82 Transcript

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[00:00:00] Dr. Sharp: Hey y’all. This is Dr. Jeremy Sharp and this is The Testing Psychologist podcast episode 82.

Today, we have Dr. Ross Greene on the podcast. This is an interview that I’ve been looking forward to for a long time. I’ve used Dr. Greene’s approach,Collaborative & Proactive Solutions (CPS), professionally and personally with my own kids quite a bit. He is an excellent interviewee. He has a lot to say and he’s passionate about what he’s doing.

If you’re not familiar with Dr. Greene, he has a lengthy bio to get acquainted with. He is the founding Director of Lives in the Balance, a nonprofit aimed at advancing the mission of helping kids with challenging behaviors and educating the public, educating teachers, and helping those kids who tend to slip through the cracks in the schools and elsewhere.

He served on the faculty at Harvard Medical School for over 20 years. He’s now an associate professor at Virginia Tech [00:01:00] and an adjunct professor at the University of Technology Sydney, in Australia.

Dr. Greene also recently added executive producer, I believe, to his resume. He has a documentary that’s currently screening across the country called The Kids We Lose, and we talk a bit about that in addition to many other things during our interview today.

So without further ado, I give you Dr. Ross Greene.

Hello. Welcome back everyone to The Testing Psychologist podcast. This is Dr. Jeremy Sharp.

Today, I have with me, Dr. Ross Greene. Y’all may have heard of Dr. Greene. I hope you have heard of Dr. Greene and his work. [00:02:00] as a new take or different take on behavior management for kids. We’ll get into it in great detail, but he’s someone that I followed for years and one of those guests, when I started the podcast I thought, oh, that would be incredible if I could get Ross Greene on the podcast. And so here we are. So I’m very grateful for that.

Ross, welcome to the podcast. 

Dr. Ross: Thank you for having me on. You got me.

Dr. Sharp: It’s happening. It’s great. I think I mentioned in the email that I sent you to reach out initially that I’ve been tapped into your model for our own kid, and as a clinician of course. So the personal and professional side just has been really important in my life. So I’m really excited to be talking to you today. I appreciate it.

Dr. Ross: Glad to be talking to you.

Dr. Sharp: Cool. Well, usually we ease into it just by getting an idea of [00:03:00] who you are, what you do day to day, how you got where you are. So I’ll just leave that door open and let you take it where you might. Does that sound okay?

Dr. Ross: Absolutely. Well, who am I? Child psychologist. Grew up in Miami, Florida. Now live in Portland, Maine, when I’m actually in Portland, Maine.

Where am I? That’s a very good question in terms of how did I get here. Professionally, I went to grad school and gravitated to kids with ADHD. And if you’re working with kids with ADHD, you’re going to be working with kids with oppositional defiant disorder (ODD) and conduct disorder. And that’s who I really gravitated to because I felt like they were not a very well-understood population. And that’s been validated by all the work I’ve been doing over the last 30-some-odd years. This [00:04:00] is a poorly understood and poorly treated population.

It’s not my way to sit and watch things not go well. So I had to buck up against my own training a little bit because I was trained as a reward and punishment guy. And I was finding that that really wasn’t what the vast majority of these kids seemed to need. That was helped out by the research that’s accumulated over the last 40 to 50 years.

What became quite clear is that challenging behavior is just the signal, just this fever, just the way the kid is communicating that he or she is stuck, but more technically, and the wording here is crucial, having difficulty meeting certain expectations. And that it wasn’t a lack of motivation that was making it difficult for them to meet those expectations. It was lagging skills. And that is just a [00:05:00] completely different set of lenses. And it leads us in a completely different direction in terms of intervention.

So I started trying some new ideas for size especially related to prioritizing all of the expectations that the kid was having difficulty meeting. Instead of using incentives to try to modify their behavior, I began trying to solve the problems that were causing that behavior. Over time, the middle word of the model Collaborative and Proactive Solutions became incredibly important because so much of what we do to these kids occurs in the heat of the moment- it’s reactive, and you don’t have to use your crisis management strategies if you are in crisis prevention mode. The problem-solving is a whole lot better if it’s collaborative instead of unilateral.

And so [00:06:00] those were pretty much the key themes that have driven the work and everything I’ve been doing for the last 30 years or so. And so I’m not exactly sure where I’m at except Portland, Maine, but that’s how I got here.

Dr. Sharp: Sounds good. What was that like to like you said, buck against your training? Was that happening as a grad student or as an early career psychologist or what? That sounds hard. 

Dr. Ross: Early career. Well, even as a grad student, I was questioning whether rewarding and punishing and contingency contracting and behavior was really all there was to it, and whether those should be our only focal points. So that was happening in graduate school.

I started trying some new things on for size shortly after grad school.  And the truth is, it was a little scary because I was not only bucking up against my training, but I was bucking up against some pretty influential [00:07:00] figures who I worried might simply blast me for thinking that there might be more to helping kids than rewarding and punishing. The good news is at no point have I felt blasted

Dr. Sharp: That’s good.

Dr. Ross: because the truth is, well, Collaborative and Proactive Solutions flow from theoretically, at least, similar underpinnings. It’s still social learning theory. That’s a lot of the underpinnings of CPS, and that’s the underpinning of rewarding and punishing as well.

And so so long as I have been helping people understand that, and so long as I have been emphasizing that BF Skinner talked every bit as much about conditions as I do, I don’t call them conditions, I call them unmet expectations or unsolved problems, that seems to make a whole lot of folks feel a whole lot better.

Dr. Sharp: I bet. That’s a good reframe. That’s interesting. [00:08:00] It’s not that far away.

Dr. Ross: I was on a call with my mentor, Tom, who is who’s been who’s largely a Parent Management Training guy. We were on the phone the other night because we were reviewing some data that we collected in Australia on comparing CPS to Parent Management Training and he was saying that he’s sometimes amazed that people don’t see the difference between CPS and PMT. From both of our perspectives, they are very different ways of thinking and doing things even if they flow emanate from similar theoretical foundations.

Dr. Sharp: The way that they manifest and come about and get put into action, it seems like are vastly different.

Dr. Ross: It seems like it to me. 

Dr. Sharp: It seems like it. That’s my perception. Well, I would love to talk about that data, that’s interesting, right [00:09:00] off the bat. Before we totally jump into all of that, can you just talk a little bit about what your life looks like now? Are you doing any private practice at all or is it a lot of speaking and writing and whatnot?

Dr. Ross: Speaking, writing, running a nonprofit which probably takes up more of my time than anything else. 

Dr. Sharp: Is that the Lives in the Balance?

Dr. Ross: Yeah. I don’t draw any income from Lives in the Balance. So basically the speaking and the royalties from the writing permit me to run a nonprofit and a nonprofit that doesn’t have to pay me any money. So, there’s a lot of things we can do because I’m not taking any money from the organization.

I do still see some kids. I’ve had to drop it off a fair amount mostly because my schedule is so funky that [00:10:00] the kids who I like working with the most are the very severe ones, but they need a lot of me, their families need a lot of me and their schools need a lot of me. And with my traveling, there’s not always a lot of me to give. And so I don’t want to feel like I am doing them a disservice by taking them on and then not being able to provide them with the level of care that they need. And so still working with a meaningful number of kids, just nowhere nearly as many as I used to. Still above it and it still keeps me sharp and it still, quite frankly keeps me in touch with just how hard it is out there for everybody.

Dr. Sharp: Right. I was just going to say, I think it’s nice to have both sides. I interview a lot of folks who are both academics and clinicians, and it’s nice to be able to marry the two and not get too far away from either one.

Dr. Ross: I agree. 

Dr. Sharp: In case, I’m sure there’s somebody out there who [00:11:00] doesn’t know what we’re talking about when you say CPS and Lives in the Balance and collaborative and this and that, can we zoom way out just for a minute and talk to me about what this model is, what it’s about, where it came from, what do we use it for?

Dr. Ross: Got it. Well, you can use it for just about any problem that needs to be solved in just about any setting in which the problem needs to be solved. In my personal experience, and professional experience, this has been done with thousands of families, hundreds of schools, dozens of inpatient psychiatry units, and residential facilities, one system of juvenile detention, one adult inpatient psychiatry unit, few adult prisons.

Dr. Sharp: Wow.

Dr. Ross: One thing I would say is that I don’t really see much difference among the people who this has applied to. If I’m doing this with a psychotic adult [00:12:00] and I’m doing this with a 3-year-old kid, believe it or not, I’m not seeing a whole lot of differences between them as it relates to identifying the skills that they’re lacking, which is one of the things the CPS model has us doing, and solving the problems that are causing the behaviors that so many other people are focused on.

So the big themes of the model are that you’re focused on problems, not behaviors. Once again, the behaviors are just a signal. Behaviors just communicate to us that there’s an expectation that a kid is having difficulty meeting or an adult. We’ve got to figure out what those are. That’s crucial.

And so this model would not have us completing behavior checklists. It really wouldn’t emphasize doing behavior observations. It would have us sitting down with caregivers and identifying a kid’s lagging skills and unsolved problems using an instrument that I developed called the Assessment of Lagging Skills and Unsolved Problems Available for Free, just like everything else on the Lives and the Balance website.

[00:13:00] Once we identify those problems, we’re going to be solving them with the kid. Well, first we have to prioritize them because a lot of the kids who are getting in trouble the most, believe it or not, are going to have 30, 40, 50 different unsolved problems if we’re identifying them the right way.

And by the way, they do tend to accumulate over time. The reason they accumulate over time is because people tend not to be focused on solving those problems. They tend to be focused on modifying the behaviors that are the byproduct of those problems. Modifying behavior solves no problems. I think that’s a very important theme. You’re solving nothing by modifying a kid’s behavior. You may be making a dent in the behavior, but you certainly aren’t solving the problem that’s causing that behavior. And that’s huge.

Dr. Sharp: That is huge.

Dr. Ross: So the other big themes are that problem-solving is collaborative, not unilateral; and proactive, not reactive. So one of the big goals of this model is to get caregivers and kids out of the heat of the moment where [00:14:00] there is nothing incredible to do except what the crisis management programs tell us to do. Diffuse, de-escalate, and keep everybody safe.

Those problems are best solved proactively and quite frankly, the best use of our crisis management strategies is to never have to use them, but you’re going to have to use them if you’re not being proactive. So those are the big themes. And then the rest of it is just the technicalities of how we go about solving a problem collaboratively and proactively because there are many ways to do it incorrectly.

And so a lot of what I’ve been doing for the last 10 years is trying to build in protections, guidance, guidelines, and strategies for making sure people stay on track in their efforts to solve problems collaboratively and proactively.

Dr. Sharp: You mentioned Parent Management Training. A lot of us I think were brought up in that model in grad school and [00:15:00] have recommended it to varying degrees over the years. So this is, again, just be super clear and super basic, it’s like an alternative to Parent Management Training. It’s a different way to work with kids who are exhibiting disruptive behavior. Is that fair? Would you use that?

Dr. Ross: Yeah, that’s fair. To tell you the truth, I don’t actually distinguish. I don’t slice the pie by what kind of behavior a kid is exhibiting. These days, I’ve been saying that I think that we have become too diagnostically oriented. That’s one way to slice the pie.

Here’s how I slice the pie. As it relates to the behaviors kids and other human beings exhibit to communicate to us that they’re having difficulty meeting certain expectations. We all fall into one of two categories. You’re either lucky or you’re unlucky. So lucky ways of communicating that are things like [00:16:00] whining, pouting, sulking, withdrawing, crying. Unlucky ways are screaming, swearing, hitting, spitting, biting, throwing, destroying, running, and worse.

What the field of developmental psychopathology tells us is that that is not the way to slice the pie. So if you’re asking me who would I do this with? 1)What type of kid is having difficulty meeting expectations? The answer is all of them. Would I reserve this only for kids who are communicating that they’re having difficulty meeting expectations in ways that are unlucky? I can’t imagine why I would. And so I don’t really make that distinction.

That said, I would say that most clinicians and most educators, and staff in restrictive therapeutic facilities are struggling more with unlucky kids than they are with lucky kids. The reason I refer to [00:17:00] the unlucky ones as unlucky is because these are the kids who we are popping into timeout, depriving of recess, holding them after school, giving them millions of detentions a year in American public schools, millions of in and out of school suspensions every year, 5.4 million of those a year. Just suspensions in American public schools, we expel them at the rate of over 100,000 a year. We do hundreds of thousands of restraints and seclusions a year. We paddle them in American public schools still in 19 different states over a hundred thousand times every school year.

Dr. Sharp: Oh my gosh, I did not know that.

Dr. Ross: You don’t know that. That’s unlucky. And so it’s not only unlucky in terms of your behavior because we are treating you [00:18:00] as if you are somehow different from kids who are communicating that they’re having difficulty meeting expectations in ways that are lucky, but these are things that are very counterproductive. They don’t help. And what they mostly serve of the purpose of doing is pushing this kid away from people who could help him if they had the right lenses on and if they had strategies beyond those which were oriented toward rewarding and punishing.

Dr. Sharp: Yeah. That those are some powerful numbers. The paddling especially is completely. That blows my mind that in public school in the United States, there’s still paddling happening.

Dr. Ross: That’s because you haven’t yet seen the movie The Kids We Lose. 

Dr. Sharp: That’s right. Yes. We got to talk about it.

Dr. Ross: At some point, cannot be now.

Dr. Sharp: Okay. We’ll bookmark that. That’s one of the newer developments for you is you can add filmmaker to your resume.

Dr. Ross: I can add executive producer. I don’t know if I count [00:19:00] as a filmmaker technically, but I count as a developer and executive producer at this point.

Dr. Sharp: That’s fantastic. So let me ask, is lucky versus unlucky hereditary, predetermined? How does that happen?

Dr. Ross:  I was taught in grad school that everything is 100% nature and 100% nurture. So I think that there are genetic predispositions.

I’m a big believer in the Diathesis–stress model. I’m a big believer on all those models that tell us that you may be at a predisposition to have difficulty or to develop a certain condition if we’re talking about disorders. But it still takes an environmental stressor to bring that out in you, which explains quite frankly why so many people who have a genetic predisposition towards something don’t develop it [00:20:00] and some who have a genetic predisposition do.

Everything’s 100% nature and 100% nurture, believe it or not, although I have an intellectual curiosity about risk factors and about how a particular kid came to be this way. As it relates to individual kids, I spend almost zero time trying to explain how this kid got to be this way.

Dr. Sharp: Oh, that’s interesting.

Dr. Ross: Well, the reason is, generally, I can’t do anything about how he came to be this way, but what I can do something about are the lagging skills and unsolved problems that are how he is, that are the way he is.

And so, one of my pet peeves is that I think we, mental health professionals and others too, spend way too much time trying to nail down with precision. And you can’t nail this down with precision anyways, how this kid got to be this [00:21:00] way. I would much rather talk about lagging skills so that we have the right lenses on and how to solve problems so we know what we’re working on. Because if we think that this was due to exposure to alcohol in utero, and the kid is now 12, and if that’s all we know, and if that’s all we’re focused on, we’re all sunk because that was 12 years ago.

Dr. Sharp: Yeah. I’ve been trying to think how to talk through that with you because we, it’s called The Testing Psychologist podcast, a lot of us are assessment-heavy clinicians, and it seems like the closest that you get to that and correct me, I know you will, but is something talking about like executive functioning… 

Dr. Ross: Now we’re in the ballpark.

Dr. Sharp: Okay. I’m in the ballpark.

Dr. Ross: I’m just talking about how he came by his executive functioning deficits. That to me seems, well, [00:22:00] two things. It’s imprecise. It’s something we often can’t do anything about. So at a very practical level, how he came to be this way is something I don’t spend a lot of time on. I’m entertained by it. I find it intellectually interesting, but as it relates to the practicalities of actually helping this kid and his caregivers, generally speaking, not something we can do much about.

But executive functioning, language processing, communication skills, emotion regulation skills, cognitive flexibility skills, social skills, now you’re talking my language. What I do say about those is that they’re very broad categories and that while they put us in Fenway Park, they don’t tell us what section we’re sitting in or what seat we’re in yet, but at least we’re in the ballpark of lagging skills.

But as you well know as well as I’m assuming all your listeners, executive skills don’t tell us much. Better than ADHD, but [00:23:00] I’d much rather talk about difficulty shifting set. I’d rather talk about difficulties with working memory. I’d much rather get much more specific if all I do, and this is practical again, is tell parents that their kid is lacking executive skills.

While I have moved them off a diagnosis that tells us about the behaviors the kid is exhibiting because he is lacking those executive skills, I haven’t helped them understand their kid very well because executive skills is too broad. But if I let them know that their kid is having difficulty shifting from one mindset to another, suddenly this kid has come alive before their very eyes and many of the challenging episodes that they have been dealing with are now explainable.

When I had trainees, I always told them that the number one role for us clinicians is to help parents understand what they’re dealing with, to help teachers understand what they’re dealing with. And [00:24:00] that’s where a testing psychologist is going to be right up my alley because what’s usually walking in the door is tell me what to do, but my pat line is can’t tell you what to do until I know what you got.

The most important part of dealing with people early on is to let them know what they got and what they got, I’m defining in terms of lagging skills and unsolved problems. Then I can tell them what to do. They also want to know how come what I’m doing that’s working for my other kids isn’t working for this one? If I don’t help them understand what they got, my explanation for that second question isn’t going to make any sense to them.

Dr. Sharp: Sure. So where do you see the role of assessment in this whole process? Is neuropsychological assessment helpful or behavior checklists or [00:25:00] your own checklist?

Dr. Ross: I am not a big checklist guy because, for me, behavior checklists are signal checklists, right? All a behavior checklist tells me is what signals the kid is emitting, but the behavior checklist doesn’t tell me what lagging skills and unsolved problems are causing the kid to emit those signals. So I’m not a big behavior checklist guy these days.  I think neuropsychology has been one of the biggest influences in informing this model.

Dr. Sharp: Oh, how so?

Dr. Ross: Well, this is a model about lagging skills. The primary explanation for challenging behavior in this model is that’s lagging skills. Where do those lagging skills come from? Neuropsychology. What’s listed on the left-hand side of the assessment of lagging skills and unsolved problems? Lagging skills. Those are the lenses we want people viewing a kid through.

At a practical level, I view the assessment of lagging [00:26:00] skills and unsolved problems as an assessment tool. And I find that it is sufficient a meaningful percentage of the time. It’s when it’s insufficient that I’m referring kids for neuropsychological testing. I have my favorite neuropsychologist in this area who I think just explain kids masterfully.

When I was teaching assessment at Virginia Tech, when I was on the faculty there, I was telling people, you know what? Anybody can give a WISC, anybody can do Woodcock-Johnson, anybody can do a Rey–Osterrieth. So anybody can do that. The eyes of the evaluator, what they’re seeing while the testing is going on, to me, that’s what defines whether somebody is really good at their craft or just doing testing.

Dr. Sharp: Sure. [00:27:00] That art versus science, right? I think a lot of people would agree with that. And the theme…

Dr. Ross: I love my local neuropsychologists. I don’t refer to them quite as often as I used to because of the assessment of lagging skills and unsolved problems, but every lagging skill on that instrument came from neuropsychology.

Dr. Sharp: Got you. Can you describe that instrument a little bit?

Dr. Ross: Pretty simple. Two sides: left-hand side is a list of 23 lagging skills. Those lagging skills come from the executive literature, the language processing and communication skills literature, the emotion regulation literature, the cognitive flexibility literature, and the social skills literature. So that’s where those skills come from. I didn’t make any of them up. I borrowed heavily. On the right-hand side is where we are writing in expectations the kid is having difficulty meeting.

In this model, those are the two most crucial [00:28:00] pieces of information. What I always say to trainees is, there are so, and I used to sit in meetings where we talked about everything, especially on inpatient units, we talk about everything in the kitchen sink, and it’s overwhelming just the number of things you could talk about with a kid. When we do that to caregivers, they don’t know what to focus on. They don’t know where to start. They don’t know what’s important. Lagging skills and unsolved problems bring this to a very concrete, basic level of analysis. The other nice thing is…

Another big model that CPS draws from is transactional models of development which basically say to us, it’s the fit or match between the characteristics of an individual and the characteristics of the environment that determine the outcome. In the CPS model, the characteristics that we are primarily focused on in the individual are [00:29:00] lagging skills. What we’re primarily focused on with the environment are the expectations the environment is placing on that kid. If the kid is behaviorally challenging, he’s having difficulty meeting a whole bunch of them.

Dr. Sharp: Sure. Can you give an example or two of a lagging skill and an unsolved problem?

Dr. Ross: Yeah. Let’s say we check off the first lagging skill which is difficulty handling transition, shifting from one mindset or task to another. We check it off. In my office, this is with parents, in a school, this is with teachers gathered around a table, in a restrictive therapeutic facility with staff gathered around the table. We’re going to have us a meeting. We’re going to have us a discussion. We’re not going to have people complete the checklist independently because that’s not conducive to the discussion.

As I always tell people, if you want to get everybody on the same page, a checklist isn’t going to do it. A discussion will. You want to get you talking the same language, a checklist isn’t going to do [00:30:00] it. A discussion will. If you want to persuade the unpersuaded, a checklist isn’t going to do it. A discussion will. So the goal here is to have a 50 to 55-minute discussion.

First lagging skill, difficulty handling transition, shifting from one mindset or task to another. If the caregivers generally agree, or if enough of them feel that lagging skill applies to this kid, we check it off. We then ask the following question, can you give me some examples of expectations Tommy is having difficulty meeting? Spring to mind. When you consider that lagging skill, when you think of him having difficulty handling transitions, shifting from one mindset or task to another. 

And so, let’s say one of the caregivers says, well, he has a devil of a time shifting from choice time, this would be in a school, to math. That unsolved problem would be worded as [00:31:00] difficulty moving from choice time to math. That’s an unsolved problem. Now we’re going to ask for more. Any other expectations the kid is having difficulty meeting when you think of him having difficulty shifting from one mindset or task to another?

Well, he is having a hard time coming in from recess back into the classroom. Back into the classroom for what? English. Difficulty coming back into the classroom from recess into English is the wording of our unsolved problem.

Now, here’s the key. There’s certain guidelines for the wording of unsolved problems. It’s probably not worth our time to go through, but people can find them on the ALSUP guide on the Lives in the Balance website. But it’s the wording of the unsolved problem as we write it in on the ALSUP that is going to translate into the wording that we use when we introduce the unsolved problem to the kid[00:32:00] when it comes time to solve that problem together.

Dr. Sharp: Yes.

Dr. Ross: Here’s what it would sound like. I’ve noticed you’ve been having difficulty coming back into the classroom for English after recess. What’s up? And the conversation is now rolling. That’s the beginning of what we call the empathy step of Plan B, which is where we are gathering information from the kid so as to understand what’s making it hard for the kid to meet that expectation.

And just as long as we’re on the topic, the second step is the defined adult concern step, which is where the adults are entering their concerns into consideration what’s important about the kid meeting that unmet expectation. And then in the invitation, kid and caregiver are collaborating on a solution, one that addresses the concerns of both parties, concerns that we identified in those first two steps of plan B.

Dr. Sharp: Cool. Can we just take that example and walk through [00:33:00] each of those three just to make it real?

Dr. Ross: Sure. Let’s go with, let’s say what the kid says in the empathy step is that… Actually, let me use the other example if that’s okay.

Dr. Sharp: Okay.

Dr. Ross: He’s having difficulty moving from choice time to math. This is the true one, the other one is very common, but I’m having trouble coming up with a kid who I can remember what it would’ve been recently. So let’s use the other one because I often use an example.

Dr. Sharp: Yeah.

Dr. Ross: Let’s say the kid… So we say what’s up? And the kid says, well I am playing a game during choice time and the game is not done. Now we’ve got to start drilling using strategies that are on the Drilling Cheat sheet on the Lives in the Balance website. Reflective listening being the most important of those strategies.

You’re not done. I’m not [00:34:00] sure I understand what you mean. What do you mean you’re not done? Well, I’m playing chess and the chess game isn’t done when I have to go to math. Got it. So the chess game isn’t done when you have to go to math, yes? Yes. Help me understand what’s hard about that. Well, I don’t know who won. Ah, so you want to know who won? Yes. What’s keeping you from knowing who won? Well, I could finish the chess game the next day, but it’s always getting wrecked between one day and the next, and then I never know who won. Ah. So the chess game is getting wrecked and so you never find out who won.

Any other concerns we should know about as it relates to the difficult, and I’m going very fast here, but any other concerns we should know about as it relates to your difficulty moving from choice time to math? Nope. [00:35:00] So if we helped you figure out who won, is there anything else that would make that difficult for you? No. Got it.

My concern is that if you are late for math, you miss a lot of the material, and that makes it harder for you to know what’s going on when you do get to math, and it’s really important for you to know what’s going on when you get to math.

Invitation. I wonder if there’s a way, the invitation always begins with the words I wonder if there’s a way, and generically it’s, I wonder if there’s a way for us to do something about Baba ba ba ba and also do something about ba ba ba ba, ba. And now we’re giving the kid the first crack at the solution. So now we’re going to plug in the concerns of both parties.

I [00:36:00] wonder if there’s a way for us to make sure we know who won and also make sure that you don’t miss the material at the beginning of math. Do you have any ideas? Well, this was a true one. We could put the chess game up high on a shelf so it doesn’t get wrecked from one day to the next. If that solution works, that problem is solved. If that problem is solved, it won’t set in motion challenging behavior.

And so not only are you solving a problem, you are also reducing the challenging behavior, and once again, as the data tell us, at least as well as you would be if you were using rewards and punishments to modify that behavior, and you are [00:37:00] simultaneously teaching the kid many of the skills that he or she is lacking just by solving problems collaboratively and proactively. What I call the three-for-one sale.

Dr. Sharp: I like it. So can you say more about that teaching the kid skills that he is lacking in the first place? How are they developing those skills through that process?

Dr. Ross: Just by engaging in those three steps? And by the way, I don’t always say this too loudly, but it’s not just the kid who’s learning skills. Whoever’s doing plan B with the kid is learning skills too.

In the empathy step, and we’ve got a graphic somewhere on the Lives in the Balance website showing this, I think it’s in the paperwork section. In the empathy step, let’s think about what skills the kid is learning and practicing.

Figuring out what one’s concerns are. Figure out how to articulate those concerns in a way that other people can hear. [00:38:00] Others as well. What skills are caregivers learning in the empathy step? Listening, taking another person’s perspective, among others. What skills is the kid learning in the defined adult concern step? Same skills the caregivers are learning in the empathy step. What skills are the caregivers learning in the defined adult concern step? The same skills the kid was learning in the empathy step.

And what skills are both parties learning in the invitation? Generating alternative solutions. Coming up with solutions that don’t just work for you, but that work for somebody else. Resolving disagreement without conflict, collaboration, and problem-solving. Those are among life’s [00:39:00] absolute most crucial skills. They’re all getting learned and they’re all getting practiced when we’re doing plan B.

Dr. Sharp: Yeah. The thing that jumps out at me when you describe all of this is that, and this is a revelation, it’s like we are treating our kids like actual people instead of just telling them what to do and assuming that they don’t have any feelings or agency in the process.

Dr. Ross: One of the words people frequently use about this model is that it’s respectful, but I would say it’s not just respectful to the kid, it’s respectful to anybody who’s participating. But it’s also respectful to classmates and siblings because if we’re not solving these problems with the sibling or with the classmate who’s making their life miserable and disrupting the learning process at school, it’s also respectful to their teachers because if they’re continuously [00:40:00] having to devote massive amounts of time and energy to a disruptive student. I’m not sure we’re doing anybody any favors.

So I think the respectful part cuts across many different constituencies. I work with schools all the time on the kids who are disrupting the process of learning in the classroom, who are taking up massive amounts of time, who are getting restrains and seclusion. And the truth is, schools don’t want to be doing that stuff. This I know. But often when they find themselves stuck in the heat of the moment, which they don’t want to be in the first place, of course, they find that they’re so far into it that they got no option. Well, there’s lots of options, but none of the good ones are in the heat of the moment. All of them are proactive. But I like to think of it’s being respectful all the way around. 

Dr. Sharp: Yeah, I’m right with you on that. I know that you’ve alluded to some of the research over the [00:41:00] course of our talk and I would love to dive into that a little bit if you’re willing. I’m curious what the research has looked like both for individuals in a private practice setting, but also schools because they… Let me back up, actually. What I hear a lot from both parents and teachers is…

Dr. Ross: I know what’s coming.

Dr. Sharp: Wait, take a guess. Let’s see. 

Dr. Ross: I think you’re about to talk about time.

Dr. Sharp: That’s exactly. I don’t have time to have these lengthy discussions every time there’s a problem. I don’t have time to talk to my kid for 30 minutes to get him to get his shoes on.

Dr. Ross: Right. Well, a few thoughts there. First of all, think of how much time you’re taking now and think about the amount of time that’s accumulated with you continuing to struggle. Some of these unsolved problems that I come across are 10 years old.

Now, let’s think about how much time it’s going to, but let’s not say it’s 10 [00:42:00] years old, let’s say it’s six months old, right? Now, let’s think of the cumulative amount of time we’ve spent dealing with that problem with it still unsolved. Half an hour is nothing. So this model’s actually going to save time. It’s just a matter of logistically how are we going to make the time so that we start saving time.

But I’ll say this, any school or parent that’s telling me that don’t have time to solve problems with their kids is spending mammoth amounts of time on challenging behavior. That is a given, right?

Dr. Sharp: Absolutely.

Dr. Ross: So time does tend to be the issue early on as people are first learning about the model, but that’s because us parents are really busy. It takes two incomes to create the lifestyle that one used to. We are busy shuttling [00:43:00] our kids from one enriching activity to another.

And all I can say is, I’d rather have a kid know how to solve problems. They know how to play the violin. As it relates to the real world, if he becomes a concert violinist, then those violin lessons are going to serve him well, but problem-solving is going to serve the concert violinist well too. I’m worried about everybody else who’s not going to be a concert violinist or a professional soccer player, or you name it. They’re going to have to know how to solve problems with their significant other, with their children, and with folks at work.

So, if I’m prioritizing, and if I’m a parent, problem-solving’s actually pretty much number one on the list, violin lessons far down the list. Violin lessons are a wonderful thing, nothing against violin lessons, knowing how to solve problems and resolve conflict is even more important. So if we don’t have time to do it, I think we’re going to pay the price for it.

[00:44:00] Dr. Sharp: Makes sense. I appreciate you addressing that. That’s a great way to talk about it with parents or teachers.

Dr. Ross: Now, parents are really busy, but you know who also is really busy? Folks in schools. But that’s because the school day was designed around academics. School discipline is designed to be reactive. School discipline is designed to be focused on behavior, not the problems that are causing that behavior. And in many schools, school discipline is primarily punitive.

Whether it was punitive or rewards, we’re not solving any of the problems that are causing a student’s challenging behavior. That’s why we are spending mammoth amounts of time on challenging behavior, and that’s also why it’s the same 10, 20, 30 kids in every building who are accounting for 80 to 90% of the discipline referrals in that building. [00:45:00] That’s extraordinarily inefficient.

So the time issue is an interesting one because that’s what everybody’s worried about. When people are implementing this model, they’re not only saving time, they’re probably saving money because of all that money that we spend placing kids into outside placements when we could have kept the kid in.

Dr. Sharp: Right. Let me ask a practical question. How do you advise getting into the schools to even have these conversations if some of us wanted to do that?

Dr. Ross: Well, invite yourself. I’ve been in school meetings where the neuropsychological report showed up. Sometimes it’s 10 to 15 pages long. Sometimes it is dismissed. Sometimes it’s incomprehensible. And often the comment is, [00:46:00] I’ll take a look at this one. The person who wrote it shows up to explain it to me.

Dr. Sharp: Interesting. Okay.

Dr. Ross: Show up to explain it. Answer questions. Help them understand why rewarding and punishing is not going to address what’s in that report.

I show up at schools all the time. They’re often fascinated that I would do that, which is tragic that the schools are surprised that the people who are working with the kid outside of school would show up. My attitude, well, if he’s having difficulty at school, I can’t think of any place I’d rather be.

Dr. Sharp: Makes sense.

Dr. Ross: Invite yourself.

Dr. Sharp: Okay. Point taken. I do want to touch on research. I think a lot of people are probably interested in that, so, what’s the research looking like for these different settings?

[00:47:00] Dr. Ross: Looking pretty good, to quote Larry David. Pretty good.

Dr. Sharp: I like it.

Dr. Ross: The people who don’t watch Larry David, of course, will have no idea what I just did, but […]

Dr. Sharp: We’ll put in the show notes,

Dr. Ross: … plug. It’s now an evidence-based model. There are now three large outpatient studies documenting its effectiveness and documenting that its effectiveness is at least commensurate with what has become the standard of care in Parent Management Training.

Dr. Sharp: That’s great.

 Dr. Ross: There are at least two, I’m trying to remember, studies from inpatient units showing that this is a very effective, no more than two, like 3 or 4 or 5 now. I’m thinking of the two that I’m on, but there’s more than that by people who’ve implemented it without me being a co-author, [00:48:00] significantly reduces or eliminates the use of restraint seclusion.

This is not published yet, but in juvenile detention significantly reduces the use of hands-on procedures, including solitary confinement, significantly reduces staph and kit injuries, and significantly reduces recidivism. In schools, dramatically reduces discipline referrals, suspension, and detention. We have not implemented it yet in a school that paddles, but I’m chomping at the bit because we could get that zero, which is where it belongs. We have one study showing that it is effective in groups.

Let me just scan my brain here. What else? We’ve got a bunch of studies from the largest scale study of CPS that took place at the Virginia Tech Child Study Center.[00:49:00] We’ve got lots of studies now on mediators and moderators of treatment response. All of these can be found on the research page, on the Lives in the Balance website.

Dr. Sharp: Fantastic. And we will link to that in the show notes and all the other resources you’ve mentioned. 

That’s great. I didn’t realize that it is officially an evidence-based practice now.

Dr. Ross: It is.

Dr. Sharp: That’s fantastic. So it’s there. What about that study you mentioned at the beginning- the Australian study comparing to Parent Management Training?

Dr. Ross: We are just looking at the data now. I’m counting that as one of the three that I mentioned because I’ve now had a look at the data there. We presented preliminary data at the World Congress in Melbourne, Australia two years ago. People can find those presentations on the research page on the Lives in the Balance website, but those papers, they’ll be in published [00:50:00] form probably in the next year to year and a half. And those will be posted on the same place. Pretty much showing the exact same thing that the two models are commensurate with each other. Of course, that’s what you need to do to be evidence-based. You need to show that your model is at least the equivalent of another well-established evidence-based model, and CPS now is.

Dr. Sharp: That’s great. So I wanted to, I know, gosh, our time is flying, but I wanted to circle back and ask about the film. What’s going on with the film?

Dr. Ross: The film has now been in three film festivals. It’s called The Kids We Lose. Quite frankly, am not especially devoted to film festivals, but it’s screening all over the country at this point. It’ll be in Australia in June and July, all over North America. I’m sure it’ll make its way around the world. There’s a website for it:[00:51:00] thekidswelose.com where people can find out, if they want to screen it in their area, how to go about doing that; as well as a video on the homepage of that website that’s a follow up because we really didn’t want the film to be an advertisement for CPS. We wanted it to be primarily an expose of what’s still going on out there in way too many places.

But there is a 16-minute video on the homepage of thekidswelose.com showing people what we hope they will do instead. And tons of videos, of course, on the Lives in the Balance website, but basically it’s an expose. It’s intended to heighten awareness of the human toll on everybody, kids, parents, educators, staff members, that’s taken by us continuing to use these heat of the moment, [00:52:00] often punitive interventions that we’ve been talking about that are extremely counterproductive, that don’t solve the problems that are affecting the kid’s life.

It’s a jungle out there and many people aren’t even aware of it. As I always tell people, unless you work with these kids, and some people who work with these kids aren’t even aware of it, but if you’re the parent of one of these kids, you are aware of it. And the goal, of course, is not only to heighten awareness in general but to advocate on behalf of change.

And so one of the things Lives in the Balance is doing with the documentary Leading the Way is advocating for change. There are policies that need to be rewritten. There are practices that need to be virtually obsolete. There are settings in which the intervention is right now predominantly reactive where intervention needs to be predominantly proactive. So there’s some really important things that need to happen out there. And so long [00:53:00] as my energy holds up, Lives in the Balance will be one of the organizations. There are others as well that are advocating for the changes that need to be made for some of our most vulnerable kids.

Dr. Sharp: It’s necessary work. The fact that you’ve turned all of this into an advocacy arm, I think is so admirable and needed.

Dr. Ross:  It’s it’s a good example. You asked me earlier, how did I get to where I’m at?

Dr. Sharp: Yeah.

Dr. Ross: How I got to where I’m at is by paying attention to what’s needed and by trying to fill those gaps. So what I thought was needed early on was a different intervention that wasn’t oriented toward rewarding and punishing. And what was needed was a heightened awareness of what factors contribute to challenging behavior in kids. And then what was needed was a book about that and for parents. And then what was needed was a book for educators. None of these are things I knew. These are all things I stumbled upon [00:54:00] along the way.

Then what was needed was a nonprofit to disseminate all of this information for free and a website to do that. And now what’s become apparent and was apparent, we’re just getting it organized, is advocacy to create those changes, because what I’ve noticed over the last 30 years is that all those speaking engagements I’ve done and the books that I’ve written and the webinars I’ve done, they’ve made a dent. They’re not enough. Now it’s time to start making those changes happen.

Dr. Sharp: That’s incredible. It’s really cool that you’re taking the steps and you’ve crafted your life in a way that allows you to do that. I think a lot of us have dreams or fantasies of that kind of thing, and to make it a reality is pretty amazing.

Dr. Ross: It feels doable to me that we can make these changes. It feels doable. And you know what? It’s worth it. Whatever the obstacles are, we’ll figure it out. [00:55:00] But the good news is that here in Maine, there are plans for our legislators, some of them anyways, to watch The Kids We Lose. And if you watch The Kids We Lose, you’re persuaded.

Dr. Sharp: Yeah. I’m thinking about how can we get it screened here if it’s not already coming. Who knows? I’m going to check that out.

Dr. Ross: Where are you again?

Dr. Sharp: I am in Fort Collins, Colorado. So about an hour north of Denver.

Dr. Ross: It’s screening in Denver. And I will, no, that was a different one. It’s screening in Denver I know, but all the screenings are on thekidswelose.com as well.

I want it screened everywhere so people know what’s going on out there, but I’ll tell you who I really want this to be in front of. The members of the Education and Labor Committee of the United States House of Representatives, which about two weeks ago, had a hearing on restraint and seclusion. I’ve had several people get back to me and say it was a complete waste of time.[00:56:00] I hope it wasn’t a complete waste of time, but this is a really important issue. We can’t waste time on it. I want members of that committee to see this film because if they see this film they’ll know that this is an urgent issue. 

Dr. Sharp: Sure. How close is that to being a reality? Getting in front of them? 

Dr. Ross: How to get in front of them?

Dr. Sharp: Yeah.

Dr. Ross: Well, if people sign up to be an advocator on the Lives in the Balance website, once again, no cost, then they will receive our newsletter, the Advocator. On our first Advocator newsletter, we gave them names of and email addresses of every member of that committee in the US House of Representatives and their email addresses and urged them to see the film and we’re happy to make the film available to them if they want to see it.

Dr. Sharp: Got you. That sounds good. I’m thinking, this podcast that I think has a wide reach within a very small niche, but certainly, there’s some folks at APA that might be listening and [00:57:00] might have some power to take some steps in that direction.

Dr. Ross: This needs to be screened at APA. This needs to be screened at ABCT. This will be screened at NAMI’s National Convention in Seattle in a few months. It’s screening at the Chad National Conference in November in Philadelphia. The more people who see this, the more people are aware of what’s going on out there, and hopefully, the more momentum there is for doing something about it.

Dr. Sharp: That’s right. It’s fantastic. Like I said, it’s good work and I feel like we…

Dr. Ross: I get most passionate when I’m talking about this. 

Dr. Sharp: Sure. Well, it’s needed, like I said, and it’s been really cool too. I feel like we started on the individual level and now we’ve gotten to this macro level and they’re all important, but this stuff is maybe the most important to really affect change from the top down, right? 

Dr. Ross: I think so.

Dr. Sharp: Well, that may be a good [00:58:00] note to end on. If people have questions or thoughts or want to reach out or find some of this, what’s the best way to in touch and find you?

Dr. Ross: The two websites that we have mentioned both have contact forms. I would say the Lives in the Balance website is better for the contact form. Go to the Lives and Balance website, go to the contact form and I’ll get it somehow.

Dr. Sharp: Okay. That sounds good. Well, I really appreciate the time, like I said, both personally and professionally. This was a conversation that I’ve been wanting to have for a long time.

Dr. Ross: Well, you’ve put in the time too, and I really appreciate you doing it.

Dr. Sharp: Of course. Well, best of luck in your ventures.

Dr. Ross: Thank you.

Dr. Sharp: And hopefully our paths will cross sometime again.

Dr. Ross: I’m sure they will.

Dr. Sharp: Take care.

Dr. Ross: Take care.

Dr. Sharp: Hey everyone. Thanks again for listening to that interview with Dr. Ross Greene. I was so thrilled to be able to get some of his time. He has a packed schedule with traveling and speaking and any number of other things going [00:59:00] on, but very fortunate to have him sit down with me for a little while and talk about many things.

I hope that you took away a lot of information about the collaborative and proactive solutions approach, and I think more than anything, got a sense for Dr. Greene’s commitment and passion to this group of kids and other individuals who might benefit from a non-rewards and consequences approach to interaction and behavior management. So go check out that documentary. I’m going to try to get it screened here, and we’ll see where that goes, and check out his books. Everything that we talked about will be in the show notes and probably some things we did not talk about.

If you have any interest in consulting, or if you’re trying to grow or build or start a testing practice, please reach out. I will be happy to help you or at least talk about whether I could be helpful to you. I have, well, at this point when I am recording, may have changed, 1 or 2 individual consulting spots open over the next few months. So if you are interested, you can reach out at thetestingpsychologist.com/consulting and we’ll see if it’s a good fit.

Okay. I think that is it. By the time this releases, we will be towards the end of April which means, hopefully, it’s getting warm. Anybody who has been listening to this for any amount of time knows that I am not a winter person. So I am excited about this summer or spring even. I’ll take spring. And maybe some of yáll are too. So, hang in there. Hopefully, spring is coming, and enjoy the rest of your week. Until next time, bye, bye.

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