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An Effective Model for Contingency Management

 Support When Your Child Is Struggling With Anxiety, Depression or Trauma

Parents will do just about anything when their child is in serious need. With dramatic increases in the diagnosis of adolescent anxiety and depression, families have become aware of the importance of early assessment, targeted treatment and continued support for their child. The stress that accompanies watching your child struggle, questioning if there were things that you, as a parent, could have done and worrying whether you made the right treatment decision can cause many sleepless nights and residual anxiety for parents themselves. Often, finding thoughtful, compassionate support for parents can be as important to decrease anxiety and increase effectiveness in learning how to best support both the child in need, their siblings and the parents themselves.

Think about the airplane model. Prior to a flight’s departure, everyone in the airplane is instructed that, in the event of an emergency or loss of cabin pressure, they should affix their own oxygen mask prior to assisting those around you. The thought process is simple: passengers are better and more effective at helping those around them when they have ample resources themselves. Parenting during a crisis can be viewed in a similar manner. Often, families in crisis only pay attention to their suffering child, neglecting their own needs for help and support, resulting in stressed and exhausted family systems that can be ineffective in supporting themselves or their child in need. When families attend to their own needs and access support while their child is in treatment, they become better and more effective parents and siblings to the child in crisis.

The CLICHÉ Model for Effective Contingency Management 

C   onsistent

 

L   ivable

 

I   ntuitive

 

C   ollaborative

 

H   olistic

 

E   stablished

 

Consistent
This is the foundation of contingency management! As we have learned from behaviorism, the most powerful type of reinforcement is intermittent. This means that when we are inconsistent with our established contingencies, we are reinforcing the very behaviors that we want to eradicate. It also means that once we are not consistent with our contingencies, it demonstrates that, at some point, we may be inconsistent in the future. It is very difficult to help our kids gain acceptance of the contingencies when they are under the impression that they could change. This can be particularly difficult if we are inconsistent due to fear, anxiety or being word down.
 
Livable
This is an important quality when establishing effective contingencies because our rewards and consequences have to be possible on a day to day basis. If we begin being frustrated with ourselves or resenting our own rules because holding the contingency makes our lives as parents miserable, they are not going to be effective because it will be difficult to remain consistent.
 
Intuitive
Contingencies should follow something that makes sense, both on the reward and consequence side, from the behavior that we are trying to positively reinforce or extinguish. It also allows us to hold a contingency that has some meaning or connection to the behavior itself. If the link between the behavior and reward/consequence is unclear, it will not serve as a good positive or negative reinforcer for the behavior.
 
Collaborative
The more buy in that exists around a contingency, the more likelihood it will have an effect on behavior. This is where it is important to ensure that everyone who is expected to hold contingencies is in agreement. There is a good chance that every parent has had to hold a limit or manage a contingency where they are not in agreement. It feels miserable. The collaboration should extend to the children or adolescents who will be most affected by the rules and rewards. Inviting children and adolescents to establish fair rewards and consequences is an important step to collaboration and family buy in.
 
Holistic
This relates to both the people involved in the management part of contingency management, as well as ensuring that the expectations all work well together. Do any of the rules, rewards or consequences cross anyone’s values? Do the rewards or consequences interfere with other parts of life, making them unenforceable. A holistic approach ensures that contingencies are clear to everyone involved and setting them is hard work, so try and set clear and behaviorally well-defined contingencies that will make the enforcement much easier.
 
Established
Imagine if societal expectations were supported by ‘in the moment’ rewards and consequences. Life would seem very chaotic. Family systems that do not take the time to establish logical, clear collaborative contingencies are operating in the same manner. The ongoing ‘prize’ of having well-established contingencies is that very little decision making has to occur in the moment of a success, struggle or when emotions are running high. Emotion-minded decisions often result in relieving anxiety or frustration through harsh and restrictive punishment that may not be logical once affect settles. It can also result in ‘eggshell parenting’, where families do not communicate or enforce/reinforce consequences or rewards. By having a clean and established contingency plan, it takes the pressure out of under- or over-reacting because the big decisions have already been made.
 
Remember:
There are times that, in spite of good planning and intentions, things come up. If a situation arises where a contingency must be changed in the moment based on unexpected circumstances, make the change in the reward/consequence in a transparent manner and explain why a parent is not able to be consistent. For more information on Paradigm’s acclaimed family programming or to view our outcome research, please visit us at www.paradigmmalibu.com