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School-Based Mental Health: Supports, Strategies and Recommendations
Dr. Anthony Folino, Ph.D., C.Psych School and Child Clinical Psychologist
Folino © 2017
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.
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
Current State of Youth Mental Health:
Implications for Schools
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.
In Canada, only 1 out of 5 children who need mental health services receives them (Kids Mental Health Info).
Barriers to Mental Health Supports and Services
• Limited Financial Resources
• 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
• 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.
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
Can schools provide effective mental health promotion, prevention, and
interventions for youth?
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.
Teaching!
• Mental Health Skills • Mental Health Strategies
• Mental Health Competencies
Effective School-Based Mental Health
Supports
Effective School-Based Mental Health
Supports
Minimal Focus on Diagnosis
Minimal Focus on Diagnosis
• When the focus is solely on diagnosis, educators often feel like they have little to offer.
Effective School-Based Mental Health
Supports
Minimal Focus on Diagnosis
Maximum Focus on Skill
Building
Maximal Focus on Skill Building
Mental Health Diagnosis
Skill Deficits
Maladaptive Interaction Styles
Social Skill Deficits
Physical Aggression
Oppositional Defiance Disorder
• 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
Effective School-Based Mental Health
Supports
Minimal Focus on Diagnosis
Maximum Focus on Skill
Building
Collection of Observational Data
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.
What to Observe?
• A-B-C’s of behaviour
XXXXX’s
XXXXX’s
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Effective School-Based Mental Health
Supports
Minimal Focus on Diagnosis
Maximum Focus on Skill
Building
Collection of Observational Data
Collaboration
“Evolution” of My Role as a School Psychologist
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
Disruptive Behaviour Disorders: Potential School-Based
Supports
Disruptive Behaviour Disorder (DBD)
Oppositional
Defiant Disorder
(ODD)
Conduct Disorder
(CD)
Truancy
Defiance towards
authority figures
Property
Destruction
Angry
Outbursts
Antisocial
Behaviours
Lying
Stealing
Aggression
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
Skill Areas to Target
DBD
Social Skills Problem Solving
Skills
Physiological
Indicators
Social Skills
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.
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.
Problem Solving Skills
Explicit teaching of problem solving skills is very effective.
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
• Especially challenging for a subset of children with reactive aggression
– Deficits with encoding and interpretation of social cues
– Hostile Attribution Bias
• 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
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
Source:http://www.ecmhc.org/tutorials/social-emotional/mod4_3.html
XXXX
Physiological Deficits in DBD
Low Resting Heart Rate and Antisocial and Aggressive
Behaviours
Resting Heart Rate
Aggressive Disruptive Antisocial
Behaviours
• 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
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
Key Finding
• Low resting heart rate from ages 5-12 years associated with increased fighting
from ages 9-12 years.
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/non-criminal, a rate significantly greater than chance
WHY?
• Why does low resting heart rate predispose some students to act in aggressive, disruptive, and antisocial ways?
Stimulation Seeking Theory (SST) (Quay, 1965; Eysenck, 1997; Raine et al., 1997)
Low Arousal
Unpleasant physiological state
Students engage in antisocial and aggressive acts to increase arousal
STUDENTS ENGAGE IN EXERCISE TO INCREASE AROUSAL
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
Anxiety Disorders: Potential School-Based
Supports
Prevalence Rates
• Clinical Levels:
– Approximately 6% of school aged children have “clinical” levels of anxiety (Canadian Mental Health Association).
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
• Fight or Flight
• Anxiety can help:
– people deal with potentially threatening situations
– study harder for an exam
– perform better in sports
• 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.
Anxiety Disorders Separation Anxiety Disorder
Anxiety Disorders Separation Anxiety Disorder
Generalized Anxiety Disorder
Anxiety Disorders Separation Anxiety Disorder
Generalized Anxiety Disorder
Specific Phobias
Anxiety Disorders Separation Anxiety Disorder
Generalized Anxiety Disorder
Specific Phobias
Social Anxiety
Anxiety Disorders Separation Anxiety Disorder
Generalized Anxiety Disorder
Specific Phobias
Social Anxiety
Obsessive-Compulsive Disorder
Anxiety Disorders Separation Anxiety Disorder
Generalized Anxiety Disorder
Specific Phobias
Social Anxiety
Obsessive-Compulsive Disorder
Panic Disorder
Anxiety Disorders Separation Anxiety Disorder
Generalized Anxiety Disorder
Specific Phobias
Social Anxiety
Obsessive-Compulsive Disorder
Panic Disorder
Post-Traumatic Stress Disorder
Skill Areas to Target
Anxiety
Unhelpful Thinking Styles
Arousal Control
Anxiety Management Plan
Unhelpful Thinking Styles
Faulty
Thoughts
Irrational
Thoughts
Catastrophic
Thoughts
Illogical
Thoughts
Components of Anxiety
Feelings
Thoughts
Behaviors
Source: PSYCHOLOGYTOOLS.ORG
Catastrophizing
Average windy day Storm that will cause trees to crash into
my house and badly hurt me
“Typical” Non-Anxious
Individual
“Typical” Anxious
Individual
Just a tiny spider Poisonous tarantula that can kill
Typical acne Disgusting rash that will cause
everyone to stare and hate me forever
Irrational
Thoughts
Illogical
Thoughts
Disproportionate
Thoughts
Catastrophic
Thoughts
If we can address the errors in thinking, we can have a
significant impact of anxiety
Help Students Change “Faulty” Thoughts to “Realistic” Thoughts
How to identify faulty thoughts
• Simple guiding question:
– “What is the worst case scenario if…….?”
• 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 ”
• 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”
BOSS BACK THOSE WORRIED THOUGHTS!!!!
Arousal Control
Physiologically impossible to be anxious and relaxed at the SAME time!
Extremely worried
thoughts
Heart starts
pounding
Sweaty palms Start feeling nauseas
Constant need to twitch my legs
Relaxation Skills
Deep Breathing Exercises
Progressive Muscle
Relaxation
Imagery
Mindfulness Exercises
www.anxietyBC.com
Anxiety Management Plan
Measuring Success
How Do We Measure Growth and Success
Focus on key dimensions of behaviour: • Frequency • Intensity • Duration
Summary
Thank You!