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Notes to Facilitators �(Hide or delete slide after review)

Be sure to download your own slide deck copy from the Core Trainer portal and rename it so that you can see the notes and tailor the presentation more for your audience.

This is a comprehensive master slide deck. Trim away! There are more slides here than what you could possibly present at one time. Included are options for in-person and online sessions. You can also break this presentation into a series of sessions.

Slide notes: Points in italics are from the MHL team to facilitators and not intended to be read aloud. Before presenting, review all notes thoroughly. You are not expected nor encouraged to read out all the notes to your audience.

We recommend that you read book 1 of the EMHLR for a solid review of MHL concepts.

Personalize this. Sharing stories and examples will enliven your presentation.

If you have questions or ideas, please contact mhliterate@gmail.com

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Go-To Educator Training

Supporting Students in

Elementary Grades

Facilitated by

Based on the work of Dr Stan Kutcher, Dr. Yifeng Wei, Andrew Baxter MSW RSW and Kyla Vieweger MSW, RSW

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We acknowledge that the land where we are virtually hosting today is the traditional territories of the people of the Treaty 7 region in Southern Alberta. The City of Calgary is also home to Métis Nation of Alberta, Region 3. We respect the histories, languages, and cultures of First Nations, Métis, Inuit, and all First Peoples of Canada, whose presence continues to enrich our vibrant community.

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© This material is under copyright.�This material cannot be altered, modified or sold.�Teens and parents are welcome to use this material for their own purposes. Health providers are welcome to use this material in their provision of health care. Educators are welcome to use this material for teaching or similar purposes. This information does not replace the consultation/advice from a health professional.

Permission for use in whole or part for any other purpose must be obtained in writing from:

https://mentalhealthliteracy.org/talk-to-us/

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Housekeeping & Expectations

Participation

Confidentiality

Topics

If presenting online::

Ensure the host has reviewed online etiquette or cover this yourself.
Remind people to close other browsing windows to improve connection.
Confidentiality: ask that the discussion of any individuals stays here and ask people to disguise any identifying information to ensure confidentiality.
Note that that there will be no graphic images however the content of this presentation can be triggering. Acknowledge this and encourage your participants to take care of themselves by taking breaks or staying online to talk with you afterwards.

If presenting in person:

Have the host review washrooms and other pertinent information.
Clarify how you would like participation (e.g. questions during presentation or at the end etc.)
Clarify confidentiality.
Note that that there will be no graphic images however the content of this presentation can be triggering. Acknowledge this and encourage your participants to take care of themselves by taking breaks etc.

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Introductions

Your name/role in school/agency?

Hope to learn?

Ideas to stay focused /engaged online?

Something you do to boost your mental health?

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How familiar are you with the MHL approach?

I teach it, live and breathe it.

What does MHL even mean?

1

10

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Agenda

Introducing the Mental Health Literacy Approach

Obtaining & Maintaining Good Mental Health

Boosting Mental Health
Understanding Stress & Anxiety

Reducing Stigma

Disorders most commonly seen in childhood

Connecting to Help

Orientation to the EMHLR

Further Learning

WORDS matter

CONNECTION matters

EVIDENCE

matters

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What is mental health literacy?

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��Mental health literacy is a �part of health literacy

Sad or Depression?

Organized or OCD?

Mental health literacy is a part of health literacy.

Do you ever go into a doctor’s office and see a sign explaining the difference between a cold and the flu? That’s an effort to boost health literacy.

Health literacy is understanding health information to make informed decisions to care for our health. It includes knowing what to expect when we have an ailment, and what kinds of treatment may help us. There have been many studies to show that people do better managing health conditions if they understand their condition better. Good health literacy also involves understanding how to boost physical health, and how to tell the good evidence-based information from the stuff just trying to sell you products with little effect, or even dangerous results!

Mental health literacy, then is one part of health literacy. The more we understand about the various states of mental health, the better we can support others as well as care for our own mental health.

Sources:

Ferguson, L. A., & Pawlak, R. (2011). Health literacy: the road to improved health outcomes. The Journal for Nurse Practitioners, 7(2), 123-129.
Tavakoly Sany, S. B., Behzhad, F., Ferns, G., & Peyman, N. (2020). Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial. BMC health services research, 20, 1-10.
WHO (2013) Health Literacy The Solid Facts https://www.who.int/europe/publications/i/item/9789289000154

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All kinds of messages out there!

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TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality

Anthony Yeung, MD, FRCPC https://orcid.org/0000-0002-2029-4515 anthony.yeung@ubc.ca, Enoch Ng, MD, PhD https://orcid.org/0000-0002-4505-8391, and Elia Abi-Jaoude, MD, PhD, FRCPC View all authors and affiliations

Volume 67, Issue 12

Review of 100 most viewed Tik Tok Videos on the topic of ADHD

52% - were classified as misleading
27% -personal experience
21% as useful

Videos on the platform were highly understandable by viewers but had low actionability. Non-healthcare providers uploaded the majority of misleading videos. Healthcare providers uploaded higher quality and more useful videos, compared to non-healthcare providers.

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Semantic Confusion

mental health illness

mental wellness illness

mental health condition

mental wellness

mental and social well-being

mental happiness and well-being

mental health issue

mental wholeness

mental illness

mental health

mental well-being

mental disorder

mental health problem

Beyond Tiktok and other social media sites, even legitimate sources can add to the confusion.

All the words on this slide have been pulled out of academic literature and government documents to describe mental disorders. This slide demonstrates how much confusion there is around the topic of mental health and mental disorders, not only in the general public but also amongst professionals in the field. By calling mental illness or disorder anything else – we add to the confusion, which can perpetuate stigma!

For example, the term ‘mental health ‘issue’’ is very unclear. It muddies the water when everything is referred to as a ‘mental health issue.’ (e.g. a child having a tantrum at a store for not getting a candy may be having a ‘mental health issue’ but so is a person with Schizophrenia having a psychotic break). When we call both of these states a ‘mental health issue’, it obfuscates the meaning.

Also, for surveys where there are self reports, the rates of ‘depression’ and ‘anxiety’ are really inflated because people are not quite sure if they feel sad (depressed) or stressed (anxiety).

As we shall see, feeling sad or anxious doesn’t equate to a mental illness. It’s called being human!

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Mental States

Mental Distress

Mental

Disorder/Illness

Mental Health Problem

No Distress, Problem or Disorder interfering with functioning

Mental Health

The Mental Health Literacy approach uses this model to describe the various mental states that we may experience. We use a pyramid to show the different states of mental health because it represents the fact that more of us spend more time in the larger bottom sections than the top sections. It is not a continuum and it is not meant to show a hierarchy.

Let’s start at the bottom:

No Distress, Problem or Disorder interfering with functioning:

At the bottom of the pyramid, we have a state where we are managing just fine. These are the times where no distress, problem or disorder is interfering with our functioning.
While it is rare to never have any kind of problem, this is the state where we are not thinking about our stresses or problems too much and are managing ourselves just fine.
We can relax, be involved in a task and forget about our ‘troubles’ for a while. It even includes times when we are sleeping (which is why this is the largest state of the pyramid).

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Mental Distress

Mental

Disorder/Illness

Mental Health Problem

No Distress, Problem or Disorder

Mental Health

Mental States

Next is Mental Distress: (You can ask your audience if they ever experience mental distress.)

Mental distress is everywhere and unavoidable. Another word for this state is STRESS!
It is an inevitable part of life and can spur on developing life skills and building resiliency!
Offer a personal example to share, e.g. “I lost wifi connection in the middle of delivering a presentation. This led me to experience mental distress.” (Sharing a humorous, relatable example of experiencing stress is a great idea).
Mental distress is a signal from our brain that we need to adapt to our environment as there is a problem that we need to solve. When we solve the problem, the distress generally goes away or lessens, and we are left with a new skill that we can use to help us solve future problems.
Mental distress or stress is necessary for growth and development. We ALL have the ability to deal with stress and this is how we learn to solve problems and develop coping skills to manage in adulthood!
We will come back to how to understand and manage stress effectively a little later.

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Mental States

Mental Distress

Mental

Disorder/Illness

Mental Health Problem

No Distress, Problem or Disorder

Mental Health

The next state is called a Mental Health Problem:

This may arise in response to an environmental stressor, but one of significantly greater magnitude such as the loss of a loved one, loss of a job, immigration, etc.
When faced with such a large stressor, our capacity to manage well may be overwhelmed for a time. This doesn’t mean that we have a mental disorder. On the contrary, what we are experiencing is an expected response to a very significant and difficult life event.
Mental health problems are an indicator that we are having difficulties adapting to the environment and may need additional help (such as counselling or additional assistance from family members or a community agency).

A good example of a mental health problem is grief which is a human, expected response to a significant loss. Other examples of mental health problems could be adjusting to life in a new country without adequate supports, the loss of a pet, a health crisis, relationship break-up, etc.

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Mental States

Mental Distress

Mental

Disorder/Illness

Mental Health Problem

No Distress, Problem or Disorder

Mental Health

At the top of the pyramid is Mental Disorder or Illness:

This is a diagnosed health condition primarily impacting the functioning of the brain.
Sometimes this disruption in brain functioning can occur regardless of environmental factors. Most often it is the result of a complex interaction between the environment and genetics..
Worldwide, 15-20 % of the population will experience a mental illness or disorder.
Youth with mental disorders need rapid access to trained professionals for proper diagnosis and proven effective treatments.
Sadly there are not enough free or affordable, readily available services.
As well, there remains a lot of stigma around mental disorders which stop many people from even attempting to get help.
Let’s get used to calling a mental disorder by it’s name and learning more to lessen the stigma.
By calling a mental illness or disorder anything else – we continue to perpetuate stigma! Let’s practice using the right terms!

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Mental States

Mental Distress

Mental

Disorder/Illness

Mental Health Problem

No Distress, Problem or Disorder

Mental Health

It is important to note that our mental health is present throughout each of the states.

Good mental health is not about being happy all the time.
The WHO defines mental health as “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.”
Someone with a well treated mental disorder may have better mental health than someone who doesn’t have a mental disorder (often because they have really worked on taking care of their mental health). This is like someone with diabetes who may have a better physical fitness level than most other people, such as professional athletes who have diabetes. The same goes for someone with a mental disorder having very good mental health because they are more aware of how they are feeling, they utilize their supports and they work really hard on maintaining the habits and practices that foster good mental health..

You can exist in each of these states at the same time. For example, a grade 5 student who has ADHD (a mental disorder) may be experiencing a mental health problem as their parents are divorcing, they may feel very anxious about their upcoming first music recital, (mental distress) and at other times they can forget about all of this for a while and enjoy a video game with their friends (experiencing no distress for a period of time).

It is important to understand that the pyramid of mental states is not a hierarchy or a continuum, and a person doesn’t work their way up or down in any order. We all experience mental distress and everyone will at some point, experience a mental health problem (i.e. grieve the loss of a loved one). But not all of us will experience a mental disorder.

1 in 5 of us will experience a mental disorder in our lifetime, so it is important to get more comfortable learning and talking about it with good information!

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Events & Adjectives on the Pyramid

Depression or Anxiety Disorder

Grief, devastation, demoralization

Agitated, disappointed, nervous

Contemplative, ‘okay’

Happy, bored etc

Writing a test, music recital, disagreement with a friend

Parents divorce, loss of a pet, moving to a new school

None required

Mental Distress

Mental Health Problem

No Distress, Problem or Disorder

Mental Disorder/Illness

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Mental Health Literacy Pyramid

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Turn & Teach Time!

In small groups, teach the pyramid of mental states to each other.

Aim to describe each state and the overall context, providing examples.

We will then debrief as a large group.

No Distress, Problem or Disorder interfering with functioning

Mental Distress

Mental Health Problem

Mental

Disorder

or Illness

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Reduce Stigma

Understand Disorders

Help Seeking Efficacy

Obtain/Maintain Good MH

Mental Health Literacy

Promotion

Prevention

Treatment/Care

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Four Components of Mental Health Literacy

Understand how to obtain & maintain good mental health

Understand & identify mental disorders

Reduce Stigma

Enhance help-seeking efficacy (Knowing how to get help)

Where have we made gains as a society/school community in these components ?

Where do we still need to improve?

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How does MHL fit with SEL?

The Focus of MHL	The Focus of SEL
Distinguishing between everyday emotions/stressors, and a mental illness/disorder	Addressing social & emotional skills (eg. identifying emotions, perspective-taking and empathy, self-control, interpersonal problem-solving and decision making)
Learning how to obtain and maintain positive mental health	Understanding one's own emotions, managing emotional distress, decreasing conduct problems
Promoting help-seeking intentions and behaviours	Improving attitudes about self, others, school, and community
Working to reduce stigma surrounding mental illnesses and their treatments	Improving pro-social behaviours, enhancing academic performance and decreasing substance use

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Pathway Through Care

Awareness

Mental Health Literacy

Identification

Access

Triage

Support

Care

Media etc.

Guide Resource

Go-to Training

Community/ On-Site Health Care Providers

The pathway through care starts with awareness but awareness is not sufficient alone. Literacy is beyond being aware; it is being able to make more informed choices and actions. Then individuals must navigate supports and have informed conversations with care providers.

Remember that students return to school or are in school while receiving care (which is why this is called the Pathway THROUGH care, not pathway TO Care ). A mental health literacy approach goes beyond identifying students for further assessment and helps educators feel more confident in the types of support they can offer students.

Source:

Baxter, A., Kutcher, S., Wei, Y. Cawthorpe, D. ( 2022) School-based mental health literacy training shifts the quantity and quality of referrals to tertiary services: A Western Canada regional study (This study publication is available on the MHL website.)

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Developing Shared Literacy

Shared Mental Health Literacy

Family School Liaisons

Support Staff

Psychologists

System Leadership

Teachers

Occupational Therapists

Speech Language Pathologists

Educational Assistants

Youth Workers

Social Workers

Police

Parents

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Role of School Staff

Teach & Promote

student mental health literacy

Recognize

potential problems

Refer

appropriately linking within the school

Support

in classroom & with other professionals

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DO NOT DIAGNOSE!

-instead describe what you see

Emphasize the message in this slide!

Refrain from using diagnostic labels and focus on recording descriptions of what you see from the student with as much detail as possible.

Remain as objective as possible (for example, what would a video recorder pick up here?)

Example: “Jasmine is having difficulties paying attention and staying seated in class.” Refrain from saying things like: “Jasmine probably has ADHD”.

Or instead of saying “James is depressed and needs therapy,“ report something like “ James has missed more school days before Christmas than he did the entire year last year. He appears sleepy and his clothes are wrinkled. James did not try out for the basketball team, even though he was a key player last year. There appears to be tension between James and his parents when he is dropped off at school in the morning. When I expressed concern to James, he shrugged and mumbled “nothing matters anyway.” This type of description would give the consulting therapist much more to explore and work from and avoids any labelling.

Leave the tasks of diagnosis and treatment prescribing to physicians and clinicians.

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The Go-To Educator

Brings a higher level of contextualized mental health knowledge to the school setting

May be a designated link to health or mental health providers in the community

Is who students turn to with concerns

Doesn’t have to be advertised in a school; students are directed to the GTE when they emerge

Links students to appropriate resources internal and external to the school

Provides ongoing support as a part of the school team

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Component 1:

Obtaining & Maintaining Good Mental Health

The Brain
The Stress Response
The Problem with Avoiding Stress
Skills to Manage Stress
The “Big 5” for Mental Health

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Brain Growth & Development

Significant brain growth and development occurs during childhood and adolescence and continues into the twenties.

Some studies show that this growth and development extends to the age of 30!

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Proliferation of grey matter through development

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The Role of the Brain

Perception & Sensing

Thinking & Cognition

Emotion & Feeling

Signaling

Physical & Somatic

6 primary domains

of brain function:

Behaviour

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Let’s talk about stress!

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Differentiating Types of Stress

Brief, increase in heart rate, mild elevations in stress hormone levels

Serious, temporary stress response, buffered by supportive relationships

Prolonged activation of stress response, without supportive relationships

POSITIVE

TOLERABLE

TOXIC

Source: Harvard Center for the Developing Child http://developingchild.harvard.edu/

First, let’s understand that there are different types of stress:

Positive Stress: helps us learn how to adapt and grow so we can build resiliency when faced with future stressors. It can include uncomfortable emotional, physical, behavioural, and cognitive states. For many of us, this type of stress occurs daily (like work deadlines and traffic!) For children, some examples are starting school or going to a new school, meeting new teachers or classmates, taking a test, giving a presentation, learning something new or experiencing an event outside of their comfort zone, such as a school dance, etc.
Tolerable Stress: may be more serious occurrences that occur across our lifetime, such as losses and other mental health problems. While it may feel intense for a time, the support of a caring adult can help a child to navigate the experience and build new coping skills.
Toxic Stress: is prolonged and extreme and can be harmful when experienced without intervention and support. Toxic stress interferes with learning, social development, and other body systems. It can also increase the risk for chronic stress-related diseases. It can be acute or chronic. Examples of toxic stress for children include physical/sexual abuse, chronic neglect or violence. Toxic stress is dangerous to developing brains and those experiencing toxic stress need and deserve support to alleviate that stress.

Stress does not always look the same. Some children may be in a constant state of hyperarousal that begins to feel so familiar to them that they do not even identify and report the stress they are experiencing, as it is their norm.

In these next slides, we are going to focus on the usual kinds of stresses we may experience in daily life.

Sources:

Harvard Center for the Developing Child f(or more information about toxic stress). http://developingchild.harvard.edu/
Researcher Kelly McGonigal’s Ted Talk does a great job of explaining how stress affects us differently, in large part due to how we think about stress: https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend?language=en

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Healthy Signalling

DANGER!!!!

Prepared to FIGHT, FLEE

FREEZE or FLOCK!

Initiation of physiologic cascade

Increased: heart rate, alertness, perception, tension

Sensory Perception + Internal Signals

Brain Registers Danger!

Let’s start by reviewing the signalling function of the brain.

What we have on this slide is a visual representation of the Sympathetic Nervous System Cascade. It happens instantly and automatically.

Danger happens
We sense the danger
Brain registers DANGER
Our body initiates the cascade of signals and circuits to make us respond instantly for survival
We go into the fight/flight/freeze/flock response (flocking is when people check out the response of others around them to gauge if they should panic or not.)

When you’re in danger, your body’s natural reaction is to rapidly initiate the fight-or-flight response. This brain response occurs immediately when someone senses danger and it activates many brain areas that are designed to protect you from that danger by preparing you to “fight” the danger or to escape from it (e.g. “flight”).

As part of this response, the brain triggers the release of adrenaline and other hormones throughout your body, so you can respond to the threat. This protective mechanism called the fight-or-flight response helps us to survive. Your emotional and physical responses during fight-or-flight can be described as high arousal to fight or take flight.

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Anxiety

No Danger

Initiation of physiologic cascade

Increased: heart rate, alertness, perception, tension

Sensory Perception + Internal Signals

Brain Registers Danger!

ANXIETY

!

-withdrawal

-avoidance

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Relationship Between Arousal & Performance

Performance

Good

Poor

Emotional Arousal

Low

(Under aroused)

Moderate

(Optimally aroused)

High

(Over aroused)

Maximum Performance

Hebb, D.O. (1955). Psychological Review, 62, 243-254

Let’s look at the relationship between arousal and performance.

The bottom left-hand side of the curve represents an individual who doesn’t have enough arousal to perform well (e.g. a baseball player who is sleepy when they get up to bat).

The bottom right-hand side of the curve represents an individual who is overly aroused (e.g. the baseball player is too nervous to grip the bat and they are shaking because they are worried about losing the game).

Individuals need to have an optimal level of arousal in order to perform their best on a task. Just the right amount of arousal keeps us alert and focused so we perform to the best of our abilities. Everyone has their own optimal level and it takes practice to find it.

Explaining this to students is very helpful as it normalizes the stress response and validates the experience that they are having. It also helps us sidestep the trap of avoiding stress at all costs. You can reassure students (when they describe feeling some of the arousal sensations) that this is your stress response getting you ready to take on a challenge!

Feel free to share some real-world experiences that you have had working with a student or from your own life experience.

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Why is it a problem to avoid stressful situations?

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Exposure Curve

Arousal

Time

Stimulus

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Exposure Curve

Time

Arousal

Stimulus

exposure

habituation

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Exposure Curve

Time

Arousal

Stimulus

exposure

1st exp. with avoidance

habituation

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Exposure Curve

Time

Arousal

Stimulus

exposure

1st exp. with avoidance

2nd exp. with avoidance

habituation

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Exposure Curve

Time

Arousal

Stimulus

exposure

1st exp. with avoidance

2nd exp. with avoidance

habituation

3rd exp. without avoidance

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1. Check your Thinking

“I notice I am having the thought that…”

My first thought is not always my best thought!

What’s a more helpful thought?

Is this thought beating me up or building me up?

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2. Problem Solving

Coach students to develop solid problem-solving skills

Ask “what do you think would help? Pros and Cons?
Want any ideas from me?

Encourage a Growth Mindset

FAIL stands for ‘first attempt in learning’
Success in life comes from Plan B or C or D

Encourage a sense of agency

“What CAN I do?”

Encourage N + 1 not avoidance

Can do/

control

Concern

Stage 2: Problem solving - Ask, “what can help the situation?” We need to give students lots of opportunities to practice problem solving. It is very difficult to hold back from advice giving, but consider instead asking, “What do you think you should do?” This also gives the message to your student that you believe in their ability to solve their problem. It is important to let them fail! That is how we learn powerful lessons.

Carol Dweck’s work around growth mindset is convincing evidence around the power of having a mindset willing to experiment and learn from mistakes, versus focusing on appearing smart and not taking risks. Know that the price of mistakes gets higher as children grow older. We want to give them plenty of opportunities to learn from feeling the impact of mistakes when they are younger so they can hone their skills and learn how to course correct for themselves….all of this at age appropriate/risk appropriate levels. It is a powerful buffer to stress when children feel confident that they can cope and can figure things out.

When taking action to face fears and build coping skills, remember the formula N+1 which we will go into more detail in a few slides.

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3. Calming the Body Response

Diaphragmatic Breathing (e.g. box breathing, 4,-7-8 or, cookie breathing)

Movement (e.g. big muscle movement)

Anchoring with ACE

Acknowledge thoughts and feelings
Connect with the body
Engage in what I am doing

Importance of Practicing Techniques

Stage 3: Calming the body response - at the peak of the stress response curve, it may be necessary to take actions to calm our nervous system to get our prefrontal cortex (thinking brain) back online. If we have done a good job at stage 1 and 2, we may not reach a high level of arousal. If, however, something upsetting happens (i.e. a fire alarm ringing) and we become immediately highly escalated, then we may need to calm ourselves down enough before we can implement our stage 1 and 2 skills.

There are a variety of strategies to calm down our sympathetic nervous system. Various deep breathing techniques can be learned and practiced (i.e. box breathing, 4-7-8 breathing, cookie breathing), walking and stretching, or coloring or singing!

People are individuals, and different techniques work better for each person. Find what works to help calm the nervous system. Breathing practices require practice, especially consistent practice at times when one is less stressed, so that the learned skill is easier to draw upon at times of heightened stress.

The cookie breathing technique is this: imagine you have a chocolate chip cookie still warm from the oven in your hands.. Breath in that delicious smell with a nice deep breath…. hold….then blow on the cookie to cool it down to eat!

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Helpful	Not Helpful
1. Identify and correct any thought distortions (Cognitive attribution.)	“Turn in” & isolate .
2. Consider how to solve the problem. Consult with others & be proactive. (Problem solving.)	Focus only on modulation of the stress response while ignoring the other approaches.
3. Modulate the apex of the stress response. Use simple & effective breath-holding & “centering”, progressive muscle relaxation techniques	AVOID.
Understand the Stress Response, its purpose and its various levels	Provide only one stress management technique.
Interpret the stress response as positive, not negative. (i.e. a challenge to be faced; a problem to be solved.)	Pathologize stress.

Summary Chart for Managing the Stress Response

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Helping to Manage the Stress Response

What has worked? What hasn’t?

How can you explain and encourage the N+1 strategy?

How can you teach and integrate these important lessons about the stress response in your classroom?

How can you design an accommodation that supports a student moving forward versus avoiding?

Other ideas?

This slide is intended for a small group discussion/exercise. Adapt questions as needed for your group’s needs.

We can support students in learning to manage their stress response through the concept of N+1:

N refers to the student's current state and the +1 means one step forward so that the experience feels’ tolerably uncomfortable’.

Sometimes we expect N+ 20 for someone and they become overwhelmed then retreat and avoid.

Think of a ladder - one rung at a time.

It is important for accommodations to be directed towards full participation, and that accommodations are FOR learning, not to AVOID learning.

Be sure to include parents or caregivers in the plan.

If discussing accommodations, prompt the group to think about who would need to be involved, how it could be structured over time and what could be the indicators for improvement.

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Understanding Stress Video

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Understanding Your Stress Response

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How can we boost mental health?

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Physical activity 3-5 times per week is good for everyone and can lessen the symptoms of Anxiety and Depression. Movement reminds our brain that our behaviour matters!

Key Points:

How can we encourage children to be more active?:

Make it a habit – instilling physical activity as a regular part of the day and routine from an early age is important. If physical activity is valued, it is more likely to become a habit and youth are more likely to be self-motivated.
Integrate movement into learning- both formal and informal times
Set limits on screen time – adopt screen-free times and set limits for children and youth.
Expose students to a variety of sports and activities - beyond just competitive sports teams

Various types of exercise:

Moderate intensity activities also make a person sweat and breathe a little harder, but they can still talk while they move their bodies. Examples include rollerblading, riding a bike around the neighborhood after school, a brisk walk or moderate level yoga.
Vigorous-intensity activities make us sweat and feel “out of breath”, leaving us able to speak only a few words between breaths. Examples include dancing and running, biking or swimming at a fast pace.
Activities that strengthen muscles and bones: strengthening muscles and bones force the body to bear weight. They include going for a hike, jumping rope, playing tennis or basketball or doing weight training with body weight or hand-held weights.

Sources:

Ever Active Schools - has several resources for encouraging more movement in schools

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Guidelines provided by: The Canadian Pediatric Society & The National Sleep Foundation

Lack of sleep can lead to irritability, more difficulty managing stress, forgetfulness, difficulties with learning, low motivation and a compromised immune system. Over time, poor sleep can negatively impact our mental health.

Key Points:

These recommendations are averages, and people have different needs for hours of sleep.

The key is: Does a person feel well rested and ready to go when they wake up?

Children who consistently get a good night’s sleep:

are more creative
can concentrate on tasks for longer
have better problem-solving abilities
are better able to make positive decisions
are more able to learn and remember new things
are more energy during the day
can create and maintain good relations with others

Tips to share to encourage a good sleep routine:

exposure to sunlight early in the day, and exercise earlier versus later in the day
a comfortable, quiet sleep environment (often cooler and darker is helpful)
‘wind down’ routine before bed, away from screens including phones (seriously consider having a house rule to not have cell phones in bedrooms at night)
keeping a regular schedule for waking and wind down time
planning for sufficient hours of sleep each night (usually 8-10 hours but there are individual differences)

Sources:

Guidelines provided by: The Canadian Pediatric Society & The National Sleep Foundation

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There is a lot of different and sometimes conflicting advice around healthy eating.

Despite the controversies, we can feel confident around these messages:

have plenty of vegetables and fruits
choose whole grain foods
eat protein foods
make water your drink of choice

Key Points:

Healthy eating is about more than just the foods you eat.
It is being mindful of your eating habits, taking time to eat and noticing when you are hungry and when you are full.
Being mindful of your eating habits can help you:

make healthier food choices more often
make positive changes to routine eating behaviors
be more conscious of the food you eat and your eating habits
create a sense of awareness around your everyday eating decisions
reconnect to the eating experience by being mindful of your thoughts, emotions and behaviors

It can be very difficult to buy fresh fruits and vegetables on a tight budget. Frozen fruits and vegetables are just as nutritious and less expensive. Eating less meat and more plant- based sources of protein can be healthier and less costly. Local FCSS agencies and AHS often have good resources for eating healthy on a budget.

Sources:

Canada's Food Guide

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More Mental Health Boosters!

Role model healthy coping and problem solving

Help clarify who owns the problem and what could help

Sense of humour! Play, fun and creativity!

Encourage flexible thinking and naming emotions

Here are more mental health boosters: :

Flexible thinking/ Perspective Taking: Ask: “How might someone else view this situation”? Or “What’s a more helpful thought”? Or “What’s another way to look at this?” Affirm them in a way that supports their willingness to try, make mistakes, and persevere. We can be a safe place for them to fall - a safe harbour for them to venture out and take on challenges. Support a growth mindset not a fixed mindset. Celebrate students’ unique interests and efforts. Instead of saying “You’re so smart” say “I like how you tried different methods to solve that problem!”
Naming emotions: Help students to expand their vocabulary of feeling words, and to be able to identify multiple emotions and how they experience them, as this practice is often calming and validating - and a way to connect and feel less alone with their emotions.
Role Model: Consider how you look after your health, including your mental health. Continue to learn and be a critical thinker about the onslaught of information in the wellness field. You can also do some purposeful “thinking out loud” to demonstrate problem solving and correcting anxious thoughts. Also, purposely let them overhear you talking to someone else how proud you are of them, and the strengths you see in them.
Problem Solving: As well as the problem-solving tips already shared, help students clarify who owns a problem, and what can help. Some students tend to take on undue responsibility for others.
Finally, have some fun together. A sense of humor goes a long way!

Sources:

Carol Dweck Growth Mindset
Dr. Russell “Drop the Worry Ball”

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Discussion

How can you encourage the ‘Five to Thrive’ in children and youth in your life?

Considering the Five Pillars, what can you improve upon to boost your own mental health?

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Component 2:

Reducing Stigma

What is stigma?
Myths about Mental Disorders

The second component of Mental Health Literacy focuses on reducing stigma. Stigma surrounding mental disorders and treatments continue to stop people from seeking support.

One study found that 40% of young elite athletes with a diagnosis of Depression or Anxiety Disorder said they did not seek treatment because of stigma.

A key way to reduce stigma is to share knowledge, thus improving literacy levels around mental health. Other effective strategies include humanizing mental health problems and disorders by sharing individual experiences.

There are videos on the MHL youtube page showing first-hand accounts from people living with mental disorders.

In the Elementary resource, to teach the concept of stigma, the character Angela is shown demonstrating both her struggles and strengths, to encourage students to have empathy for others whose brains may work differently than theirs.

Source:

Gulliver, A., Griffiths, K.M. & Christensen, H. Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry 12, 157 (2012). https://doi.org/10.1186/1471-244X-12-157

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Mental Disorders: Stigma Busters!

Myth	Fact
People with mental illness don’t get better	With early identification and proper treatment, substantial improvement and success is likely
Poverty causes mental illness	Poverty does not cause mental disorders but it can have a negative impact on outcomes
People with mental illness are violent	People with mental illness are more likely to be victims than perpetrators of violence
Mental illness is a weakness of character or the result of bad parenting	Disorders are the result of complex factors including genes and environment

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Lunch Break!

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Component 3:

Understanding Mental & Neurodevelopmental Disorders

Overview
Generalized Anxiety Disorder
Selective Mutism
Separation Anxiety
Depression
Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorder (ASD)
Obsessive Compulsive Disorder

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Age of Emergence of Major Mental Disorders

Source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)

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Why do some people develop a mental illness while others do not?

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Mental disorders

Symptom Expression

Perturbations in Usual Brain Functions

Cultural Factors

Some Signs & Symptoms but

No Disease

Environmental Influences

Genetics

Prenatal

Perinatal

Birth

Postnatal

Infancy

Childhood

Adolescence

Adult

Interaction, Correlation, Epigenetic Effects

We don't know the specific reason(s) as to why any one person develops a mental disorder, but we do know that it is a complex interplay between genes and environment. It is always both factors playing a part.

There are sensitive periods during our development (prenatal, early childhood, adolescence, etc.) where different environmental influences may have more impact. For example, maternal alcohol abuse while in utero may lead to FASD. Or consider a young child’s ability to learn multiple languages without an accent. When we are older, we can still learn a different language, however it will take more effort as our brain is not as primed for this as when we are a young child.

Researchers are learning about epigenetics - meaning “above/around genes” to better understand the causes of mental illness/disorder. Epigenetics means that the environment can shape how our genes are expressed. For example, good food or good sleep may influence genes to turn on or turn off, thus affecting how they make proteins which then may impact different aspects of human emotions, cognition and behaviour.

All of these factors and influences combine to influence the functioning of a brain. This may result in no disease, some signs and symptoms but not enough to be classified as a disease or disorder, or it may result in a disease or disorder of varying severity.

All symptom expression happens in a culture that can influence the impact or outcomes or even the types of commonly expressed symptoms themselves. Examples may be of youth being identified with ADHD in traditional classroom settings but a youth who has the same symptoms in a hunter-gathering setting may not be impacted.

Another example is Social Anxiety Disorder. For a student from the dominant North American culture that emphasizes the individual over community, they may worry about embarrassing themselves in front of other students. For a student with Social Anxiety Disorder from a culture that prioritizes the group needs over the individual (such as from Asia), that student may worry more about bringing shame upon their family. Consider also how different cultures have norms for the degree of emotional expression considered to be ‘normal’.

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Mental Disorders: Symptoms + Impairment

Time

Intensity

Signs & Symptoms

Impairment

Disorder

Prodrome

Let’s discuss how a diagnosis of a mental disorder is made. It is important to first clarify the definition of signs and symptoms.

Signs are what could be noticeable to others – such as what a video camera could pick up (e.g. someone may be in bed longer, isolating themselves from others, and not showering or changing their clothes).
Symptoms are what someone feels inside - which may not be obvious to others (e.g. a person may be smiling, yet experiencing the symptoms of feeling extremely low mood and having disturbing thoughts that they don't share with anyone).
We all may relate to some signs or symptoms of various mental disorders however does it lead to impairment?

A good way to understand a mental disorder is:

A person may be experiencing signs and symptoms for a time, yet still be functioning all right, such as going to school or work and taking care of life tasks.
When the level of impairment rises over time to the point where they can no longer function to meet their life demands as they had before, then that is when they may meet the criteria for a mental disorder.
The period of time before symptoms and impairment meet is called the prodrome.
Some people may experience some prodromal symptoms but may never meet the criteria for a diagnosis. For example, someone may have a tendency to worry a lot and feel quite anxious, but may still manage and participate in all areas of their life. They would not meet the criteria for an Anxiety Disorder.

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So what are some common childhood mental disorders?

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Anxiety Disorders:

Generalized Anxiety

Separation Anxiety

Selective Mutism

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Generalized Anxiety Disorder

Worrying about many things, much more than other people seem to worry and seeking constant reassurance

Having trouble “letting go” of the worry

Usually seeming tense or “on edge”

Worrying with such intensity that it interferes with enjoying life or doing things that they would like to do

Persistent physical symptoms that cause distress but for which there is no good medical explanation. e.g. headaches; stomach aches; pain; etc.

Generalized Anxiety Disorder (GAD) is a disruption in how your brain controls the signals it uses to identify danger and initiate action to help you avoid it. With GAD, this signaling mechanism does not work as it should and a person experiences the danger signal when there is no danger.

Feeling anxious in response to danger or in new situations is a perfectly normal response and can help us survive in dangerous situations. But these typical feelings are different from GAD. A person with GAD may constantly feel tense and on edge, even when there is no danger present.

GAD is excessive anxiety and worry about everyday events that occurs over a prolonged period of time. Someone with GAD worries excessively about many different things and is not able to control his or her worry. They are ‘Masterful Worriers.’

The worrying and anxiety causes serious emotional distress, and causes problems at school, during extracurriculars, and in relationships. The experience of anxiety often has physical components too, including headaches, aches and pains, nausea, shaking and sweating.

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Separation Anxiety

More than shyness and hesitancy.

Extreme distress when separated from caregivers

Gradual transitions help; slow, consistent separations ease anxiety

Child may fear for safety of their caregiver, or may fear being kidnapped or separated from caregiver

Most prevalent Anxiety Disorder in children under the age of 12

May have tantrums and aggression. May experience nightmares, upset stomach, headaches, nausea

Separation Anxiety Disorder is characterised by developmentally inappropriate and intense fears related to separation from one’s home, parents or other attachment figures.

Children with Separation Anxiety Disorder may experience:

persistent and excessive worries that something bad might happen to a caregiver (e.g. illness, injury, death)
refusal to leave home, go to school or elsewhere
excessive distress (e.g. throwing tantrums) when anticipating or experiencing separation from home or from major attachment figures
fear that they may be kidnapped or otherwise taken away from their caregiver
refusal to be alone or go to bed at night
refusal to sleep away (e.g. sleepovers)
nightmares about separation
physical symptoms (e.g. nausea, headache, stomach aches) in response to separation

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Selective Mutism

More than ‘just shy’. An anxiety disorder where a child has intense fear of speaking in certain situations despite speaking comfortably in others.

Interferes with academic planning and achievement.

Difficult for educator to assess academically.

Student is not unwilling to speak to teacher, but feels unable to do so.

May speak in a whisper, very low volume, minimally, or engage another student to speak for them.

Requires therapeutic milieu treatment

(Best treated in the school environment, guided by a clinician, working with a small team to support the child’s progress.)

Below is a detailed overview of Selective Mutism for your review. You may forward this information from psychologist Terryl Makuk to interested participants.

Your communication style with a child with selective mutism determines how she will become social and communicative with you. A relaxed conversational style will help put the child at ease. We hope she will then follow your lead and respond at the level she is comfortable with. She may begin with a head nod or a shoulder shrug, for example. That level is her version of a conversation. She is communicating with you. Often though, we are witness to a direct, controlling style of interaction between an adult and a child, which we know will increase anxiety. If you continue to be directive with open-ended questions or commands, you lose the casual, natural interaction and in turn, raise the child’s anxiety level.

Try to notice the child’s reaction to your questions. If she freezes up, hides behind her parent, breaks eye contact, and does not respond verbally, make a comment to her that would not require a reply or an action. You can give some information to her by saying “I heard you went to see the Harlem Globetrotters. I love basketball too. It is my favourite sport.” This type of comment engages her without an expectation for her to speak to you. She might connect with you because she too loves basketball. You may leave that interaction without knowing that about her, however, you have interacted with her, acknowledged her presence, and made a comment about something that may be of interest to her.

You could also indirectly verbally prompt her by saying “Let me know if you want to play intramural basketball at lunch someday. I am in the gym Tuesdays and Thursdays. You can think about it and let me know” . This prompt is good when you don’t absolutely need a response from her.

In time, you may be able to give her a direct verbal prompt which encourages more interaction between the two of you. “Please let me know if you would like to sign up for the intramural basketball tournament. I need to know how many students will be coming.” This interaction is good when you absolutely need a reply for some reason. At this stage, the child has to be ready and feel brave enough to respond to you. It is a fine line when to use this latter approach, given that we know that if the child feels undue pressure to speak, she may not respond.

I don’t mean to put pressure on her, so how do I proceed?

For spontaneous learning to take place from your interaction, your student must experience success in communicating. In turn, he will be motivated to stay in the exchange of conversation for a longer period of time. When you are nondirective, it is possible that reciprocity will occur, stress in the interaction decreases, anxiety is reduced, and the child responds within the interaction.

Keep in mind that when you speak to a child with selective mutism, this provokes her anxiety. At that point, it is difficult for her to respond to you. It is not that she is unwilling to respond to you, but rather that she is unable to. She is not consciously being impolite or disrespectful. In fact, she is feeling significant pressure to respond.

Give her time to warm up to you. Don’t ask any questions during this time. Chat with her, talk about things around you, and expect to have a one-sided conversation. You can do this by using the following strategies:

i. Labelled Praise: “Wow; that is amazing! You built a tall tower from that Lego.” (no questions, no judgment, just acknowledgement). Labelled praise tells the student exactly what you like.

ii. Use Reflections: If she says: “I built a tower,” you reflect: “Yes, you built a tower.” Reflections repeat or paraphrase what your student says. (Use this in response to a student’s comments.)

iii. Imitate her: “I’m building a tower.” You imitate the action and the words: “I’m building a tower too!” Imitation copies what your student is doing with the toy.

iv. Describe what you see: “You are making a purple tower this time.” Behavioural descriptions say what your student is doing.

v. Enthusiasm: “That is the tallest tower I have ever seen.” Enthusiasm lets the student know you enjoy being with him.

Continue to build your relationship with her in order to increase her comfort level with you. Communication, in the form of a reciprocal conversation, comes after the child is comfortable. These strategies increase the comfort level in the relationship and subsequently lower her anxiety.

At what point should I start to expect her to talk?

We all expect a child to talk back to us. The fact is that even once you feel you have a relationship with the child with selective mutism, and you think she is ready to talk to you, she may not. We encourage you to provide the opportunity for her to talk to you and hope for a response. It is crucial to build a relationship and a comfort level with her in order to facilitate talking. The strategies above will assist with that relationship. Once a sufficient comfort level appears to have been built with the child, then a sequence of questions can be used to help initiate talking. These questions could follow this progression:

Try to ask an Open-Ended question first. (“Where would you like to sit?”)

Wait approximately 3-5 seconds. Count to yourself in your head (1 one thousand, 2 one thousand ...). Make another comment, not a command. (“This is a great place to sit because you can see the board easily.”) Wait. Give her the opportunity to respond.

If you still do not get a response, use a Forced-Choice question. Forced-choice questions are used when you do need a response. Some examples are:

1) “Would you like to sit in the front of the class or the back of the class?”

2) “Would you like to sit in the front of the class or the back of the class, or somewhere else?” By adding the somewhere else, you afford her the opportunity to answer you. After all, she may not want to sit at the front or the back.

Lastly, if she has not answered you, ask a Closed question. (“Would you like to sit here?”) Alternatively, you could ask her to show you. (“Show me where you would you like to sit.”)

Once she has responded in one of the ways above, move on to the activity. (“Okay. Let’s move your things.”)

It is important to recognize what stage you are at in a conversation with a child with selective mutism in order to be able to bring that information to the attention of the professional you are working with. He or she can then gauge where to assist you and your team. Ideally, we do not want a child responding with nods, head shaking, or gestures forever! It is important to shift that interaction to include at least some type of verbal response.

So it is important to provide the opportunity to speak, with no pressure to speak?

Exactly right! Too often as adults, we do all the talking. Sometimes we talk before the child responds as a way to relieve her discomfort. She learns that it is perfectly acceptable to let others do the talking. However, it is helpful to anticipate a response from the child with selective mutism as well. Conversations are usually reciprocal and unfortunately for children with selective mutism, that reciprocity is lacking.

The difficulty for a child with selective mutism is that they freeze up and can’t easily participate or respond. Remember: You may have to wait a few seconds for a response. Initially, accept any form of communication. It can be nonverbal communication such as a head nod. It can be low volume such as a whisper. No matter the form of communication he gives you, accept it is as a successful form of communication. Show your acceptance by giving him a response back.

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Anxiety:

Treatment &

Role of the School

Very treatable! Usually takes 8 – 10 weeks before a substantial improvement is evident. Importance of exposure and building distress tolerance and coping skills.

Make sure that accommodations support interventions designed to treat anxiety disorder (i.e. accommodations are FOR learning, not to AVOID learning.)

Psychological treatments such as cognitive behavioral therapy (CBT) are recommended before medication. .

Medications can play a part in the treatment plan when the arousal level is consistently very high.

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Tips to Encourage Communication Progress with Selective Mutism

Engage in a relaxed conversational style

Seek support from school specialist for further guidance

Offer opportunities for the child to respond in various ways (not just verbally)

Acknowledge small wins/ progress

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Anxiety Disorder

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Emotions & Moods

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Emotions Wheel

Being able to name emotions helps to manage emotions

“Name it to tame it!”

(Dan Siegel)

��

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Typical Mood Graph

+

-

Usual

Baseline Mood

Usual Range & Intensity of Mood

Transient shift toward (-) pole consequent of (-) life events

Transient shift toward (+) pole consequent of (+) life events

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Baseline Shift to the Negative Pole - Depression

+

-

Usual Baseline Mood

Usual Range & Intensity of Mood

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L

Loss of interest and pleasure in activities usually found to be pleasurable

Decreased functioning at home at work/school

(poor concentration)

Thoughts of death/suicide or preparation for death

Withdrawal from family or peers/friends

A change from baseline behaviour for the student

Difficult to explain frequent & persistent physical complaints (headaches; stomach aches; fatigue; etc.)

Depression

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Depression: Treatment &

Role of the School

Treatment can take a substantial amount of time for improvement to be experienced (e.g. months).

Know school protocols for suicidal ideation, ensure safety plans are in place and regular communication with families.

Best results are a combination of medication and cognitive behavioural therapy (CBT).

Modify academic expectations and encourage mood elevating activities.

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Depression

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Neurodevelopmental Disorders:

ADHD

Autism Spectrum Disorder

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Attention Deficit Hyperactivity Disorder

(ADHD)

It is a disorder of executive functioning and may co-exist with a learning disorder

Onset before 12 years of age

Impacts 3 major domains:

Attention

Hyperactivity

Impulsivity

Oppositionality is NOT a feature of the disorder

Often impacts mood regulation and social interactions

Attention Deficit Hyperactivity Disorder is the most commonly diagnosed behavioural disorder of childhood.

Although ADHD is usually associated with children, the disorder can persist into adulthood.

The three predominant signs & symptoms of ADHD are:

1) inability to regulate activity level (hyperactivity);

2) inability to attend to tasks (inattention);

3) impulsivity, or inability to inhibit behaviour

Common symptoms include varying degrees of the following:

Poor concentration and brief attention span
Increased activity - always on the go
Impulsive - doesn't stop to think
Social and relationship problems
Fearless and takes undue risks
Poor coordination
Sleep problems
Normal or high intelligence but underperform at school

ADHD is a neurodevelopmental disorder, which means that it’s a disorder caused by problems in the growth or development of the brain. This is why some children may “grow out” of ADHD. Their brain growth and development improves.

What causes these problems? From what we understand today, ADHD has an important genetic component. It tends to run in families, which means that the immediate family members of someone with ADHD are much more likely to also have ADHD than the general population.

Environmental factors may also play a role. A person’s environment can influence the extent to which ADHD causes problems in his or her life.

Boys are two to three times more likely than girls to be diagnosed with ADHD. Girls with ADHD are more likely to have difficulty paying attention, but they often don’t demonstrate as much hyperactivity as boys. Girls who have trouble paying attention often daydream, whereas inattentive boys are more likely to move around constantly and impulsive actions may land them in trouble.

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ADHD:

Treatment &

Role of the School

Can usually be effectively treated in primary care with rapid results (e.g. within a week).

Expect to complete screening forms to help with assessment and treatment plans. Seeing students in their strengths is key to their success.

Medications are usually necessary. Trial and error, monitoring and tweaking needed. Side effects are common (e.g. loss of appetite, sleep disturbance).

Classroom strategies can include self-management supports, cueing, reminders, breaking tasks into chunks, etc. May need to accommodate a learning disorder.

Some will ask “why would you give a stimulant to a hyperactive child?” You can explain that the stimulant medication serves to wake up the part of the brain that can apply the brakes on too much distracting, outside stimuli.

The medication is fast-acting so the effect may be seen quickly. Many will report “it feels like glasses for my brain!” For other students where medication results are not apparent, they may need to be assessed for a learning disorder.

It may take some trial and error to find the right medication and right dosage. This needs to be monitored as the child grows. Appetite is often adversely affected, so sometimes breaks from the medication may be suggested.

Be aware of a limited working memory and often a poor sense of time. You may need to be their externalized prefrontal cortex.

Consider what routines and checks and balances can be built in for the student. It is often helpful to break tasks down into manageable pieces, offer variety and opportunities for creativity to help with engagement, provide cues for timed or memory tasks, etc.

Teachers and EAs will often be asked to fill out screening forms as part of the assessment for ADHD. Note and celebrate their strengths!

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ADHD

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What strategies have you found helpful to support a student with ADHD?

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Autism Spectrum Disorder (ASD)

Diverse Presentations: Autism varies widely.

Social Communication: challenges with cues and interactions.

Difficulty with empathy, social norms and friendships

Sensory Sensitivities: heightened or lowered sensory response.

Self injury

Rigidity with routines & structure.

Restricted and intense interest areas

May have exceptional advanced abilities in certain areas such as memory, mathematics or music

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects a person’s social skills, communication, interaction and behaviour.

There is a wide variation in how these signs and symptoms present, and the degree of impairment experienced. There is a saying “If you know one person with Autism, you know one person with Autism.”

Diagnosis is usually made in the first 2 to 5 years of life.

Challenges may include:

• Difficulties understanding that others may think, feel and perceive the world differently from them

• Lack of awareness of social norms

• Deficits in non-verbal communication (e.g. limited eye contact, unusual facial expressions, limited use of gestures)

• Absent, delayed or unusual use of verbal language (e.g. seemingly meaningless repetition of words from media or other people

• Difficulties forming and sustaining age-typical relationships

• Difficulties following the 'rules' of typical back-and-forth conversation (e.g. not taking turns speaking, focusing on own interests, trouble sharing interests, thoughts and feelings with others)

• Restricted patterns of behaviour (e.g. repetitive movements, insistence on sameness and extreme distress for even minor changes in routine, highly restricted interests, variable sensitivity to sensory stimulation such as pain tolerance, temperature, texture, smell, taste, lights or sound

• Self-injury (e.g. skin picking, hand biting, head banging)

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Autism:

Treatment &

Role of the School

Significant variability in diagnoses. Those with greater functional impairment require specialty mental health care teams.

Consider alterations to the environment where possible and identify student strengths to encourage engagement..

Early diagnosis and treatment is key, for when the brain is most malleable.

Work closely with care team(s) on individualized school management plan, including both social and academic strategies.

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ASD

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Obsessive Compulsive Disorder (OCD)

Obsessions -

recurrent, intrusive, unwanted thoughts or images or impulses that cause significant distress and functional impairment

Compulsions –

recurrent, repetitive behaviours that are time consuming and cause significant distress or functional impairment

May realize that the obsessions and compulsions are excessive and unrealistic but can not control them

More than a preference for order, cleanliness or organization.

Not classified as an Anxiety Disorder, but may experience high anxiety.

The person may be secretive about their degree of distress

Everyone has unwanted or recurring thoughts at times, or behaviours like double checking that a door is locked.

Similarly, lots of people have idiosyncrasies and preferred ways to do tasks (e.g. routines, superstitious habits)

However OCD is far more than that. It is a mental disorder that leaves people feeling trapped in a cycle of distressing thoughts and/or behaviours that become so extreme they get in the way of daily life, consume large amounts of time and attention, or result in significant suffering.

Obsessions are recurrent and persistent thoughts, urges or mental images that are intrusive and unwanted. Examples may include:

concerns about cleanliness or contamination
bad events happening (e.g. violence, horrible scenes, or being attacked)
doubts about whether an action was performed
possessions or actions having to be in a specific order (e.g. symmetry or order)

Compulsions or 'rituals' are repetitive behaviours or mental acts done to reduce distressing feelings associated with an obsession that the person feels driven to perform according to extremely rigid rules.

However, these behaviours or mental acts only work for a short time so they need to be continuously repeated, thereby interfering with daily life. They are time consuming (e.g. more than 1 hour per day) or cause clinically significant distress or impairment.

Examples may include:

repetitive behaviours (e.g. washing hands; tapping a desk; repeatedly checking to make sure a task has been completed)
placing items in a specific order or requiring symmetry
asking for reassurance pertaining to their compulsions
mental acts (e.g. counting items, repeating words silently)

Children with OCD may avoid friends, quit sports they like, experience rejection from peers, struggle to concentrate at school, argue or have conflict with family members, spend more time on tasks than others, and have trouble enjoying hobbies and life in general.

Because the person is aware that their thoughts or behaviours are excessive and unhelpful, they may keep their struggles a secret and may not ask for support.

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OCD:

Treatment &

Role of the School

Typically takes 12 weeks for symptom reduction.

Align school interventions with treatment plan and encourage flexible thinking and coaching on distress tolerance.

Requires specialty mental health care and is best treated with a combination of medications and cognitive behavioural therapy (CBT).

With this awareness, express concerns and describe observable behaviours that may indicate a student needs assessment and support.

OCD is typically treated with therapy and medication as well as learning about how the disorder affects the brain.

Certain medications appear to be more helpful than others but it is often trial and error to find the right medication and the best dose.

Exposure and response prevention (a type of CBT) helps people face the obsession without giving in to the compulsion in a safe and supported environment.

If you are concerned that a student may have OCD, refer the student to the school counsellor or school-based health professional who can then refer the student to a professional best suited to provide treatment.

As a teacher, continue to provide emotional and learning support to the student as part of their ‘circle of care'.

It is important for teachers to be included in the treatment plan and incorporate any academic modifications.

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OCD

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Keys to Supporting Students

Be willing to look beyond the obvious signs and symptoms with students.

View oppositional behaviour as a sign the student needs help.

“Kids do well if they can do well.” (Ross Greene)

Be proactive as much as possible! We can all support optimal mental health.

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Fast Facts about Mental Disorders

Early identification and treatment leads to better outcomes

Treatment success rate is on par with other health conditions

Stigma often stops people from getting help

More free, accessible treatment services are needed

will experience a mental illness

/disorder in our lifetime

20% of us

Key Points:

The good news is that treatments for mental disorders have about the same success rate as treatment for other health disorders.
The bad news is – just like other health conditions, it may be difficult to find a treatment that works well with little side effects.
There are also differences in severity (just like arthritis) and sadly sometimes a person may experience a severe illness that does not respond well to treatments currently available (as is the case with some other medical conditions).
Unfortunately, there are not enough resources/affordable options to serve all who need treatment in a timely manner. Mental health treatment is funded at a much lower rate than funding for other health conditions. We need to advocate for more high quality, accessible services.
Globally, mental disorders contribute about one third of the burden of disease, considering mortality and morbidity. This is more than: HIV/AIDS; TB; respiratory diseases; cardiovascular diseases and war/violence COMBINED!
We can all improve our literacy levels around mental health, reduce stigma, and advocate for improved mental health services.
Talking about mental health, mental health problems and mental disorders with more openness and clarity helps!

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Component 4:

Help Seeking Efficacy

Understanding Treatment
What to Expect
When to Connect for Help
Expressing Concerns

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What are treatments expected to do?

Improve the symptoms that the person is suffering from.

Improve the person’s ability to function at home; at work; with friends; etc.

Lessen the intensity, frequency and duration of episodes of impairment.

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Treatment: Use of Best Evidence

Standard treatments - have been scientifically demonstrated to show significant positive effects for a specific disorder

Complementary treatments – may help specific treatments work more effectively or bring added value, such as exercise, nutrition, specific social interactions; etc., but are not likely to be enough on their own

Alternative treatments – interventions that take the place of standard treatments but do not have the evidence needed to be recommend as treatments

Standard treatments - scientifically demonstrated treatments for disorders are treatments that have been tested to be effective and safe. These are specific and we call these types of treatment “evidence-based”. They are approved by legitimate organizations and meet a standard of quality and criteria.

(Check out our powtoon videos regarding evidence based medicine: https://youtu.be/YMmgzhON14U and https://youtu.be/psVXL0W5vrs)

Complementary treatments – may help specific treatments work better but are not sufficient on their own to treat disorders. Exercise, vitamin D, and Omega 3 supplements are examples.

Alternative treatments – these are interventions that do not have evidence or research to prove effectiveness. Sadly, there are many out there quick to make money off of any perceived problem. Not only are some of these ‘treatments’ not proven to be effective, they may very well be harmful..

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Evidence is Hierarchical

Randomized controlled trials

Prospective cohort

or case-control studies

Retrospective cohort or case-control studies

Case Series or studies with no controls

Expert opinions without explicit critical appraisal

Quality of Evidence

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Positive Treatment Effect

Time

Depression

Positive Treatment Effect

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Realistic Expectations for Treatments

Not all people respond in the same way to a specific treatment.

All treatments have the potential for side effects, including psychological treatments.

Many treatments have a delayed time of onset – a person can feel even worse before they begin to feel better.

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Realistic Expectations for Treatments

Treatments for mental disorders have similar success rates as those for physical illnesses.

Trial and error may be necessary to find the right treatment or dose of medication.

Different treatments take different amounts of time to show effects.

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Understanding Treatment

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When to be concerned

CHANGES in behaviour, attitude, appearance,

performance

Withdrawal from family, others and activities

Change in peer group

or more secrecy

Physical complaints

Expressing more negativity about self and others

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Check Out Your Concerns

Look, listen, express concern

Check in with parents or caregivers

Connect to more help within the school system

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Expressing Concerns to Students

“Some kids I know…..Is that true for you?

Describe what you are noticing, and do a “light check in”.

Show genuine interest. Ask what they can teach you. Value their opinion.

Connection is foundational.

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Expressing Concerns to Parents & Caregivers

From a parent: “Remember you are not seeing us at our best”.

This slide is an optional opportunity for a group share exercise. You may want to ask, “What challenges have you faced when working with parents? And what has worked well?”

It’s not uncommon for family members to deny the existence of a mental health or behavioural problem. If during your conversation a parent/guardian grows defensive or rejects your concerns, continue to rely on these conversational tools:

Start the conversation early.
Welcome constructive criticism and ideas.
Remember that you and the parent are allies.
Focus on problems, not personalities.
Share feedback – if you have objective data about the concern (grades, attendance, etc.), share it.
Affirm, reinforce and compliment – frequently acknowledge the positives in both the student and the parents.
Discuss a plan – transition from discussing the concern to providing options and negotiating a plan for addressing it.
Provide information and resources.

And remember that the way you behave and respond plays a big role in either diffusing or aggravating resistance.

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Mental Health Literacy – Further Learning

Owen

Hazel

Alex

website: mhlcurriculum.org

password: childh3alth

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MHL Website Resources� https://mentalhealthliteracy.org/�

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Further Learning with AHS Mental Health Collaborative

https://mhcollab.ca/

Community Education Services

http://community.hmhc.ca

/

http://ahsmore.mhcollab.ca

https://chps.mhcollab.ca /

https://wp.hmhc.ca/canreach/

Subscribe to the CES newsletter:

https://ces.hmhc.ca/newsletter/

https://cpd.mhcollab.ca/

This slide may be useful for Alberta presentations re: resources from other programs within the same department.

Below is a brief description of these programs under the umbrella of “Mental health Collaboratives”:

CES delivers free, evidence-informed education for parents, caregivers, and community members on topics related to child and youth mental health.

MORE provides Alberta educators free, online, multimedia courses on mental health and substance use topics with applicable classroom strategies.

CHPS provides evidence-based substance use prevention and mental health promotion services and resources in Calgary. Their focus is building protective factors and reducing risk factors associated with substance misuse and mental health disorders.

Through an accredited 6-month mini-fellowship CME, CanREACH educates and empowers health care providers to assess and treat pediatric mental health concerns in primary care. CanREACH changes health care provider practices, benefiting patients and the larger health care system. On their website, you can search by location to find family physicians who have completed CanREACH training.

CPD develops free web-based, online courses intended for healthcare professionals in Alberta working with children and adolescents in the area of addictions and mental health. Social workers can earn Class A accredited course credit.

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Waterfall Share:

1. Key learning from the training?

2. Your next step in learning and sharing this information?

Write your thoughts in the chat box without pressing the ‘enter’ key.

Then when I say “Waterfall” we will all press enter at the same time to create a cascade of ideas!!

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CONNECTION matters