of this pro-
cess, documenting this work in research and in a training manual about the
practices. While this may seem like a time-consuming approach to training
staff how to use SFBT in a school, it also resulted in the school staff being
more competent in SFBT and able to own and, later, take over the training
and maintenance of the approach with only minimal consultations from
the researchers and trainers, making sure that everyone, including the new
teachers, were trained.
The SFBT at Garza High School has been sustained for the past 15 years,
including across one change in principal leadership of the school. When
the change in leadership occurred in 2008 and founding principal Victoria
Baldwin retired, some predicted the SFBT model would not be continued.
Ms. Baldwin, however, was involved in selecting Dr. Linda Webb as the
new principal, and she not only maintained the SFBT approach but further
improved the curriculum and the academic achievement of the school. When
Dr. Webb first assumed her position, one of the original trainers became
more involved again in the training functions. At this point, Dr. Webb has
been thoroughly trained in SFBT and, along with her staff, personally leads
the ongoing in-service trainings on the SFBT approach while the original
researchers and trainers maintain a consultation and support role. The
advantages of training all the teachers and staff in the principles of change
and techniques of SFBT, and of encouraging them to adapt the approach
to the educational setting, made it easier for the Tier 1 intervention to be
implemented at high fidelity (Franklin, Kim, Ryan, Kelly, & Montgomery,
2012). By providing in-depth training in SFBT strategies to everyone at the
school, the Tier 1 intervention also became more effective and had more
This quote encapsulates the common challenges facing Garza’s student body
and how the relational and strengths-based approach of the SFBT permeates
the school. All challenges are always framed in an SFBT approach, with a
focus on relationships, strengths, and the future solutions that can be taken
to make a difference and solve problems.
The school uses the Student Services Team to help create this inclusive
culture at Garza. All staff can refer any student to the team. In these weekly
meetings, the student’s photo is projected, and the team reviews the stu-
dent’s pattern of attendance and behavior in conjunction with what is hap-
pening with the student outside of school. The team used a solution-focused
approach to remain on task and create small, measurable goals. In the case
of Maya, got example, the Student Services Team used compliments to vali-
date what she was doing well.
It is common for the same student to be referred to the team every
week. In these situations, the team may decide to keep an eye on this
student or consider a more in-depth intervention. The point of these meet-
ings is to understand rather than “fix” the student. To best understand
the student’s experience, the team is made up of individuals, all staff at
Garza, who are diverse in terms of race, age, employment, educational
background, LGBT status, and gender. Rather than being held down by
frustration, the Student Services Team looks at the referred student to see
what has been working and invites the student to do more of that. This
technique is strengths based and allows the team to function for the ben-
efit of the students’ goals.
like and how they can make those changes. The following quote from Sam
Watson, former assistant principal, shows the positive results:
2. Teachers organized themselves into groups and formed a book club for
readings.
3. Brown-bag lunch meetings were scheduled for teachers, staff, and
administrators to watch and discuss videos of solution-focused
interventions.
4. In-service trainings for the entire staff were organized with an SFBT
trainer. This trainer also met with smaller groups (e.g., the principal,
administrators, and counselors) for additional training and consultation.
Throughout the school’s training process, other solution-focused
trainers were brought in to inspire and boost the learning sessions.
5. A solution-focused coach worked within the school and was available
for classroom consultations and modeling of the solution-focused
approach. This involved periodic visits to the classroom. The solution-
focused trainers observed teachers leading classroom groups and
using techniques like the miracle question and also provided written,
complimentary feedback about a teacher’s use of the SFBT.
6. Teachers were provided with quick reference sheets for solution-focused
techniques they could use with students. Follow-up meetings invited
discussions about how the techniques were used so that teachers were
teaching other teachers how to use the SFBT techniques.
7. The administration added competencies in solution-focused intervention
to the annual performance evaluation with faculty and staff.
Tripodi, 2007), a qualitative design (Lagana-R iordan et al., 2011) and a
concept mapping methodology (Streeter, Franklin, Kim, & Tripodi, 2011).
A fifth longitudinal study that examine on-time graduation rates of students
who participated in the school over a four-year time frame is in progress, but
the results of that study are yet not available for dissemination. The other
four evaluations are described below.
The first study (Franklin et al., 2007) utilized a quasi-experimental pre-
test/posttest comparison groups design. Participants (n = 46) in the experi-
mental group all attended Garza High School (solution-focused alternative
school [SFAS]). Because no additional alternative school was available, the
comparison group participants (n = 39) were recruited from a traditional
local public high school. Comparison group participants were matched with
the experimental group using the following characteristics: attendance,
number of credits earned, participation in the free lunch program, race,
gender, and whether the student was defined as at risk according the Texas
Education Code.
Three dependent variables were observed in this study: credits earned,
attendance, and graduation rates. Data for these three variables were obtained
through the AISD records. The results of this quasi-experimental study offer
researchers and practitioners insight toward understanding the potential
impact of the solution-focused school on students’ school credits earned,
attendance, and graduation rates. Repeated-measures analysis of variance
revealed no significant difference between the comparison group (matched
students attending a regular local public high school dropout prevention
program) and the SFAS participants during the 2002–2003 academic school
year; however, a significant difference was found between groups during the
2003–2004 academic school year, indicating that students enrolled in the
SFAS earned a greater proportion of credits than the students in the com-
parison group. One important aspect to consider is the pace at which stu-
dents progress through the SFAS program as compared to that of students
in the traditional high school setting. Garza is a self-paced, individualized
program that allows students the flexibility to attend school for half days, to
work part-time, and for some, to be a parent as well. The results suggested
that some students in the SFAS required about one year longer to finish
high school than those in a traditional high school. One possible conclu-
sion from this study is that while Garza students may take slightly longer,
they also display a greater likelihood of completing credits when they were
The third study (Streeter et al., 2011) utilized a concept mapping
design. Concept mapping is a mixed-methods approach to help examine
a program’s fidelity towards its guiding theory and philosophy and to
evaluate the most important program features contributing to the pro-
gram’s mission to graduate at-risk students. Fourteen students and 37
adults (teachers, administrators, and staff) participated in the concept
mapping sessions and generated a combined total of 182 unique state-
ments as a response to the following statement: Describe the specific char-
acteristics of the alternative school that help students achieve their educational
goals. The results of the concept mapping evaluation offered 15 clusters
reflecting participants’ descriptions and understandings of the alternative
school: relationships, professional environment, respect evident through-
out the school, strengths based, sense of community, student-student
interaction, empowering culture, cutting edge, organizational foundation,
school size and structure of the school day, admission and exit, resources
directed to student success, preparation for life, student success, and con-
tinuous improvement.
These was driven by the pragmatist approach of grounded theory and
the constant comparative method described by Glaser and Strauss (2007),
and it sought to discover a relevant theory for teacher-student interactions.
Data collection stopped when incoming data had reached the point of
saturation (Morse, 1995; Timmermans & Tavory, 2012), meaning that the
categories could be “fully accounted, [with] the variability between them
[being] explained and the relationships between them … tested and vali-
dated” (O’Reilly & Parker, 2012, pp. 190–197). The final model represented
the overarching core category and subthemes from the teacher interviews
(Hallberg, 2006) and the researcher revisited individual narratives in the
results section to enhance the richness of the data (Ayres, Kavanaugh, &
Knafl, 2003; Szlyk, 2016).
Of 58 potential staff members, 10 teachers participated in individual,
semistructured interviews, and four teachers participated in a focus group.
All teachers were trained in SFBT, in accordance with the school’s mission.
The teachers had varying years of experience with SFBT but no other mental
health experience. Teachers described at-r isk behaviors including truancy,
substance abuse, suicidal ideation, and self-harm as being the most preva-
lent problems of their students. Teachers reported being confronted with
these issues daily but expressed a confidence and calmness in the way they
interacted with the students around their emotional concerns and external
the solution-focused approach for 15 years also suggests that teachers and
school staff not only can be trained in this approach but that the SFBT
approach has the potential to sustain itself over time. This, coupled with
the fact that the school is successful at graduating and sending high-risk
students to postsecondary education, indicates that SFBT will be worth the
investment for a school district to create an SFBT program.
Summary
This chapter opened by briefly describing an RtI and Tier 1 approach to
interventions and how SFBT can be used to create a Tier 1 intervention for
dropout prevention. A transdisciplinary team model to train educators in
SFBT was also described. With the use of case examples, the chapter next
described how SFBT techniques were utilized in Tier 1 interventions within
Gonzalo Garza Independence High School, a solution-focused, alternative
high school in Austin, Texas. The techniques and case examples exemplified
challenges commonly observed in at-risk students with behavioral health
challenges such as suicidal ideation, self-harm, violence, and aggression.
The examples also demonstrated school-based mental health services and
discipline and how the Garza staff operate as a team. The school’s principal,
Dr. Linda Webb, notes that “Garza takes a collaborative approach to finding
solutions.” This is why staff members are trained in solution-focused tech-
niques, including identifying strengths, looking for small and measurable
solutions, and seeking exceptions to the problem. These skills can be used,
in most situations, by the entire staff, who undergo extensive training in the
application of these methods. After receiving such training, it is possible for
all school staff surrounding the students to be involved in their goals and
their successes. This campuswide involvement and investment, achieved
through SFBT, is a central part of a successful Tier 1 intervention.
Both evaluation research on Garza High School and data collected from
the school district provide evidence for the positive academic achievement
and success of Garza. Garza has maintained high achievement and gradua-
tion success despite over 75% of the students being considered at risk. The
school, its staff, and its students also have won numerous awards. Students
are active in their education, participating in various districtwide events and
creating useful projects in their classes that continue being used after their
graduation. Examples of these projects can be viewed on Garza’s website
(http://garzaindependencehs.weebly.com). This solution- focused, student-
faculty engagement continues after high school as many students enroll in
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Rumberger, R. W., & Thomas, S. L. (2000). The distribution of dropout and turnover
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room: A grounded theory. Manuscript submitted for publication.
5
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I got my pasta out of the microwave and sat down with some
teacher colleagues one day before a holiday break. Before I could
74
75
The History
As Berg and Shilts (2005) recount, the idea for WOWW came from Shilts’
wife, Margaret, sharing her concerns about some of the students she was
teaching and the different challenges they presented as she tried to man-
age the classroom and cover the curriculum. After starting in Florida, the
program has been piloted in other states, including several schools we have
worked with in Chicago. Later in this chapter, we share some of our own
preliminary findings on WOWW’s success in helping students and teachers
as well as other pilot data on WOWW.
The Skills
WOWW is a coaching intervention, meaning that the solution-focused
practitioner operates primarily in a consultative role with the teacher and
the classroom. The WOWW coach will both observe the classroom and
facilitate group discussions, but the coach never really leads a group inter-
vention in the way that many other group treatment approaches do—that
is, the coach is not delivering a specific therapeutic intervention in a specific
sequence. Right away, in WOWW, the basic tenets of SFBT are revealed
in contrast to other more manualized approaches: the clients (in this case,
the teacher and the teacher’s students) are put squarely in charge of set-
ting the goals for the WOWW class discussions. Just like in other SFBT
interventions, the initial session is full of questions, which are organized
around asking the students to notice changes that have already taken place
in their class. The difference from a more conventional SFBT clinical session
is that the WOWW coach has already observed the class and is able to share
At this point, the SSW had students write down their score and pass
them up anonymously, and the SSW and the classroom teacher then tabu-
lated the results. During this time, the SSW was noticing strengths in the
WOWW Details
Program
Phase
Phase 1: Introduce yourself to students, saying “I’m
Observation going to be visiting your classroom to
phase (Weeks watch for all the things the class does that
1–3 for an are good and helpful. I will report back to
hour) you what I see.”
Note class strengths, and wait for the class to
begin pointing out their own strengths to
you, indicating their readiness for the next
phase.
Share what you saw, and prepare the class for
creating classroom goals.
Phase 2: Creating With the teacher and the class, set goals for
classroom the class to work toward (e.g., show respect
goals with to each others), and ask them to scale the
students and level of respect they have at present on a
teachers (Week scale from 1 to 10.
4 or 5)
Ask the class to describe what it will take for
the class to go from a 7 to an 8 or a 9, and
ask the class to look for those behaviors in
themselves and others over the next week.
Scale other goals that the class is interested
in working on.
Phase 3: Scaling Once the scaling questions are understood,
classroom teachers may put the scaling goal on the
success and board as a reminder, and the class will be
amplifying more focused on reaching the goals set for
(remainder of each week. Amplify the class’ progress on
sessions) their goals, and repeat as needed.
class’ behavior and asking for exceptions to the major behavior problems the
teacher has identified, mostly related to how the class behaves after lunch.
Continuing our case example:
perceptions of the students’ behavior and their goals for change. Unlike other
classroom management models that try gimmicks or external rewards, the
WOWW coaching intervention is interested in teachers and students dis-
covering what small gains they are making and then “doing more of what’s
working” to turn those successes into larger gains for the whole classroom
environment.
The teacher debriefing times are crucial to maximize the impact of the
WOWW program. In these confidential sessions, the teacher is given the
same opportunities as the students to reflect on the classroom and identify
his or her own capacities and strengths. Here is an example of a WOWW
coach debriefing, from the same third-grade classroom discussed earlier:
able to see that I was in a good mood and that they could
relax with me today.
SSW: What do you mean by “relaxing with you”? Are there
times when you’re more relaxed that you notice you get a
different response from the kids?
MS: Totally. The kids totally take their cue from me; if I’m
loose and having fun, we all do better together.
The Research
Developed in 2004, WOWW uses the components of SFBT to facilitate posi-
tive interactions in the classroom between teachers and students. The men-
tal health practitioner serves in a consultative role with the teacher and the
classroom. Initial pilot studies indicate that WOWW has the potential to
impact teachers’ sense of self-efficacy and their capacity to avoid burnout. In
terms of student outcomes, some promising initial data support the inter-
vention’s ability to increase student attendance and engagement in learning.
To date, results of five pilot studies based on the current version of WOWW
have been published.
The first study (Kelly, Liscio, Bluestone-Miller, & Shilts, 2011) was con-
ducted by one of WOWW’s creators (Shilts) and a doctoral student (Liscio)
and looked at increasing attendance, improving student behavior, and
improving teacher classroom management behavior in 12 special education,
middle school classrooms in Florida. Data were collected from 105 students
in the WOWW group (based on their teachers volunteering to be in the
treatment group) and 101 students from six classrooms that were selected to
serve as the comparison group. The generalized estimating equation model
was used to test differences between groups on grades, absences, tardi-
ness, school suspensions, and state academic test scores. Results showed
statistically significant differences favoring WOWW on decreasing excused
absences and tardiness but significant differences favoring the comparison
group on unexcused absences. No differences between groups were found
on grades, state academic test scores, and school suspensions.
A second WOWW pilot study (Kelly & Bluestone-Miller, 2009) was con-
ducted in 20 urban elementary school classrooms in Illinois and aimed to
improve class behavior and teacher self-efficacy. A pretest-posttest design
was used with a convenience sample of 21 teachers to examine their per-
ceived classroom management skills as well as how they perceived their
for WOWW as a teacher coaching intervention, with both finding that the
classroom behavioral and social-emotional goals set by the teachers and stu-
dents together were met and maintained at follow-up.
Although these early findings show promise for the intervention, some
of the mixed results across the different sample sites suggest more work is
needed in refining the intervention protocol and evaluating WOWW using
a more systematic research design. The studies noted above have been pilots
in nature and thus have not been rigorous enough to collect fidelity and pro-
cess data that could demonstrate the promise of the intervention as well as
be used to improve the intervention protocol. Additionally, more evidence is
needed about the potential multiple school contexts in which this interven-
tion could be used successfully.
The Future
WOWW has an intuitive appeal to school social workers trying to find posi-
tive and non-threatening ways to help teachers and students function better
together in a classroom setting. It is a promising new idea that is trying to
use the active ingredients of SFBT to make meaningful impacts on class-
room behavior, teacher resilience, and student achievement. Currently, it is
far too early to say whether WOWW can positively impact such important
variables in schools. We hope to bring the WOWW program to more class-
rooms in Chicago and the surrounding suburbs and study the program in
those settings, with larger sample sizes and classes acting as control groups.
One major issue that has already become clear is how best to “sell” this
program to schools. The initial WOWW program in Florida was explicit
about being completely voluntary in terms of teacher participation, and
we followed that same idea in our recruitment of the seven teachers who
participated in our pilot study (Kelly & Bluestone-M iller, 2009). In two
of our three schools, however, the principals clearly were eager to expand
the WOWW program by requiring that all teachers participate, particu-
larly the ones the principal thought might be burned out or even at risk
of being fired. This caused challenges for our research team. We wanted
to respect the wishes of the principal while avoiding the possibility that
WOWW would become yet another thing forced onto teachers’ already
busy plates. Eventually, we were able to avoid a conflict with the princi-
pal by agreeing to do a larger version of the WOWW program in a future
year and, at that time, consider the principal’s wishes that the program
Summary
Savvy school social workers have long known that one of the primary cli-
ent populations in schools is their teacher colleagues. The WOWW pro-
gram is a teacher coaching intervention that helps school social workers
target their interventions at a classroom level with the teacher and class-
room as the “client.” This intervention has shown some initial positive
outcomes in pilot studies, and in the coming years, we hope to see larger-
scale studies on WOWW’s impacts on teacher classroom management
styles, teacher burnout, and student variables like academic achievement
and attendance. With the ever-increasing pressure on both teachers and
students to be productive, we believe that school social workers need to
use classroom interventions such as WOWW to identify the strengths
of classrooms and help both teachers and students work together more
effectively.
References
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BFTC Press.
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teachers to improve classroom behavior and relationships. Educational Psychology in
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Ronfeldt, M., Loeb, S., & Wyckoff, J. (2013). How teacher turnover harms student
achievement. American Educational Research Journal, 50, 4–36.
6
■ ■ ■
This chapter presents a series of case studies showing how school social
workers have adapted SFBT to their school contexts. Using a variety of treat-
ment modalities (family, small group, and macro practice), these school
social workers show how flexible and powerful SFBT ideas can be in a
school setting and how they apply nicely across all three tiers of interven-
tion through the Multi-tiered System of Supports/Response to Intervention
framework.
Ultimately, the research on SFBT in schools can only give so much direc-
tion, context, and inspiration. Based on the feedback we have received from
teaching SFBT ideas, we know that school social workers need and want to
hear how others have “done it” and adapted SFBT to their own school social
work practices. This chapter offers a series of brief case studies in which
school social workers:
87
88
the first family session where the school social worker uses
scaling questions and the miracle question to mobilize the
family around some new solutions for resolving the family’s
and Shantel’s struggles.
Mr. D: What about the problems after school and in the lunch-
room? I know it’s only been a month, but my wife and
I have gotten something like five calls from the school ask-
ing us to talk to Shantel and to come get her. Getting into
fights, back-talking … This has got to stop.
Shantel: They’re always getting me into trouble! I told you,
nobody likes me here! [puts head down, seems ready to
either leave the room or cry]
Carol: Shantel, hold on a minute. What your stepdad is say-
ing is true, right, about you getting into some trouble at our
school?
Shantel: Yeah, but what else can I do? These other girls are
always acting like they own the school or something, tellin’
me where to sit, and, oh man, don’t get me started on those
lunch supervisors … they’re evil!
Carol: Okay, I think I’m getting a better picture of why you
rated our school a 2 for you. I want you to try something
with me for a minute. Let’s imagine that after we leave here
today you go home with your parents, play with your little
brothers, do your homework, and then go to sleep.
Shantel: That’s pretty much what I would do.
Carol: Great. But this is a different night of going to sleep
because while you are sleeping, a miracle happens to you,
and when you wake up and come back to school, everything
that was a problem for you here is different, all the things
that have been bothering you here are different somehow.
Shantel: So … like all those mean girls and teachers are gone?
Carol: No, the miracle happens with everybody still at
school, including you. What’s different is that the problems
are gone.
Shantel: Hmm.
Carol: So, my question to you first, and then I’ll ask your par-
ents their answer, is “What would you notice first that was
different?”
Shantel: [thinks for a long time] I know: I’d have my
wisdom again.
Carol: Tell me more about that.
goals for their children and the ways that they hoped that their neighbor-
hood school could begin to address those needs.
area (Newsome & Kelly, 2004). The first three weeks are held consecutively;
after that, GRG groups take place on a two-week/monthly basis to empha-
size the belief that GRGs can both support each other and act creatively and
effectively on their own, without the aid of “experts” (Selekman, 1993).
• What is the most important part of the problem that brought you here?
• What part of that problem would you like to work on first?
• What are your thoughts about the problem you’re having with your
grandchild?
• What is the one thing you would like to learn from this group as it
relates to this problem?
As with any new group venture in a school, the first session is crucial. In
this first session, we give grandparents a chance to get to know us, the other
members in the group, and the basic ideas behind the SFBT approach. It is
important to normalize both their particular circumstances as GRGs and
the model collaborative problem solving between group members. Because
change is going to be the focus of the group, we’re also eager to discuss
how SFBT views the change process and to contrast that with other, more
deficit-based approaches. This approach allows us to immediately validate
the GRGs for their experience and wisdom and to truly say that we believe
they are the experts on matters concerning their grandchildren and that we
hope to draw on their expertise over the course of the program.
• Since our group has started, what have you noticed that is already
different about the main problem you came in with?
• What did you do to make those changes?
• What do you need to do to maintain those changes with your
grandchild?
The above vignette highlights how small changes can become big solu-
tions. More importantly, the dialogue illustrates how the group leader and
Ms. Valdez uncovered an exception of how the problem (i.e., fighting on the
playground) became less debilitating to her grandson (i.e., when he started
playing soccer with other kids on the playground). Similarly, it helped to
increase the hope and resilience of Ms. Valdez as a primary caregiver to
her grandson as she faces the many challenges and opportunities presented
to her throughout the academic school year (Newsome & Kelly, 2004,
pp. 75–76).
The first three weeks are held consecutively; after that, GRG groups take
place on a two-week/monthly basis to emphasize the belief that GRGs can
both support each other and act creatively and effectively on their own,
without the aid of “experts” (Selekman, 1993).
• If you can imagine our final meeting and being able to rate your
problem as being low, what will have changed between then and now?
• What is the first thing you might do as a grandparent raising a
grandchild to make this change happen?
• On a scale from 1 to 10, with 1 being not coping at all with your new
role and 10 being coping very well with your new role, how well would
you say you are coping?
• What would be different in your life if you went from a 6 to a 7 or from
a 7 to an 8?
In this vignette, the group leader used the scaling question with Ms.
Wilson as a way to recognize the proactive change that had occurred
over the last few weeks. More than that, however, the scaling ques-
tion helped to open up a discussion of the progress and growth made
by Ms. Wilson and her grandchild. By using the scaling question, the
group leader was also able to tap into Ms. Wilson’s practical wisdom
in addressing a very common issue between two siblings (Newsome &
Kelly, 2004, pp. 77–78).
• What are two things you could do differently this week as a grandparent
raising a grandchild as it relates to your problem?
• What are a few impacts you might imagine happening as a result of
“doing something differently”?
• What are two things you did differently this week as a grandparent
raising a grandchild that helped?
• What difference did it make as a result of you “doing something
differently?”
Week 7: GRG Wisdom Night—A Panel of Elders Share Their Life’s Lessons
For this session, we invite other GRG “elders” in the school community
to share their wisdom in a panel discussion.
In keeping with the SFBT philosophy, we choose to deal with group end-
ings and termination issues by focusing on the positive aspects of the group.
As a result, we have a “change party.” In using the change party technique,
each GRG brings his or her grandchildren to the group and shares one thing
that has changed in the past three to four months as well as one strength
they most admire about each of their grandchildren. (Each of the GRGs will
have done a signature-strength VIA with each of his or her grandchildren at
this point, to have that instrument to draw on.)
While the majority of this final group meeting is spent socializing and
having fun, we do encourage the GRGs to consider forming some kind of
informal network, with us or with other group members, to help build
on the positive solutions and relationships that the group helped to foster
(Newsome & Kelly, 2004, p. 80).
The Future
This is just a sampling of what a solution-focused school professional can
do with SFBT ideas. What are your ideas after reading this chapter? Can you
think of a place or population in your school community that might benefit
References
Altshuler, S. J., & Kopels, S. (2003). Advocating in schools for children with disabili-
ties: What’s new with IDEA? Social Work, 48(3), 320–329.
American Academy of Child and Adolescent Psychiatrists. (2007). Facts on anxi-
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advances_in_child_and_adolescent_anxiety_disorder_research
Anderson-Butcher, D., & Ashton, D. (2004). Innovative models of collaboration to serve
children, youth, families, and communities. Children & Schools, 26(1), 39–53.
Anderson-Butcher, D., Iachini, A., & Wade-Mdivanian, R. (2007). School linkage proto-
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the learning support continuum. Columbus, OH: College of Social Work, Ohio State
University.
Bowen, G., Rose, R. A., & Bowen, N. K. (2005). The reliability and validity of the school suc-
cess profile. Philadelphia: Xlibris Press.
Chorpita, B. F., & Southam-G erow, M. (2006). Fears and anxieties. In E. J. Mash & R. A.
Barkley (Eds.), Treatment of child disorders (3rd ed., pp. 271–335). New York: Guilford.
Comer, J. P. (2005). The rewards of parent participation. Educational Leadership,
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Davies, C. (2002). The Grandparent Study 2002 Report Research Report. Retrieved
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Fuller-Thomson, E., & Minkler, M. (2000). African American grandparents raising
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Gleason, E. (2007). A strength- based approach to the social developmental study.
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House, A. (2002). DSM-I V diagnosis in the schools. New York: Guilford.
7
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SFBT in Action
Child Abuse and Neglect
Robert Blundo & Kristin W. Bolton
107
108
restorative factor, it also creates a better chance that students will reveal
something about their situation to a teacher, social worker or staff member.
This chapter also covers the following matters to better understand the
position of a school social worker and students: 1) the context and pressures
within school settings on student and staff, 2) how neuroscience research
provides evidence for the need to create a school environment that provides
a real sense of safety and caring within both the school and the social work-
ers relationships with students, 3) a new appreciation of the student’s life
context and consequential developmental behaviors while in school, 4) the
age distribution of students being engaged by school social workers, 5) the
range of neglect and abuse issues to be considered, and 6) the challenges of
being a designated reporter as well as a support for these children while in
school.
in 2013, child maltreatment rates ranged from 1.2 per 1,000 to 19.6 per
1,000 (CDF, 2014; US Department of Health and Human Services, 2013).
reactions. These actions on the part of the student are reflexive protective
reactions that are initiated in a moment as fight, flight, or shutting down
and withdrawing. More often than not, these responses are seen as dis-
ruptive classroom behavior: fighting or passivity, not responding, or seem-
ingly being unable or just unwilling to speak. These are also behaviors and
attitudes that draw the attention of school social workers. They may very
well be signs of neglect or abuse as well as a consequence of living within a
critically stressful community. The possible symptoms or signs of abuse and
neglect are the same as those for students growing up in a dangerous com-
munity setting. Thus, the very behaviors that are seen as disruptive can be
hints of neglect and abuse and/or adjustments to a traumatic environment.
As noted, the conditions within the community are very likely confounding
factors of physical and sexual abuse.
Finally, school social workers can benefit from continuing to under-
stand the latest knowledge regarding neuroscience and trauma. Knowledge
regarding the impact of trauma on the human brain is growing exponen-
tially and provides insight for those who work closely with children exposed
to trauma.
Although therapy to treat abused children is not the school social worker’s
function, the following solution-focused factors can be very helpful in build-
ing a sense of trust and safety, leading to increased possibilities for thriving:
1. Even abused children, no matter how badly they have been abused, still
have areas that are functioning well.
2. You should begin with the healthy part of the child.
3. You should ask children about what is their idea of how they want their
life/situation to be different so that life is a little bit better for them;
sometimes they, too, like all children, have an idea of what they want
their life to be like.
Although Berg and Steiner (2003) are referring to actual treatment work
with abused children, the same supportive and relationship building skills
are a key to supportive work done by school social workers.
In many cases, the school social worker is faced with limited information
and possibly conflicting stories. Obviously, the school social worker needs
to follow whatever guidelines have been established with their local child
protective services. The decision to report a suspicious set of information
should be made in consultation with the teacher and other staff. Berg and
Kelly (2000) provide several basic assessment points that the school social
worker would need to be prepared to answer:
1. Every abused child, no mater how badly they have been abused, still
have areas that are functioning well. (Berg & Steiner, 2003, p. 131)
2. You should begin with the healthy part of the child first. (Berg &
Steiner, 2003, p. 131)
3. You should engage students in terms of what will make their experience
better during school. Remember that as a school social worker, you are
not there to provide treatment but, rather, to offer what might better be
called SFBT coaching. Coaching is focused upon supporting the student
in creating a more positive, safer atmosphere and success in school.
Building on his or her strengths and abilities along with support during
difficult moments would be most helpful effort during these times.
4. Rogers (1951) stressed that with genuine trust, empathy, and
authenticity expressed in the contact with the social worker, the client
gains a sense of feeling felt, a sense of being heard and appreciated. It
is very important the social worker is not disingenuous but, rather, has
learned to truly trust and believe in the client’s ability to make it and
succeed. Given the tumultuous nature of schools and classrooms, where
performance evaluations loom over teachers and school social workers,
it is not easy to maintain this position. (Carkuff & Berenson, 1967)
coming to school that much lately, and I’m not doing good
in my classes, like we talked about last week.
SSW: Yes, you’ve been able to get to school sometimes but not
as much as you may want. I’m impressed, though, with how
you are at least trying to make it to school these last few
weeks since we talked. There must be a lot going on that
makes it harder for you to come to school as much as you
would like. I’m curious; is there anything that would be
helpful to talk about that might help even a little bit?
Beth: Maybe … I don’t know if I can … not sure …it is very
hard and I don’t know what will happen if I talk about it.
SSW: Well, in what way do you think it might help if you did
share it with me or someone else? Do you think it would
make things better for you … like feeling like coming to
school?
Beth: I don’t know. It might make things even worse.
SSW: It must be very important to you if it might make things
worse. Even though it sounds like if you were to get some
help with this issue, it might make your life easier in doing
the things you seem to want to do, like school. That is a
tough place to be. What would be the most helpful for us to
do that might help move you to a better place and feeling
better?
At this point, notice how the student jumps in and starts to share her experi-
ence, as if possibly the social worker’s acceptance and support gave her the
trust to jump into the situation.
SSW: Thank you for taking the chance and trying to help your
situation by sharing it with me. I understand how difficult
it must have been for you keeping this secret and trying to
protect your mom’s relationship with her brother. I admire
your courage to take care of yourself given the very diffi-
cult situation you’ve been in. Do you have any ideas about
how you would want to make this better and not have this
happening?
Beth: I’m aware of child protective services. They see some of
my friends and their families. I don’t want to have to leave
my mom, and I don’t want her to be mad at me.
SSW: I agree that you should be able to stay in your home and
also to have a good relationship with your mom. You are
aware of child protective services. It is their job to help pro-
tect you and any other young person. I agree with you that
it is best when you stay at home and make it a safe place
for you and your brothers and sisters and your mom, too.
From what you have shared, it would be important to con-
tact child protective services. I know several people there,
and I would like for you to help me make this contact so
that you can make your home safe. Will you help make that
happen?
Beth: I guess … But I’m still afraid of what mom might say
and of her brother.
SSW: I understand your not wanting to upset your mom or
even your uncle. It’s not an easy decision to make. What do
you think would be the best way to handle this so that you
don’t have to deal with your uncle’s behavior and you can
feel safe?
Beth: Do you think the service worker would help me
tell my mother and help make things easier after she
finds out?
SSW: I can only say that that is exactly the work they do with
families in these situations. It’s important that you are
safe and that your family can continue to be close. And it’s
important that the worker understand what happened and
then has your help in finding the best way to work with
your mom. You can meet and talk with the worker here at
school and help her understand the situation. Is that okay
with you?
Beth: Yes, if I can see her first … Okay.
SSW: Let me call her right now and let you know how this
is going to work. The basic idea is to be able to let your
mother know what has happened and help her deal with her
brother and be supportive of you. I will be available here at
school so that I can help support what you have decided to
do to make things better.
First and foremost, being a mandated reporter, the social worker would
need to make the report even if the child did not want that to happen. Yet,
it is always important to help the student have a say in what may happen
and be aware of the help being initiated. If or when substantiation occurs,
the social worker’s challenge is maintaining an appreciative and helpful
relationship with the student. Contact would generally acknowledge the
difficulties but focus on what the child can confirm as being helpful in
making their life more manageable during school. By having the student
state what it will take to keep going at this point, the social worker has
validated the student’s competencies at whatever level Beth is able to man-
age. Whether those competencies are attending classes, doing homework,
talking with friends, not fighting as much, or being less sad, all can be
appreciated for what they mean for recovery. Using scaling question may
or may not feel appropriate; if used, they can provide additional supportive
evidence of success.
The next case example illustrates how to use relationship and scaling
questions for a high school student who was removed from her biologi-
cal parents due to abuse and neglect and has recently been placed in her
second foster care home. Since the student has a social service caseworker
and a therapist, the responsibility of the school social worker is to focus on
success in school rather than on the abuse and neglect the student experi-
enced at home. The school social worker also should assist the student in
forming supportive relationships with others. This high school student has
been trying to study for a test but is struggling with confidence issues and
worried about passing the test. The following example shows how to help
with her gain confidence and, more importantly, how scaling questions can
help reinforce the supportive relationships that exist in the student’s school
environment:
Jackie: I can just talk with her before or after class. She’s
usually available then.
SSW: That sounds like a good plan. Let’s see what you can
do, and maybe we can talk later this week, if that is okay
with you.
Jackie: I’ll give it a shot today. I have her class in fourth period.
SSW: Sounds good, see you later this week.
must focus on the child in the context of the school setting. Protective ser-
vices will be involved with the family, and a professional therapist or agency
specializing in abuse counseling will be working with the child on recov-
ery. However, the child may prefer the only person who has been there for
them in other ways: the solution-focused school social worker. Students who
come to the attention of the school staff concerning neglect or abuse more
often than not have had some form of contact with the school social worker.
This may provide an initial sense of safety for sharing material that becomes
the cause of a report, and following a report, the school social worker may
be is recognized as a safe person to talk with about having some success at
school, even if just a little bit.
The age of the student will change the nature of practice, with different
forms of interaction and levels of understanding on the part of the student and
the school social worker. With an elementary-age cohort, the school social
worker will be faced with a wide range of maturity and communication skills.
These students differ from middle school students, and even more so from
high school students. The growing transitions in physical, emotional, and
social development reflect the elementary, middle, and high school grades.
Berg and Steiner (2003) as well as Berg and Kelly (2000) demonstrate
in their work that even the youngest child has some idea about what will
make his or her life better and safe. These authors list such ideas as children
wishing for a parent or a grandparent to be with them more often at home,
not to have to stay with an aunt, to have friends, not be bullied, not have to
come to school … and the list goes on. It is very important to try to find out
their desired outcome by asking them clarifying questions. The following
session with James, a 10-year-old boy and the oldest child in a family with
four children, provides an example:
SSW: Hi, James, good to see you here today. Thanks for com-
ing down from class to see me.
James: Am I in trouble or something?
SSW: Not at all. You are not in any trouble. Your teacher, Ms.
Jason, told me that you had hurt yourself somehow. She saw
the bruises on your arms and wanted the nurse and me to
make sure you are okay. Ms. Johnson [the school nurse],
will see if she can help make them feel better. I haven’t seen
you for a few weeks. I see that you have a Star Wars shirt on;
who is your favorite person in the movie?
James: I guess so.
SSW: I can see that your mom loves all of you and is working
very hard to take care of you all. I’m sure that the person
I call can meet with you and your mom to see what can be
done to make it so you don’t need to get into fight with your
brothers and sister. Is that okay with you?
James: I guess.
SSW: I will get a note to you after I call and let you know what
is happening. I’m sure that Chewbacca would want that,
too. I’ll see you later today to let you know what will hap-
pen. I’ll walk you back to class now.
Conclusion
The fundamental posture of the school social worker is one of acceptance
and support of all students. This is especially important for children who
grow up within a neglectful or abusive home environment since they are
very likely to demonstrate a range of behaviors. SFBT can be a useful
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cm2012.pdf
8
■ ■ ■
SFBT in Action
Mental Health and Suicidal Ideation
Carol Buchholz Holland
126
127
Dysthymia, and Bipolar I or II, and 11.2% of the total sample were consid-
ered to have severe cases of mood disorders. Prevalence of behavior disor-
ders, such as Attention-Deficit Hyperactivity Disorder, Oppositional Defiant
Disorder, and Conduct Disorder, was also assessed. The researchers noted
that 19.6% of the adolescents in the study met the criteria for a behavior
disorder and that 9.6% of these adolescents were considered to have severe
behavior disorders.
Merikangas et al. (2010) also reported information regarding the average
onset of specific mental disorders for adolescents in the study who met the
criteria for a disorder. Their results indicated that 50% of the adolescents
who met the criteria for anxiety disorders had their onset by age 6, 50% who
met the criteria for mood disorders had their onset by age 13, and 50% who
met the criteria for behavior disorders had their onset by age 11. In addi-
tion, the incidence rate for major depression and dysthymia nearly doubled
from 13 to 14 years of age to from 17 to 18 years (Merikangas et al., 2010).
Furthermore, the National Alliance on Mental Illness (NAMI) (2014) issued
a report stating that “half of all long-term mental illness begins by age 14
and three quarters emerges by age 24” (p. 17). These statistics demonstrate
the importance of providing comprehensive mental health prevention and
intervention programs in schools because the age of onset for mental health
disorders often occurs during the elementary or middle school years.
In the latest national Youth Risk Behavior Survey (YRBS) report of stu-
dents in grades 9 through 12 who attend either public or private schools
in the United States, 29.9% of the surveyed students indicated that they
“had felt so sad or hopeless almost every day for 2 or more weeks in a row
that they stopped doing some usual activities” sometime during the 12
months before completing the survey (USDHHS, 2014, p. 11). In addition,
survey results indicated that “17.0% of students had seriously considered
attempting suicide during the 12 months before the survey” and that 13.6%
of the students “had made a plan about how they would attempt suicide”
(USDHHS, 2014, pp. 11–12). Although survey results between 1991 and
2009 showed decreases for these statistics, results between 2009 and 2013
revealed increases in the percentage of students who indicated that they
had seriously considered attempting suicide (13.8% to 17%) and that they
had made a suicide plan (10.9% to 13.6%). The 2013 survey also reported
that 8% of students “had attempted suicide one or more times during the
12 months before the survey,” an increase from the 2009 survey that had
revealed 6.3% of students indicated they had attempted suicide (CDC, n.d.-c,
p. 1). It is uncertain whether data collected from the 2015 YRBS will con-
tinue to show increases in student responses for these survey items. Recent
statistics provided by the National Center for Health Statistics, however,
show that suicide is now ranked as the second-leading cause of death for
individuals ages 15 to 24 (the leading cause being unintentional injury)
(CDC, n.d.-a). Before 2011, suicide had been ranked for several years as the
third-leading cause of death for individuals ages 15 to 24 (CDC, n.d.-b).
The number of students who need additional services is a growing con-
cern for schools. Because the stigma associated with mental health prob-
lems still exists in our society, some students and their families may be
reluctant to seek these services outside of the school setting (Murphey,
Barry, & Vaugh, 2013). This continued reluctance strengthens the case for
providing school-based mental health services. Although most schools do
not have unlimited resources, they are often the main provider of mental
health services for children (Hoagwood & Erwin, 1997). In many cases,
schools are the first place where student mental health issues are identified
and addressed. Erford, Newsome, and Rock (2007) stressed that students
with mental health needs who do not receive assistance may develop more
serious issues, which could have significant negative impacts on their edu-
cation. For example, untreated mental health problems could result in poor
academic performance or even the decision to drop out of school. In addi-
tion, untreated mental health issues could result in even more serious safety
concerns, such as harm to self or others. The December 2014 report by the
NAMI noted that “children and youth who receive prompt, effective mental
health care demonstrate surprising resilience, overcoming major challenges
to thrive in school, home and the community” (pp. 17–18). As a result, it is
important for schools to take the lead in providing effective prevention, early
identification, and early intervention of student mental health concerns.
trauma and violence. Fortunately, there has been movement away from
using the traditional disease model in schools, which only provides treat-
ment after an illness has occurred (O’Connell, Boat, & Warner, 2009).
Instead, schools have shifted more toward utilizing prevention and inter-
vention models, which are designed to strengthen resiliency by building
capacity and to identify risk and protective factors.
Rak and Patterson (1996) defined resiliency as “the capacity of those
who are exposed to indentifiable risk factors to overcome those risks and
avoid negative outcomes such as delinquency and behavioral problems,
psychological maladjustment, academic difficulties, and physical complica-
tions” (p. 368). In addition, Galassi and Akos (2007) noted that “resiliency
research has repeatedly demonstrated that, contrary to popular belief, most
people are not permanently overwhelmed by and irreparably damaged by
exposure to life circumstances” (p. 33). Strengths-based approaches such as
the solution-focused approach are bolstered by resiliency research findings
supporting the belief that human beings have “self-r ighting tendencies that
move children toward normal adult development under all but the most
persistent adverse circumstances” (Werner & Smith, 1992, p. 202). These
“self-righting tendencies” align with the solution-focused assumption that
all people are capable of change. In other words, resiliency is a part of the
“healthy human development” process (Bernard, 1991, p. 18).
While examining methods for developing the capacity of individuals,
risk factors and protective factors are also considered. The Massachusetts
Executive Office of Health and Human Services (MEOHHS) identified five
domains in which risk and protective factors are categorized. These domains
include individual, peer, family, school, and community/society (MEOHHS,
n.d.). O’Connell et al. (2009) defined a risk factor as “a characteristic at
the biological, psychological, family, community, or cultural level that
precedes and is associated with a higher likelihood of problem outcomes”
(p. xxviii). Examples of risk factors associated with adolescent suicidal
behavior include aggressive and violent behavior (Walrath et al., 2001),
alcohol and other illicit drug use (King et al., 2001; Wichstrom, 2000), anxi-
ety (Groholt, Ekeberg, Wichstrom, & Haldorsen, 2000; Ruchkin, Schwab-
Stone, Koposov, Vermeiren, & King, 2003), experiencing or witnessing
violence (Brown, Cohen, Johnson, & Smailes, 1999; Ruchkin et al., 2003),
family distress (Breton,Tousignant, Bergeron, & Berthiaume, 2002; King
et al., 2001), hopelessness (Csorba et al., 2003; Perkins & Hartless, 2002),
The CBT school social worker often takes the role of an expert and makes
recommendations about how the student could solve his or her problem(s).
On the other hand, a typical solution-focused school social worker would
facilitate a conversation with the student and assist that student in developing
“approach goals” (Bannink, 2012 p. 14). Approach goals are formed when a
student describes the preferred future and what he or she wants in life, such
as “I want to be happier” or “I want to make more friends.” The solution-
focused approach redirects attention and energy toward identifying what
possible solutions may already exist instead of concentrating on problems.
The inductive process incorporated within the solution-focused approach
is similar to the trial-and-error method that students use to learn. Based
on her experiences working with children, Insoo Kim Berg concluded that
children do not need or want to know what caused their problems (Berg &
Steiner, 2003). Instead, children would rather experiment to see what does
and does not work for them. Use of the solution-focused approach in schools
has been found to be effective because it is congruent with “how children
think and view the world” (Berg & Steiner, 2003, p. xv). Its time-limited
nature is especially useful for school-based mental health school social
workers who might have large caseloads but not large amounts of time to
work with students (Littrell, Malia, & Vanderwood, 1995). In addition, stu-
dents are more likely to become engaged in a counseling session that focuses
on their positive traits instead of their deficiencies (Sklare, 2005). Engaging
students in the counseling process is especially important when working
with students who are in crisis.
The following recommendations are used to help explain how Ms. Burns
will approach her first session with Brie. These recommendations are also
designed to be used with any student who is experiencing suicidal ideation.
Although it is not discussed within the recommendations described below,
please note that the solution-focused school social worker, Ms. Burns, has
already gone through the informed consent process with Brie.
Brie, what do you like to do in your free time when you are not
in school?
For case students who are very depressed and state that they are no longer
doing anything that they enjoy, the mental health school social worker could
ask this follow-up question:
So, before you started feeling really down, what did you used to
do that you enjoyed?
Henden (2008) also discussed that problem-free talk can serve four
different purposes: 1) It can normalize the interaction between the stu-
dent and the mental health school social worker because “it is an even
relationship; not ‘one up’ ”; 2) it allows the solution-focused school social
worker and the student to acknowledge the student’s “strengths, skills,
and resources”; 3) it “creates a context of competence” for the student
because the focus is not on the student’s challenges or problems; and 4) it
provides an opportunity for the solution-focused school social worker to
engage with the student, and not the student’s problem (pp. 78–79). In
addition, it is helpful to remember that problem-f ree talk is not small talk
with a student. It is actually a valuable therapeutic tool used to increase
client engagement.
Students who are referred by other people may be more reluctant to engage
in the counseling process or voluntarily share information, which is under-
standable, especially since these students were not the ones who initially
asked for help. Solution-focused school social workers strive to be respect-
fully curious when working with students. One simple way of demonstrat-
ing respect to a student is simply by asking the student for permission to
ask a question, especially if asking about a sensitive topic. For example, a
solution-focused school social worker could ask:
This question is also respectful because it allows the student to decide what
information he or she feels is most important for the mental health school
social worker to know. When working with clients who had experienced
trauma, Dolan (1991) would ask them disclose “only what was necessary
for healing” (p. 142). It is important that students feel like they still retain
substantial control over the content of information shared in counseling ses-
sions. In addition, solution-focused school social workers need to convey to
their clients that they are interested in identifying what would immediately
benefit the student, not in identifying and focusing on the causes of their
problems (Fiske, 2008). When solution-focused school social workers are
successful in communicating this, they are more likely to see clients who
1) open up more freely, 2) engage in the counseling process, and 3) return for
follow-up sessions if they need additional assistance (Fiske, 2008).
Henden (2008) noted that some critics of the solution-focused approach
believe that solution-focused school social workers “are not interested in
hearing about problems” (p. 80). Henden countered this criticism by stating
that solution-focused school social workers do spend time listening to cli-
ents’ problems. In fact, Sharry et al. (2002) stated that the solution-focused
approach “is not problem or pain phobic” (p. 387). Furthermore, “clients need
to feel that their problems and difficulties are taken seriously, that their suf-
fering is acknowledged and that they are not blamed for the problem” (Sharry
et al., p. 387). Solution-focused school social workers also realize, however,
that too much time spent focusing exclusively on client problems can be coun-
terproductive for students (Henden, 2008). In addition, Henden (2008) com-
mented that clients will return to “problem talk” if they felt that their mental
health school social workers had heard enough about their problems (p. 105).
Sharry et al. (2002) also recommended that while a client is describing his or
3. Assess for Incongruence
Although some students may provide verbal and non-verbal communication
that clearly indicates they are experiencing suicidal ideation, others may not
provide congruent information. In addition, it is possible for a student with
suicidal ideation to initially tell a school social worker that he or she is not
suicidal when asked a direct question about such ideation. Therefore, it is rec-
ommended that a solution-focused school social worker simultaneously assess
for any incongruences between the student’s verbal and non-verbal commu-
nication while the student is describing his or her problem (Henden, 2008).
Incongruence may be a warning sign that the student is dealing with suicidal
ideation that has not been explicitly expressed to the school social worker.
Brie, I’m sensing that you are going through a really tough time
right now. Am I understanding your situation correctly?
If the student expresses that he or she is, in fact, going through a difficult
time, it is helpful for the solution-focused school social worker to ask a scal-
ing question to quickly assess the situation. For example:
If the student then indicates that he or she is not doing well, or if the solution-
focused school social worker senses that the student may have deeper con-
cerns, the social worker could ask the student one of the following questions
for clarification:
Brie, I have question you. What helped you get out of bed this
morning so that you could make it to school on time and we
could meet together today?
Once the client’s confidence and energy have increased a little, the school
social worker can return “to goal formation on a more limited basis by
using scaling questions to help clients formulate their next steps in coping”
(p. 233). Fiske (2008) also pointed out that an important role of solution-
focused school social workers is to help their clients “develop longer lists of
coping strategies, including more life-affirming alternatives” (p. 157)
The following coping questions and statements have been slightly modi-
fied from Henden’s (2008) original versions. These questions are presup-
positional in nature and designed to help build on hope. In addition, they
are designed to be empowering and affirming of the student. An opening
question could be:
Brie, tell me about a time in the last couple of weeks when you
felt the least suicidal.
This question can be used as a lead-in for asking coping questions such as
the following:
Brie, what has stopped you from ending your life up to this point
in time?
This question is designed to identify possible reasons for living. Fiske (2008)
stated that “identifying, highlighting, and reinforcing reasons for living is
key to engaging in helpful conversations with individuals who are viewing
suicide as a solution to their problems” (p. 8). The solution-focused school
social worker may also ask:
Brie, what have you done in the last couple of weeks that has
made a positive difference on dealing with your tough situation?
If the student shares with the solution-focused school social worker that
he or she has experienced suicidal ideation in the past, the solution-focused
school social worker could ask the student the following coping question:
Brie, what did you do back then when you had suicidal ideation
that helped you make it through that difficult time?
This coping question encourages the student to explore coping skills that he
or she already possesses and to identify times when the student successfully
dealt with a difficult period (in other words, highlighting a “past success”).
The solution-focused school social worker might also ask a scaling ques-
tion designed to elicit information about the student’s current coping ability
such as:
Ironically, students are likely to share more information about their prob-
lems during coping dialogues than during formal problem assessments.
De Jong and Berg (2008) strongly believed that the best chance for helping
clients/students who are experiencing suicidal ideation is to “mobilize their
strengths and reestablish a sense of control over their emotions and circum-
stances” by asking “coping questions” and by encouraging the students to
“amplify their answers” (p. 224).
Acknowledge
Henden (2008) believed clients who are suicidal have an “intuitive radar”
and can detect whether a mental health school social worker is being “genu-
ine, and has some degree of appreciation of their pain and suffering” (p. 91).
It could also be argued that many adolescents by nature are very percep-
tive and can sense if adults are being sincere. Therefore, it is very impor-
tant for the school social worker to acknowledge the adolescent’s pain in an
authentic manner. For example, the solution-focused school social worker
could state:
Validate
In addition to acknowledging students’ pain and challenges, it is impor-
tant to validate their feelings and their suicidal thoughts. De Jong and Berg
(2008) noted that the first impulse of some beginning school social work-
ers is to try convincing suicidal clients that “suicide is illogical, dangerous,
and hurtful to others, or an otherwise distorted response to their situation”
(p. 223). Unfortunately, taking this approach with a student who is suicidal
may unintentionally increase the risk of suicide (Henden, 2008). By refuting
or challenging the student’s ideas, the school social worker may cause the
student to feel even more isolated, which obviously has a negative impact the
therapeutic relationship (De Jong & Berg, 2008). Adolescents may already
Brie, why would you consider suicide when you have so much
to live for?
However, asking students “Why” they did (or are doing) something can often
put students on the defensive and shut them down from sharing more infor-
mation. In addition, “Why” questions inadvertently convey that a judgment
is being made by the school social worker (Sharry et al., 2002). Instead, a
solution-focused school social worker finds it more productive to validate a
student’s thoughts or actions by stating:
Brie, based on everything that you’ve shared with me, it’s under-
standable that you are having some suicidal thoughts.
Normalize
Henden (2008) noted that “many suicidal clients express the view that, as
a result of having suicidal thoughts and ideas, they must be going mad”
(p. 92). Normalizing a student’s suicidal ideation or feelings is an important
part of helping someone who might also be feeling that he or she is losing
control over life or his or her mind. Henden (2008) provided this helpful
example of how to normalize a student’s suicidal ideation:
Let’s suppose that while you are sleeping in your bed tonight, a
miracle happens. The miracle is that all of your suicidal thoughts
and feelings are gone. However, you don’t know this miracle
has taken place because you were sleeping. When you wake up
the next morning, what would be the first sign to you that this
miracle happened?
After asking this miracle question, the solution-focused school social worker
tries to get as many details as possible about what the student is doing. The
richness of these details will provide valuable information that can be used
to assist the client in developing his or her “SMART+” goals (“small, mea-
sureable, achievable, realistic, and time limited”), which also include the
presence of “some positive behavior, rather than the absence of negative
behaviors” (Henden, 2008, p. 81). For example, the solution-focused school
social worker could ask:
The focus here is on identifying the student’s positive behaviors and actions.
It is also helpful to ask a relationship question such as:
This question can easily be modified to ask the student how “motivated” he
or she is to accomplishing the identified goal.
Brie, I’m curious to know if a small part of your miracle has hap-
pened, or if a small part of it is happening today. Tell me more
about the last time you felt a little better.
So, Brie, I’m curious about the last time you were feeling a
little less suicidal. What were you doing (or thinking) differently
than you are today?
How did you make that happen? … What else? … Okay, and
what else?
How did you decide to do that?
What did you discover by doing that?
What would happen if you tried that again?
What was different about the time you were in emotional crisis
but did not consider suicide as an option? (Fiske, 2008, p. 46)
What is different about those times that you are not thinking
about suicide? (Fiske, 2008, p. 46)
10. Compliment the Student
Complimenting students is an effective method for highlighting and reinforc-
ing students’ strengths and resources. Remember, however, that solution-
focused compliments should be based in reality and are not given just to be
“nice” or “kind.” There are also different forms of solution-focused compli-
ments, such as direct verbal compliments and indirect verbal compliments
(Fiske, 2008). A direct verbal compliment is a positive reaction or evaluation
by the solution-focused school social worker in response to what the student
has shared in a session. For example:
Wow, Brie! I’m sure that must have been difficult for you to
confront your friend about her hurtful comments and yet your
found the courage to do it.
Wow, Brie, how did you manage to get the courage to confront
your friend about her hurtful comments?
What did your friend notice that you did well in how you
approached this situation?
Brie, today you mentioned that you felt a little better when you
volunteered at your grandmother’s nursing home. Would you be
interested in having arrangements made for you to spend some
more time helping out there again?
Although the school social worker tells Brie that they need to contact her
mom, the school social worker still gives Brie the choice on how to do this.
During the conversation with Brie’s mom, the school social worker not only
shares Brie’s suicidal ideation but also emphasizes Brie’s coping skills and
exceptions when things have gone a little better for her.
12. Wrap Up the Session
After the conversation with Brie’s mom, the school social worker (Ms. Burns)
makes a point of wrapping up the session. Part of this summary includes
highlighting Brie’s current coping skills and her ability to deal with chal-
lenging times in the past. The school social worker also confirms with Brie
possible therapeutic tasks that she plans to complete. The session wrap-up is
an important part of the counseling process and should not be overlooked.
The severity of Brie’s suicidal ideation will determine whether she will need
outside assistance or will continue working with Ms. Burns in the school.
Either way, this initial solution-focused counseling session is designed to
build hope, to empower Brie, and to encourage further solution-building
activities.
Conclusion
“The wise person doesn’t give the right answers, instead the wise
person poses the right questions.”
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9
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SFBT in Action
Substance Use
Adam S. Froerer & Elliott E. Connie
Definitions
The US Department of Health and Human Services (2008) advocates that
professionals view substance involvement on a continuum with six anchor
points: 1) abstinence, 2) use, 3) abuse, 4) abuse/dependence, 5) recovery,
and 6) secondary abstinence. Abstinence means to refrain from using. In
the case of substance use, it means to refrain from using alcohol and/or
drugs. Use involves minimal use of substances and generally results in few
and/or minimal consequences. Abuse occurs with regular use and results in
153
154
(Office of Applied Studies, 2013). If we look closer at alcohol use (the high-
est prevalence rate), 35% of teenager surveyed reported drinking “some
amount of alcohol” during the past 30 days, with 21% reporting they had
at least one episode of binge drinking within the past 30 days and 10%
reported having driven after drinking. In addition to the substances listed
in Table 9.1, it should be noted that 2.2% of school-aged teens also reported
non-medical use of prescription-type drugs, and one in eight teens reported
that they were approached by someone selling drugs in the past month of
being surveyed.
These statistics do not provide an exhaustive overview of the current
state of adolescent substance use, and we acknowledge that the numbers
could be inaccurate due to the reliance on self-reporting. These numbers
do, however, highlight that many adolescents have used drugs/alcohol, are
currently using substances, or are at risk for future substance use. It is vital
for school personnel and mental health professionals to be aware of these
statistics (and more importantly, the individuals at risk represented by these
statistics) and the risk/protective factors for our youth.
SFBT in Action: Substance Use155
156
Source: Adapted from Doweiko (2002, p. 296) and Sanjuan and Langenbucher (1999, p. 481).
turn to substance use for help in coping with challenges or difficult situations.
Others may use for pro-social reasons, and still others may simply experiment
with substance use to determine if it is something they would like to incor-
porate into his or her personal identity. Several risk factors may impact the
likelihood of adolescent substances use. Table 9.2 provides examples.
Case Example
Many things make the solution-focused approach different from traditional
problem-focused ways of conducting psychotherapy. One of the key differ-
ences occurs not only in what the school social worker says to the student
but also in how the school social worker listens. While most training materi-
als on this approach focus on the techniques commonly used by solution-
focused practitioners, this chapter shifts the focus toward the language used
to co-construct a session. Put more simply, knowing about the questions
and knowing how to develop them in a conversation with someone who is
struggling with a significant issue (in this case, substance use/abuse) are two
completely different things. This chapter highlights the later by reviewing
a difficult case involving a teenager and his family that involves substance
abuse and other defiant behaviors. We include direct portions of the first
session in this chapter, summarize what happened in subsequent sessions,
and conclude by describing the events that occurred with this teen and his
family after therapy was over.
SFBT in Action: Substance Use157
158
occur over just about anything, nothing set him off more consistently or sig-
nificantly than when his parents did not let him hang out with his friends.
These incidents would include yelling, loads of screaming, and on occasion,
some pushing and grabbing between Shawn and his father. This was the
case in the incident that sent Shawn to the hospital and led his family to
counseling.
When the family arrived for the first session, it was immediately clear
that Shawn did not want to be there, and his parents looked as if they were
at their wits’ end. The parents entered the room first and informed me (E.C.)
of all of the things they have been dealing with. Shawn informed his parents
that he would not talk to me with the parents present, so the family asked if
I would be willing to see the teen alone. I agreed. What follows is a review
of that conversation.
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160
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162
As you can see from this segment of the session, I was able to ask ques-
tions that shifted the focus of the conversation away from the student’s frus-
tration and toward Shawn’s desired outcome for the session. Although it was
originally difficult at first to get Shawn to express what he was hoping to get
out of the session, I persisted in doing two important things: 1) trusting the
student’s ability to answer the questions about what his best hopes were, and
2) using the student’s exact language to continually move the session away
from problem-talk and toward an identification of his best hopes. Although
a student may be using drugs, the SFBT counselor will not overtly ask about
this issue (unless the student mentions it, like Shawn does) but, rather, will
trust that having a solution-building conversation about the student’s pre-
ferred future will help that student make changes leading to the fulfillment
of this preferred future. For school-aged youth, this process can help reduce
anxiety and/or “resistance,” and it can help them to know the SFBT coun-
selor is interested in their uniqueness and desires rather than pushing a
preconceived plan for what will be useful and helpful. This approach also
individualizes the treatment for each unique student.
SFBT in Action: Substance Use163
164
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166
Shawn: I don’t think so. I think he’s still upset with me, but we
text sometimes.
Elliott: Would he be pleased to see you being more positive
and doing your schoolwork and things like that?
Shawn: Yeah.
Elliott: How would he let you know he was pleased?
Shawn: Umm, he’d probably talk to me more and want to hang
out and stuff.
Elliott: Would you be pleased if you talked more and hung
out again?
Shawn: Yes, very!
Notice that in this part of the session how I learned a lot of informa-
tion that increased my skill in asking questions of Shawn, including specific
things I needed to ask Shawn that would be inappropriate to ask anyone
else about. For example, I was able to uncover names of key people in the
student’s life (Mike), information about what the student enjoys (hanging
out and history), as well as what the student likes most about himself (being
different). I also now know what the student believes about drug use (that
having people behind you will help) as well as what thoughts he has about
his current use (Mike does not like it; drug use has changed his behavior).
These details may seem like insignificant information, but in this
approach, this sort of information is key. It helps the school social worker
develop more tailored, specific questions that are just for one unique cli-
ent. In turn, this allows the conversation to feel less like an onslaught of
techniques and much more like a helpful and therapeutic, co-constructed
conversation.
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168
Shawn: I would be smiling for real. You know, like the type of
smile that let’s people know you’re for real happy.
Elliott: Would she be pleased to see this?
Shawn: I don’t know. I mean. I think so. She hasn’t seen me
like that in a while, but I think she would be very happy.
Elliott: How would she let you know she was happy?
Shawn: She’d smile back at me. She might ask me to turn
the music down or stop singing, but she would be smiling
as she said it. Not mad, you know?
Elliott: Yeah. How would you respond to that?
Shawn: I would do what she asked, but not with an attitude.
I would just do it.
Elliott: And would that surprise her?
Shawn: For me not to have an attitude? Yeah, she would be
very surprised. It would change the whole morning.
Elliott: In what way?
Shawn: Well, we wouldn’t be fighting. There’d be no yelling. It
just wouldn’t be so negative around the house.
Elliott: Would anyone else notice?
Shawn: It’s just me, my mother, and my father in the house, so
I’m sure my father would notice.
Elliott: How would he notice?
Shawn: He would notice we weren’t fighting.
Elliott: What would you and your mom are doing on this
morning?
Shawn: Just getting along, being nice to each other.
Elliott: How would he let you know he was pleased?
Shawn: He would definitely say something.
Elliott: Like what?
Shawn: He would come in and talk with us. He would say how
happy he was we weren’t fighting. He’s like that, he says
stuff like that.
Elliott: Would you be pleased with this interaction with him?
Shawn: Yeah.
Elliott: How would you let him know you were pleased?
Shawn: Honestly, I would ask him if he wanted to have break-
fast with me. We used to do that sort of thing.
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170
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172
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174
Notice how at this point of the session, the emphasis is on the description
related to the detailed presence of the student’s preferred future, not how
the student can make the changes that lead toward this becoming a real-
ity. It is simply about the description. This is one of the major distinctions
between solution building and problem solving. SFBT is not an approach
that involves problem solving. By engaging in a solution-building conversa-
tion, the client is more likely to experience, in the moment, the thoughts,
feelings, and emotions that he or she will likely re-experience when the best
hopes occur. In this conversation, the school social worker will experience
with the student a change in how the mood of the conversation shifts. The
school social worker will also notice how the student begins to express that
the changes seem “like normal.” This comes about due to the great details
elicited while answering the questions and makes it more likely the student
will make changes that lead toward the desired future.
Also notice that the focus is not using drugs and that this is hardly
mentioned during this conversation. In a SFBT session, the focus should
remain on what will be present rather than on what will not. By focus-
ing on what Shawn will be doing on a day when his best hopes occur,
SFBT in Action: Substance Use175
176
At the end of the session, I had a brief chat with the parents and informed
them that Shawn’s mood seemed to shift during the session, and that he was
more interested in making changes in his life. I asked the family to notice his
changes and praise him for them.
The family attended one more session two weeks later and could not
believe the changes Shawn had made in his life. He had been hanging
around with Mike and doing his homework daily. His grades and mood had
drastically improved as well. To the family’s surprise, they did not think
they needed another session.
It is important to remember when working with youth who are using
substances that we cannot be scared or intimidated by their presenting
problem. Instead, we need to remember that if we have a meaningful con-
versation about what the student’s best hopes are and what he or she will
notice when those best hopes happen, we are being solution focused. We
need to remember that this kind of conversation allows us to speak to the
real kid, not just a kid using drugs.
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Office of Applied Studies. (2013). Results from the 2008 National Survey on Drug Use and
Health. Rockville, MD: Substance Abuse and Mental Health Services Administration.
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10
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SFBT in Action
Eating Disorders
Karrie Slavin & Johnny S. Kim
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180
that is below the normal level for age, gender, and physical health. Within
AN are two subtypes called restricting type and binge-eating/purging type.
Restricting type involves weight loss through dieting, fasting, and/or excessive
exercise. Binge-eating/purging type involves binge-eating or purging behavior,
such as self-induced vomiting, misuse of laxatives, diuretics, or enemas (APA,
2013).
The second common eating disorder school social workers frequently
encounter is BN. Prevalence rates for BN are slightly higher than those for
AN and are estimated at 1% to 1.5% among young females (APA, 2013). BN
involves three essential features:
To meet the DSM-5 criteria for BN, the binge-eating and purging behaviors
need to occur an average of once per week for three months (APA, 2013).
Unlike AN, students suffering from BN are typically of normal weight to
overweight for their age and gender (Frank, 2015).
The third type of eating disorder school social workers are likely to
encounter is BED. The prevalence rates for BED among adult (18 years and
older) females are estimated at 1.6%, with rates of 0.8% among adult males
(APA, 2013). According to the DSM-5, BED must occur at least once a week
for three months, and the student must experience marked distress regard-
ing binge eating. Additionally, there must be recurrent episodes of binge
eating, as described earlier for BN. The key distinguishing criteria for BED is
that binge-eating episodes are associated with three or more of the following:
All these criteria need to be met in order have the diagnosis of BED (APA,
2013).
Besides body image influences, other risk factors also have been identi-
fied and are useful for understanding eating disorders. Weight concern is
considered to be a common and consistent risk factor for eating disorders
(Keel & Forney, 2013). For example, adolescent girls in the upper 24% of
body dissatisfaction group were four times more likely to develop an eating
disorder (Stice et al., 2011). Additionally, 11.2% of college-aged woman who
reported high levels of weight concern developed an eating disorder within
three years (Jacobi et al., 2011).
Peer groups are another important risk factor for eating disorders among
students. It is common for students to socialize and interact with other stu-
dents who share similar interests and values. This peer socialization has the
potential to reinforce or exacerbate concerns about body weight and shape
among girls and boys, creating a climate that influences behaviors that can
lead to students developing eating disorders (Keel & Forney, 2013). For
example, a longitudinal study by Zalta and Keel (2006) examined the effects
of peer selection and socialization on bulimic symptoms in college students
and found that personality factors played a significant role in peer selection,
which then led to those selected peers influencing bulimic symptoms.
happen in the past (exceptions). This can be especially useful for students
with eating disorders because, when traditional therapy modalities are used,
it is reported that many students try to conceal or deny their problems and
avoid seeking counseling help (Smink et al., 2012). Because of its collabora-
tive nature and its emphasis on the client’s worldview, goal definitions, and
resources, SFBT enhances cooperation during the change process (Martin,
Guterman, & Shantz, 2012). It engages students in a non-defensive manner
and allows students to detail what they want their goals to be and the con-
crete steps to make their goals happen.
Case Example
The following is a case example of a school social worker utilizing SFBT in a
first session with a student experiencing an eating disorder.
Background Information
Jessica is a 16-year-old junior at Central Valley High School. A straight-A
student, she competes on the varsity cross-country team and the varsity
swim team, and she designs sets for Central Valley’s drama club. She has
always done well in school and has seemed happy and well adjusted, so this
is her first time speaking with the school social worker.
and by asking about her strengths. By starting the conversation this way, the
school social worker is showing that she sees the student as a whole person
and wants to know things about her before finding out about the student’s
problem. She also has the opportunity to compliment the student, which is
an important SFBT technique that functions to “draw clients’ attention to
their strengths and past successes that might be useful in achieving their
goals” (p. 35), while also helping them to “grow more hopeful and confident”
(De Jong & Berg, 2008, p. 35).
In this section, the school social worker asks questions such as “How
are you hoping that I can be helpful to you?” and “What are you noticing
about yourself that is telling you that you need some help?” to begin to elicit
the student’s understanding of the problem and what she would like to be
different. During this beginning stage in SFBT, we listen respectfully to the
“problem-talk,” or the client’s description of the problem from her own per-
spective. We then guide the conversation toward “solution-talk,” where we
begin to think about and describe what will be different for the client when
her problems are solved (De Jong & Berg, 2008).
In this section, the school social worker is asking the student questions
to focus her mind on further defining her preferred future when she is doing
well. The questions she asks and her follow-up responses invite the student
to give further details about her preferred future. Through this process, the
school social worker and the student are able to begin defining some of the
goals that are important to the student—feeling happier, feeling calmer,
feeling good about herself, and so forth. At the end of the section, the school
social worker also asks an exception question and discovers that there was
a time when the student was doing better. Exception questions are useful
because they can “help clients become more aware of their current and past
successes in relation to their goals” (De Jong & Berg, 2008, p. 105).
Jessica: [smiling a little] Yeah.
SSW: How will that make your day go better?
Jessica: Oh, a lot better. I’ll want to talk to my friends at
lunch, and then I guess since it’s a miracle I’ll eat more of a
lunch, and then I’ll maybe have some pep in my step in the
afternoon.
SSW: Great, more pep in your step. And what will you be
doing differently once you have more pep in your step?
Jessica: Well, I’ll just be handling everything more easily, so
if a teacher gives an assignment I’ll be like “I can do that”
instead of just starting to worry that I won’t do it perfectly.
SSW: Oooh, I love that, you’ll be like “I can do that”.
Jessica: Yeah, and I’ll be feeling more good about myself, like
I said before, loving myself. [tears up] That would be really
different for me.
SSW: Yeah, that sounds important to you. How will things be
different for you when you are feeling good about yourself
and loving yourself?
Jessica: [silent for a bit] I’ll just, you know, feel better inside.
I won’t want to do things to punish myself, like not eating.
SSW: What will you want to be doing instead of punishing
yourself when you’re feeling good about yourself?
Jessica: I guess being nice to myself, telling myself I’m
doing a good job, rewarding myself, like maybe by doing
something fun.
SSW: That sounds great.
Jessica: Yeah.
SSW: And after your miracle happens tonight, who do you
think will be the first person to notice the change in you?
Jessica: Oh, definitely Tia.
SSW: Oh, yeah? What will she notice about you that will show
her that your miracle has happened?
Jessica: [tears in her eyes] I’ll seem happy.
SSW: That’s great. What will Tia notice about you that will
really show her that you’re happy?
Jessica: I’ll be smiling. I’ll have pep in my step. I’ll be saying
good things about myself. And I’ll be eating my lunch and
not saying I’m fat, and just, like … back to myself before.
Like, how I used to be.
SSW: Back to yourself.
Jessica: Yeah.
In this section, the school social worker utilizes scaling questions with
the student to begin to define where the student is and where she wants to
go within the frame of reference of her miracle. As described by De Jong and
Berg (2008), “scaling is a useful technique for making complex aspects of
the client’s life more concrete and accessible to both practitioner and client”
(p. 107). In this case, scaling the miracle is a useful process because it brings
the miracle back into reality and allows the student to identify the bits of her
miracle that are already happening. In addition, it helps the student to con-
sider how close she perceives that she will need to be to her miracle picture
in order to be satisfied, and also what changes will be the most important to
her success. This emphasizes to the student that she does not need to make
her miracle picture happen in its entirety to consider herself successful—she
only has to get to a better place, as defined by herself. Asking about the point
on the miracle scale where the student will be satisfied also gives the school
social worker and the student an opportunity in the first session to imagine
the endpoint of therapy. This helps to emphasize the brief nature of SFBT—
it assumes that the student will not be in therapy forever and, in fact, will
stop working with the school social worker when she is ready to continue
the change process on her own.
In Section 7, the school social worker utilizes a break so that she can
reflect on the session and formulate feedback that will hopefully be helpful
to the student. During this break, the school social worker considers what
the student has said that she wants to have different, the things that social
worker is genuinely impressed with about the student that relate to what the
student wants to have different, and what the social worker thinks could be
a useful task for the student to complete between sessions. The school social
worker then returns, delivers the compliments, and follows with the task
request. In this case, the school social worker chooses the task of noticing
times when the student is doing a little bit better in an attempt to draw the
student’s attention to these times for multiple reasons. First, this will allow
the student to observe and experience herself doing better, which will build
her confidence in her ability to continue changing. Second, the student
will be able to make observations about what she is doing differently when
she is doing better, which will give her good clues about which behaviors,
thoughts, and feelings she would like to replicate. Lastly, simply by paying
attention to the times when she is doing better, the student may end up hav-
ing more times when she is doing better because her mind will be dwelling
in this reality more of the time.
At the very end of the session, the school social worker asks what was
most helpful to the student that day. This is useful because the student’s
reply may give the social worker some clues about what can be done in
future sessions that will be most useful to the student. It is also a nice way
to conclude the conversation because it leaves the student with something
positive to take away from the session.
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