Evidence-Based Healing: Mark Amendola on Aggression Replacement Training and Cognitive Interventions

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Mark Amendola, LCSW, Co-Founder and Senior Master Trainer of Education and Treatment Alternatives, Inc.

Mark describes his path into adolescent behavioral health and his global work advancing Aggression Replacement Training (ART), which integrates social skills training, anger control, and moral reasoning to teach impulse control and problem-solving with fidelity and measurable outcomes. He discusses expanding ART for schools and correctional settings, the link between movement and brain-based regulation, shifts in boys’ participation in sports, and the need to invest in universal, trauma-informed prevention models that build belonging and psychological safety in schools and communities.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-022726-GK

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Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director here at Quality Insights, and today's guest is Mark Amendola, LCSW. He's an internationally recognized leader in evidence-based behavioral healthcare for children and adolescents. Mark is the co-founder of education and Treatment Alternatives.

This is an organization that has provided aggression replacement training, which is very unique. Something I've been very curious about and this training is providing training across the globe since 1998. More than 6,000 practitioners in all 50 states have been trained across the United States and internationally.

He was personally trained and mentored by Dr. Arnold Goldstein, the primary developer of aggression replacement training, and today serves as a senior master trainer, helping ensure fidelity and measurable outcomes nationwide. With more than 30 years of clinical and administrative experience, mark has served as CEO of a large multi-service youth agency.

Co-developed a charter school, teaches at the college level and currently coordinates evidence-based practices at Perseus House. In addition to his clinical work, he coaches high school boys basketball. I've been. Been firsthand  present in, in his coaching, and he is passionate about what he does, so he has a powerful front row seat to both the emotional and development needs of today's youth.

I am very excited to jump into this important, very relevant topic. Mark, thank you so much for joining us. Yeah, thank you. That was kind Gene. Thank you. So your career has spanned decades in clinical services. Yeah. Education and evidence-based practice, which I said in the intro. So what first drew you into working with adolescents and aggressive behavior and, yeah. that's a great question. I it's an odd path because in high school and college, I worked in my grandfather's construction business. So I wheeled concrete and finish cement and laid block and did that kind of stuff. Thought that was gonna be the path. Thought I was gonna be the owner of that with my uncle.

 That didn't work out that way  I actually went to Lakin State in Pennsylvania  for a couple years, played basketball, realized  I'm gonna play basketball now. So I actually transferred to Gannon in Erie, got a social work degree, worked for a couple years, and realized I liked what I was doing.

 I was working with an agency that served  adolescents, behaviorally disordered.  And so I went back and got my degree. I got my master's in social work from Case Western, and along that path it became evident to me that I, I. I obviously developed some skill along the way, but I enjoyed working with kids.

 For one year in my career, I worked for the Erie County base unit service unit, which, which authorizes all the services from kids to adolescents to adults. And I was working with geriatric and realized that, you know what? I don't like this at all. I was going to Warren State Hospital and seeing patients down there.

And so I ended up going back and working with kids and that's what I've done. That's what I've done. Like you said, I am the evidence-based coordinator at Percy's House, so I assure all their cognitive-based treatments are  within Fidelity. And  yeah. And I am the co-founder of Dr. Robert Oliver, who's retired assistant superintendent from the school district.

And yeah, we've had that since uh, 1998. And Dr. Allen Goldstein  we worked with him. We started writing with him, and so it developed over time. He passed away in 2002, but before he died, asked us if Bob and I would take it over, and we've done that. Yeah. So I'm really excited to talk, start talking about this aggression replacement therapy.

And as I was reading it has three core components, skill streaming, anger control, and moral reasoning, which sound. I mean, I'm very, as I said, I'm very curious. So for listeners who are new to ART, I'm gonna refer to it as ART Aggression Replacement Therapy. How do these pieces work together to actually change behavior?

 So the primary philosophical tenet is that. Kids can learn their environments. They can learn  bad behavior, but they can also learn good behaviors. So that was the original tenet that Goldstein started with, that kids can learn these behaviors. They may be taught these other behaviors, but we can teach 'em something different.

So they started with social skills. They started with 50 social skills, and then they, and they realized that. And the primary authors were Goldstein, Glick and Gibbs, and they realized they had to have this impulse control piece to it. So with Eva, fine Long Island, they developed  anger control, and then John Gibbs from Ohio State helped them develop more reasoning.

And before Arnie died, he asked Dr. Oliver and I if we would continue to develop the curriculum. And we have done that. We have five workbooks right now, two that are at the SEL and social emotional level that are gonna come out probably in about six to eight months. So we've paid attention. To that core curriculum, but then develop these cognitive curriculums as the research has changed over time.

I think that's super important, right? Very important. Yes because the research changes, right? We gotta pay attention to the research. So the research guides what we do, obviously. Yeah. So you referenced the concept of learn to  move to learn, which I love this. I feel like I tried to do it in my own life like probably do.

Yeah. Well, I don't, I feel like if I don't get up in the morning and kind of do some kind of movement, like my brain hasn't turned on, you're exactly correct.  Right. The movement, the minute you stand up, you engage your brain.  The minute you start talking anything. Okay. So Gene Blades, Madigan, who does all the research on this.

Really has done a good job at showing the connection to movement and brain activity. And so we can now connect the movement that we're engaging in and make it with purposeful action. And so now, Dr. Oliver's wife who, Sarah Oliver, who is the developer of this curriculum. Is a health and phys ed teacher, instructor, and it really connects.

So we, so as an example, we have a full movement curriculum. Okay? So we engage and we engage in activities that, kids, they're not gonna fail on, right? They are the simplest activities. And then they get titrated up, and then we add that with our anger control. So one of the reducers is. Deep breathing, and so now we're connecting all these together and just what you're talking about, it's just healthy living.

It's just strategies for healthy living for kids  along with really trying to get to that impulse control target. That's really important. Yeah. So just, just to maybe a follow up. Sure. So we talked about like cognition and learning so we're also talking about emotional regulation.

Correct. Which is gonna help modify, I guess a aggressive behaviors. There's no doubt. There's no doubt.  It's not, we're not trying to teach kids what to think. We're trying to teach them that there's a logical consequence for behavior. So as part of the curriculum, we actually make them.

Think in it from a contingency point of view. So if this happens, then this happens. We literally make them say that aloud to us for their plan, and they have to tell us how they're gonna problem solve. What are they gonna do to get out of that situation. So the cognitive piece is critical because then as we think, we act and we really try to explain to the kids that this is forever.

This is gonna happen forever in your life. I, it's so important. Yes. In this day and age, like you think about how many school shootings and just to giving kids these tools.  Huge. Yeah. So important. We don't get a manual on how to be human beings, right? Absolutely not.    We do have to figure it out as we go along.

No doubt. Yeah. So just branching off from there. Education and treatment alternatives emphasizes the importance of the prepared adult and the prepared student. So what do these terms Sure. So I could explain that a little bit. So, When Goldstein developed a curriculum, it was just for adolescents.

 There was a preschool curriculum, an elementary curriculum, and a high school, an adolescent curriculum.  As we started working with him. We realized that the behaviors were very similar in correctional facilities, so we were primarily doing this in schools and residential agencies, but then started developing it.

 And the Department of Corrections actually approve this, where they actually tell sites that you can just pick 10 of the skills. We're saying no. Make the skills, be prescriptive, make the skills, meet the needs of your clientele. So now we have two prison projects right now, correctional facilities in Pennsylvania that we're piling two projects.

 So the strategies are very similar. How do you think, how do you problem solve? How do you control yourself? But it's the content that's different for the adult curriculum. So it's very similar strategies.  But then we make sure that it fits for the adults. Okay. So very similar strategies, but then they're just, the curriculum is a little bit different depending.

Yeah. Yeah. It's developmentally    even the reading levels, although at the correctional level, it's a fifth grade reading level which is the adolescent level. That's the adolescent level too.  So that curriculum we can easily, it easily gets adopted to that population.

And then what we had to do was on the moral reasoning side, we just had to develop Character education scenarios that are adult scenarios, so we just made it fit for the population. Okay. So you really feel like, I mean, you have to have the prepared student and the prepared adult for like real behavioral change. Yeah. That's the deep end on the intervention side.  I think we spend way too, we gotta spend money on the intervention side. I get that. Not enough money on the prevention. All right.  You know, We got, our goal is to say all the time to is catch a low to prevent it high. And how true is that? If we can start with these prevention programs early in school because there's been this shift  there's been the shift which you just talked about, the environment is different.

It's different for boys right now. It's different for girls too, but  so the environment has clearly shifted, so we gotta be able to align what we're doing to match what's going on right now, if that makes sense. And I wanna talk about this. I know you and I have talked offline about the different Yes.

What is going on with boys compared Yeah, sure. You and I have both seen some differences, but I mean, I think that's, that's very helpful. Yeah. So I just, yeah, very helpful.  I might take a little different look at that, only from the sense that, but boys still have the same emotional needs.  The sense of belonging, freedom, fun, power, all those things which I needed, you needed to grow up to be healthy.

They still need that. It's just now, it's so different, right? Depression, anxiety is increasing over the last 10 years. The educational gap is wider for gender.  Are we paying attention to that?  Boys have more high internalizing kinds of behaviors where not so much of those aggressive behaviors, but they're in their head too much.

I could talk about this all day, Jean. Yeah. We'll put a pin in. Yeah. Because I'm gonna kind of set the stage here. Sure. So you have experience as a clinician and as I said, a high school basketball coach. You're currently the JV coach. Yes. Harbor Creek High School. In Harbor Creek, Pennsylvania.

So, What have you observed? About the mental health of student athletes who participate in team sports, because we did several podcasts about what does participation in team sports mean for the mental health of not only high school athletes  as they're going through it, but then the impact in  adulthood of participating in sports.

Sure. So what have you seen maybe from both of those perspectives as a clinician and a coach? Yeah    the one thing I know is we gotta be talking to kids all the time. We have to be talking to them. We gotta know what's going on. And they might not be honest with us, right?  We're telling, we're developing relationships and we're honest with these guys, but  so you have to be talking to 'em all the time.

 You know, It is interesting that you gotta be really clear with the expectations.  We're seeing the last couple years less kids play. I don't know why that is. Jean. We could certainly have ideas about that, but.  But we have expectations and those expectations have to be articulated.

And I think that if they're not articulated, it almost gives kids a reason to bail out. So you have to be real clear. You have to be real clear on the consequence side of that. And I'm not sure if that's where you wanted me to go with that  but I see a change. It's definitely  there's less kids that want to participate.

It's hard. No matter what you do in high school, if you participate in some extracurricular something, you gotta commit to time to it, right? And basketball, as an example, is not easy. So I think you know, more kids are steering away from that, and that's unfortunate, I think because now what do I think basketball does now for kids?

I think it gives 'em some structure that they don't have as much in their life that they used to have. So I think that really becomes really important for them. And then it helps them problem solve. It does help them regulate their emotions,  and I think if more kids participate, they'd have the opportunity to do that.

 I just think it's tough right now for some of the things there's so many distractions for kids right now. There's so many things for kids to do right now. Yeah.  I, and it makes it tough. Yeah, I would agree. and, maybe we can talk a little bit more about boys. So you've noticed a shift in high school.

Absolutely. Yeah. So emotionally, socially, behaviorally, I think over the last several years I have been struck.  Just to, maybe I'm looking at the local Harbor Creek level, the amount of girls that come out for sports. Interesting. Isn't it?  Like I've seen like volleyball, having girls volleyball is having record numbers in the school, and I think it's been that way, maybe nationwide.

It's a lot. Yeah.  I agree. Yeah. But you look at like. You know, Boys basketball, they're struggling a little bit with  not a little bit. I had six kids on a bench one day, right?  To play a game. So we have been struggling. You're right. I don't know what the answer is 'cause it's the same strategy.

It's the same approach.  It's the same approach in terms of what the expectations are. So it's interesting.  I guess I'm just curious what you think is driving these changes that boys are not participating.   Is it the fallout from COVI? Like I don't. I don't know, but there's something it seems that's happening and I'll just throw out this statistic and I don't know if this is related or not.

I, okay. Yeah. I recently saw, statistic that like young adult boys that maybe from their late teens into their early twenties, like a large subset of boys, maybe it's close to 50%, maybe it's 40%, have not talked to a female at all. That's interesting. No, that's an interesting point.  Female, like, yeah. To like, engage, you know, a female in like dating or whatever.

I don't know. Like, It's interesting. That's interesting. 10 years ago, I used to run a boys group at Percy's house when I was a CEO and we would, it was a volunteer group, and we'd get about 10, 11, 12 kids. And then at one point the girl says  why? Why? Why? Are we not talking to men? Why are we not able to talk to men?

Right? And then the boys said, well, wait a second. Wait, why are we not able to talk to the teacher, the women teachers?  It's like, wait a second. Okay, we can do this. But exactly what you're talking about, they wanted to hear somebody else's perspective that wasn't in the classroom, that wasn't their mother telling them something.

Exactly what you're saying. That was 10 years ago that they wanted to do that. So you might be hunting to something. So I don't know, like what is going on with high school boys? Yeah.   you know, 1, 1, 1 of the things that I think, and this might be me just being 67 years old, Jean, I don't mind telling you that.

Okay. It's tough, what we do with basketball and baseball and football  it's, they are a tough sport If you want to succeed. You have to compete all the time. You have to train and work out all year round, right? For all these sports now. And if you don't do that, you're not gonna be competing at the higher level at some level, right?

So I think that's part of it. Certainly you can throw in what you said earlier, acceleration of smartphones and the pandemic and everything  did not help this at all, right? It just pushed boys further into their homes.  Kids were able to stay home and log in at 11:00 AM and they were in school.

I'm confused. Okay. But  we allowed all that. Now we're trying to pull back from all of that, and I think that's some of the resistance we're getting.  It's much more than that. But I think those are, those certainly tie into it. So you think maybe these boys don't want to put in the commitment to train all?

I believe that many of the kids that we might have had 20 years ago. you know, I mean, you see the number of kids, right? So I think that's part of it. They just don't wanna put the, there's so many other things for them to do after school, right? It's not  they're just not part of the basketball team or whatever.

There's so many things and it's hard work. And if you come in here and work and you don't start  it's only basketball's a tough one, right? 'cause only five kids that can play at any given time. Yeah. So if you're not playing and you're putting all that time in.   At some level I do understand that at some level, right?

 But that's not the whole thing. But it's definitely not it's definitely part of it. No doubt. So I guess there's this shift of Hey, if I'm gonna put this time and effort in, I better be getting the recognition from Okay. Parents. Yeah. Don't, oh yeah, you got it. You're right on it.

Okay. Not too cool.  We not cool enough.    Also when you think about that. Just the number of opportunities there are, there's a lot of opportunities. But, and aren't parents like that? They send their kids to camp. They spend money. That's an investment.  And I'm  I just never was involved in that kinda stuff.

But parents do that too, right? There's an investment in their child's future from a sports point of view. Not, I don't mean playing professional sports, but just they think they should be playing in high school. They spent all this money, they send 'em a camp. Again, that's only one perspective.  But I think it all fits in.

Yeah, I agree. And it, it's a shame because like, can we maybe shift away from this?  Oh, you get the recognition to, like, you actually, even if you know, you train, you training all year rounds. You're putting all this effort in, you're gaining benefits cognitively, huge benefits on emotional regulation.

All of these things are so maybe more important than the recognition you're maybe, maybe more important. You're right, because you're problem solving. We don't, one of the, I'm sorry I'm, I'm interrupting you, but No, that's okay. No, go ahead. One of the things that I would think about as I was preparing for this when I was young and I grew up in Erie, we would go, and this, now I'm sound like an old man, but we'd go play baseball in the morning down at the field.

No, there was no parent supervision.  We'd come home, we'd do whatever, eat lunch, whatever. And we were problem solving in that. Right now you're talking about the cognitive part of that. We were problem solving. There had to be emotional regulation 'cause you couldn't get in fights, you weren't gonna play.

So you, there were things in that type of play that forced you to learn those skills. So how do we still get the kids to learn that skill? 'cause they have to learn in order to be healthy adults. A hundred percent. Yep. Yeah.   We're talking about youth mental healthcare. So looking ahead, where do you see the future of youth mental healthcare going?

I think we can get better. Oh, I'm sorry. Go ahead. No, go ahead.  I was just gonna say, especially for adolescents. Yeah. Who we see they're struggling with aggression trauma. Absolutely. I think we can get better, right? We're definitely better at diagnose and we're better with trauma. I think our.

Strategies have to include trauma in that  we've all experienced trauma obviously, but different levels, right?  The kids at Percy's house experience multi complex traumas and you know, when you look at their histories, you think, man, how would I ever respond to something like that?  So I think we're better at understanding traumas.

I think you know, we need to get more into the brain-based and neuroscience  informed strategies. They're out there.  Of course it ends up being for a lot of the deep end kinds of kids. So if we go back to my prevention thing and go back to more school embedded  early intervention, do some trauma informed models.

You, we, Dr. Oliver and I have a trauma informed care model for schools. It's not, it's for everybody gets it. It's a universal approach. So it's just a universal approach. We start with a community meeting. How are you feeling? You know that we ask questions, every kid gets to ask a question. And then the last question is there anyone that can help you?

So we're trying to get kids to problem solve right in first grade, second grade, and third grade also goes along with another. Program that we use, but it really is getting  at, it really is spending money at that prevention level I think. So this is not for  kids who have gotten into trouble or Right.

 No. It's a pre universal, it's a universal prevention model. Yes. So it's different than all of our other models, and I think that's where our money should be spent is a prevent. So  do whole schools adopt this or like they can? They can. Yes, they can. Yeah.  We would encourage Whole Schools to adopt it because you can teach developmentally the social skills you want to do, and then you can pull out the annual control part, the character ed developmental.

You can pick the scenarios you want so that we have to have whole schools do this. We have the Harrisburg school district right now that's doing it all at their high school level. They've identified issues at their high school level for just the, what we're talking about, communication, problem solving, impulse control.

So they wanted everybody focusing on the same type of skills that they're working on. So this works so well.  It was, yeah, they've had some luck with it too, actually. I'm thinking about the Montessori method as an example. Yes. Very similar. Like they get the kids all together. Yeah. Some ages, like problem solving together.

It does work. Like I, and it's easy, right? It's simple. It's not as hard as people make it out to be. It is pretty simple actually. We do community meetings in our charter school with 20, 21, 22 kids every day. That takes about four or five minutes. Amazing. How are you feeling? What's your goal? Who can help you?

Those three questions. Those kids gonna answer those three questions every day before they start their day. How are you feeling? How are you feeling? What's your goal? Who can help you? That's awesome. Every day, Jean. Yeah.  Yeah. I think we're engaging them. Just like I said you in the beginning, we're engaging their brains.

We're making 'em think about, you're in school  of all we, first of all, it's mood identification.  They don't do well with mood identification. Yeah. So we're doing that every day. Some in our residential programs, we're doing it three times. We're doing it in the morning when they wake up. They do a shift change.

They do it before they go to bed. So it's just that constant communication of healthy communication. I'm expressing how I feel healthy.   No. I'm not being aggressive about that. 'cause that's how a lot these kids are.  But again, it's a model that  we can drill it down to just to that prevention level where you're just teaching skills, basic skills that everybody needs.

   And then develop it as you move up.  Yeah, we've had, actually over time, we've had multiple schools that have done that. Now, again, it takes money to do that, but if you think of two, three people that are coordinators, one or two  at each level  versus full, these full blown programs that cost all of the money that they cost it, there really is cost savings involved in it too.

Yeah. And I can see this happen working in, healthcare staffing. Absolutely. Absolutely. How, what your goal, who can help you? I mean, it's great. Uh, How about that? How about that For LECOM residents? as an example. Okay. Just start the day with that one.  Yeah, a hundred percent. So it's engagement.

It's engagement, right? That's like we were just to go back these basketball kids, I think we've always talked them, but I think it's really, we just gotta try to get so much in their head. 'cause there's so much in their own heads,  it's amazing. It's absolutely amazing. Yeah.

So last question. Sure. Yeah. If schools. Families and communities could make just one fundamental change in how they support young people. What do you believe would have the greatest long-term impact on that? Yeah. I'm gonna go back that sense of belonging. So developing a culture of belonging, and then we're gonna add something to that's not just culture of belonging, it's a psychological safety in the community.

You know that we all are belonging. We all live in Harbor Creek as an example. I'm using that one as an example.  We all participate in community activities, we all engage all those kind of things. And then, and we engage with the kids as part of that. So how do we get kids to understand  and they have to gauge, right?

 What's the problem with trauma sometimes And people can, can't gauge rest.   They have to gauge that kind of stuff. But if we can do that in the community, if we can build a community like that. That has that sense of belonging and that psychological safety, I think we're gonna be in much better shape.

Honestly, I've, I believed that for a long time. I still believe that. Yeah. Psychological safety.  That's huge. And that's what team sports does, right? That is what it does. That is exactly right what it does. Sure. Yeah. Awesome. So if people want to learn more about education and treatment alternatives, how can they do that?

It is the United States Center for Aggression Replacement Training. Very simple. URL US CAR t.org, US cart.org, and they can find out more about you and contact you. All the information. Yeah, all that information's on that website. Yes. Excellent. Mark Amendola, thank you very much. Yes, thank you very much for being with us.

Yes, very good. You take care.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.