Acceptance and Commitment Therapy for In-School Suspension: Does It Work?

1 Acceptance and Commitment Therapy for In-School Suspension

Acceptance and Commitment Therapy for In-School Suspension: Does it Work?

A single–subject-design research project using ACT as a psycho-educational intervention

Elizabeth C. Frampton 4/16/2011 West Virginia University

SOWK 618: Personal Practice Assessment

Chatman Neely, MSW, LCSW, ACSW

Instructor 2 Acceptance and Commitment Therapy for In-School Suspension Abstract

The number of out-of-school suspensions (OSS) has increased dramatically over the years in spite of warnings from the Centers for Disease Control (CDC), the American Academy of

Pediatrics (AAP), and mental health professionals of its dangers. Student misbehavior is considered to be an indication of underlying issues which can be exacerbated by removing the student from the school setting. Despite recommendations by the CDC and AAP that schools implement well- structured in-school-suspension (ISS) classrooms which provide support and psycho-educational sessions, it appears it is not an option many school systems are implementing. This paper covers a single-system design research project evaluating the use of Acceptance and Commitment Therapy

(ACT) in a high school which is exploring the use of structured ISS.

Introduction

Our society has long viewed adolescence as a period of rapid personal change accompanied by great emotional upheaval, personal angst, and atrocious behavior (Adelman & Ellen, 2002;

Greco & Eifert, 2004). Current research appears to indicate that while young people in the age group from ten to the late teens or early twenties are transitioning from childhood to adulthood, the process is not as turbulent as previously hypothesized (Adelman & Ellen, 2002; Greco & Eifert,

2004). Sexual, physical, and increased reasoning ability causes individuals in this group to seek to develop a sense of individuality, and set of personal values which may or may not be in line with those of their parents (Greco & Eifert, 2004). It may be this personal quest for identity has caused the adolescent developmental phase to be labeled as tumultuous, but indeed, the struggle may lie as much within the parents and social systems in which they operate as it does with the adolescents themselves. Granted, while this life phase creates a need for the individual to work through, and understand themselves in a social, home, and school environment, while taking more 3 Acceptance and Commitment Therapy for In-School Suspension responsibilities in those domains (Greco & Eifert, 2004), it appears most adolescents pass through this life stage successfully (Adelman & Ellen, 2002), but for some, the transition can be difficult.

Adelman and Ellen (2002) state adolescence pivots on four major areas: “independence, body image, peer group and identity” (p. 72). As the individual moves through this phase, the decision making process moves from fear of punishment, to doing what is true to the values which are being formed. While this process is necessary and healthy, it can create conflict with the systems in which the person functions. One arena in which this conflict plays out is the public school system.

An adolescent’s growing need to establish his personal identity can create issues within the very system which is geared toward preparing him for life. School safety has become a pivotal goal within the educational system starting in the 1980’s due to rising juvenile crime, and has become a driving issue since the 1999 Columbine tragedy (Sundius, J. & Farneth, M., 2008). Zero tolerance has become the modus operandi within public schools, with between 79% to 94% of public schools nationwide having established such a policy (American Academy of Pediatrics, AAP, 2003) even though the only federal law which requires specific action is the Gun-Free Schools Act (Sundius, J.

& Farneth, M., 2008). Ninety percent of the public supports zero-tolerance, yet the American Bar

Association (ABA) voted in 2001 to end these policies, stating they were too rigid and did not give leeway to consider the special circumstances of each student. (AAP, 2003). The importance of school safety cannot be emphasized enough, yet in its quest for safety, the number of out-of-school suspensions (OSS) by public schools have increased dramatically in recent years (Dupper, Theriot,

& Craun, 2009; Sundius, & Farneth, 2008). Nationally, the number of suspensions has risen from

7.1 percent for 1995-1996 to 9.0 percent in the 2006-2007 school year (Sundius, & Farneth, 2008).

Dupper, Theriot, & Craun, (2009) and Sundius, & Farneth,( 2008) agree that many times the rules governing suspension are vague, and are for relatively minor infractions. The AAP (2003) concurs, 4 Acceptance and Commitment Therapy for In-School Suspension noting in 1997, 3.1 million students were suspended, ninety per cent of which were for “nonviolent and noncriminal acts” (p. 1207).

Sundius, and Farneth, (2008) state many suspensions are over behaviors, which in the past, would have been viewed as immature or inappropriate, but not cause for being removed from school. They note, in 2007, the state of Maryland had more suspensions for tardiness and skipping school than for “dangerous substances, weapons, arson/fire/explosives, and sex offenses combined.”

(p. 5). The primary cause for suspension appears to be disrespectful behavior or behavior which appeared to challenge teacher authority (Dupper, Theriot, & Craun, 2009; Sundius, & Farneth,

2008). While orderly classrooms are necessary for optimal learning, the current solution of OSS may be creating more problems than it resolves.

OSS increases the likelihood a student will ultimately drop out of school. Elkstrom, et al

(1986) noted, a student suspended during their sophomore year of high school was three times more likely to drop out than their peers (as cited by Sundius, & Farneth, 2008). The AAP (2003) states, missed work during the suspension period, OSS threatens a student’s ability to complete school; something it considers quite serious since success in the area of education is considered to be in direct correlation with health and safety. The Center for Disease Control (CDC, 1994) notes students removed from school are more likely than their in-school peers to engage in risky behavior, including, but not limited to, substance abuse, carrying a weapon, fighting and sexual intercourse.

The AAP (2003) maintains the position that a majority of the time behavioral problems in students are due to depression, mental health issues, or violence in the home, personally experienced or witnessed. One study cited by the AAP (2003) noted 15% of students suspended the previous year had not been abused themselves, but were witnesses to domestic violence (Kernic, et al, 2002, as cited by the AAP, 2003). Suspending these students may be counterproductive and putting them in harms way. The AAP (2003) points out students from single-parent households are two to four times as likely to be suspended than those who have both parents in the home, meaning these 5 Acceptance and Commitment Therapy for In-School Suspension students are less likely to be supervised while on suspension. Isolation, lack of supervision during

OSS, and the failure to receive professional help at a time when one may need it the most, increases the chances of suicidal ideation and behavior (AAP, 2003).

Additionally, the CDC (2001) states,

Alternatives to expulsion that will improve student behavior and school climate could be considered (250). Alternatives that retain suspended or expelled students within an educational atmosphere (e.g., alternative schools or in-school suspension) are essential to maintaining the student's connection with school and academic work (188,198). However, simply referring students to alternative educational settings is not sufficient. These programs should be of high quality and should limit the potentially harmful effects of grouping students at high risk. Effective alternative programs can support students and provide them with opportunities to learn how to manage inappropriate behaviors (188,198).

Despite recommendations for in-school-suspension (ISS) from the AAP, CDC, and other professionals (e.g. social workers), little research has been conducted concerning the efficacy of such a program (Dupper, Theriot, & Craun, 2009). Based on the conclusions of AAP, students most likely to be suspended, are a vulnerable population with specific needs, yet structured ISS has been a little explored option by most school districts. School districts which have attempted ISS, often use it as little more than a holding pen for students (Dupper, Theriot, & Craun, 2009). What is needed is a well-thought-out, intentional intervention during the ISS period (AAP, 2003; CDC,

2001; Dupper, Theriot, & Craun, 2009). One of the challenges then is to find an intervention which can be used for the limited amount of time a student may spend in ISS. Acceptance and

Commitment Therapy (ACT) may be such an intervention.

Acceptance and Commitment Therapy

ACT is a third wave therapeutic method which originates in Relational Frame Theory

(RFT); a complex theory dealing with language and cognition (Association for Contextual

Behavioral Science, ACBS; Polk, 2011). Contextual psychology stems from RFT, which is the 6 Acceptance and Commitment Therapy for In-School Suspension theory upon which ACT is based (ACBS; Polk, 2011). Third wave therapies deal with behavior by changing a person’s relationships to their thoughts, as opposed to attempting to change thoughts, as

Cognitive Behavior Therapy which is second wave, or by behavior modification which is considered first wave (O’Brian, Larson, and Murell, 2008). ACT’s basic premise is that suffering comes because a person becomes overly attached to certain thoughts (fusion) or is continually judging thoughts as good or bad (a function of language). This fusion causes inflexibility in the way a person functions (O’Brian, Larson, and Murell, 2008). ACT uses mindfulness and acceptance as part of the therapeutic process. There are a multitude of attempts to define mindfulness. I define it as observing, here and now, what is happening externally and internally.

ACT addresses six areas: “Self as Context, Defusion, Acceptance, Contact with the present moment, Values, and Committed Action (Hayes, et al, 2006, p. 8). O’Brian, Larson, and Murell,

(2008) maintain the first four of these areas deal with mindfulness. Unlike CBT which challenges and attempts to change negative thoughts, ACT promotes acceptance of one’s thoughts with non- judgmental observation, and assessing if the thoughts are moving one in the direction of their values. Hayes, et al., (2005) states the focus of ACT is to help a client identify and clarify his values so that he can choose actions which promote, or move him in his desired life direction. Often a person becomes enmeshed in certain ideas which create a barrier to moving forward toward values

(cognitive fusion), or because of previous life experience, embrace certain self-defeating ideas about himself, which ACT calls “Attachment to the Conceptualized Self” (p. 6). Since certain thoughts or memories are painful, and because an individual may project painful memories into the future, assuming pain will occur again, experiential avoidance (EA) occurs. In order to stop painful internal experience, a client may engage in self-defeating behaviors such as substance abuse, anger, or any number of behavioral issues.

The use of mindfulness in ACT is to develop a sense of oneself as an observer to thoughts; to recognize thoughts as simply a function of the mind, and not necessarily indicators of truth or 7 Acceptance and Commitment Therapy for In-School Suspension reality. By being in contact with the present moment, while accepting thoughts as just thoughts, one can choose actions which move them in the direction of their values, instead of becoming bogged down with the idea, all thoughts are true. The process of developing mindfulness is achieved by using metaphors or exercises in a therapy session, which begin to point out how thoughts come and go as one moves through daily routines. As a client becomes an observer of his thoughts, he can begin to develop psychological flexibility, and not act on a thought which does not move him in the direction of his values. This process is called defusion (Hayes, et al, 2005, O’Brian, Larson, and

Murell, 2008). This approach is another way in which third wave therapies differ from second wave; the emphasis is more on how thoughts occur, the process, as opposed to the content of thoughts (Coyne, Cheron, and Ehrenreich, 2008). The idea is not to change thoughts, but to change one’s relationship to their thoughts (Hayes, et al, 2005; Coyne, Cheron, and Ehrenreich, 2008). The ultimate goal of ACT is to develop this mindfulness and acceptance of thoughts, so the client is free to choose actions based on his values, rather than simply behaving in way which is an attempt to avoid painful thoughts, memories, or anticipated pain (Coyne, Cheron, and Ehrenreich, 2008).

Coyne, Cheron, and Ehrenreich (2008) state ACT has been shown, empirically, to be effective in working with adults. Due to the complexity of its concepts, the use of ACT with adolescents and children has been questioned, and research in this area is relatively new and growing. O’Brien, Larson, and Murrell, (2008), assert the distress suffered by children and adolescents is not that different from adults, yet consideration must be given to the position they hold in society and their environment. Due to their status as minors, O’Brien, Larson, and Murrell

(2008) encourage full participation in the ACT process for not only the clients, but by the school and family systems as well, a stance the AAP (2003) and CDC (2001) promote as well. A discussion which would include an environmental treatment falls outside of the parameters of this paper. 8 Acceptance and Commitment Therapy for In-School Suspension Growing research indicates ACT is effective in the treatment of adolescents when the treatment is geared toward the developmental stage of the client (O’Brien, Larson, and Murrell,

2008). O’Brien, Larson and Murrell (2008) state between the ages of nine to fifteen, a youth is able to think abstractly, so the concepts of ACT should not create difficulties, and in fact, they believe

ACT is suited for child or adolescent clients because of its use of “experiential exercises and metaphor” (p. 19).

Hypothesis

Since ACT has been shown to be effective in the treatment of some adolescent issues, in particular with youth at risk of dropping out of school (Moore, et al, 2003 as cited by O’Brien,

Larson and Murrell, 2008) it is proposed the use of ACT in an ISS-ALC will give students insights into the way their behaviors move them toward or away from their values, helping them to think about behavior choices.

The Setting

My research project took place in Riverside High School, located in Kanawha County, West

Virginia. This school is engaging in a pilot study regarding ISS, and uses an Alternate Learning

Center (ALC) during school hours in lieu of suspension for certain school rule infractions. The

ALC at Riverside is a structured classroom with a full time teacher, to my knowledge the only structured ISS classroom in the state, although this ISS classroom structure is recommended by the

AAP and CDC. At times during the research period I would ask students what they thought about being in the ALC classroom and, interestingly, often students would state it has been a positive experience. They reported the structure of the classroom gave them the opportunity to catch up on school work, or to think about their actions. These comments were made at the beginning of the group. 9 Acceptance and Commitment Therapy for In-School Suspension Kanawha County schools has in place a rating system with regards to student misbehavior. A listing of infractions and subsequent referral to ALC can be found in Appendix 2.

Christopher Cantrell, Vice Principal at Riverside, states there are some gray areas with regards to rule infractions, and part of his job is to assess the appropriate action to take, while taking into consideration the individual student (Personal interview, March, 2011). More information concerning the structure of the ALC is contained in Appendix 3 of this paper.

Riverside High School has partnered with Cabin Creek Health Systems (CCHS) to improve the content of the ALC classroom. Previously, ALC was essentially a holding room for referred students, but in recent years a full time teacher has been employed to provide a structured, consistent setting for these students and CCHS is now offering psycho-educational sessions for students in the classroom. One of these psycho-educational sessions is an ACT-based group (Farley, letter to Board of Education, April 10, 2010). This research project evaluates the efficacy of the

ACT psycho-educational session in the school’s ALC.

ACT Session Structure in ALC

Psycho-educational sessions conducted in the ALC are based on a matrix grid developed by

Kevin Polk, Ph.D. (Farley, letter to Board of Education, April 10, 2010)( Handouts used during the process are included in Appendix 4). The process involves talking to the students about their experience in the world. They observe through the five senses, and then the brain creates thoughts or interpretations about what has been taken in through the senses. The brain also retains memories which have been interpreted as positive or negative. The manner in which sensory input is interpreted or remembered can create an emotional response within the individual, which can impact the body. Positive interpretations or memories are pleasant and may cause a person to smile, feel happy, and relaxed. Negative interpretations of sensory input or a negative memory may cause 10 Acceptance and Commitment Therapy for In-School Suspension the student to experience emotional upset with ensuing tension in the body, creating headaches, stomach difficulties, or other issues.

The students are given a copy of the matrix and it is also used on a SMART board or a dry erase board. Exercises are used to help the students notice how the brain is always thinking.

Sometimes they are asked to close their eyes, and not think about anything for five minutes. This request is usually followed by comments from the students saying it is not possible to do. Students are asked to identify someone who has influenced them, and if comment is made the influential person loves me, they are asked to identify what the person does to show their love.

The emphasis is on the fact, no one can know the inner standards a person holds unless actions are congruent with those values. Students are asked to identify their values, and what actions they can take to move them in the direction of these inner principles. They are asked to identify internal feelings, thoughts, or conditions which may create a barrier in moving toward valued living. Barriers may include anger, depression, anxiety, or fear; conditions which are unpleasant, and the students may try to avoid by engaging behaviors such alcohol, drug abuse, or physical altercations, etc. These behaviors are identified by the students. The session emphasis is to encourage students to move in the direction of their values, in spite of unpleasant thoughts or feelings. Thoughts are just thoughts, and do not have to be a barrier to moving in a valued direction.

The Process

Since ACT covers various aspects of thought and behavior, the challenge was deciding what characteristic of the intervention to measure. The psycho-educational interventions are brief (one hour), and students may be seen only once during the research period. Measuring change in behavior was not practical, since there are not ongoing sessions with the same students, or follow up. There was a need to keep the measurement tool brief, due to the length of time during a session, 11 Acceptance and Commitment Therapy for In-School Suspension and to maximize response; a long questionnaire would have been perceived as annoying to this population.

Given that one of the facets of ACT is thoughts, I chose to create a measurement tool which focused on what effect the session had on the way students thoughts or perceptions of thoughts may have changed during the session. Questions as to whether they considered the session to be helpful, the clarity of the session, and presenter apparent trustworthiness were included as well. Six questions used a Likert scale, with two qualitative questions about what was enjoyed the most, and least during the group; creating a questionnaire limited to one page in length with eight questions.

This particular project called for a brief, simple, measurement tool which could be administered without resistance by the population. I choose wording which would “speak” to high school students, and attempted to measure an aspect of the intervention which could be assessed after one session, without follow up. I also included an option for the students to identify themselves as male or female, simply to see if there was any measurable difference in the responses. A sample of the evaluation questionnaire can be found in Appendix 1.

Results

The evaluations were collected over a seven week period, with forty-five students participating in the psycho-educational ACT sessions and completing evaluations. I led the sessions for six of the weeks, with the instructor who trained me in ACT, filling in for me one week when I could not be present. Initially, I had not planned on collecting evaluations the week I was not to be in the classroom, but later decided to see if there would be a difference in student response if the session was taught by a different individual. There was no significant difference in student response.

Eighteen students identified themselves as female, twenty-one as male. Four students chose to not identify their gender on the evaluation, while two checked both male and female. 12 Acceptance and Commitment Therapy for In-School Suspension

Responses to the evaluation by question follow: 13 Acceptance and Commitment Therapy for In-School Suspension 14 Acceptance and Commitment Therapy for In-School Suspension 15 Acceptance and Commitment Therapy for In-School Suspension 16 Acceptance and Commitment Therapy for In-School Suspension

Females appear less ambivalent in their responses than males.

Due to the brief nature of the intervention, my hopes were to, at least, cause the students to think about ways they could do things differently in their lives. Question 4 touches on the minimum target, with a positive on questions 5 or 6, considered to be above expected results. I considered questions 4-6 to be a progression, but was surprised when the progression did not always pan out, with some 4’s being negative on student evaluations, but with 5 or 6 being positive. It is possible the students were indicating they were not just thinking in general, but thinking specifically, or planning on change. The charts show the number represented graphically above. 17 Acceptance and Commitment Therapy for In-School Suspension Questions #1 #2 #3 #4 #5 #6 Strongly Agree 16 32 25 12 5 7 Sort of Agree 23 12 12 16 20 12 No Opinion 5 7 15 16 17 Sort of Disagree 1 3 5 Strongly Disagree 1 1 2 1 4

Number of students per assessment answer.

Questions #1 #2 #3 #4 #5 #6 Strongly Agree 36% 71% 56% 27% 11% 16% Sort of Agree 51% 27% 27% 36% 44% 27% No Opinion 11% 16% 33% 36% 38% Sort of Disagree 2% 7% 11% Strongly Disagree 2% 2% 4% 2% 9%

Total 100% 100% 100% 100% 100% 100% Assessment Answers by %

Forty five students participated in the groups; eighty-seven percent of whom thought the group was helpful to some extent. Ninety-eight percent felt the presentation was clear, with eighty- three percent stating the presenter seemed to be trustworthy. Question 3 was included in an attempt to evaluate the ability of the presenter to establish rapport with the students. It was also postulated the information would be received with more openness if the presenter was perceived as one who can be trusted. Sixty-three percent (28 students) indicated the group helped them to think about ways they could do things differently in life, 55% (25 students) saying they were thinking about changes they could make, and 43% (19 students) stating they were going to make changes as a result of the group. If neutral answers are not considered to be negative, but rather an expression of the ambivalence often experienced by adolescents, the efficacy of the intervention is outstanding; of course, “no opinion” might mean a lack of buy-in to the concepts as well. A time extended research project which involved follow up with the students could shed light on the meaning on the “No

Opinion” and all responses. The quantitative portion of the assessment indicates the use of an ACT- based intervention makes an impact on student thinking for a majority of the students participating, 18 Acceptance and Commitment Therapy for In-School Suspension influencing students to think about life choices in the future, and leading some to work toward behavior change immediately.

Qualitative Portion of Assessment and Discussion

The assessment included two qualitative questions: “What did you enjoy the most about the presentation?”(Question 7) and, “What did you enjoy the least?”(Question 8). Four students out of forty-five (9%) did not answer the qualitative portion of the assessment.

The challenge when working with adolescents is the life stage through which they are passing. They may be wrestling with life choices, how to respond to authority, and how to learn to function in the world. This concept may be especially true with students in ALC, who, as pointed out by the AAP, are possibly struggling with issues beyond normal adolescent; therefore, the qualitative portion on this assessment yielded a wide variety of responses. Additionally, a few students added a qualitative comment on the quantitative portion of the form. An example of which was made by a student who answered “neutral” for question 4, but then wrote in that he was doing fine, indicating he did not need to think of things differently. An initial response to such a statement may be cynicism or the thought the student was in some type of denial, yet a conversation with the

ALC teacher (private conversation), shed a different light on the matter. On that particular day some students were present because their teacher lost control of the classroom and sent the entire class to

ALC. As a result, one of the people in the session was one of the top performing students in the school, with a GPA of over 4.0.

On the other hand, there were students in the classroom who appeared to have severe issues.

One student was removed by the teacher when he began screaming and yelling after I told him to

“chill” after making an inappropriate sexual comment to me. Other students sat with their heads down and answered questions so quietly it was difficult to hear them, some of the qualitative answers that day stated they did not like hearing about depression during the session. Some answers 19 Acceptance and Commitment Therapy for In-School Suspension challenged what may be a general attitude that misbehaving students just do not care; one male answered he did not like hearing about suffering, because he did not like to see people suffer.

All of the responses to these questions were recorded and then reviewed for themes, and while some comments such as, having to sit, listen, or even being present in ALC could be expected, two major themes arose from the qualitative portion. Themes to which I will refer to as

Values and Voice. It may come as a surprise to some people that one portion of the presentation the

ALC students liked the most was hearing about, talking about, participating in exercises which focus on values. Additionally, several students indicated they enjoyed the entire presentation, a majority of which focuses on values, even when they did not specifically mention values. Twenty- one students (47%) stated there was nothing about the presentation they did not like.

Another dominating theme of the qualitative portion of the assessment, can be encapsulated in an answer given by one student to question 7, “Just the fact she listened.” It is a theme I will label as “Voice.” In various ways students stated they enjoyed having someone come into the classroom who seemed to notice them; someone who would take time out of the day and come into the classroom, allowing them to express thoughts, discuss ideas, get to know them, allowing them to get to know each other, who listened when they talked, and helped them to look at life in a different way; they were given a voice, they were noticed, and treated with respect. One of the more interesting responses to question 7 was “I felt opened.” It lead the researcher to conclude a majority of these students do not feel heard or noticed. Sometimes during the sessions, I would make a statement about feeling invisible; a statement which would often draw nods from the group. The qualitative portion of the assessment revealed it was powerful for students to have a time when they were noticed and respected.

Conclusions 20 Acceptance and Commitment Therapy for In-School Suspension This single-subject research project supports other literature which promotes the use of ACT with adolescents. O’Brien, Larson, and Murrell (2008) maintain the concepts of ACT should not be difficult for adolescents to comprehend. Responses to Question 2 indicates all students, with the exception of one, believed the presenter to be clear in the concepts being taught. Occasionally, a student would ask for clarification about a word or term, but there was no indication during the session the students did not understand the concepts of ACT. The ACT emphasis on values was well received by the group, as were other aspects of the intervention; the noticing of thoughts, realizing thoughts are just thoughts, to name a few.

The challenge in this setting is the time frame, and lack of follow up. A more in-depth project could track student behavior from the session on to see the impact on behavior.

Additionally, ACT covers so many aspects of human behavior, a one hour session is inadequate to fully work with a vulnerable population group. Due to lack of time, it may be too much information is trying to be conveyed, and a few students commented the session seemed long. If an intervention could be spread out over a two to three weeks time frame, with the same students, there would be more time to engage in more of the experiential exercises ACT employs, which could impact the efficacy of the intervention.

One portion of the project which bears consideration is the setting itself. It is entirely possible a similar intervention in an unstructured ISS would not have the same impact as

Riverside’s ALC. The structure of the school’s ALC may be creating a mindset which helps the students to be more receptive to the intervention. The ALC teacher states there are occasions in which a student’s grades will improve while they are in ALC (ESMH Conference, April 12, 2011).

A statement in line with student comments.

Recommendations 21 Acceptance and Commitment Therapy for In-School Suspension During the course of the research it became apparent ISS classrooms are not always used in a manner which would benefit students. A conversation with one health care professional indicated

Riverside was the only school in the state which is providing a structured ISS classroom with a full time teacher (personal communication, April, 2011). How ISS is used on a national level is unknown; however, research seemed to indicate many schools use ISS as a holding pen for students, without structure or intervention, making it a stop on the way to OSS (Dupper, Matthew and Craun, 2009), as opposed to an opportunity to intervene with a vulnerable population. Further exploration into structured ISS classrooms is highly recommended. It should be noted, O’Brien,

Larson, and Murrell (2008) propose, if ACT is being used with adolescents, it should also be incorporated into the environment in which the adolescents function (e.g. school and family). The presence of highly successful students in the ALC during the research period, indicate there may be a benefit to integrate ACT into faculty training as well.

The combined results of the quantitative and qualitative portions of the assessment, indicate

ACT can be used effectively with adolescents in a structured ISS setting. Students appreciated exploring values and barriers which may prevent them from moving in their valued life direction.

The intervention’s use of exercises which emphasis the ability to choose actions congruent with values appeared to impact a majority of the students. Further research which follows up with students could give more insight to the long term effects of an ACT intervention. 22 Acceptance and Commitment Therapy for In-School Suspension

References

American Academy of Pediatrics, (APA). (2003). Out-of-school suspension and expulsion.

Pediatrics, 112(5), 1206-1209.

Adelman, W., & Ellen, J. (2002). Adolescence. In A. M. Rudolph, Kamei, R.K., & Overby, K.J.,

(Eds.), Rudolph's fundamentals of pediatrics (pp. 70-109). International Edition: McGraw-

Hill. Retrieved from http://books.google.com/books?id=qsQWI-

v50MwC&pg=PA70&lpg=PA70&dq=adolescence+as+a+modern+concept&source=bl&ots

=guHYckWDSQ&sig=DOEo6Zhnp_B4S1cnYo3A8x5htgc&hl=en&ei=9KJ7TdaWJuWa0Q 23 Acceptance and Commitment Therapy for In-School Suspension GW5oziAw&sa=X&oi=book_result&ct=result&resnum=4&ved=0CCwQ6AEwAw#v=one

page&q=adolescence%20as%20a%20modern%20concept&f=false

Association for Contextual Behavioral Science website used for ACT information (Retrieved,

March, 2011) from http://contextualpsychology.org/

Centers for Disease Control and Prevention (1992). Health Risk Behaviors Among Adolescents Who

Do and Do Not Attend School -- United States, 1992. Morbidity and Mortality Weekly

Report Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/00025174.htm,

March 12, 2011

Centers for Disease Control and Prevention, (2001). School health guidelines to prevent

unintentional injuries and violence (December 7, 2001 / 50(RR22);1-46). Atlanta, GA:

Morbidity and Mortality Weekly Report . Retrieved from

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5022a1.htm

Dupper, D.R., Theriot, M.T., & Craun, S.W. (2009). Reducing out-of-school suspensions: practice

guidelines for school social workers. Children & Schools, 31(1), 6-14.

Elkstrom, R.B., Goertz, M.E., Pollack, J.M., & Rock, D.A. (1986). Who drops out of high school

and why?: findings from a national study. Teacher's College Record, 87(3), 356-373.

Greco, L. A., & Eifert, G. H. (2004). Treating Parent-Adolescent Conflict: Is Acceptance the

Missing Link for an Integrative Family Therapy?. Cognitive and Behavioral Practice, 11(3),

305-314. doi:10.1016/S1077-7229(04)80045-2

Hayes, S.C., & Greco, L.A. (2008). Acceptance and mindfulness for youth; it's time. In L.A. Greco,

and Hayes, S.C.,(Eds.), Acceptance & Mindfulness treatments for children & adolescents

(pp. 3-13). Oakland, CA: New Harbinger Publications, Inc. 24 Acceptance and Commitment Therapy for In-School Suspension Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and

commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy,

44(1), 1-25. doi:10.1016/j.brat.2005.06.006

Kernic, M.A., Holt, V.L., Wolf, M.E., McKnight, B., & Huebner, C.E., & Rivara, F.P. (2002).

Academic and school health issues among children exposed to maternal intimate partner

abuse. Arch Pediatric and Adolescent Medicine, 156, 549-555.

Moore, D., Wilson, K.G., Wilson, D.M., Murrell, A.R., Roberts, M., Merwin, R, et al.(2003, May).

Treating at-risk youth with an in-school acceptance and commitment training program.

Paper presented at the meeting of the Association for Behavior Analysis, San Francisco, CA.

O'Brien, K.M., Larson, C.M., & Murrell, A.R. (2008). Third-wave behavior therapies for children

and adolescents: progress, challenges, and future directions. In L.A. Greco, and Hayes, S.C.,

(Eds.), Acceptance & Mindfulness treatments for children & adolescents (pp. 15-35).

Oakland, CA: New Harbinger Publications, Inc.

Polk, K. P. (2011). Psychological Flexibility Training (PFT): Flexing Your Mind along with Your

Muscles [Kindle Version]. Retrieved from www.amazon.com/dp/B004M8S4Z4

Sundius, J., & Farneth, M. (2008, Septermber). Putting kids out of school: what's causing high

suspension rates and why they are detrimental to students, schools, and communities.

Retrieved from

http://www.soros.org/initiatives/baltimore/articles_publications/articles/suspension_200801

23/whitepaper2_20080919 25 Acceptance and Commitment Therapy for In-School Suspension

Appendix 1

ACT Evaluation Gender(optional) Male___Female___

1. I found this presentation helpful:

Strongly agree Sort of agree No opinion Sort of disagree Strongly disagree

2. I thought the presenter was clear in what she was trying teach.

Strongly agree Sort of agree No opinion Sort of disagree Strongly disagree 26 Acceptance and Commitment Therapy for In-School Suspension 3. The presenter seemed like someone I could trust.

4. The group helped me to think about ways I could do things differently in my life.

5. I’m thinking about some changes I could make in my life because of this group.

6. I expect to make changes in my life as a result of this group.

7. What did you enjoy the most about the presentation?

8. What did you enjoy the least?

Thank you for your participation. If you think you would like to schedule an appointment to talk to someone about concerns you have in your life, please put your name on this evaluation. 27 Acceptance and Commitment Therapy for In-School Suspension Appendix 2 28 Acceptance and Commitment Therapy for In-School Suspension

Appendix 3 29 Acceptance and Commitment Therapy for In-School Suspension

Appendix 4