Presented by Kathleen Kern, Ph.D Lorain County Board of Mental Health Mental Health and Student Success Helping Teens with Their Mental Health Issues Presented by Kathleen Kern, Ph.D Lorain County Board of Mental Health Into and question regarding roles

Mental Health and Your Students According to the CDC study of youth aged 9-17, if you are a teacher with 30 students in your class, within the last six months: 4 are likely to have an Anxiety Disorder 2 will have a Mood Disorder 3 will have a Disruptive Disorder Discussion of likihood that this applies to our county

Closer to Home In a 2009 survey of over 10,000 6th, 8th, 10th and 12th graders in Lorain County: 35 % of students indicated that they were depressed more days than not last year. 33% report that they sometimes believe that they are no good at all. 14% of students report that they are inclined to think of themselves as a failure. 8% of students across grades 6,8,10 and 12 indicated that their worries always interfere with their ability to get things done. Remember that Depression is the number one risk factor for Suicide. So we have local and national data indicating that are youth are struggling with an illness that is definitely debiliating and can risk their life. If there was an analogous health risk and we had some confidence that concervatively 1 in 6 or our students may have a treatable illness that, left untreated could be debilitating, I think we would screen for it

Objectives To understand: The Origin of Mental Health Problems. The impact of trauma on mental health The role of schools in early identification and resiliency building Characteristics indicative of student behavioral health concerns The resources that are available in our county So statistics tell us that our students have mental health issues, but that is only part o the story.

Mental Health Problems: Nature AND Nurture There is a huge amount of research pointing to the mental health disorders having a genetic component. Historically, we understood mental illness through The Diathesis-Stress Model. The Vulnerability-Stress–Protective factors model tells us that protective factors may mitigate stress and reduce likelihood of symptom expression. (Analogous to Health) We are going to talk about the three contributing factors.

Vulnerability: Biology of Mental Illness Studies have noted rates of child psychiatric diagnosis among offspring ranging from approximately 30% to 50%, as compared to an estimated rate of 20% among the general child population. Estimates of heritability factors are as follows: Bipolar Disorder 59% (NIMH, 1998), with Schizophrenia slightly higher Various studies estimate the overall heritability rate for major depression are about 39% This information is based on studies of monozygotic and dyzogotic twins. If a disorder is heritable, identical twins should have a higher rate of concordance rate that fraternal twins.. These studies use difference between concordance rates to determine the liklihood that the manifestation of a disorder will occur based on biology.

Environmental Stress-Trauma ACES Study of 17,000 Kaiser Permanente Members is California connected Adverse Childhood Experiences to negative outcomes in adulthood. Abuse (Emotional, Physical or Sexual) Abuse Neglect (Physical or Emotional) Mother Treated Violently Household Substance Abuse Household Mental Illness Parental Separation or Divorce Incarcerated Household Member The ACE Study was initiated at Kaiser Permanente from 1995 to 1997, and its participants are over 17,000 members who were undergoing a standardized physical examination. No further participants will be enrolled, but we are tracking the medical status of the baseline participants. Each study participant completed a confidential survey that contained questions about childhood maltreatment and family dysfunction, as well as items detailing their current health status and behaviors. This information was combined with the results of their physical examination to form the baseline data for the study. The prospective phase of the ACE Study is currently underway, and will assess the relationship between adverse childhood experiences, health care use, and causes of death.

Long Term Impact Analysis of he ACE Score data indicates that as the number of ACE increase, the risk for the following health problems increases in a strong and graded fashion: *alcoholism and alcohol abuse *COPD *fetal death *health-related quality of life *illicit drug use *heart disease *liver disease * STDs *risk for intimate partner violence *smoking *multiple sexual partners * unintended pregnancies *adult unemployment *suicide attempts

An Example: Depression and Trauma (www.Acestudy.org)

Trauma Has Multifaceted Impact Changes Brain (chemically and structurally) Educational Impact Impact on Perceptions Relations with other Behaviors (Health and Risk)

Trauma’s Biological Impact: Lateral Ventricles Measures in an 11 Year Old Maltreated Male with Chronic PTSD, Compared with a Healthy, Non-Maltreated Matched Control Non-Maltreated Maltreated Ventricles

Trauma’s Educational Impacts of Trauma Greater than 50% of abused children have problems at school (including conduct problems) Greater than 25% of abused children require special education services Several studies suggest that child abuse and neglect reduce a child’s IQ (nest slide) Maltreated children have lower social competence (which is a significant predictor of academic achievement). They may have reduced empathy or emotional intelligence. Children can experience changes in perception that interfere with learning and social skills According to Dr. Frank Putnam, MD, Cincinnati Children’s Hospital

Cumulative Trauma Lowers Intelligence

Impact on Social Functioning: Physically Abused Children See Anger Where Others See Fear Graphic by: Seth Pollak, courtesy PNAS Problems with trust, attachment, self care, emotional expression

Trauma Symptoms in Adolescents Adolescents – Avoidance, problems with attention and concentration, nightmares, hypervigilence, possible depersonalization, self-injuries or risk taking behaviors, substance abuse, intermittent anger/aggression caused by survival instinct, perceptual changes, brain-related changes, and the avoidance that interferes with changing cognitions So, what symptoms are we seeing from youth who are traumatized

Take Home Points Many mental health disorders have a genetic component that is activated by a stressful environment. This environmental stress can actually change the functioning in the brain (Demonstrated with Depressed and PTSD clients). Children who experience multiple Adverse Childhood Experiences (Traumatic Events) are at great risk for poor, long-term outcomes, if there is no intervention.

The Third Factor: Resiliency In Lorain County and surrounding areas, our students are faced with many challenges (poverty, violence in home and community, etc.) Some of these are beyond our ability to immediately impact. What we CAN do is strengthen the children for the challenges that they will face. According to Emmie Werner and the Research on Developmental Assets, building a child's strengths can make a huge difference. Children can manage amazing adversity if they feel safe and supported and can learn different ways to cope.

Developmental Assets Since 1990, the Search Institute studied more than one million students and 213 communities. The Institute articulated 40 Developmental Assets 20 Internal Assets 20 External Assets Which assets can schools influence?

Assets in Schools Positive other adult relationship (3+ non-parent adults) Caring school climate Parent involvement in school Service to others (one or more hours per week) Safety: youth feel safe at school School boundaries: clear rules and consequences Adult role models High expectations

Assets in Schools Creative activities (3+ hours/week) Youth programs (3+ hours/week) Achievement motivation School engagement Homework Bonding to school POWER OF ONE CARING ADULT (Demonstrated by research and practice)

The Informed Adult… Knows how to set up an environment to build resiliency (including safety, predictability) Knows how to recognize possible mental health symptoms and how to add needed protective factors, including treatment Is willing to reach out to youth building rapport, asking about the youth’s well being, providing support and connection

The Good News Effective Treatment is Available A growing body of research demonstrates the efficacy of mental health interventions for children and families. Trauma Focused Cognitive Behavioral Therapy has been proven to effectively reduce symptoms associated with trauma and to increase functioning.

TFCBT The only treatment proven effective for the treatment of sexual abuse. The Goal is to integrate the trauma as an event that occurred but did not define the youth. Includes Pyschoeducation, Building Cognitive and Emotional Coping, Direct Discussion of the Trauma and Sharing of the Child’s Story with a non-offending adult (Very Important).

Resources in Lorain County Services will be determined according to symptoms and best practices but parents should be aware that in Lorain County: Seven agencies offer mental health services for children within the Network Four offer TFCBT Three offer child psychiatry Four offer a sliding fee scale that goes down to zero, depending on income All services are confidential

Non-Emergency Resources A continuum of care is available so that the needs of the child or adolescent can be matched with the appropriate level of care. Contact information for all agencies, and a weekly update that indicates which agencies have openings within fourteen days can be found at www.lcmhb.org Parents or Educators who have questions should not hesitate to email or call kkern@lcmhb.org; 440-233-2020 (x4239)

Review of Objectives and Questions Understanding the Origin of Mental Health Problems. The impact of trauma on mental health The role of schools in early identification and resiliency building Characteristics indicative of student behavioral health concerns The resources that are available in Lorain County

Interesting Resources National Child Traumatic Stress Network has amazing resources for educators, parents, social workers, etc. (www.NCTSN.org) For more information on the ACES Study http://www.cdc.gov/ace/index.htm To learn about your own ACE score acestudy.org/

Thank You Kathleen Kern, Ph.D. Lorain County Board of Mental Health kkern@lcmhb.org; 440-233-2020 (x4239)