Addiction Counseling Licensure Issues for Licensed Professional Counselors

Sep 4, 2014 | Article, Volume 2 - Issue 1

Keith Morgen, Geri Miller, LoriAnn S. Stretch

This article addresses the obstacles of effectively integrating addiction counseling into a nationwide definition of professional counseling scope of practice. The article covers an overview of issues, specific licensure and credentialing frameworks (LPC, CADC, LCADC) in two U.S. states, and recommendations to effectively bridge the gap between professional and addiction counseling. Historical origins and an overview of addiction counseling are presented.

Keywords: addiction, licensure, credentialing, LPC, CADC, LCADC

The question of professional identity within the counseling profession, first considered during the founding of the American Personnel and Guidance Association (Sweeney, 1995), still exists today (Calley & Hawley, 2008; Cashwell, Kleist, & Schofield, 2009; Mellin, Hunt, & Nichols, 2011; Myers, Sweeney, & White, 2002; Nassar-McMillan & Niles, 2011; Remley & Herlihy, 2009). One possible reason for the continual debate around professional identity may lie in the multitude of specialty fields (e.g., addiction, career, and school) within counseling (Gale & Austin, 2003; Myers, 1995; O’Brien, 2010). Remley (1995) underscores that unlike psychology, psychiatry and social work, counseling is the only mental health profession that licenses specialty areas. Specialty areas such as career and school counseling only denote a practice area or population; whereas addiction counseling actually entails a DSM-IV-TR Axis I disorder (i.e., Substance Use Disorders; American Psychiatric Association, 2000). No other Axis I or Axis II disorder receives such attention.

Addiction is considered a part of professional counseling as implied by the latest CACREP standards (2009). However, a separate licensure track exists for the profession of addiction counseling. If the practice of addiction counseling really is a part of counseling (as implied by the latest 2009 CACREP standards), then the time has come to recalibrate the rest of the counseling profession to better fit an inclusive and unifying professional counseling identity that includes addiction counseling. Thus, the purpose of this paper is to start the dialogue regarding the mixed messages on the issue of counselor identity and specialization for addiction counseling (Morgen, Miller, Culbreth, & Juhnke, 2011; Tabor, Camisa, Yu, & Doncheski, 2011). The article is divided into an overview of issues, specific licensure and credentialing frameworks in two sample states (New Jersey and North Carolina), and recommendations in response to the concerns discussed.

Overview of Issues

Henriksen, Nelson, and Watts (2010) criticize the counseling specialty system by arguing that counseling specialties do not define counseling but merely denote a practice area, and that counseling specialty licensure/credentialing implies that only a small proportion of the counseling profession is qualified to work with this population. The addiction area is one such area of specialization that comes with a separate licensure/credentialing process. The authors believe that in regard to addiction counseling, the additional supervisory and training hours required for addiction licensure/credentialing (in addition to the supervisory and training hours required for licensure as a professional counselor) implies that addiction content falls outside the professional counseling scope of practice.

For instance, if the graduate counseling program does not possess an addiction track, a cursory review of curriculum at CACREP and non-CACREP programs found the typical option of one addiction course as an elective. However, curricular reviews of numerous programs find few to no electives on other DSM-IV-TR disorders (e.g., mood, anxiety). Thus, the authors argue this produces a confusing mixed message in that licensure as a professional counselor covers practice areas that typically receive minimal exclusive attention (e.g., one-week discussion on anxiety disorders in a maladaptive behavior course), yet an area where one (or more) electives are typically offered for in-depth study of a disorder (such as addiction) comes with an entirely unique and separate licensure process.

The presence of a separate licensure/credentialing process for addiction counseling seems antiquated considering the extensive training required for a graduate counseling degree. Furthermore, most states consider addiction work within the professional counselor scope of practice (Tabor et al., 2011). Thus, the pioneering issue this paper addresses is whether it is time to thoughtfully reconsider how addiction is conceptualized in professional counseling (beyond the inclusion in the most recent CACREP standards) and recalibrate the education and licensure processes accordingly. In order to begin this dialogue a brief review of the history of the licensure/credentialing process of addiction counselors needs to be provided.

Historical Origins of the Issue

Historically across most states, the advent of addiction counseling licensure/credentialing standards occurred parallel with the professionalization of the counseling field (i.e., the master’s-level state licensure laws). States mandated that graduate school-level professionals conduct counseling, leaving many long-time and effective addiction counselors (many of whom possessed only a high school diploma or GED) out of the counseling mainstream. Consequently, addiction licensure/credentialing boards were established to achieve two goals. The first goal was to professionalize the addiction counseling field in a manner similar to professional counseling via mandated supervised practice hours and education across a subscribed addiction curriculum. The second goal was to provide a mechanism to grandfather into the profession those addiction counselors who had long worked in the field and provided outstanding services. Without the grandfather clause, many of these addiction counselors would have lost their profession or would have needed to put their career on pause as they obtained the required education and/or training.

The professionalization of addiction counseling, including licensure and credentialing, strengthened the field and provided a higher quality of care to those struggling with addiction. Unfortunately, a system also was established that over 30 years reinforced the notion that addiction falls outside the scope of practice for professional counseling (i.e., the presence of a separate licensure and certification processes focused on addiction counseling). While the addiction counseling field did need professionalization, perhaps the original high standards (e.g. upwards of 3,000 hours of clinical practice with supervision) now require recalibration that takes into account a new era where counselor training for those engaged in addiction work extends far beyond a high school diploma or GED.

Professionalization or Deterrent?

The authors’ perspective in this paper is that imbedded in the current licensure and credentialing process for addiction counseling is the message that LPCs cannot or should not do addiction work. The message comes from a confusing mixed array of information. Using the graduate trainee (the next generation of counseling professional) as an example, it becomes clear as to how future LPCs may shy away from addiction work. For instance, in the classroom graduate students read about how counseling includes working in the addiction area (as per the latest CACREP standards). Graduate students are trained in a graduate counseling curriculum that offers advanced addiction course electives and the possibility of doing practicums or internships at an addiction facility. Many of these graduate students may even attend school in a state where addiction work is covered in the professional counseling scope of practice. But, these students also see professional counselors with separate addiction licenses (e.g., LPC and LCADC) and employment announcements requesting/requiring an addiction license. Even the National Board of Certified Counselors (NBCC) Master Addiction Counselor Credential (MAC) focused on this one DSM-IV-TR disorder class (with no other NBCC credential so narrowly focused on one DSM-IV-TR disorder). Because the student does not see an NBCC credential for mood disorders or sees a licensure for anxiety disorders, the imbedded message is strengthened.

The mixed messages coupled with the burdensome task of meeting the mandates for two professional bodies (professional counseling and addiction) may drive some new counselors from the addiction field. For example, at the end of a panel discussion on this topic at the 2011 American Counseling Association Conference (Morgen et al., 2011), a new graduate of a professional counseling master’s program said she would like to start accruing practice hours in a substance use disorders clinic as she had completed some internship hours there and took a course on substance use disorders. However, the facility where she wanted to work required her to obtain an addiction license in addition to her professional counseling license. She subsequently indicated that she did not have the time, money, or the energy to do both and was thus looking outside the substance use disorders field for employment. This anecdote clearly demonstrates how newly graduated counseling professionals (especially those working in the provisional licensure period) may be inhibited from entering the addiction counseling field.

How many qualified, talented and motivated students are we turning away from the addiction counseling field due to these extra training requirements unique to working with the specific DSM-IV-TR Axis I Substance Use Disorder diagnosis at a time when there is an ever-growing need for services (e.g., addiction in returning veterans or the chronically unemployed)? Effective training of LPCs who work with addiction requires coordination between educational training institutions and actual practice that reflects reasonable experienced-based requirements for working in the area of addiction as well as respect for the graduate-level degree (e.g., master’s or doctorate) and training the counselor has already received. Such coordination varies from state to state and without a guarantee of such coordination the danger is that well-intentioned, well-trained counselors will enter the field technically qualified to counsel individuals, but philosophically lacking the integration of theory and practice necessary for treating addiction. This could mean, for example, that the counselor is more vulnerable to enabling the active addictive process and thereby not providing counseling in the best interest of the client.

In an effort to initiate the dialogue on how to perhaps recalibrate the system, it first seems warranted to review the professional and addiction counseling licensure laws and policies within two states. The authors intend to (over the next few years) review the state laws and policies for all 50 states. However, for the purposes of this initial paper, New Jersey and North Carolina will be discussed below.

Specific State Issues

New Jersey
New Jersey operates a professional counseling license (LPC) with a minimum education of a graduate counseling degree, a certified alcohol and drug abuse counselor credential (CADC) requiring a minimum education of bachelor’s degree, associate degree, high school diploma or GED, and a licensed clinical and alcohol and drug abuse counselor (LCADC) with a minimum education of a graduate counseling degree and qualification for the CADC. The LPC is governed by the Professional Counselor Examiners Committee (imbedded within the Marriage and Family Therapy Board), whereas the CADC/LCADC is governed by the Alcohol and Drug Counselor Committee.

According to the regulations for professional counseling, New Jersey defines counseling in part as “using currently accepted diagnostic classifications including, but not limited to the DSM-IV” (NJ Board of Marriage and Family Therapy Examiners, 2009, 13:34-10.2, p. 34-22). Substance use disorders fall within Axis I of the DSM-IV-TR, thus work with substance use disorders seems in line with the professional regulations of the LPC. Further evidence of this fact exists within the LCADC regulations (NJ Alcohol and Drug Counselor Committee, 13:34C-2.6, p. 34C-10) that states the following individuals are exempt from the LCADC licensure requirement:

A person doing work of an alcohol or drug counseling nature, or advertising those
services, when acting within the scope of the person’s profession or occupation and
doing work consistent with the person’s training, including physicians, clinical social
workers, professional counselors, marriage and family therapists, psychologists, nurses
or any other profession or occupation licensed by the State, or students within accredited
programs of these professions, if the person does not hold oneself out to the public as
possessing a license or certification issued pursuant to the Act or this chapter.

As long as an LPC does not advertise oneself as an addiction or substance abuse counselor, they are completely free to practice counseling with individuals presenting with addiction.

However, new counselors and LPCs who wish to accrue hours toward addiction licensure/credentialing face obstacles within the hiring process for addiction-focused positions. For example, despite the clear language in the LPC and CADC/LCADC regulations, advertised positions in the addiction counseling field in New Jersey typically include language stating “actively pursuing CADC/LCADC” or “must hold a New Jersey CADC/LCADC.” These requirements (which again, contradict the language of the New Jersey LPC and LCADC regulations) are typically in place due to a mandate of the program funding source (e.g., state or federal). Private practice counselors (who do not operate any funded programs with the above-mentioned requirements) are free to practice addiction work if qualified. However, most (if not all) of the addiction counseling positions where a new professional counseling graduate can accrue hours are housed in some type of treatment facility that very likely must adhere to the LCADC mandate, thereby limiting access to positions for those seeking to accrue LPC hours within the addiction counseling field.

In New Jersey, the typical master’s student who wants to accrue hours for licensure as an LPC must produce approximately 4,500 supervised counseling hours. This process comes immediately after the challenging two to three years of graduate study and passing the National Counselor Exam (NCE). However, to obtain the LCADC these students must complete an additional and separate 3,000 supervised addiction counseling hours, 270 clock hours of education focused on counseling and addiction, and 300 hours of supervised practical training in core counseling areas such as screening, intake, assessment, etc. The primary and most time-consuming problem lies in the need to accrue the supervised addiction counseling hours. Since the supervised counseling hours cannot be combined (e.g., there is no language in either the LPC or LCADC regulations permitting or denying the “double-dipping” of an hour for inclusion in both the LPC and LCADC hours accrual for licensure; this alone is confusing and indicates a need for clarification), the trainee working towards licensure who wishes to work in an addiction facility must accrue thousands of extra hours or opt to only work towards the LCADC. No other DSM-IV-TR disorder class comes with this burdensome extra mandated training requirement.

Recent efforts to integrate the mental health and addiction licensure processes in New Jersey are in motion, but still in an early phase. Much of this work is coming from a project sponsored by the New Jersey Division of Mental Health and Addiction Services designed to train the next generation of dual-licensed and trained (mental health and addiction) practitioners. However, this need to streamline the process is only present because of the dual licenses already in place. Furthermore, the premise of the program (though an excellent contribution) still propels the notion that addiction falls outside the scope of LPC practice and there needs to be a process to merge the two together. Despite the benefits of this new initiative, the end result is still the same: two different licenses. Again, this is the only DSM-IV-TR disorder that receives this treatment.

North Carolina
North Carolina has a well-coordinated system for addiction counselors. All professionals who want to be licensed to work in the addiction counseling field need to go through the same board, the NC Substance Abuse Professional Practice Board (the Board), which is “recognized as the registering, certifying, and licensing authority for substance abuse professionals” (Practice Act, 2005, Senate Bill 705, North Carolina General Assembly, § 90 113.32). One board eliminates competition between boards and the related issues that arise. In fact, the Licensed Professional Counselors Act (LPC law) specifically exempts substance abuse counselors from the counseling law by declaring that nothing in the LPC law “shall prevent a person from performing substance abuse counseling or substance abuse prevention consulting” (NC Board of Licensed Professional Counselors, 2009, § 90-332.1.d). Having one board brings together individuals from various professions in a concerted effort to address the issues related to addiction counseling and to advocate for the field at a state level. This framework has the strength of cooperation between different professional groups and the absence of competition within a state.

This cooperation is enhanced by a tiered system (licensure and credentialing). Individuals may apply for licensure as a Licensed Clinical Addictions Specialist. With regard to entry at the licensure level, there are four main routes or criteria (Criteria A, Criteria B, Criteria C, and Criteria D). Although initially the system may be confusing to determine the criteria under which one fits, the advantage is that there is greater flexibility for the individual applying for licensure. This flexibility is the result of minimum requirement variation in the areas of education, training, experience, and supervision (Criteria A, B, & C), as well as professional discipline (e.g., psychology, social work, counseling—Criteria D). For specific guidelines and clarification of this summary, the reader is referred to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_90/Article_5C.html.

In terms of similarities for the individual applying for licensure, there are two aspects that remain the same under Criteria A, B, and C: the submission of three letters of reference (there is some variation allowed for the individuals who can write these letters) and a passing score on a master’s level written examination administered by the Board. The variations under these criteria are as follows. In the area of education, Criteria A and B require a minimum of a master’s degree with a clinical application in a human services field from a regionally accredited college or university. In addition, in terms of training, Criteria A requires 180 hours of substance abuse specific training from either a regionally accredited college or university, which may include unlimited independent study or from training events of which no more than fifty percent (50%) shall be in independent study. Criteria C combines the education and training requirement in the minimum requirement of a master’s degree in a human services field with both a clinical application and a substance abuse specialty from a regionally accredited college or university that includes 180 hours of substance abuse specific education and training. In the area of experience, Criteria A requires two years postgraduate supervised substance abuse counseling experience, while Criteria B requires the applicant to be certified as a substance abuse counselor. Finally, regarding supervision, Criteria A requires documentation of a minimum of 300 hours of supervised practical training and provision of a board-approved supervision contract between the applicant and an applicant supervisor, while Criteria C requires one year of postgraduate supervised substance abuse counseling experience. Criteria D simply requires that the applicant has a substance abuse certification from a professional discipline that has been granted deemed status by the Board (i.e., possession of a certification to practice addictions work under another discipline, such as social work, and that certification is recognized by the counseling board).

Note that the Board also offers numerous credentials through certification for non-master’s-level professionals. These include the Certified Substance Abuse Counselor (CSAC), Certified Substance Abuse Prevention Consultant (CSAPC), Certified Criminal Justice Addictions Professional (CCJP) and the Substance Abuse Residential Facility Director (CSARFD) credentials. In terms of the CSAC and the CSAPC, the applicant needs to be of good moral character, not be (or have been) engaged in any practice or conduct that would be grounds for disciplinary action, have a minimum of a high school diploma or a high school equivalency certificate, sign a form attesting to the intention to adhere fully to the Board’s ethical standards, and submit a complete criminal history record check.

Additionally, a CSAC who completes a clinical master’s degree program in a human services field can seek the LCAS via Criteria B as outlined above. This criterion recognizes the fact that the CSAC has already completed a 300-hour supervised clinical practicum and has substance abuse specific work experience. In addition to submitting proof of one’s master’s degree, all one has to do to obtain the LCAS via this criteria is to submit three letters of reference from LCAS’s and/or master’s level CSAC’s and pass the LCAS examination.

This tiered system allows the counselor to enter the field with or without a masters’ degree and allows the master’s=level counselor to have an accelerated process if they acquire clinical application experience enhancing the possibility they are both technically and philosophically prepared to work in the addiction counseling field. The requirement of the clinical application experience may be a barrier for some counselors, but the intent is to serve the best interests of the public.

Finally, there is collaboration between the Board and specific university degree programs regarding the type and quality of the courses, thus increasing the chance that counselors are effectively trained to work in the addiction counseling field. While there is not “board approval” on the content areas, programs are approved for addiction counseling. Students who graduate from these master’s degree programs may seek the LCAS license via Criteria C (outlined above). The Board maintains a current list of school programs approved for application under Criteria C on its website: http://www.ncsappb.org/certificationssteve/criteriaschools2.htm.

While North Carolina’s tiered system of licensure and credentialing allows for greater flexibility for the individual applying to work in the addiction counseling field, the system can be overwhelming and does contribute to the perception that addiction counseling is a separate profession with separate education, training, supervision and practice. Kaplan and Gladding (2011), King (2011), and Gladding, Kaplan, Linde, Mascari, and Tarvydas (2011) have advocated along with others about the importance of a unified counseling identity with common skills, training and practice (particularly among counseling specialties).

Recommendations

Overall, there appears to be a need for a recalibration of the experienced-based training required for LPCs at a national level that will enhance their entrance into the field of addiction counseling. Currently, states that do not allow for multiple entries into the field have a tiered system of entry, or an approval mandate of the type or quality of the addiction training program, that may inhibit LPCs from practicing in the addiction counseling field. In states where there are significant barriers, professional counselors (fully licensed or in-training) entering the addiction counseling profession with a graduate degree may be required to complete additional training requirements that were created during a time when the addiction counseling professional possibly possessed no more than a high school diploma or GED, and such credentialing requirements (e.g., thousands of supervised hours) were imposed as a mechanism to professionalize the field. Considering the graduate counseling degree (and associated supervised counseling hours) held by a LPC or counselor-in-training accruing licensure hours, these mandates currently seem excessive and possibly even redundant. Presently, the North Carolina system may be one of the few in the United States that provides the fewest barriers for LPCs entering the addiction counseling field.

In the following section, two remedies for the licensure/credentialing problems are presented. Although myriad issues complicate the process (e.g., counselors are called different titles in different states and different state requirements are present for licensure/credentialing as an addiction counselor), the following suggestions in some conceptualization may spur more tangible action. Any formal action should likely come from a national committee set up through the American Counseling Association (ACA) and in conjunction with the ACA addiction division, The International Association of Addictions and Offender Counselors (IAAOC), as well as CACREP, and national bodies such as the National Association of Alcoholism and Drug Abuse Counselors (NAADAC) and the International Certification and Reciprocity Consortium (IC&RC). Committee representatives from these parties could examine the coordination of experience and training. Such a committee could develop guidelines for balancing these concerns for states to use in their individual recalibration of requirements.

Possible Solution #1: Nationally Recognized Tiered System of Addiction Counselor Credentialing
One of the difficulties in terms of the current state of addiction credentialing in the U.S. is the absence of uniform national curriculum training standards in the addiction field. Also, there are two main national credentialing groups: NAADAC and the IC&RC. Issues arise because affiliation with one of the two main credentialing groups and credentialing variations between these organizations can result in issues in terms of competition and the nature of the boards and exams required for credentialing. Miller, Scarborough, Clark, Leonard, and Keziah (2010) recommend the following with regard to addiction counseling: (a) portability of credentials, (b) competition reduction between credentialing groups and state boards, (c) national standards for addiction education and training, and (d) a standardized national licensure/credentialing process. Unfortunately, these recommendations have not yet been fully implemented.

One possible solution is to develop a tiered system of addiction counseling credentials at a national level that takes into account professional experience as well as educational training. There needs to be a balance between the idea that anyone with a general counseling degree can do addiction counseling and the idea that only a few select counselors can do the work. Furthermore, this balance should be firmly based upon the ACA Ethical Code that indicates that counselors only practice within their area(s) of competence (2005).

For example, graduates of professional counseling programs (e.g., those working towards LPC status) who have taken a nationally-approved addiction counseling curriculum and have completed practicum/internship experiences could be designated as having addiction credentials in addition to the LPC (i.e., a nationally approved addiction concentration). Therefore, graduate counseling coursework that includes addiction counseling education and practical experiences would enable new graduates to move seamlessly into the addiction counseling profession without the need for additional supervision hours or educational components (i.e., beyond the required supervised counseling hours and educational components required for the LPC). The system would eliminate the need for a professional counselor to acquire an additional and separate addiction license/certification. In addition, the national standards could promote portability of credentials. This compromise works to maintain the licensed/certified addiction counseling credentials in each state while also providing the LPC with the documented expertise required for many addiction facility positions. This tiered system also could facilitate enhanced training during the process of accruing hours for licensure by better focusing the training hours upon the interface between addiction and other mental health issues as opposed to the current parallel and disparate relationship between addiction and other mental health issues.

Possible Solution #2: Nationally Recognized Addiction Counseling Concentration Curriculum
There are issues regarding standardization of training that need to be addressed within the context of academia. In essence, what are the theoretical and practical skills required of an addiction counselor nationwide? There are numerous initial places to look into the process of establishing a nationally recognized addiction counseling concentration, such as the 2009 CACREP standards for addiction counseling and the Center for Substance Abuse Treatment’s (2006) Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice. By using these (and other) standards, all counseling programs (regardless of CACREP accreditation) can follow a standard recommended education experience for students who desire the addiction credential discussed in the first possible solution. Curricular issues would likely include standalone addiction courses, infusion of addiction content into other courses, faculty expertise in the addiction area and practicum and internship hours focused on addiction counseling practice.

In addition, the NCE and National Clinical Mental Health Counselor Examination (NCMHCE) would require some recalibration to take into account the curricular changes to a professional counseling education that includes the addiction counseling concentration. One caution is that any discussion of these and other training issues may produce opposing forces within academia, the counseling profession, the addiction counseling profession, state licensing/credentialing boards (both professional counseling and addiction) and individual counselor education professors and college/university departments. Again, that is why a national committee comprised of all involved parties is necessary to navigate this challenging process.

Concluding Comments

Two students graduate with a master’s degree in counseling. Both took elective courses in their area of interest; one in mood disorders, the other in addiction, and both did an internship in a counseling setting focused on their interest area. Upon graduation, the student with an interest in mood disorders can easily be brought onto the clinical roster of a mood disorders clinic and immediately start accruing hours towards licensure. Their provisional license is all that is required during the training period. Unfortunately, the graduate with an interest in addiction may face competing licensure and/or credentialing requirements between professional and addiction counseling, mandated extra training coupled with thousands of extra supervised hours, and/or the possibility of a denial of employment without the appropriate addiction credential.

The purpose of this article is to start the dialogue on how to effectively incorporate addiction counseling into the scope of practice and accepted role of the professional counselor. We firmly believe that effective counseling focused on addiction issues requires specific and rigorous counselor training. However, we also believe the current national practice of training and credentialing for addiction counseling must change. State-by-state, burdensome (and in some instances outdated) rules and regulations are keeping countless qualified, capable, and motivated counselors from entering the addiction field. The time has come to recalibrate the rest of the counseling profession to better fit an inclusive and unifying professional counseling identity that includes addiction counseling.

References

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Keith Morgen, NCC, teaches at Centenary College, Geri Miller teaches at Appalachian State University and LoriAnn S. Stretch teaches at Walden University. The authors thank Anna Misenheimer, Executive Director of the North Carolina Substance Abuse Professional Practice Board, for serving as a reader of the early drafts of this paper. Her feedback was critical in our sharpening the preliminary focus of the paper. Correspondence can be addressed to Keith Morgen, Centenary College, 400 Jefferson Street, Box 403, Hackettstown, New Jersey, 07840, morgenk@centenarycollege.edu.

Psychosocial Prevention Education: A Comparison of Traditional vs. Thematic Prevention Programming for Youth

Sep 3, 2014 | Article, Volume 1 - Issue 2

Rebecca A. Newgent, Kristin K. Higgins, Stephanie E. Belk, Bonni A. Nickens Behrend, Kelly A. Dunbar

Group counseling has been highlighted as one effective intervention for at-risk students, yet debate remains as to the comparable efficacy of traditional interventions versus thematic interventions. This study compared two psychosocial educational programs, the PEGS and ARK Programs, designed to help elementary school students with social skills development, problem behaviors, bullying, and self-esteem with 15 elementary-aged students. Results revealed no differences between the programs and improvement on many indicators. Implications for school counselors are presented.

Keywords: elementary students, psychosocial education, prevention programs, school counseling, traditional interventions, thematic interventions

Group work can be an effective means of counseling at-risk students. As such, the American School Counselors Association (ASCA) has endorsed group work as an important component of school counseling (ASCA, 2005). Groups can help students learn to solve problems in an efficient and effective manner and is an ideal method for meeting the needs of at-risk populations (Akos & Milsom, 2007). Group counseling allows students to develop connections while at the same time exploring factors that may affect their achievement (Kayler & Sherman, 2009). Groups are used to address such issues as social skills (Bostick & Anderson, 2009), bolstering students’ self-perceptions (Eppler, Olsen, & Hidano 2009), preventing problem behavior (Todd, Campbell, Meyer, & Horner, 2008), increasing academic success (Brigman, Webb, & Campbell, 2007), and reducing school-wide bullying (Allen, 2010). Further, Quinn, Kavale, Mathur, Rutherford, and Forness (1999) conducted a meta-analysis (35 studies) of social skills interventions used with children exhibiting problem or emotional behaviors. Results revealed several important issues. First, it appears that there is a wide range of presenting deficits in children’s social skills. Second, social skills training is widely used as a mechanism to address problem behavior in children; however, it may not be as effective at addressing problem behaviors when used in isolation. The purpose of this study is to compare the effectiveness of two psychosocial intervention programs, Psychosocial Educational Groups for Students (PEGS) and the At-Risk Kids Groups (ARK) and to assess the impact of each program. The PEGS and ARK Programs are designed to help elementary school students in the following areas: social skills development, problem behaviors, bullying, and self-esteem.

Issues Addressed in Groups

According to Berry and O’Conner (2010), social skills are a set of learned behaviors that allow for positive social interactions, such as sharing, helping, initiating and sustaining relationships. Children who enter the academic setting with problem behaviors are often the children who lack the social skills to create and maintain positive social interactions. In a recent study by Bostick and Anderson (2009), 49 third graders with social skill deficits participated in a 10-week social skills program aimed at reducing loneliness and anxiety in an academic setting. Findings revealed significant reductions in loneliness and anxiety as well as significant increases in reading scores.

Groups also can be an effective manner in addressing children with problem behavior. For example, Hudley, Graham, and Taylor (2007) studied the level of children’s aggression in relation to personal responsibility. After a series of 12 lessons related to detecting other’s intentions, externalization, and positive responses, students showed improvement in socially acceptable behavior along with a reduction in overall aggression. For additional examples also see Cotugno (2009), McCurdy, Lannie, and Barnabus (2009), and Todd, Campbell, Meyers, and Horner (2008).

Olweus (1997) defines bullying as purposeful behavior, repeated over time, including an imbalance of power. Several psychoeducational programs have been developed to address the issue of bullying in schools (Horne, Bartolomucci, & Newman-Carlson, 2003; Jenson & Dieterich, 2007; Olweus, 1991). At-risk students are at particular risk for bully-related behaviors, including both roles of victim and perpetrator (Allen, 2010). Therefore, group intervention in the schools may be a beneficial way of directly addressing bullying.

Self-esteem, also known as self-concept, is often defined as the way in which children think about themselves in relation to their attributes and abilities (Kenny & McEachern, 2009). “Part of preventing problem behaviors is increasing the self-esteem of those with problem behaviors” (Newgent, Behrend, Lounsbery, Higgins, & Lo, 2010, p. 82). There are relatively few empirical studies, however, on the effectiveness of groups and self-esteem (e.g., O’Moore & Kirkham, 2001; Whitney & Smith, 1993).

Prior Research

A paucity of research exists on addressing multiple presenting problems in children. A major implication of the Quinn et al. (1999) meta-analysis suggested that psychoeducational groups may need to address more than one problem. A study conducted by Newgent et al. (2010) examined the effectiveness of a 6-week psychosocial educational group for students that addressed social skills, problem behaviors, bullying, and self-esteem. Results showed that students with multiple presenting issues benefited from a group addressing multiple issues. Further, results showed that students with no clinically relevant presenting issues also benefited from the multi-issue group (Newgent et al., 2010). In addition, some research is suggesting that while traditional, process-oriented groups can be effective at addressing problems, thematic groups have become more prevalent, especially when there is a time constraint (Hartzler & Brownson, 2001). While the benefit of thematic groups is a more specific or more common goal it also can lack the breadth of more traditional groups.
This study aimed to compare the effectiveness of two selective intervention programs (traditional vs. thematic) on measures of social skills, problem behaviors, teacher- and self-reports of peer relationships (bullying behaviors and peer victimization), self-esteem (self-worth, ability, self-satisfaction, and self-respect) and perception of self. Further, this study aimed to assess the impact of each of the intervention programs. The following research questions were tested: Is there a differential impact when comparing the PEGS Program to the ARK Program? Do the PEGS and ARK Programs have a positive impact on social skills, problem behaviors, peer relationships, and self-esteem?

Method

Participants
Eleven (n = 11) students were enrolled in the PEGS Program and four (n = 4) students were enrolled in the ARK Program. No attrition of program participants occurred. While participation was open to all students, teachers only recommended male students for both programs. Students in the PEGS Program were in the 4th grade and students in the ARK Program were in the 5th grade. In the PEGS Program five students (45%) identified as Caucasian/White, four (36%) identified as African American, one (9%) identified as Hispanic, and one (9%) identified as other. In the ARK Program one student (25%) identified as Caucasian, one student (25%) identified as African American, and two students (50%) identified as Hispanic. No students were identified as having some type of diagnosed learning, behavioral, or emotional disability.

Selective Intervention Program
One of the underlying tenants of the PEGS and ARK Programs is that students should not be labeled or stigmatized for having problems. Therefore, both programs utilized referrals that were based on underlying characteristics that lead to specific problems, not labels. Thus, students who are impulsive, depressed, dominant, lonely, easily frustrated, anxious, lack empathy, have low self-esteem, have difficulty following rules, are socially withdrawn, view violence in a positive way, have few friends, make negative attributions, have mood swings, instigate conflict, have difficulty handling conflict, or are aggressive or stressed were identified by their teachers and recommended for one of the two programs.

While both the PEGS and the ARK Program cover the same underlying psychosocial educational content, the primary difference is that the PEGS Program consists of traditional psychosocial education units while the ARK Program units are targeted toward peer victimization (i.e., bullying). Both PEGS and ARK provide a series of 6 one-half hour group sessions over the course of 6 weeks for elementary school students in grades 3–5. The six psychosocial education components of each of the intervention programs include: (a) improving social skills, (b) building and increasing self-esteem, (c) developing problem-solving skills, (d) assertiveness training, (e) enhancing stress/coping skills, and (f) prevention of mental health problems/problem behaviors. Lessons for the PEGS Program were adapted from Lively Lessons for Classroom Sessions (Sartori, 2000), More Lively Lessons for Classroom Sessions (Sartori, 2004), and the Missouri Comprehensive Guidance Programs (Frankenbert, Grandelious, Keller, & Schaaf, n.d.). These lessons focused on cooperation, encouraging students to be proud of who they are, breaking the chain of violence, handling anxiety and stress, and tolerance regarding differences. Lessons for the ARK Program were adapted from Bully Busters: A Teacher’s Manual for Helping Bullies, Victims, and Bystanders (Horne, Bartolomucci, & Newman-Carlson, 2003). These lessons focused on increasing awareness of bullying, building personal power, recognizing the bully and the victim, recommendations and interventions for helping victims, and relaxation and coping skills. Puppets were utilized in both programs to help model the lessons being taught. Worksheets related to the lessons also were utilized to help crystallize the concepts.

All recommended students participated in the one of the programs. Given class schedules, the school counselor recommended that students be assigned to one of the programs by grades. Therefore, all recommended 4th grade students were assigned to the PEGS Program and all recommended 5th grade students were assigned to the ARK Program. These assignments were done on a random basis. No control groups were utilized in this study at the school’s request. The same facilitators were used for both programs.

Instruments
Social Skills Improvement System – Teacher Form (SSiS–T). The Social Skills Improvement System – Teacher Form was developed by Gresham and Elliott (SSiS; 2008) and published by NCS Pearson, Inc. The SSiS–T is an 83-item rating scale designed specifically for teachers to use to assess children’s school-related problem behaviors and competencies. Scores reported for each of the three measurement areas are percentiles. Clinical levels for each of the three areas are as follows: social skills (≤ 16), problem behaviors (≥ 84), and academic competence (≤ 16). That is, lower scores on social skills and academic competence and higher scores on problem behaviors are considered clinically problematic. For the purposes of this study, only social skills and problem behaviors were evaluated. Cronbach alphas for social skills were .95 and .92 at pre- and post-test assessment, respectively. Cronbach alphas for problem behaviors were .86 and .89 at pre- and post-test follow-up assessment, respectively.

Social Skills Improvement System – Student Form (SSiS–S). The Social Skills Improvement System – Student Form was developed by Gresham and Elliott (SSiS; 2008) and published by NCS Pearson, Inc. The SSiS-S is a 75-item rating scale designed specifically for students aged 8–12 to use to assess their own school-related problem behaviors and competencies. Scores reported for each of the two measurement areas are percentiles. Clinical levels for each of the two areas are as follows: social skills (≤ 16) and problem behaviors (≥ 84). That is, lower scores on social skills and academic competence and higher scores on problem behaviors are considered clinically problematic. Cronbach alphas for social skills were .80 and .87 at pre- and post-test assessment, respectively. Cronbach alphas for problem behaviors were .74 and .70 at pre- and post-test assessment, respectively.

Peer Relationship Measure – Teacher Report. The Peer Relationship Measure – Teacher Report (Newgent, 2009a) was developed specifically for the PEGS and ARK Programs. It measures teachers’ perceptions about peer victimization. Nine items measure bullying behaviors and 9 items measure victimization. Items are scored as 0 = never, 1 = sometimes, and 2 = a lot, with scores ranging from 0 to 18 for each area. Scores reported for both of the measurement areas are totals. A high score indicates a high level of bullying behaviors and/or victimization; a low score indicates a low level of bully behaviors and/or victimization. Cronbach alphas for bullying behaviors were .89 and .90 at pre- and post-test assessment, respectively. Cronbach alphas for victimization were .78 and .90 at pre- and post-test assessment, respectively.

Peer Relationship Measure – Self Report. The Peer Relationship Measure – Self Report (Newgent, 2009b) was developed specifically for the PEGS and ARK Programs. It measures students’ perceptions about peer victimization. Nine items measure bullying behaviors and nine items measure victimization. Items are scored as 0 = never, 1 = sometimes, and 2 = a lot, with scores ranging from 0 to 18 for each area. Scores reported for both of the measurement areas are totals. A high score indicates a high level of bullying behaviors and/or victimization; a low score indicates a low level of bully behaviors and/or victimization. This measure is a parallel measure to the Peer Relationship Measure – Teacher Report. Cronbach alphas for bullying behaviors were .07 and .87 at pre- and post-test assessment, respectively. Cronbach alphas for victimization were .81 and .82 at pre- and post-test assessment, respectively.

Modified Rosenberg’s Self-Esteem Inventory (a). The Modified Rosenberg’s Self-Esteem Inventory (a) (Zimprich, Perren, & Hornung, 2005) measures an individual’s level of self-esteem (i.e., perception of self-worth, ability, self-satisfaction, and self-respect) and was completed by the students. The 10-item inventory uses a 4-point likert scale (strongly agree, agree somewhat, disagree somewhat, and strongly disagree). Five of the items are reverse coded and the score reported is the total, which ranges from 0–30. A high score indicates a high level of self-esteem; a low score indicates a low level of self-esteem. Cronbach alphas were .60 and .54 at pre- and post-test assessment, respectively.

Modified Rosenberg’s Self-Esteem Inventory (b). The Modified Rosenberg’s Self-Esteem Inventory (b) (Zimprich et al., 2005) measures an individual’s self-esteem (i.e., perception of self) and was completed by the students. The 4-item inventory uses a 5-point likert scale (never, seldom, sometimes, often, always). One of the items is reverse coded and the score reported is the total, which ranges from 4–20. A high score indicates a high level of self-esteem; a low score indicates a low level of self-esteem. Cronbach alphas were .59 and -1.56 at pre- and post-test assessment, respectively.

Procedure

Fifteen students were recommended by their teachers for the PEGS and ARK Programs and 15 parental consents/child assents were received. Recommending teachers completed the SSiS–T (Gresham & Elliott, 2008) and the Peer Relationship Measure – Teacher Report (Newgent, 2009a) at the start of the PEGS and ARK Programs and at two months after the conclusion of the PEGS and ARK Programs. Ideally, we would have liked an additional follow-up assessment; however, there was difficulty in securing a longer period of involvement in the assessments. Students completed the SSiS–S (Gresham & Elliott, 2008), the Peer Relationship Measure – Self Report (Newgent, 2009b), the Modified Rosenberg’s Self-Esteem Inventory (a) (Zimprich et al., 2005), and the Modified Rosenberg’s Self-Esteem Inventory (b) (Zimprich et al., 2005) at the start of the PEGS and ARK Programs and at two months after the conclusion of the PEGS and ARK Programs. All participating students received a certificate of completion at the conclusion of the last session.

Sessions for both programs were co-facilitated by two graduate students in the counseling and educational research programs. Both facilitators passed criminal background checks and had prior professional experience working with children who exhibit problematic behaviors. Supervision was provided to the facilitators by two counseling faculty members overseeing the programs.

Data Analytic Plan
Each student who participated in the PEGS or ARK Programs was assessed at two time points utilizing a variety of measurement instruments (see Instruments section). Pre-test scores on each of the instruments were initially analyzed using independent-samples t-tests to test the underlying assumption that participant scores between the groups were not significantly different. Next, scores were analyzed using independent-samples t-tests to assess for significant differences on the post-test assessment scores between the PEGS Program and the ARK Program participants. Finally, paired-samples t-tests, comparing pre-test to post-test assessment scores within each program, were used to assess the impact of each of the programs. Effect sizes are reported as small (d = .20), medium (d = .50), and large (d = .80) (Cohen, 1992; O’Rourke, Hatcher, & Stepanski, 2005).

Results

Between-Group Analysis
Teacher-reported measures. Results were initially analyzed using independent-samples t-tests comparing the pre-test assessment scores of the PEGS Program to the ARK Program. Statistical comparisons are displayed in Table 1. Analysis of teacher-reported social skills failed to reveal a significant difference between the two groups, t(12) = 0.76; p < .46. The effect size was computed as d = .76, which represents a large effect. Analysis of teacher-reported problem behaviors also failed to reveal a significant difference between the groups, t(10.73) = -0.15; p < .88. The effect size was computed as d = .08, which represents a very small effect. Analysis of teacher-reported bullying behaviors failed to reveal a significant difference between the groups, t(12) = -0.97; p < .35. The effect size was computed as d = .97, which represents a large effect. Analysis of teacher-reported peer victimization also failed to reveal a significant difference between the groups, t(12) = -2.14; p < .054. The effect size was computed as d = 2.13, which represents a very large effect.

Results were then analyzed using independent-samples t-tests comparing the post-test assessment scores of the PEGS Program to the ARK Program. Statistical comparisons are displayed in Table 1. Analysis of teacher-reported social skills failed to reveal a significant difference between the two groups, t(12) = 0.08; p < .94. The effect size was computed as d = .08, which represents a very small effect. Analysis of teacher-reported problem behaviors also failed to reveal a significant difference between the groups, t(12) = -0.28; p < .78. The effect size was computed as d = .28, which represents a small effect. Analysis of teacher-reported bullying behaviors failed to reveal a significant difference between the groups, t(12) = -1.56; p < .14. The effect size was computed as d = 1.56, which represents a very large effect. Analysis of teacher-reported peer victimization revealed a significant difference between the groups, t(11.29) = -3.48; p < .005. The effect size was computed as d = 1.84, which represents a very large effect.

Self-reported measures. Results were initially analyzed using independent-samples t tests comparing the pre-test assessment scores of the PEGS Program to the ARK Program. Mean scores, significance, and effect size are displayed in Table 1. Analysis of self-reported social skills failed to reveal a significant difference between the two groups, t(3.25) = 1.16; p < .32. The effect size was computed as d = 5.88, which represents a very large effect. Analysis of self-reported problem behaviors also failed to reveal a significant difference between the groups, t(13) = 0.56; p < .59. The effect size was computed as d = .56, which represents a medium effect. Analysis of self-reported bullying behaviors failed to reveal a significant difference between the groups, t(13) = 1.25; p < .23. The effect size was computed as d = 1.25, which represents a very large effect. Analysis of self-reported peer victimization also failed to reveal a significant difference between the groups, t(13) = 1.09; p < .30. The effect size was computed as d = 1.09, which represents a very large effect. Analysis of self-reported self-esteem failed to reveal a significant difference between the groups, t(13) = 0.18; p < .86. The effect size was computed as d = .18, which represents a small effect. Analysis of self-reported perception of self also failed to reveal a significant difference between the groups, t(13) = -1.17; p < .26. The effect size was computed as d = 1.17, which represents a very large effect.

Results were then analyzed using independent-samples t-tests comparing the post-test assessment scores of the PEGS Program to the ARK Program. Mean scores, significance, and effect size are displayed in Table 1. Analysis of self-reported social skills failed to reveal a significant difference between the two groups, t(13) = 2.03; p < .06. The effect size was computed as d = 2.03, which represents a very large effect. Analysis of self-reported problem behaviors also failed to reveal a significant difference between the groups, t(13) = 0.56; p < .59. The effect size was computed as d = .56, which represents a medium effect. Analysis of self-reported bullying behaviors failed to reveal a significant difference between the groups, t(13) = -1.31; p < .21. The effect size was computed as d = 3.40, which represents a very large effect. Analysis of self-reported peer victimization also failed to reveal a significant difference between the groups, t(13) = 0.82; p < .43. The effect size was computed as d = .82, which represents a large effect. Analysis of self-reported self-esteem failed to reveal a significant difference between the groups, t(13) = 0.79; p < .44. The effect size was computed as d = .80, which represents a large effect. Analysis of self-reported perception of self also failed to reveal a significant difference between the groups, t(13) = 0.33; p < .75. The effect size was computed as d = .33, which represents a small to medium effect.

Within Group Analysis – PEGS
Teacher-reported measures. Results were analyzed using paired-samples t-tests comparing the pre-test assessment scores of the PEGS Program to the post-test assessment scores of the PEGS Program. Mean scores, significance, and effect size are displayed in Table 2. Analysis of teacher-reported social skills failed to reveal a significant difference between the pre- and post-test assessments, t(10) = 0.38; p < .71. The effect size was computed as d = .11, which represents a very small effect. Analysis of teacher-reported problem behaviors also failed to reveal a significant difference between the pre- and post-test assessments, t(10) = 1.95; p < .08. The effect size was computed as d = .59, which represents a medium effect. Analysis of teacher-reported bullying behaviors failed to reveal a significant difference between the pre- and post-test assessments, t(10) = 0.13; p < .90. The effect size was computed as d = .04, which represents a very small effect. Analysis of teacher-reported peer victimization also failed to reveal a significant difference between the pre- and post-test assessments, t(10) = -0.20; p < .84. The effect size was computed as d = .06, which represents a very small effect.

Self-reported measures. Results were analyzed using paired-samples t tests comparing the pre-test assessment scores of the PEGS Program to the post-test assessment scores of the PEGS Program. Mean scores, significance, and effect size are displayed in Table 2. Analysis of self-reported social skills failed to reveal a significant difference between the pre- and the post-test assessments, t(10) = -1.52; p < .16. The effect size was computed as d = .46, which represents a medium effect. Analysis of self-reported problem behaviors revealed a significant difference between the pre- and post-test assessments, t(10) = 2.81; p < .02. The effect size was computed as d = .85, which represents a large effect. Analysis of self-reported bullying behaviors failed to reveal a significant difference between the pre- and post-test assessments, t(10) = 0.52; p < .62. The effect size was computed as d = .15, which represents a small effect. Analysis of self-reported peer victimization revealed a significant difference between the pre- and post-test assessments, t(10) = 2.95; p < .01. The effect size was computed as d = .89, which represents a large effect. Analysis of self-reported self-esteem failed to reveal a significant difference between the pre- and post-test assessments, t(10) = -0.22; p < .83. The effect size was computed as d = .07, which represents a very small effect. Analysis of self-reported perception of self also failed to reveal a significant difference between the groups, t(10) = 0.76; p < .46. The effect size was computed as d = .23, which represents a small effect.

Within Group Analysis – ARK
Teacher-reported measures. Results were analyzed using paired-samples t-tests comparing the pre-test assessment scores of the ARK Program to the post-test assessment scores of the ARK Program. Mean scores, significance, and effect size are displayed in Table 3. Analysis of teacher-reported social skills revealed a significant difference between the pre- and post-test assessments, t(2) = 6.25; p < .02. The effect size was computed as d = 3.61, which represents a very large effect. Analysis of teacher-reported problem behaviors failed to reveal a significant difference between the pre-and post-test assessments, t(2) = 1.84; p < .21. The effect size was computed as d = 1.06, which represents a very large effect. Analysis of teacher-reported bullying behaviors revealed a significant difference between the pre- and post-test assessments, t(2) = 5.00; p < .04. The effect size was computed as d = 2.88, which represents a very large effect. Analysis of teacher-reported peer victimization failed to reveal a significant difference between the pre- and post-test assessments, t(2) = 0.00; p < 1.00. The effect size was computed as d = 0, which represents no effect.

Self-reported measures. Results were analyzed using paired-samples t-tests comparing the pre-test assessment scores of the ARK Program to the post-test assessment scores of the ARK Program. Mean scores, significance, and effect size are displayed in Table 3. Analysis of self-reported social skills revealed a significant difference between the pre- and post-test assessments, t(3) = -4.14; p < .03. The effect size was computed as d = 2.07, which represents a very large effect. Analysis of self-reported problem behaviors failed to reveal a significant difference between the pre- and post-test assessments, t(3) = 1.31; p < .28. The effect size was computed as d = .65, which represents a medium effect. Analysis of self-reported bullying behaviors revealed a significant difference between the pre- and post-test assessments, t(3) = 5.42; p < .01. The effect size was computed as d = 2.71, which represents a very large effect. Analysis of self-reported peer victimization failed to reveal a significant difference between the pre- and post-test assessments, t(3) = 1.14; p < .34. The effect size was computed as d = .57, which represents a medium effect. Analysis of self-reported self-esteem also failed to reveal a significant difference between the pre- and post-test assessments, t(3) = -0.80; p < .48. The effect size was computed as d = .40, which represents a small to medium effect. Analysis of self-reported perception of self failed to reveal a significant difference between the groups, t(3) = -0.69; p < .54. The effect size was computed as d = .34, which represents a small effect.

Discussion
The purpose of this study was to compare and assess the impact of two selective intervention psychosocial education programs (traditional vs. thematic) on measures of social skills, problem behaviors, teacher- and self-reports of peer relationships (bullying behaviors and peer victimization), self-esteem (self-worth, ability, self-satisfaction, and self-respect) and perception of self in a small number of elementary school students. The PEGS and ARK Programs were designed to be short-term, non-stigmatizing programs that can easily augment current school counselor or school-based counseling services. Two groups of students were assigned to one of two programs. A discussion of the comparison between the programs and impact of each program follows.

Comparison
Findings indicated that there were no significant differences between the pre-test assessment measures when comparing the PEGS and ARK Program participants. That is, the participants in each group were comparable prior to their participation in their respective programs. Therefore, should we find significant differences between the two programs at post-test assessment, we may attribute those differences to the impact of the program. Further, there were no significant differences between the post-test assessment measures when comparing the two programs’ participants, with the exception of teacher-reported peer victimization. In other words, participants in each group were comparable after their participation in the respective programs with the exception of participants in the ARK Program having significantly lower levels of teacher-reported victimization than those in the PEGS Program. Note however that there was no difference between the pre- and the post-test assessment for ARK participants on this measure and only a non-significant increase for PEGS participants.

While these results indicate that the implementation of thematic programming directed at peer harassment does not have a significantly greater positive impact on students than traditional programming directed at students who show more generalized problems, there were some large effects (d ≥ .80) between the groups. This may indicate that there may have been some differences between the participants of the two programs, although not statistically significant.

PEGS
Findings indicated that there was significant improvement on self-reported problem behaviors and peer victimization when comparing the pre- and post-test assessments for the PEGS Program participants. In other words, students reported fewer problem behaviors and a decrease in victimization by their peers. While not significant, improvement also was found for teacher-reported problem behaviors and bully behaviors and self-reported social skills, bully behaviors, and self-esteem.

ARK
Findings indicated that there was significant improvement on teacher-reported bully behavior and on self-reported social skills and bully behaviors. In other words, students reported increased social skills and both teachers and students reported a decrease in victimization. Additionally, meaningful improvements (d ≥ .80) were found on teacher-reported problem behaviors. That is, teachers noted fewer problem behaviors in students after their participation in the ARK Program.

Conclusions

Finding effective programming that can positively impact at-risk students can be difficult. Further complicating the issue is the onslaught of thematic programming targeting specific groups of at-risk students (Hartzler & Brownson, 2001). While targeted programming can be beneficial to a select group of students it may exclude other students who can benefit but may not have the same “label.” This study showed that the more traditional group (i.e., PEGS) was equally effective as the more thematic group (i.e, ARK).

Limitations and Future Directions

There were several limitations to this study. First, we were limited to working within the parameters the school established. That is, we were limited to 4th and 5th grade males only and we were limited to providing services during their respective lunch periods. It may have been beneficial to have both genders in each group as well as a mix of grades. Second, group sizes were small. While larger group sizes would result in a greater ability to detect a statistically significant difference if one exists, larger group sizes also can result in reduced effectiveness. Third, we were unable to have a no-treatment group. The use of a control group may have resulted in a more robust study. Finally, the unequal group sizes may have impacted the comparison of the two groups. We attempted to adjust for this by using the Satterthwaite method when the equality of variances was significantly different (O’Rourke et al., 2005).

Implications

There are several implications for school and school-based counselors. First, it would be important in program management if school and school-based counselors are made aware that traditional psychoeducational groups are similarly effective to thematic psychoeducational groups. With this information they can make more informed decisions about the type of groups they implement as well as the type of intervention programs they offer and purchase. If the results of this study hold true for other groups of students and other schools, school and school-based counselors who choose to utilize more traditional programming would be able to provide these services to a broader range of students, consistent with the ASCA Model (ASCA, 2005), and not limit it to a select group of students targeted for a specific issue. Additionally, the purchase of thematic intervention programs can be costly given that the use is limited to a smaller number of students and several different types of programs are needed to address students with differing issues.

Second, the PEGS Program is an empirically supported program (see Newgent et al., 2010). It is a short-term, inexpensive, and non-intrusive program that can positively impact students with a variety of underlying issues. School and school-based counselors can easily augment their services with the implementation of this program. School administrators may be more supportive of a program that is both cost effective and would not hinder counselors from fulfilling other duties. The ever changing demands on school and school-based counselors will most likely continue. Counselors need effective tools that they can use to help students address problems, increase self-esteem, improve social skills, and decrease peer victimization.

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Rebecca A. Newgent, NCC, is a Licensed Professional Clinical Counselor with Supervision Designation in Ohio, a Licensed Professional Counselor with Supervision Specialization in Arkansas, and Professor and Chairperson of the Department of Counselor Education at Western Illinois University – Quad Cities. Kristin K. Higgins is a Licensed Professional Counselor with Supervision Specialization in Arkansas and an Assistant Professor of School Counseling in the Counselor Education Program at the University of Arkansas. Stephanie E. Belk is a certified school counselor in the state of Arkansas and a doctoral student in the Counselor Education Program at the University of Arkansas. Kelly A. Dunbar, NCC, is a Licensed Professional Counselor in Oklahoma, a doctoral candidate in the Counselor Education Program at the University of Arkansas, and is an Assistant Professor of Counseling and Psychology at Northeastern State University. Bonni A. Nickens Behrend has a Master of Science degree in Education Statistics and Research Methods and is currently a master’s student in the Counselor Education Program and a Senior Graduate Research Assistant at the National Office for Research on Measurement and Evaluation Systems at the University of Arkansas. This research was supported in part by a grant from Mental Health America in Northwest Arkansas. Correspondence can be addressed to Rebecca A. Newgent, Department of Counselor Education, 3561 60th Street, Moline, IL, 61265, ra-newgent@wiu.edu.

A Preliminary Exploration of Support Systems for Parents of Children with Special Needs

Sep 3, 2014 | Article, Volume 1 - Issue 1

Chiharu Hensley

Raising a child with special needs exacerbates the inherent challenges of parenting. Although the needs of children with special needs are addressed frequently in the literature, the needs of the parents of children with special needs are often neglected. In order to offer effective and useful services for parents of children with special needs, this article examines the types and nature of support services used by the parents of children with special needs and the effectiveness of those support services in reducing the parents’ stress levels and/or increasing their coping skills. Seventy-four parents of special needs children were assessed and results revealed that low-cost services, particularly those that resulted in mutual support, were a significant priority among parents. The article concludes with a discussion of clinical implications and needed directions for future research.

Keywords: parenting, children, special needs, support services, counseling

Parenting involves much effort and countless responsibilities. Child rearing can be one of the most challenging tasks with which a person is confronted. Raising a child with special needs intensifies the challenge significantly. However, although the needs of children with special needs are addressed frequently in professional literature and in the media, the needs of parents of children with special needs are addressed far less often. In order to offer effective and useful services for parents of children with special needs, their experiences with common issues and concerns and how their needs can be met must be investigated and understood because such information is essential to enable parents to feel empowered in raising their children with special needs.

Parents of children with special needs often experience high levels of stress from both internal and external factors. For example, a study conducted by Heiman (2002) revealed that 84.4% of the participants who had children with various special needs experienced feelings including “depression, anger, shock, denial, fear, self-blame, guilt, sorrow, grief, confusion, despair, [and/or] hostility” at the time of their children’s first diagnoses. Barnett, Kaplan-Estrin, and Fialka (2003) reported a study of parents of children who were mildly or moderately impaired that showed about half of the parents were still experiencing negative responses to their children’s diagnoses two or more years after the initial diagnosis.

In addition, parents of children with special needs may suffer being stereotyped by others. For example, Goddard, Lehr, and Lapadat (2000) used focus groups to collect individual narratives from parents of children with special needs. They found that, more than the parents’ guilt or the condition of the child, being perceived as a victim of a tragedy and the sole advocate for the child as well as a lack of understanding from others, including professionals, contributes to parental stress. Financial concern is another external factor which contributes to high stress levels in parents raising children with special needs. Looman, O’Conner-Von, Ferski, and Hildenbrand (2009) found that the severity of a child’s special needs increased the odds of financial burden experienced by the family. Clearly, there are a variety of both internal and external stressors, and accompanying emotional reactions, with which parents of children with special needs are confronted. Therefore, providing services to reduce the stress and negative feelings to minimum levels would lead to better quality of life for the parents of children with special needs.

Given the relative lack of attention to the support service needs of parents raising children with special needs, the purpose of this study was to conduct an exploratory investigation of the types of services used by parents of children with special needs and the effectiveness of those services for reducing parents’ stress levels and increasing their coping skills.
Four primary research questions were addressed in this study:
1. What are the types of services used by parents of children with special needs?
2. How effective are services in reducing stress levels of such parents?
3. How effective are services in increasing the coping skills of parents?
4. What are some of the needs of parents which may be met by counseling services?

Method

There were two major parts to this research. The first involved distribution of a survey to parents of children with special needs and the second involved an extensive interview with a representative parent of a child with special needs. In the first part of the study a survey was used to collect data for approximately one year. Potential respondents included parents and/or primary caregivers of preschool or school-age children with special needs who resided in a Midwestern state. No restriction was placed on the potential respondents based on the type or number of special needs their child had. Participants were recruited through contact with organizations for families of children with special needs (e.g., local associations for learning disabilities, pervasive developmental disabilities, and physical disabilities) and snowball sampling with assistance of professionals at local public schools who work with children with special needs and their parents. An online survey, the primary means of data collection, was created using a commercial website (www.surveymonkey.com), and potential respondents were directed to the survey webpage from either the websites of the organizations or by typing in the website address found on a distributed survey invitation flyer. A paper version of the survey was prepared for participants from a university clinic for speech and hearing.

The second part of the study involved an individual follow-up interview. Initially, the intent was to garner enough participants for a focus group activity. Unfortunately, however, of all the survey respondents, only one expressed interest in participating in a focus group. Therefore, this respondent was selected and interviewed in order to explore the stressors, challenges, and supports available for the parents in greater depth. The interview was audio-taped and transcribed by the investigator.

Results

There were a total of 74 respondents. Among the respondents, 70 (94.6%) completed the survey online and 4 (5.4%) completed the paper form of the survey. Selected survey items and the resultant data are shown in Table 1.

Table 1

Selected Survey Items and the Resultant Data

Survey Items No. of Responses % Responses

Items for all the respondents (N = 74)
How would you rate your degree of stress on the following scale?
In the last month?
Very low 0 0.0
Low 8 10.8
Moderate 22 29.7
High 33 44.6
Very High 9 12.2

In the last year?
Very low 0 0.0
Low 5 6.8
Moderate 23 31.1
High 24 32.4
Very High 21 28.4

What would be the ratio of each factor that might be contributing to your stress level?

Raising a child(ren) with special needs
About 1–25% 9 12.2
About 26–40% 15 20.3
About 41–60% 15 20.3
About 61–80% 23 31.1
About 81–100% 11 14.9

Financial concerns
About 1–25% 15 20.3
About 26–40% 20 27.0
About 41–60% 12 16.2
About 61–80% 7 9.5
About 81–100% 15 20.3

Have you sought professional services (i.e., therapies) in dealing with your stress of raising a child(ren) with special needs?
Yes 30 40.5
No 43 58.1

If you answered No to the previous question, what was (were) your reason(s) for not seeking professional services (i.e., therapies)? (n = 43)

Unable to afford the service 5 11.6
Schedule conflict 7 16.3
Did not know about any service available 7 16.3
Unable to find a service that seemed
helpful for your needs 12 27.9

Counseling as a category of received service (n=30)

Type of service you have received:
Individual counseling 22 73.3
Couples counseling 3 10.0
Family counseling 7 23.3

How helpful was the service for dealing with your stress?
Very helpful 7 23.3
Somewhat helpful 12 40.0
Neutral 2 6.7
Somewhat unhelpful 2 6.7
Very unhelpful 3 10.0

Compared with your stress level before receiving service, how much has it changed after
receiving service?
Not changed at all 2 6.7
Greatly reduced 12 40.0
Somewhat reduced 7 23.3
Unsure 2 6.7
Somewhat increased 2 6.7
Greatly increased 2 6.7

Compared with your outlook on raising your child(ren) with special needs before receiving service, how much has it changed after receiving service?
Not changed at all 3 10.0
Greatly more optimistic 12 40.0
Somewhat more optimistic 4 13.3
Unsure 6 20.0
Somewhat more pessimistic 1 3.3
Greatly pessimistic 0 0.0

Group as a category of received service (n=16)

Group counseling 2 12.5
Support group 14 87.5

How helpful was the service for dealing with your stress?
Very helpful 6 37.5
Somewhat helpful 8 50.0
Neutral 1 6.3
Somewhat unhelpful 0 0.0
Very unhelpful 1 6.3

Compared with your stress level before receiving service, how much has it changed after receiving service?
Not changed at all 0 0.0
Greatly reduced 10 62.5
Somewhat reduced 3 18.8
Unsure 1 6.3
Somewhat increased 2 12.5
Greatly increased 0 0.0

Compared with your outlook on raising your child(ren) with special needs before receiving service, how much has it changed after receiving service?
Not changed at all 1 6.3
Greatly more optimistic 8 50.0
Somewhat more optimistic 2 12.5
Unsure 3 18.8
Somewhat more pessimistic 1 6.3
Greatly more pessimistic 0 0.0

Items for the respondents who sought a professional service(s) in the past for dealing
with their stress of raising their children with special needs (n=30)

What have you gained from receiving service(s)?
Peer support 8 26.7
Professional support 7 23.3
Network 10 33.3
Specific knowledge about the
child(ren)’s disability(ies) 14 46.7
Specific skills for dealing with
the child(ren)’s needs 13 43.3

What are some of the factors that you consider when choosing a service?
Cost (including transportation
and session fees) 20 66.7
Schedule/frequency 21 70.0
Format (e.g., individual vs. group vs.
psychoeducational vs. counseling) 16 53.3

How likely are you to seek an additional service(s) in the future?
Very likely 9 30.0
Likely 8 26.7
Unsure 6 20.0
Unlikely 1 3.3
Very unlikely 0 0.0

If you were to receive an additional service(s), what would be the most likely format/venue?
Individual counseling 15 50.0
Couples counseling 4 13.3
Family counseling 8 26.7
Group counseling 1 3.3
Support group 13 43.3
Parenting training individual sessions 4 13.3
Parenting training group sessions 6 20.0
Individual psychoeducational sessions 0 0.0
Psychoeducational group sessions 3 10.0
Coping skills—individual sessions 5 16.7
Coping skills—group sessions 3 10.0
Stress management—individual sessions 8 26.7
Stress management—group sessions 4 13.3

Note. Some of the items allowed multiple answers by a single respondent. Percentage of respondents for each item was measured based on the number of respondents corresponding to specific items.

Some of the 74 respondents did not provide responses for all items. The respondent group included 67 females (90.5%) and 63 (85.1%) participants who identified themselves as Caucasian/White. Thirty-five respondents (47.3%) were between ages 31 and 40, and 58 (78.4%) were married. Fifty-nine of the respondents (79.7%) had one child with special needs and 31 (41.9 %) reported the child’s disability as moderate.

In regard to stress levels, 33 respondents (44.6%) indicated that they had experienced a high degree of stress in the past month, and 45 (60.8%) indicated that they had experienced either a high or very high degree of stress in the past year. Twenty-three respondents (31.1%) indicated that raising their child with special needs contributed to about 61–80% of their total stress level, and 20 (27.0%) indicated that their financial concerns contributed to about 26–40% of their total stress level. In regard to help seeking, 45 (60.8%) indicated that they had never sought professional services (e.g., various possible therapies) to cope with the stress of raising a child with special needs. The most frequently cited (n = 12, 27.9%) reason for not seeking support services was that they were unable to find services that they perceived to be helpful for their needs.

Among the 30 respondents who had sought professional services, 22 (73.3%) indicated that they had sought individual counseling (which also was the most used type of service). The second most used type of service was support groups, in which 14 respondents (46.7%) indicated that they had joined or were current members of a support group. Among those who had received individual, couple, family, or any combination of counseling, 19 (73.1%) indicated that their stress levels were reduced to some or a great extent after receiving such service(s) and 16 (61.6%) responded that their outlook on raising their child with special needs became somewhat or greatly more optimistic.

Specifically, among the 16 (53.3%) who had received either group counseling, participated in support groups, or both, 13 (81.3%) indicated that their stress levels were somewhat or greatly reduced and 10 (62.5%) indicated that their outlook on raising their child) with special needs became somewhat or greatly more optimistic. Finally, 14 (46.7%) responded that they had gained specific knowledge about the child’s disability from receiving the services and 13 (43.3%) responded that they had gained specific skills for coping with the child’s needs.

Although the respondents in this latter subgroup had participated in a wide variety of support services, it appears that most were psychoeducational in nature. Seventeen respondents (56.7%) also reported that they were either likely or very likely to seek additional services in the future. The three most selected types of services that these respondents would most likely seek were individual counseling (n=15, 50.0%), support groups (n=13, 43.3%), and family counseling (n=8, 26.7%). Session schedule and frequency, cost (including transportation and session fees), and format of the service were all important factors considered in use of support services.

The second part of the study was an interview with the mother of a son with cerebral palsy in order to gather information about personal experiences, particularly those contributing to her level of stress. The interview was conducted at a house close to the hospital to which she periodically brought her son for treatment. At the time of the interview, Amy (a pseudonym), the mother, was 39 years old, and Michael (a pseudonym), her son, was two years old. Amy was Caucasian, between 31 and 40 years old, married, and had one child with special needs; therefore, she was “typical” of the majority of the respondents to the survey. Specific interview questions were not prepared in advance. Rather, Amy was asked to convey her most important and/or strongest experiences and emotions as a mother of a child with special needs.

A wide variety of issues were discussed during the interview, but the most pressing issue mentioned by Amy was the lack of available resources for parents of children with special needs. Amy related that large cities might have many resources available, “but especially not my little small town—the resources are so limited.” She talked about how in attempting to acquire information and resources to aid in Michael’s care, she had asked many different people. Importantly, she did considerable research on her own, primarily using the Internet. She felt that many, or perhaps most professionals did not know more than she did, regardless of their formal education and training. She gave the example of having told one of Michael’s doctors about Euro-Pēds, a facility specializing in physical therapy for children with cerebral palsy and other neuromuscular disorders. The doctor did not know about this resource. Amy also related how shocked she was when a receptionist at a local mental health facility was not aware of a “respite” fund provided by the facility. She expressed that it was “disheartening that these people are supposed to guide me, and they just couldn’t.” Then she went on to describe a situation in which parents of children with special needs could not obtain the service they wanted because they did not use the technical term:

I was told that there were even situations where people who aren’t articulate would call and say, ‘I need a
babysitter.’ And they say, ‘We don’t do babysitting services.’ Click. Because they didn’t say ‘respite,’ they were turned away…. It’s their job to be in tune with, maybe there’s something I’m not getting here. Let me figure out what’s wrong with this person that’s calling my mental health facility.

Amy was often disappointed in seeking resources and help, probably because of the lack of understanding and education among professionals.

Amy lamented that resources external to the family should not cause more stress because parents of children with special needs already are overwhelmed by feelings of guilt, helplessness and stress. She believed that Michael was not the cause of her issues, but rather that the actual problems were the by-products of his having a disability:

It’s not always directly related to the child, but all the side effects that how they affect you… A lot of it is just the overwhelming feeling that sometimes you wake up in the morning and say, ‘I can’t believe that he has so many problems.’ And you feel sorry for him, and you feel stressed out about it.

Amy also felt guilty about not being able to spend as much time as she would have liked with her other two children; the demands of Michael’s situation dominated all her plans. Amy had tried to be with her other children whenever she could, but still felt that she was not doing enough for them. Thus, she believed that Michael’s disability affected not only her, but also everyone else in the family. Amy also felt tremendous pressure when talking to Michael’s doctors:

Michael’s doctors say, ‘We don’t know if he can ever walk. But we don’t know if he won’t. It’s gonna be up to you, Mom. It’s gonna be, if he’s got the potential to do it. You’re the one that’s gonna push him…’It’s a lot of pressure and I don’t think that these doctors meant to give me that unneeded pressure… But I work very hard to push Michael, you know, everyday. But it scares me. It scares me that, ‘Am I pushing him enough? Am I pushing him too hard?’

Obviously Amy (and other parents of children with special needs like her) suffers from high levels of stress from both internal and external factors. To Amy, taking care of Michael was like “not knowing how to swim and you get thrown into a pool with another person who doesn’t know how to swim.” When Michael was born, Amy had to teach herself how to raise a child with special needs because “these children don’t come with an instruction manual…or a book of resources.” She believed that knowledge about Michael’s disability would be particularly important in order for her to take care of him properly and effectively. She also was aware that the process of accepting her son’s disability and learning how to take care of a child with special needs could be “a nightmare for some people,” because “even someone with formal medical training struggles with these children.” Amy related that she thought a support group to provide opportunities for the parents of children with special needs to discuss and share experiences and feelings would be beneficial. She also believed that inviting a professional such as a social worker to the group who could help the parents fill out paperwork for requesting funds and other assistance would be beneficial because many parents of children with special needs struggle with understanding and completing formal documents properly. At the end of the interview, Amy indicated that she felt like she was contributing at least in a small way to improving the lives of parents of children with special needs by participating in the research and that the interview was helpful in reducing her stress.

Discussion

This preliminary research was conducted to gather data, collect descriptive personal information, and, from the data, suggest future practices for gaining understanding of the unique needs of parents of children with special needs. Suggested in the results of this exploratory study, is that counseling services for parents of children with special needs are both warranted and needed. The format of such services likely should be group counseling because of lower cost and potential for mutual support among group members. Such group counseling sessions should be in part psychoeducational and in part intended to foster support to meet the goals of knowledge and skill acquisition for parenting children with special needs and sharing personal experiences with others. Individual and/or family counseling might be used as a follow-up service, especially for parents or families of children with special needs who appear to need intensive care. Finally, parents of children with special needs should be able to choose how they would like to interact, such as by phone, home visit, or face-to-face because they often struggle with finding child care for when they are away from home. Having support group meetings at each other’s homes also can be an option so that parents can take turns watching children during meetings.

Limitations of this study included a small number of male participants. Whether more responses from fathers would have changed the results is only a matter of speculation. Thus, future research that includes significantly more input from fathers of children with special needs is needed. Also, to be noted is that some participants reported confusion about terms such as psychoeducation, which may have influenced their responses. Therefore, future research should identify specific services rather than the categories of services. Any online survey is limited to those who have access to the Internet and are comfortable using computers. Future studies can overcome this limitation to a great extent by incorporating multiple methods involving several types of data collection. Finally, the case interview was perhaps the most valuable part of the study in terms of revealing the reality and challenges faced by parents of children with special needs. Thus, qualitative, phenomenological research also would be beneficial, especially for understanding the unique and complex concerns of parents of children with special needs.

References

Barnett, D., Clements, M., Kaplan-Estrin, M., & Fialka, J. (2003). Building new dreams: Supporting parents’ adaptation to their child with special needs. Infants and Young Children, 16, 184–200.
Ergüner-Tekinalp, B., & Akkök, F. (2004). The effects of a coping skills training program on the coping skills, hopelessness, and stress levels of mothers of children with autism. International Journal for the Advancement of Counselling, 26, 257–269.
Goddard, J. A., Lehr, R., & Lapadat, J. C. (2000). Parents of children with disabilities: Telling a different story. Canadian Journal of Counselling, 34, 273–289.
Heiman, T. (2002). Parents of children with disabilities: Resilience, coping, and future expectations. Journal of Developmental and Physical Disabilities, 14, 159–171.
Looman, W. S., O’Conner-Von, S. K., Ferski, G. J., & Hildenbrand, D. A. (2009). Financial and employment problems in families of children with special health care needs: Implications for research and practice. Journal of Pediatric Health Care, 23, 117–125.

Chiharu Hensley, NCC, is a professional counselor in Nagasaki, Japan. The author thanks Dr. Devika Dibya Choudhuri for generously and patiently guiding me through the entire process of the current study while I was a Master’s counseling student at Eastern Michigan University, and those who willingly participated in the study. Correspondence can be addressed to Chiharu Hensley, 9-1-403 Manabino 2-chome, Nagayo-cho, Nishisonogi County, Nagasaki, Japan, 851-2130, chiharu.hensley@gmail.com.