Preventing+Eating+Disorders

Component #1: Needs, Goals & Objectives

Eating disorders are on the rise and anorexia nervosa is a major concern within our schools. Girls within the Western society are being held to and compared with an expectation of thinness. Ads and media portray the image of beauty as the determination of successful within our society. Girls starting as young as 9 are becoming concerned with their body weight (Bardick, 2004). According to the National Association of Anorexia Nervosa and Associated Disorders, anorexia is the 3rd most common chronic illness among adolescents and over one third teenage girls use unhealthy weight control behaviors such as missing meals, fasting, smoking cigarettes, vomiting, and taking laxatives. The National Alliance on Mental Health states that more than 90% of anorexia cases affect adolescent and young women. A document analysis of teacher surveys, student surveys, and parent surveys was conducted. The teacher surveys reviled that 80% of teachers believe that low self-esteem is affecting students’ academic performance. Student surveys indicate that 90% of students, 80% females, are concerned with their appearance and body image. 80% of parent surveys signify that they are concerned with the pressures of physical appearance issues within their child. A group for 5 adolescent girls between the ages of 12 and 14 will be conducted based on referrals and observations from the school nurse and classroom teachers made in reference to low self-esteem and visible pressures they are experiencing. Referrals will be put through a screening process to identify which students are more compatible to work together. Cultural and ethnic backgrounds will be researched to determine the most beneficial candidates for the group. The group will meet over the course of 8 weeks in the guidance counselor’s office. Group Goal: Educate students about the causes and dangers of eating disorders. Professional school counselors need to create data-driven, needs-based programing to identify the significance of their program to administrators and other officials. Their programming needs to be justified and related to promoting students success. Counselors also need to consider and incorporate the mission of the school when creating a program to ensure the students needs and professionalism is addressed. Working with administrators and other academic officials increases the success of the counseling program and benefits the students. Component #2: Research- Supported and Standards-Based Content Students will be given a pre and post assessment to measure the knowledge and understanding gained from the session. See attached assessments. ** Opening ** 1. Welcome students back to the group and collect any consent forms from prior group session. 2. Icebreaker activity: 3 truths and a fib 3. Review rules created by students and confidentiality laws. Students will be reminded of the reasons for necessary breaches of confidentiality. 4. Introduce the goal of the group and introduce objectives for the session. ** Working/Processing ** 1. Introduce the topic of eating disorders and discuss the various types of eating disorders (anorexia nervosa, bulimia nervosa, disordered eating). 2. Focusing on Anorexia Nervosa discuss the definition (a condition characterized by being dangerously underweight) and identify statistics of anorexia nervosa in adolescent girls (95% of anorexics are females). What does it mean to be anorexic and why do you think the majority affected are females? 3. Discuss what causes anorexia. -Family pressures -Social Pressures -Family History -Strict Dieting -Difficulty Expressing Feelings -Transitions (social & Biological) Do you ever experience any of these situations? How do they make you feel? 4. Discuss the affects of anorexia nervosa. (See attachment) -Brain and nerves -low body weight -Lack of energy and weakness -Tooth decay and gum damage -Muscles & Joints -Heart -Hormones -Skin 5. Discuss how anorexia affects everyone. Introduce some celebrities that have experiences the illness. Use some of the following questions to drive discussion. -Who do you think anorexia nervosa affects? -Think about your favorite celebrities/entertainers? Why do you like them? Do you like the way they look? -Do you think celebrities always feel good about the way they look and themselves? -Have you watched or listen to anything that has made you feel bad about yourself this week? -Explain to students that everyone experiences these feelings even if they seem “Perfect” on the outside. 6. Now we are going to listen to music that deals with issues of self-esteem, body image, and eating disorders. -What do you think the song title means? -How does the title relate to the lyrics? -What is the songwriter saying? What do you think they were feeling when they wrote the song? -How did the song make you feel? Was it expressing feelings that are similar to your own? -What do you think her message is? -What are some familiar ideas or terms you hear in the song? (“good enough”, “win first place”, “good girl”) -What teen problems are related to these ideas? (Parental pressures, peer pressure, competition) ** Closing ** 1. Review concepts discussed in session. 2. Tell students between sessions to pay attention to how things in the media make them feel. 3. Assign homework/own-work.
 * 1) Student identifies two __existing__ data sources and one other approach for assessing student needs and describes how these data sources will be analyzed in order to identify needs and gaps in achievement. **
 * 2) Student develops one overarching goal for the group program based on identified need; the goal aligns with the academic mission of schools. **
 * 3) Student develops __two__ measurable objectives for session #1 of the structured group program that supports the established goal (__one__ school counseling content and __one__ mathematics content). **
 * Session 1: **
 * Objective #1: After discussing eating disorders and been given the definition of anorexia, students will identify 4 situations and outcomes related to anorexia.
 * Objective #2: Given songs to listen to and lyrics to read students will identify themes of self-esteem, body image, and eating disorders by interpreting them both subjectively and objectively.
 * 4) Student develops __two__ measurable objectives for session #2 of the structured group program that supports the established goal (__one__ school counseling content and __one__ language arts content). **
 * Session #2: **
 * Objective #1: After discussing causes that lead to anorexia students will identify 4 triggers.
 * Objective #2: After identifying triggers that lead to anorexia nervosa students will list and order personal triggers by personal severity.
 * 5) Student briefly describes the importance of data-driven, needs-based programming that clearly aligns professional school counseling with the mission of schools. **
 * 1) Student provides step-by-step process and activities to be covered in session #1 (research support for theoretical orientation and techniques required from at least one scholarly peer reviewed counseling journal, preferably ASCA’s journal, //Professional School Counseling//. Cite/attach handouts to be used. **
 * Title of Session #1: ** A Sad Tune
 * Brief Summary of Session: ** This session is going to introduce the topic of anorexia nervosa. We are in the second session entering into the working stage. The focus of this session will be to identify causes, effects, and population of anorexia. Students will be given the ability to interpret and internalize the meaning of music and how it is connected to anorexia.
 * Theoretical Orientation: ** Cognitive behavioral therapy examines contradictions in thought and behavior; specific purposes of eating disordered symptomatology, advantages and disadvantages of beliefs and behaviors, as well as the costs and benefits of change (Choate, 2007). In working toward a change in behavior and belief system cognitive behavioral therapy will be beneficial. Helping the client develop self-esteem and confidence is key in preventing eating disorders and disordered eating. In addition a psycho-educational approach would also be beneficial to provide objective information to confront unreasonable thinking related with eating disorders (Choate, 2007). Adolescents need to be made aware of the situations and conditions that lead to eating disorders and the outcomes.
 * Specific Group Technique: ** Socratic questioning and Journal writing
 * Structure: ** This group will be a closed group consisting of five 6th and 7th grade girls between the ages of 12-14. The group will meet for 60 minutes once a week over 8 sessions. The sessions will meet during the student’s special period rotating days every week in the attempt that the students do not miss the same class consistently. The first session will be a welcome meet and greet session. Students will be given an opportunity to get to know and be comfortable with the counselor and other members. The following 6 sessions will be divided focusing on anorexia nervosa and bulimia nervosa. The last session will focus on termination and address future referrals for other sessions.
 * Materials/ Media: ** song, copies of lyrics for each student, pens,
 * Core ASCA Standard(s): **
 * A: A1.1 Articulate feelings of competence and confidence as learners
 * A: A2.3 Use communications skills to know when and how to ask for help when needed
 * PS: A1.1 Develop positive attitudes toward self as a unique and worthy person
 * PS: B1.2 Understand consequences of decisions and choices
 * PS: C1.7 Apply effective problem-solving and decision-making skills to make safe and healthy choices
 * Core State Academic Standard(s): **
 * 3.3.7.A.1-7) Use verbal and non-verbal language to communicate ideas in personal, group, public, and global situation.
 * (3.3.7.B.1-8) Demonstrate effective use of a variety of questions, including literal, inferential, and evaluative through  group discussions and interviews.
 * (3.5.7.B.1-5) Interpret verbal and non-verbal messages in media.
 * (3.4.7.B.1-7) Effectively listen, comprehend, and analyze what is heard from a variety of sources.
 * Objectives: **
 * #1: After discussing eating disorders and been given the meaning of anorexia, students will identify 4 situations and outcomes related to anorexia.
 * #2: After listening to songs and reading lyrics students will identify themes of self-esteem, body image, and eating disorders by interpreting them both subjectively and objectively.
 * Assessments ** :
 * Procedures/Instructional Strategy: **
 * Play the song “Perfect” written by Alanis Morissettte. Tell students to just listen to it and pay attention to how it makes them feel.
 * Distribute the lyrics to students and play the song again. Ask students to follow along as they listen to the song.
 * Use following questions to guide the discussion:
 * Alanis Morissettte has admitted to struggling with anorexia nervosa. In her song perfect she is sending a message.
 * Homework/Own-work ** : Think about the song you listened to and determine if you like or dislike it. If you did like it, describe one experience in your life that relates to the emotions expressed. If you did not like it explain how you feel differently and give an experience to support your feeling. Journal your responses and bring them to the next session.


 * 2) Student provides step-by-step process and activities to be covered in session #2 (research support for theoretical orientation and techniques required from at least one scholarly peer reviewed counseling journal, preferably ASCA’s journal, //Professional School Counseling//. Cite/attach handouts to be used. **
 * Title of Session #2: ** Let’s Cope
 * Brief Summary of Session: ** In this session we will continue through the working stage. During this session students will identify and discuss triggers and how they relate to anorexia nervosa. They will discuss how they encounter and are affected by specific triggers. IPED will be used to teach students ways to cope with triggers.
 * Theoretical Orientation: ** Cognitive behavioral therapy examines contradictions in thought and behavior; specific purposes of eating disordered symptomatology, advantages and disadvantages of beliefs and behaviors, as well as the costs and benefits of change (Choate, 2007). In working toward a change in behavior and belief system cognitive behavioral therapy will be beneficial. Helping the client develop self-esteem and confidence is key in preventing eating disorders and disordered eating. In addition a psycho-educational approach would also be beneficial to provide objective information to confront unreasonable thinking related with eating disorders (Choate, 2007). Adolescents need to be made aware of the situations and conditions that lead to eating disorders and the outcomes.
 * Specific Group Technique: ** Students will Role Play in order to apply IPED to various situations.
 * Structure: ** This group will be a closed group consisting of five 6th and 7th grade girls between the ages of 12-14. The group will meet for 60 minutes once a week over 8 sessions. The sessions will meet during the student’s special period rotating days every week in the attempt that the students do not miss the same class consistently. The first session will be a welcome meet and greet session. Students will be given an opportunity to get to know and be comfortable with the counselor and other members. The following 6 sessions will be divided focusing on anorexia nervosa and bulimia nervosa. The last session will focus on termination and address future referrals for other sessions.
 * Materials/ Media: ** paper, pen,
 * Core ASCA Standard(s): **
 * A: B1.5 Organize and apply academic information from a variety of sources
 * A: C1.4 Demonstrate an understanding of the value of lifelong learning as essential to seeking, obtaining and maintaining life goals
 * PS: B1.12 Develop an action plan to set and achieve realistic goals
 * PS: C1.11 Learn coping skills for managing life events
 * Core State Academic Standard(s): **
 * A: B1.5 Organize and apply academic information from a variety of sources
 * A: C1.4 Demonstrate an understanding of the value of lifelong learning as essential to seeking, obtaining and maintaining life goals
 * PS: B1.12 Develop an action plan to set and achieve realistic goals
 * PS: C1.11 Learn coping skills for managing life events
 * Objectives: **
 * #1: After discussing 5 causes that lead to anorexia students will identify 4 triggers.
 * #2: After discussing triggers students will develop a strategy for coping (IPED).
 * #3: After identifying triggers that lead to anorexia nervosa students will list and order personal triggers by frequencies.
 * Assessments ** : Students will be given a pre and post assessment to measure the knowledge and understanding gained from the session. See attached assessments.

** Opening ** 1. Welcome students back to the group 2. Icebreaker activity 3. Review rules created by students and confidentiality laws. Students will be reminded of the reasons for necessary breaches of confidentiality. 4. Review previous sessions homework 5. Introduce the goal of the group and introduce objectives for the session. Working/Processing 1. Introduce the term “Triggers” and explain that something that leads to the behavior is called a trigger. 2. Allow students to discuss what possible triggers can lead to an eating disorder, anorexia. -Family members -Friends -Weight scale -Food -Pictures of yourself -The media -Emotions -Jealousy -Comparisons -Pro Ana Sites: sites that encourage eating disorders by starvation. 3. Students can discuss the following questions: -How do you think you might react to these triggers? -How can you cope when faced with these triggers? 4. Explain a theoretical process as a coping mechanism: IPED Identify the behavior/situation Predict the outcome of the behavior Decide what to do Execute your decision After preforming IPED you can review you decision and actions and make future corrections if they are negative. 5. Give students situations and allow them to role play practice using IPED. 6. From the triggers discussed students will list triggers that affect them. After creating the list they will put them in order of how of how often they encounter them and the severity of the encounters. Students can share their lists with the group and explain their reasoning for the order they put them in. Closing 1. Review concepts discussed in session. 2. Tell students between sessions to pay attention to triggers they encounter and how they deal with them. 3. Assign homework/own-work.
 * Procedures/Instructional Strategy: **
 * Triggers: **
 * Homework/Own-work ** : Students will continue to monitor triggers they encounter and journal them identifying how they feel during the encounter.

** Core ASCA Standard(s): ** A: A1.1 Articulate feelings of competence and confidence as learners A: A2.3 Use communications skills to know when and how to ask for help when needed PS: A1.1 Develop positive attitudes toward self as a unique and worthy person PS: B1.2 Understand consequences of decisions and choices PS: C1.7 Apply effective problem-solving and decision-making skills to make safe and healthy choices ** Core State Academic Standard(s) ** ** Core ASCA Standard(s): ** ** Core State Academic Standard(s): ** It is important to support theoretical orientations and techniques in school counseling prevention and intervention programs to insure that the program is theory based. Using specific proven techniques that are linked to the prevention/intervention within sessions will ensure that the program is following a well-planned out/ thought out process. Identifying theoretical orientations and techniques specific to the school setting will increase the credibility to the counseling program and the productivity of the sessions.
 * 3) Student identifies ASCA Standards and core academic standards covered in Session #1 and Session #2. **
 * Session #1: **
 * (CCCC) Students conduct research on issues and interests by generating ideas and questions, and by posing problems. They gather, evaluate, and synthesize data from a variety of sources (e.g., print and non-print texts, artifacts, people) to communicate their discoveries in ways that suit their purpose and audience.
 * (CCCC) Students use spoken, written, and visual language to accomplish their own purposes (e.g. for learning, enjoyment, persuasion, and the exchange of information).
 * (3.3.7.A.1-7) Use verbal and non-verbal language to communicate ideas in personal, group, public, and global situation.
 * (3.3.7.B.1-8) Demonstrate effective use of a variety of questions, including literal, inferential, and evaluative through  group discussions and interviews.
 * (3.5.7.B.1-5) Interpret verbal and non-verbal messages in media.
 * (3.4.7.B.1-7) Effectively listen, comprehend, and analyze what is heard from a variety of sources.
 * Session #2 **
 * A: B1.5 Organize and apply academic information from a variety of sources
 * A: C1.4 Demonstrate an understanding of the value of lifelong learning as essential to seeking, obtaining and maintaining life goals
 * PS: B1.12 Develop an action plan to set and achieve realistic goals
 * PS: C1.11 Learn coping skills for managing life events
 * (4.4) Apply techniques of systematic listing, counting, and reasoning in a variety of different contexts
 * (4.4) Collect, generate record, organize and display data generated from surveys
 * (4.4) Collect, generate record, organize and display data generated from surveys
 * 4) Student discusses the importance of supporting theoretical orientations and techniques in school counseling prevention and intervention programs. **

Component #3: Ethical, Legal, Multicultural

In-group counseling with minors students are given confidentiality and privilege to speak freely and openly about their issues, problems, and thoughts. These students and parents are made aware of the rules for confidentiality. Students can speak and share freely with confidence of confidentiality unless they reference to hurting themselves, hurting someone else, or a being hurt. Counselors will be obligated to report any situations related to harm of the client or anyone else. See attachment This group program will be offered to a variety of ethnic cultures in an inner city district. Research has been conducted to address the eating habits and rituals of various individuals. Understanding the economic status of the environment will provide resourceful when addressing under eating and environmental factors. During the group everyone is accepted for who they are and their beliefs and lifestyles are also accepted. When issues of conflict, bias, prejudice, oppression, and discrimination arise they will be addressed and clarified within the group. In order to provide a positive, caring, and safe learning group environment all students will be made aware of the rule for confidentiality. All members will have a voice and made to feel accepted. They will be expected to be respectful at all times and when a situation arises it will be confronted and resolved within the group. Counselors must consider many issues while forming, implementing, and terminating a group. In order for a group to run smoothly and be productive it is important to make sure that student and parents are both on board with the group. Rules of confidentiality and the rights of the students, parents, and counselors must be clearly outlined. Students need to be social and non-conflicting with other students. Group members should not be in close relationships with each other or have previous conflicts. Cultural significance is also important. The culture and background of group members should be considered and respected during the process. It is important to consider these issues throughout the entire process in order to provide a productive and successful group. Component #4: Program Evaluation
 * 1) Student identifies ethical and legal considerations in-group work with minors in the schools and those specific to this group program. **
 * 2) Student creates a signed consent form to be distributed to parents of students prior to participation in group counseling to include limits to confidentiality in group work (attach as a supplemental form in LiveText for this section). **
 * 3) Student identifies how the group program is culturally sensitive, describes how issues of conflict, bias, prejudice, oppression, and discrimination are to be addressed during group, and identifies strategies included in the group program that promote a positive, caring, and safe learning group environments. **
 * 4) Student discusses the importance of carefully considering issues related to ethics, legal, professional, and cultural significance in the group process from making group opportunities available and member selection to group termination. **

See attachment See attachment The development of a program must always begin by knowing the end goal. Outcome driven programing must have a focus that remains insight. The purpose of the program is to reach the end goal. In school counseling, counselors define a need and determine a goal. The program is then created to meet the needs. In determining the success of the program there needs to be assessments to measure the progress made. It is important for school counselors to evaluate the progress and record the outcomes both for themselves and the students. Counselors may need to show cause for creating groups, maintaining their positions, and making referrals. Component #5: Scholarly Writing
 * 1) Student creates a pre-post measure for session #1 that includes __only__ one multiple choice item for each session objective for a total of two items (one for the school counseling content and one for the core academic content). **
 * 2) Student creates a pre-post measure for session #2 that includes only one multiple choice item for each session objective for a total of two items (one for the school counseling content and one for the core academic content). **
 * 3) Student briefly describes the importance of program evaluation and outcome-driven programming in professional school counseling **

Students please contact the writing center, publisher of the journal, or research the journal using the Internet to determine if your selected journal is peer-reviewed.
 * Student uses correct grammar, punctuation, sentence structure, and spelling. **
 * Student includes at least three peer-reviewed journal articles to support group content and choice of theoretical approach and techniques—best practices. **

References:

Bardick, M (2004). Eating Disorder Intervention, Prevention, and Treatment: Recommendations for School Chounselors. Professional School Counseling pp168-175. Retrieved June 18, 2012 Boes, S (2004). Unmasking Eating Disorders in the Schools. Professional School Counseling. Pg 376. Retrieved June 18, 2012 Choate, L (2007). Counseling Adolescent Girls for Body Image Resilience: Strategies for School Counselors. Professional School Counseling. Pg.317 Retrieved June 18, 2012 Corey, G (2008). Theory and Practice of Group Counseling. Canada: Brooks/Cole Cengage Learning Crow, J (2009). Eating Disorder Statistics. National Association of Anorexia Nervosa and Associated Disorders. Retrieved June 18, 2012 from [|www.anad.org/get] [|informaton/about-eating-disorders/eating-disorders-statistics/] Eford, B (2010). Group Work in the Schools. Upper Saddle River, New Jersey: Pearson Education. NEDA (2008). National Eating Disorder Association Retrieved June 21,2012 from [] Smith, Melinda (2012). Anorexia Nervosa. HelpGuide.org. //Retrieved June// // 20,2012, fr[] // Steinhart, Madlyn. Hearing between The Lines. In The Mix. //Retrieved June// // 20,2012 from //[|//http://www.pbs.org/inthemix/educators/lessons/selfimage2///]