Behavior Targets and Practice Elements are documented in Tiered Service Plans and Session Logs.
The following definitions are from Child and Adolescent Mental Health Division (CAMHD), Hawai‛i Department of Health. (2019). Instructions and codebook: Treatment targets, progress ratings and practice elements.
Behavior Targets
Targets are the strengths and needs being addressed as part of the mental health services for youth and family clients.
Academic Achievement – issues related to general level or quality of achievement in an educational or academic context. This commonly includes performance in coursework and excludes cognitive-intellectual ability/capacity issues and specific challenges in learning or achievement.
Activity Involvement – issues related to general engagement and participation in activities. Only code here those activities that are not better described by the particular activity classes of school involvement, peer involvement, or community involvement.
Adjustment to Life Transition – issues related to a youth’s global response to a life transition or specific challenge (e.g., change of school, change of living situation, treatment transition or discharge, etc.).
Aggression – verbal and/or physical aggression, or threat thereof, that results in intimidation, physical harm, or property destruction.
Anger – emotional experience or expression of agitation or destructiveness directed at a particular object or individual. Common physical feelings include accelerated heartbeat, muscle tension, quicker breathing, and feeling hot.
Anxiety – a general uneasiness that can be characterized by irrational fears, panic, tension, physical symptoms (e.g., stomach aches, difficulty breathing, accelerated heartbeat, muscle tension, sweatiness, dizziness), and/or excessive anxiety, worry, or fear.
Assertiveness – the skills or effectiveness of clearly communicating one’s wishes. For example, the effectiveness with which a child refuses unreasonable requests from others, expresses his/her/their rights in a non-aggressive manner, and/or negotiates to get what he/she/they wants in relationships with others.
Attending to Basic Needs – issues related to finding or stabilizing an appropriate living situation for a youth and/or establishing a safe and secure environment for the youth’s development (formerly housing/living situation and safe environment).
Attention Problems – described by short attention span, difficulty sustaining attention on a consistent basis, and susceptibility to distraction by extraneous stimuli.
Avoidance – behaviors aimed at escaping or preventing exposure to a particular situation or stimulus.
Cognitive/Intellectual Functioning – issues related to cognitive-intellectual ability/capacity and use of those abilities for positive adaptation to the environment. This includes efforts to increase intelligence quotient, memory capacity, or abstract problem-solving ability.
Community Involvement – detailed description of amount of involvement in specific community activities within the child’s day.
Contentment/Enjoyment/Happiness – refers to issues involving the experience and expression of satisfaction, joy, pleasure, and optimism for the future.
Depressed Mood – behaviors that can be described as persistent sadness, anxiety, or “empty” mood, feelings of hopelessness, guilt, worthlessness, helplessness, decreased energy, fatigue, etc.
Eating/Feeding Problems – knowledge or behaviors involved with the ingestion or consumption of food. May include nutritional awareness, food choice, feeding mechanics (e.g., swallowing, gagging, etc.), and social factors relating to eating situations.
Empathy – identification with and understanding of another person’s situation, feelings, and motives.
Enuresis/Encopresis – enuresis refers to the repeated pattern of voluntarily or involuntarily passing urine into inappropriate places (e.g., bed, clothes) during the day or at night. Encopresis refers to a repeated pattern of voluntarily or involuntarily passing feces into inappropriate places (e.g., bed, clothes) during the day or at night.
Gender Identity – issues related to a youth’s self-concept or self-understanding involving sex roles and social behaviors in relation to his/her/their biological sex. This does not address self-concept issues involving sexual orientation, which would be coded as “other.”
Grief – feelings associated with a loss of contact with a significant person in the youth’s environment (e.g., parent, guardian, friend, etc.).
Health Management/Medical Regimen Adherence – issues related to the improvement or management of one’s health, inclusive of both physical illness and fitness. In addition to dealing with the general development of health-oriented behavior and management of health conditions, this target can also focus on exercise or lack of exercise. This includes knowledge, attitudes or behaviors related to regular implementation procedures prescribed by a health care professional, covered under medical regimen adherence. This also includes lifestyle behaviors (e.g., exercise, nutrition), taking medication, or self-administration of routine assessments (e.g., taking blood samples in a diabetic regimen).
Hyperactivity – can be described by fidgeting, squirming in seat, inability to remain seated, talking excessively, difficulty engaging in leisure activities quietly, etc.
Impulsivity – behavior characterized by little or no forethought, reflection, or consideration of the consequences of an action that impairs functioning. This can include behaviors that put a youth at risk, including emotional dysregulation. Behaviors that are purely physical or motoric (e.g., shaking legs) should be coded as hyperactivity. Impulsivity related to self-injurious behavior and mania should be coded under those behaviors respectively.
Independent Living Skills – issues related to the development of independent living, social functioning, financial management, and self-sufficiency skills that are not better captured under other codes such as personal hygiene, self-management, social skills, housing/living situation, or occupational functioning/stress (formerly adaptive behavior/living skills).
Learning Disorder/Underachievement – refers to specific challenges with learning or educational performance that are not better accounted for by cognitive/intellectual functioning or general academic achievement.
Mania – an inflated self-perception that can be manifested by a loud, overly friendly social style that oversteps social boundaries, high energy and restlessness, and a reduced need for sleep.
Oppositional/Non-Compliant Behavior – behaviors that can be described as refusal to follow adult requests or demands or established rules and procedures (e.g., classroom rules, school rules, etc.).
Peer Involvement – a greater involvement in activities with peers. Activities could range from academic tasks to recreational activities while involvement could range from working next to a peer to initiating an activity with a peer. This differs from positive peer interaction in that peer involvement targets actual engagement in activities with peers regardless of interactional processes, while positive peer interaction focuses on interactional behavior, styles, and intentions.
Peer/Sibling Conflict – peer and/or sibling relationships that are characterized by fighting, bullying, defiance, revenge, taunting, incessant teasing and other inappropriate behaviors.
Personal Hygiene – challenges related to self-care and grooming.
Phobia/Fears – irrational dread, fear, and avoidance of an object, situation, or activity.
Positive Family Functioning – issues related to healthy communication, problem-solving, shared pleasurable activities, physical and emotional support, etc. in the context of interactions among multiple persons in a family relation, broadly defined.
Positive Peer Interaction – social interaction and communication with peers that are pro-social and appropriate. This differs from peer involvement in that it focuses on interactional behavior, styles, and intentions, whereas peer involvement targets actual engagement in activities with peers regardless of interactional processes.
Positive Thinking/Attitude – this target involves clear, healthy, or optimistic thinking, and involves the absence of distortions or cognitive bias that might lead to maladaptive behavior.
Runaway/Elopement – running away from home or current residential placement for a day or more.
School Refusal/Truancy – reluctance or refusal to attend school without adult permission for the absence. May be associated with school phobia or fear manifested by frequent somatic complaints associated with attending school or in anticipation of school attendance, or willful avoidance of school in the interest of pursuing other activities.
Self-Injurious Behavior – acts of harm, violence, or aggression directed at oneself.
Self-Management/Self-Control – issues related to management, regulation, and monitoring of one’s own behavior.
Sleep Disturbance/ Sleep Hygiene – difficulty getting to or maintaining sleep.
Social Skills – skills for managing interpersonal interactions successfully. Can include body language, verbal tone, assertiveness, and listening skills, among other areas.
Suicidality – issues related to recurrent thoughts, gestures, or attempts to end one’s life.
Traumatic Stress – issues related to the experience or witnessing of life events involving actual or threatened death or serious injury to which the youth responded with intense fear, helplessness, or horror.
Treatment Engagement – issues related to targeting interest, motivation, or active participation in therapeutic activities. This includes targeting improved rapport.
Willful Misconduct/Delinquency – persistent failure to comply with rules or expectations in the home, school, or community. Excessive fighting, intimidation of others, cruelty or violence toward people or animals, and/or destruction of property.Other – any written response to an open-ended question that could not be categorized into another treatment target sub-category and did not necessitate the addition of a new category.
Practice Elements
Practice elements are the discrete clinical intervention strategies (e.g., “time out,” “praise”) applied by the therapist and/or treating provider within a treatment session.
Accessibility Promotion – any efforts to make treatment services more convenient and accessible (e.g., on-site child care, taxi vouchers, bus tokens, rides).
Activity Scheduling – the assignment or request that a child participate in specific activities outside of therapy time, with the goal of promoting or maintaining involvement in satisfying and enriching experiences.
Anger Management – treatment in the family of anger management with no specific practices identified.
Assertiveness Training – exercises or techniques designed to promote the child’s ability to be assertive with others, usually involving rehearsal of assertive interactions.
Assessment – a service provider learning more about the child and family through formal and codified evaluation, testing, or observation (that would not qualify as parent- or self-monitoring).
Attending – exercises involving the youth and caregiver playing together in a specific manner to facilitate their improved verbal communication and nonverbal interaction. This can involve the caregiver’s imitation and participation in the youth’s activity, as well as parent-directed activities (previously called directed play).
Behavioral Contracting – the development of a formal agreement to specify rules, consequences, and a commitment by the youth and relevant others to honor the content of the agreement. Includes contracting that is not better characterized by goal setting.
Care Coordination – coordinating among the service providers to ensure effective communication, receipt of appropriate services, adequate housing, etc.
Cognitive/Coping – any techniques designed to alter interpretation of events through examination of the child’s reported thoughts, typically through the generation and rehearsal of alternative counter-statements. This can sometimes be accompanied by exercises designed to comparatively test the validity of the original thoughts and the alternative thoughts through the gathering or review of relevant information.
Commands/Limit Setting – training for caregivers in how to give directions and commands in such a manner as to increase the likelihood of child compliance.
Communication Skills – training for youth or caregivers in how to communicate more effectively with others to increase consistency and minimize stress. Can include a variety of specific communication strategies (e.g., active listening, “I” statements).
Crisis Management – immediate problem-solving approaches to handle urgent or dangerous events. This might involve defusing an escalating pattern of behavior and emotions either in person or by telephone and is typically accompanied by debriefing and follow-up planning.
Cultural Training – education or interaction with culturally important values, rituals, or sites with no specific practices identified.
Educational Support – exercises designed to assist the child with specific academic problems, such as homework or study skills. This includes tutoring.
Exposure – techniques or exercises that involve direct or imagined experience with a target stimulus, whether performed gradually or suddenly, and with or without the therapist’s elaboration or intensification of the meaning of the stimulus.
Family Engagement – the use of skills and strategies to facilitate family or child’s positive interest in participation in an intervention. This is distinct from relationship/rapport building, which aims to increase the quality of the relationship between the youth and the therapist.
Goal Setting – the clarification of specific goals and developing commitment from youth or family to attempt to achieve those goals (e.g., academic, career, etc.), that is not better characterized by behavioral contracting.
Guided Imagery – visualization or guided imaginal techniques for the purpose of mental rehearsal of successful performance. Guided imagery for the purpose of physical relaxation (e.g., picturing calm scenery) is not coded here, but rather is coded under relaxation.
Ignoring/ Differential Reinforcement of Other Behavior – the training of parents or others involved in the social ecology of the child to selectively ignore mild target behaviors and selectively attend to alternative behaviors.
Insight Building – activity designed to help a youth achieve greater self-understanding.
Line of Sight Supervision – direct observation of a youth for the purpose of assuring safe and appropriate behavior.
Maintenance/Relapse Prevention – exercises and training designed to consolidate skills already developed and to anticipate future challenges, with the overall goal to minimize the chance that gains will be lost in the future.
Mentoring – pairing with a more senior and experienced individual who serves as a positive role model for the identified youth.
Mindfulness – exercises designed to facilitate present-focused, non-evaluative observation of experiences as they occur, with a strong emphasis of being “in the moment.” This can involve the youth’s conscious observation of feelings, thoughts, or situations.
Modeling – demonstration of a desired behavior by a therapist, confederates, peers, or other actors to promote the imitation and subsequent performance of that behavior by the identified youth.
Motivational Interviewing – exercises designed to increase readiness to participate in additional therapeutic activity or programs. These can involve cost-benefit analysis, persuasion, or a variety of other approaches.
Narrative – exercises designed to assist the child in developing and sharing a verbal, written, or artistic narrative or story about the child’s life events (typically traumas) and the cognitive and affective processing of those events.
Natural and Logical Consequences – training for parents or teachers in (a) allowing youth to experience the negative consequences of poor decisions or unwanted behaviors, or (b) delivering consequences in a manner that is appropriate for the behavior performed by the youth.
Parent Coping – exercises or strategies designed to enhance caregivers’ ability to deal with stressful situations, inclusive of formal interventions targeting one or more caregiver.
Parent or Teacher Monitoring – the repeated measurement of some target index by the caregiver or teacher.
Parent or Teacher Praise – the training of parents, teachers, or others involved in the social ecology of the child in the administration of social rewards to promote desired behaviors. This can involve praise, encouragement, affection, or physical proximity.
Peer Pairing/Peer Modeling – pairing with another youth of same or similar age to allow for reciprocal learning or skills practice.
Personal Safety Skills – training for the youth in how to maintain personal safety of one’s physical self. This can include education about attending to one’s sense of danger, body ownership issues (e.g., “good touch-bad touch”), risks involved with keeping secrets, how to ask for help when feeling unsafe, and identification of other high-risk situations for abuse.
Physical Exercise – the engagement of the youth in energetic physical movements to promote strength or endurance or both. Examples can include running, swimming, weight-lifting, karate, soccer, etc. Note that when the focus of the physical exercise is also to produce talents or competence, skill building may also apply.
Play Therapy – the use of play as a primary strategy in therapeutic activities. This may include the use of play as a strategy for clinical interpretation. Different from attending, which involves a specific focus on modifying parent-child communication. This is also different from play designed specifically to build relationship quality.
Problem Solving – techniques, discussions, or activities designed to bring about solutions to targeted problems, usually with the intention of imparting a skill for how to approach and solve future problems in a similar manner.
Psychoeducation with Child – the formal review of information with the child about the development of a problem and its relation to a proposed intervention.
Psychoeducation with Parent or Teacher – the formal review of information with the caregiver(s) about the development of the child’s problem and its relation to a proposed intervention. This often involves an emphasis on the caregiver’s role in either or both.
Relationship/Rapport Building – strategies in which the immediate aim is to increase the quality of the relationship between the youth and the therapist. Can include play, talking, games, or other activities. This is distinct from family engagement, which focuses on the use of skills and strategies to facilitate family or child’s positive interest in participation in an intervention.
Relaxation – techniques or exercises designed to induce physiological calming, including muscle relaxation, breathing exercises, meditation, and similar activities. Guided imagery exclusively for the purpose of physical relaxation is also coded here.
Response Cost – training parents or teachers how to use a point or token system in which negative behaviors result in the loss of points or tokens for the youth.
Response Prevention – explicit prevention of a maladaptive behavior that typically occur habitually or in response to emotional or physical discomfort.
Self-Monitoring – the repeated measurement of some target index/behavior by the child.
Self-Reward/Self-Praise – techniques designed to encourage the youth to self-administer positive consequences contingent on performance of target behaviors.
Skill Building – the practice or assignment to practice or participate in activities with the intention of building and promoting talents and competencies.
Social Skills Training – providing information and feedback to improve interpersonal verbal and non-verbal functioning, which may include direct rehearsal of the skills. If this is paired with peer pairing/peer modeling that should be coded as well.
Stimulus/Antecedent Control – strategies to identify specific triggers for problem behaviors and to alter or eliminate those triggers in order to reduce or eliminate the behavior.
Strengthening Informal Supports – working with youth or families to make use of informal supports in their homes and communities (e.g., cultural or faith-based groups, neighbors and friends, etc.).
Supportive Listening – reflective discussion with the child designed to demonstrate warmth, empathy, and positive regard, without suggesting solutions or alternative interpretations.
Tangible Rewards – the training of parents or others involved in the social ecology of the child in the administration of tangible rewards to promote desired behaviors. This can involve tokens, charts, or record keeping, in addition to first-order reinforcers.
Therapist Praise/Rewards – the administration of tangible (i.e., rewards) or social (e.g., praise) reinforcers by the therapist.
Time Out – the training of or the direct use of a technique involving removing the youth from all reinforcement for a specified period of time following the performance of an identified, unwanted behavior.
Other – any written response to an open-ended question that could not be categorized into another intervention strategy sub-category and did not necessitate the addition of a new category.