ADDRESSING MENTAL HEALTH ISSUES: STRATEGIES FOR TEACHERS

1. ADDRESSING MENTAL HEALTH ISSUES: STRATEGIES FOR TEACHERS Toni R. Tollerud, Ph.D. LCPC, NCC, NCSC, ACS PEL Distinguished Teaching Professor Emerita Northern Illinois University VALEES In-service Day, March 1, 2019

2. Getting Started • How does your school address social/emotional learning? • What challenges have you faced as an educator with students experiencing mental health challenges? • Share your questions about supporting and addressing student emotional regulation needs? • How are these topics connected?

3. Mental Health Issues have been referred to as an Epidemic in our Schools! This Photo by Unknown Author is licensed under CC BY-NC-ND

4. Why is this so important to Address?

5. Statistics

6. More Statistics….These are OUR Kids…. • The Department of Health and Human Services (2016) documented 12.8% of teens ages 12 to 17 experiencing at least one major depressive episode in the past year, and approximately 31.9% have had an anxiety disorder. • The 2016 report also indicated increasing levels of suicidal ideation and suicide attempts among adolescents. • Starting with the tragedy at Columbine High school, over 187,000 students have experienced gun violence during the school day (Cox & Rich, 2018). • Students will emotional and behavioral disorders have the worse graduation rate of all students with disabilities (40% compared to 76%).

7. Teachers Play an Important Role in Mental Health • Teachers observe students • Front line each day • Every classroom has some students struggling • Not enough counselors or mental health professionals • Students are unique • Teachers integrate social-emotional learning into class • Teacher attitude is critical in the student’s success • Teachers have a direct line to school counselors, social workers, psychologists and administrators to recommend a student in need

8. Multi-tiered Systems of Support This Photo by Unknown Author is licensed under CC BY-SA

9. Tier One • School culture • Expectations for all students • Social Emotional Learning integration in class (intentional) • Restorative Practice • Trauma-Informed Schools • Intentional connection • Identifying points of disconnection

10. Trauma-Informed • The Problem • 1. Many students have traumatic experiences • 2. Trauma can impact learning, behavior and relationships at school • The Solution • 3. Trauma-sensitive schools help students feel safe to learn • How we get there • 4. Trauma sensitivity requires a whole-school effort • 5. Helping traumatized children to learn should be the focus of educational reform See www.traumasensitiveschools.org

11. Restorative Practices • A positive school environment that is safe, welcoming, and inclusive is critical for student success • See Restorative practices in Education-Videos

12. Tier One-Social Emotional Literacy • http://learning2breathe.org • Emotion regulation skills develop over the course of infancy and childhood and continue to mature during adolescence. These skills are critical to mental health, academic achievement, and good social relationships. Poor emotion regulation skill (called emotional dysregulation) is viewed as a core feature of emotional problems and maladjustment. Such dysregulation has been linked to problems like depression, substance abuse, cutting, poor performance and aggressive behavior, to name a few. This Photo by Unknown Author is licensed under CC BY

13. Self-awareness Self-management Responsible decision-making social & emotional learning Social awareness Relationship Skills What are the CoreSE Competencies? Recognizing one’s emotions and values as well as one’s strengths and limitations Managing emotions and behaviors to achieve one’s goals Making ethical, constructive choices aboutpersonal andsocial behavior Forming positiverelationships, working inteams, and dealing effectivelywith conflict Showing understanding and empathy for others Graphic: CASEL

14. Illinois Social and Emotional Learning Goals Graphic: University of Illinois Extension

15. Check in What Tier 1 practices does your school have in place for behavior and/or social/emotional learning? Restorative Practices? Trauma-informed sensitivity? Programs/Policies? Mental Health Issues?

16. Students in the Schools • There is a stress and anxiety crisis in our schools. More than 25% report some unusual stress within a school year. • It is suggested that even kindergarten students experience higher levels of perfectionism and anxiousness but often lack the ability to share feelings. This Photo by Unknown Author is licensed under CC BY-NC-ND

17. Adolescents and Anxiety • According to a 2015 study by the Child Mind Institute, 80% of kids with a diagnosable anxiety disorder and 60% with depression are not getting treatment. • Kids experience fear, nervousness, and shyness, start to avoid places and activities • NIMH estimates that 31.9% of adolescent have an anxiety disorder, higher for females than males

18. Increase of youth with anxiety but not able to handle it • Increased anxiety seems even more rampant in special groups: LGBTQ, women, immigrants, disabled • What’s out there? • experience feeling paralyzed by news • strong impact from social media • More suspicion toward outsiders • negative emotional climate • significant apathy • sense of hopelessness • results impact weight gain, relationship issues, family dysfunction, sleeplessness This Photo by Unknown Author is licensed under CC BY-NC-ND

19. What is Stress? • Stress is defined as a process that exists over time. When it continues, it can often lead to a debilitating outcomes as it accumulates. • Stress affects all aspects of ones functioning • Stress is manifested in a person as ANXIETY when there is a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome. • When a threat to their safety, their brains trigger a complex set of chemical and neurological events known as the “stress response”. Stress generally causes a release of stress hormones in the body and can develop into serious issues from suicide ideation to isolation. IF left unaddressed in can morph into an anxiety disorder and follow a youth into adulthood.

20. How do you respond to students who come to you and are experiencing heightened ANXIETY? • Additional Suggestions: • Reassure youth • Emphasize safety • Encourage talk and questions • Let them know they can express their real feelings • Answer questions honestly • Avoid discussing worst case scenarios • Protect them from what they don’t need to know • Suggest they not watch so much TV or use social media • Help youth stick to their daily routine This Photo by Unknown Author is licensed under CC BY-SA

21. General Responses • Anxiety and Depression Association of America recommend that parents and caregivers do the following: • Pay attention to youth’s feelings • Stay calm when the youth is anxious • Recognize and praise small accomplishments • Don’t punish mistakes or lack of progress • Be flexible • Modify expectations • Anxiety is NOT a sign of poor parents but it often adds to family stress

22. How to Help in the school Context • Practice stress reduction strategies • Develop self-regulation skills • Make students stress smart • Increases mindfulness (see anxiety as helpful and not the enemy) • Learn and develop coping skills • Collaborate with students • Help identify students from internaling anxiety to bring it out • Provide a supportive environment • Involve teachers and other school staff in addressing anxiety • Address high anxiety times in the schools

23. Explicit and Implicit Memory HIPPOCAMPUS: Explicit memory - governs recollection of facts, events or associations CORTEX: higher level thought processes, planning, problem solving AMYGDALA: Implicit memory – No conscious awareness (procedural memory – e.g., riding a bike and emotional memory- e.g., fear) Cortisol Cortisol Adrenal gland Chronic stress = overstimulation of the Amygdala,resulting in the release of cortisol, possible shrinkage or atrophy of the Hippocampus and Cortex, affecting memory and cognition, and leading to anxiety or depression. (Adapted from: Brunson, Lorang, & Baram, 2002)

24. The Impact of Extreme Trauma on Brain Development 1997, Bruce D. Perry, M.D., Ph.D.

25. Development of the Prefrontal Cortex • In the prefrontal cortex two major areas are being affected: • Myelination: Where the nerve fibers pick up a covering of myelin, a substance that insulates these nerve fibers so that the signals in the brain can be transmitted more effectively • Synaptic pruning: nerve growth is pruned back so that the remaining nerves are more capable of transmitting signals in the brain more effectively Young Adult Development Project, 2008 This Photo by Unknown Author is licensed under CC BY-ND

26. Understanding The Signs of Depression • Use this checklist to document behaviors/moods that you have observedfor the past two weeks or more: • Sad, depressed or irritable mood Loss of interest in favorite activitiesSignificant weight loss or gain Restlessness, agitation or anxietyFeelings of guilt Trouble concentrating or making decisionsFrequent headaches and stomach-aches Cutting or other self-injuryExtreme aggressiveness Inattention to appearanceExcessive risk-taking behavior Drop in school performanceLow tolerance for frustration Lack of motivation, apathyDisrespect MisbehaviorUnable to store or retrieve information Forgotten materials/assignmentsFrequent absences, trips to school nurse Social withdrawal Low Self Esteem Fatigue or loss of energy, including sleeping in class Repeated thoughts of death or suicide, expressed verbally or in writing

27. When asked what they want teachers to know about depression, students responded:

28. Self-Injury • Young people self-harm to deal with overwhelming feelings for which they may have no other effective coping strategies. • Educators of all types are in a unique position to help kids. Many students may not have all of their basic needs recognized and met within their home environments. Do not assume that parents or caregivers are noticing and taking care of your students’ needs. ww.mindmatters.edu.au/spotlights/self-harm This Photo by Unknown Author is licensed under CC BY-SA

29. Self-Injury (NSSI-Non-suicidal Self-Injury) • Educators of all types are in a unique position to help. Many students may not have all of their basic needs recognized and met within their home environments. Do not assume that parents or caregivers are noticing and taking care of your students’ needs. • Don’t ignore it- trust your gut • Extend an attitude of calm and understanding • Be willing to be a link with a school counselor/nurse/social worker • Refer to the school nurse, counselor, psychologist or social worker-check policy • Schools should develop a specific policy for dealing with self-injury cases • Self injury should not be treated solely within the school environment • Involvement of parents • Limitation of confidentiality • Consultation or counseling from an outside professional • Collaboration between all people involved to assist in the ongoing needs of the student www.educatorsandselfinjury.com/educator-response/

30. Teachers and Self-Injury Self-harm is mostly about coping Self-harm is a risk factor for suicide Know the warning signs School staff play an important role A whole school approach is key www.mindmatters.edu.au/spotlights/self-harm

31. Returning from Hospitalization • How could we prepare and encourage all the students in a classroom or school to welcome with sensitivity and empathy a peer returning from hospitalization? • Young people undoubtedly have questions when a classmate is mysteriously absent, and we need to have honest conversations with them about mental-health challenges. • We also need to respect each student's right to privacy while negotiating the occasional need for shared information among school, family, and medical personnel. This Photo by Unknown Author is licensed under CC BY-SA

32. Teachers and Hospitalization • Strategies for Schools and School Personnel: • Identify a point person • Conduct meetings using a mental health strengths-based approach • Note that the goal of hospitalization is to stabilize the child or adolescent, not “fix” her • Develop a crisis plan • Set a clear plan for addressing long-term absence and missed work, and allow for adjustments in classwork/homework upon return • Implement daily check-ins with the student • Provide regular feedback to all school personnel • Provide family and peer-to-peer support, if available

33. Handling Mental Health Issues

34. We Need to Talk… I notice. “Is everything okay? I’ve noticed you have been….” I care. “I’m concerned because I know this isn’t normal for you. How can I help? “What can I do to help? Let's come up with a plan together.” • Ask questions and listen • Be prepared for the truth • Validate feelings • Listen to your gut • Take action and follow up • Let your student drive the ship

35. Classroom Accommodations Expect a certain level of disorganization, forgetfulness or trouble concentrating. • Be flexible - balancing the enabling paradigm • Find the good - Build on strengths • Work to build good relationships with all your students, even the difficult ones • Exercise compassion • Validate and encourage

36. Build on Feelings • Learn how to recognize when anxiety is escalating and have a plan on what to do • Stress room—or allow breaks or time to destress • Acknowledge feelings as real • Classroom time out • Send student to counselor

37. Ask for Continuous Training • Request help from school administration for training on dealing with mental health in the classroom • Review your own personal values • Work collaboratively to be a part of the system of care in school • Practice being a trauma-informed school • Use restorative practices when possible • See guidance and help through school policies • Remember you are never alone…refer a student for help to the school mental health professionals

38. Summing It Up! • Processing resources to address mental health • Curriculum and Classroom Ideas and Strategies I intend to takeaway! • Personal Goals I Can Set to Address Mental Health in my Classroom

39. References and Resources • Bray, B. (June, 2017). Living with Anxiety. Counseling Today, Vol. 59 #12, 28-35. • Meyers, L., (September, 2017). High anxiety. Counseling Today, Vol 60, #3, pp. 38-43 • MaCormac, M. (September, 2016). Address student anxiety. ASCA SchoolcounselorASCA. pp. 1-4. • Thompson, E. H., Robertson, P., Curtis, R., and Frick, M. H.. (January, 2013). Students with anxiety: Implications for professional school counselors. ASCA Professional School Counseling, ASCA, pp. 222-234. • nami.org/Find-Support/NAMI-Programs/NAMI-Ending-the-Silence • www.educationdive.com/news/school-need-additional-strategies • www.acmh-mi.org/get-help/navigating/problems-at-school • CASEL.org