School-Based Mental Health: Supports, Strategies and Recommendations

Transcription

1 School-Based Mental Health: Supports, Strategies and Recommendations Dr. Anthony Folino, Ph.D., C.Psych School and Child Clinical Psychologist Folino 2017

2 Note: Please do not disseminate the contents of this presentation without the explicit consent and authorization of Anthony Folino. Note: This presentation covers a number of topic areas. If you feel that some of this information may be of benefit to your child in the school board, it is recommended that you consult with the Psychology Services staff member at your child s school to determine how best to put some of these strategies into place.

3 Presentation Overview Current state of youth mental health Implications for schools School-based mental health supports Model and philosophy to maximize school-based supports Specific school-based strategies Disruptive behaviors Anxiety disorders Measuring success

4 Current State of Youth Mental Health: Implications for Schools

5 Youth Mental Health Facts Prevalence: 10-20% of Canadian youth are affected by a mental illness or disorder (CAMH). Mental illness can be treated very effectively (CMHA) Early identification and early intervention typically yield best outcomes.

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7 In Canada, only 1 out of 5 children who need mental health services receives them (Kids Mental Health Info).

8 Barriers to Mental Health Supports and Services

9 Limited Financial Resources

10 Between 2004 and 2011: Ontario government invested : $220 million in mental health care $18.5 billion in health care Per Capita Spending in Health Care $1361 Per Capita Spending in Mental Health Care $16.45

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12 Stigma Canadian Youth Mental Health and Illness Survey (1996) 63% of youth point to stigma as the most likely reason to not seek help Navigating Services Parents for Children s Mental Health: Family Input Survey (2013) 76% of families surveyed indicated it was extremely difficult to know where to find help in Ontario.

13 Current State of Youth Mental Health High prevalence of mental health challenges in youth. Low rates of children accessing help from community supports. Major dilemma Systemic Societal Educational

14 Can schools provide effective mental health promotion, prevention, and interventions for youth?

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16 Key Research Finding Review found clear evidence for the effectiveness of specific school-based strategies for mental health promotion, prevention, and treatment of internalizing and externalizing disorders.

17 Teaching! Mental Health Skills Mental Health Strategies Mental Health Competencies

18 Effective School-Based Mental Health Supports

19 Minimal Focus on Diagnosis Effective School-Based Mental Health Supports

20 Minimal Focus on Diagnosis When the focus is solely on diagnosis, educators often feel like they have little to offer.

21 Minimal Focus on Diagnosis Maximum Focus on Skill Building Effective School-Based Mental Health Supports

22 Maximal Focus on Skill Building Mental Health Diagnosis Skill Deficits Maladaptive Interaction Styles

23 Oppositional Defiance Disorder Social Skill Deficits Physical Aggression

24 When our focus is on: Understanding what skills are lagging What skills need to be developed The classroom setting becomes an ideal environment for the promotion of various skills

25 Minimal Focus on Diagnosis Maximum Focus on Skill Building Effective School-Based Mental Health Supports Collection of Observational Data

26 Collection of Observational Data Must be data driven and data hungry School setting is ideal for observations to occur Rare opportunity to see child in action Systematic observations lead to a better understanding of what skills are lacking.

27 A-B-C s of behaviour What to Observe?

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32 Minimal Focus on Diagnosis Maximum Focus on Skill Building Effective School-Based Mental Health Supports Collaboration Collection of Observational Data

33 Evolution of My Role as a School Psychologist

34 It takes a Village Most effective school-based mental health supports are provided when we work collaboratively within our multidisciplinary teams FAMILY STUDENT Teachers Educational Assistants Psychologists Social Work Speech and Language Pathologists

35 Disruptive Behaviour Disorders: Potential School-Based Supports

36 Disruptive Behaviour Disorder (DBD) Angry Outbursts Oppositional Defiant Disorder (ODD) Conduct Disorder (CD) Antisocial Behaviours Property Destruction Defiance towards authority figures Aggression Stealing Lying Truancy

37 Prevalence & Prognosis of DBD 5 10% of students meet criteria for ODD or CD. Students who exhibit chronic levels of antisocial and aggressive behaviours prior to age 13 are at increased risk of: Academic failure and drop-out Violence Unplanned pregnancies Unemployment Substance abuse Depression Suicide Difficulties with parenting and marriage

38 Skill Areas to Target Social Skills Problem Solving Skills DBD Physiological Indicators

39 Social Skills

40 Social Skills Training Good social skills are critical for successful functioning in life. Examples of social skills Accepting a compliment Giving a compliment Joining a group Interpreting non-verbal cues Tone of voice Respecting boundaries Etc.

41 Social Skills Training Key components to consider when teaching social skills: Explain the new skill What is the skill? Why is the skill important? When should the skill be used? Demonstrate the new skill Modeling of new skill as often as possible Pointing out when other students or adults in the room used the skill (or could have used the skill) Provide student with opportunities to practice the new skill Use plenty of role-playing, coaching, prompting, cueing Solicit involvement from peers We are helping Johnny work on accepting compliments, can you compliment his art work please? Discussion of real or imagined scenarios Imagine that you wanted to be a part of the game, lets talk about how you could invite yourself. Provide as much feedback as possible Consider a reward or reinforcement system for use of desired social skill.

42 Problem Solving Skills Explicit teaching of problem solving skills is very effective.

43 Problem Solving Effective problem solving is a complex task Involves multiple steps 1) Identifying the problem 2) Generating possible solutions 4) Evaluating each solution 5) Choosing the best solution 6) Trying out the solution 7) Evaluating the effectiveness of the solution

44 Especially challenging for a subset of children with reactive aggression Deficits with encoding and interpretation of social cues Hostile Attribution Bias

45 When we actively teach problem solving, we better understand where the true deficits are. 1)Identifying the problem 2) Generating possible solutions 3) Evaluating each solution 4) Choosing the best solution 5) Trying out the solution 6) Evaluating the effectiveness of the solution

46 Social Problem Solving When we actively teach social problem solving, we better understand where the true deficits are. 1)Identifying the problem 2) Generating possible solutions 3) Evaluating each solution 4) Choosing the best solution 5) Trying out the solution 6) Evaluating the effectiveness of the solution

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49 Physiological Deficits in DBD

50 Low Resting Heart Rate and Antisocial and Aggressive Behaviours Resting Heart Rate Aggressive Disruptive Antisocial Behaviours

51 Relationship between low resting heart rate and increased behaviour problems: Shown in animal studies. Replicated in human studies. Broadly the same for males and females. Replicated in 7 different countries. Is diagnostically specific. Has predictive value

52 Key Finding: Resting heart rate assessed in 1,795 children at age 3 Aggression assessed at age 11 Aggressive children had significantly lower heart rates than non-aggressive children Results suggest that low resting heart rate at age 3 predisposes children to aggression at age 11

53 Key Finding Low resting heart rate from ages 5-12 years associated with increased fighting from ages 9-12 years.

54 Key Finding: Low cardiac arousal at age 15 years in normal unselected school boys predicted criminal behaviour at age 24 years. Measures of arousal correctly classified75% of all subjects as criminal/noncriminal, a rate significantly greater than chance

55 Why does low resting heart rate predispose some students to act in aggressive, disruptive, and antisocial ways? WHY?

56 Stimulation Seeking Theory (SST) (Quay, 1965; Eysenck, 1997; Raine et al., 1997) Low Arousal Unpleasant physiological state Students STUDENTS engage ENGAGE in antisocial IN EXERCISE and aggressive TO acts INCREASE to increase AROUSAL arousal

57 Key Finding: 30 min of moderate to intense aerobic exercise resulted in approximately 90 minutes of behavioural improvements in: Disruptive behaviours Prosocial Behaviours Compliance to teacher requests

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59 Anxiety Disorders: Potential School-Based Supports

60 Prevalence Rates Clinical Levels: Approximately 6% of school aged children have clinical levels of anxiety (Canadian Mental Health Association).

61 Key Issues Anxiety, fear, and worry are normal body reactions. Anxiety is a biological warning system that enables us to anticipate and avoid harm and failure. Appropriate levels of anxiety is key for our survival and safety. Fight or flight response

62 Fight or Flight

63 Anxiety can help: people deal with potentially threatening situations study harder for an exam perform better in sports

64 Anxiety Disorders: The brain and the body is acting as if there is an immediate and major threat even if one does not exist. Individuals with anxiety tend to: OVERESTIMATE risk, danger, and threat UNDERESTIMATE coping abilities.

65 Anxiety Disorders Separation Anxiety Disorder

66 Anxiety Disorders Separation Anxiety Disorder Generalized Anxiety Disorder

67 Anxiety Disorders Separation Anxiety Disorder Generalized Anxiety Disorder Specific Phobias

68 Anxiety Disorders Separation Anxiety Disorder Generalized Anxiety Disorder Specific Phobias Social Anxiety

69 Anxiety Disorders Separation Anxiety Disorder Generalized Anxiety Disorder Specific Phobias Social Anxiety Obsessive-Compulsive Disorder

70 Anxiety Disorders Separation Anxiety Disorder Generalized Anxiety Disorder Specific Phobias Social Anxiety Obsessive-Compulsive Disorder Panic Disorder

71 Anxiety Disorders Separation Anxiety Disorder Generalized Anxiety Disorder Specific Phobias Social Anxiety Obsessive-Compulsive Disorder Panic Disorder Post-Traumatic Stress Disorder

72 Skill Areas to Target Unhelpful Thinking Styles Arousal Control Anxiety Anxiety Management Plan

73 Unhelpful Thinking Styles Faulty Thoughts Illogical Thoughts Irrational Thoughts Catastrophic Thoughts

74 Components of Anxiety Thoughts Feelings Behaviors

75 Source: PSYCHOLOGYTOOLS.ORG

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77 Catastrophizing Typical Non-Anxious Individual Typical Anxious Individual Average windy day Storm that will cause trees to crash into my house and badly hurt me Just a tiny spider Poisonous tarantula that can kill Typical acne Disgusting rash that will cause everyone to stare and hate me forever

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80 Irrational Thoughts Disproportionate Thoughts Illogical Thoughts Catastrophic Thoughts If we can address the errors in thinking, we can have a significant impact of anxiety

81 Help Students Change Faulty Thoughts to Realistic Thoughts

82 How to identify faulty thoughts Simple guiding question: What is the worst case scenario if.?

83 Using the so what questioning technique Identify first thought; after each thought, we put the word so what... I m not a very good speaker so what? I might make a mistake.so what? I will look like I don t know what I m doing.so what? The audience will think I don t know anything in this area The audience will think I don t know anything at all They will tell other people about how I don t know anything More people will know about my lack of skills and knowledge I will develop a poor reputation of being incompetent Important people will also find out about my incompetence I won t be able to get a job I ll be a failure

84 Test (faulty) thoughts by examining available evidence and experiences: Discussing: What happens to other people in similar situations? Most likely thing to happen? What happened when I worried before? How many times has my worst case scenario actually come true? Etc. Do research to find the hard facts

85 BOSS BACK THOSE WORRIED THOUGHTS!!!!

86 Arousal Control Physiologically impossible to be anxious and relaxed at the SAME time!

87 Extremely worried thoughts Heart starts pounding Sweaty palms Start feeling nauseas Constant need to twitch my legs

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89 Relaxation Skills Deep Breathing Exercises Progressive Muscle Relaxation Mindfulness Exercises Imagery

90 Anxiety Management Plan

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96 Measuring Success

97 How Do We Measure Growth and Success Focus on key dimensions of behaviour: Frequency Intensity Duration

98 Summary

99 Thank You!