Running head: COUNSELING CASE STUDY

MA/CAGS School Psychology Portfolio

Counseling Case Study

Kelsey Evans

William James College

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Counseling Case Study

Background Information

Jacob is a five-year-old kindergarten student attending ABC Elementary School. School records indicate

that Jacob attended XYZ Day Care prior to beginning kindergarten. According to school records, Jacob

demonstrated some behavioral concerns in the classroom setting while enrolled at XYZ Day Care, as he often had

difficulty accessing his more beneficial skills due to impulsivity, distractibility, and disorganization. According to

school records, Jacob was referred for an initial evaluation by his mother through the ABC School District

Committee on Preschool Special Education at age three due to concerns regarding his behavior and motor

development. At that time, Jacob was identified as a preschool child with a disability, though his disability

category remained unspecified during his preschool years. According to preschool records, he was primarily

demonstrating social-emotional concerns as demonstrated by difficulty being a part of the class and cooperating

with others (e.g., pulling toys away from other students; yelling out; running around the classroom). He would

reportedly act out in class by pinching and biting. Additionally, Jacob’s gross motor development (i.e., crawling

and walking) was significantly delayed. Reportedly, when Jacob presented as anxious or tense in the classroom

(i.e., not doing work, raising his voice), he would require direct support to regulate himself and return to the

expected activity. In March of 2018, Jacob was diagnosed with Attention Deficit Hyperactivity Disorder-

Combined Type by Dr. C. of XYZ House.

Jacob was referred for a supplemental Functional Behavior Assessment (FBA) by the ABC School

District Committee on Preschool Special Education in May of 2017 to address continuing behavioral concerns in

the classroom setting. Jacob’s behavior at the start of his kindergarten year has been rather inconsistent, making it

difficult to steadily manage his behaviors when he is dysregulated. As a result, his Behavior Intervention Plan

(BIP) was recently revised to better address his specific concerns in the current elementary school setting. The

behaviors outlined in the FBA and BIP include disruptive behaviors (e.g., running, crawling hiding) and

aggressive behaviors (e.g., hitting, kicking, spitting, pinching, biting, hair-pulling). See Figure 1 for a visual

representation of Jacob’s disruptive and aggressive behaviors by day over almost four school weeks.
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Disruptive Behaviors Aggressive Behaviors

7
Number of Occurrences

6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Day

Figure 1. Total frequency of disruptive and aggressive behaviors by day.

On several occasions this year, Jacob’s behaviors led to unsafe situations for both himself and his

classmates and therefore, the school staff trained in crisis intervention and behavior management through the

Handle with Care Behavior Management Program had to intervene to implement a restraint. Jacob’s parents were

informed after each restraint was performed and if he was restrained two times or more in one day, he was to be

picked up because he could not be maintained. After several restraints were performed over the course of a week,

there was a temporary plan put in place to promote greater success in which Jacob’s school days were shortened.

However, even during these shortened days, Jacob’s behavior was quite variable, and his behavior led to restraints

on two of the five shortened school days. With limited success on his shortened days, Jacob went back to his

regular school day schedule. At this point, when two or more restraints were performed, the special education

director advised the school staff to suspend him for the day for which the suspensions would be contributing to

the ten-day limit under the Individuals with Disabilities Education Act (IDEA) (Lee, 2018). See Table 1 for a

chart of Jacob’s restraints and suspensions to date.

Table 1
The Frequency of Restraints and Suspensions by Month
Month Restraints Suspensions
September 0 0
October 10 2
November 6 1
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Problem Identification and Analysis

The data shown in Figure 1 has informed Jacob’s current behavior plan thus far. Teacher reports and

antecedent-behavior-consequence observations indicate that Jacob’s disruptive and aggressive behaviors are often

triggered by non-preferred activities, conflicts with peers, transitions in and out of the classroom, and bathroom

use. During observations, Jacob typically demonstrated disruptive behaviors such as crawling, running, hiding,

blocking and yelling. Based on observation, Jacob begins to laugh or presents with a smile on his face making

many believe that it feels like a game to Jacob and/or reinforces the behavior. When the behavior is ignored, the

situation typically escalates, as Jacob will intensify the behavior or switch to a more aggressive behavior to

warrant adult attention. Attempting to redirect Jacob with a different activity (usually one that is more preferred)

can sometimes result in a reduction of the behaviors but has not consistently been a successful de-escalation

strategy. Occasionally, Jacob will not respond to redirection and will see taking a break as a way to escape the

classroom and start running around the building.

Jacob’s aggressive behaviors include hitting, kicking, spitting, pinching, hair pulling and biting. More

recently, Jacob has started to throw furniture, such as classroom chairs or stools and materials within his reach.

According to behavioral data, Jacob will sometimes state that he is going to engage in one of the abovementioned

aggressive behaviors prior to him acting on it. Other times, Jacob’s aggressive behaviors don’t seem to be

intentional, in that he is just trying to escape a situation. Jacob can escalate to aggressive behaviors in a matter of

seconds, making it difficult to detect consistent antecedents and/or “catch it” before the situation fully escalates.

Given Jacob’s behavioral concerns displayed throughout the first several months of school, the team met

and agreed that psychological counseling be added as a related service with the goal of helping Jacob identify

emotions and utilize coping strategies. Before counseling began, I spoke with Jacob’s parents and met with his

classroom teacher and special educator as part of the intake process. I consulted with them regarding relevant

history and their perceptions of the presenting problem. I also reviewed his school records and observed him in

his classroom and specials, as many of his behaviors occur during these times. Overall, Jacob is easily

overwhelmed and overstimulated in a large classroom setting, which manifests in many problem behaviors (i.e.,

running, hitting, kicking). It appears that Jacob’s challenges are manifesting as externalized behaviors but may
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truly be a function of his self-regulation challenges related to the demands of school and the feelings he

experiences when faced with challenging or non-preferred tasks. When considering the presenting problem, it is

critical that various factors be considered including those related to diversity. In this regard, Jacob’s internal

social-emotional struggles and demonstrated behaviors do not seem to be impacted by issues of diversity but

rather by extreme irritability, impulsivity, sensory sensitivity, and anxiousness, characteristics consistent with his

diagnosis of Ring of Fire ADD, a more specific type of attention disorder identified by Dr. A in October of 2018.

Considering the information gathered through observations, record reviews, teacher and parent

interviews, and data collection, a hypothesis was formed to summarize Jacob’s current social-emotional

difficulties. Developed in collaboration with Jacob’s parents and teachers, the hypothesis theorizes that Jacob’s

challenges in responding to transitions and non-preferred activities with school-appropriate behaviors are

adversely affected by his impulsivity, which impacts his ability to identify personal feelings, utilize effective

coping strategies, and maintain appropriate behavior. An alternate hypothesis involves a lack of school readiness,

characterized by weak executive functioning skills, which negatively affects Jacob’s ability to self-regulate and

engage in learning activities. Further, his home environment may lack structure and expectations that conflict

with the expectations put on him during school.

During my first counseling session with Jacob, my primary goal was to build rapport by validating what

he was saying and asking simple questions to garner additional information. During this time, Jacob played with

various sensory toys (e.g., fidget cube, therapy putty, animal figurines) as I explained the limits of confidentiality

in age-appropriate terms and shared that I would be seeing him every Thursday morning for 30 minutes. We

spoke casually about many different topics including his twin brother and who he likes to play with at recess. I

asked him to identify things he is good at and things he would like to get better at. He had some difficulty

thinking of specific items independently and therefore, I offered suggestions, for which he responded to the best

of his abilities. During the second session, I used a social skills activity from speechtherapyfun.com to measure

Jacob’s baseline ability to identify feelings in hypothetical situations (See Appendix B). Jacob accurately

identified nine of 20, or approximately 45%, of scenarios with appropriate or expected feelings. Then, a Goal

Attainment Scale was developed to identify specific, concrete goals for Jacob to work towards (see Table 2). A
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total of five goals were developed to develop Jacob’s self-coping and emotional regulation skills; however, goals

one and two were the primary focus of this case study.

Table 2
Goal Attainment Scale for Goals One and Two
Goal 1 Goal 2
Level of When given a hypothetical situation, When given a hypothetical social situation,
Attainment Jacob will accurately identify feelings of Jacob will accurately identify coping
characters. strategies to be used.
+2 Jacob will accurately identify feelings in Jacob accurately identifies 5 or more coping
Much More more than 60% of hypothetical situations. strategies when given a hypothetical situation.
than Expected
+1 Jacob will accurately identify feelings in Jacob accurately identifies 3-4 coping
More than 50-60% of hypothetical situations. strategies when given a hypothetical situation.
Expected
0 Jacob will accurately identify feelings Jacob accurately identifies 1-2 coping
Expected Level in 40-50% of hypothetical situations. strategies when given a hypothetical
of Outcome situation.
-1 Jacob will accurately identify feelings in Jacob accurately identifies one coping strategy
Less than 30-40% of hypothetical situations. when given a hypothetical situation.
Expected
-2 Jacob will accurately identify feelings in Jacob is not able to identify any coping
Much Less less than 30% of hypothetical situations. strategies when given a hypothetical situation.
than Expected
Note: Baseline performance is indicated in bold text and post-intervention data is indicated in italics.

Intervention Design

Considering both Jacob’s baseline ability to accurately identify his feelings in 45% of hypothetical

situations and the information gathered from the problem identification and analysis processes, the primary goal

of the current intervention is for Jacob to accurately identify his feelings in more than 50% of the presented

hypothetical situations. On top of that, Jacob will work on improving his ability to identify coping strategies

when presented with such hypothetical situations. Finally, when asked to reflect on an event at school, Jacob will

work to accurately identify his own feelings more than 50% of the time. It is hoped that Jacob is able to

effectively master each of the presented goals. For the purpose of this case study, goals one and two will be the

primary focus. Should he master the three abovementioned goals, two additional goals (i.e., Goal Four: When

reflecting on a behavioral incident of his own, Jacob will accurately identify a self-regulation/coping strategy that

he could have used; Goal Five: When Jacob becomes upset, frustrated, or angry, he will identify and utilize self-
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regulation/coping strategies (e.g., movement break, deep breathing, quiet space break, deep pressure/heavy work

activity, etc.) to maintain school-appropriate behavior) will be addressed.

The research suggests that self-regulation is closely correlated with school success (Duckworth &

Carlson, 2013). The ability to regulate emotions, reflect on experiences, and engage in positive social interactions

with teachers and peers is critical in developing school-appropriate behaviors that will contribute to future success

(Blair & Raver, 2014). Furthermore, emotional awareness is an essential component of social problem solving

(Duckworth & Carlson, 2013). With the supporting research in mind, intervention procedures were developed to

increase Jacob’s ability to identify feelings of others as well as himself in addition to identifying and utilizing

appropriate coping strategies in school. To do so, various materials were adapted from evidence-based programs

such as the Promoting Alternative Thinking Strategies (PATHS) curriculum and the How Does Your Engine Run

program to assist Jacob in building his skills in regard to emotion identification and self-regulation. During each

session, Jacob was presented with a short activity designed to target one or both of the first two goals (See

Appendices B-F for activity examples and materials). Each session ended with several hypothetical situations

being presented in order to collect accurate intervention data. For each hypothetical situation, he was asked to

identify how each person is feeling and identify as many coping strategies as possible to address that feeling.

The current intervention plan is designed to be conducted over an eight-week period in which Jacob will

meet with the counselor weekly on Thursday mornings for thirty minutes in the school psychologist’s office. In

order to implement the intervention, feelings identification cards will be required to evaluate Jacob’s progress

with the first goal. Additional activity materials adapted from evidence-based programs (e.g., PATHS and the

How Does Your Engine Run program) were used to help support the development of Jacob’s self-regulation

skills. At various points throughout the intervention, Jacob’s teachers and mother were contacted to provide

progress updates.

As previously mentioned, the first meeting with Jacob consisted of building rapport and baseline data was

collected during the second session. When he offered an answer that did not fit the scenario, the counselor

presented a feeling word that was more appropriate. Several times during this activity, Jacob asked, “What does

that mean?” to which the counselor explained the feeling in developmentally-appropriate language. During
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baseline data collection, the number of Jacob’s correct responses was divided by the total number of scenarios in

order to calculate a percentage that was then plotted on a graph representing each level of the goal attainment

scale. For each session, data was collected in the same manner by the counselor. For Jacob’s second goal, the

number of accurate responses provided by Jacob was compared to the goal attainment scale levels and plotted

accordingly. Communication between the counselor and Jacob’s teachers and parents will be ongoing through the

duration of the intervention.

While the research suggests many effective, evidence-based practices, there are almost always unintended

outcomes or limitations of the planned intervention, particularly in school settings. In this case, Jacob’s

behaviors resulted in safety concerns and therefore, several restraints were performed. It is difficult to know the

unintentional aftereffects that such practices may have on a five-year-old student, consequently affecting his

progress in counseling. Furthermore, several scheduled counseling sessions were not held due to various reasons

including two suspensions and a snow day, which likely impacted the effectiveness of the intervention. Due to

the counselor’s role as a school psychology intern, only one of the three canceled sessions was able to be made up

in the same week. On at least one occasion, Jacob was in an escalated state when the counselor went to his

classroom to bring him to counseling, which not only required time to help him regulate but also suggests that he

may not have been as emotionally available as he would have been had he entered the session in a calm manner.

Given Jacob’s development, it is difficult to gauge how much the interventions will generalize to other settings,

especially with added demands.

To monitor the integrity of the intervention, the counselor intends on taking weekly case notes that

include the treatment plan, adherence to the intervention design, and progress on Jacob’s functioning in regard to

the goal attainment scale.

Intervention Evaluation

Jacob’s baseline data and progress for each of the two measured goals are visually represented below in

Figures 4 and 5. The baseline and progress monitoring data reflected below align with each defined level of the

goal attainment scale (see Table 2). Compared to Jacob’s baseline level of performance, the progress monitoring

data reflects effective progress. Goals one and two were targeted simultaneously, as they both required a
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hypothetical situation to be presented. Considering the progress reflected below in Figures 4 and 5, the focus of

counseling will now shift to target goal three. Upon attainment of goal three, Jacob’s work in counseling will

again shift to target goals four and five. Throughout the duration of the intervention, Jacob was often engaged in

the work. However, he required several breaks and a behavioral reinforcement (i.e., three minutes of playing with

fidget toys) was offered if he completed the tasks asked of him. Periodically, he was asked questions such as

“What do you think of these situations?” and “How are these activities helping you?” his feelings seemed to

change from session to session. Sometimes, he would be eager to participate, saying “What’s next?” and “You

can’t trick me,” but other times he was disinterested, asking when we could do something else.

2 2
Goal 1 Level of Attainment

1 Goal 2 Level of Attainment 1

0 0

-1 -1

-2 -2
1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
Weeks Weeks

Figure 4. Goal attainment progress for goal 1. Figure 5. Goal attainment progress for goal 2.

Toward the latter half of the intervention period, Jacob’s mother and teachers were consulted regarding

their perceptions of Jacob’s progress after participating in counseling for many weeks. While both stakeholders

(i.e., Jacob’s mother and classroom teacher) perceived positive changes in Jacob’s ability to identify his feelings

and “use feeling words,” they also acknowledged the continued need for counseling in school to assist in the

generalization of identifying his feelings and appropriate coping skills as well as applying his coping skills during

behavioral incidents. At home, Jacob’s mother shared that she has seen less conflict between Jacob and his twin

brother and an overall decrease in how often she must intervene.

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After reflecting on the success of the intervention, it was encouraging to see progress in Jacob’s ability to

identify feelings and coping strategies in various situations. For Jacob, in particular, it was important to build a

strong, therapeutic relationship and to encourage him to seek out additional support at school when needed. As he

continues to work on the identified goals, it is important to consider the small gains that he has made along the

way. He has spent more time in his general education classroom, supported by a teaching aide than he did prior to

counseling. He has increased his feelings vocabulary and continues to utilize more feeling words. The increment

between each goal is manageable for Jacob and each successive goal builds upon the one prior, ultimately leading

to a goal in which Jacob will be able to identify and utilize coping strategies in school to maintain school-

appropriate behavior. In my work with Jacob, I found him to be bright and generally receptive to our work. I

attempted to motivate him through more challenging activities and engaged regularly in conversation with him.

He quickly became comfortable with me as I also spent time in his general education classroom.

It will be critical to transfer counseling work to other settings to support Jacob’s attainment of his goals.

In order to reach his final goal, it will be important for Jacob to practice feelings identification and coping

strategies in various settings, including the resource room, general education classroom, and lunchroom in

addition to at home. In order to see him accomplish this, all adults working closely with him (e.g., teaching aide,

special education teacher, specials teachers, parents, etc.), should encourage consistent language and positive

reinforcement when he verbally expresses his feelings or engages in a coping strategy. Ongoing communication

with all relevant stakeholders will be beneficial to promote Jacob’s school success.

To address appropriate follow-up, it is determined that I will continue to see Jacob during our regularly-

scheduled Thursday morning meeting time. Additionally, I will continue to keep weekly case notes and monitor

his progress using the goal attainment scale with the addition of goals three through five. Given Jacob’s

behavioral difficulties and academic challenges, he will continue to receive counseling services as mandated by

his Individualized Education Plan (IEP) for the remainder of the school year. His goals will be monitored and

adjusted according to his progress. Jacob will be made aware of when counseling will end and the plan for next

year, given my role as an intern. Finally, the termination of our counseling sessions will naturally end as the

school year concludes.

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References
Blair, C., & Raver, C. C. (2014). School readiness and self-regulation: a developmental psychobiological

approach. Annual review of psychology, 66, 711-31.

Duckworth, A. L., & Carlson, S. M. (2013). Self-regulation and school success. In B. W. Sokol, F. M. E. Grouzet,

& U. Müller (Eds.), Self-regulation and autonomy: Social and developmental dimensions of human

conduct, (pp. 208-230). New York: Cambridge University Press.

Lee, A. M. I., (2018) School Discipline: The Rights of Students with IEPs and 504 Plans. Retrieved November 5,

2018, from https://www.understood.org/en/school-learning/your-childs-rights/basics-about-childs-

rights/school-discipline-the-rights-of-students-with-ieps-and-504-plans
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Appendix A: Abbreviated Session Notes

Session 1
- Check-in
- Rapport-building
- Limits of confidentiality
Session 2
- Check-in
- Continued rapport building
- Feelings identification activity to collect baseline data for goals one and two (Appendix B)
- Introduction of coping strategies (Appendix C)
Session 3
- Emotion cards with prompts activity (Appendix D)
- Process of activity
- Further exploration of preferred coping strategies
Session 4
- Check-in and de-escalation from classroom incident
- Feeling and coping strategy activity
- Introduction to “How Does Your Engine Run?” visual (Appendix E)
- Reinforcement of coping strategies
Session 5
- Check-in; Jacob was more hesitant to activities
- Check-in with “How Does Your Engine Run?” visual
- Introduction of PATHS “Turtle Technique” (Appendix F)
- Reinforcement offered after activity to increase motivation
- Feelings and coping skills identification
Session 6
- Emotions wheel activity (Appendix G)
- Application of “Turtle Technique”
- Feelings and coping skills identification
Session 7
- Guess the emotion PowerPoint activity
- Feelings and coping skills identification
Session 8
- Check-in
- “I Know What to Do” activity (Appendix H)
- Feelings and coping skills identification
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Appendix B: Feelings Identification Cards (www.speechtherapyfun.com)

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Appendix C: Coping Strategy Cards

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Appendix D: Emotion Cards with Prompt Cards

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Appendix E: “How Does Your Engine Run?” Visual

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Appendix F: PATHS “Turtle Technique”

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Appendix G: Emotions Wheel (www.childhood101.com)

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Appendix H: “I Know What to Do” Activity