Mental Health and Schools

1
Mental Health and Schools

• A Primer

2
Overview

• Why Mental Health and Schools?
• Development and Mental Health
• Risk and Protective Factors
• Mental Health Disorders 101
• Treatment Options
• What You Can Do

3
MENTAL HEALTH QUIZMatch the behaviors on the
right to the mental health diagnoses on the
left.(behaviors can be used for more than one
diagnosis)

• ADHD
• __________________
• Depression
• __________________
• 3. Oppositional Defiant
• __________________
• 4. Bipolar
• __________________
• 5. Anxiety
• __________________
• 6. PTSD/ Trauma
• __________________
• Reactive Attachment

• A. difficulty concentrating
• B. angry/ anger outbursts
• C. argumentative
• D. irritability
• E. tearful
• F. talkative
• G. preoccupation with thoughts/objects
• H. sleep difficulties
• I. forgetful
• J. bullies
• K. fidgets
• L. distant/ detached

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Why Mental Health and Schools?
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Because Schools Are The Most Universal Natural
Setting

• Over 55 million youth attend 114,700 schools
  (K-12) in the U.S.
• 6.8 million adults work in schools
• Combining students and staff, approximately 20
  of the U.S. population can be found in schools
  during the work week.

University of Maryland Prince Georges County
Public School System, Mental Health 101 for
Non-Mental Health Providers.
6
Because Schools Are The Most Universal Natural
Setting

20

• Schools provide a uniquely appropriate setting
  through which all children can access the full
  continuum of mental health services.

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Because Our Students Have Mental Health Needs

• Between 20 to 38 of youth in the U.S. have
  diagnosable mental health disorders
• Between 9 to 13 of youth have serious
  disturbances that impact their daily functioning
• Only one-sixth to one-third of youth with
  diagnosable disorders receive any treatment

Adapted from University of Maryland Prince
Georges County Public School System, Mental
Health 101 for Non-Mental Health Providers.
8
Because Those Needs Impact Our Classrooms

• Loss of instructional time
• Lack of academic progress
• Negative class climate
• Parental complaints
• Teacher stress

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Because Those Needs Impact Our Schools

• AYP performance
• Negative effect on school culture climate
• Teacher turnover
• Safety security
• Negative effect on attendance, discipline, school
  suspension and graduation rates

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Because Those Needs ImpactOur Communities

• Increased crime rates
• Increase in juvenile delinquency
• Failure to graduate productive members of society
• Continuation of the problem cycle

TENNESSEE
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And Because Those Needs Impact Individual Learners

• Low academic motivation
• Academic underachievement
• Poor relationships
• Low self-concept
• Defiance/non-compliance with authority figures

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Because Those Needs Impact Learning
Learning
Psychological Needs
Environmental Needs
Biological Needs
Maslows Hierarchy of Needs
13
Mental Health SchoolsA Win-Win for All

• Schools win since mental health is directly
  linked to educational outcomes.
• Children families win since accessible,
  affordable mental health services are most easily
  and consistently provided in an educational
  setting.

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Development and Mental Health
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Stages of Development
 Eriksons Psychosocial Crisis Stage Life Stage Age range, other descriptors
 1. Trust v Mistrust Infancy 0-1½ yrs, babyhood, birth to walking
 2. Autonomy v Shame and Doubt Early Childhood 1-3 yrs, toddlerhood, toilet training
 3. Initiative v Guilt Play Age 3-5 yrs, pre-school, nursery
 4. Industry v Inferiority School Age 6-12 yrs, early school
 5. Identity v Role Confusion Adolescence 13-18 yrs, puberty, teens
 6. Intimacy v Isolation Young Adult 18-40, courting, early parenthood
 7. Generativity v Stagnation Adulthood 30-65, middle age, parenting
 8. Integrity v Despair Mature Age 50, old age, grandparents
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Typical or Troubled?
Guidelines for making the distinction

• Students who are exhibiting typical behavior are
  more likely to have
• Concerning behaviors at the same rates of
  frequency and intensity as the general peer group
• One or two concerning behaviors at a time
• No impairment in functioning

• Students who are exhibiting troubled behavior are
  more likely to have
• Concerning behaviors at frequencies and
  intensities that exceed those of the general peer
  group
• Clusters of concerning behaviors
• Significant impairment in one or more areas of
  functioning

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Risk and Protective Factors
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Risk Protective Factors
Risk and protective factors refer to the elements
of an individuals life that act to decrease or
increase the likelihood of positive
outcomes. High levels of protective factors are
associated with increased resiliency.
Risk
Protective
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Two Key Environmental Stressors

• Living in poverty
• Exposure to Trauma

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Key Biological Stressors

• Physical health disorders
• Mental health disorders with primary biological
  etiology

21
Identifying Risk and Protective Factors Practice
Activity
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The Human Brain
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The Brain
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The Emotional Brain
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The Amygdala Mental Illness
Amygdala
Healthy Patient
Depressed Patient
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Stress Containment Analogy
Response generated by the Frontal Lobe
Response generated by the Limbic System
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Mental Health Disorders 101
28
Disorder Classifications

• Disruptive Behavior Disorders
• Mood Disorders
• Anxiety Disorders
• Attachment Disorders
• Autism Spectrum Disorders
• Psychotic Disorders

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Disruptive Behavior Disorders

• Attention Deficit Hyperactivity Disorder
• Oppositional Defiant Disorder
• Conduct Disorder
• Intermittent Explosive Disorder

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Attention Deficit Hyperactivity Disorder

• Difficulty paying attention
• Easily distracted
• Unorganized
• Often loses things
• Often fidgets
• Talks excessively
• Often interrupts others

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Oppositional Defiant Disorder

• Argues with adults
• Actively refuses to comply with adults
• Annoys others
• Blames others for misbehavior
• Angry and resentful
• Spiteful and vindictive

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Conduct Disorder

• Often bullies, threatens or intimidate others
• Physically cruel to people and/or animals
• Deliberately destroys property
• Often lies (cons others)
• Truancy

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Intermittent Explosive Disorder

• Several episodes of failure to resist aggressive
  impulses
• The degree of aggressiveness expressed is out of
  proportion to the precipitating stressor

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Mood Disorders

• Depressive Disorder
• Bipolar Disorder

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Depressive Disorder

• Depressed or irritable mood
• Fatigue, low energy or sluggishness
• Sleep disturbances
• Diminished ability to concentrate
• Diminished interest or pleasure in most activities

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Depression in Childhood

• Excessive irritability
• Social withdrawal
• Negative self-talk, pessimism
• Increased sensitivity to rejection
• Vocal outbursts or crying
• Physical agitation
• Expressions of turmoil or confusion
• Increased dependency on caregivers (i.e.
  clinginess)
• Thoughts of death or suicide

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Bipolar Disorder

• Key diagnostic feature Mania
• Manic episodes are characterized by
• Inflated self-esteem
• Distractibility
• More talkative than usual /or rapid, pressured
  speech
• Decreased need for sleep
• Flight of ideas/racing thoughts
• Increase in goal-directed activity or in activity
  level

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Bipolar in Childhood

• Rapid severe cycling with chronic irritability
• Few clear periods of wellness between episodes
• Explosive, lengthy often destructive rages
• Hyperactivity, agitation distractibility
• Impaired judgment impulsivity
• Highly risky behavior
• Excessive, unexplainable silliness
• Inappropriate or precocious sexual behavior

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Anxiety Disorders

• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder
• Posttraumatic Stress Disorder
• Acute Stress Disorder
• Adjustment Disorder

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Generalized Anxiety Disorder

• Excessive uncontrollable worry
• Restlessness
• Irritability
• Difficulty concentrating
• Sleep disturbance
• Easily fatigued

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Obsessive-Compulsive Disorder

• Recurrent thoughts or impulses that cases
  distress
• The thoughts and impulses are not excessive
  worries about real life problems
• Repetitive behaviors
• The repetitive behaviors are used to reduce
  distress

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Post-Traumatic Stress Disorder

• Exposure to a traumatic event
• The traumatic event is frequently re-experienced
• Presence of avoidance or emotional numbing
• Increased arousal or vigilance

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Acute Stress Disorder

• Same as those for PTSD
• Symptoms are present for no more than 4 weeks

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Adjustment Disorder

• Emotional or behavioral symptoms develop as a
  result of an identifiable stressor
• Reaction to event out of proportion to event
  itself
• There is significant impairment in social/
  educational functioning

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Reactive Attachment Disorder

• History of severe abuse, neglect and/or disrupted
  caregiving relationships in early childhood
• A severe need to control everything and everyone
• Hypervigilance
• Superficially charming and engaging, particularly
  around strangers
• Indiscriminate affection, often to strangers but
  not affectionate on caregivers terms
• Trouble understanding cause and effect
• Poor impulse control
• Little or no empathy

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Autism Spectrum Disorders

• Aspergers Disorder
• Autism Disorder

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Aspergers Disorder

• Impairment in social interaction
• Restricted repetitive and stereotyped patterns of
  behavior, interest or activities
• The disturbance causes significant impairment
• Delays not present until after age 3

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Autism Disorder

• Impairment in social interactions
• Impairments in communication
• Restricted repetitive and stereotyped patterns of
  behavior, interest or activities
• Delays are present prior to age 3

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Autism Video Clip
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Psychotic Disorders

• Schizophrenia
• Schizoaffective Disorder
• Brief Psychotic Disorder

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Schizophrenia

• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms

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Schizophrenia Video Clip
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Schizoaffective Disorder

• Symptoms of schizophrenia accompanied with
• Major depression episode
• Manic episode
• Both

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Brief Psychotic Disorder

• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or cationic behavior
• Duration is at least 1 day but less than 1 month

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Substance Use

• Substance Abuse
• Continued use of a substance despite negative
  consequences (e.g. legal problems, interpersonal
  problems, etc.)
• Continued use in situations in which it is
  physically dangerous (e.g. driving or operating
  machinery)

• Substance Dependence
• Increased tolerance of substance
• Withdrawal symptoms
• Usage begins to dominate ones life
• Attempts to cut down or control usage are
  unsuccessful

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Mental Health Quiz ANSWERS

• 1. ADHD

A. difficulty concentrating B. angry/ anger
outbursts C. argumentative D. irritability E.
tearful F. talkative G. preoccupation with
thoughts/objects H. sleep difficulties I.
forgetful J. bullies K. fidgets L. distant/
detached
A
F
G
I
K
2. Depression
A
B
C
D
I
L
E
H
3. Oppositional Defiant
B
C
D
E
F
G
H
L
4. Bipolar
B
C
D
F
H
J
5. Anxiety
A
B
D
E
F
H
K
6. PTSD/Trauma
A
B
D
E
G
H
K
L
7. Reactive Attachment
B
C
D
E
G
J
L
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Treatment Options
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Treatment Options

• Therapy
• Medication
• Case Management

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Classification of Medications

• Anti-Hyperkinesis
• Anti-Depressants
• Anti-Hypertensive
• Anti-Manics Anti-Convulsants
• Anti-Psychotics
• Anti-Cholinergics
• Sedative Hypnotic Agents

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What You Can Do
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When you know the student has a diagnosis

• Communicate with the student
• Ask the student what helps
• Avoid using escalators when problem behavior
  occurs
• Respect the students right to confidentiality
• Communicate with the parent
• Ask parent what works best
• Provide frequent feedback regarding progress or
  regression
• Request permission to communicate with mental
  health professionals obtain written
  authorization for release of information
• Communicate/coordinate with mental health
  professionals
• Consult with provider to learn specific
  interventions for student
• Provide feedback on progress or regression
• Understand behaviors exhibited may be symptoms of
  illness or medication side effects

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When you suspect the student has mental health
needs

• Communicate with student
• Express your concerns in a supportive,
  problem-solving mannerdo not shame or blame
• Focus on observed behaviorsdo not offer a
  diagnosis
• Use reflective listening skills You seem
  feeling because apparent reason for feeling.
• Communicate with parents
• Express your concerns in a supportive,
  problem-solving mannerdo not shame or blame
• Focus on observed behaviorsdo not offer a
  diagnosis
• Respect their knowledge and understanding of
  their child
• Identify mental health resource in your school
  and refer student
• Keep documentation of specific concerns
• Understand behaviors exhibited may be symptoms of
  illness or medication side effects

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Build Positive Relationships with All Students

• Greet student daily with their name and a smile
• Show students that you are interested in their
  lives, not just their school work
• Provide unconditional positive regard
• Focus on strengths, not deficits
• Bring fun into your classroom
• Use positive discipline strategies
• Use diffusers rather than escalators when
  responding to challenging behaviors

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Behavioral Challenges
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The Brain and The De-Escalation Process
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Use Diffusers Rather Than Escalators

• Diffusers
• Calm, neutral tone of voice
• Addressing issues in private
• Reflective listening
• Problem-solving approach as opposed to punitive,
  confrontational approach
• Acknowledging positive as well as negative
  behavior
• Providing student with a save face option

• Escalators
• Yelling
• Public confrontation
• Sarcastic or judgmental tone of voice
• Invading personal space
• Shaming and blaming
• Bringing up the past
• Engaging in power struggle (i.e. arguing back)
• Backing student into a corner

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De-Escalation Techniques

• Connect
• Clarify
• Call for Action/ Plan

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Keep Your Cool

• Remember its not personal
• Relax
• Take a deep breath
• Give yourself time to think
• Model the behavior you want to see
• Change your thoughts

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Change Your ThoughtsChange Your Feelings and
Actions

• Common Thought
• John is ruining my class again.
• Common Feeling
• Angry, powerless, resentful
• Common Action
• Yell, send John out.

• Alternative Thought
• John is having a tough day.
• Different Feeling
• Empathic, calm.
• Different Action
• Speak calmly, offer assistance.

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Avoiding Compassion Fatigue

• Definition
• Strategies for prevention and/or management

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Questions/ Discussion
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Online Resources

• Positive Behavior Support Initiative (free
  powerpoints) http//frank.mtsu.edu/pbsi/index.ht
  ml
• Coping Skills for KidsThe Brain Works Project
  http//www.copingskills4kids.net/
• Iris Center (free online training modules)
  http//irispeabody.vanderbilt.edu
• Minnesota Association for Childrens Mental
  Health www.macmh.org
• SchoolMentalHealth.org www.schoolmentalhealth.org
  

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Presenters

• Marcy Melvin, LPC/MHSP
• Centerstone, School-Based Services Program
  Manager
• marcy.melvin_at_centerstone.org
• Lauren Munn, LCSW
• Centerstone, School-Based Services Senior
  Clinician
• lauren.munn_at_centerstone.org
• Les Pearson, MS
• Centerstone, School-Based Services Mental Health
  Liaison
• leslie.pearson_at_centerstone.org