Bounce Back Program Manual Copyright 2015 the Regents of The

Home , Lean Back, The One with the Cat, Try This

Bounce Back Program Manual

Bounce Back Program Manual 1

Session 1: Treatment Expectations, Introductions, and Psychoeducation

Materials Needed:

 Written group schedule  Whiteboard or poster board and markers for agenda and group rules  Confidentiality forms  M&M’s  Know the number of students in the school, and calculate the number that is 25% or 10% of that for the discussion in this session  Goals Worksheet  Parent handout Session 1

Schedule/Outline/Agenda:

1) Provide Students with information about what they may expect from the program

2) Create and review Group Rules, Confidentiality, & Behavioral Reward Program

3) Lead the students in the M&M Icebreaker Game

4) Provide initial psycho education: Prevalence of trauma exposure and normal anxiety response

5) Review Goals Worksheet and teach children how to fill them out at home

6) Introduce students to the reinforcement program

Bounce Back Program Manual 2

1) What to Expect from the Program/Group

Welcome the students to the group. Pass out written schedules of each group session for the students to take home. Let them know that their teachers have this schedule and they will help remind students when to go to the location the group will be held. Review the schedule, ensuring the children understand exactly how many sessions there will be and how many weeks you will be working together. Be sure to point out any relevant breaks or irregularities in the schedule. Emphasize the importance of being on time and trying not to be absent on group days so that they do not miss anything in the group. Explain that there will be a folder that they should bring to each meeting.

“Welcome to Bounce Back! As you all know, this is a group for students who have been through stressful things in their lives. In this group we’re going to work as a team to learn some things that will help you all deal with stress, feel better, and Bounce Back. Each time we meet we’re going to learn new things, so it’s important that you come to all the groups. [Go over group schedule].

“Don’t worry, we’ll remind you when you have a group and will come and get you from class. If you miss a group, I’ll try to find a time that we can talk so I can tell you what happened in the group so you’ll be ready for the next one.

“I’m going to give you a folder to use for the group as well. Try to bring the folder with you every time. It’s a good idea to keep it in your backpack so you’ll have it with you when we meet. You can decorate it however you’d like.”

Display the Session I Schedule and express clearly that students will always know what is going to be covered in each session to reduce anxiety about any unknowns or the element of surprise. As you review the agenda, let the students know that most sessions will follow a pattern of: Review of previous session, Demonstration of a new skill or tool, In-session practice, Take home practice assignment.

“Each time we meet, we’ll do the same basic things. First we’ll go over what we’ve already learned and anything you did for practice, then I’ll teach something new and we’ll spend some time practicing that. At the end, I’ll tell you some things you can do to practice more before the next time we meet.”

Review the idea that the group will involve the leader and every student working together to maximize program success. The following is a sample dialogue:

“In this group we will work together as a team in two ways.

“I know how to help kids who have been through stressful or scary things feel better, [so I am an expert in that way]. Each of you know yourselves the very best of anyone,[ so you are the

Bounce Back Program Manual 3

experts on YOU]. So you and I have to put what we know [our expertise] together to make the program work the best for you.

“Since we will be together as a group, the second way that we have to work together is to be a team with each other as we all learn new ways to feel, think, and act better.”

2) Group Rules, Confidentiality, and Behavioral Reward Program

Group Rules

Using a whiteboard or poster board that can be hung on a wall, work with the group to identify respectful rules that will be important for everyone to get the most out of being in the program. With younger children, you may want to prepare pictures in advance that represent the rules most likely to be used. The pictures can be placed next to the words for each rule. For example if one rule is “keep our hands to ourselves” you could cut out pictures of a child with hands on their lap from a magazine. Assist students in filling in the blanks as needed to ensure that all important group rules for the developmental level have been identified and agreed to as a group.

If the students don’t offer rules, you can suggest some and see if they like them. Some rules to consider might be:  One person talks at a time  We support each other by listening to each other  Keep our hands and feet to ourselves  Give everyone a chance to talk

Confidentiality

Review the concept of confidentiality and describe that things that are talked about in the group should be kept private so that everyone can feel comfortable sharing. Give a couple of examples of what this might mean.

“One thing that will be important in this group is to make sure that everyone feels like it is safe to share things and talk about themselves. So let’s talk about privacy for a few minutes.

“Let’s say that there is a boy named Joaquin in the group. If Joaquin were to tell everyone in the group that he and his brother argue a lot, we would want to keep that private. That means we would not share it with our other friends at school or at soccer practice or wherever, because that is Joaquin’s private business. Just like if you told us something about yourself that you may not want everyone to know, that would be your “private business.” You would not want the kids in the group to tell people about it. ”

Ask group members why they might want to keep things private.

Bounce Back Program Manual 4

Clarify that a group member can talk about their own “private business” with whoever they trust to talk to, like a parent, other trusted adult, or a close friend. They just shouldn’t talk about other students’ private business.

Have students write their first names on a confidentiality agreement. Be sure to answer any questions students have and provide examples as necessary.

Behavioral Reward Program

Describe the behavioral reward program you will implement for the current group. There are many potential ways to create an age-appropriate reinforcement program. The key is to identify rewards that will be motivating to the group members and therefore reinforcing. One could provide tickets, coupons, or stickers that each child earns for behaviors such as paying attention, participating, returning take home practice, doing brave things (i.e., working on fear hierarchy), being a good friend, etc. and then students could turn tickets in for rewards with a menu of how many tickets can be exchanged for each reward. For example, 3 tickets may be exchanged for or a small toy, school, or art supply and 8 tickets or stickers could be exchanged for lunch with a favorite PE coach. Alternately, the group could try to earn a reward together. For example, if everyone follows group rules and 4 out of 6 people attend and participate in group and turn in take home practice, the group gets a “pizza slice” on their pizza board for that session and if the “pizza board” is filled with slices by the end of the group, everyone will get a pizza party.

3) Ice Breaker M&M Game1

The goal of this game is to build group rapport and model that this group will involve talking and sharing. Try to use questions that will be relevant and interesting to the children in the group (taking into account, age, gender, interests, and maturity level). Try to avoid questions that will lead to too much self-disclosure at this early stage in the group.

Pass around a bag of M&M’s or other multicolored treat (skittles, trail mix, etc) and instruct each child to take a small handful but not to eat them yet. Tell the group that you are going to ask them some fun questions about themselves and that everyone who has a certain color M&M in their hand can give one answer for each M&M of that color they have. After they answer, they can eat those M&Ms.

“We’re going to spend a few minutes getting to know each other. I’m going to hand out some M&M’s – take a small handful but don’t eat them yet.”

For example, “For every brown M&M, please share something that you like to do for fun after school or on the weekends.”

1 This game was modified from one originally used in Gillian, J., Jaycox, L.H., Reivick, K.J., Seligam, M.E.P., & Silver, T. (1991). Manual for Leaders of the Coping Skills Program for Children. Unpublished Manual. Copyright Foresigh Inc.

Bounce Back Program Manual 5

Model an appropriate answer to the question yourself and play along so they can also get to know you a bit. You can select from the list of potential follow up questions below, and/or create your own.

“What kind of job would you like to have when you grow up?” “ What is your favorite kind of music/song?” “What is your favorite subject in school?” “What are your favorite sports or games?” “Can you tell us something about your family?” “What are some things that you are good at?”

4) Psychoeducation: Prevalence and Normalization

Prevalence Discuss prevalence of trauma exposure and post traumatic stress symptoms to normalize the children’s experience and reduce stigma and anxiety. The following is a sample dialogue:

“Did you know that you aren’t the only kids that have gone through something stressful or scary or that have seen stressful or scary things happen to someone else? About one fourth (25%) to one half (50%) of young people have had this type of experience that we sometimes call “trauma” or “traumatic”— something that is very stressful or scary or that feels really bad. And about 10% of kids, or 10 in every 100, have a really hard time feeling better afterward.”

“How many kids go to your school? [Tell students the actual number] That means there are probably about [number of kids in school/4] kids in your

Bounce Back Program Manual 6

school who have been through some tough stuff and about [number of kids in school/ 10] who are having a really hard time because of it. You may not know very many of these other kids have been through these things because most kids have a hard time telling others about what they’ve been through. Maybe that’s hard for you too.”

Present Anxiety as a Normal, Adaptive Response

The following is a sample dialogue you may want to use:

“I want to talk for a minute about anxiety. Does anyone know what that is? Anxiety is feeling scared or nervous. Does anyone have a different word for being scared or nervous that you or your family use?”

Try to ascertain the most relevant language for the group of children in the group, integrating it into the following discussion and remembering it for later sessions.

“Well everyone feels anxious, nervous, or scared sometimes. It is part of being a human being. These are normal feelings that actually help us stay safe. If we never got scared or anxious then there would be nothing to stop us from crossing the street when cars were coming or jumping into the ocean if we couldn’t swim. In fact, fear and anxiety have helped humans survive for a long time. It is kind of like an alarm going off in our bodies to tell us that something is not safe.”

Create an analogy that demonstrates how having a “fight or flight” response in reaction to something dangerous can be protective.

“Let’s imagine we are way back in the time of cave people. If two of these cave people are out for a walk and they cross paths with a big, snarling, sabre tooth tiger, let’s say the first cave person has the alarm go off, and feels nervous or afraid. What might he or she do?” [Let the children respond—you are looking for something related to fighting or fleeing].

“That’s right; the cave person would either run away as fast as possible or would pull out a spear and try to defend him or herself from the saber tooth tiger. Now let’s say this second cave person did not have the alarm go off, and did not feel this anxiety, what do you think would happen then?” [Let children answer waiting for a response akin to the person being eaten].

“That’s right—the second cave person would be lunch for the tiger!”

Explain the idea that anxiety plays an important protective role, but anxiety in the wrong situation or too much anxiety can cause difficulties for us and it functions something like a false alarm. “So some anxiety in the “sabre tooth tiger” kind of dangerous situations can be very helpful. But what often happens when we have been through a very scary or stressful thing is that we start to feel scared or anxious or nervous almost all the time, even when we don’t really need to. It’s

Bounce Back Program Manual 7

like the alarm is going off too much, even when things are safe. So our bodies may start to act as if there is a sabre tooth tiger when it may actually be a housecat. Has that ever happened to any of you?”

“One thing this group will do is help us calm ourselves down so we don’t have to respond to false alarms.”

5) Review Goals Worksheet and plan for Independent Practice.

Hand out goals worksheet and describe the activities assignment of setting goals for what each person wants to get out of the group. Read through the steps of the worksheet with them, and have the students begin to work on it if there is time. Tell them to share their worksheets with their parents or other trusted adult and ask their parent or trusted adult to complete the bottom section. Ask them to bring the worksheets to the next group lesson. Also ask them to give your letter to a parent or trusted adult, asking them to sign it and bring it back next time.

“The things we learn in Bounce Back are new skills, and they take practice. Can anyone tell me of a time when they learned something new, and it took a while before they got to be good at it? Well this is the same thing, like learning to catch a ball, or jump rope, or ride a bike. At first, it’s very hard to do and you have to concentrate really hard, but then after a while, you can do it really easily. The more you practice the easier it gets. Every time we meet, I’m going to give you something to practice and something to show your parents or trusted adult. So this week, I would like you all to work on the Goals Worksheet….

Show worksheet: Explain how to do it: Goals Worksheet “…a worksheet that asks you to think about what you want to get out of the Bounce Back program. It says “Goals” at the top. I want you to sit down with your parents or trusted adult and work on this together. You can answer the questions, and your parent can help you fill out the form, and can add in their own comments at the bottom. Bring it back next week, and we’ll all talk about how it went at the beginning of the next group.”

If there is time, allow the children to get started on their portion of the worksheet, asking questions while they are still with you] “Can anyone think of a way to help remind us to bring back our practice sheets each week? [Elicit ideas and/or share your own, such as placing in their folder and in their back pack as soon as they are through, ask a parent or other family member

Bounce Back Program Manual 8

to remind them to put it in their backpack the night before the group, make a note to put on their bedroom mirror or bedside table, etc.] Finally, here is the letter that I would like you to give your parents or trusted adult this week. Please have them sign it and bring it back with your practice sheet. So what two things should you bring back next week? That’s right, your practice sheet filled out by you and your parent or trusted adult and your signed parent letter.”

6) Remind students of the reinforcement program and briefly Preview Session 2

“Don’t forget that for all your hard work this week, I will have stickers/coupons/tickets ready for you [or we will be adding a slice to our pizza chart] and I look forward to hearing back from everyone and their parents or other trusted adult about your goals for our group. Next week we will be talking about how this group can help, names for different feelings, and things that we can do to have fun and feel good.”

Parent phone call:

Call parents or trusted adult who is involved if possible to remind them of what to expect. Let them know letters will be sent home with their child each week and they are welcome to write a comment on the letters to be returned or to set up a phone call or in person meeting if they wish. Invite parents to parent sessions and individual child session(s).

Bounce Back Program Manual 9

Session 2: Rationale, Feelings and Positive Activities, and Normalizing Common Reactions Materials Needed:

 Whiteboard or poster board and markers (post agenda)  Common Reactions Handouts  Feelings Flashcards  Feelings Grab Bag  Feelings Poster  Feelings Thermometer  Practice Sheet Session 2  Parent handout for Session 2

Schedule/Outline/Agenda:

1) Review group rules and goals worksheet, reward practice completion

2) Introduce CBT triangle and treatment rationale

3) Teach ways to identify and name feelings

4) Provide students with education about common reactions to Stress or Trauma/picture book

5) Lead the students in identifying things that make them happy

6) Help students identify 2 things they can do that week that they enjoy and that make them feel good/happy and show them how they can log their activities on the practice sheet

7) Handout Parent sheet for Session 2, remind students of reinforcement program, and preview the content of Session 3

Bounce Back Program Manual 10

1) Review from Session 1 and Practice

Review group rules established in Session 1. It can be helpful to keep these posted during each session.

“Does everyone remember the group rules we came up with last week? Who can remind us of one thing we thought would be an important rule to keep our group safe? [Allow children to respond with one or two or more]. Excellent job! I brought the list of our group rules with me and I am going to put it up on the wall today and during each of our groups to help us all remember how important our group rules are. Following these rules will help everyone be able to feel comfortable and safe and focus on bouncing back.”

Review each group member’s “Goals” Worksheet by asking for volunteers to share their goals.

“Let’s start by reviewing the practice from last time. Was everyone able to do their practice this week?”

[If no]:

[If yes, but didn’t bring worksheet]:

“That’s ok, we can still talk about it. I have a blank one here that you can look at, and you can answer as we go along and tell us what your answers were.”

Reassure group members that goals are attainable and remind them about the ways in which you will help them with each goal. At the same time, point out which goals may be unrealistic, and help group members understand how they can begin work on some goals in group lesson and then continue to work on them on their own afterwards. The overall tone of this part of the lesson should convey a realistic, hopeful attitude. Examples follow:

Bounce Back Program Manual 11

Stated goal Suggested Response Do more of the things “Great. We’re going to be working on that in the group. I I used to do. (checks think that’s a goal for a lot of people. “ box next to this on worksheet) Writes in: Sleep “We’ll talk today about how lots of kids have some trouble better. sleeping. And this is something that should get better as the group goes on – we have a few different ways to help you with that.” Writes in: Do better “That’s a good goal. We can help with some parts of that, like in school. helping you concentrate better and helping you sleep better. But you’ll have to do your homework, too!” Writes in: Get along “Has that been more of a problem since the stressful stuff with my mom. happened [event]? If so, we can work on that. We can help you talk with your mom about the kinds of problems you’ve been having, and in the last few meetings we’ll be working on how to solve problems that you are having with others.”

If some group members did not complete the worksheet or their parents or trusted adult did not complete it, still review the activities with them in real-time. Ask them the answers to the questions on the worksheet even if they don’t have it filled out. This will keep them involved. Also spend a few minutes troubleshooting ways to increase homework compliance and parental involvement to the extent possible. If a student did not feel comfortable sharing the homework with their parents or trusted adult, normalize that for them (“Yes, parents and adults can be busy, and it can be hard to get this done,” or “Yes, sometimes these things feel too private to share with others”). This will help ensure that they are not embarrassed in front of the group.

2) Introduce CBT triangle and Treatment Rationale

Begin by introducing the concept for the session.

“Today we’re going to talk about how kids feel, think, and act in different situations.”

Draw 2 triangles on the board and write thoughts, feelings and behaviors, one at each corner for each triangle. “That’s right, our thoughts (draw thought bubble), our feelings (draw face or heart), and our actions (draw stick figure).”

OPTION 1: Two different situations [may be best suited for children ages 8-11] Ask the group to call out something that most kids their age like to do for fun. Then enlist their help in identifying what a child might be thinking, feeling, and doing during that activity that they enjoy.

Bounce Back Program Manual 12

“What is something that most kids you know like to do? [group responds—choose an answer that seems a fair consensus—for this example let’s say it is playing video games]. Okay, so let’s say that a student in your grade is playing her favorite video game. How might she be feeling? What might she be thinking? How is she acting?”

The triangle for this example may look something like this: Leaning forward, moving body with actions of game, smiling (actions)

happy, excited “I love this game!” (thoughts) (feelings)

With a new triangle, ask the group about something that would make most kids their age pretty sad or worried or upset. Again, enlist their help in identifying what a child might be thinking, feeling, and doing in a situation where they are having negative feelings that activity that they enjoy.

“What is something that would make most kids in your grade pretty sad or worried or upset? [group responds—choose an answer that seems a fair consensus—for this example let’s say it is not getting invited to someone’s birthday party]. Okay, so let’s say that a student in your grade just found out that he was not invited to a classmate’s birthday party. How might he be feeling? What might he be thinking? How is he likely acting?”

Bounce Back Program Manual 13

The triangle for this example may look something like this:

head down, arms crossed (actions)

sad, nobody likes me bad(feelings) (thoughts)

OPTION 2: Same situation, two different reactions [suitable for kids ages 5 and up]

“Let’s talk about two different kids who are just your age for a minute. Josie has invited Maria over for a playdate and they have just started playing Josie’s absolute favorite video game. Now, Josie plays this game nearly every weekend and is really, really good at it. She has been excited all day about playing this game during her playdate. Given what we know, how might Josie be feeling? What might she be thinking? How is she acting?” [Fill out triangle according to responses]. Now let’s talk about Maria. Maria has never even heard of this game and she doesn’t really enjoy playing video games much in general because her brothers always tell her she is really bad at it. What will Maria’s triangle look like? The triangles for this example may look something like this:

Bounce Back Program Manual 14

JOSIE: Feelings: happy, excited Thoughts: This is one of my best scores ever; I love this game; I can’t wait for Maria to see how good I am Actions: leaning forward, moving body with actions of game, smiling

leaning forward, moving body with actions of game, smiling (actions)

happy, excited “This is one of my best scores (feelings) ever; I love this game; I can’t wait for Maria to see how good I am” (thoughts)

Bounce Back Program Manual 15

MARIA: Feelings: bad; embarrassed Thoughts: I am terrible at video games; Now Josie will see how bad I am and not want to have me over for another playdate Actions: head down, arms crossed, making an excuse for not being able to play or needing to go home head down, arms crossed, making an excuse for not being able to play or needing to go home (actions)

bad; embarrassed “I am terrible at video games; (feelings) Now Josie will see how bad I am and not want to have me over for another playdate” (thoughts)

Make the point that it is the same situation, playing a video game, but two very different triangles.

“So in both of these situations, the kids are playing a video game, but the two triangles look very different. “

Also point out that each point of Josie’s triangle affects what the other points are and likewise for Maria. In other words, it would be very unlikely to see someone thinking “this is the best afternoon I have had in a long time” and be feeling sad or bad and acting withdrawn. Every point on the triangle affects the other. Likewise, if we can change one point on the triangle (emphasizing for the better), then the other points will change too.

“Did everyone notice how the points on Josie’s triangle go together with each other point. It’s like her thoughts and feelings and actions all make sense because each point affects the other. So she is really into the game and smiling and feeling excited because she is thinking about how

Bounce Back Program Manual 16

well she is doing. And, even though Maria’s triangle looks pretty different from Josie’s, all the points on her triangle go together too. Because all of these points affect each other, do you think Maria could be thinking about how bad she is at video games and that Josie isn’t going to like her and feeling something that doesn’t go with that—like happy and excited and getting into the game—No way. Each point of our triangle affects the other. So if we want to feel better, or act in a better way, what would we have to change?”

Explain that trauma affects the whole triangle.

“When we have been through something stressful or traumatic, it can change every point on the triangle. Let’s use an example of a car accident. If a student about your age was in a car accident with his or her mom, what might happen the next time mom says, “let’s drive across town to visit grandma”. Let’s fill out a triangle for this child. What might the child be thinking when mom says this? Feeling? What might he or she do or how would he or she act? “

The triangle for this example may look something like this:

pretend to be sick, do something bad to get in trouble so can’t go, hide in room, start to cry (actions)

scared, nervous, We will get in another car worried (feelings) accident (thoughts)

Rationale

“In this program, we are going to work on all three corners of the triangle. We are going to:

 Learn some exercises that will make you FEEL better, and less nervous or upset.  Learn some ways to THINK about things that will help you feel better.  Learn some ways to DO things so that you are able to do everything you want to be able to do and not feel upset when you do it.”

Bounce Back Program Manual 17

3) Identifying and Labeling Feelings

In this section, the children participate in activities that help identify various feelings and note when they may have felt that feeling.

“We’re going to start off today talking about the FEELINGS part of the triangle.”

It can be nice to start off by discussing what clues we use about others to figure out how they are feeling. For example, you could ask about a well known teacher or principal or a parent and elicit information about what they noticed about the person’s facial expression, their posture, body language etc that lead them to their conclusion:

“How do you know when your teacher is feeling happy, mad______?”

Read “My Many Colored Days” by Dr. Seuss to recognize that we can all feel a range of emotions.

Next, depending on time engage in one or all of the activities below:

Feelings Flashcards

The goal of this activity is to begin a discussion about feelings by trying to identify feelings in others. This will require pre-prepared pictures of people’s faces (be sure to include children) that are cut out of magazines and laminated.

The group members will take turns choosing a “face” and guessing what that person is feeling by observing the facial expression, posture, and any contextual cues. The leader can demonstrate and take turns as well.

Feelings Grab-bag

The goal of Feelings Grab-bag is to increase awareness of one's own and others’ emotions. It is similar to Charades, with the following steps:

1. The children take turns drawing a feeling out of the grab-bag (a hat or bag) 2. The actor acts out the feeling without words, and the others try to guess the feeling 3. Once the feeling is guessed, the actor tells a time he or she has felt that feeling 4. The others can offer a time when they felt that feeling if they’d like

Level and complexity of the feelings in the hat or bag will vary with the developmental level of the child. For example, with 5-8 year olds, you want to include simpler terminology you will see in the left column of the workbook such as SAD, MAD, HAPPY, SCARED. With 9-12 year old

Bounce Back Program Manual 18

students you can also include a few more examples, such as embarrassed, disappointed, excited, etc as you see in the right column of the Feelings Grab Bag page of the workbook. The leader is involved in demonstrating a turn with the game and participating in the guessing in order to keep the game moving except when he or she may need to help a child read their card.

Our Feelings Poster

The goal of Our Feelings Poster is to engage the group in identifying what feelings they have (and what terminology they use for certain feelings) and in discussing examples of when they have recently felt each of those feelings. Children work together as a group to complete a poster that shows a wide range of feelings by drawing simple faces with words underneath depicting each feeling or by drawing faces in more detail or by just writing the words. The poster can be used in later sessions to assist with feelings identification. After any of the exercises above, apply the clues of what we notice about others to identifying their feelings. “Great. Now that we have some names to put with different ways we might feel, we can use these words to help us figure out how people around us may be feeling, how we are feeling, and when our feelings change. We will be talking about feelings in many of our meetings together and you can also practice naming your feeling at home. “

4) Common Reactions to Stress/ Picture Book

Introduce the picture book, “A Terrible Thing Happened” by Margaret Holmes. Read the picture book aloud to the children showing them pictures as you read.

“Did you know that all human beings react to going through something really stressful, difficult or scary. Just like Sherman Smith the raccoon, it is very normal for us all to have some pretty common feelings and problems when we have been through something like this. It is part of being human (and a raccoon in Sherman’s case) and normal. We are going to talk about some things that a lot of people start to feel after a stressful thing has happened and even though everyone doesn’t have all of these reactions, most people have at least a few and sometimes a lot of them. Sherman described some of the feelings and problems that came up for him after he saw something terrible. Can you remember some of those things?”

Pause to allow children to respond or review the following yourself as they came up in the book: 1) tried not to think about what he saw 2) did not feel as hungry 3) had stomachaches and headaches 4) felt sad 5) felt scared or nervous 6) had trouble sleeping 7) had bad dreams 8) felt angry all the time and got in trouble

Bounce Back Program Manual 19

As the child mentions each symptom, if the group seems comfortable, you may inquire about how many of them have had similar responses. Always further elucidate the symptom (similar to what is prepared on the common reactions to stress or trauma handout for parents) to:  Normalize the symptom—explain that this is a common reaction; and  Provide hope for how the group can help address it

It is essential to make the connection between these symptoms and what the children have experienced. For example:

“It really makes sense that some of you have been feeling _____ given that you experienced something that was so stressful/scary.”

Pass out the Session 2 Practice Sheet and review additional symptoms that Sherman did not mention in the book that are also quite common. Next, have the children check off anything from this discussion that they would like to share with their parent or trusted adult about which of these feelings or problems (symptoms) they have been personally struggling with.

“Okay group, can each of you look at your Session 2 Practice Sheet? [Point to the top of the worksheet where it says ‘My Common Reactions to share with my trusted adult(s)’] I am going to read through the list of common reaction to stressful things. Some of these things we just talked about because Sherman was having them, but there are other very common feelings and problems that kids can have after something stressful happens. As I read through the list, I would like you put a check next to the things that you have been feeling yourself so you can share this with your parents or trusted adult.”

Read through the list one by one helping the students follow along and prompting them to check or not check each one according to what their experience has been.

5) Things You Can do to Feel Happy/Good

Continuing with the Session 2 Practice Sheet, help children write down and share some things that they can concretely and routinely do that make them feel happy. Examples may be things like: listen to music, pet my dog, play outside in the back yard, talk to my grandma on the phone, ride my bike, talk to my older sister, play basketball, hug my mom, watch the stars.

“Let’s keep working on our Practice Sheet and think about what each of you can do this week to feel happy and good. For example, I feel happy when I listen to music and also playing basketball makes me feel better when I am upset about something or just tired [make these real examples for you]. Other examples may be things like playing outside, talking to someone who loves you or calling them, petting your dog or cat, riding your bike, hugging someone you love, or lying under a tree or watching the clouds or the stars. Let me help you make a list of things that make you feel good or happy.”

Bounce Back Program Manual 20

In order to get a full list of things they can do to improve their negative mood, it can be helpful to identify different ways to feel better for different negative emotions. For example, ask what they can do to feel better when they feel sad (e.g., they could seek a family member to talk to or get a hug from) or if they felt mad (e.g., do some exercise or go to a quiet spot to calm down), etc.

“Let’s be sure we aren’t forgetting anything on our lists. What if you were feeling sad, can you think of something you could do that would make you feel better? [pause for responses] For example, when I am sad or worried, it makes me feel better to talk to someone in my family or a friend. What about you? Can you add to your list? What about when you are mad? For example, when I am mad, doing some exercise or going someplace quiet can help me calm down and feel better. What about you? Can you think of anything to add to your list now?”

6) Homework: Do 2 Things that make you feel happy/good

Next, assist each child in identifying two of these things that they can do this week to make themselves feel good. Spend some time ensuring that they are realistic and “doable” in the coming week. Will they need permission, are they likely to get the permission they need, does it require the presence of someone else and is that person likely to be available, etc. It can be helpful to think through times they think it will be possible for them to fit in those 2 activities before the next session.

“Remember how we are going to practice new things each time we meet? Well today the practice is going to be….”

Show worksheet: Explain how to do it: Session 2 Practice Sheet to choose two of these things you’re your list of things that make you feel good and happy that you are pretty sure you can do this week. That means we need to be sure you can fit it into your schedule, maybe get permission from you parents to do it, have the people around that you may need to do it or get to it, things like that. So looking at your list can everyone choose 2 things they can do and maybe even think about what day would be best to do it? I can help you write the two things down on your practice sheet and then you or your parents or trusted adult can write down how things went when you do them and we can talk about it next week.”

Bounce Back Program Manual 21

7) Handout Parent sheet for Session 2, remind students of reinforcement program, and preview the content of session.

“Please give this letter to your parent or trusted adult this week and don’t forget to show them what you are working on with your activities that make you feel good. I can’t wait to hear about how things went with your practice when I see you next week. And I will have lots of stickers/coupons/tickets ready to reward you for your hard work. Next time we meet we will also be talking about body feelings or what happens in our bodies when we feel nervous, mad, sad or upset. Great job today. Well done!”

Bounce Back Program Manual 22

Session 3: Body Feelings (Physiological Arousal) and Relaxation Training

Materials Needed:

 Whiteboard or poster board and markers (post agenda)  Poster Board with Body Feelings  Practice Sheet Session 3  Parent handout for Session 3

Schedule/Outline/Agenda:

1) Review Session 2 Practice Sheet; Reward practice completion

2) Introduce Feeling Thermometer

3) Review CBT triangle; discuss body feelings—what happens when our bodies get revved up?

4) Relaxation Exercises a) Guide students through Diaphragmatic Breathing Exercises b) Lead students in guided imagery and progressive muscle relaxation techniques

5) Hand out Session 3 Practice Sheet and Muscle Relaxation Pictures Handout and have kids think of 2 times they can practice one of the relaxation techniques before the next session

6) Handout Parent sheet for Session 3, remind students of reinforcement program, and preview the content of session 4

Bounce Back Program Manual 23

1) Review Session 2 Practice Sheet; Reward practice completion

Review the Session 2 Practice Sheets with each child, providing reinforcement for those who were able to engage in two positive activities. Engage other students who may have completed the activities but not written them down and troubleshoot with those who had a hard time remembering to do the practice or finding time to do so.

“Let’s start by reviewing the practice from last time. Was everyone able to do their practice this week?

[If no]:

[If yes, but didn’t bring worksheet]:

“That’s ok, we can still talk about it. I have a blank one here that you can look at, and you can answer as we go along and tell us what your answers were.”

2) Introduce Feeling Thermometer

Present children with copies of Feeling Thermometer and have one displayed on the board. You can choose to focus on the numbered thermometer or the faces depending on the group’s developmental level and what you think they will best be able to understand. For example, 5-8 year olds may have an easier time with the faces, whereas 9-12 year olds may be okay with the numbers alone or the numbers and the faces. Present the idea that recognizing when your temperature is rising helps you know when to utilize strategies to avoid the boiling point and calm down.

“Does anyone know what a thermometer is? It is something that measures temperatures – how hot or cold something is. In this group we’re going to use thermometers to measure how strong your feelings are. A really strong feeling measures a lot, like in this example (show graphic), and when you feel something just a little bit then it looks like this on the thermometer (show graphic).

“It can help people to know when their feelings are really strong, so they can try to calm themselves down. So remember last week when we were talking about different kinds of feelings we have? Today we are talking about measuring how strong (or hot) those feelings are on our feelings thermometer. We’re going to be using this thermometer a lot in the rest of the groups, so let’s see how it works.”

Bounce Back Program Manual 24

Ask each child to identify times when s/he felt upset or nervous and to write what would trigger the different levels on the feeling thermometer.

Give a couple of scenarios and see where each would rate on the feeling thermometer or ask each what could make them a 3 then 6 then 9 on the FT. The leader should offer his or her examples first.

“Who can tell me about a time when they felt just a little bit nervous, like a 2 or a 4 on the feeling thermometer? I’ll start off. I felt a 2 just this morning, when I looked at the clock and realized that I was a little bit late on my way to school. [Ask for other examples. If they seem stronger or weaker than a 2, probe a little bit and either adjust the rating or adjust the situation so that everyone agrees that the emotion matches the rating.] How about an 8? I know I felt an 8 recently right before I had to go on stage at the parent meeting. I got really nervous because the Principal was there and I wanted to make a good impression. Who else can give an example of an 8?”

3) Review CBT triangle; discuss body feelings—what happens when our bodies get revved up?

Review CBT Triangle

Draw a CBT triangle on the board for students, reminding them of the relationships between thoughts, feelings, and behaviors and introducing the concept that feelings include both emotions and physiological sensations.

“Remember our triangles from our first meeting? Does anyone remember the 3 things we talked about for each point on the triangle? That’s right, our thoughts (draw thought bubble), our feelings (draw face or heart), and our actions (draw stick figure?). And remember how each of these things affect the other—so if I am thinking a certain way, it affects what I feel and what I end up doing or how I act, etc. I also wanted to let you know that there are really two different kinds of “feelings”. One is what we were talking about last week—our emotions—can anyone name a couple of different kinds of feelings from last week? Great!

“We also get different feelings in our bodies and these body feelings can be clues that we need to check what is going on in our triangle and maybe calm ourselves down. Like, when I have to go to the dentist and am worried I may need a filling, my heart beats faster and my hands feel sweaty. Those are two body feelings that I have that are a clue that I am feeling nervous and may be thinking something bad is going to happen and I am probably sitting with my legs shaking up and down and not being very friendly to those around me [pointing to triangle as you go through example].

“Let’s talk about what other body feelings happen when we are upset or worried or scared or nervous.”

Bounce Back Program Manual 25

Body Feeling Worksheet

Pass out the Body Feeling Worksheet to each child. Display poster of a body with various physiological symptoms of anxiety. On this worksheet with a simple drawing of a body, ask each child to draw or write on the body what they feel when nervous or upset. They can use what is on the sample poster or come up with their own.

Leader gives an example from him or herself by drawing on his or her worksheet (i.e., heart beating faster and sweaty hands).

“Here is a picture of a body. I’m going to draw on this one some things that I feel when I am nervous or upset. It’s different for everyone, but here are some of the things that my body does. First, I often notice my heart beating fast. I’m going to draw a heart here and little lines coming off of it to show its beating fast. Also, the palms of my hands can get really sweaty. So I’m going to draw some water drops there to show that. Sometimes I get a headache. So I’m going to draw little lightning bolts to show that up here near my head. Can each of you start drawing or writing words on your worksheet to show us what happens in your body when you are nervous or upset?”

After giving the group a few minutes to come up with things on their own, ask them to share what they came up with and encourage the youth to add items to their worksheets if ideas from other group members make sense for them too. Let the children know that you would like them to share this with their parents or trusted adult and demonstrate how they might do so, by discussing your worksheet, adding to your worksheet body feelings that the group may have missed or been too embarrassed to say, such as intestinal distress (stomach aches, butterflies, or diarrhea), frequent urination, etc., making every attempt to normalize and diminish giggling (although some is to be expected and should also be normalized and discussed in a matter of fact way).

4) Relaxation Exercises

Diaphragmatic Breathing Exercises

Pass out small stuffed animals or beanie babies and ask each child to lean back in their seats and place the stuffed animal on their bellies—not their chests. Instruct children on how to properly do “deep breathing” in order to calm their bodies down. It may be helpful to have children turn their chairs away from one another to decrease self-consciousness.

“Place your little animal on your belly and lean back in your seat comfortably [or have them lie on the ground if appropriate for room and setting]. We are going to practice taking nice deep breaths all the way into our bellies, slowly lifting our animals up on our bellies as we fill it with air and then watching them go down as we breathe out all our air, nice and slowly. Watch me first and notice my stuffed animal as I breathe. Deep belly breath in [animal rises] and slowly out

Bounce Back Program Manual 26

[animal goes down with belly]. Now let’s all follow my words together. Nice deep breath in – animals rise---and out---animals slowly down. Deep belly breath in—nice job—and out—bellies down. And breathe in—fill up your belly—and out animals back down. Great job, everyone!”

Helpful hint: to ensure that children are slowly exhaling as well as inhaling, it can be helpful to describe the exhale as how one would blow on their soup to cool it off. You have to breathe out slowly so all the soup doesn’t fly off the spoon. Also be sure that your instructions take up the amount of time you want the inhalation and exhalation to last—something like a slow “Breathe in-1-2-3 and breathe out 1-2-3” or “Belly breath in, animals rise and slow breath out, animals fall.”

Guided Imagery and Progressive Muscle Relaxation Techniques2

Ask students to sit comfortably in their chairs again, or lie down on the floor, and read through the script below. Just as in the prior exercise, you may want to have them face away from one another to minimize self-consciousness and giggling.

[Note: If you have limited time, you may only do the muscle tense-relax once for each body part below.]

“This exercise is a way to relax your body muscles. Just listen to my voice and follow my instructions. If something doesn’t feel comfortable, you don’t need to do it.”

Hands and Arms

Pretend you have a whole lemon in each of your hands. Now squeeze them hard. Try to squeeze all the juice out. Feel the tightness in your hands and arms as you squeeze. Now drop the lemons and your arms. Notice how your muscles feel when they are relaxed. Take another lemon in each hand and squeeze them. Try to squeeze this one harder than you did the first one. That’s right. Real hard. Now drop your lemons and relax. See how much better your hand and arm feel when they are relaxed. Good. Now relax and let the lemon fall from your hand.

Arms and Shoulders

2 A Relaxation Training Script modified from Koeppen, 1974; cited in Ollendick, T. H., & Cerny, J. A. (1981). Clinical behavior therapy with children. New York: Plenum Press.

Bounce Back Program Manual 27

Shoulders and Neck Now pretend you are a turtle. You’re sitting out on a warm rock by a nice, peaceful pond Oh- oh! You sense danger. Pull your head into your house. Try to pull your shoulders up to your ears and push your head down into your shoulders. Hold in tight. It isn’t easy to be a turtle in a shell. The danger is past now. You can come out into the warm sunshine and, once again, you can relax and feel the warm sunshine. Watch out now! More danger. Hurry, pull your head back into your house and hold it tight. You have to be closed in tight to protect yourself. Okay, you can relax now. Bring your head out and let your shoulders relax. Notice how much better it feels to be relaxed than to be all tight. Nothing to worry about. Nothing to be afraid of. You feel good.

Face and Nose

Here comes a pesky old fly. He has landed on your nose. Try to get him off without using your hands. That’s right, wrinkle up your nose. Make as many wrinkles in your nose and face as you can. Scrunch your nose and eyes up real hard. Good. You’ve chased him away. Now you can relax your nose and face. Oops, here he comes back again. Shoo him off. Wrinkle your face and nose up hard. Hold it just as tight as you can. Okay, he flew away. You can relax your face. So when you relax your nose, your whole face relaxes too, and that feels good. Let your face go smooth, no wrinkles anywhere. Your face feels nice and smooth and relaxed.

Stomach

Hey! Here comes a cute baby elephant. But he’s not watching where he’s going. He doesn’t see you lying there in the grass, and he’s about to step on your stomach. Make your stomach very hard. Tighten up your stomach muscles real tight. Hold it. It looks like he is going the other way. You can relax now. Let your stomach go soft. Let it be as relaxed as you can. That feels so much better. Oops, he’s coming this way again. Get ready. Tighten up your stomach. Real hard. If he steps on you when your stomach is hard, it won’t hurt. Make your stomach into a rock. Okay, he’s moving away again. You can relax now. Kind of settle down, get comfortable, and relax. Notice the difference between a tight stomach and a relaxed one. That’s how we want it to feel: nice and loose and relaxed.

Legs and Feet

Now pretend you are standing barefoot in a big, fat mud puddle. Squish your toes down deep into the mud. Try to get your feet down to the bottom of the mud puddle. You’ll probably need your legs to help you push. Push down, spread your toes apart, and feel the mud squish up between your toes. Now step out of the mud puddle. Relax your feet. Let your toes go loose and feel how nice that is. It feels good to be relaxed. Back into the mud puddle. Squish your toes down. Let your leg muscles help you push your feet down. Push your feet. Hard. Try to squeeze that mud puddle dry. Okay. Come back out now. Relax your feet, relax your legs, relax

Bounce Back Program Manual 28

your toes. It feels so good to be relaxed. No tenseness anywhere. You feel kind of warm and tingly.

“With one final breath, let’s all sit back up in our chairs and wiggle our arms and legs out a bit to wake them up, ready to finish group. How does everyone feel [wait for responses and provide appropriate feedback]? You all started to look pretty relaxed and I felt relaxed too. Does anyone want to share a part they liked best or something that felt harder for them do [wait for and briefly process responses]?”

5) Hand out Session 3 Practice Sheet and Muscle Relaxation Pictures Handout and have kids think of 2 times they can practice the belly breathing and progressive muscle relaxation before the next session.

“Remember how we are going to practice new things each time we meet? Well this week the practice is going to be….” Show worksheet: Explain how to do it: Practice Sheet Session 3 “…practicing the relaxation that we just did at least 2 times. I will be sending these home to your parents or trusted adult too so they can even read them to you like I did or you could do the relaxation together. I would like you to do the belly breathing and the muscle relaxation two times this week. Also, be sure to do some fun thing that make you happy this week again and write them down. Don’t forget to bring your practice sheet back next week, and we’ll all talk about it together at the beginning of the next group.” 6) Handout Parent sheet for Session 3, remind students of reinforcement program, and preview the content of session 4.

“Everyone looked so nice and relaxed today. I want you to remember that feeling and try to carry it around with you this week. Please give your parents or trusted adult the letter for this week, share your body feeling worksheet with them and ask them to read the muscle relaxation script for you so you can practice and even teach your parents or trusted adult the belly breathing so they can do it with you. I can’t wait to hand out some more coupons/ticket/stickers [add another pizza slice] when everyone brings back their practice sheets next week. When I see you next, we will be talking about what goes on in our thought bubbles and even how to start to have more helpful and brave thoughts”

Bounce Back Program Manual 29

Session 4: Using Helpful Thoughts

Materials Needed:

 Cave people cartoon picture  Cartoon pictures 1-6  Blank Courage Cards  Practice Sheet for Session 4  Parent handout for Session 4

Schedule/Outline/Agenda:

1) Review Session 3 Practice Sheet; Reward practice completion

2) Guide the group in how to identify thoughts in other people using cartoon pictures

3) Use comic vignettes to provide the link between thoughts, feelings, and actions

4) Lead the students in identifying the super powers of helpful thoughts and creating courage cards

5) Hand out Session 4 Practice Sheet and teach students how to fill out their thoughts and feelings log for the week. Ask them to fill in 2 times they can also practice their relaxation exercises during the week.

6) Handout Parent sheet for Session 4, remind students of reinforcement program, and preview the content of session 5

Bounce Back Program Manual 30

1) Review Session 3 Practice Sheet; Reward practice completion; do a deep breathing exercise

Review the Session 3 Practice Sheets with each child, providing reinforcement for those who were able to practice the relaxation exercises.

“Let’s start by reviewing the practice from last time. Was everyone able to do their practice this week?” [If no]:

Engage other students who may have completed the practice but not written them down and troubleshoot with those who had a hard time remembering to do the practice or finding time or a private place to do so.

[If yes, but didn’t bring worksheet;]

“That’s ok, we can still talk about it. I have a blank one here that you can look at, and you can answer as we go along and tell us what your answers were.”

Engage the students in a brief deep breathing exercise as a way to review and to focus everyone for session 4 (for younger kids, you may use beanie babies for their belly breathing).

Diaphragmatic Breathing Exercise

“Just like last week, please place your little animal on your belly and lean back in your seat comfortably [or have them lie on the ground if appropriate for room and setting]. We are going to practice taking nice deep breaths all the way into our bellies, slowly lifting our animals up on our bellies as we fill it with air and then watching them go down as we breathe out all our air, nice and slowly. Watch me first and notice my stuffed animal as I breathe. Deep belly breath in [animal rises] and slowly out [animal goes down with belly]. Now let’s all follow my words together. Nice deep breath in –animals rise---and out---animals slowly down. Deep belly breath in—nice job—and out—bellies down. And breathe in—fill up your belly—and out animals back down. Great job, everyone!”

Helpful hint To ensure that children are slowly exhaling as well as inhaling, it can be helpful to describe the exhale as how one would blow on their soup to cool it off. You have to breathe out slowly so all

Bounce Back Program Manual 31

the soup doesn’t fly off the spoon. Also be sure that your instructions take up the amount of time you want the inhalation and exhalation to last—something like a slow “Breathe in-1-2-3 and breathe out 1-2-3” or “Belly breath in, animals rise and slow breath out, animals fall.”

2) Guide the group in what we mean by “thoughts” and how to identify them

The session on thoughts begins with an exercise in what we mean by “thoughts” and how to identify them. Present cartoon pictures one by one, highlighting the thought bubble and the idea that all of us have thoughts in our thought bubbles nearly all the time.

“Today we are going to talk about our thoughts and the Thoughts point of our triangle. [Show Cartoon Card #1] Does everyone see this thought bubble in the picture. Did you know that all of us have thoughts going on in our thought bubbles up here [point to head] all the time?

“Let’s look at a couple of cartoon pictures and see if we can guess what these people are thinking? [still displaying Cartoon #1] This boy loves to play baseball and almost always gets a hit and gets on base. He is just coming up to bat. What do you think is in his thought bubble? What would be in your thought bubble if you were going up to bat or that last time you did?

Bounce Back Program Manual 32

[display Cartoon #2]

“This girl’s teacher has just announced that it is time for recess, what do you think would be in her thought bubble? What is in your thought bubble when you hear your teacher say that? So we all tend to have something in our thought bubbles most of the time even if we don’t notice what we are thinking.”

3) Use cartoon vignette to provide the link between thoughts, feelings, and actions.

Show the group the cartoon of the Cave People

“In this picture, two cave people are looking at the same thing. If you take a look at their thought bubbles, which one of these cave people is having the most helpful thought or the one that is the most real? That’s right, the one with the cat in the picture. How do you think he is feeling? And what do you think he will do? What about our other cave person? How do you think his thought bubble is making him feel? And how might he be likely to act?”

Reiterate that there are different ways to think about a situation that affect what we feel and what we do.

“So there are lots of different things that can be in our thought bubble even in the same situation. But what is in that bubble will definitely make us feel and act certain ways and even do one thing over another.

Bounce Back Program Manual 33

“Let’s look at a different situation and see what happens when we change what is in the thought bubble. “

Cartoon Series #3:

Use Cartoon Series #3 to point out the way that two different thoughts lead to 2 different feelings and outcomes (actions). First, display Cartoon#3a and insert Thought Bubble #1 (“I am not very good at math. The whole class is going to laugh at me if I mess up.”).

Ask the group members to point to the feeling on the feeling chart that would match that thought-ask the group for agreement.

“If this boy is thinking ‘I am not very good at math. The whole class is going to laugh at me if I mess up,’ how do you think he is feeling? Let’s look at our feelings chart—what would we all agree he may be feeling here? I think you are right—because of what was in his thought bubble, he felt so______[insert feeling they choose—sad, mad, embarrassed, ashamed, etc] that look at what his action was, what he did… “

Display cartoon #3b

“He told the teacher he felt sick so he could go to the nurse’s office and not have to do the math problem in front of the class. Poor guy. I don’t think he or his teacher will end up feeling very

Bounce Back Program Manual 34

good about how that turned out, do you? Now let’s take the same boy and help him out by giving him a more helpful thought for his thought bubble and see what happens.”

Display Cartoon #3c and a more helpful thought bubble

“Here is our friend at the board again. This time he thinks ‘We practiced this yesterday. I will do my best. It will be okay.’ If this is what he is thinking, how would these thoughts make him feel? Let’s look at our feelings chart again [wait for/guide group agreement] So even though he may not exactly feel excited about it, he probably feels okay or neutral and maybe even a little bit brave for going for it and giving it his best. Now let’s see what he does with these more helpful and courageous thoughts, in other words what action these thoughts and feelings lead to …”

Display cartoon #3d.

“He did it. His helpful thoughts made him feel better and be able to try his best and he and his teacher look like they are both happy with how things turned out.”

Bounce Back Program Manual 35

4) Lead the students in identifying the power of helpful thoughts (helpful/brave/realistic thoughts) and creating personal courage cards.

“In this cartoon the 2nd thought bubble had what we call helpful thoughts. Helpful thoughts give us more power to do our best and to feel better. You can think of it as your Courage thoughts I am passing out courage cards to each of you. I would like you to write down 3 helpful thoughts that you can use to help yourself be brave and feel better. I am going to write down a couple of ideas that other kids have tried and found helpful that you are free to use if you’d like. Try to come up with at least one of your own, though, too. I’d like you to carry this courage card with you this week to remind you of your helpful, brave, powerful thoughts to help you be brave and try your best so you can feel better. I can help you write your ideas down too.”

Write the following statements on the board as examples: “I can do this, Nothing bad will happen to me, I can trust some people, I will try my best, Give it a chance, I am safe at school, others?”, etc.

“On the other side of your courage card, you’ll see a roaring lion—you can look at this image to help remind you to be brave and powerful and to have courage to use thoughts that help you do your best and feel better.”

Use Cartoons #4-6 as time allows to assist the group members in coming up with courage thoughts they can use for themselves in each of the common situations.

“So I would like you to start practicing using your courage thoughts for things that come up for you everyday. Let’s see if we can try it out before we leave today. [Display Cartoon #4]”

Bounce Back Program Manual 36

“What courage thoughts could you use the next time you are in this situation? [Elicit ideas from group—there are many options, but ensure all are encouraging, helpful thoughts and if not, engage the group in discussion about why it might not be so helpful; some examples may be “Some people like me”. “Oh they like my dress.” “I wonder who they are talking about?”] Did we just come up with any new courage thought ideas that you want to add to your cards? [Assist students in doing so if applicable]”

Display Cartoon #5

“What about when you get a spelling test back that maybe wasn’t as good as you were hoping it might be? What are some helpful or courage thoughts you could use there? elicit ideas from group—there are many options, but ensure all are encouraging, helpful thoughts and if not, engage the group in discussion about why it might not be so helpful] Did we just come up with any new courage thought ideas that you want to add to your cards? [assist students in doing so if applicable]”

Display Cartoon #6

Bounce Back Program Manual 37

“Can anyone think of a good courage thought you could use to help yourself feel better or more brave when the teacher calls on you in class? What are some helpful or courage thoughts you could use there? [elicit ideas from group—there are many options, but ensure all are encouraging, helpful thoughts and if not, engage the group in discussion about why it might not be so helpful] Did we just come up with any new courage thought ideas that you want to add to your cards? [Assist students in doing so if applicable] Great! I think we are ready to practice this week.”

“Remember how we are going to keep practicing new things in between our meeting? Well this week the practice is going to be….”

Show worksheet: Explain how to do it: Session 4 Practice Sheet “on top of carrying your courage cards this week and remembering to use your helpful courage thoughts, I’d like you to write down two things that happen over the week—they can be fun situations or hard situations. Please Look at your Practice Sheet [Double Bubble drawings] with me so you can see where I would like you to write down what the situation is and then your first thought on one side and a helpful thought on the other side. Maybe your helpful thought is something from your courage card or maybe it’s something else you come up with just for that situation. So looking at the Double Bubbles here, let’s say that the teacher tells you she or he needs to talk to you. Your first thought may be that you are in trouble, so you would write that in the bubble next to first thought or draw a picture. A more helpful thought may be that your teacher just needs to ask you a quick question or has something he or she needs you to take to the office for her/him or there may be a courage thought you could use like “nothing bad is going to happen”. So you would draw that in the other bubble that says helpful thought or write it there. Make sense?”

Bounce Back Program Manual 38

6) Handout Parent sheet for Session 4, remind students of reinforcement program, and preview the content of session 5.

“You have done another great job today. Right now in my thought bubble it says, “What a great group of hardworking students. Most of us really tried our best today.” Please give your parents or trusted adult the letter for this week, share your courage cards with them and if you need help with writing or reading, ask them to help you fill out your thought bubble journal and practice your relaxation script with you. I will have plenty of coupons/ticket/stickers [add another pizza slice] to reward everyone who brings back their practice sheets next week. When I see you next, we will be talking about how to overcome our nervous or scared feelings so we can do everything we want and need to do.”

Bounce Back Program Manual 39

Session 5: “I Can Do It Ladder” (In vivo Exposure Hierarchy)

Materials Needed:

 Ladder handout  Practice Sheet for Session 5  Parent Handout for Session 5

Schedule/Outline/Agenda:

1) Review Session 4 Practice Sheet; Reward practice completion; Lead progressive muscle relaxation exercise

2) Describe an analogy related to avoidance to the group

3) Handout Ladders and help students fill out top wrung of staircase and explain how the Feeling Thermometer can work with the ladder

4) Help students identify a feasible bottom rung step that can be completed before the next session, working individually with students as needed

5) Hand out Session 5 Practice Sheet and teach students how to write in their ladder practice journal and fill it out once completed. Handout Parent sheet for Session 5, remind students of reinforcement program, and preview the content of session 6.

Bounce Back Program Manual 40

1) Review Session 4 Practice Sheet; Reward practice completion; Lead progressive muscle relaxation exercise.

Review the Session 4 Practice Sheets with each child, providing reinforcement for those who were able to write in their thought bubble journal and/or practice the relaxation exercises.

“Let’s start by reviewing the practice from last time. Was everyone able to do practice using their courage thoughts and helpful thoughts this week? “

[If no]:

Engage other students who may have completed the practice but not written them down and troubleshoot with those who had a hard time remembering to do the practice or finding time, a private place, or adult help to do so.

[If yes, but didn’t bring worksheet;]

“That’s ok, we can still talk about it. I have a blank double bubble sheet here that you can look at, and you can answer as we go along and tell us what your answers were for your own situation or maybe something someone else brings up.”

Engage the students in the progressive muscle relaxation exercise as a way to review and to focus everyone for session 5.

Guided Imagery and Progressive Muscle Relaxation Techniques3

“This exercise is a way to relax your body muscles. Just listen to my voice and follow my instructions. If something doesn’t feel comfortable, you don’t need to do it.

3 A Relaxation Training Script modified from Koeppen, 1974; cited in Ollendick, T. H., & Cerny, J. A. (1981). Clinical behavior therapy with children. New York: Plenum Press.

Bounce Back Program Manual 41

Hands and Arms

Arms and Shoulders

Shoulders and Neck

Now pretend you are a turtle. You’re sitting out on a warm rock by a nice, peaceful pond Oh- oh! You sense danger. Pull your head into your house. Try to pull your shoulders up to your ears and push your head down into your shoulders. Hold in tight. It isn’t easy to be a turtle in a shell. The danger is past now. You can come out into the warm sunshine and, once again, you can relax and feel the warm sunshine. Watch out now! More danger. Hurry, pull your head back into your house and hold it tight. You have to be closed in tight to protect yourself. Okay, you can relax now. Bring your head out and let your shoulders relax. Notice how much better it feels to be relaxed than to be all tight. Nothing to worry about. Nothing to be afraid of. You feel good.

Face and Nose

Bounce Back Program Manual 42

Stomach

Legs and Feet

2) Work through an analogy related to avoidance with the group.

Normalize that avoiding things that make us feel nervous or scared or uncomfortable makes sense, especially when we have been through something really stressful or scary. But avoiding things that we used to be able to do or that we need to be able to do can cause some real problems for us too. The following are a couple of examples you may use:

“Have any of you ever had to do ‘show and tell’ or read something out loud in front of the class? Or maybe you performed in front of the school by singing a solo or being in a play or playing an instrument in front of an audience? Have you ever felt nervous about doing something like that and just wanted to not do it at all—maybe you said you were sick that day or cried or told your mom or teacher you just couldn’t do it?

“Even if this hasn’t happened to you, let’s pretend for a minute that you felt that way. If you were to skip it or avoid it, you may feel better right away, but actually over time you would feel worse because it gets harder and harder to do things we avoid. That feeling can be like a little snowball at the top of a hill because as we avoid doing something that makes us nervous, even if we feel better right that minute, over time that snowball starts rolling down the mountain and it picks up more snow as it goes and before you know it, it is a huge snowball you can’t even see

Bounce Back Program Manual 43

over, so what was feeling a bit nervous becomes feeling very, very nervous—so much so that it seems huge like the giant snowball at the bottom of the mountain. So avoiding things makes our nervousness worse and we also miss out on things, like getting a good grade for participation in class or being at the school recital with our friends.”

Introduce the idea of gradual exposure in order to be able to overcome worry feelings and get back to doing what you need to do.

“Luckily, we know the best way to get over this kind of nervousness. It’s by doing the thing we are nervous about over and over until it feels much easier. This is how you learn to do something or do something again. This is how you learned to swim and learned to ride a bike— at first it felt a bit frightening or was really hard to do, but with lots of practice doing it over and over again now you are good at it, you have mastered it, and it’s not so hard or so scary anymore.”

“Today we are going to start working on our “I can do it” Ladders. We are going to start working on things that you would like to be able to do or that you used to be able to do, but that make you nervous or upset or feel hard to do now. We are going to only take really small steps that just bother you a little bit and gradually move up to harder steps over time as we feel more comfortable . It’s kind of like when you want to go into the pool, but the water is a little chilly. First you just dip your toes in until they get used to the temperature of the water. Then you go in up to your knees, and it feels a bit cold again, but you can manage it and after that is comfortable you go in up to your waist and wait until you get used to that and then eventually your whole body is in the water and you are having a great time at the pool. We will work on small steps toward doing what each of you want to be able to do without it being so hard or upsetting. We will work together to be sure that each little step is one you are ready to try. In other words, if you don’t want to jump in the water up to your neck all at once, that is okay. We will just dip our toes in first until that gets more comfortable, and then move up to our knees, etc. So it is a lot easier to go in up to your neck when you are already comfortable up to your waist.”

Use an “I Can Do It” Ladder to demonstrate how it may work for the book report or the school performance

“Let’s take a look at this ladder and think about a student your age who may be very nervous about sharing in front of the class [write: sharing in front of the class on top rung and Feeling Thermometer Rating=8-10 or a sad face or hand far apart depending on age].

“Now what would be some small steps down here on the bottom rungs that wouldn’t feel like jumping all the way in the water, but would be like just going in up to your toes for giving a book report [wait for responses and interject quickly if none arise.] Great ideas.

Bounce Back Program Manual 44

“So let’s write down ‘practice sharing out loud in your room by yourself’ on this lowest rung. Then once that feels pretty easy and you know what you want to say pretty well, you may be able to move up to the next rung, which could be something like sharing in front of the mirror or to your pet. Let’s see what the rest of the ladder may look like. Tell me what you think [fill in the ladder with something similar to the following from lowest to highest: share out loud to self in room, share to self in the mirror, share with mom or dad, share with babysitter, parents, and brother, share in front of empty classroom (ask teacher to borrow the room for a few minutes), share in a small group at school, share to class.”

Decide how much to ask them to generate versus simply writing this down and going through it with them based on developmental and cognitive level and how generative the group may be.

“So do you see that by the time this student feels comfortable with sharing in front of an empty classroom or in a small group of classmates, doing it in front of the class probably won’t seem as difficult or scary any more? That student has lots of “I can do it” experience and confidence now.”

3) Handout Ladders and help students fill out top rung of ladder and explain how the Feeling Thermometer can work with the ladder.

Assist students in identifying something that they may be avoiding, worried about doing, or that is very hard or anxiety provoking for them to do. Draw on information provided by the parents during their intake assessment. If you have already discussed something to use for the hierarchy with the parents, go ahead and list it on the top rung of the ladder for the child (they may have already selected something the child could benefit from working on). If not, it can be useful to have in mind any functional impairment mentioned by the student or parent/ trusted adult as a concern (i.e, sleeping in their own bed, being alone or away from caregiver(s), going on playdates, playing outside) and/or anything associated with the child’s traumatic experience that may have generalized into an anxiety-provoking trigger (i.e., certain places or people that remind them of the traumatic event, driving in a car or riding the bus, going to parks or a mall or a market, a friend, grandma, people of a certain gender, ethnicity, or build, dogs, water).

Be sure to emphasize that the “I can do it” Ladders are only for things that are safe to do, not for things that we should be afraid of (walking home in the dark in an unsafe neighborhood, guns or gang members, etc.) , nor for things that are designed to be scary like haunted houses, scary movies and roller coasters.

The following questions may be helpful in eliciting ideas from the students.  “Is there anything you used to be able to do but stopped doing after the stressful event you went through? Like have you stopped going places that remind you of what happened or doing things you were doing when the stressful thing happened?”  “Have you started having a hard time being alone or sleeping in your own bed, or being away from your parent(s), or being in the dark?”

Bounce Back Program Manual 45

 “Do you try not to talk about what happened? Is there someone you would like to be able to talk to about it?”  “Do you avoid any TV show or movies or video games or friends or family members who make you feel upset because they remind you of what happened?”

Let the students know that as they decorate their ladder sheet as they would like, you will be pulling each aside to help them come up with steps for their ladder. If a student comes up with more than one, try to ascertain which one is interfering for them the most, while also taking into consideration which is the most feasible given availability, access and duration of the group. For younger students, you will likely need to help with the writing or create a picture or cut out from a magazine that demonstrates what they are avoiding.

Once each student has something written down, use the Feeling Thermometer to help students fill in what they think their FT rating would be if they did that thing Right Now.

NOTE: If possible, make copies of the completed ladders so that the child can take one home and you can keep one to continue to reference in case they forget to bring it back to the next session[s].

4) Help students identify a feasible bottom rung step that can be completed before the next session, working individually with students as needed.

“Now that everyone has their top rung of the ladder, I am going to work with each of you to think about a really small step that each of you can practice this week that would be more like just dipping your toes in, like a 2 or 3 on your feeling thermometer to try this week. Like for our sharing in front of the class example, we thought that reading the report in the student’s room would be on this rung and a first thing for the student to try out and get comfortable with. What would something like that be for each of you? I’d like you all to think about it now while you are decorating your ladder page and then we can work on it together as I call you over. If you can think of things to put on the other rungs too, that’s great, but you don’t have to do that right now if you don’t want to or don’t have time.”

When you are working with each child individually, copy the item you come up with for their bottom rung onto their Session 5 Practice Sheet and ask them to think about when they can fit that practice in (days/times/with whom, etc.) before the next session, taking into consideration when adults may be available to help with transportation, logistics, or support and when they may be free from school and other extra curricular activities. If the practice involves anything that can be done on campus, is there a way to incorporate the practice into a group session or work with the student’s teacher or other school staff to increase the likelihood that the student has an opportunity to practice and feel successful?

Bounce Back Program Manual 46

Helpful Hints Box

Common avoidance responses (not specific to one type of stressful/traumatic event):

 Trouble being alone or sleeping alone  Not wanting to go to school (sometimes because of separation anxiety—or something bad happening to themselves of their loved ones while away from each other and sometimes due to something stressful that happened at school or on their way to or from school)  Avoiding cars, busses, or other transportation due to fear of an accident or other altercation

Questions to Help identify Successive Steps Begin probe with “What would your feeling thermometer rating be if…

 You did that during the day or at night (get ratings for both)?  Your parents/trusted adult were with you when you tried i? What if your friends were with you?  You just imagined doing that?  You read something about that? What if you watched a video about it on the internet?  You went to a similar place but not exactly the same place (i.e., park, market, street, library, room)  You were able to do that for just 5 minutes? 10 minutes? 20 minutes?

End with “Which step of your “I can Do It Ladder” would it go on right now, with the top step being in the 8-10 range and the bottom rung in the 1-3 range.

5) Handout Parent sheet for Session 5, remind students of reinforcement program, and preview the content of session 6.

“Well done everyone. Guess what is in my thought bubble right now? You were right [or close]. It says, “I am really proud of everyone here today. I can’t wait to see how their “I can do it” practice goes.” Please remember to use your relaxation and your courage cards for brave thoughts to help you during your “I can do it” practice this week AND be sure to have each practice time last long enough that you start to feel more comfortable and your feeling thermometer ratings come down. Don’t forget to give your parents or trusted adult the letter for this week, share your ladder with them, and let them know how you need them to help you with the practice and/or with writing down what you practiced. I will have plenty of coupons/ticket/stickers [add another pizza slice] to reward everyone who brings back their practice sheets next week. We are half way through our group meetings. Next time we meet, we will be reviewing and putting together all of the fun things we have learned so far. You can do it this week. Si se puede.”

Bounce Back Program Manual 47

SESSION 6: Review Coping Skills

Materials Needed:

 CBT Triangle  Treasure Hunt Clues (envelopes optional)  For Treasure Hunt Stations: Feelings chart, Body Feelings Poster, stuffed animals, courage card, cartoon thought bubble scenarios, I can Do It Ladder, “A Terrible Thing Happened” Book, a small prize for each child  Practice Sheet for Session 6  Parent handout for Session 6

Schedule/Outline/Agenda:

1) Review Session 5 Practice Sheet; Reward practice completion; Lead group in Body Scan Relaxation Exercise

2) Hand out Session 6 Practice Sheet and help students identify the next rung in their ladder for practice. Teach students how to write in their ladder practice journal and fill it out once completed

3) Review CBT Triangle

4) What have we learned about Feelings, Thoughts, and Actions?

5) Handout Parent sheet for Session 6, remind students of reinforcement program, and preview the content of session 7

Bounce Back Program Manual 48

1) Review Session 5 Practice Sheet; Reward practice completion; Lead group in Body Scan Relaxation Exercise.

Review the Session 5 Practice Sheets with each child,

“Let’s start by reviewing the practice from last time. Was everyone able to do their practice this week?”

Provide reinforcement for those who were able to complete their “I can do it” practice and write on their practice sheet. Determine if there are any exposure activities that can be done in the group or on campus during group to improve homework compliance and access to practice opportunities.

[If no]:

“I know things can get busy but the more you practice at home, the easier it will be to help yourself feel better. Let’s talk about how you can make sure to get some practice in at home during the next week. We can also look for ways for you to get more practice while you’re here in the group.”[You may be able to provide a way for a child to practice what was on their list during the session or give them an idea of how they could complete it during the school day].

[If yes, but didn’t bring worksheet;]

“That’s ok, we can still talk about it. I have a blank one here that you can look at, and you can answer as we go along and tell us what your answers were.”

Introduce the students to the Body Scan relaxation exercise as another way to relax their bodies and to focus everyone for session 6.

Body Scan

“Today I am going to teach you a quick new way to get your body calm that you can do anywhere. Let’s get seated comfortably in our chairs and imagine that there is a magic wand with a warm blue light [or any other color that is warm and safe to you] and it is raised just above your head. As the warm gentle wand passes over each part of your body, that part becomes completely relaxed. The wand starts to move over your forehead, leaving it warm and relaxed. Next the warm light travels over your nose and cheeks and jaw and your face feels soft and warm and completely relaxed. The wand continues down over your neck and shoulder, aah—you feel so calm and then over your chest and back, filling you with the warm light and

Bounce Back Program Manual 49

leaving all the muscles in your arms, back, chest and belly very very relaxed as you breathe slowly in and our of your calm belly. The magic wand continues to pass over your hips and your thighs relaxing all the muscles, down over your knees and your lower legs and finally your feet and as it warms and relaxes every single toe all your tension is gone and it exits your toes along with the calming beam of the wand. With one final deep breath, let’s all open our eyes, sit back up in our chairs and wiggle our arms and legs out a bit to wake them up, ready to be focused on our Bounce Back group.”

2) Hand out Session 6 Practice Sheet and help students identify the next rung in their ladder for practice.

“Today we are going to do things a little bit out of order so that we can get all the paperwork business done first before we do our fun review activity. You know all about the importance of practice, right? Well, this week we will practice by…”

Show worksheet: Explain how to do it: Session 6 Practice Sheet “…coming up with the next step or rung on our ‘I Can Do It Ladder’ that we are ready to practice this week. I will be coming around to help make sure everyone comes up with something they can try at least 3 times in the next week. If you look at your practice sheet, you will also see that I would like you to write down 2 good things that may happen during your practice or if you get better at doing what is on your ladder. Remind yourself of these good things as you practice this week as another way to make your thought bubbles more helpful. Remember that on the practice sheets there is space for you or your parents to write down what you did, what your feeling thermometer rating was, and any courage thoughts or other tools you used to help yourself, like the 2 good things that can happen. Please bring it back next week, and we’ll all talk about it together at the beginning of the next group.”

3) Review CBT Triangle

While displaying the CBT triangle, engage the group in a discussion of the 3 points on the triangle letting them know that today will be a time for reviewing what they have learned about

Bounce Back Program Manual 50

how to FEEL better, use helpful THOUGHTS, and DO what they need to do again. Today’s review is a way to check in to see how each student is using their skills and doing so far.

4) What have we learned about Feelings, Thoughts, and Actions?

Option 1: Treasure Hunt Review Activity [may be most suitable for kids ages 5-7]

Prepare the group space as a treasure hunt. Students can all work together in one group or can be split into two teams if there are co-leaders, but younger students will likely need one adult leader with each group. Students will start off at the door of the room where their Clue #1 awaits them. Clues can be placed in envelopes or simply turned upside down at the various stations. Stations should not be positioned in order, that way, students have to move around the room between each station. The room will need to be set up to allow for the following clue stations:

1) The Front Door of the Room: Clue #1 “To get this treasure hunt started, find the thing on the wall that gives us words and pictures for how we feel. Once you get there, you must complete a task in order to receive your next clue.” 2) Feelings Chart on the Wall: Clue #2 “Each person must point to how they feel right now. Once completed successfully, look for your next clue by a ‘body.’” 3) Body Feelings Poster: Clue #3 “Each of you share 1 thing that happens in your body when you are feeling nervous, worried, or upset and point to it on the body poster. Once you are finished, look for your next clue in the spot we usually sit for group.” 4) Table or Rug: Clue #4 “Work together to take one belly breath and do the “turtle” relaxation exercise. Once completed, go to the picture of the brave lion.” 5) Image of Courage Card on Wall, Desk or Cabinet: Clue #5 “Work together to come up with at least 1 courage or helpful thought for the kids in the cartoon situations next to the courage card. When you finish, go to the thing that helps you take small steps to get back to doing something that was hard for you.” 6) I Can Do it Ladder: Clue #6 “Each person should share how they are doing with their I Can Do It Ladder and any ways that it is getting easier to do things. You can also share about why it is important to practice these things and not avoid them. Once completed, your next clue can be found near a book about a raccoon named Sherman.” 7) Something Terrible Happened Book: Clue #7 “Remember that Sherman had something stressful happen to him. Work as a group to say why it may be helpful for Sherman to talk and write or draw about his story of what happened to him with his counselor. Once you successfully complete this, you are headed for Bounce Back treasure in the ______”[insert final clue of where you have hidden the small treasure chest prizes OUT OF SIGHT in your room]. 8) Location of treasure hunt prizes you have hidden out of sight in the room.

If students are split into 2 groups, have the second group start at the table or on the rug with Clue #4. They will move from Clues #4-6 and then include Alternate Clue #7 that will lead them

Bounce Back Program Manual 51

back to the door for Alternate Clue #1, Clue #2, and then, Alternate Clue #3 that will end with directions to Clue #8 - the treasure prize spot. You could also have the treasure prizes hidden in two different spots so that it is a surprise to each group if their timing is different.

Option 2: Group Discussion [suitable for ages 8 and over] Feelings Ask students to help lead a review of the following program components: Feelings chart, Body Feelings, and different Relaxation techniques (belly breathing, progressive muscle relaxation, body scan). Encourage discussion and sharing from all members about what they have been using and/or what has been working best for them. Choose two students who would like to lead the group in one relaxation technique at the end of the session.

Referring to the CBT triangle, go through an example pulled from information shared in the discussion of how group members may have used the relaxation tools thus far in order to change the way they feel. Highlight how that change in feelings can now impact thoughts and actions, pointing to the appropriate portions of the triangle as you go.

“I heard some of you saying that when you were feeling upset or nervous you could use your belly breathing or muscle relaxation to calm your body down and feel calmer or more happy. So if you are feeling calm and happy, what might your thoughts look like? What do you do or how do you act when you are calm and happy? Wow—so being able to improve our feelings can really help us all around our triangle.”

Thoughts Ask students to help lead a review of the following program components: Identifying Thoughts (may revisit cartoons), using helpful thoughts and courage cards. Encourage discussion and sharing from all members about what they have been using and/or what has been working best for them.

Referring to the CBT triangle and a Double Bubble cartoon, go through an example pulled from information shared in the discussion of how group members may have used their helpful thoughts and courage cards in order to change their thought bubbles. Highlight how that change in their thoughts can impact feelings and actions, pointing to the appropriate portion of the triangle as you go.

“I heard some of you saying that when you are thinking something bad might happen, you are able to use your courage cards or brave, powerful thoughts to make your thought bubble more helpful [use Double Bubble cartoon to illustrate first or bad thought and then helpful thought]. If you are thinking something brave and helpful, what are some feelings that go along with that? How would the helpful thought bubble affect what you do or how you act? Okay, so being able to make our thoughts brave and helpful can also really help us all the way around our triangle.”

Bounce Back Program Manual 52

Actions Ask students to help lead a review of the following program components: “I Can Do It” Ladder, “My Story” from individual Sessions. Encourage discussion and sharing from all members about what coping strategies they have been using, and what has been most helpful as they work on their ladder steps and on their narratives in the individual sessions. [Note: Try to ensure that content related to individual session has a general focus on the rationale for the narrative and any coping strategies that are helpful to them as they go through the process, while not speaking directly about individual session narrative content.]

Referring to the CBT triangle, go through an example pulled from information shared in the discussion of how group members may have used their I Can Do It practice and individual session “My Story” work in order to change what they are able to do (their actions). Highlight how the change in their actions (what they are now able to do with more confidence) can impact their thoughts and feelings, referring to the appropriate portion of the triangle as you go. “I heard some of you saying that now it is easier for you to do some of the things on your ladder and to talk about your stressful event. Now that your actions are different and these activities can be done with more confidence, how would that change your thought bubbles in those situations (something from your ladder or talking about your story)? And how would your feelings be different now when you are doing those things? Great, so being able to do things that used to be hard, including talking about our stressful events can help us feel better and have more helpful thoughts too. Again, it helps us all the way around our triangle.”

5) Handout Parent sheet for Session 6, remind students of reinforcement program, and preview the content of session 7.

“You guys have done it again. My thought bubble is full of things like, “I am so impressed with everything the group has remembered” and “I am feeling really proud of all of your hard work and progress.” Please remember to use your relaxation, your courage cards for brave thoughts, and thinking of 2 positive things that can come out of your practice to help you during your “I can do it” practice this week AND be sure to have each practice time last long enough that you start to feel more comfortable and your feeling thermometer ratings come down. Don’t forget to give your parents or trusted adult the letter for this week, share your ladder with them, and let them know how you need them to help you with the practice and/or with writing down what you practiced. As always, I will have coupons/ticket/stickers [add another pizza slice] ready to reward everyone who brings back their practice sheets next week. We will have 4 more meetings together as a group. Next time we meet, we will be talking about how to solve real life problems when they come up. I can’t wait to hear about how everyone is working their way up the ladder and changing their whole triangle for the better next week.”

Bounce Back Program Manual 53

Session 7: Social Support and Problem Solving

Materials Needed:

 The Invisible String picture book  For 5-8 year olds construction paper and pens/crayons  Who is on Your Team Handout  What to do when your Feeling Thermometer is Rising Handout (LARGE)  Practice Sheet for Session 7  Parent handout for Session 7

Schedule/Outline/Agenda:

1) Review Session 6 Practice Sheet; Reward practice completion; Have 1-2 students lead group in deep breathing and Body Scan relaxation exercises

2) a) Read picture book “The Invisible String” and complete the Who are you connected to activity b) Lead discussion about Social Support/Identifying trusted others/Who is on your team

3) Lead discussion of “What to do when your Feeling Thermometer is Rising?”

4) Hand out Session 7 Practice Sheet, help students identify the next rung in their ladder for practice and teach them how to fill in their problem solving practice

5) Handout Parent sheet for Session 7, remind students of reinforcement program, and preview the content of session 8

Bounce Back Program Manual 54

1) Review Session 6 Practice Sheet; Reward practice completion; Have 1-2 students lead group in deep breathing relaxation exercise and Body Scan

Review the Session 6 Practice Sheets with each child, providing reinforcement for those who were able to complete their “I can do it” practice and write on their practice sheet.

“Let’s start by reviewing the practice from last time. Was everyone able to do their practice this week?” [If no]: Determine if there are any exposure activities that can be done in the group or on campus during group to improve homework compliance and access to practice opportunities.

[If yes, but didn’t bring worksheet]:

“That’s ok, we can still talk about it. I have a blank one here that you can look at, and you can answer as we go along and tell us what your answers were.”

Choose 1-2 students to lead the group in deep breathing exercise and the Body Scan as a way to review and to focus everyone for session 7. Leading others in the exercises can help reinforce students’ memory and understanding of the relaxation exercises to enhance their own practice using it.

2a.) Option 1 (for younger children-ages 5-8): Read picture book “The Invisible String” and complete the “Who are You Connected to?” activity.

Read “The Invisible String” aloud to the group. Hand out a piece of construction paper, scissors, string, glue, and pens/crayons and ask each student to draw him or her self in the middle of a piece of construction paper. Next, ask them to draw people (or names of people) around them that they can trust and rely on and feel positively connected to, drawing lines in to connect the picture of themselves to the people they are connected to. Engage the group in a discussion to help identify which of these people can be there for them in different situations, when they have different feelings, and when they are in different settings.

Bounce Back Program Manual 55

“Now that you have drawn all the wonderful people you are connected to, let’s think a little about when those people can be there to help you and support you the most. Looking at your picture, who would you want to go to when you are feeling happy or to share your excitement about something with? This can be more than one person, of course. Who would you want to go to when you are feeling sad or nervous? Now let’s think about when these people are most available to be with you or support you. Who can you go to for help or support at school? The next time you need help or are feeling upset, can you remember to go to that person? Who would you want to tell if you were having a problem with a friend at school? How can you remember to go to that person the next time this comes up? What about at home? Who would you want to talk to if you were feeling upset or bored at home? Can you remember to go to this person the next time you are upset or bored? Who would be most helpful to you in the after school hours? Who can help you answer questions about your homework or something you don’t understand? Is there anyone that you need to add to your page of people you are connected to [take a few moments to do so as needed].I would like you to keep ahold of your “Who are you connected to?” page and post it somewhere to remind you of all of the people that are there for you and to go to them when you need something or when you need someone to help you feel better. ”

2b) Option 2 (for children 8-11): Lead discussion about Social Support/Identifying trusted others.

Pass out the “Who is On Your Team?” Handout and ask group members to think about and write down people on the team banners that they feel they can rely on and go to for support when needed in different situations, with different feelings, and in different settings (home, school, after-school activities, weekends). Engage the group in a discussion of who in their lives is available to them and encourage them to engage these people when they want to share both positive and difficult things they are experiencing. “If you take a look at the ‘Who is on Your Team?’ sheet in front of you, you will see five different banners. Let’s go around and each read one of the titles on top of a banner. Great. What I would like you to do, is write down the names of people that are there for you, that you can go to for help or if you are feeling upset, first while you are at home. Then I would like you to do the same, list names of people who can be there for you, at school, during your after school time, on the weekends, and then if there is another situation or place where you spend some time. I will be coming around to make sure that everyone is coming up with things and to help you as needed.”

Once most group members have a few names on each list, ask if anyone wants to share what they came up with and then encourage them to post the worksheet and reach out to these support people when they need to.

“Now that everyone has had a chance to think about all of the people that are available to support you, I would like you to post the “Who is On Your Team” Handout somewhere you

Bounce Back Program Manual 56

can see it to remind you of all the people who are there for you and to go to them when you need some help with something or someone to help you feel better.” 3) Review Actions corner of CBT Triangle and Lead discussion of “What to do when your Feeling Thermometer is Rising”.

Distribute the “What to do when your Feeling Thermometer is Rising” Handout, a list of potential coping strategies to the group. Go over the list as a group, having students say each out loud, and ensure that students understand the meaning of each action. Next, read through some of the following situations and have the group brainstorm other actions they may add to the list of What to Do When Your Feeling Thermometer is Rising. Then have them decide what possible actions from the complete list will likely work best to solve the problem with as few negative consequences as possible. Include one or two examples as time allows and that best fit according to your knowledge of the group. It is best if you can include examples that you know have come up for the students and/or you may use the following:

“Take a look at the ‘What to do when your Feeling Thermometer is Rising’ handout in front of you. You will notice that you have already been practicing some of the things on this list, like naming your feelings, relaxing your body, using courage thoughts, or going to a support person. I am going to read through the rest of the list here and if you would like to read one, just raise your hand. Now, you will notice some blank lines for the last few numbers on the list. That is where we can add some actions that we come up with for each situation. Now, I am going to read out some situations, and I want you to first tell me if you have other ideas to add to ‘What to do when your Feeling Thermometer is Rising’ list.”

YOUR FEELING THERMOMETER IS RISING BECAUSE:  Your classmate is trying to copy your homework or test.  Your friends just told you that a classmate said something bad about you during recess.  You just got your test back with a bad grade.  You are feeling sad or worried about something that happened at home last night.  Your teacher tells you that you will be reading or performing in front of the school at an assembly.  You can’t stop thinking about the stressful event you have been through.  You find out that you weren’t invited to your friend’s birthday party  Someone threatens to beat you up after school.  You have a headache or stomachache

“Next, I’d like you to choose from the list of actions what may be best to use to deal with each situation. Try to come up with some possibilities that would make the situation better, not worse, or at least leave the situation the same and not make it worse. So, for the first situation, ‘Your classmate is trying to copy off your test,’ what would be some good things to try to do? [Continue with other situations].“

Bounce Back Program Manual 57

4) Hand out Session 7 Practice Sheet, help students identify the next rung in heir ladder for practice and teach them how to fill in their problem solving practice.

“Remember how we have been practicing new things each time we meet? Well this week, we will be…”

Show worksheet: Explain how to do it: Session 7 Practice Sheet “…continuing to climb up the “I Can Do It Ladders” by choosing the next step you are ready to practice this week. I am going to come around to help make sure everyone comes up with something they can try at least 3 times in the next week. Please post your ‘Who is On Your Team’ or your ’Who Am I Connected To?’ Sheet someplace that will remind you to go to your support people when you need help or to feel better. If you look at your practice sheet, you will also see that I would like you to practice using your “What to do when your feeling thermometer is rising” list this week when any problems come up and write down or have your parent or trusted adult write down what you tried and how it went. When you bring it back next week, we’ll all talk about it together and see how everyone did.”

5) Handout Parent sheet for Session 7, remind students of reinforcement program, and preview the content of session 8.

“Thank you for working so hard together today. Please remember to use your relaxation, your courage cards for helpful thoughts, and the people on your team (or connected to you) during your “I can do it” practice this week AND be sure to have each practice time last long enough that you start to feel more comfortable and your feeling thermometer ratings come down. Don’t forget to give your parents or trusted adult the letter for this week, share your ladder with them, and let them know how you need them to help you with the practice and/or with writing down what you practiced with your ladder steps and your “What to do when my feeling thermometer is rising” practice. We will have 3 more meetings together as a group. Next time we meet, we will be doing more practice with how to solve real life problems when they come up. I can’t wait to hear about how everyone is working up their ladder rungs and changing their whole triangle for the better next week.”

Bounce Back Program Manual 58

SESSION 8: Practice with Problem Solving

Materials Needed:

 What To Do When Your Feeling Thermometer is Rising Worksheet (Large laminated)  Role Play cards  Empty child size milk carton  Practice Sheet for Session 8  Parent handout for Session 8

Schedule/Outline/Agenda:

1) Review Session 7 Practice Sheet; Reward practice completion; Have 1-2 students lead group in progressive muscle relaxation exercise.

2) Normalize real life problems and reintroduce role plays.

3) Role Play problem solving situations using the “What To Do When Your Feeling Thermometer is Rising” worksheets with prepared cards.

4) Hand out Session 8 Practice Sheet, help students identify the next rung in their ladder for practice and teach them how to fill in their problem solving practice.

5) Handout Parent sheet for Session 8, remind students of reinforcement program, and preview the content of session 9.

Bounce Back Program Manual 59

1) Review Session 7 Practice Sheet; Reward practice completion; Have 1-2 students lead group in progressive muscle relaxation exercise.

Review the Session 7 Practice Sheets with each child, providing reinforcement for those who were able to complete their “I can do it Ladder” and “What to do when my feeling thermometer is rising” practice and write on the practice sheet. Determine if there are any exposure activities that can be done in the group or on campus during group to improve homework compliance and access to practice opportunities.

“Let’s start by reviewing the practice from last time. Was everyone able to do both their ‘I can do it Ladder” practice and their “What to do when my feeling thermometer is rising practice this week?” [If no]:

“I know things can get busy but the more you practice at home, the easier it will be to help yourself feel better and bounce back. Let’s talk about how you can make sure to get some practice in at home during the next week. We can also look for ways for you to get more practice while you’re here in the group.”

[If yes, but didn’t bring worksheet;]

“That’s ok, we can still talk about it. I have a blank one here that you can look at, and you can answer as we go along and tell us what your answers were.”

Choose 1-2 students to lead the group in the progressive muscle relaxation exercise as a way to review and to focus everyone for session 8. Leading others in the exercises can help reinforce students’ memory and understanding of the relaxation exercises to enhance their own practice using it.

2) Normalize real life problems and reintroduce role plays.

Normalize for the group that everyone runs into some everyday real life-problems, and explain what they have control of and what they can’t control.

“Many times we have problems come up that are hard to handle. Sometimes it can be hard to figure out what to do. Sometimes you don’t have a lot of control over things that go on during the day, at school, or in your family, especially when you are young and not in charge of things, like when your parents or other people that take care of you make a decision that upsets you, or

Bounce Back Program Manual 60

something at school is causing a problem for you, or your friends are doing something that bothers you. Remember there are always two things that you can do that can help the problem:  You can control what you think about the situation [use helpful thoughts]  You can control what you do about the situation [make good action choices]

If we go back to our triangle, you all know now that changing what you think and do can also change how you feel about it. We’ve been practicing those things since the beginning of the group!!”

“Last week we started talking about a list of things that you can always use to help you when your feeling thermometer is rising which is sometimes because you are having a problem with someone or something. Who can remind me of something on that list? So those actions can also always be available to you when a problem comes up. If we look at that list, there are some blank lines at the bottom so we can also add a list of action choices that go just exactly with the problem you are facing—we call that being more specific. So today we are going to get lots of practice coming up with and choosing action choices. It is another thing you can do to make problems better once you are sure you are thinking and acting the best that you can.”

3) Role Play problem solving situations using the “What to Do When Your Feeling Thermometer is Rising” worksheets.

Redistribute copies of the “What to do when your Feeling Thermometer is Rising” handout and display a large in front of the group Workbook (Session 7).

“As we practice how to handle different problems today, we can look at our What To Do When Your Feeling Thermometer is Rising sheet and brainstorm other action choices to add to the list [Point to blank lines on the bottom of the worksheet]. Does anyone know what I mean by “brainstorm”? It is basically like a storm of ideas, all pouring out of our heads. Some ideas are good, some are bad, but it doesn’t matter, we’re just trying to let them all pour out. [Point to the list on the worksheet below the images]. So we would list possible actions we could take to make our problem better here.

“Then we will choose an action from the list and try it out. So we need to figure out which are the best actions for this problem and choose an action that we think will work well, one that won’t make the problem any worse, and could make it better.”

Lead the group through an example using the “What To Do When Your Feeling Thermometer is Rising” sheet and brainstorming other action choices to add to the list for each problem.

“Let’s give it a try together. Let’s say that someone just bumped into you pretty hard while you were standing in the lunch line and you almost dropped your milk.”

Bounce Back Program Manual 61

Guide Students through referring to the list and adding additional action choices: Referring to the list, generate additional options to add to it that may be specifically useful for this problem. Be sure to emphasize that no judgment is placed on brainstorming solutions or actions. Anything goes and you can judge later when you are deciding the best course of action.

“Here we have our list of “What To Do When Your Feeling Thermometer is Rising” (review the action choices aloud). Can anyone think of other options we could to help with this problem of someone bumping into you while you are in line in the cafeteria? Let’s get our brains storming with ideas and if you can call them out one at a time, I will add them here on our list.” [Allow the group to generate a handful of options, i.e., push them back, ignore them, ask them why they ran into you, tell an adult in the cafeteria, start crying, etc]

Guide Students through choosing an Action Choice: Before moving on to the role play, choose a couple of options from the list (one that seems like it isn’t the best solution and one that seems pretty good. For example, for the problem of someone bumping into you in the lunch line, you could choose to act out option 1: push the person back and option 3: Use Your Words to say what you are upset about or get more information “Stop. I don’t like that. Why’d you bump me?”). Select or have students volunteer to act out the first option and then discuss how things are going with that option—any consequences that would outweigh the benefits? Next, have them act out the better option and discuss the difference in thoughts and feelings that would go along with the two scenarios, as well as which would lead them the closest to the goal of getting rid of the problem with the fewest negative consequences and nobody getting hurt.

“That’s a nice list of action choices. So let’s see what these actions would look like in real life. I would like two of you to act out this situation and I will be your acting coach. I will also need a couple of you to stand in line as “extras”. So one of you will bump into the other and then the first choice we will try out is to push the person back. Just like in the movies, when we act things out we have a way of making it look like a real push even when it isn’t a very hard push at all. Let’s try it. [Have group act out the scenario including the action then have them freeze].

“How is this action choice going? Is it helping us get closer to making the problem better or to go away and not making it worse? [Give children a few minutes to share what they notice/think]. Now let’s take it from the top, but this time after he/she bumps you, you are going to go with a different action choice—you will say, ‘Stop. I don’t like that. Why did you bump into me? And the bumper will say, ‘sorry, I tripped on someone’s shoe.’ Here we go from the top then [following the role play of the second action choice, have the students freeze once again]. Now how do we think this action choice has been. How is it helping us get closer to making the problem better and not making it any worse?”

Based on what they have role-played, ask students which action would be best to choose (one of those two or another from the list) and try that will take care of the problem with the fewest negative consequences and without anybody getting hurt or making the problem worse.

Bounce Back Program Manual 62

“So given what we just role played, what do you think the best action for this situation is? It can be one of the two we role played or something else on the list? Can you tell us why you chose the one you did?”

Continue to role play other examples as time permits allowing different actors to participate and serve as “extras”. You may use the examples below, or generate a list of real-life problems from the group.

Other Examples:  Your classmate is trying to copy your homework or test  Your friends just told you that a classmate said something bad about you during recess.  You just got your test back with a bad grade.  You are feeling sad or worried about something that happened at home last night.  You are feeling sad or worried about something that happened at home last night.  Your teacher tells you that you will be reading or performing in front of the school at an assembly.  You can’t stop thinking about the stressful event you have been through.  You find out that you weren’t invited to your friend’s birthday party.  Someone threatens to beat you up after school.  You have a headache or a stomachache.

4) Hand out Session 8 Practice Sheet, help students identify the next rung in their ladder for practice and teach them how to fill in their problem solving practice.

“Okay, it’s time to talk about practice. This week, we will …”

Show worksheet: Explain how to do it: Session 8 Practice Sheet “…continue climbing up the “I Can Do It Ladders” by choosing the next step you are ready to practice this week. I am going to come around to help make sure everyone comes up with something they can try at least 3 times in the next week. If you look at the second page of your practice sheet, you will also see that I would like you to practice using your “What to Do When Your Feeling Thermometer is Rising” sheet when any problems come up this week and write down or have your parent or trusted adult write down the action choices you brainstormed and added, what you chose and tried and how it went. When you bring it back next week, we’ll all talk about it together and see how everyone did.”

Bounce Back Program Manual 63

5) Handout Parent sheet for Session 8, remind students of reinforcement program, and preview the content of session 9.

“Nice work today. Keep using your relaxation and your courage cards to help you during your “I can do it” practice and your What To Do When Your Feeling Thermometer is Rising this week AND be sure to have each “I Can Do It” practice last long enough that you start to feel more comfortable and your feeling thermometer ratings come down. Don’t forget to give your parents or trusted adult the letter for this week, share your ladder with them, and tell them what you learned about problem solving. Tell them how you need them to help you with the practice and/or with writing down what you practiced. I will have plenty of coupons/ticket/stickers [add another pizza slice] to reward everyone who brings back their practice sheets next week. We are nearing the end of our group meetings and will meet together 2 more times. Next time we meet, we will see how everyone’s practice has gone and have some fun putting together all of the tools we are learning to use to feel, think, and act in ways that make us feel better and able to do what we need to do. I really want you to try your best this week with all of your practice. I know you can do it!”

Bounce Back Program Manual 64

Session 9: Review, Check Hierarchy Progress, Relapse Prevention

Materials Needed:

 CBT Triangle  Review Game Questions  Practice Sheet for Session 9  Parent handout for Session 9

Schedule/Outline/Agenda:

1) Review Session 8 Practice Sheet; Reward practice completion; Lead group in Body Scan Relaxation Exercise.

2) Putting it all together; Relapse Prevention—Tools you can use.

3) Fun Review of Skills Game.

4) Hand out Session 9 Practice Sheet and help students identify the next rung in their ladder for practice. Review with students how to write in their ladder practice journal and fill it out once completed.

5) Plan out Consolidation Project.

6) Handout Parent sheet for Session 9, remind students of reinforcement program and final rewards during the next session, preview the content of the final session 10.

Bounce Back Program Manual 65

1) Review Session 8 Practice Sheet; Reward practice completion; Lead group in Body Scan Relaxation Exercise.

Review the Session 8 Practice Sheets with each child, providing reinforcement for those who were able to complete their “I can do it” and problem-solving practice and write on their practice sheet. Determine if there are any exposure activities that can be done in the group or on campus during group to improve homework compliance and access to practice opportunities.

“Let’s start by reviewing the practice from last time. Was everyone able to do their practice this week? [If no]:

[If yes, but didn’t bring worksheet;]

“That’s ok, we can still talk about it. I have a blank one here that you can look at, and you can answer as we go along and tell us what your answers were.”

Engage the students in the Body Scan relaxation exercise as a way to review and to focus everyone for session 9.

2) Putting it all together—Tools You Can Use.

While displaying the CBT triangle, engage the group in a discussion of the 3 points on the triangle. Ask students to help lead a review of the skills learned for each point on the triangle (i.e., identifying feelings, Relaxation techniques, doing things that make us happy and feel better, using brave thoughts and courage cards, focusing on positive things that can happen in situations, I Can Do It Ladder, “My Story” from individual Sessions, What To Do When Your Feeling Thermometer is Rising list) Encourage discussion and sharing from all members about what they have been using and/or what has been working best for them.

Bounce Back Program Manual 66

Referring to the CBT triangle, go through an example pulled from information shared in the discussion of how group members may have used their skills and highlight how that change has affected all parts of their triangle.

“So if we can put everything we have learned together, you now have several tools you can use to help you feel better and do what you need and want to do. I heard some of you saying that when you were feeling upset or nervous you could use your belly breathing or muscle relaxation to calm your body down and feel calmer or more happy. When you are thinking something bad might happen, you are able to use your courage cards or brave, helpful thoughts to make your thought bubble more helpful. It is easier for many of you to do some of the things on your ladder and to talk about your stressful event without getting so upset, so your actions are different and these activities can be done with more confidence. And when you feel a bit stuck, you can now look to your ‘What to do when your feeling thermometer is rising’ sheet to help you find the best action to get rid of a problem without anyone getting hurt or making the problem worse. Can anyone think of something coming up where they might be able to use some of these skills? Maybe something that will make you feel a bit nervous or where you might feel stuck about what to do or how to handle it or you may be at risk for getting into trouble or having a problem?”

Work through an example provided by the group or have one prepared (i.e., changing schools, spring state testing, a change in household configuration, etc.) and have the kids decide what skills they could use in that situation and then how their choice of skill would affect other parts of the triangle.

3) Fun Review of Skills Game.

Create the opportunity for a fun and structured review of the key program concepts. One option is to create a fun trivia game and divide the group into teams, offering points for correctly answered questions. Teams can choose a name for themselves and “buzz in” by tapping on the table or desk or by making an assigned animal noise, such as “moo” or ‘quack”. The team that answers first should be given a minute to confer as a group to come up with their agreed upon answer. See “Review Game” Handout for examples of potential questions and add more that are developmentally appropriate and group relevant.

4) Hand out Session 9 Practice Sheet and help students identify the next rung in their ladder for practice. Review with students how to write in their ladder practice journal and how to fill out their “Putting it all Together” log.

“It’s hard to believe, but this is the last week that you will have a practice sheet. This week, I hope you can… ”

Bounce Back Program Manual 67

Show worksheet: Explain how to do it: Session 9 Practice Sheet “…take another step closer to the top of your “I Can Do It Ladders” by choosing the next step you are ready to practice this week. I am going to come around to help make sure everyone comes up with something they can try at least 3 times in the next week. If you look at the second page of your practice sheet, you will see that you have lots of choices for filling in whatever parts of the “putting it all Together Log” you use this week. It would be great if everyone could fill out at least two parts. So you can fill in fun things that you did to feel happy over the next week, times you practiced relaxing, times you used your courage thoughts or went to a support person for help or to feel better, times you used an idea from your “What to do when your feeling thermometer is rising” list or tried out your 2 Step Problem Solving this week. You can also have your parent or trusted adult help you fill it in. I can’t wait to see how everyone is using what we’ve learned!”

5) Plan Out Consolidation Project.

Work together with the group to plan for a “Consolidation Project” of some type that enables them to review what they have learned, tools they can now use, how they have grown, etc. This can take the form of a skit, poem, song, commercial, drawing, etc. Try to ensure that each group member has a role. For example, the group could make up a song about all of the items in the “Tools You can Use List” or the group could draw a poster with one side labeled “Before Bounce Back” and words or drawings about how they felt at that point and the other side with “After Bounce Back” with words and images from the group tools or their feelings and thought bubbles now or a poster with an image of Bounce Back in the middle divided into sections so that students can rotate around and draw or write something in each section--“my favorite thing about BB”, “something from BB that I want to keep working to get better at” “what I would tell other kids who needed BB about it” “what I got much better at during BB.”. If you are able, you can plan to video record the product in Session 10 and then play it back to the students so they can see their work. The goal would be to decide on a format, outline content and assign roles if applicable before the close of session. If any props are needed, children can be assigned what they may need to bring and you can write this on their practice sheets for the week.

Bounce Back Program Manual 68

6) Handout Parent sheet for Session 9, remind students of reinforcement program and final rewards during the next session, preview the content of the final session (10).

“Wow. Let me tell you about my CBT Triangle right now. My thought bubble is full of things like, “I am so impressed with everything the group remembered” and “Every one of these kids has worked so hard.” Any guesses at what I am feeling? That’s right, very happy and proud and privileged to know each and every one of you and be on this journey with you. And that leads to my next action [give everyone a high five]. It will be great to have each of you write in your logs about all the skills you use this week AND be sure to have your “I Can Do It” practice time last long enough that you start to feel more comfortable and your feeling thermometer ratings come down. Don’t forget to give your parents or trusted adult the letter for this week, share your ladder and the list of all the Tools you Can Use with them, and let them know how you need them to help you with the practice and/or with writing down what you practiced. Next week, you all will create something special to celebrate your progress and what you’ve learned and we will have a reward party for all of your hard work. Just because next week is the last time we will meet for this group, it doesn’t mean it is the last time you will see me or each other. It will be a really special celebration, so be sure to come on time. I look forward to seeing you then.”

Bounce Back Program Manual 69

SESSION 10: Graduation/Celebration

Materials Needed:

 Materials for skit, poem, song, commercial, drawing or other consolidation project  Rewards that students have earned  Relapse Prevention Practice Sheets  FILLED OUT Parent handout for Session 10

Schedule/Outline/Agenda:

1) Review Session 9 Practice Sheet; Reward practice completion.

2) Consolidation Project Planning and Practice (group or individual).

3) Celebration of Progress.

4) Handout Parent sheet for Session 10 with individual feedback about each child. Let students know what type of information you have included in the Parent Sheet.

5) Have students take turns leading group through Relaxation Exercises

Bounce Back Program Manual 70

1) Review Session 9 Practice Sheet; Reward practice completion.

Review the Session 9 Practice Sheets with each child, providing reinforcement for those who were able to complete their “I can do it” and Tools you Can Use practice and write on their practice sheet. In this last group, be prepared to provide the rewards that student have been working towards.

“Let’s start by reviewing the practice from last time. Was everyone able to do their practice this week?”

[If yes, but didn’t bring worksheet;]

“That’s ok, we can still talk about it. I have a blank one here that you can look at, and you can answer as we go along and tell us what your answers were.”

2) Consolidation Project

Work together with the group from the outline created during Session 9 to create a “Consolidation Project” of some type that enables them to review what they have learned, tools they can now use, how they have grown, etc. This can take the form of a skit, poem, song, commercial, drawing, etc. Again, try to ensure that each group member has a role. If you are able, you can video record the product and then play it back to the students so they can see their work. After completing and/or viewing the consolidation project, provide an opportunity for the students to write down anything about their project they would like to share with their parents or trusted adult. Be sure to remind students of confidentiality of other students in the group, but they could take what was included in the consolidation project as long as it applied to them to share with trusted adults.

3) Celebration of Progress

Have a certificate of completion in hand and as you call each student up to receive their certificate and a handshake make a positive statement about the progress you have noted in the student. This can be something that you have also shared on their parent letter. This activity should be done with respect and honor and leave each student proud of his or her progress and role in the group.

Bounce Back Program Manual 71

If there is time, it may also be nice to pass a piece of paper around with each child’s name on it and have each person write down a positive word or sentence about each person, but without signing their own names [You may have to write things down as they are said with children less comfortable with writing]. That way, each child can leave with a list of nice things about themselves from their group-cohort. Sometimes students decide to also exchange phone numbers or email addresses at this time.

4) Handout Parent sheet for Session 10 with specific information about each child’s progress. Hand out Take Away Package.

Hand each student a small “Take away package” with small things that reflect the program’s core concepts (thermometer, pad and pencil for brainstorming/problem solving, courage card for brave thoughts, etc.; see workbook session 10)

5) Have students take turns leading group through Relaxation Exercises as Time permits.

Bounce Back Program Manual 72

INDIVIDUAL SESSION 1: Trauma Narrative

Materials Needed:  My Story pages  Crayons, markers, pencils, lined and unlined paper  Parent handout for Individual Session 1

Schedule/Outline/Agenda:

1) Provide rationale for trauma narrative 2) Exposure to Trauma Memory via creation of the Trauma Narrative

1) Provide rationale for trauma narrative

Provide the child with an explanation for why processing or working through their trauma story helps to reduce the frequency and intensity of their symptoms. The idea is that although what happened was frightening, the memory of the event cannot harm them now and children can recover and lead full and healthy lives. Thinking and talking about it in a supportive environment with you enables them to process it so that when they are reminded of it, they do not feel as upset or scared by the memory. It is another way they can take charge of their symptoms and help all points of their triangle.

“Have you ever had a splinter? If you get a splinter, say in your hand, and you just ignore it and try not to think about it, will it go away? No, it doesn’t go away, instead it keeps bugging you and getting red and swollen and hurting and getting worse so it seems like you will never be rid of that splinter. When we go through something really stressful or scary it is kind of like that splinter. We try to ignore it, avoid thinking or talking about it, but what we saw or

Bounce Back Program Manual 73

experienced still affects us and keeps bugging us. To get rid of a splinter we sometimes have to dig at it a little bit and then pull it out. Now the digging and pulling may hurt temporarily, but then the splinter is out and the body can heal itself. Before we know it, we aren’t thinking about the splinter so much anymore as it is healing over.

“Today I am going to ask you to tell your story, and by talking about it and drawing it and sharing your memory of what happened, just like taking the splinter out, you will be able to start healing and not be so bothered by it. Even though you went through something really hard and scary [use wording applicable to the child], we know that you can recover and lead a full and healthy life. The more you are able to work through your story, the easier it gets each time and the less you will find yourself thinking or worrying about it.”

Tips for Selecting from Multiple or Changing Stressful Events If a child has experienced more than one stressful or traumatic event, they will likely need guidance from you in selecting which stressful event to create a trauma narrative for. In doing so, keep in mind the following:  Try to assist the child in identifying the event that is currently the most distressing/bothersome o Which events are they having intrusive thoughts about during their school work or when trying to go to bed at night? o Which event is linked to the anxiety triggers that are currently interfering in their lives or with their daily functioning? o Which event is the hardest for them to think or talk about?  If the most distressing event changes: o Between screening and the trauma narrative, move forward with the event that is the most distressing when the individual sessions begin o In the midst of the trauma narrative sessions, allow for some processing of the initial stressful event and move on to the event newly identified as most distressing as there is time. Refer to the Group Leader Training Guide for further information.

2) Exposure to Trauma Memory via verbal sharing and written creation of “My Story”

The child creates the trauma narrative with the clinician’s support. The narrative will cover what happened just before, during, and just after the traumatic event. First, the child will verbally share the story of their memory of the stressful or traumatic event. Note: Although sample scripts are provided throughout, it is important to be responsive to what the child actually produces.

Bounce Back Program Manual 74

The following steps should occur:

1. You will help the child create an outline and provide their first verbal exposure of their trauma memory. Using the My Story Outline form, ask the child to tell you the story of what happened just before, during and just after their traumatic event. Let them know in advance that you will be jotting down parts of their story to help them later in the creation of their “My Story” written narrative. As they are telling their story, try not to interrupt them, other than being an empathic and encouraging presence, writing down the parts of the stories they convey. Below is a sample dialogue that may be used to get the story started:

“I would like you to tell me about your story of what happened or what you saw. I am first going to ask you what was going on just before your stressful event, then ask you to tell me about the stressful event, and then what happened just afterward. As you tell me your story, I am going to be writing down the parts of the story, so you will see me jotting things down on this page [show them the ‘my story outline’] When you finish, we are going to go through each part of the story together to make sure we got it all down. We will also use this outline later when you write or draw out your story. Why don’t you go ahead and start by telling me what was happening just before your stressful event happened.”

2. After the child has told his or her story from beginning to end, thank them for their courage, and repeat back to them what you heard. Here is a sample dialogue for ending the first telling of the story:

“You did a great job telling me your story. I am really proud of you for having the courage to do that. Let’s take a couple of our belly breaths. Good. Now, you can correct me if I got things wrong, but I’d like to read back to you the parts of the story I heard you say just now. I would like to ask for your feeling thermometer rating for thinking or talking about each part of the story right now. Okay? The Feeling Thermometer is right here, so you can just point to a number or you can use your hands to tell me or you can say a number out loud—whatever works best for you. [Read back the parts of the story from just before to just afterward pausing to ask for a feeling thermometer rating for each part—“what is it like to think or talk about that part of the story right now?”

When you have ratings for all parts of the story ensure the child is satisfied that everything relevant is included. Does it sound like we got all the parts to your story in there? [If no, add in the extra parts].”

3. Ask the child to tell you the story again from the beginning, this time stopping to ask for Feeling Thermometer ratings at the 2-3 parts of the story that garnered the highest ratings during part 2 of this exercise. These ratings are to give you a sense for the child’s feelings and when habituation (anxiety reduction) begins to occur. Below is a sample dialogue that may be used to progress to the retelling of the story:

Bounce Back Program Manual 75

“Okay, now that we have gotten your story written down, I’d like you to tell it to me again from the beginning. I am going to ask you to tell me your story several times. Remember, I am not asking you to tell your story over and over again because I didn’t hear you, it is because we know that the more you are able to tell it, the easier it should get and the less you will worry about it. Like the splinter, right? It feels so hard to dig it out at first, but then it can heal so much easier and gets better with time. I will be checking in with you a few times as you tell your story by asking for Feeling Thermometer ratings. Again, you can tell me the number you are feeling on your Feeling thermometer at the moment I ask for it, or you can point to a number on the thermometer here, or hold up the number of fingers to show your feeling thermometer rating at that moment. So let’s start at the beginning again with what was happening just before the stressful event…[if any new parts were added, add: and this time include the extra parts we just talked about].”

[Child retells story]

4. Repeat Step 3 one-or two more times. You should start to notice that the child’s anxiety and Feeling Thermometer ratings are beginning to go down during the 2-3 times that you check in for feeling thermometer ratings during the retelling of the story.  Not all children will demonstrate anxiety in the first place, and not all will demonstrate anxiety reduction. All different kinds of patterns of distress are possible, but the long-term goal of repetition and accompanying anxiety reduction remain the same. a. If distress / anxiety starts high i. and reduces, then you are on the right track. Continue with additional practice (writing) to consolidate gains ii. and stays high, use the remaining time in the session to continue with the verbal storytelling to try to reduce it. If it is still high at the end of the session, reassure the child that with more practice (verbal and written), he/she will begin to feel better. Schedule extra time with this student as possible. b. If distress / anxiety starts low i. And stays low, that’s fine. Stick with the process because written disclosure has been found to be helpful for people even if they do not have significant levels of anxiety. ii. And gets worse, use the remaining time in the session to continue with the verbal storytelling to try to reduce it. If it is still high at the end of the session, reassure the child that with more practice (verbal and written), he/she will begin to feel better. Schedule extra time with this student as possible.

5. Next, with the child’s input on what they would prefer to do, select a format for “My Story.”

Bounce Back Program Manual 76

Some options are:  Drawing pictures on the pages and having the clinician write the narration and create “thought and feeling bubbles” based on quotes from the child about his or her picture (younger children) (4-6 pages maximum in order to fit into the time frame, since drawing can take a while).  Creating a “My Story” with a mixture of drawings and words or captions describing each page (4-6 pages maximum in order to fit into the time frame).  Writing their story without pictures on lined paper (older children)

6. Begin to outline the written trauma narrative.  If the child has selected to do a small My Story book, use a 4-6 page paper booklet and the “My Story Outline” to assist the child in planning out what they may want to draw or write on each page and making a note of it from start to finish. After you have a plan for how they will use the pages of their book to describe their story, allow the child to begin the first page, assisting them with writing in narrative or thought or feeling bubbles as needed. In order to elicit more details and/or engagement in the story-telling process, respectfully probe for details regarding thoughts and feelings during the various portions of the trauma story. These can be added to the text, captions, etc.  If the child would like to only write out the story, allow them to do so on lined paper. Once the child has completed the first page of the My Story Book or has written out their story on paper, ask them to read it aloud and check-in regarding Feeling Thermometer ratings. Let them know that you will continue working on the story and drawings in subsequent session(s).

7. Ensure the child is ready to return to class and develop a plan to check in with the child later that day and or for how they can access their support people if they become upset (revert to splinter analogy—it may hurt a bit temporarily because it is like we just dug out and pulled your splinter).

Bounce Back Program Manual 77

Individual Session 2: Child:  Continued trauma narrative processing, preparing for joint session

1) Add onto or continue to process trauma narrative

“You did such a nice job last time we met. Today you will have a chance to continue your ‘My Story Book’ or to write out your story. [For children who are doing the My Story book:] Last time we made a plan for how you were going to use the pages of your book. Now, you can spend some time finishing those pages.[Personalize this message according to each child]”

Allow the child to continue working on the drawings and written narrative for their small My Story book. Assist the child with writing down narrative or thought or feeling bubbles as needed. In order to elicit more details and/or engagement in the story-telling process, respectfully probe for details regarding thoughts and feelings during the various portions of the trauma story. These can be added to the text, captions, etc. If the child is writing out their story, allow them to do so on lined paper. Once the child has completed the My Story book or has written out their story on paper, ask them read it aloud or have you do so and check-in regarding Feeling Thermometer ratings.

Bounce Back Program Manual 78

As the child completes or reads back the written narrative or the My Story Book, pay careful attention to any maladaptive cognitions and help the child to observe and challenge these thoughts providing realistic information (i.e., most 8 year olds do not have the power to stop something like that from happening) and using the cognitive coping strategies (i.e., thinking about it now, is there a more helpful way to think about that?).

At the bottom of the My Story Outline page, you can record any maladaptive negative thoughts, and the helpful thoughts that you and the child are able to generate.

2) Prepare for conjoint session

Prepare the child for sharing their trauma story with their parents or trusted adult. This may include role-playing the session as well as asking them if there is anything in particular that they may need to hear or see from their parents or trusted adult in the session in order to feel supported through the process.

“Now that you have worked so hard on your story, I would like you to share your story with your parents or trusted adult. This will give you another chance to digest it and make it easier to talk and think about. It will also help you be better able to talk to your parents about what you have been through later on [ in the future] when you might be thinking about it or worrying about something related to it.”

3) If you have confirmed that child’s parent or trusted adult will be joining for individual session (which is the goal in most cases)

“Next week your parent/trusted adult will be joining us. I will meet with them first to talk about all of the progress you have made and how proud I am of your hard work. I will share some of your story with them so they can see what you have been working on. Then we will meet together and you can go through your story with them.

If there is an extenuating issue and the parent is not confirmed to join the session, role play the child having a chance to share their story at home if you deem this to be safe and appropriate.

“Let’s think about a time that would be good for you to share your story with your parent or trusted adult at home. Sometimes grownups get so busy that it can help to make an appointment with them. I can send a letter home with you today to give to your parent/trusted adult letting them know to make an appointment with you this week when they will have time to give you their attention and support so you can share the story you have been working on with them.

Bounce Back Program Manual 79

Either way, role play the child sharing the story with their parents or trusted adult so that he/she will have practice doing so and be more comfortable:

“Right now, why don’t we practice you sharing your story with your parents. I will pretend that I am your parent/trusted adult and you are sharing your story. Let’s give it a try.” [complete role play].

Ask the child if there is anything that his or her parents could do or say that would make the child feel supported by them and write this on the parent letter you send home. Let the child know you will check in the following week to see how things have gone [this could be a brief check-in before the next group starts or a shorter version of individual Session 3].

Record the things the child requests from the parent on the bottom of the My Story Outline worksheet.

Bounce Back Program Manual 80

Individual Session 3: Parent Meeting/Conjoint Session:  Meet with parent  acknowledge progress and prepare them for the  conjoint session  conduct conjoint session

Thank the parent for coming and provide a brief review of progress their child has made in the group skill-building sessions as well as in your individual sessions together.

Let them know that you would like to review their child’s story with them so that they have a chance to see/hear and process it with you before their child presents it to them. Normalize that hearing or seeing the narrative can be difficult, but that it is important for their child to be able to process the memory of their stressful event and feel comfortable sharing about it with their parent(s) and opening the lines of communication so that their child can come to them in the future if they are thinking or worrying about the event.

Using the My Story Outline worksheet, share the child’s story with the parent, providing support as they hear it.

Review any negative maladaptive thoughts the child has related to the traumatic event, and the helpful thoughts you generated together (middle of worksheet).

Bounce Back Program Manual 81

Prepare the parent for the best way to support their child when he or she shares the story with them later in the session by telling them the things the child has requested (bottom of worksheet).

Given your work with the child, let them know what they may expect from their child’s response and anything their child expressed during Individual Session 2 related to how their parents may be able to best provide support.

Give parents the “Tips for Listening to Your Child” handout and review the main points

 Try to remain calm o Show your child that you are strong, and that you can handle the story. . If your child cries, comfort him/her, but encourage him/her to continue. . If you cry:  take some deep breaths  Remind yourself that this is important for your child. If they can’t tell you, who can they tell?  Explain that you are ok: “I’m upset that this happened to you, so I’m crying. But I can handle it, I want you to go on and finish the story. I want to hear everything.”  Show that you are listening, o Make eye contact, nod. o Repeat parts of what you hear, using your child’s words: “So first you didn’t really know what was happening.”  Allow your child to choose the pace o Allow your child to give lots of details, or only a few, it’s up to him/her. o Resist the urge to ask questions. . Ask yourself, “Is this something I really need to know?” . Ask yourself, “Am I asking this for me, or because I think it will help my child?”  Show strong support for the child o Provide a verbal reaction at the end of the story: . “Thank you for telling me.” . “I’m really proud of you for telling me the whole story. You are so brave.” . “Its going to be helpful to me to understand what you went through. I’ll be able to help you more.” . “I wish that hadn’t happened to you. That was really hard to hear. But I’m glad you told me.” o Be careful not to blame or criticize the child.

Bounce Back Program Manual 82

. Children are very prone to blaming themselves. . You can find ways for your child to stay safe in the future without making them feel bad about what already happened. o Fill any specific request the child has made for support  Help your child use coping strategies o Ask your child to teach you the relaxation skills he/she has learned o Review helpful thoughts if the child showed self-blame or other negative thoughts o Ask your child if the courage cards might be useful, and how to use them

Briefly role-play reading the story as if you are the child, allowing the parents/trusted adult to practice responding to the child in the manner you have just discussed.

“I am going to go through your child’s story again with you, but this time I would like us to pretend that I am your child, so that you can practice responding to me (playing your child) in the ways we just discussed.”

Give feedback as necessary, asking the parent to maintain eye contact, nod, encourage, say something at the end. Answer any of the parents’ questions. Also, discuss with the parent or trusted adult if there is somebody that they may be able to talk to within their social support network after the session in case they need to further process any feelings that come up. Normalize that just like the child needs support in processing their stressful events, the parent may also need a support person in their lives that they can go to as they are processing their child’s disclosures.

Following the role play with the parent, you will need to assess if the parent has had sufficient enough time to process the story and be able to respond appropriately during the child’s sharing of the story. If you do not feel they will be able to hear the child tell their story and remain supportive, you will need to continue helping the parent work through and process the information and understand the importance of their conveying support to the child.

Examples of this may that the parent is minimizing domestic violence or its impact on the child, doesn’t believe the child’s story is valid, can’t believe that the child is still thinking about or bothered by an event that happened some time ago, or is shocked, emotionally overwhelmed, or guilty by hearing about the story. It will be important to provide time to work through these issues with the parent until they are able to regulate their own emotions, can arrive at a place of understanding and are willing to listen to your cues on how to show support for their child during the joint portion of the session. It may be important to follow up with a parent by phone after the session if continued processing may be helpful.

Remember that parents may be hearing some of this information from their child’s perspective for the first time. They may need guidance and support in getting over some of the shock and some time to deal with it. This does not mean that the joint session should be avoided. It means

Bounce Back Program Manual 83

that some time may be needed to work through their responses and appropriately prepare the parent for the session, engaging them in understanding the critical role that the child’s sharing of the story can play in their recovery. It is best to convey to the parent that the joint session will only take place when the parent is ready to hear the child share their story and be supportive. You may have to repeat the role play again to ensure that they are able to respond appropriately.

Once the parent is calm enough and prepared to be supportive in the ways you have guided them, ask the child to join you.

Joint Session. Sharing trauma narrative

Have child join you in session and share their trauma narrative with their parents or trusted adult by reading through their story, showing pictures and captions, etc. Parents or trusted adult use supportive language and stance practiced in parent sessions. Below is a sample dialogue you may use to help introduce the reading of the trauma narrative:

“Today you have the chance to share your story with your parent/trusted adult. I know you might have talked about it before, maybe even a lot, but we’re going to do the whole story here today. The will help you [the child] feel better when you talk about what happened, and it will help you [the parent] be able to hear it and talk about it more often at home. Its important to share stories like this, just the way you share stories of fun things that happened to you, or stories from when [child] was little, or things about your [adult] life when you were younger.”

Allow the child to read through his or her story to their parent/trusted adult. Below is a sample of what you may want to say to help get the child started:

“Just like we talked about, this is the time for you to share your story [hand child the story drawing book or written story]. I will be sitting here if you need any help.“

Acknowledge both child and parent for taking the important step of sharing their story and prompt parent(s) to provide any supportive statements discussed earlier in the session by reminding them to look a the Tips for Listening to Your Child sheet as needed. Help the child and parent process any issues that may arise for them in the retelling or immediately afterward.

Encourage the child to try to set aside time to talk with their parent again about their story if they are thinking or worrying about it [but not at bedtime].

Bounce Back Program Manual 84

If you have worked with the child on restructuring any maladaptive thoughts about the stressful event, help the child to share this with their parents/trusted adult so they are aware of how the child is currently working on thinking about elements of the event in a more adaptive manner.

Acknowledge that processing stressful events can lead to an increase in feelings about what happened for a short time even though it will help lessen those feelings over time (refer back to splinter analogy—this is kind of like when you have to dig in and get the splinter out so that it can then heal). If the session is early in the day, you may want to tell the child that you will be checking in with him or her toward the end of the school day to be sure that they are doing well. Remind parent of their plan to check in with an adult support person as needed.

****If there is ever a time during the joint session that the parent responds in an unsupportive manner and cannot be redirected or behaves in a way that is counter- therapeutic for the child, promptly end the session, letting the child know that you need try doing this differently and resume meeting with the child alone and the parent alone separately. ****

Prepare child and parent for end of session/return to class. Some possibilities include:

 Ask the child to help lead a relaxation exercise  Ask the child to share some of the skills they have been using with their parent/trusted adult (i.e., courage cards)  Ask parent and child what some of their favorite things to do together are and then help them plan a time to do one or two of those activities in the coming days  Talk to the parent and child about any upcoming family activities that they are looking forward to  Ask the child about something happening in class that day or the next that they are looking forward to

Bounce Back Program Manual 85

Session 1

Workbook (Session Materials and Worksheets)

Session 1

Confidentiality Contract

By writing my name below, I agree to keep everything that other kids say during the group private and expect that other kids in the group will do the same.

______

Name of Group Member Date ______

Session 1

Name: ______Date:______Goals

Our group is designed to help you bounce back from a stressful experience.

What do you want to get out of the group? (Check all that apply)

BY THE END OF THIS GROUP…

I also want to: ______Parent/Trusted Adult’s Section

What would you like to see your child get out of the Bounce Back Program?

Session 1

______

Session 1

Session 1 Letter to Parents

Dear Parent or Caregiver,

I want to introduce myself to you – I will be your child’s Bounce Back group leader. I am looking forward to working with your child! As you may remember, we will be working on helping your child with the following things in the group:  Feeling calmer and being able to relax  Understanding the ways students can be affected by stressful events  Coping with problems in daily life  Feeling less upset and nervous when he/she thinks about what happened

Today in Group Session 1 we:  Introduced the group and created respectful Group Rules  Agreed to keep private what others share in the group  Learned how the group can help us bounce back from a stressful event  Agreed to complete the following practice this week: o Goals Worksheet (child and parent sections)

I invite you to share any concerns you have about your child with me, and to convey any questions you have. Please write anything you wish below or on the other side, and tell me the best place and time to reach you by telephone or to meet with you in person at the school. My phone number is: ______and my email address is: ______. Be sure to include a good contact number and best time to reach you in your correspondence.

Sincerely,

Session 1

************************************************************************ Your Name ______

Check one: ⁭ I don’t have any questions or concerns. ⁭ Please call me to discuss ______

Phone number(s): ______Best time to reach me: ______Please schedule an in-person meeting. Best times for me are:______

Session 2

FEELINGS FOR FEELINGS GRAB BAG

Sad Proud

Happy Disappointed

Mad Confused

Scared Ashamed

Shy Embarrassed

Brave Excited

Calm Stressed

Surprised Confident

Session 2

Common Reactions to Stress or Trauma Parent Handout

There are many different ways that young people react to stressful life events. Below we’ve listed several kinds of reactions, all of which are very common. We’ve asked your child to show this list to you and to talk with you about which ones he or she has had problems with recently. You might also notice that this list describes some of the ways that you have reacted to stressful events in your own life. Feel free to call us if you have any questions about these problems or the way in which the group will address them.

Having nightmares or trouble sleeping. When something really scary or upsetting happens, it takes awhile to figure out exactly what happened and what it means. After stress or trauma, people tend to keep thinking about what happened in order to “digest” it, just like your stomach has to work to digest a big meal. Nightmares are one way of digesting what happened.

Thinking about it all the time. This is another way to digest what happened. Sometimes children will reenact what happened as they are playing or in their interactions with other people. Just like nightmares, thinking about the stressful event or trauma all the time is a problem because it makes you feel upset. It can be unpleasant.

Wanting to NOT think or talk about it. This is natural, since it is upsetting to think about a past stress or trauma, and it can make you feel all sorts of emotions. Avoiding it makes things easier, but only for a little while. It’s important to digest what happened sooner or later. So, while avoiding it sometimes makes sense, you have to set aside some time to digest it also.

Avoiding places, people, or things that make you think about it. Just like not wanting to talk about or think about the stressful event, avoiding situations that remind you of what happened can help you feel better right then. The problem with this, though, is that it keeps you from doing normal things that are an important part of your life.

Feeling scared for no reason. Sometimes this happens because you remember what happened to you, or you are thinking about what happened. Other times it happens because your body is so tense all the time that you just start feeling scared.

Feeling “crazy” or out of control. If all of these things are problems for you, you can start to feel really out of control or even crazy. Don’t worry, though; these problems don’t mean that you are going crazy. They are all common reactions to stress or trauma.

Not being able to remember parts of what happened. This happens to a lot of people. The stressful event can be so awful that your memory doesn’t work the way that it usually does.

Session 2

Sometimes it gets easier to remember it later on, and sometimes it gets harder. This can be frustrating, but it’s really normal.

Having trouble concentrating at school or at home. With all the nervousness you are feeling and all the time you are spending thinking about what happened, it can be hard to concentrate on school work or even what your friends and family say to you.

Being on guard to protect yourself; feeling like something bad is about to happen. After something bad happens to you, it makes sense to be prepared for another bad thing to happen. The problem with this is that you can spend so much time waiting for the next bad thing to happen that you don’t have time or energy for other things in your life. Also, it is scary to think that something bad is going to happen all the time.

Jumping when there is a loud noise. This is another way to say that your body is prepared for action; in case something else happens. It can get very tiring to always be prepared fro something bad to happen.

Feeling anger. Sometimes people feel angry about the stress or trauma that happened, or the things that happened afterward. Other times, people just feel angry all the time, at everything and everybody.

Feeling shame. Sometimes people are ashamed about what happened to them, or how they acted. Even though it’s hard to believe, this gets better the more that you talk about what happened. If you keep it a secret, it’s hard for the shame to go away.

Feeling guilt. People can feel guilty about what happened or about something they did or did not do. Sometimes you blame yourself for things that you couldn’t control. You may also feel guilty for upsetting other people. Guilty feelings can make it hard to talk about what happened.

Feeling sadness/grief/loss. Sometimes stressful events include losing someone close to you or losing something that is important to you. This makes you feel sad and down.

Feeling bad about yourself. Sometimes, all this stress can make you feel really bad about yourself, like you’re a bad person or that no one likes you. This makes it harder to be friendly and to have fun with others.

Having physical health problems and complaints. Stress has an effect on your body as well. People tend to get sick more often and to notice pain and discomfort more often when they have been under stress.

Session 2

Name: ______Date:______Practice Sheet Session 2:

My Common Reactions to share with my trusted adult(s): __ Having nightmares or trouble sleeping. __Thinking about it all the time. __NOT wanting to talk about it. __Avoiding places, people, or things that make you think about it. __Feeling scared for no reason. __Feeling “crazy” or out of control. __Not being able to remember parts of what happened. __Having trouble concentrating at school or at home. __Being on guard to protect yourself; feeling like something bad is about to happen. __Jumping when there is a loud noise. __Feeling mad. __Feeling shame. __Feeling guilt. __Feeling sad and down. __Feeling bad about yourself. __Feeling sick a lot.

Things that make me feel happy: 1) 2) 3) 4) 5) 6) 2 Things I will do this week that make me feel happy 1) 2) When I did this and I how I felt:______

Session 2

Session 2 Letter to Parents

Dear Parent or Caregiver,

I am really enjoying the opportunity to work with your child and get to know him/her. It would be great if you have a chance to help provide opportunities for your family to have fun together this week, take a walk together, play a short game after dinner, cook together, or do whatever your family finds enjoyable. Today in Group Session 2 we:  Talked about the relationship between Thoughts, Feelings, and Behaviors and how they all affect each other.  Learned names for different feelings, how to guess what others may be feeling, and made a list of feelings that most of us have.  Learned about common reactions to stress or trauma  Made a list of things that make each of us feel happy or feel better.  Agreed to complete the following practice this week: o Share with you something from what they learned today o Do 2 activities that make them feel good or happy.

Please review the attached “Common Reactions to Stress or Trauma” sheet and assist your child in completing his weekly practice sheet before our next meeting.

As always, please feel free to share any concerns or questions you may have about your child with me. My phone number is: ______and my email address is: ______. Be sure to include a good contact number and best time to reach you in your correspondence.

Sincerely,

Session 2

*************************************************************

Your Name ______

Check one: ⁭ I don’t have any questions or concerns. ⁭ Please call me to discuss ______

Phone number(s): ______Best time to reach me: ______Please schedule an in-person meeting. Best times for me are:______

Session 3

Body Feeling Worksheet

Session 3

Name: ______Date:______Session 3 Practice Sheet

Share your body feelings worksheet with a parent or trusted adult. Have them write something down here about what you shared if they would like to.

______

Write down at least 2 times that you practiced your relaxation this week. You can do belly breathing and muscle relaxation or belly breathing and body scan. Teach your parents to do the relaxation exercise with you or read the script for you.

What I did What day and where Time 1: ______

Time 2: ______

Time 3: ______

2 Things I will do this week that make me feel happy 1) 2) When I did this and I how felt: ______

Session 3

Session 3 Letter to Parents

Dear Parent or Guardian,

We had another great group session this week. The group is really starting to work well together. Please provide praise for your child this week when you notice him or her working to calm down when upset, nervous, or angry. Today in Group Session 3 we:  Learned about Body Feelings that we notice in our body when we are feeling nervous or upset.  Learned and practiced 3 ways to make our bodies feel calmer: o Belly Breathing o Relaxing our Muscles o Body Scan  Agreed to complete the following practice this week: o Share the Body Feeling worksheet with you o Practice relaxation exercises at least 2 times this week. o Continue to schedule fun/happy activities

Please note the attached “Muscle Relaxation Script.” It may be helpful for you to read this to your child as they practice.

Also, ask your child to teach you to do belly breathing and body scan as part of their practice if you have the time.

As always, please feel free to share any concerns or questions you may have about your child with me. My phone number is: and my email address is: . Be sure to include a good contact number and best time to reach you in your correspondence. Sincerely,

Session 3

************************************************************* Your Name ______

Check one: ⁭ I don’t have any questions or concerns. ⁭ Please call me to discuss ______

Phone number(s): ______Best time to reach me: ______Please schedule an in-person meeting. Best times for me are: ______

Session 4

MUSCLE RELAXATION SCRIPT4

Hands and Arms

Pretend you have a whole lemon in each of your hands. Now squeeze them hard. Try to squeeze all the juice out. Feel the tightness in your hands and arms as you squeeze. Now drop the lemons and your arms. Notice how your muscles feel when they are relaxed. Take another lemon in each hand and squeeze them. Try to squeeze this one harder than you did the first one. That’s right. Real hard. Now drop your lemons and relax. See how much better your hand and arm feel when they are relaxed. Once again, take a lemon in each of your hands and squeeze all the juice out. Don’t leave a single drop. Squeeze hard. Good. Now relax and let the lemon fall from your hand.

Arms and Shoulders

Next, pretend you are a furry, lazy cat. You want to stretch. Stretch your arms out in front of you. Raise them up high over your head. Way back. Feel the pull in your shoulders. Stretch higher. Now just let your arms drop back to your side. Okay, kitten, stretch again. Stretch your arms out in front of you. Raise them over your head. Pull them back, way back. Pull hard. Now let them drop quickly. Good. Notice how your shoulders feel more relaxed. This time let’s have a great big stretch. Try to touch the ceiling. Stretch your arms way out in front of you. Raise them way up high over your head. Push them way, way back. Notice the tension and pull in your arms and shoulders. Hold tight now. Great. Let them drop very quickly and feel how good it is to be relaxed. It feels good and warm and lazy.

Shoulders and Neck

Now pretend you are a turtle. You’re sitting out on a rock by a nice, peaceful pond, just relaxing in the warm sun. It feels nice and warm and safe here. Oh-oh! You sense danger. Pull your head into your house. Try to pull your shoulders up to your ears and push your head down into your shoulders. Hold in tight. It isn’t easy to be a turtle in a shell. The danger is past now. You can come out into the warm sunshine and, once again, you can relax and feel the warm sunshine. Watch out now! More danger. Hurry, pull your head back into your house and hold it tight. You have to be closed in tight to protect yourself. Okay, you can relax now. Bring your head out and let your shoulders relax. Notice how much better it feels to be relaxed than to be all tight. Once more time, now. Danger! Pull your head in. Push your shoulders way up to your ears and hold tight. Don’t let even a tiny piece of your head show outside your shell. Hold it. Feel the tenseness in your neck and shoulders. Okay. You can come out now. It’s safe again. Relax and feel comfortable in your safety. There’s no more danger. Nothing to worry about. Nothing to be afraid of. You feel good. Jaw

4 A Relaxation Training Script modified from Koeppen, 1974; cited in Ollendick, T. H., & Cerny, J. A. (1981). Clinical behavior therapy with children. New York: Plenum Press.

Session 4

You have a giant jawbreaker bubble gum in your mouth. It’s very hard to chew. Bite down on it. Hard! Let your neck muscles help you. Now relax. Just let your jaw hang loose. Notice how good it feels just to let your jaw drop. Okay, let’s tackle that jawbreaker again now. Bite down. Hard! Try to squeeze it out between your teeth. That’s good. You’re really tearing that gum up. Now relax again. Just let your jaw drop off your face. It feels so good just to let go and not have to fight that bubble gum. Okay, one more time. We’re really going to tear it up this time. Bite down. Hard as you can. Harder. Oh, you’re really working hard. Good. Now relax. Try to relax your whole body. You’ve beaten the bubble gum. Let yourself go as loose as you can.

Face and Nose

Here comes a pesky old fly. He has landed on your nose. Try to get him off without using your hands. That’s right, wrinkle up your nose. Make as many wrinkles in your nose as you can. Scrunch your nose up real hard. Good. You’ve chased him away. Now you can relax your nose. Oops, here he comes back again. Shoo him off. Wrinkle it up hard. Hold it just as tight as you can. Okay, he flew away. You can relax your face. Notice that when you scrunch up your nose that your cheeks and your mouth and your forehead and your eyes all help you, and they get tight too. So when you relax your nose, your whole face relaxes too, and that feels good. Oh-oh! This time that old fly has come back, but this time he’s on your forehead. Make lots of wrinkles. Try to catch him between all those wrinkles. Hold it tight now. Okay, you can let go. He’s gone for good. Now you can just relax. Let your face go smooth, no wrinkles anywhere. Your face feels nice and smooth and relaxed.

Stomach

Hey! Here comes a cute baby elephant. But he’s not watching where he’s going. He doesn’t see you lying there in the grass, and he’s about to step on your stomach. Don’t move. You don’t have time to get out of the way. Just get ready for him. Make your stomach very hard. Tighten up your stomach muscles real tight. Hold it. It looks like he is going the other way. You can relax now. Let your stomach go soft. Let it be as relaxed as you can. That feels so much better. Oops, he’s coming this way again. Get ready. Tighten up your stomach. Real hard. If he steps on you when your stomach is hard, it won’t hurt. Make your stomach into a rock. Okay, he’s moving away again. You can relax now. Kind of settle down, get comfortable, and relax. Notice the difference between a tight stomach and a relaxed one. That’s how we want it to feel: nice and loose and relaxed. You won’t believe this, but this time he’s really coming your way and no turning around. He’s headed straight for you. Tighten up. Tighten hard. Here he comes. This is really it. You’ve got to hold on tight. He’s stepping on you. He’s stepped over you. Now he’s gone for good. You can relax completely. You’re safe. Everything is okay, and you can feel nice and relaxed.

This time imagine that you want to squeeze through a narrow fence and the boards have splinters on them. You’ll have to make yourself very skinny if you’re going to make it

Session 4

through. Suck your stomach in. Try to squeeze it up against your backbone. Try to be as skinny as you can. You’ve got to get through. Now relax. You don’t have to be skinny now. Just relax and feel your stomach being warm and loose. Okay, let’s try to get through that fence now. Squeeze up your stomach. Make it touch your backbone. Get it real small and tight. Get as skinny as you can. Hold tight now. You’ve got to squeeze through. You got through that skinny little fence and no splinters. You can relax now. Settle back and let your stomach come back out where it belongs. You can feel really good now. You’ve done fine.

Legs and Feet

Session 4

Cartoon #1

Session 4

Cartoon #2

Session 4

Cave People Cartoon

Session 4

Cartoon #3a

Session 4

Cartoon #3b Child needing to go to the nurse

Session 4

Cartoon #3c

Session 4

Cartoon #3d

Session 4

Courage Cards

Session 4

Cartoon #4

Session 4

Cartoon #5—

Session 4

Cartoon #6—getting called on in class

Session 4

Name: ______Date:______Session 4 Practice Sheet

1) Share what you learned today about thought bubbles and courage thoughts with a parent or trusted adult. Ask them to help you fill out the double bubbles below during the week.

2) Write down 2 situations this week where you feel a bit nervous or unsure or even angry and use your double bubble to see if there is a more helpful way to think about it that can make you feel better. So write down your first thought (that may not be very helpful) on the left and then a courage thought or more helpful thought on the right. You can draw the thought instead of write it if you would like.

Situation 1:______

Session 4

Situation 2: ______

3) Write down at least 2 times that you practiced your relaxation this week. You can do belly breathing or muscle relaxation. Teach your parents to do the relaxation exercise with you or read the script for you.

What I did What day and where Time 1: ______

Time 2: ______

Time 3: ______

Session 4

Session 4 Letter to Parents

Dear Parent or Guardian,

The children did a really nice job in group this week. They are all really working hard. Today in Group Session 4 we:  Learned about our thoughts and what is in our thought bubbles  Discussed how some thoughts are unhelpful and can lead to problematic feelings and actions while others are more helpful and make us feel better and act bravely or with more courage.  Created “Courage Cards” to carry with us to remind us to use our brave thoughts to try our best and feel better.  Agreed to complete the following practice this week: o Share the Courage Card with you o Keep a journal of 2 situations and the first thoughts and helpful thoughts your child has for each one. o Practice relaxation exercises at least 2 times this week.

Please encourage your child to use their brave or helpful thoughts when they are in a situation that may be anxiety provoking or a bit hard for them to do. For example, if your child is hesitant to give a book report in front of the class, encourage them to come up with some courage thoughts or brave thoughts that will help them feel better and do their best, like “ I can do this.” “I may feel nervous at first, but it will get easier. I have practiced at home.” “Nothing bad will happen if I just try my best”. If your child seems upset or to be having a hard time, you may want to ask them “what is in your thought bubble?” to get a sense for what they are thinking about and how that may be impacting their feelings and mood at the time. If your child has difficulty writing, please help them fill out their thought bubbles journal as appropriate.

PLEASE SEE NEXT PAGE

Session 4

As always, please feel free to share any concerns or questions you may have about your child with me. My phone number is: and my email address is: ______. Be sure to include a good contact number and best time to reach you in your correspondence.

Sincerely,

************************************************************* Check one: ⁭ I don’t have any questions or concerns. ⁭ Please call me to discuss ______

Phone number(s): ______Best time to reach me: ______Please schedule an in-person meeting. Best times for me are: ______Parent Name ______

Session 5

Name: ______Date:______

Session 5 Practice Sheet

Session 5

Name: ______Date:______Session 5 Practice Sheet

1) Share the “I Can Do It” Ladder you started today with a parent or trusted adult. Tell them about the step you would like to practice several times this week and make a plan for when you should be able to fit the practice in. Be sure to check their schedules to be sure they can help you with it if needed AND be sure to plan it so you can practice until you feel more comfortable and your feeling thermometer rating goes down each time.

2) Fill in the following “I Can Do It” Ladder Practice Journal when you practice at least 3-5 times this week.

This week I am going to practice: Draw it here!

Day What you did FT Rating Courage thought or helpful tool

Session 5

Session 5 Letter to Parents

Dear Parent or Guardian,

Today we completed the halfway point in our groups. The children are continuing to work well together and support each other as they learn new coping strategies. Please encourage your child’s practice his week by being supportive emotionally and helping them organize time for their practice. Today in Group Session 5 we:  Learned about how avoiding things that are hard for us may feel good in the short term, but can also cause us to miss out on things we want to be able to do.  Talked about how taking small gradual steps toward doing something can make it easier.  Created an “I Can Do It” Ladder and listed something hard for us to do at the top rung of the ladder and a very small step toward that thing on the very bottom rung of the ladder. We will continue to fill in the other ladder rungs over the next few weeks.  Agreed to complete the following practice this week: o Share the “I Can Do It” Ladder with you o Complete the practice written on the lowest rung on the ladder 3-5 times this week and write it in the “I Can Do It” Ladder Practice Journal along with any helpful thoughts or other techniques used to make the practice manageable (i.e., relaxing my body, having a parent with me).

PLEASE SEE NEXT PAGE

Session 5

Please try to plan 3-5 times during the week that you can support your child’s “I Can Do It” practice either by providing transportation, support, or other logistics, and reminding them to use their relaxation and power thought skills as they practice. It is important that your child practice until it become easier for them within each practice session. So they need to stick it out until they start to feel more comfortable. You can check in to see how they are doing by asking them for the Feeling Thermometer Rating (on a scale from 0-10 where 10 is feeling the most upset and 0-1 is feeling just fine). Sometimes children choose to practice something that turns out to be much harder than they thought. If you feel they have given it a solid try and it is just too much for them, please let them know that this sometimes happens and is still a success because we learned that this practice should go on a higher rung and I will work with them in our next meeting to come up with a smaller and easier step to start with. As always, please feel free to share any concerns or questions you may have about your child with me.

My phone number is: ______and my email address is:______. Be sure to include a good contact number and best time to reach you in your correspondence.

Sincerely,

************************************************************* Check one: ⁭ I don’t have any questions or concerns. ⁭ Please call me to discuss ______

Phone number(s): ______Best time to reach me: ______Please schedule an in-person meeting. Best times for me are:______Parent Name ______

Session 6

Treasure Hunt Review Activity

Students will start off at the door of the room where their Clue #1 awaits them. Clues can be placed in envelopes or simply turned upside down at the various stations. Stations should not be positioned in order, that way, students have to move around the room between each station.

If students are split into 2 groups, have the second group start at the table or on the rug with Clue #4. They will move from clues #4-6 and then include Alternate Clue #7 that will lead them back to the door for Alternate Clue #1, Clue #2, and then, Alternate Clue #3 that will end with directions to Clue #8 - the treasure prize spot. You could also have the treasure prizes hidden in two different spots so that it is a surprise to each group if their timing is different.

Place Clue #1 or Alternate Clue #1 at the The Front Door of the Room. Place Clue #2 near the Feelings Poster you have on the Wall. Place Clue #3 or Alternate Clue #3 near a Body Feelings Poster posted somewhere in the room. Place Clue #4 where you usually meet as a group at the Table or on the Rug. Place Clue #5 near an Image of a Courage Card on Wall, Desk or Cabinet. Place Clue #6 near an image of an “I Can Do it” Ladder. Place Clue #7 or Alternate Clue #7 next to the “A Terrible Thing Happened To Me” Book Hide prizes for each student out of sight and be sure to fill in the blank on Clue #7 and/or Alternate Clue #3 with final instructions to reach prize location.

Clue #1 “To get this treasure hunt started, find the thing on the wall that gives us words and pictures for how we feel. Once you get there, you must complete a task in order to receive your next clue.”

Alternate Clue #1“You are getting closer to your prizes. Next, find the thing on the wall that gives us words and pictures for how we feel. Once you get there, you must complete another task in order to receive your next clue.”

Clue #2 “Each person must point to how they feel right now. Once completed successfully, look for your next clue by a ‘body.’”

Clue #3 “Each of you share 1 thing that happens in your body when you are feeling nervous, worried, or upset and point to it on the body poster. Once you are finished, look for your next clue in the spot we usually sit for group.”

Alternate Clue #3 “Each of you share 1 thing that happens in your body when you are feeling nervous, worried, or upset and point to it on the body poster. Once you are finished, you are headed for Bounce Back treasure in

Session 6

the______[Insert final clue of where you have hidden the small treasure prizes OUT OF SIGHT in your room]

Clue #4 “Work together to take one belly breath and do the “turtle” relaxation exercise. Once completed, go to the picture of the brave lion.”

Clue #5 “Work together to come up with at least 1 courage or helpful thought for the kids in the cartoon situations next to the courage card. When you finish, go to the thing that helps you take small steps to get back to doing something that was hard for you.”

Clue #6 “Each person should share how they are doing with their I Can Do It Ladder and any ways that it is getting easier to do things. You can also share about why it is important to practice these things and not avoid them. Once completed, your next clue can be found near a book about a raccoon named Sherman.”

Clue #7 “Remember that Sherman had something stressful happen to him. Work as a group to say why it may be helpful for Sherman to talk and write or draw about his story of what happened to him with his counselor. Once you successfully complete this, you are headed for Bounce Back treasure in the______.. [insert final clue of where you have hidden the small treasure chest prizes OUT OF SIGHT in your room]

Alternate Clue #7 “Remember that Sherman had something stressful happen to him. Work as a group to say why it may be helpful for Sherman to talk and write or draw about his story of what happened to him with his counselor. Once you successfully complete this, find your next clue at the front door of this room.”`

Session 6

Name: ______Date:______Session 6 Practice Sheet

1) Tell your parent or trusted adult about the “I Can Do It” Ladder step you would like to practice several times this week and make a plan for when you should be able to fit the practice in. Be sure to check their schedules to be sure they can help you with it if needed AND be sure to plan it so you can practice until you feel more comfortable and your feeling thermometer rating goes down each time.

2) Try to think of 2 positive things that can happen during your practice or as you get better at doing this I Can Do It step. Try to think of these things during your practice instead of any worry you may have about something bad that might happen while you do it.

1.______2. ______

3) Fill in the following “I Can Do It” Ladder Practice Journal when you practice at least 3- 5 times this week.

This week I am going to practice: Draw it here!

______

Day What you did FT Rating Courage thought or helpful tool 1)

Session 6

Session 6 Letter to Parents

Dear Parent or Guardian,

Today we had a very productive group meeting. It is evident that the children are really starting to use some of their new tools to improve their thoughts, feelings, and behaviors. Please praise your child when you notice them improving and or using their coping skills in any small way.

Today in Group Session 6 we:

 Reviewed the CBT Triangle

Actions

Feelings Thoughts

PLEASE SEE NEXT PAGE

Session 6

 Agreed to complete the following practice this week:  Practice the next step up on the “I Can Do It” ladder 3-5 times this week and write it in the “I Can Do It” Ladder Practice Journal along with any helpful thoughts or other techniques used to make the practice manageable (i.e, relaxing my body, having a parent with me).  Identify 2 positive things that can happen during the practice or as an outcome of getting better at doing it and thinking of these things during the practice instead of any worry about something bad that might happen during the practice.

Please try to plan 3-5 times during the week that you can support your child’s “I Can Do It” practice either by providing transportation, support, or other logistics, and reminding them to use their relaxation skills, brave thoughts, and thoughts of positive things that might happen as they practice. It is important that your child practice until it become easier for them within each practice session. So they need to stick it out until they start to feel more comfortable. You can check in to see how they are doing by asking them for the Feeling Thermometer Rating (on a scale from 0-10 where 10 is feeling the most upset and 0-1 is feeling just fine). Sometimes children choose to practice something that turns out to be much harder than they thought. If you feel they have given it a solid try and it is just too much for them, please let them know that this sometimes happens and is still a success because we learned that this practice should go on a higher rung and I will work with them in our next meeting to come up with a smaller and easier step to start with.

As always, please feel free to share any concerns or questions you may have about your child with me. My phone number is:______and my email address is: ______. Be sure to include a good contact number and best time to reach you in your correspondence.

Sincerely,

Session 7

Name: ______Date:______What To Do When My Feeling Thermometer Is Rising

1) Use Words to say what you are Feeling or are upset about a. I need some space b. I feel mad/sad when you______

2) Use Helpful or Courage thoughts

3) Relax your body

4) Ask an adult for help

5) Ask a friend for help

6) Walk away

7) Ignore

8) Do something that makes you feel better like play with your friends or read a book

9) ______

10) ______

Session 7

Name: ______Date:______Session 7 Practice Sheet

2) Fill in the following “I Can Do It” Ladder Practice Journal when you practice at least 3- 5 times this week.

This week I am going to practice: Draw it here!

______

Day What you did FT Rating Courage thought or helpful tool

3) Practice your “What to do when my Feeling Thermometer is Rising” Skills this week and log them below: What was the problem? What did you try? How did it work? 1.

Session 7

Session 7 Letter to Parents

Dear Parent or Guardian,

It was great to see your child working hard in group today. We focused on actions and finding support and I hope you enjoy discussing the content with your child. As a parent you are in a key position to provide love and support to your child as they bounce back from adversity. Thank you for doing all you do for your child!

Today in Group Session 7 we:  Discussed the importance of having people in our lives we can rely on and seek out for support. Your child identified different people they can go to at home, at school, and elsewhere when they need help or support.  Reviewed options for what we can do to solve a problem when our feeling thermometers are rising.  Practiced choosing the best action in different problematic situations.  Agreed to complete the following practice this week: o Practice the next step up on the “I Can Do It” ladder 3-5 times this week and write it in the “I Can Do It” Ladder o Write down any problems or times that your child’s feeling thermometer rises over next week, what action they took to try to solve the problem, and how it worked.

PLEASE SEE NEXT PAGE

Session 7

Please try to plan 3-5 times during the week that you can support your child’s “I Can Do It” practice either by providing transportation, support, or other logistics, and reminding them to use their relaxation skills, brave thoughts, and thoughts of positive things that might happen as they practice. It is important that your child practice until it become easier for them within each practice session. So they need to stick it out until they start to feel more comfortable. You can check in to see how they are doing by asking them for the Feeling Thermometer Rating (on a scale from 0-10 where 10 is feeling the most upset and 0-1 is feeling just fine). Sometimes children choose to practice something that turns out to be much harder than they thought. If you feel they have given it a solid try and it is just too much for them, please let them know that this sometimes happens and is still a success because we learned that this practice should go on a higher rung and I will work with them in our next meeting to come up with a smaller and easier step to start with. As always, please feel free to share any concerns or questions you may have about your child with me. My phone number is: ______and my email address is: ______.

Be sure to include a good contact number and best time to reach you in your correspondence.

Sincerely,

************************************************************* Check one: ⁭ I don’t have any questions or concerns. ⁭ Please call me to discuss ______

Phone number(s): ______Best time to reach me: ______Please schedule an in-person meeting. Best times for me are:______Parent Name ______

Session 8

Name: ______Date:______What To Do When My Feeling Thermometer Is Rising

1) Use Words to say what you are Feeling or are upset about a. I need some space b. I feel mad/sad when you______

2) Use Helpful or Courage thoughts

3) Relax your body

4) Ask an adult for help

5) Ask a friend for help

6) Walk away

7) Ignore

8) Do something that makes you feel better like play with your friends or read a book

9) ______

10) ______

Session 8

Session 8 Role Play Cards

Somebody just bumped into you in the Your classmate is trying to copy your hallway homework or test

Your friends just told you that a You just got your test back with a bad classmate said something bad about grade you during recess

You are feeling sad or worried about Your teacher tells you that you will be something that happened at home last reading or performing in front of the night school at an assembly

You can’t stop thinking about the You find out that you weren’t invited stressful event you have been through to your friend’s birthday party

Someone threatens to beat you up You have a headache or stomachache after school.

Session 8

Name: ______Date:______Session 8 Practice Sheet

2) Fill in the following “I Can Do It” Ladder Practice Journal when you practice at least 3- 5 times this week.

This week I am going to practice ______

Day What you did FT Rating Courage thought or helpful tool

SEE NEXT PAGE

Session 8

Name: ______Date:______

3) Practice your Problem-Solving this week and log how things go below:

Problem I had:______

STEP 1:

ACTION CHOICES I got from the “What To Do When My Feeling Thermometer is Rising” List or added myself 1.______2.______3.______4.______5.______

I TRIED THIS ACTION: ______

It worked

Session 8

Session 8 Letter to Parents

Dear Parent or Guardian,

It was great to see your child working hard in group today. We continued our discussion of “What to do When My Feeling Thermometer is Rising”. It would be great to remind your child to practice this skill when they encounter everyday problems or issues at home or school. Also, please praise them when you notice them thinking through options before acting and/or handling things well at home or at school.

Today in Group Session 8 we:

 Role played dealing with daily life problems using the “What to Do When My Feeling Thermometer is Rising” sheet and some brainstorming.  Agreed to complete the following practice this week: o Practice the next step up on the “I Can Do It” ladder 3-5 times this week and write it in the “I Can Do It” Ladder Practice Journal.  Use the What To Do When My Feeling Thermometer is Rising sheet and write down actions tried for any problems or times that your child’s feeling thermometer rises over next week, what their possible options (action choices) were for addressing the situation, what they chose to do, and how it worked.

PLEASE SEE NEXT PAGE

Session 8

Please try to plan 3-5 times during the week that you can support your child’s “I Can Do It” practice either by providing transportation, support, or other logistics, and reminding them to use their relaxation skills, brave thoughts, and thoughts of positive things that might happen as they practice. It is important that your child practice until it become easier for them within each practice session. So they need to stick it out until they start to feel more comfortable. You can check in to see how they are doing by asking them for the Feeling Thermometer Rating (on a scale from 0-10 where 10 is feeling the most upset and 0-1 is feeling just fine). Sometimes children choose to practice something that turns out to be much harder than they thought. If you feel they have given it a solid try and it is just too much for them, please let them know that this sometimes happens and is still a success because we learned that this practice should go on a higher rung and I will work with them in our next meeting to come up with a smaller and easier step to start with. As always, please feel free to share any concerns or questions you may have about your child with me. My phone number is: and my email address is: ______. Be sure to include a good contact number and best time to reach you in your correspondence.

Sincerely,

*************************************************************

Check one: ⁭ I don’t have any questions or concerns. ⁭ Please call me to discuss ______

Phone number(s): ______Best time to reach me: ______Please schedule an in-person meeting. Best times for me are:______Parent Name ______

Session 9

Putting it All Together: Tools you can Use

How am I feeling? Name My Feelings

Relaxation: Belly Breathing, Relax my muscles, Body Scan

Think of a Happy and Calm Place

Do something that makes me Feel Better and Happy

Use Brave Thoughts and Courage Cards

Focus on the Good Things that might happen

I Can Do It Ladder

Talk about my feelings and what happened

Who is on Your Team? Who are you connected to?

What to do when my Feeling Thermometer is rising

Session 9

Session 9 Review Trivia Game Examples

1. Name the 3 points on the Bounce Back triangle

2. Name one thing you can do to calm down your body

3. When you are working on your I Can Do It Ladder steps, should you start with the hardest step or an easier step first?

4. Why is it important to remember who we are connected to or who is on our team at school or home?

5. When you are doing belly breathing which way should your stomach or your stuffed animal go when you take a deep breath IN?

6. Which would be a more helpful thing to THINK in your thought bubble before your spelling test “I can focus and do my best” or “I want to kick a trash can”?

7. Name two people who you can go to when you need someone to help you feel better?

8. Name 2 things you can do if your Feeling Thermometer is Rising during recess because someone just cut in line in front of you for 4 square?

9. Which would be more likely to help you calm down, “yelling at your friend” or doing a “body scan”?

Session 9

Name: ______Date:______Session 9 Practice Sheet

2) Fill in the following “I Can Do It” Ladder Practice Journal when you practice at least 3- 5 times this week.

This week I am going to practice Draw it here!

Day What you did FT Rating Courage thought or helpful tool

3) Putting it All Together Log: Share your “Putting it All Together Sheet” with your parent or trusted adult also. See if there is something you can teach them about what you have learned.

Session 9

Fill in any of the following that you use this week:

2 Fun Things I did this week that made me happy 1)______

2)______

2 times that you practiced your relaxation this week. You can do belly breathing and muscle relaxation or belly breathing and body scan. Teach your parents to do the relaxation exercise with you or read the script for you.

What I did What day, where, with whom Time 1:

Time 2:

Times I used my Courage Thoughts or my support people: What was happening? Courage Thought or support person I used

Times I used my “What to do when your feeling thermometer is rising” List or 2 Step problem Solving:

What was happening? What action I tried How it worked

Things I need to bring for the final project next week:

Session 9

Session 9 Letter to Parents

Dear Parent or Guardian,

After today we will only have one more group session. It has been a pleasure working with your child and being able to see the growth of each child in the group. Today we reviewed all of the skills that your child has learned and how to put them all together to continue to help your child feel better and be able to do all that he or she needs to be able to do. I hope that you can take some time to review and continue to reinforce these skills with your child. Today in Group Session 9 we:  Put together all of the skills your child has learned.  Played a game to review the key components of the program  Agreed to complete the following practice this week: o Practice the next step up on the “I Can Do It” ladder 3-5 times this week and write it in the “I Can Do It” Ladder Practice Journal along with any helpful thoughts or other techniques used to make the practice manageable (i.e, relaxing my body, having a parent with me). o Fill out the Putting it all Together: Tools I can Use Log by writing down when different coping skills are used this week.

PLEASE SEE NEXT PAGE

Session 9

Sincerely,

************************************************************* Check one: ⁭ I don’t have any questions or concerns. ⁭ Please call me to discuss ______

Phone number(s): ______Best time to reach me: ______Please schedule an in-person meeting. Best times for me are: ______Parent Name ______

Session 10

Bounce Back Bag

This Bounce Back bag was made for YOU to use as needed. A Triangle To remind you that feelings, thoughts, and actions all work together.

A Feelings Card To remind you to name your feelings and talk about them with your trusted adults.

A Team Banner To remind you to get support from people who care about you.

A Small Stuffed Animal (turtle, cat) To remind you to practice your belly breathing and relax your muscles.

A Courage Card To write down new helpful thoughts.

A Ladder To remind you that you feel better and heal when you stop avoiding and face things.

A Crayon and Pad of Paper To draw or write a list of things that make you feel better and happy

A Thermometer To remind you to use your “What To Do When My Feeling Thermometer is Rising” List

A Bouncy Ball To remind you of your strength and your ability to Bounce Back.

Session 10

Session 10 Letter to Parents

Dear Parent or Guardian,

Today we met for our last group session. It was wonderful to be able to review the progress of each child and celebrate what the group has accomplished together. I would like to share some of the ways I have seen your child grow throughout our time together. If you would like to discuss this information further by phone or in person, please just let me know some times that you may be available to do so below.

I would like to give you some specific feedback about your child’s progress: ______

Please try to continue to help your child at home by: ______PLEASE SEE NEXT PAGE

Session 10

Other follow-up Recommendations: ______

My phone number is: ______and my email address is: ______Please be sure to include a good contact number and best time to reach you in your correspondence.

Sincerely,

************************************************************* Check one: ⁭ I don’t have any questions or concerns. ⁭ Please call me to discuss ______

Phone number(s): ______Best time to reach me: ______Please schedule an in-person meeting. Best times for me are:______Parent Name ______

Session 10

My Story Outline

What was happening just before the event: FT Rating NOW ______

Parts of the event: ______

What happened just after the event: ______

Negative thoughts and interpretations Helpful Thoughts ______Ideas for how the parent / trusted adult can support the child during sharing:______

Session 10

Tips for Listening to Your Child

Session 10

. “I’m really proud of you for telling me the whole story. You are so brave.” . “Its going to be helpful to me to understand what you went through. I’ll be able to help you more.” . “I wish that hadn’t happened to you. That was really hard to hear. But I’m glad you told me.” o Be careful not to blame or criticize the child. . Children are very prone to blaming themselves. . You can find ways for your child to stay safe in the future without making them feel bad about what already happened. o Fill any specific request the child has made for support  Help your child use coping strategies o Ask your child to teach you the relaxation skills he/she has learned o Review helpful thoughts if the child showed self-blame or other negative thoughts o Ask your child if the courage cards might be useful, and how to use them

Parent Sessions

PARENT EDUCATION SESSION 1

Materials Needed:  Schedule of three parent meetings  Common Reactions to Stress or Trauma Worksheet  CBT triangle  Feelings Cards Worksheet  Feeling Thermometer  Relaxation Scripts

Schedule/Outline/Agenda: 1) Introductions and Agenda for the 3 Parent Education Sessions 2) Provide initial psychoeducation: Prevalence of trauma exposure 3) Present Common Reactions to Stress or Trauma worksheet 4) Introduce CBT triangle and Rationale for Bounce Back 5) Present about Feelings: Identifying, Measuring, and Positive Activities 6) Introduce Relaxation Exercises 7) Wrap Up

1) Introductions and Agenda

Introduce yourself and your role in the Bounce Back program or at the school. Briefly describe the purpose and agenda of the three parent education sessions.

“As you know, the Bounce Back program is designed to help children bounce back from stressful events so they are able to feel better and do well in school and in their lives. The purpose of the three parents sessions are to provide you all with the information and skills that your children are learning so you can reinforce them at home and further support your child in using the coping strategies from Bounce Back.

Today, in Parent Session 1, we will talk a bit about the framework of the Bounce Back program, what your children are learning about labeling their feelings, the importance of scheduling in positive activities for your child and family, common

reactions to stress or trauma that your children may be experiencing, and relaxation.”

2) Psychoeducation

1) Prevalence of Trauma Exposure and PTSD

Discuss prevalence of trauma exposure and post traumatic stress symptoms to normalize the children’s experience and reduce stigma and anxiety. The following is a sample dialogue:

“Many children experience stressful and adverse events. In fact, about one fourth (25%) to one half (50%) of young people have had this type of experience that we sometimes call “trauma” or “traumatic”— something that is very stressful or scary or that feels really bad. And about 10% of kids, or 10 in every 100, have a really hard time feeling better afterward.

So given that ______kids go to this school [Tell parents the actual number] there are probably about [number of kids in school/4] kids in this school who have been through some tough stuff and about [number of kids in school/ 10] who are having a really hard time because of it.

You may not know very many of these other kids or families have been through these things because most have a hard time telling others about what they’ve been through. Maybe that’s hard for your child too. But our students are definitely not the only children experiencing these types of things. Luckily, we have a program like Bounce Back that helps kids get back on track and back to doing things they want and need to be able to do well.”

3) Review Common Reactions to Stress or Trauma Worksheet

This part of the session conveys information about general types of problems that children experience when they have been exposed to stressful or traumatic life events. The goal is to 1) normalize these symptoms and 2) provide hope by explaining that the children will be learning skills and strategies during Bounce Back that will help address and improve many of these reactions.

Pass out the Common Reactions to Stress or Trauma worksheet and encourage parents to read along and make notes for themselves about any symptoms that they have noticed their child potentially struggling with.

Also, explain that parents may have noticed some of these reactions in themselves because of stressful things they have gone through themselves. Open a discussion about how these reactions can, on the one hand, make parents understand what their child is going through, and, on the other hand, make them not want to think about it or talk about it themselves, making it harder to support their child.

Read through the Common Reactions Handout together.

4) Introduce CBT triangle and Treatment Rationale

Explain that trauma affects the whole triangle.

“When a child has been through something stressful or traumatic, it can affect everything about them. Let’s use an example of a car accident. If a child was in a car accident with his or her mom, what might happen the next time mom says, “Let’s drive across town to visit grandma”. Let’s fill out a triangle for this child. What might the child be thinking when mom says this? Feeling? What might he or she do or how would he or she act? “

The triangle for this example may look something like this: pretend to be sick, do something bad to get in trouble so can’t go, hide in room, start to cry (actions)

scared, nervous, worried We will get in another car (feelings) accident (thoughts)

“In this program, we work on all three corners of the triangle with the kids. We help them:  Learn some exercises that will make them FEEL better, and less nervous or upset.

 Learn some ways to THINK about things that are more helpful and will make them feel better.  Learn some ways to DO things so that they can do everything they want or need to be able to do and not feel upset when they do it.”

“The children learn about the connection between how they feel, think, and act – when they are upset or having a problem and also in their daily activities. It can be helpful for parents to understand this too, so you can reinforce the idea and better understand your child at home”

5) Feelings: Identifying, Measuring, and Positive Activities Introduce feelings Identification and handout Feelings Cards “Over the course of the three parent meetings, we will talk about all three corners of the triangle. Tonight we will start by talking about the FEELINGS part of the triangle. Early on in the program, the children participate in activities that help identify various feelings and start to label their own feelings. Your handouts list some feelings that kids may have. Labelling their feelings can help them communicate what they are feeling with you and recognize when they may be feeling worried or sad and use some of the strategies they learn to help themselves feel better.”

Introduce Feeling Thermometer

“We also teach the children to be able to measure how much they are feeling a certain way, usually to measure how upset they are feeling (nervous, sad, or mad). We use the Feeling Thermometer to do this [refer to feeling thermometer]. Similar to a thermometer that measures temperature, the feeling thermometer measure how upset a child is feeling where 0 is feeling just fine and a 10 is feeling really upset, overwhelmed, and at their worst. This provides another way for children to recognize how strong their feelings may be and provides a common language so that they can communicate to you and to us about where they are at with their feelings at any given time. As they learn to use more coping strategies to calm themselves down and think in more helpful ways, they are able to recognize decreases in their felling thermometer ratings. The feeling thermometer becomes part of many of the take home practice exercises so you will be seeing this often.”

Ask parents to identify things that might make their feeling thermometers rise, offer examples for yourself of what might take you to a 3, 6 or 9 and ask them to think about (or share) anxiety triggers for themselves, including things related to the stressful event that they may have experienced along with their child (or an item on the list may even

be seeing their child upset by remembering what they went through). Be sure to normalize, be supportive, and reinforce participation.

Explain the role of Things You Can do to Feel Happy/Good

“In order to increase positive feelings and the ability to help children feel better and overcome a negative mood, we ask the children to generate a list of things that make them feel happy. Examples may be things like: listening to music, petting the dog, playing outside in the back yard, talking to grandma on the phone, riding their bike, painting their nails with their older sister, play basketball, hugging a parent, watching the stars, whatever they can actually do during most days when they are feeling down or worried. It can also be really helpful as a family to schedule in these types of activities so that everyone can share some positive time and feelings together. This can be a family ritual, like movie night, pancake breakfast, taking walks together, or reading stories at bedtime. Or it could be a special activity that you plan for one on one time with your child. The point is that is nice to have things that we can look forward to and enjoy and share positive feelings. With our busy schedules, it is more and more important to be sure we are also making time for these positive activities. Even a few minutes together when you are able to give your child your undivided attention can go a long way.”

6) Introduce Physiological Feelings and Relaxation

“Finally, children learn about two different kinds of “feelings” in the Bounce Back program. One is our emotions—feeling sad, mad, happy, etc. We also get different feelings in our bodies and these body feelings can be clues that we need to check what is going on in our triangle and maybe calm ourselves down. Like when I have to get up and talk in front of a group at first my heart beats faster and I notice my hands sweating [or any other physiological responses you may have]”

Ask parents to share any physiological responses to anxiety that they notice themselves or experience when worried, nervous, or upset. Reinforce participation.

“So given that most people have some type of physical anxiety response and that many of the common reactions to stress and trauma we discussed a few minutes ago involve these kinds of feelings, like trouble sleeping, difficulty concentrating, feeling on edge, we move very quickly into introducing children how to calm down their bodies using relaxation. These are exercises that anyone can practice and use and something nice to do along with your child or even the whole family. We only have time to go over one quick way to relax our bodies here, but I am going to send you home with scripts for a couple of other ways to help your child relax.”

Diaphragmatic Breathing Exercises

Describe how we ask children to place a small animal on their bellies—not their chests— as they lean back in their seats. Ask them to place their hands on their own stomachs and lead them through some deep breathing.

“With your hands on your stomachs, we are going to practice taking nice deep breaths all the way into our bellies, not just our chests and then watch our bellies go back down as we breathe out all our air, nice and slowly. Watch me first and notice my stomach moving. Deep belly breath in [stomach rises] and slowly out [stomach goes down]. Now let’s all follow my words together. Nice deep breath in –stomachs rise---and out---stomach slowly down. Deep belly breath in—nice job—and out—bellies down. And breathe in—fill up your belly—and out belly back down. Great job, everyone! So this is belly breathing. It is easy to do without anyone even noticing.”

Guided Imagery and Progressive Muscle Relaxation Techniques and Body Scan

Review the outline of the progressive muscle relaxation script and the body scan, demonstrating a small part of each it if there is time.

“If you are reading relaxation scripts to your child, it can be helpful to use a calm and soothing voice and also to go slowly enough to ensure that your child is feeling both the muscle tension and then the relaxation of their muscles. I’m going to hand out a script that you could read to your child to help him or her relax. I’ll start us off by reading a bit to show you what it’s like.”

“First we’ll work on relaxing the hands and arms:”

“Pretend you have a whole lemon in each of your hands. Now squeeze them hard. Try to squeeze all the juice out. Feel the tightness in your hands and arms as you squeeze. Now drop the lemons and your arms. Notice how your muscles feel when they are relaxed. Take another lemon in each hand and squeeze them. Try to squeeze this one harder than you did the first one. That’s right. Real hard. Now drop your lemons and relax. See how much better your hand and arm feel when they are relaxed. Once again, take a lemon in each of your hands and

squeeze all the juice out. Don’t leave a single drop. Squeeze hard. Good. Now relax and let the lemon fall from your hand.5”

“As you can see, we work through the entire body, part by part. Finally, we also teach kids to scan their bodies so that they can relax any remaining parts that are tense:”

5 Source: A Relaxation Training Script modified from Koeppen, 1974; cited in Ollendick, T. H., & Cerny, J. A. (1981). Clinical behavior therapy with children. New York: Plenum Press.

Body Scan

“ Now that our bodies are feeling pretty relaxed, I am going to teach you a quick way to get your body calm or help your child’s body feel calm like this that can be done anywhere. Let’s stay seated comfortably in our chairs and imagine that there is a magic wand with a warm blue light and it is raised just above your head. As the warm gentle wand passes over each part of your body, that part becomes completely relaxed. The wand starts to move over your forehead , leaving it warm and relaxed. Next the warm light travels over your nose and cheeks and jaw and your face feels soft and warm and completely relaxed. ….And so on…we continue like that across the entire body.”

“What do you all think about these exercises? Do you think you can use them with your kids?”

7) Wrap-Up

“So these are some of the ways we start to work with children on the feelings portion of their triangle. Next week we will talk about how we help them work on the thoughts and actions portion of their triangles. If anyone cannot be at the next meeting, please let me know and we can try to see if there is another way for me to share the information with you. Thank you for taking the time to come today. Also, please remember that you are always welcome to contact me with any questions [supply contact information]. I will also be communicating with you via a parent letter sent home with your child each time we meet. It will help you know what your child worked on that day, what they agreed to practice, and how you can help them with their practice and be supportive of the skills they are learning. There is always a space on there with my contact information and for you to write a note back to me as well.”

PARENT EDUCATION SESSION 2

Materials Needed:  Relaxation scripts  Cartoons: Cave People, Courage Card, Double Bubble  Tips for Listening to Your Child handouts

 I Can Do It Ladder

Schedule/Outline/Agenda: 1) Guide the group in what we mean by “thoughts” and how to identify them

2) Explain the idea of the Courage Cards and Double Bubble Practice to

Parents/Trusted adults 3) Provide rationale for individual meetings and guidance for trauma narrative/sharing 4) Describe Avoidance 5) Describe Ways to Gradually Face Anxiety and the “I Can Do It Ladder”

1) Introductions and Agenda

Introduce yourself and your role in the Bounce Back program or at the school. Briefly describe the purpose and agenda of the second parent education session.

“Today, in Parent Session 2, we will talk a bit about the thoughts and actions corners of the triangle. We’ll review thoughts and how children can focus on helpful thoughts, and on what avoidance is and how we address it in the program.”

2) Guide the group in what we mean by “thoughts” and how to identify them

Present cartoon pictures one by one, highlighting the thought bubble and the idea that

all of us have thoughts in our thought bubbles nearly all the time.

“Now we are going to move to the Thoughts portion of our triangle. Children in the Bounce Back program learn to first understand what thoughts are—we talk about what is in our thought bubbles---and then how to use the most helpful thoughts they can. The idea is that we all tend to have something in our thought bubbles most of the time even if we don’t notice what we are thinking.”

Show the group the cartoon of the Cave People .

Reiterate that there are different ways to think about a situation that affect what we feel and what we do.

“So there are lots of different things that can be in our children’s thought bubble even in the same situation. But what is in that bubble will definitely make them feel and act certain ways and even do one thing over another.

3) Explain the idea of the Courage Cards and Double Bubble Practice to Parents/Trusted adults

Courage Cards

“Helpful thoughts give children more power to do their best and to feel better. We give each child a courage card and have them write in a few helpful thoughts that they can use to be braver and feel better. These may be things like ‘I can do this, Nothing bad will happen to me, I can trust some people, I will try my best, Give it a chance, I am safe at school’ or things specific to each child and in their own words. Also, the image of the roaring lion can help remind them to be brave and powerful and to have courage to use thoughts that help them do their best and feel better.”

Double Bubble

“When the children practice using helpful thoughts, they can use a Double Bubble. This enables them to note what their first thought is in a situation and a more helpful thought they can use in its place to feel and do better. So if they accidentally broke their friend’s pencil and their first thought is that their friend will kill them or won’t like them anymore” a more helpful thought may be “Everybody makes mistakes. I can give him one of my pencils and he will still be my friend.” Or it may be something from his or her courage card, like “It will be okay. Nothing so bad will happen.”

4) Provide rationale for individual meetings and trauma narrative

Explain why processing or working through the child’s trauma story helps to reduce the frequency and intensity of their symptoms.

“The idea behind this part of the program is that although what happened was frightening and they may be grieving a loss, the memory of the event cannot harm them now and children can recover and lead full and healthy lives. Thinking and talking about it in a supportive environment with us, the group leaders, and then with you, their parents or trusted adult, enables them to process it so that when they are reminded of it, they do not feel as upset or scared by the memory. It is another way they can take charge of their symptoms and help all points of their triangle.”

“When we explain to the children why we want them to tell us their story, we use an example of having a splinter. If you get a splinter, say in your hand, and you just ignore it and try not to think about it, will it go away? No, it doesn’t go away, instead it keeps bugging you and getting red and swollen and hurting and getting worse so it seems like you will never be rid of that splinter. When we go through something really stressful or scary it is kind of like that splinter. We try to ignore it, avoid thinking or talking about it, but what we saw or experienced still affects us and keeps bugging us. To get rid of a splinter we sometimes have to dig at it a little bit and then pull it out. Now the digging and pulling may hurt temporarily, but then the splinter is out and the body can heal itself. Before we know it, we aren’t thinking about the splinter so much anymore as it is healing over.

So during our individual meetings with the child, we ask them to tell their story, and by talking about it and drawing it and sharing their memory of what happened, just like taking the splinter out, they will be able to start healing and not be so bothered by it. We can’t change what happened and that it was very [sad/scary/awful], but the memory of it cannot hurt them now and they can recover and lead full and healthy lives. The more they are able to work through their story, the easier it gets each time and the less they will find themselves thinking or worrying about it.”

Discuss the importance of the Parent/Trusted Adults’ Role in Hearing the Child’s Story.

“Hearing or seeing your child’s story can be difficult, but it is important for your child to be able to process the memory of their stressful event and feel comfortable sharing about it with you and opening the lines of communication so that your child can come to you in the future if they are thinking or worrying about the event.”

Let the parents know that they will be invited to come to an individual meeting with the group leader (you) where you will help prepare them to hear/see their child’s story of the stressful event. You will be able to review the child’s story with them, let them know what they may expect from their child’s response given your previous work with him or her, and anything their child expressed related to how their parents may be able to best provide support. You will also have time to remind them of some of the things that are reviewed during this parent session.

Explain that listening to the child’s story can be difficult.

“When your child is doing this work, it is important for parents or trusted adults to get some support as well. Just like your child needs your support, you may need some support also. In addition to it being hard to hear about bad things happening to your child, it can also remind you of bad things that have happened to you in your own life. Some parents don’t feel like it’s the right time for them to help their child in this type of work. If that’s true for you, we can come up with some alternatives, so just talk to me about it after the meeting tonight. “

Pass out and Review the Tips for Listening to Your Child handout:

Tips for Listening to Your Child

5) Describe avoidance

Explain that avoiding things that make us feel nervous or scared or uncomfortable makes sense, especially when we have been through something really stressful or scary. But avoiding things that we used to be able to do or that we need to be able to do can cause some real problems for us too. The following are examples you may use:

“Have any of you ever had to do something that makes you nervous or anxious? Maybe you performed in front of a group of people or had to give a speech? Have you ever felt so nervous about doing something like that and just wanted to not do it at all—maybe you found a way to get someone else to do it, or to cut it short, or just didn’t do it? This is very common for kids, especially young kids, and it can get worse when they’ve been scared by a difficult life event.

What happens when you avoid something you are afraid of? We explain it to the kids like this: If you were to skip it or avoid it, you may feel better right away, but actually over time you would feel worse because it gets harder and harder to do things we avoid. That feeling can be like a little snowball at the top of a hill because as we avoid doing something that makes us nervous, even if we feel better right that minute, over time that snowball starts rolling down the mountain and it picks up more snow as it goes and before you know it, it is a huge snowball you can’t even see over, so what was feeling a bit nervous becomes feeling very, very nervous—so much so that it seems huge like the giant snowball at the bottom of the mountain. So avoiding things makes our nervousness worse and we also miss out on things, like getting a good grade for participation in class or being at the school recital with our friends. This type of avoidance also applied to talking about the memory of stressful events (which we work on in those individual meetings when they create and share their stories. It can also apply to things that remind us of the stressful event we’ve been through. ”

6) Describe ways to gradually face anxiety and the I Can Do It Ladder

“In Bounce Back, we teach the kids how to work on these types of situations so that they can face them without feeling so worried or nervous. We explain that it’s by doing the thing we are nervous about, over and over, that makes it feel much easier.

“We’ll be developing “I can do it” Ladders with your children.

“We are going to start working on things that your child used to be able to do, but that makes them nervous or upset or feels hard to do now. Common

examples for kids this age are having difficulty sleeping alone, or being alone, wanting to stay home from school, avoiding trauma reminders that are safe (like the place where the scary event happened, even if it is a safe place now), and being in the dark.

“With your kids, we are going to only take really small steps and gradually move up to harder steps over time as they feel more comfortable . It’s kind of like when you want to go into the pool, but the water is a little chilly. First you just dip your toes in until they get used to the temperature of the water. Then you go in up to your knees, and it feels a bit cold again, but you can manage it and after that is comfortable you go in up to your waist and wait until you get used to that and then eventually your whole body is in the water and you are having a great time at the pool.

“This is part of the program where we really need your help as a parent or trusted adult. For these exercises to work their best, kids need to do them over and over again. Sometimes they’ll need you to take them somewhere for this exercise, or stay with them, or make time for them to do it.

“If you went through the scary event yourself, you might find this difficult because you might get anxious and nervous also. Or you might just worry about your child and want them to feel better faster and so it might be hard to sit with them when they are feeling anxious. We’d like to talk to you about any problems like that and help support you, so you can support your child.”

7) Wrap-Up

“So these are some of the ways we start to work with children on the thoughts and actions portion of their triangles. Next time we’ll talk about social support and problem-solving. If anyone cannot be at the next meeting, please let me know and we can try to see if there is another way for me to share the information with you. Thank you for taking the time to come today. Also, please remember that you are always welcome to contact me with any questions [supply contact information. I will also continue to communicate with you via a parent letter sent home with your child each time we meet.”

PARENT EDUCATION SESSION 3

Materials Needed:  Invisible String book  Who is on your team handout  What to do when your fear thermometer is rising  Two-step problem solving worksheet

Schedule/Outline/Agenda: 1) Explain the importance of social support and show how we teach it 2) Review “What to Do When your Feeling Thermometer is Rising” 3) Wrap-up

1) Introductions and Agenda

Introduce yourself again and your role in the Bounce Back program or at the school. Briefly describe the purpose and agenda of the last parent educations sessions.

Today, in Parent Session 3, we will talk a bit about the actions corner of the triangle, focusing on social support, and actions children can take to feel better to solve problems.”

2) Review importance of social support

“There are two ways we explain why social support is important to your children – one for younger kids, and one for older kids. I’m going to show them both to you.”

Show “The Invisible String” book to the group.

“I’m going to pass around the book that we read to the younger children. Take a look at it. It [describe here]. After we read this to the children, we ask them to draw the people that they can trust and rely on and feel positively connected to, and to glue string to connect the picture of themselves to the people they are connected to. We discuss how we all have different types of supports in different settings, and people we can get support from in different ways. There are some people that can help us with certain things, but not others, and it pays to have a variety of people in your life who can support you for different things at different times.”

Pass out the “Who is On Your Team” Handout.

“For the older kids, we ask them to use this worksheet to write down people that they feel they can rely on and go to for support when needed in different situations, with different feelings, and in different settings (home, school, after- school activities, weekends)..

“If you take a look at the ‘Who is on Your Team’ worksheet in front of you, you will see five different banners. Last time we talked about how having your child in a program like this can mean that you yourself needs some extra social support, so I’d like you to take a few minutes to fill out this worksheet for yourself. In the school section, you can think about support at work if you are working, or someplace else outside the home. You can change the headings so it makes sense for your life. ”

3) Review “What to do when Your Feeling Thermometer is Rising” as a way to problem solve

Explain for the group that everyone runs into some everyday real life-problems, and explain what they have control of and what they can’t control.

“We start by explaining to the children that when problems come up, there are a couple things that they have control over, no matter what else is happening. We tell them:

“Many times we have problems come up that are hard to handle. Sometimes it can be hard to figure out what to do. Sometimes you

don’t have a lot of control over things that go on during the day, at school, or in our family, especially when you are young and not in charge of things, like when your parents or other people that take care of you make a decision that upsets you, or something at school is causing a problem for you, or your friends are doing something that bothers you. Remember there are always two things that you can do that can help the problem:  You can control what you think about the situation [use helpful thoughts]  You can control what you do about the situation [make good action choices]

Distribute the “What to do when Your Feeling Thermometer is Rising” Handout.

“Take a look at the ‘What to do when Your Feeling Thermometer is Rising’ handout in front of you. By the time we use this worksheet, your children will have already learned some of the things on this list, like naming your feelings, relaxing your body, using courage thoughts, or going to a support person. In the group, we discuss different problems and how the children can use some of the things on the list to help with those problems. Using the solutions on this list or another potential solution they brainstorm, what might a child want to try from this list if: “  Somebody just bumped into them in the lunch line and they dropped their milk.  Their classmate is trying to copy their homework or test.  Their teacher tells them that they will be reading or performing in front of the school at an assembly.  They can’t stop thinking about the stressful event they have been through.

Discuss the different options on the list with parents or trusted adults. Be sure to emphasize that no judgment is placed on brainstorming solutions or actions. Anything goes and you can judge later when you are deciding the best course of action.

“After we make a list like this, we ask the children to act out a couple of the options that they came up with, to see how well they work. Then they evaluate which ones might make the problem better.”

4) Wrap-Up

“This is the end of the parent sessions. I hope that you’ve been able to see the different types of things your children have been learning, and have gotten some ideas about how you might be able to support and extend that work at home.

I’ll be in touch with you before the end of the program to see if you have any questions or concerns before the program ends.”