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Understanding and Supporting Students with Mental Health Needs

Lauren Bessa, MSW, LCSW

Michaela Johnson, Ed.S.

SDR Learning Fair, January 2023

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Common Mental Health Challenges in Youth

Anxiety �
Depression �
ADHD �
Oppositional Defiant Disorder�
Conduct Disorder �
Stress �
Sleep Challenges

It is very uncommon for significant disorders, such as BiPolar Disorder or Schizophrenia, to onset prior to late teens or early 20s.

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Common Signs and Symptoms

Persistent sadness for +2 weeks
Withdrawal from social interactions
Self-injury actions or discussion
Talk of death or suicide
Behavioral outbursts or change
Irritability
Significant changes to mood, behavior, or personality
Changes in academic performance
School avoidance, chronic absences

Significant weight loss
Change in eating habits
Trouble sleeping
Complaints of frequent headaches and/or stomachaches
Difficulty concentrating

*consider patterns of symptoms

*changes from what is typical for a student

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What Should I Do with Concerns of Student’s MH?

Process/Procedure at Building Level

Notify School Counselor, School Psychologist, or School Social Worker with concerns of alleged abuse, neglect, or MH related concerns. �
Learning Support staff then reach out to appropriate staff to gather information. �
Parent contact is made to determine further steps through psychosocial assessment.

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Community Resources Available to Students and Families

Outpatient Therapy
Koller Behavioral Health - Aspirus
Transitions Center
Phoenix Counseling
Healing Associates (Out of Pocket Pay)
Human Service Center
Child/Adolescent Psychiatry
CCS/CST/CLTS
Day Treatment - Northwest Journey
OCDSS - facilitated through mandated reporting

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Protective Factors

Diet
Physical Activity
Limited Screen time
Sufficient Sleep

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Tools and Strategies

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Skill 1: Sensory Breaks to Up-Regulate and Down-Regulate Emotions and Attention

FIDGETS
MUSIC
BOOKS
BOUNCING
ROLLING
SWINGING
AROMATHERAPY
RUNNING IN PLACE
YOGA
WRAPPING IN SOFT BLANKETS

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Me Moves

Co-regulation idea – calming all the brains in the room at one time

Using movement and music to align the heart rates and focus of participants.

Let’s Try It!

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Skill 2: Use Compassion

Strategies:

Remember these mantras:

Connect before you correct.
Ask before you tell.

Assume the best.
Talk like a team.

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Assume the Best

“This is not like you. Something in this class is setting things off…I wonder what it could be?”

“I like you and think you have a lot to offer here… I’d like to hear your ideas.”

“What can I do to help reduce the stress in here?”

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Talk Like a Team

Ask for buy-in eg. “I’d like your help in solving this problem. Can you work with me?”�
Ask, “If you had your wish, how would you make this work?”�
“Thanks, that’s a start. Let’s start with your idea first.”

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Skill 3: Establishing Safety

Strategies:

Clarifying your role with the student
Establishing yourself as a safe individual. Create an environment of respect.
Give the student opportunities to make choices.
Talk about safety and what steps you will take to help the student be safe.
Connect the student to the appropriate resources/ people.
Message: You are not alone

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Create a Sense of Safety

with Body Language

Use a calm but clear voice when making a request
Smile big and long
Make gentle eye contact or look at the floor
Back-up or sit down – stay out of their bubble
Speak softly
Turn down the lights

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Factors that contribute to a safe classroom environment:

Assigned seating -- Communicates to students that they belong
Check-in and check-out -- Shows that school staff care
Posting of pictures -- Sends a message of family and belonging.
Notes or calls home -- Sends the message that we care about student well-being and success. Also sends message that they are important to us and that we are there for them.
Predictable Structure- Routines help students know what to expect from the teacher and their day. Clear and consistent rules for managing behavior and setting limits.
Reduce bullying & harassment

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Intentionally Speak

“Safety” Language

“Everyone deserves to feel comfortable and safe here...”�
“This room should feel safe to everyone. If it doesn’t, please let me know.”�
“You are safe here. I am here to help.”�
“This is a “Safe Zone”, I care about you.”

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Skill 4: Stress Management / Relaxation

Strategies:

BREATHE!!
Provide students with a calm or quiet place to sit or talk.
Remain calm, quiet, and present. Use LOW and SLOW when needed.
Offer suggestions on self-calming techniques.

Breathing
Rapid Relaxation
Music, exercise, stretching

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LOW & SLOW

LOW

Lower the volume and pitch of your voice.
Keep a matter of fact tone regardless of the situation.
Speak in short sentences without a lot of questions.
Don’t preach-- this is about talking with the student, not at the student.

SLOW

Slow yourself down by slowing down your heart rate. Take slow, deep breaths.
Slow down your rate of speech and make sure to pause between sentences.
Slow down your body movements.
Slow down your agenda and take time

Source: Community Counseling Center (2008): TF:CBT Clinician Implementation Guide: 1st Edition: 1st Edition.

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Breath-Based Meditation

The breath is an easy way to start strengthening the Thinking Brain…�
Even kids can do it… ☺☺☺�
http://amysmartgirls.com/short-film-just-breathe-helps-kids-deal-with-emotions/

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Skill 5: Feeling Expression and Coping

Strategies

Identify and label emotions and feelings.
Use of scales and “thermometer” to rate emotion intensity.
Identify coping skills to help decrease emotional intensity. Help youth find positive ways to cope.

Connect students to friends, peers, or supportive
Participating in creative and positive social activities.
Relaxation techniques

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Enlarge the Feelings Vocabulary

Ask students to give you “2 feeling words” for their stress rating.
Collect new feelings words on a bulletin board
Explore a feeling word-of-the-week
Make a poster with facial expressions and feeling words so youth have some options to choose from
Keep a pack of Feelings Flashcards handy…

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Use the Stress Thermometer

Introduce and practice it during calm times
Use the colored zones for younger children and the numbers for older youth
Ask them for a rating before and after a discussion or interaction
Remind them that being in the “yellow” zone simply means it’s time to call for the Thinking Brain.

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23

– 10 _______________________________________

– 9 _______________________________________

– 8 _______________________________________

– 7 _______________________________________

– 6 _________________________________

– 5 _________________________________

– 4 _________________________________

– 3 _______________________________________

– 2 _______________________________________

– 1 _______________________________________

Stress Thermometer

�

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Skill 6: Behavior Management

Strategies:

Use of specific praise

“You did a great job paying attention in class today” vs. “Good job today.”
10:1 (Ratio of positive to negative statements for traumatized children/adolescents)

Active ignoring of negative behavior
Consistent expectations and behavior plans

Behavior plans based on reward systems, not punishment

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Distraction Before Negative Behaviors Heat Up

“John, I just remembered that Mr. Friendly needs this paper right away. Would you mind taking it to him?”

“What an awesome vest you are wearing today! The color is so perfect on you.”

“Are you related to …? Just wondering, ‘cause you look like them. I knew them a long time ago. Nice folks…” (the “Columbo” move)

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�When Prevention strategies aren’t enough…�

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Manage Your Own Distress First

Depersonalize the problem-- It’s not about you!
Notice your own body sensations, feelings, and thoughts.
Exhale, take a short break, name your feelings, look down, count to 10…
Resist anger and your danger alarm’s ‘fight’ reaction.
Be Compassionate to yourself and the student
Think out loud so the youth can learn how to calm the brain.

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De-Escalation Strategies

Reassure that you like them and want to help
Attunement – describe what you see. Eg. “I am noticing that your voice sounds loud and upset.”
Generate compassion for both of you in your own mind and heart, eg. “wow, it must be hard to live in that brain right now.”
Engage by doing less – step back, lower your voice, release eye contact, turn down the lights.
Reassure them that you want to help and hear their side of the story.

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Thinking Out Loud

When you are stuck, breathe first. Then think through the dilemma out-loud.

Start by describing what’s happening in non-judgy language. Eg. “Paul is yelling and my danger alarms are going off.”

Talk to yourself out-loud through a body-calming strategy like long, slow exhales or strong sitting. Eg. “I know if I can get a slow, deep exhale, my danger alarms will calm down.

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Do the Opposite

Respond with behaviors that are soothing and opposite to what the youth expects�
Eg. If the youth was yelled at often, respond with a quiet voice, downcast eyes and physically back up.�
Say, “I’m sorry that my reminder made you upset. I want you to feel safe in this classroom. How can I help you refocus your concentration?

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Questions?

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Resources

https://www.nimh.nih.gov/health/publications/children-and-mental-health

https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/mental-illness-in-children/art-20046577

https://www.nimh.nih.gov/health/publications/children-and-mental-health