Mental Health and Mental Health and Student SuccessStudent Success

Helping Teens with Their Mental Health IssuesHelping Teens with Their Mental Health Issues Presented by Kathleen Kern, Presented by Kathleen Kern,

Ph.DPh.D

Lorain County Board of Mental Lorain County Board of Mental HealthHealth

Mental Health and Your Mental Health and Your StudentsStudents

According to the CDC study of youth According to the CDC study of youth aged 9-17, if you are a teacher aged 9-17, if you are a teacher with 30 students in your class, with 30 students in your class, within the last six months:within the last six months:

4 are likely to have an Anxiety 4 are likely to have an Anxiety DisorderDisorder

2 will have a Mood Disorder2 will have a Mood Disorder 3 will have a Disruptive Disorder3 will have a Disruptive Disorder

Closer to HomeCloser to Home

In a 2009 survey of over 10,000 6In a 2009 survey of over 10,000 6thth, 8, 8thth, 10, 10thth and 12and 12thth graders in Lorain County: graders in Lorain County:

35 % of students indicated that they were 35 % of students indicated that they were depressed more days than not last year. depressed more days than not last year.

33% report that they sometimes believe 33% report that they sometimes believe that they are no good at all. that they are no good at all.

14% of students report that they are 14% of students report that they are inclined to think of themselves as a inclined to think of themselves as a failure.failure.

8% of students across grades 6,8,10 and 8% of students across grades 6,8,10 and 12 indicated that their worries 12 indicated that their worries alwaysalways interfere with their ability to get things interfere with their ability to get things done.done.

ObjectivesObjectives

To understand:To understand: The Origin of Mental Health Problems.The Origin of Mental Health Problems. The impact of trauma on mental healthThe impact of trauma on mental health The role of schools in early The role of schools in early

identification and resiliency buildingidentification and resiliency building Characteristics indicative of student Characteristics indicative of student

behavioral health concernsbehavioral health concerns The resources that are available in our The resources that are available in our

countycounty

Mental Health Problems:Mental Health Problems:Nature AND NurtureNature AND Nurture

There is a huge amount of research There is a huge amount of research pointing to the mental health disorders pointing to the mental health disorders having a genetic component.having a genetic component.

Historically, we understood mental illness Historically, we understood mental illness through The Diathesis-Stress Model. through The Diathesis-Stress Model.

The Vulnerability-Stress–Protective The Vulnerability-Stress–Protective factors model tells us that protective factors model tells us that protective factors may mitigate stress and reduce factors may mitigate stress and reduce likelihood of symptom expression. likelihood of symptom expression. (Analogous to Health)(Analogous to Health)

Vulnerability: Vulnerability: Biology of Mental IllnessBiology of Mental Illness

Studies have noted rates of child psychiatric Studies have noted rates of child psychiatric diagnosis among offspring ranging from diagnosis among offspring ranging from approximately 30% to 50%, as compared to an approximately 30% to 50%, as compared to an estimated rate of 20% among the general estimated rate of 20% among the general child population. Estimates of heritability child population. Estimates of heritability factors are as follows:factors are as follows:

Bipolar Disorder 59% (NIMH, 1998), with Bipolar Disorder 59% (NIMH, 1998), with Schizophrenia slightly higherSchizophrenia slightly higher

Various studies estimate the overall Various studies estimate the overall heritability rate for major depression are heritability rate for major depression are about 39%about 39%

Environmental Stress-Environmental Stress-TraumaTrauma

ACES Study of ACES Study of 17,000 17,000 Kaiser Permanente Kaiser Permanente Members is California connected Adverse Members is California connected Adverse Childhood Experiences to negative Childhood Experiences to negative outcomes in adulthood.outcomes in adulthood.

Abuse (Emotional, Physical or Sexual) Abuse (Emotional, Physical or Sexual) AbuseAbuse

Neglect (Physical or Emotional)Neglect (Physical or Emotional) Mother Treated ViolentlyMother Treated Violently Household Substance AbuseHousehold Substance Abuse Household Mental IllnessHousehold Mental Illness Parental Separation or DivorceParental Separation or Divorce Incarcerated Household MemberIncarcerated Household Member

Long Term ImpactLong Term Impact

Analysis of he ACE Score data indicates that as the Analysis of he ACE Score data indicates that as the number of ACE increase, the risk for the following number of ACE increase, the risk for the following health problems increases in a strong and health problems increases in a strong and gradedgraded fashion:fashion:

*alcoholism and alcohol abuse *alcoholism and alcohol abuse *COPD*COPD*fetal death *fetal death *health-related quality *health-related quality

of lifeof life*illicit drug use *illicit drug use *heart disease *heart disease *liver disease *liver disease * STDs * STDs *risk for intimate partner violence *risk for intimate partner violence *smoking *smoking *multiple sexual partners *multiple sexual partners * unintended * unintended

pregnancies pregnancies *adult unemployment*adult unemployment *suicide attempts*suicide attempts

An Example: An Example: Depression and Trauma Depression and Trauma

((www.Acestudy.org)

Trauma Has Multifaceted Trauma Has Multifaceted ImpactImpact

Changes Brain (chemically and Changes Brain (chemically and structurally)structurally)

Educational ImpactEducational Impact Impact on PerceptionsImpact on Perceptions Relations with otherRelations with other Behaviors (Health and Risk)Behaviors (Health and Risk)

Trauma’s Biological Trauma’s Biological Impact: Impact: Lateral Ventricles Measures in an Lateral Ventricles Measures in an 11 Year Old Maltreated Male with Chronic PTSD, 11 Year Old Maltreated Male with Chronic PTSD,

Compared with a Healthy, Non-Maltreated Compared with a Healthy, Non-Maltreated Matched ControlMatched Control Non-MaltreatedNon-Maltreated Maltreated Maltreated

Ventricles

Trauma’s Educational Trauma’s Educational Impacts of Trauma Impacts of Trauma

Greater than 50% of abused children have problems Greater than 50% of abused children have problems at school (including conduct problems) at school (including conduct problems)

Greater than 25% of abused children require special Greater than 25% of abused children require special education serviceseducation services

Several studies suggest that child abuse and neglect Several studies suggest that child abuse and neglect reduce a child’s IQ (nest slide)reduce a child’s IQ (nest slide)

Maltreated children have lower social competence Maltreated children have lower social competence (which is a significant predictor of academic (which is a significant predictor of academic achievement). They may have reduced empathy or achievement). They may have reduced empathy or emotional intelligence.emotional intelligence.

Children can experience changes in perception that Children can experience changes in perception that interfere with learning and social skillsinterfere with learning and social skills

According to Dr. Frank Putnam, MD, Cincinnati Children’s According to Dr. Frank Putnam, MD, Cincinnati Children’s HospitalHospital

Cumulative Trauma Lowers Cumulative Trauma Lowers IntelligenceIntelligence

Impact on Social Impact on Social Functioning: Functioning: Physically Physically

Abused Children See Anger Abused Children See Anger Where Others See FearWhere Others See Fear

Graphic by:Graphic by: Seth Pollak, courtesy PNAS Seth Pollak, courtesy PNAS

Trauma Symptoms in Trauma Symptoms in AdolescentsAdolescents

Adolescents – Adolescents – Avoidance, problems with Avoidance, problems with attention and concentration, attention and concentration, nightmares, hypervigilence, possible nightmares, hypervigilence, possible depersonalization, self-injuries or risk depersonalization, self-injuries or risk taking behaviors, substance abuse, taking behaviors, substance abuse, intermittent anger/aggression caused intermittent anger/aggression caused by survival instinct, perceptual changes, by survival instinct, perceptual changes, brain-related changes, and the brain-related changes, and the avoidance that interferes with changing avoidance that interferes with changing cognitionscognitions

Take Home PointsTake Home Points

Many mental health disorders have a genetic Many mental health disorders have a genetic component that is activated by a stressful component that is activated by a stressful environment.environment.

This environmental stress can actually This environmental stress can actually change the functioning in the brain change the functioning in the brain (Demonstrated with Depressed and PTSD (Demonstrated with Depressed and PTSD clients).clients).

Children who experience multiple Adverse Children who experience multiple Adverse Childhood Experiences (Traumatic Events) Childhood Experiences (Traumatic Events) are at great risk for poor, long-term are at great risk for poor, long-term outcomes, if there is no intervention. outcomes, if there is no intervention.

The Third Factor: The Third Factor: ResiliencyResiliency

In Lorain County and surrounding areas, our In Lorain County and surrounding areas, our students are faced with many challenges students are faced with many challenges (poverty, violence in home and community, etc.)(poverty, violence in home and community, etc.)

Some of these are beyond our ability to Some of these are beyond our ability to immediately impact. What we CAN do is immediately impact. What we CAN do is strengthen the children for the challenges that strengthen the children for the challenges that they will face. they will face.

According to Emmie Werner and the Research on According to Emmie Werner and the Research on Developmental Assets, building a child's Developmental Assets, building a child's strengths can make a huge difference.strengths can make a huge difference.

Children can manage amazing adversity if they Children can manage amazing adversity if they feel safe and supported and can learn different feel safe and supported and can learn different ways to cope.ways to cope.

Developmental AssetsDevelopmental Assets

Since 1990, the Search Institute studied Since 1990, the Search Institute studied more than one million students and more than one million students and 213 communities.213 communities.

The Institute articulated 40 The Institute articulated 40 Developmental AssetsDevelopmental Assets

20 Internal Assets20 Internal Assets 20 External Assets20 External Assets

Which assets can schools influence?Which assets can schools influence?

Assets in SchoolsAssets in Schools Positive other adult relationship (3+ non-Positive other adult relationship (3+ non-

parent adults)parent adults) Caring school climateCaring school climate Parent involvement in schoolParent involvement in school Service to others (one or more hours per Service to others (one or more hours per

week)week) Safety: youth feel safe at schoolSafety: youth feel safe at school School boundaries: clear rules and School boundaries: clear rules and

consequencesconsequences Adult role modelsAdult role models High expectationsHigh expectations

Assets in SchoolsAssets in Schools

Creative activities (3+ hours/week)Creative activities (3+ hours/week) Youth programs (3+ hours/week)Youth programs (3+ hours/week) Achievement motivationAchievement motivation School engagementSchool engagement HomeworkHomework Bonding to schoolBonding to school POWER OF ONE CARING ADULT POWER OF ONE CARING ADULT

(Demonstrated by research and (Demonstrated by research and practice)practice)

The Informed Adult…The Informed Adult…

Knows how to set up an environment to Knows how to set up an environment to build resiliency (including safety, build resiliency (including safety, predictability)predictability)

Knows how to recognize possible mental Knows how to recognize possible mental health symptoms and how to add needed health symptoms and how to add needed protective factors, including treatmentprotective factors, including treatment

Is willing to reach out to youth building Is willing to reach out to youth building rapport, asking about the youth’s well rapport, asking about the youth’s well being, providing support and connectionbeing, providing support and connection

The Good NewsThe Good News

Effective Treatment is AvailableEffective Treatment is Available A growing body of research A growing body of research

demonstrates the efficacy of mental demonstrates the efficacy of mental health interventions for children and health interventions for children and families. families.

Trauma Focused Cognitive Behavioral Trauma Focused Cognitive Behavioral Therapy has been proven to effectively Therapy has been proven to effectively reduce symptoms associated with reduce symptoms associated with trauma and to increase functioning. trauma and to increase functioning.

TFCBTTFCBT

The only treatment proven effective for The only treatment proven effective for the treatment of sexual abuse.the treatment of sexual abuse.

The Goal is to integrate the trauma as an The Goal is to integrate the trauma as an event that occurred but did not define the event that occurred but did not define the youth.youth.

Includes Pyschoeducation, Building Includes Pyschoeducation, Building Cognitive and Emotional Coping, Direct Cognitive and Emotional Coping, Direct Discussion of the Trauma and Sharing of Discussion of the Trauma and Sharing of the Child’s Story with a non-offending the Child’s Story with a non-offending adult (Very Important). adult (Very Important).

Resources in Lorain Resources in Lorain CountyCounty

Services will be determined according to Services will be determined according to symptoms and best practices but parents symptoms and best practices but parents should be aware that in Lorain County:should be aware that in Lorain County:

Seven agencies offer mental health Seven agencies offer mental health services for children within the Networkservices for children within the Network

Four offer TFCBTFour offer TFCBT Three offer child psychiatryThree offer child psychiatry Four offer a sliding fee scale that goes Four offer a sliding fee scale that goes

down to zero, depending on incomedown to zero, depending on income All services are confidentialAll services are confidential

Non-Emergency Non-Emergency ResourcesResources

A continuum of care is available so that the A continuum of care is available so that the needs of the child or adolescent can be needs of the child or adolescent can be matched with the appropriate level of care. matched with the appropriate level of care.

Contact information for all agencies, and a Contact information for all agencies, and a weekly update that indicates which weekly update that indicates which agencies have openings within fourteen agencies have openings within fourteen days can be found at www.lcmhb.orgdays can be found at www.lcmhb.org

Parents or Educators who have questions Parents or Educators who have questions should not hesitate to email or callshould not hesitate to email or call

kkern@lcmhb.orgkkern@lcmhb.org; 440-233-2020 (x4239); 440-233-2020 (x4239)

Review of Review of Objectives and Objectives and

Questions Questions Understanding the Origin of Mental Health Understanding the Origin of Mental Health Problems.Problems.

The impact of trauma on mental healthThe impact of trauma on mental health

The role of schools in early identification and The role of schools in early identification and resiliency buildingresiliency building

Characteristics indicative of student behavioral Characteristics indicative of student behavioral health concernshealth concerns

The resources that are available in Lorain CountyThe resources that are available in Lorain County

Interesting ResourcesInteresting Resources

National Child Traumatic Stress National Child Traumatic Stress Network has amazing resources for Network has amazing resources for educators, parents, social workers, educators, parents, social workers, etc. (etc. (www.NCTSN.orgwww.NCTSN.org))

For more information on the ACES For more information on the ACES StudyStudy

http://www.cdc.gov/ace/index.htmhttp://www.cdc.gov/ace/index.htm To learn about your own ACE score To learn about your own ACE score

acestudy.org/acestudy.org/

Thank YouThank You

Kathleen Kern, Ph.D.Kathleen Kern, Ph.D.

Lorain County Board of Mental Health Lorain County Board of Mental Health

kkern@lcmhb.orgkkern@lcmhb.org; 440-233-2020 ; 440-233-2020 (x4239)(x4239)