Counseling Charter Handout Safe Harbor Counseling Charter
My Private Space to Talk, Learn, and Grow
Student: ___________________
Date: ___________________
Welcome to counseling! This is a safe, confidential space where you can share thoughts and feelings honestly without getting into trouble. We are a team working together on awesome strategies to handle tough moments.
The Confidentiality Promise
What is said in here stays in here! Your counselor will not share our private conversations with teachers, friends, or classmates, EXCEPT for 3 critical safety situations:
1. Hurting Yourself
If someone shares that they plan to hurt themselves.
2. Hurting Others
If someone shares that they plan to hurt someone else.
3. Someone Hurting You
If someone is hurting you or making you unsafe.
What We Do in Counseling
Build coping skills like deep breathing & journaling
Spot anger body clues before losing control
Practice flipping angry thoughts into calm thoughts
Role-play real recess and classroom scenarios
My Counseling Commitment
I understand the rules of confidentiality and I am ready to practice healthy coping strategies to become a Calm Champion.
Student Signature:
Counselor Signature:
Getting to Know Me
Icebreaker & Strengths Discovery Activity
Session 1 Activity
1. My Favorite Activities & Hobbies
2. Two Things I Am Really Good At
3. Things That Annoy or Frustrate Me
4. What Helps Me Calm Down Right Now
Rapid Fire: Circle Your Pick!
Drawing / Art OR Playing Sports
Video Games OR Board Games
Listening to Music OR Watching Movies
Quiet Room OR Outdoor Playground
My Personal Goal for Our 8 Weeks
When I get mad, frustrated, or stressed, I want to be able to:
Take deep breaths before reacting
Write or draw in my cool-down journal
Use positive self-talk to cool my brain down
Session 1 complete — Rapport established & Confidentiality verified
Inner Calm Quest: Week 1 of 8
Goal Tracker Assessment Sheet IEP Counseling Goal Data Tracker
Progress Monitoring Log & Session Data Collection
Student: __________________
IEP Target Date: Feb 2025
Eligibility: SLD / OHI (Grade 5)
Official IEP Counseling Goal
"By February 2025, student will report using healthy coping strategies, such as deep breathing or journaling, to manage anger in response to triggering situations, as recorded by the mental health staff during individual sessions, at least 2 times per week for 4 consecutive weeks."
• Schedule: 1x/wk (25 min) • Strategy Focus: Deep Breathing, Journaling, REBT Self-Talk • Criteria: ≥2x/week for 4 consecutive weeks
Weekly Progress & Self-Report Log
Wk / Date Triggering Situation Identified Strategy Reported Times / Wk Goal Met (≥2x)? 1: __/__ Baseline intake & rapport Baseline survey ___ / wk [ ] Yes [ ] No 2: __/__ ___ / wk [ ] Yes [ ] No 3: __/__ ___ / wk [ ] Yes [ ] No 4: __/__ ___ / wk [ ] Yes [ ] No 5: __/__ ___ / wk [ ] Yes [ ] No 6: __/__ ___ / wk [ ] Yes [ ] No 7: __/__ ___ / wk [ ] Yes [ ] No 8: __/__ ___ / wk [ ] Yes [ ] No
Consecutive Mastery Milestone (4 Weeks in a Row)
Week 1 Target
[ ] Met (≥2x)
Week 2 Target
[ ] Met (≥2x)
Week 3 Target
[ ] Met (≥2x)
Week 4 Target
[ ] Met (≥2x)
Mental Health Provider / School Psychologist: ___________________________ Page 1 of 2
Weekly Scenario Progress Check
Student Oral/Written Assessment Protocol
Session #: _______
Date: _____________
SLD/OHI Administration Accommodations: Provider reads scenarios aloud. Student may answer orally, point to visual cards, or write brief responses to eliminate writing fatigue.
Part 1: Weekly Coping Recall Check-in
1. "Think about this past week at school or home. Did you feel your body getting angry or frustrated?"
[ ] Yes, (____ times) [ ] No, stayed calm all week
Trigger description: ____________________________________________________________________
2. "Which healthy strategy did you use when you felt angry?"
[ ] Deep Breathing (Box / 4-7-8) [ ] Cool-Down Journaling [ ] REBT Thought Flip
Part 2: Scenario Problem-Solving Quiz
Scenario Prompt for the Week:
"You are working on a 5th-grade science group project, and a classmate accidentally erases your drawings on the poster board. You feel heat rising in your chest."
A. Identify the Anger Level (1-5): _______ / 5
B. Best Immediate Coping Choice:
[ ] 4 Deep Belly Breaths before speaking
[ ] Grab cool-down journal to vent thoughts
[ ] Say: "It was an accident; we can fix it"
[ ] Ask teacher for a 2-minute reset break
Clinical Mastery Rating for Session
1 - Emerging
Requires prompt to name coping strategy; unable to report weekly usage.
2 - Developing
Names strategy independently; reports 1x weekly usage with prompt.
3 - Mastered (Goal Met)
Independently reports ≥2x weekly use and applies to scenario.
Inner Calm Quest: Progress Assessment Protocol Page 2 of 2
Safe Harbor Facilitator Guide Session 1 Facilitator Guide: Safe Harbor
Therapeutic Intake, Confidentiality & Rapport Building (25 Min)
Week 1 of 8
Modality: Client-Centered & REBT
Target Grade: 5th Grade (SLD / OHI)
Session Length: 25 Minutes
25-Minute Structured Session Protocol
1 Warm Welcome & Safe Space Setup (3 Mins) Min 00:00 - 03:00
Greet student warmly at eye level. Establish unconditional positive regard. Offer a fidget/tactile tool (OHI accommodation). Script: "Welcome! This is our private office time where you are safe to be yourself."
2 Confidentiality Charter Walkthrough (7 Mins) Min 03:00 - 10:00
Review the Counseling Charter Handout . Walk through the 3 safety exceptions with clear visual examples (hurting self, hurting others, someone hurting you). Sign the commitment together.
3 Strengths Icebreaker & "This or That" (10 Mins) Min 10:00 - 20:00
Complete Page 2 of the handout. Use client-centered reflective listening: reflect student feelings without judgment ("You feel really passionate about gaming, but get frustrated when glitches happen." ).
4 Baseline IEP Data Check & Calm Reset (5 Mins) Min 20:00 - 25:00
Administer baseline check on the Goal Tracker Sheet . Practice one grounding breath before returning to class. Provide positive affirmation.
SLD & OHI Clinical Accommodations
Reading Support (SLD): Read all charter text aloud; use visual icons to reinforce concepts.Attention Regulation (OHI): Provide tactile handheld stress ball or squeeze toy during discussion.Writing Reduction: Allow student to dictate responses or circle choices instead of writing full sentences.
Inner Calm Quest: Lesson 1 Facilitator Protocol Session 1 of 8
Baseline Coping Quiz Baseline Coping Skills Quiz
Pre-Intervention IEP Counseling Assessment (Week 1)
Student: ___________________
Date: ___________________
Admin: Pre-Test (Baseline)
Instructions: This quiz helps us see what calming tools you already use before starting our quest. There are no right or wrong answers! Mark your honest response.
Part 1: How Often Do You Use Calming Tools Right Now?
1. In the past week, when you felt mad or upset, how many times did you use Deep Breathing to calm down?
[ ] 0 times [ ] 1 time [ ] 2 times [ ] 3+ times
2. In the past week, when you felt mad or stressed, how many times did you Write or Draw in a Journal to cool off?
[ ] 0 times [ ] 1 time [ ] 2 times [ ] 3+ times
3. In the past week, when angry thoughts started, how often did you use Calming Self-Talk (e.g. "I can handle this")?
[ ] 0 times [ ] 1 time [ ] 2 times [ ] 3+ times
4. When you start getting upset, how easy is it for you to notice physical clues in your body (like tight fists or a fast heartbeat)?
[ ] Hard / Not sure [ ] Sometimes notice [ ] Easy to notice
Part 2: Body Clues & Anger Signals
5. Check all the body clues you usually feel when anger begins to rise:
[ ] Clenched fists
[ ] Hot red face
[ ] Racing heartbeat
[ ] Tight stomach
[ ] Heavy breathing
[ ] Clenched teeth/jaw
Inner Calm Quest: Baseline Pre-Test Page 1 of 2
Scenario & Strategy Pre-Assessment
Baseline Problem Solving & Thought Reflection
Pre-Test Part 3 & 4
Part 3: What Would You Do Right Now?
6. Scenario: During 5th-grade math, you get stuck on a difficult problem and feel yourself getting very frustrated. What is your current typical response?
[ ] I shut down, cross my arms, or stop doing any work.
[ ] I snap or raise my voice at the person next to me.
[ ] I take 3 slow belly breaths and ask for help or take a calm pause.
[ ] I crumple my paper or shove my materials away.
7. Scenario: At recess, someone cuts in front of you in the four-square line. What thought goes through your head first?
[ ] "They did that on purpose to disrespect me! This is totally unfair!"
[ ] "I can pause, breathe, and speak up calmly or tell the recess monitor."
[ ] "I'm going to push them right back so they learn their lesson."
Part 4: Self-Confidence in Calming Down (1-5 Stars)
Clinical SOAP Notes Worksheet School Counseling SOAP Note
Clinical Session Documentation & Progress Record
Confidential School Record
Student: ________________
Grade / DOB: ____________
Date: ____/____/____
Time: ____:____ (___min)
Service Framework: [ ] IEP [ ] 504 [ ] Tier 2/3 MTSS [ ] General Ed
Focus Area / Goal: ___________________________________
S Subjective (Student Self-Report, Stated Feelings, Affect & Presenting Concerns)
Affect: [ ] Calm [ ] Anxious [ ] Withdrawn [ ] Frustrated [ ] Flat [ ] Overwhelmed [ ] Cooperative
O Objective (Clinical Interventions Used & Direct Behavioral Observations)
[ ] CBT / Cognitive Restructuring [ ] Mindfulness / Somatic Breathing [ ] Solution-Focused Counseling [ ] Emotional Regulation Tools [ ] Social Skills & Role-Play [ ] Expressive Art / Journaling
A Assessment (Clinical Evaluation, Response to Intervention & Target Progress)
Progress: [ ] Minimal [ ] Emerging [ ] Moderate [ ] Goal Met Engagement: [ ] High [ ] Moderate [ ] Low
P Plan (Subsequent Interventions, Consultations & Follow-up Actions)
[ ] Schedule subsequent individual counseling session
[ ] Teacher / Parent consultation & check-in
Provider Name & Title: _________________________________________ Signature / Date: ___________________
Multi-Session SOAP Tracking Grid
Continuous Counseling Session Notes & Clinical Tracking
Student: ___________________
School Year: ___________________
Condensed clinical entries with large writing areas for session notes. 3 Sessions per Page
SESSION ENTRY # ___ Date: ____/____/____ Time: ____:____ (___min) Progress: [ ] Emerging [ ] Developing [ ] Mastered
S (Subjective) & O (Objective):
A (Assessment) & P (Plan):
SESSION ENTRY # ___ Date: ____/____/____ Time: ____:____ (___min) Progress: [ ] Emerging [ ] Developing [ ] Mastered
S (Subjective) & O (Objective):
A (Assessment) & P (Plan):
SESSION ENTRY # ___ Date: ____/____/____ Time: ____:____ (___min) Progress: [ ] Emerging [ ] Developing [ ] Mastered
S (Subjective) & O (Objective):
A (Assessment) & P (Plan):
School Counseling Documentation Series Page 2 of 2
Annual Counseling Service Log Annual Counseling Service Log
Full-Year IEP Service Delivery & Attendance Record (Semester 1)
School Year: ___________________
Mandated Service: ___________________
Student: ________________
Grade: ________________
Eligibility: ________________
Provider: ________________
Semester 1 Service Log (Q1 & Q2)
Target: _____ Min / Session
Date Time (In - Out) Mins Skill / Topic Covered Brief Description of Work & Progress Init Safe Harbor Intake Body Clues & Scale Breath Power Routine Mind Messengers ABC Thought Flippers Journal Journey Scenario Showdown Calm Champion Post Maintenance Check-in Coping Strategy Review
Semester 1 Mandated Mins: _____ min
Total Delivered Mins: _____ min
Service Compliance: [ ] 100% Met [ ] Make-up Req
Inner Calm Quest: Year-Long Service Delivery Record Semester 1 (Page 1 of 2)
Annual Counseling Service Log
Full-Year IEP Service Delivery & Attendance Record (Semester 2)
School Year: ___________________
Term: ___________________
Anger Thermometer Worksheet My Anger Thermometer
Recognizing Emotional Heat Levels Before I Boil Over
Name: ___________________
Date: ___________________
Anger doesn't jump from 0 to 100 instantly. It gives us warning signs! Use this scale to track how your body and feelings change at each level so you can use your coping tools early.
5 Exploding
Level 5: Out of Control / Boiling Emergency Coping
Body Cues: Heart racing fast, clenched fists, screaming, unable to think straight.
What to do: Take a safe reset break; disengage; breathe immediately.
4 Very Mad
Level 4: Steaming & Agitated High Alert
Body Cues: Hot face/ears, heavy breathing, glaring, tense shoulders, pacing.
What to do: 4 deep belly breaths, write in journal, walk away.
3 Frustrated
Level 3: Annoyed & Heating Up Action Zone
Body Cues: Tight stomach, gritting teeth, crossing arms, frowning.
What to do: Flip the thought: "I can handle this", take 2 deep breaths.
2 Mildly Irritated
Level 2: Slight Bother Early Warning
Body Cues: Sighing, rolling eyes, feeling restless or distracted.
What to do: Drink water, stretch, ask for clarification calmly.
1 Cool & Calm
Level 1: Relaxed & Focused Baseline
Body Cues: Relaxed muscles, steady breathing, smiling, able to learn.
What to do: Keep up great habits; enjoy the moment!
Inner Calm Quest: Body Clues Page 1 of 2
My Body Clues Map
Where in My Body Do I Feel Anger First?
Session 2 Activity
Check My Physical Signs
Head: Headache / buzzing thoughts
Face & Ears: Feeling hot or red
Jaw: Clenching or grinding teeth
Chest: Heart beating like a drum
Stomach: Butterflies or knots
Hands: Making tight fists
Feet: Wanting to stomp or kick
My Top 3 Anger Triggers
Check or write what sparks your anger:
Losing a game or sports match Being interrupted or blamed Hard schoolwork / test frustration Unfair rules or referee calls
My #1 Early Warning Sign Is:
The Golden Rule of Body Clues:
Whenever you notice your #1 body clue, that is your brain's alarm bell to start
Body Clues Facilitator Guide Session 2 Facilitator Guide: Body Clues
Somatic Trigger Recognition & Anger Thermometer (25 Min)
Week 2 of 8
Focus: Somatic Awareness
Materials: Anger Thermometer WS
Data Check: Weekly Coping Tracker
25-Minute Structured Session Protocol
1 Warm-up & Weekly IEP Data Check-in (4 Mins) Min 00:00 - 04:00
Welcome student. Log weekly coping strategy frequency on the Goal Tracker Sheet . Inquire about any frustration experienced during the past week using client-centered open reflection.
2 Anger Thermometer 1-5 Scale Exploration (7 Mins) Min 04:00 - 11:00
Introduce the 1-5 scale on Anger Thermometer Worksheet . Explain that anger is a normal human emotion, but catching it early (at Level 2-3) allows us to stay in control before reaching Level 5 (Boiling Point).
3 Body Clues Somatic Mapping Activity (10 Mins) Min 11:00 - 21:00
Guide student to shade their personal body signals on the body silhouette (hot forehead, clenched fists, fluttery stomach). Clinician prompt: "Where in your body does anger knock first to warn you?"
4 Early Warning Reset & Affirmation (4 Mins) Min 21:00 - 25:00
Identify student's primary early warning cue. Practice noticing that sensation and taking two cleansing breaths. Reinforce autonomy and self-awareness strengths.
SLD & OHI Clinical Accommodations
Kinesthetic Mapping: Allow student to use colored highlighters/markers to color the body outline rather than writing.Sensory Integration (OHI): Have the student squeeze fists tight for 5 seconds and release to physically feel muscle tension vs. relaxation.
Inner Calm Quest: Lesson 2 Facilitator Protocol Session 2 of 8
Breath Power Toolkit Poster Breath Power Tactile Cards
Calming My Nervous System with Finger-Tracing & Belly Breathing
Name: ___________________
Date: ___________________
When anger spikes, your body's alarm system speeds up your heart. Slow, steady breathing sends a message to your brain: "I am safe. I am in control."
Technique 1: The 4x4 Box Breath (Trace with Your Finger)
4-Count Rhythm
1. Inhale In through nose (4s)
2. Hold Pause gently (4s)
3. Exhale Out mouth slowly (4s)
4. Rest Pause empty (4s)
Technique 2: 5-Finger Mountain Tracing
Tactile Reset
Spread one hand out like a star. Take the pointer finger of your other hand. Trace up the outside of your thumb while breathing in; trace down the inside while breathing out. Repeat across all 5 fingers!
Thumb
Pointer
Middle
Ring
Pinky
My In-Session Practice Check:
Starting Calmness (1-10): _____
After 3 Cycles Calmness (1-10): _____
Inner Calm Quest: Somatic Calming Tools Page 1 of 2
5-4-3-2-1 Grounding Anchor
Quick Sensory Focus When Your Brain Feels Overloaded
Sensory Tool
5
SEE: Look around the room. Name 5 things you can see right now (e.g., clock, desk, shoes).
4
FEEL: Touch 4 physical textures (e.g., cool desk surface, soft hoodie, smooth pencil).
3
HEAR: Listen carefully. Name 3 sounds (e.g., hallway footsteps, clock ticking, hum of lights).
2
SMELL: Identify 2 scents in the air (e.g., fresh pencil shavings, clean air, hand sanitizer).
1
TASTE / SAY: Notice 1 taste or say 1 kind positive affirmation (e.g., "I can stay calm and handle this." ).
Cut & Keep Pocket Cue Cards
Pocket Box Breath
1. Inhale 4 sec
Keep in pencil pouch!
5-4-3-2-1 Grounding
5 See • 4 Feel • 3 Hear
Keep in binder or pocket!
Inner Calm Quest: Lesson 3 Breath & Sensory Grounding Page 2 of 2
Breath Power Facilitator Guide Session 3 Facilitator Guide: Breath Power
Somatic Calming & Tactile Breathwork Routines (25 Min)
Week 3 of 8
Focus: Somatic Regulation
Materials: Breath Power Poster
Data Check: Weekly Coping Tracker
25-Minute Structured Session Protocol
1 Check-in & Weekly Data Log (4 Mins) Min 00:00 - 04:00
Welcome student. Record weekly deep breathing usage on the Goal Tracker Sheet . Validate student efforts and acknowledge any emotional challenges from the school week.
2 Physiology of Calm & Box Breathing (7 Mins) Min 04:00 - 11:00
Explain how deep diaphragm breathing triggers the parasympathetic "calm switch" in the brain. Model Box Breathing (Inhale 4s, Hold 4s, Exhale 4s, Hold 4s) using the visual tracing square on the poster.
3 5-Finger Breathing & 5-4-3-2-1 Grounding (10 Mins) Min 11:00 - 21:00
Have student trace their own fingers while inhaling up and exhaling down. Practice the 5-4-3-2-1 Sensory Grounding routine to pull attention away from angry thoughts into the immediate physical environment.
4 Personal Practice Plan & Wrap-up (4 Mins) Min 21:00 - 25:00
Have student choose their favorite breathing method to try at their desk this week. Provide positive praise for participation and emotional courage.
SLD & OHI Clinical Accommodations
Tactile Feedback: Place student's hand on their abdomen so they can physically feel their belly expand and contract.Visual Pacing (OHI): Use a visual timer or finger-tracing motion rather than silent counting to maintain pacing and focus.
Inner Calm Quest: Lesson 3 Facilitator Protocol Session 3 of 8
Mind Messengers Worksheet The ABCs of My Mind
Connecting Triggers, Brain Self-Talk, and Reactions (REBT)
Name: ___________________
Date: ___________________
Did you know?
Events do not make us angry all by themselves. It is what we think about the event (our brain's inner voice) that creates our anger! Let's decode the ABC formula:
A
Activating Event (The Trigger)
What actually happened? Just the camera-replay facts without opinions.
Example: "Someone bumped my desk and knocked over my pencil case."
B
Belief / Self-Talk (The Brain Message)
What did your inner voice say about it? Is it helpful or angry self-talk?
Example: "They did that on purpose to disrespect me! I hate them!"
C
Consequence (Feelings & Actions)
How did you feel (Level 1-5) and what did your body do?
Example: "Level 5 Anger -> Yelled and shoved their desk back."
The Big Secret of REBT
You cannot always change A (accidents happen, rules exist). But you ALWAYS have the power to change B (your self-talk), which completely changes C (your feelings and choices)!
Inner Calm Quest: Lesson 4 REBT Foundations Page 1 of 2
Decode the Story
Guided REBT Practice with Real School Situations
Guided Practice
Situation 1: The Missed Pass at Recess Case Study
"During a 5th-grade basketball game, your teammate passes the ball over your head and it goes out of bounds. The other team gets the ball."
A - Activating Event:
The pass went out of bounds and our team lost possession.
B - Unhelpful Angry Self-Talk (Write or Circle):
[ ] "They did that on purpose because they think I'm bad!"
[ ] "They ruined everything, this whole game is stupid!"
C - Angry Consequence (What happens next):
Feelings: Level 4 Anger • Action: Kicking the ball away and yelling.
Situation 2: Now Try Your Own! (Draw or Write)
A (What happened?):
B (What was your brain saying?):
C (What did you do / feel?):
Inner Calm Quest: ABC Skill Mastery Page 2 of 2
Mind Messengers Facilitator Guide Session 4 Facilitator Guide: Mind Messengers
REBT ABC Framework & Internal Dialogue Connection (25 Min)
Week 4 of 8
Focus: REBT ABC Model
Materials: Mind Messengers WS
Data Check: Weekly Coping Tracker
25-Minute Structured Session Protocol
1 IEP Progress Review & Rapport Check (4 Mins) Min 00:00 - 04:00
Record weekly strategy count on the Goal Tracker Sheet . Ask student if they practiced deep breathing when facing a trigger. Validate any real-world progress.
2 Introducing the ABC Bridge (8 Mins) Min 04:00 - 12:00
Using the Mind Messengers Worksheet , explain that A (Activating Event) does not directly cause C (Consequences / Anger) . It is B (Beliefs & Self-Talk) in our head that creates the feeling!
3 Comic Strip Case Practice (9 Mins) Min 12:00 - 21:00
Walk through the comic scenarios on Page 2. Help student spot "Brain Glitch" words like "always," "never," "they must," "it ruined everything." Connect these rigid thoughts to explosive angry feelings.
4 Self-Talk Detective Wrap-up (4 Mins) Min 21:00 - 25:00
Have student state their personal "Mind Messenger" goal for the week: to catch what their brain whispers before reacting. Close with an encouraging grounding high-five.
SLD & OHI Clinical Accommodations
Comic Dialogue Format: Use visual speech bubbles rather than long text boxes to make abstract cognition concrete.Oral Scribing: Allow student to orally state beliefs while the counselor writes them down to prevent writing avoidance.
Inner Calm Quest: Lesson 4 Facilitator Protocol Session 4 of 8
Thought Flipping Worksheet The Thought Flipper
Challenging Angry Thoughts & Building Flexible Self-Talk
Name: ___________________
Date: ___________________
Step D & E: Dispute & Exchange!
When your brain gets angry, it often tells you "brain traps" like "Everybody is against me!" or "I must win every game or I'm a failure!" Let's test those thoughts like a detective and FLIP them into calm, powerful truths!
The 3 Detective Dispute Questions
1
Is it 100% True?
Do I have real proof, or am I just guessing their intention?
2
Is it Helping Me?
Does thinking this solve the problem, or make me get into trouble?
3
What's the Worst?
Can I survive this frustrating moment and handle it calmly?
The Flip Zone: Angry Thought vs. Calm Truth
Angry "Stuck" Thought
Flipped "Calm" Truth
"They cut in front of me in line on purpose! I'm gonna push them!"
"Maybe they didn't see the line. I can use a calm voice to speak up or tell the teacher."
"I got this math problem wrong! I'm stupid and this is impossible!"
"Mistakes are part of learning. I can take 2 deep breaths and ask for help."
"My friend wanted to play with someone else. They hate me forever!"
"People can have other friends. We can still hang out at lunch or tomorrow."
Inner Calm Quest: Lesson 5 Cognitive Restructuring Page 1 of 2
Flip Your Own Thoughts
Hands-on Practice Replacing Angry Beliefs
Session 5 Practice
Exercise: Flip this Angry Thought!
Angry Thought:
"The referee called a foul on me! That ref is totally unfair and trying to make me lose!"
Apply Your Detective Tools:
[ ] Is it 100% true that the ref is targeting me? (No, refs make quick calls).
[ ] Will yelling at the ref help? (No, it earns a technical foul or benching).
My Flipped Calm Statement (Write or complete):
My 4 Go-To Coping Power Phrases
"I can stay calm even when things don't go my way."
"I am in control of my words and my hands."
"Take 4 slow breaths before I react."
"This is frustrating, but I can handle it."
Inner Calm Quest: Lesson 5 Cognitive Mastery Page 2 of 2
Thought Flippers Facilitator Guide Session 5 Facilitator Guide: Thought Flippers
REBT Cognitive Restructuring & Rational Disputing (25 Min)
Week 5 of 8
Focus: Cognitive Restructuring
Materials: Thought Flipping WS
Data Check: Weekly Coping Tracker
25-Minute Structured Session Protocol
1 Weekly IEP Goal Data Log & Review (4 Mins) Min 00:00 - 04:00
Record weekly coping frequency on the Goal Tracker Sheet . Celebrate reaching the second half of the sequence. Prompt student to share one trigger event from the past week.
2 3 Disputing Questions ("The Thought Test") (7 Mins) Min 04:00 - 11:00
Introduce REBT disputation using 3 kid-friendly questions: 1) Is this thought 100% true? 2) Does thinking this help me or hurt me? 3) What would I say to a best friend in this situation?
3 Flipping Angry Thoughts & Pocket Cards (10 Mins) Min 11:00 - 21:00
Complete the Thought-Flipper table on Thought Flipping Worksheet . Transform "He ruined my whole day on purpose!" into "He made a mistake, and I can still enjoy the rest of my day." Cut out or customize pocket coping cards.
4 Pocket Card Anchor & Grounding (4 Mins) Min 21:00 - 25:00
Have student select one anchor statement to place in their school binder or pocket. Practice saying the calm thought aloud with steady breath.
SLD & OHI Clinical Accommodations
Pre-printed Statements: Offer pre-written rational coping phrases for student selection to minimize written output demands.Color Contrast Highlighting: Highlight "Hot Thoughts" in red and "Cool Replacement Thoughts" in green for visual organization.
Inner Calm Quest: Lesson 5 Facilitator Protocol Session 5 of 8
Cool Down Journal Guide My Cool-Down Journal
Safe Space to Release Steam, Vent, and Reset
Date: ____________
Time: ____________
Starting Anger Level (Circle):
1 Calm 2 Annoyed 3 Frustrated 4 Mad 5 Boiling
Step 1: What Sparked My Anger? (Complete the starter)
"I started feeling upset or frustrated when: __________________________________________________"
"The thing that felt unfair was: ___________________________________________________________"
Step 2: The Vent Box (Draw, Scribble, or Sketch the Feeling) Draw what it looks like inside your brain
Step 3: My Reset Action (Check what you did)
Took 4 slow box breaths Wrote or drew in this journal Flipped my angry self-talk Asked for a 2-minute cool break
Ending Anger Level After Journaling: [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]
Page 1 of 2
Journaling Helper & Starters
Sentence Banks and Weekly Independent Tracker
Support Bank
Easy Sentence Starters (Pick any one to write or say!)
Describing Frustration:
• "Right now my chest feels..."
• "I got overwhelmed when..."
• "It felt unfair because..."
Finding Calm Solutions:
• "What I need right now is..."
• "I can remind myself that..."
• "Next time, I will try to..."
My Weekly Strategy Tally (Goal: 2x This Week)
Each time you use Deep Breathing or your Journal to handle anger at school or home, check a box below!
Time 1 (This Week)
Day: ____________
Tool used: [ ] Breath [ ] Journal
[ ] Completed!
Time 2 (Goal Milestone!)
Day: ____________
Tool used: [ ] Breath [ ] Journal
[ ] Target Reached!
Remember: Writing or sketching your feelings gets the anger out of your head and onto the paper so you can make smart, calm choices!
Inner Calm Quest: Lesson 6 Journal Journey Page 2 of 2
Journal Journey Facilitator Guide Session 6 Facilitator Guide: Journal Journey
Low-Stress Cool-Down Journaling & Quick-Draw Venting (25 Min)
Week 6 of 8
Focus: Journaling & Expression
Materials: Cool Down Journal Guide
Data Check: Weekly Coping Tracker
25-Minute Structured Session Protocol
1 IEP Progress Review & Data Log (4 Mins) Min 00:00 - 04:00
Record weekly strategy use on the Goal Tracker Sheet . Evaluate whether student has reached 2 consecutive weeks of ≥2x strategy use.
2 De-escalation via Journaling Demystified (7 Mins) Min 04:00 - 11:00
Present the Cool Down Journal Guide . Emphasize that counseling journaling is NOT graded English writing: spelling, grammar, and neatness do not matter. The only goal is transferring intense emotion from body to paper safely.
3 Quick-Draw Venting & Sentence Starters (10 Mins) Min 11:00 - 21:00
Practice two formats: 1) "Doodle the Storm" (sketching angry energy with lines, symbols, or shapes), and 2) Sentence starter fills ("Right now I feel furious because... One thing I need to feel better is..." ).
4 Classroom Access Plan & Safe Storage (4 Mins) Min 21:00 - 25:00
Agree on where the journal will stay (in student desk or counseling folder). Practice asking a teacher for a 3-minute journal break.
SLD & OHI Clinical Accommodations
Dysgraphia / SLD Support: Encourage comic doodling, emoji mapping, or single-word bubble clouds over complete paragraph writing.Scribing Option: Provide counselor dictation if the student prefers to verbalize their cool-down entry.
Inner Calm Quest: Lesson 6 Facilitator Protocol Session 6 of 8
Scenario Showdown Cards Scenario Showdown Cards
Real 5th-Grade Role-Play & Strategy Selection Practice
Set 1 (Cards 1-3)
How to Play: Read the scenario aloud with your counselor. Identify the anger level, identify the body clues, and role-play choosing your healthy coping strategy!
Card #1: The Recess Four-Square Dispute Recess Conflict
Situation: You hit the ball cleanly into square 2. The other player shouts, "You hit the line! You're OUT!" and everyone tells you to go to the back of the line. You know you weren't out.
Angry Impulse: Scream, refuse to leave, kick ball.
Healthy Coping: 4 box breaths + flip thought ("It's just recess, I'll get back in").
Card #2: The Timed Math Test Overload Classroom Stress
Situation: The teacher sets a 5-minute timer for a 20-problem fractions worksheet. You get stuck on question #3. The clock is ticking loudly and your chest feels tight.
Angry Impulse: Rip paper, slam pencil, put head down.
Healthy Coping: 5-finger breathing trace + raise hand for accommodation/help.
Card #3: The Group Project Left Out Peer Dynamics
Situation: Two classmates in your science group start whispering, laughing, and deciding the whole poster design without asking for your ideas.
Angry Impulse: Knock over supplies, mutter insults.
Healthy Coping: Quick journal sketch + assertive calm voice: "I want to draw the diagrams."
Inner Calm Quest: Lesson 7 Role-Play Cards Page 1 of 2
Scenario Showdown Cards
Real 5th-Grade Role-Play & Strategy Selection Practice
Set 2 (Cards 4-6)
Card #4: The Lunch Line Cut-in Cafeteria Chaos
Situation: You have been waiting 7 minutes in the pizza line. Right before you reach the front, a student walks right in front of you and grabs the last slice.
Angry Impulse: Shove the student or yell across cafeteria.
Healthy Coping: 5-4-3-2-1 grounding + calm statement: "Excuse me, the line starts back there."
Card #5: The Teasing Nickname on the Bus Bus / Transition
Situation: On the bus ride home, a student sitting two rows behind you repeats an annoying nickname and laughs every time you look back.
Angry Impulse: Throw backpack or start a physical fight.
Scenario Showdown Facilitator Guide Session 7 Facilitator Guide: Scenario Showdown
Real-World Peer Conflict Role-Play & Strategy Synthesis (25 Min)
Week 7 of 8
Focus: Role-Play Simulation
Materials: Scenario Cards
Data Check: Weekly Coping Tracker
25-Minute Structured Session Protocol
1 IEP Weekly Data Log & Progress Check (4 Mins) Min 00:00 - 04:00
Record weekly strategy use on the Goal Tracker Sheet . Check if student has achieved 3 consecutive weeks meeting the IEP criteria (≥2x/week).
2 Role-Play "Safety Rules" & Strategy Selection (6 Mins) Min 04:00 - 10:00
Review the Scenario Showdown Cards . Establish the "Role-Play Freeze Rule" (either player can shout "Freeze!" to hit the pause button and deliberate the best calming choice).
3 Live Scenario Showdown Simulations (11 Mins) Min 10:00 - 21:00
Enact 2-3 realistic 5th-grade scenarios: Card 1 (Four-Square line cut) , Card 2 (Science group erased work) , Card 4 (Cafeteria spill) . Counselor acts as peer trigger; student enacts body awareness, pauses, takes 4 box breaths, flips the hot thought, and responds with assertive calm language.
4 Debrief & Rehearsal Mastery Badge (4 Mins) Min 21:00 - 25:00
Process physiological response during role-play. Commend student for keeping their anger meter below Level 3.
SLD & OHI Clinical Accommodations
Role-Reversal: If student feels anxious being triggered, let student play the antagonist first while counselor models de-escalation.Visual Strategy Cards: Keep Breath Power and Thought Flipper cue cards on the table as instant visual prompts.
Inner Calm Quest: Lesson 7 Facilitator Protocol Session 7 of 8
Calm Champion Action Plan My Calm Champion Action Plan
Personalized Maintenance & Anger Reset Protocol
Champion: ___________________
Date: ___________________
1. My Top 2 Early Warning Signs (Level 2-3)
A. _________________________________
B. _________________________________
2. My Favorite Breathing Technique
4x4 Box Breath 5-Finger Mountain Trace 5-4-3-2-1 Grounding
3. My Power Coping Phrase (Thought Flip)
"I can stay calm and..."
4. Trusted Adults I Can Ask for a Reset
At School: _________________
Counselor: _________________
At Home: ___________________
Inner Calm Quest: Relapse Prevention Action Plan Page 1 of 2
Certificate of Mastery
Inner Calm Quest • 8-Week Counseling Series
This official certificate is proudly awarded to:
__________________________________________________
For demonstrating outstanding dedication, emotional awareness, and mastering healthy coping strategies including Deep Breathing , Cool-Down Journaling , and REBT Thought Flipping to manage anger in triggering situations.
Breath Master
Box & 5-Finger Reset
Thought Flipper
REBT Rational Beliefs
Journal Pro
Vent & Refocus
School Psychologist / Counselor
Calm Champion Student
Post Test Assessment Rubric Post-Test Coping Skills Assessment
8-Week IEP Counseling Sequence Outcome Assessment
Student: ___________________
Date: ___________________
Admin: Post-Test (Week 8)
Week 8 Final Check-in: You've completed 8 weeks of Inner Calm Quest! Let's see all the awesome calming tools and self-control strategies you have mastered.
Part 1: Current Coping Strategy Usage (This Past Week)
1. In the past week, when you felt angry or frustrated, how many times did you use Deep Breathing (Box / 5-Finger) to reset?
[ ] 0 times [ ] 1 time [ ] 2 times (Goal) [ ] 3+ times
2. In the past week, when you felt angry or overwhelmed, how many times did you use Cool-Down Journaling or Drawing ?
[ ] 0 times [ ] 1 time [ ] 2 times (Goal) [ ] 3+ times
3. When an angry thought pops into your head, how well can you Flip the Thought to a calm coping statement?
[ ] Still need adult help [ ] Sometimes flip it [ ] Regularly flip it myself
Part 2: Post-Test Conflict Scenario Application
"Scenario: You worked hard on a math worksheet, and a peer accidentally bumps your desk, knocking your water bottle over and soaking your paper. You feel your face get hot (Level 4 Anger)."
[ ] I yell and push their desk to get even.
[ ] I take 4 box breaths, flip my thought ("It was an accident"), and ask the teacher for a clean copy.
[ ] I shut down and refuse to speak for the rest of the school day.
Inner Calm Quest: Post-Test Student Form Page 1 of 2
IEP Counseling Goal Scoring Rubric
8-Week Outcome Evaluation & Clinical Data Comparison
Mental Health Provider Form
Pre-Test vs. Post-Test Data Comparison
Target Skill / Objective Baseline (Wk 1) Post-Test (Wk 8) Net Growth Weekly Strategy Frequency (Goal: ≥2x/wk) ____ / week ____ / week + ____ times/wk 4 Consecutive Weeks Target Met? [ ] No [ ] Yes [ ] No [ ] Goal Achieved Somatic Body Trigger Recognition ____ / 6 clues ____ / 6 clues + ____ clues Scenario Conflict Problem-Solving ____ / 4 rating ____ / 4 rating + ____ levels
Standardized IEP Goal Mastery Rubric
Calm Champion Facilitator Guide Session 8 Facilitator Guide: Calm Champion
Post-Assessment, Relapse Prevention & Graduation Celebration (25 Min)
Week 8 of 8
Focus: Post-Test & Mastery
Materials: Post-Test, Action Plan
Outcome: IEP Goal Progress Report
25-Minute Structured Session Protocol
1 Celebration Welcome & 8-Week Journey Reflection (3 Mins) Min 00:00 - 03:00
Welcome student with enthusiastic praise for completing the 8-week quest. Review their growth journey from intake to mastery.
2 Administer Post-Test Assessment (8 Mins) Min 03:00 - 11:00
Administer the Post Test Assessment Rubric (Page 1). Read items aloud (SLD accommodation). Record strategy frequency and scenario response. Complete Page 2 clinical rubric scoring and compare with Week 1 baseline data.
3 Calm Champion Relapse-Prevention Action Plan (9 Mins) Min 11:00 - 20:00
Complete the Calm Champion Action Plan . Consolidate the student's "Top 3 Calming Superpowers", emergency classroom reset routine, and trusted adult helpers list.
4 Graduation Certificate Presentation (5 Mins) Min 20:00 - 25:00
Present and co-sign the official Calm Champion Certificate . Take a commemorative celebration moment to solidify emotional self-efficacy and agency.
IEP Progress Reporting Protocol
Data Synthesis: Transfer 4-consecutive-week tracking data and post-test rubric rating to the district IEP progress monitoring portal.Generalization Check: Provide classroom teacher with a copy of the student's Top 3 Coping Superpowers summary.
Inner Calm Quest: Lesson 8 Facilitator Protocol Session 8 of 8
