FLIP IT: Transforming Challenging Behaviors

Nature of the Problem

A growing body of literature indicates that our nation continues to see an increase in the number of young children exhibiting emotional and behavioral problems. Estimates of the number of children suffering from emotional and behavioral problems varies tremendously ranging from 5% to 26%. What does not vary is the widespread recognition that our nation must find ways to better support the social and emotional health of children from the earliest ages. Experts from across disciplines agree that it is essential to support the social and emotional health of our youngest children and their families through a continuum of comprehensive, individualized, culturally competent services that focus on promotion, prevention and intervention. Finding solutions to this growing problem is complex and requires increased levels of support for research, treatment, and education. At the same time that our nation grapples with the complexity of the issues that underlie the problem and researches best practices to address it, a body of existing research supports one strategy that can be part of a larger and much more comprehensive solution. FLIP IT: Transforming Challenging Behaviors is a four-step strategy to help young children learn about their feelings, gain self-control, and reduce challenging behaviors.

Program Description

FLIP IT is a strategy to reduce children’s use of challenging behaviors and promote social and emotional skills. FLIP IT offers a simple, kind, strength-based, commonsense and effective four step process to address day-to-day challenging behavior as well as more severe behavior concerns. The four steps are embodied in the FLIP IT mnemonic which stands for F– Feelings, L – Limits, I– Inquiries, and P– Prompts. FLIP IT can be used effectively by professionals and parents. Implementing the FLIP IT strategy requires that adults always acknowledge a child’s feelings when intervening to stop challenging behaviors. Helping children understand, label and regulate their feelings is critical to their healthy development, including interacting and forming healthy relationships. While adults learn to honor a child’s feelings, they also quickly vocalize limits. Children need to be taught clear, calm, appropriate and consistent limits in order to reduce challenging behaviors and promote the use of acceptable alternatives. After telling a child about limits, adults immediately inquire and prompt children to come up with appropriate alternative behaviors. Rather than adults immediately jumping in to suggest appropriate resolutions to a conflict, FLIP IT supports children in learning to problem solve and generate their own solutions.

Disruption

Children’s use of challenging behaviors is frequently cited as a barrier to successful treatment and long-term success for children served in behavioral health care programs. Teaching adults, including parents and professionals, how to successfully support children who use challenging behaviors is often one of the most pressing needs addressed in professional development and parent trainings. While the trauma and risk that underlies children’s challenging behaviors is often quite complex, the FLIP IT strategy is innovative in its simplicity that is captured in the mnemonic name, FLIP. FLIP IT author, Rachel Wagner, often says that FLIP IT is nothing new, but is everything wise and well-researched, re-packaged into an easy to remember, practical, portable, and user-friendly strategy that adults can remember to use during both crisis moments and everyday challenging situations. FLIP IT enhances more comprehensive efforts that address complex issues related to children’s overall health and well-being.

Leadership

Behavioral healthcare providers across the country face significant challenges related to managing children’s challenging behaviors and providing staff and parents with the necessary resources that allow them to teach children appropriate social and emotional skills. Devereux recognizes the need to research solutions and best practices in this area and has, since our inception in 1912, taken a leadership role in this regard. Devereux’s Institute for Clinical and Professional Training and Research (ICPTR) conducts research in our programs across the country. ICPTR’s research and evaluation projects are presented at national conferences and often published in peer review journals, allowing us to share information that improves not only Devereux’s services but the services of the entire behavioral health care field. In 2017, based on FLIP IT research outcomes, Devereux invested in the development of an online learning course to teach adults the FLIP IT strategy.

Scalability

Another innovative element of the FLIP IT strategy is its ability to scale. The simplicity of the four step FLIP IT process allows adults, including parents and direct care professionals who may have limited formal education and training, to comprehend the simple process. Equally important to comprehension is acceptability. Outcome data suggests that not only can adults learn the strategy, but they clearly understand how the strategy fits within their parenting and caregiving styles. It is the acceptability of the strategy that supports its continued use in the long-term, well after any formal training. To further support scalability, Devereux recently invested in the creation of an online, self-paced e-learning course. The interactive, hands-on course is appropriate for any adult who plays an important role in the life of a child, can be taken in one sitting or over time, includes knowledge checks and offers downloadable resources for continued reference.

Results/Outcomes

The most thorough evidence currently supporting FLIP IT comes from a study completed by Miami University. This study shows that FLIP IT can be an effective strategy for decreasing children’s behavior problems, anxiety, depression, withdrawal, and aggressive or delinquent behavior; and increasing children’s initiative, self-regulation, and attachment. Researchers found these positive outcomes to be substantial and long-lasting, even after conducting only one FLIP-IT parent training session. In addition to positive child outcomes, the adults also benefit. Being able to successfully help a child develop the ability to effectively manage their behavior in appropriate, pro-social ways decreases the feelings of frustration, helplessness and ineffectiveness that parents and caregivers may experience and improve the positive rapport with children. Over a longer time-frame, the consistent application of FLIP IT can result in significant positive impacts for both children and the important adults in their lives. Please visit www.moreflipit.org for the full research study.