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Innovative and therapeutic school for students with neurological differences - The Monarch Institute Part 2

Innovative and therapeutic school for students with neurological differences - The Monarch Institute

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  • Part2 (This paper)

Edited by Dr. Bryant Shaw

D. The Monarch School

The Monarch School offers a research-based and learner-centered program, which focuses on four core goals, an educational and therapeutic approach with four core goals: self-regulation and self-awareness, executive functions, relationship development, academic and professional competence. They also believe that growth takes place within a developmental context, which includes four unique stages: Novice, Apprentice, Challenger and Voyager. For each level, students work on individual objectives within the four core goals.

Courtesy: The Monarch Institute for Neurological Differences

(1) Four Developmental Levels

Interviewer: Tell me more about the four developmental levels you have.

Dr. Shaw: Students tend to be grouped into cohorts that share a common developmental level, but that isn't hard and fast because each learner is unique. The programmatic level names that we chose actually make a great deal of intuitive sense so it starts with practicing as a novice. What is a novice? A novice is someone who doesn't know anything and maybe doesn't care to know anything.

That's usually where we're starting with people but that doesn't necessarily mean you're little. It might mean you have very severe symptoms or that you've been under identified or under treated for a long time or something else has you stuck at that level, like cognitive flexibility problems or something like that.

Interviewer: Who created those four levels?

Dr. Shaw: The founders and early leaders of the school. The next level up from novice has been called "apprentice." An apprentice is someone who's looking more to the teacher like how am I supposed to do this, so the spark of ownership for the skill development start to show at that level.

The burning question for the apprentice is, "How do you want me to do this?" When our novice students start to ask this question, we start to re-conceptualize their developmental level.

Interviewer: Do you help kids to learn from each other?

Dr. Shaw: Yes. The cohorts, you might call them classes are very deliberately constructed to allow for opportunities for observing people who were at higher level of mastery than you and perhaps a lower level as well.

Interviewer: How does age play for creating cohorts?

Dr. Shaw: They tend to be within 3 or 4 years age range in the same cohort. Let's say we have teenagers that are pretty severely symptomatic and maybe under treated, they may still have novice level objectives but we're not going to have those kids in the same room with the 7 year olds practicing the same objectives because they needed a different kinds of practice.

Interviewer: Let's say some students are strong in one area. How do you meet their academic needs in a mixed cohort?

Dr. Shaw: Individualized instruction comes into play to address each student's academic learning. Especially at these lower levels we're talking about because many students have novice level self-regulation basically but may have really strong academic competence, in which case your individualized academic instructions are going to be largely age appropriate or better.

Interviewer: How can teachers decide or determine that a student is ready to move on to the next level?

Dr. Shaw: It's a team thing. We're doing some standardized assessment pieces, like we're doing the Behavior Rating Inventory of Executive Functions (BRIEF), for example, regularly as an index of kids' change over time in the executive functions. So that's one way to look at readiness for the next level of practices.

Another very important consideration is the degree to which the person is regulated emotionally so if they have at least apprentice level skill in self-regulation and self-awareness, they have a better chance of entering a broader practice arena that's less self-contained. You would get more chances to practicing in the real world when you're better regulated, I guess.

Every stage of development has its own set of coping strategies that are developmentally appropriate and we try to begin in early childhood to teach coping, calming, what do you do with your emotions to help bring yourself back to equilibrium, to get ready to rejoin, where you begin your work.

(2) Curriculum

The curriculum at The Monarch School consists of Day School (school from August - May), Summer Programs (one month summer program), Life Academy (school-based business experiences), and the Get Out Program (outdoor education).

Interviewer: Your curriculum covers age appropriate academics? Do your students take the same standardized tests that public schools require?

Dr. Shaw: We use standardized assessment for some parts of our planning, but we do not use the STAR tests that public schools use. Student abilities vary widely here. We've had kids before, for example, whose math ability was so high that we didn't even have a faculty person that could do level of math so we had to contract with somebody to come in and teach the extremely advanced calculus pieces. You get what you need in this environment but you also get what you're ready for which can sometimes be tough to help parents understand.

Sometimes, kids may show plenty of evidence that their intelligence is intact enough to perform academically but perhaps their ability to sustain mental energy won't support that or their inhibition won't support that. We have to do quite a bit of re-education around the topic of obstacles to age appropriate learning. When students are ready to progress academically, the programs are there for them.

Interviewer: You have gifted students, I'm assuming. Do you have individualized instruction for them?

Dr. Shaw: Yes, we do. That's right. In all areas too, we have kids that are gifted in some pretty surprising ways.

Interviewer: Do your students take standardized tests like SAT and ACT? Those kinds of things like other students do?

Dr. Shaw: Yes.

Interviewer: Your staff can teach those classes to be able to help them?

Dr. Shaw: Yes. We also can do all the assessment pieces relevant to requesting accommodations, standard time for example. Because we have our own psychology clinic on site, we can competently do all kinds of assessment.

What we don't do is STAR testing which is the Texas Public School standard. We're much more about teaching kids to be ready for life, not teach them to be proficient at taking tests. We want to be sure they learn the material and can apply it. On the other hand, our curriculum is pretty standard and tied to accepted educational standards and we are an accredited education provider so that it's not like we just get to decide everything on our own.

Interviewer: What percent of your students transfer to other schools for typically developing students?

Dr. Shaw: Over the years, about 10% of our learners have returned to mainstream settings. For every kid for whom that's an appropriate goal, that's the goal we're working toward. This past academic year I know of two kids that we're transitioning out to a more mainstream kind of environment.

Interviewer: What percent of your students go to college or community college?

Dr. Shaw: About 30% of our 100 or so graduates have gone to engage in college course work after leaving Monarch. Also everybody who comes back to join with us for transition services to be a part of our voyager level of service provision is involved in some kind of ongoing self-betterment program be that volunteering, learning a job, or going to school.

We have quite a few kids in transitional services that go to Houston Community College.

E. Diagnostic Clinic
Courtesy: The Monarch Institute for Neurological Differences

The Monarch Diagnostic Clinic offers a wide variety of assessments for those who are interested in formal evaluations related to neurological differences (e.g., ASD). Not only does the clinical team establish a diagnosis, but also a multi-disciplinary team provides recommendations for a preliminary treatment plan based on each person's learning style, the areas of strength, and functional emotional development status. We offer specialized therapeutic services (DIR® therapy, psychosocial groups, speech/language services, individual tutoring, executive functioning development sessions, and educational consultations), which are open to the community: it is not required that anyone be a student of The Monarch School to receive therapy services.

Interviewer: At your clinic what is the average time between when they first contact you and they can actually see you?

Dr. Shaw: It's usually less than a month.

Interviewer: That is amazing. How can you do that?

Dr. Shaw: Because we get them in as quickly as we can. We keep space available in our schedule and the Institute sponsors our time to facilitate that. That being said, it takes time to analyze all the data in preparation for developing a treatment plan. We may be to get you in right away but it's going to take us a little while to think through what we're going to recommend to you.

Interviewer: Do you have comprehensive treatment plans put together by the research teams who gather all information?

Dr. Shaw: We do serial editing too, which means we take turns with the draft of the final report, with each of us adding our own clinical perspectives.

Interviewer: Why do you do this serial editing instead of putting it all together later?

Dr. Shaw: Simultaneously merging all the ideas got to be just nightmare-ish.

Interviewer: It's more of a process.

Dr. Shaw: That's right. The way it goes now, it just goes around the chain and then we review the final version together.

F. Therapy Services

Based on the strengths and challenges of each student and the Monarch's four core goals, they provide various types of therapies. Through the therapies, they intend to build emotional connections with the child, which, in turn, helps to develop their mind and brain. The options available to the families are (a) DIR Developmental, Individual-Difference, Relationship-Based Therapy (also known as DIR/Floortime™), (b) Speech/Language Therapy, (c) Occupational Therapy, and (d) Music Therapy.

Interviewer: Tell me more about executive functioning development sessions and DIR. Do you involve parents and how many hours do you do?

Dr. Shaw: Yes. Kids who are functioning at the novice level who are involved in our Chrysalis program have pull-out individual DIR therapy as part of their tuition and they get to do it with one of our master therapists. It is a requirement that a household member attend to the extent that's humanly possible and we really push for that.

Interviewer: At this institution or in the home setting?

Dr. Shaw: Here.

Interviewer: I see.

Dr. Shaw: We're pulling our novice level students out of class to do therapy. We want mom or nanny or dad to come so that what we are working on in therapy in terms of targets and what we're doing in terms of approaches is demystified for the parents and they get a chance to practice and hopefully set stage for them to better be able to extend the work home.

Interviewer: That's great.

Dr. Shaw: Yes. It's a requirement that parents be involved and that if looks like parents are under-involved or having trouble extending the work, we'll look for ways as a team to try to improve that. Then, through the year, we do as much parent education as we can find time for and there are really strong mechanisms in place for communication between team members which include parents. All of their communication goes to all the members of team simultaneously to facilitate exchange of information.

Interviewer: I'm just curious how you differentiate the parent education. Some parents have already experienced an ABA program, for example.

Dr. Shaw: Every family comes to us in a different place in that regard. Sometimes, it's the case that parents may bring us their pre-adolescent child and say, "We've done an ABA program and I think we're reaching the maximum of our benefit" and we may or may not agree with that. What we sometimes see in kids who only had an ABA approach is that they tend to be really oriented toward responding rather than initiating or being planful and purposeful so then they become reactive instead of proactive and ... that's not exactly the kind of citizen we want to shape.

We do sometimes have to re-educate families about experimental design and how to determine the agent of change when change occurs. For example, there are a lot of professionals and journal articles, et cetera that would seem to suggest that ABA is the only real therapy that's out there and that's a limited way of viewing what the data say about it. We have to ... without being disrespectful to another kind of system, we have to find ways to help enlighten parents about other aspects of functioning that may be at least as important as responding to prompts in expected ways.

Interviewer: Parents agree with what you do and that's why they send their kids here, right?

Dr. Shaw: Usually. Families experience varying degrees of difficulty adopting a new system, for example. Some families are more entrenched than others in their ways of being and family dynamics are really complex to work through, which is part of the reason why our Butterfly faculty in particular is pretty heavily populated with people that are professional counselors or marriage and family therapist.

G. Replication

Monarch Replication provides fee-based, hands-on assistance with planning, launching and maintaining new schools similar to The Monarch School throughout the world.

Interviewer: Now, I want to move on to questions about replication schools. How many do you have right now?

Dr. Shaw: There are two established. At the present time, there's a Colegio Monarch in Guatemala City, Guatemala. It was the first, followed by Monarch Therapy School in Mexico City, Mexico.

Interviewer: Would you mind telling me how much they end up paying at your school?

Dr. Shaw: The Replication program requires spending a year in Houston training with us, so there are those associated costs as well as the requirement that the group wanting to replicate our model can demonstrate financial sustainability.

H. Training Center

Monarch Training Center shares their knowledge on a local, national, and international level. They educate more than 2,000 parents, professional educators, therapists, medical and mental health professionals, administrators, superintendents and professors annually through Monarch's Minutes radio show and dynamic workshops and seminars.

I. Transition Services

The Monarch Institute offers a program that bridges the gap between school and adult life through providing local housing and employability training. They also provide coaching and case management for the students in transition so that they are ready for more independent self-management.

J. Others

Interviewer: What are your future goals for yourself as well as the goals for this institution?

Dr. Shaw: Let's start with me because what I'm trying to do for and through this institution is to raise the bar for the quality of assessment and treatment planning for children that are neurodevelopmentally divergent in early childhood, so that's our major focus and to forge that path where you've had to stay current on research and really think about what's effective from what we've recommended in the past and survey and follow up people to find out what they found easy to implement and what was hard.

I've had a long career in mental health and I've written thousands of reports for assessments in various settings and just the degree to which the faculty of the day school here really think intensively about the individual and how to support them has been very influential in us forging a more enlightening and helpful model of assessment for our clients. We use it for our core goal model and putting together a treatment plan for adults or children.

Interviewer: Do you follow up with your clients?

Dr. Shaw: We do that anonymously through survey so the responses we get, we don't really know exactly who they're talking about. That isn't necessarily always the case because one of the things we stress pretty heavily with all of our assessment plans is the need to repeat assessment fairly regularly and we typically recommend every three years like the school would recommend.

We find ourselves doing three-year intervals with quite a few kids and just recently, what was really remarkable was one of the kids that we saw that we viewed as one of our most interactively impulsive kids we've ever seen, his parents followed our treatment suggestions and then got creative, added some more that were really good to what we had suggested and the child came back a different person. I was able to substantiate his gains through scores on cognitive testing.

Interviewer: It's amazing.

Dr. Shaw: That's just one success being pulled out there but, yeah, when we do get to track these kids what we find is if the parents have made a concerted effort to follow through with our suggestions there usually is some solid improvement observable.

Interviewer: That's good to know and so your work must be so rewarding, seeing some of the changes.

Dr. Shaw: Absolutely. Yeah, it is. As I mentioned earlier, as our reputation grows, we often take cases that are more and more difficult and so I'm thrilled when some of the people that I saw initially who had such great obstacles to their functioning when they were young coming back and showing their progress. I often get to take another look at them and they're dramatically different after a lot of hard work. It tells me it's all worth it.

Interviewer: Yeah. Definitely. Thank you so much.

report_porter_noriko_02.jpg Noriko Porter
Noriko Porter is an Instructor in the Department of Human Development at Washington State University. Before immigrating to the United States, she worked as an Associate Professor in the Early Childhood Education Department at Hokuriku Gakuin College in Japan. She received a Ph.D. from the Department of Human Development and Family Studies at the University of Missouri, Columbia in 2008. Her current research interests are cross-cultural parenting, autism, and early childhood development. In 2012 she received the research excellence award from the Japan Society of Research on Early Childhood Care and Education for a manuscript based on early intervention programs for her son who is a child with autism. Since June 2013, she has worked as a visiting scientist, receiving training from Dr. Katherine Loveland at the Department of Psychiatry & Behavioral Sciences in the University of Texas Medical School, Houston. Recently, she has been awarded the Abe Fellowship for the 2015-2016 period.