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

XXXXX

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!