Dawna-Cricket-Martita Meehan, Ph.D. Center for School-Based Mental Health Programs

1. Mental Health Triage for Children and Youth: Actionable Steps to Support Mental/Behavioral Health Dawna-Cricket-Martita Meehan, Ph.D. Center for School-Based Mental Health Programs Miami University

2. Learning Objectives At the end of this session, participants will be able to… • Recognize the signs and symptoms of common mental health and behavioral health issues experienced by children and youth; • Implement action steps to support children and youth experiencing mental health and behavioral health concerns; • Identify appropriate referral pathways that can help children and youth in need of mental health resources and supports.

3. Opioid Epidemic School Shootings

4. 1 in 6school-aged youth: significant impairments in life functioning due to a mental illness(e.g., ADHD, behavioral problems, conduct problems, anxiety, and/or depression) • 1 in 4 youth: growing up in poverty and may be exposed to violence, chronic insecurity, loss, hardship, and disruption of life • 1 in 5 youth: high levels of traumatic adverse childhood experiences • 1 in 4 students: bullied by peers • 1 in 10 adolescents: victim of physical violence by a dating partner • Suicide is 2nd leading cause of death for youth (ages of 10-24)

5. Whereas approximately 20% of all children and adolescents have a mental health disorder, 50% of youth involved in the child welfare system have mental health disorders

6. Oftentimes, we ask… “What’s wrong with you?”

7. A Poem by Abdullah Shoaib

8. Changing the conversation to… “What happened to you?”

9. Now Read From the Bottom Up…

10. Strength-Based Approaches • emphasize individuals’ strengths, capabilities, and resources • allow individuals to see opportunities, hope, and solutions

11. Positive Youth Development An intentional, prosocial approach that engages youth within their communities, schools, organizations, peer groups, and families in a manner that is productive and constructive; recognizes, utilizes, and enhances young people’s strengths; and promotes positive outcomes for young people by providing opportunities, fostering positive relationships, and furnishing the support needed to build on their leadership strengths.

12. Strength-Based Approaches for Positive Youth Development

13. CASA volunteers are in an ideal position to be a positive, strength-based advocate in a young person’s life.

14. Building aStrength-Based Approach for Positive Youth Development through a…

15. …Comprehensive & Coordinated Continuum of Mental Health/ Behavioral Health Supports

17. MH/BH Awareness Training • MH/BH Awareness Training • All adults and youth are trained to recognize the signs and symptoms of MH/BH issues and refer individuals in need of help to appropriate strength-based, asset-driven resources and support • Examples include: • Youth Mental Health First Aid training • Red Flags National • Question, Persuade, Refer • Safety & Violence Prevention training (Ohio HB 276/HB 1)

18. MH/BH Awareness: Action Steps for CASA Volunteers • Pay attentionto and notice what the children and teens you serve are experiencing in their lives • Recognize and identify the signs and symptomsof MH/BH concerns in the children and teens you serve • Take actionto help children and teens who display signs and symptoms of MH/BH concerns • Please note: • You are NOT being asked to diagnose MH/BH concerns • You are NOT being asked to treat MH/BH concerns

19. Recognize the Signs and Symptoms Common MH/BH issues experienced by children and teens: • Anxiety Disorders • Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, Separation Anxiety Disorder, Specific Phobias • Stress Related Disorders • Acute Stress Disorder, PTSD • Mood Disorders • Disruptive Mood Regulation Disorder, Major Depressive Disorder, Dysthymia • Obsessive-Compulsive Disorders • Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, Skin-Picking Disorder • Disruptive Behavioral Disorders • Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, Oppositional Defiant Disorder

20. Recognize the Signs and Symptoms Other common issues experienced by children and teens: • Adverse Childhood Experiences (ACES) • Trauma (resulting from ACES or other experiences) • Bullying • Interpersonal/Dating Violence • Suicidal Ideation

21. Recognize the Signs and Symptoms

22. Recognize the Signs and Symptoms of Anxiety • Being very afraid when away from parents (separation anxiety) • Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias) • Being very afraid of school and other places where there are people (social anxiety) • Being very worried about the future and about bad things happening (general anxiety) • Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder) • Irritability and/or anger • Problems sleeping, such as sleeping too much or too little • Physical symptoms like fatigue, headaches, or stomachaches

23. Recognize the Signs and Symptoms of Stress/PTSD • Feeling numb, detached, or being emotionally unresponsive • Reliving the event over and over in thought or in play • Nightmares and sleep problems • Becoming very upset when something causes memories of the event • Lack of positive emotions • Emotions not feeling real • Intense ongoing fear or sadness • Irritability and angry outbursts • Constantly looking for possible threats, being easily startled • Acting helpless, hopeless, or withdrawn • Denying that the event happened or feeling numb • Avoiding places or people associated with the event • Being restless, fidgety, or have trouble paying attention and staying organized

24. Recognize the Signs and Symptoms of Depression • Feeling sad, hopeless, or irritable a lot of the time • Not wanting to do things • Not enjoying fun things • Having a hard time paying attention • Feeling worthless, useless, or guilty • Showing self-injury and self-destructive behavior • Showing changes in eating patterns • eating a lot more or a lot less than usual • Showing changes in sleep patterns • sleeping a lot more or a lot less than normal • Showing changes in energy • being tired and sluggish or tense and restless a lot of the time

25. Recognize the Signs and Symptoms of Obsessions and Compulsions • Having unwanted thoughts, impulses, or images that occur over and over and which cause anxiety or distress • Having to think about or say something over and over (for example, counting, or repeating words over and over silently or out loud) • Having to do something over and over (for example, handwashing, placing things in a specific order, or checking the same things over and over, like whether a door is locked) • Having to do something over and over according to certain rules that must be followed exactly in order to make an obsession go away

26. Recognize the Signs and Symptoms of Attention-Deficit and Hyperactivity • Daydream a lot • Forget or lose things a lot • Squirm or fidget • Talk too much • Make careless mistakes • Take unnecessary risks • Have a hard time resisting temptation • Have trouble taking turns • Have difficulty getting along with others

27. Recognize the Signs and Symptoms of Behavior Problems • Often being angry or losing one’s temper • Often arguing with adults or refusing to comply with adults’ rules or requests • Often resentful or spiteful • Deliberately annoying others or becoming annoyed with others • Often blaming other people for one’s own mistakes or misbehavior • Breaking serious rules, such as running away, staying out at night when told not to, or skipping school • Being aggressive in a way that causes harm, such as  bullying, fighting, or being cruel to animals • Lying, stealing, or damaging other people’s property on purpose

28. Recognize the Signs and Symptoms of Adverse Childhood Experiences (ACES) & Trauma • Difficulty trusting others • Uncertain about the reliability/predictability of others • Interpersonal difficulty • Social isolation • Difficulty seeking help • Clingy, difficulty with separations • Sensorimotor development problems • Hypersensitivity to physical contact • Somatization • Oppositional behavior • Excessive compliance • Sleep disturbance • Eating disorders • Reenactment of traumatic event/past • Pathological self-soothing practices • Difficulty paying attention • Lack of sustained curiosity • Problems processing information

29. Recognize the Signs and Symptoms of Adverse Childhood Experiences (ACES) & Trauma • Increased medical problems • Problems with coordination and balance • Problems with emotional regulation • Easily upset and/or difficulty calming • Difficulty describing emotions and internal experiences • Difficulty knowing and describing internal states • Problems with communicating needs • Poor impulse control • Self-destructive behavior • Aggressive behavior • Problems focusing on/completing tasks • Difficulty planning and anticipating consequences • Learning difficulties, developmental delays • Problems with language development • Lack of continuous/predictable sense of self • Poor sense of separateness • Disturbance of body image • Low self-esteem • Shame and guilt

30. Recognize the Signs and Symptoms of Bullying … of being bullied • Unexplainable injuries • Lost or destroyed clothing, books, electronics, or jewelry • Frequent headaches or stomach aches, feeling sick or faking illness • Changes in eating habits, like suddenly skipping meals or binge eating (may come home from school hungry because they did not eat lunch) • Difficulty sleeping or frequent nightmares • Declining grades, loss of interest in schoolwork, or not wanting to go to school • Sudden loss of friends or avoidance of social situations • Feelings of helplessness or decreased self esteem • Self-destructive behaviors such as running away from home, harming themselves, or talking about suicide … of bullying others • Get into physical or verbal fights • Have friends who bully others • Are increasingly aggressive • Get sent to the principal’s office or to detention frequently • Have unexplained extra money or new belongings • Blame others for their problems • Don’t accept responsibility for their actions • Are competitive and worry about their reputation or popularity

31. Recognize the Signs and Symptoms of Interpersonal/Dating Violence • Excessive jealousy • Constantly checking in with partner or making partner check in with him or her • Attempts to isolate partner from friends and family • Insulting or putting down people that partner cares about • Is too serious about the relationship too quickly • Has had a lot of bad prior relationships - and blames all of the problems on the previous partners • Is very controlling; may include giving partner orders, telling partner what to wear, and trying to make all of the decisions for partner • Blames partner when he or she treats partner badly by telling partner all of the ways partner provoked him or her • Does not take responsibility for own actions • Has an explosive temper (“blows up” a lot) • Pressures partner into sexual activity with which partner is not comfortable • Has a history of fighting, hurting animals, or brags about mistreating other people • Believes strongly in stereotypical gender roles for males and females • Partner worries about how he or she will react to the things partner says or being afraid of provoking him or her • He or she owns or uses weapons • Refuses to let partner to end the relationship

32. Recognize the Signs and Symptoms of Suicide • Preoccupation with death (e.g., recurring themes of death or self-destruction in artwork or written assignments) • Intense sadness and/or hopelessness • Not caring about activities that used to matter • Social withdrawal from family, friends, sports, social activities • Sleep disturbance (either not sleeping or staying awake all night) • Giving away possessions • Risky behavior • Lack of energy • Inability to think clearly/concentration problems • Declining school performance/increased absences from school • Increased irritability • Changes in appetite • Substance abuse

33. Remember Your Action Steps… • Pay attentionto and notice what the children and teens you serve are experiencing in their lives • Recognize and identify the signs and symptomsof MH/BH concerns in the children and teens you serve • Take actionto help children and teens who display signs and symptoms of MH/BH concerns • Please note: • You are NOT being asked to diagnose MH/BH concerns • You are NOT being asked to treat MH/BH concerns

34. MH/BH Response Techniques • All adults and youth know what to do when they recognize signs and symptoms of MH/BH issues • Examples include: • ALGEE Action Plan • A=assess for risk of suicide or harm • L=listen non-judgmentally • G=give reassurance and information • E=encourage appropriate professional help • E=encourage self-help and other support strategies • Build positive relationships using a framework like the • Developmental Relationship Framework from Search Institute

35. MH/BH Response Techniques: Action Steps for CASA Volunteers • Build positive relationships with the children and teens you serve • When you recognize and identify the signs and symptoms of MH/BH concerns in the children and teens you serve, take action to help: • Talk with children and teens about their MH/BH concerns • Listen (without distraction) to what they have to say • Teach them how to recognize the signs and symptoms of MH/BH concerns • Educate them about MH/BH concerns they may be experiencing • Help them identify coping strategies to mitigate their symptoms • Advocate for them if they are in need of professional mental health help

37. Developmental Relationships Framework Search Institute has identified five elements—expressed in 20 specific actions—that make relationships powerful in young people’s lives. Express Care Challenge Growth Provide Support Share Power Expand Possibilities

38. Express Care Show me that I matter to you • Be dependable—Be someone I can trust • Listen—Really pay attention when we are together • Believe in me—Make me feel known and valued • Be warm—Show me you enjoy being with me • Encourage—Praise me for my efforts and achievements

39. Challenge Growth Push me to keep getting better • Expect my best—Expect me to live up to my potential • Stretch—Push me to go further • Hold me accountable—Insist I take responsibility for my actions • Reflect on failures—Help me learn from mistakes and setbacks

40. Provide Support Help me complete tasks and achieve goals • Navigate—Guide me through hard situations and systems • Empower—Build my confidence to take charge of my life • Advocate—Stand up for me when I need it • Set boundaries—Put in place limits that keep me on track

41. Share Power Treat me with respect and give me a say • Respect me—Take me seriously and treat me fairly • Include me—Involve me in decisions that affect me • Collaborate—Work with me to solve problems and reach goals • Let me lead—Create opportunities for me to take action and lead

42. Expand Possibilities Connect me with people and places that broaden my world • Inspire—Inspire me to see possibilities for my future • Broaden horizons—Expose me to new ideas, experiences, and places • Connect—Introduce me to people who can help me grow

43. MH/BH Response Techniques: Action steps for CASA volunteers when you recognizethe signs and symptoms of MH/BH concerns in children and teens

44. How to Help Children/Teens who are Anxious • Talk with children and teens about their anxiety or worries • Teach children and teens to recognize signs of anxiety in themselves and to ask for help when they experience anxiety • Help them find coping strategies for their anxiety or worries • Relaxation techniques, such as taking three deep, slow breaths, breathing in for a count of three and out for three • Calming/coping toolbox • Distraction techniques (think of favorite things, squeeze something, counting) • For severe and/or persistent anxiety, advocate for the child/teen to visit a mental health professional

45. How to Help Children/Teens who have Stress/PTSD • Offer support and understanding to children and teens after a stressful event • Keep children/teens’ schedules and lives as similar as possible to before the event • Encourage children and teens to talk about the stressful/traumatic event when and if they feel ready (but don’t force the issue) • Reassure them that their feelings are typical and that they're not "going crazy" • Help build self-confidence by encouraging children and teens to make everyday decisions where appropriate (PTSD can make kids feel powerless, so helping them have control over some parts of their lives is very healing) • Tell them that the stressful/traumatic event is not their fault (encourage talking about any feelings of guilt, but don't let them blame themselves for what happened) • Do not criticize regressive behavior (returning to a previous level of development) • Advocate for the child/teen to visit a mental health professional (if needed)

46. How to Help Children/Teens who are Depressed • Talk with children and teens about things in their lives that may be bothering them • Teach children and teens to recognize signs of depression in themselves and to ask for help when feeling depressed • Promote health (healthy diet, getting enough sleep, daily exercise) • Teach coping strategies (e.g., self-worth statements, mindfulness) • Encourage fun activities and positive social interactions with others • For severe and/or persistent depression, advocate for the child/teen to visit a mental health professional

47. How to Help Children/Teens who experience Obsessions and Compulsions • Educate child/teen about obsessions and compulsions • Help child/teen to identify what ‘triggers’ obsessive thoughts and compulsive behaviors • Encourage child/teen to challenge the obsessive thoughts • Encourage child/teen to resist acting on the compulsions • Ensure that child/teen has support from others • Reduce stress in the child/teen’s life • For severe and/or persistent obsessions and compulsions, advocate for the child/teen to visit a mental health professional

48. How to Help Children/Teens with Attention-Deficit and Hyperactivity • Advocate for child/teen to have a structured, consistent schedule • Break down activities in smaller (more manageable) steps • Establish clear rules, expectations, and consequences • Determine if child/teen needs a ‘fidget’ to help concentrate better • Help child/teen simplify and organize their tasks and responsibilities • Limit distractions (e.g., quiet place for homework) • Encourage ‘out loud’ thinking to help with self-control • Encourage child/teens to take breaks, when needed (but not to ‘give up’ on tasks)

49. How to Help Children/Teens with Behavior Problems • Use behavior management techniques: • Increase supervision of child/teen during ‘high-risk’ activities • Encourage child/teen to apologize to help in social conflicts • Ignore behavior that is not harmful (e.g., annoying) - “Pick your battles” • Remove privileges for misbehavior • Praise positive behaviors (behaviors opposite of misbehavior) • Offer choices whenever possible • Make tasks more manageable • Encourage child/teen to reach out for help (when needed) • If anyone’s safety is at risk, seek immediate professional help (law enforcement, medical help, mental health professionals)

50. How to Help Children/Teens with ACES & Trauma • Ask “what’s happening?” rather than “what is wrong with this child?” • Recognize when child/teen is triggered by something in the environment • Respond in a calm, kind, compassionate way • Provide a safe place for child/teen to talk about what happened • Understand that behavior problems may be related to trauma • Re-establish a sense of safety • Identify coping strategies for dealing with overwhelming emotions • If symptoms become overwhelming, advocate for the child/teen to visit a mental health professional