1. Supporting Student and Teacher Mental Health
Paul Dupont, Ph.D.
Counseling Director, University Counseling Services Ellen Gormican, MPH Victim Advocate and Survivor Support Coordinator, Office of Health Promotion and Wellness
Lori Bokowy, M.Ed Interim Mental Health Outreach Coordinator, Office of Health Promotion and Wellness

2. Workshop Objectives
Review signs/symptoms indicating that students may be struggling with a traumatic response
Provide tools for integrating trauma-informed accommodations into the classrooms 
Discuss pros/cons/risks of assisting emotionally distressed students
Provide guidance on deciding if and how to intervene 
Discuss the importance of boundaries and how to care for oneself
Provide time for Q&A

3. Trauma & the Impact on Students
Ellen Gormican, MPH
Victim Advocacy & Survivor Support Coordinator

4. Trauma at a Glance
Almost half (47.9%) of the U.S.’s children have experienced at least one or more types of serious childhood trauma
22.6% of U.S. youth age 12 – 17 have experienced two or more types of childhood trauma (percentages range by state from 23 – 44%)
Incidence of childhood trauma is directly linked to the adult onset of chronic diseases including:
Mental illness
Addiction
Autoimmune disorders
Future victimization

5. ACEs rarely occur in isolation…
If you have 1 ACE, you are 95% more likely to have more than one. If you have 2, you’re 82% more likely to have more than two, etc.
Additional ACEs (%) _____________________________
If you had…
A battered mother

6. Trauma and the Brain
Children and young adults who experience trauma often develop a faulty stress response
The Stress Response:
All humans experience stress and the same stress response
The human stress response is a automatic reaction to a overwhelmed brain
Biological purpose is to guarantee survival – fight/flight/freeze
Can be triggered by accumulated stress (work/poverty/relationship strife) because the brain is overwhelmed
TRAUMA = an experience that overwhelms the individual’s ability to cope

7. Frontal and Prefrontal Cortex
The Stress Response
The human brain develops from “back to front”
Completes development ~25-28 years old
All three regions work together to stay alive, have experiences we feel and sense, & make meaning of those experiences
Frontal and Prefrontal Cortex
Limbic – Midbrain
Region
Survival
region

8. Cognitive Shutdown
Brain development goes back to front, cognitive shutdown goes front to back
Very simply…
#3 goes first
#2 goes second
#1 is what is left alert as long as possible in order to keep you safe
cortisol 3 2 1

9. Our responses typically follow the order of cognitive shut down
Stress Response
FIGHT – while you are still able to use your executive functions
FLIGHT – while you are still able to feel emotion
FREEZE –both frontal and midbrain functions have slowed or stopped
FAINT – lost consciousness
Our responses typically follow the order of cognitive shut down

10. During the Stress Response…
We cannot make rational decisions
We cannot analyze a situation
We cannot learn new concepts/ideas
We react automatically (influenced by life experience)
Emotional responses may not match situation: over or under-reaction
Our memories are fragmented without full context
How can this impact a student?

11. Common Immediate Trauma Reactions
EMOTIONAL
Numbness and detachment
Anxiety, severe fear
Guilt, shame
Mania
Anger
Sadness
Helplessness
Disassociation (feeling outside one’s body)
Disorientation
Denial
PHYSICAL
Nausea/gastrointestinal distress
Sweating or shivering
Faintness
Muscle tremors, uncontrollable shaking
Elevated heartbeat, respiration, and blood pressure
Extreme fatigue, exhaustion
Greater startle response
Depersonalization

12. Common Delayed Trauma Reactions
EMOTIONAL
Irritability and/or hostility
Depression
Mood swings, instability
Anxiety (e.g. phobia, generalized)
Fear of trauma recurrence
Grief reactions
Shame
Fragility/vulnerability
Emotional detachment
PHYSICAL
Sleep disturbances, nightmares
Somatization (increased focus on and worry about body aches and pains)
Appetite and digestive changes
Lowered immune response
Persistent fatigue
Elevated cortisol levels (fight or flight hormone)
Hyperarousal
Long-term health effects including heart, liver, autoimmune disease

13. Finding Success in College
What is needed?
Organization
Self-direction
Pre-planning
Focus
Healthy coping skills
Identity development
Future outlook
Supportive networks
Emotional management
Healthy risk taking
Common trauma impact
Creating chaos
Low self-image, “what’s wrong with me”
Tethered to the past
Difficulty with memorization, focus, planning for the future, multitasking
Using “unhealthy” coping skills
See world as adversarial, unresolved resentments and anger
Quick emotional responses based in survival
Difficulty making decisions
Chronic fear/hyper-vigilant
-missing classes (without explanation)
-difficulty asking for help
-withdrawal and isolation
-anger, dissociation when stressed
-fear of taking risks
**Students with a trauma history may present as “difficult”; they may be hostile to authority and reluctant to trust others esp. adults

14. Promoting Student Resiliency
What educators identify as maladaptive behaviors are often misapplied survival skills (unhealthy coping skills “work”)
Being admitted to college demonstrates an existing level of post- traumatic growth and potential for success
You have the power to help a student build their resiliency by being a supportive adult in their life

15. Trauma Informed vs. Safe Spaces
Popular media has negatively portrayed the idea of “safe spaces”
Through a trauma-informed lens, safe spaces are NOT about
Policing 1st amendment rights (for instructors or students)
Shielding students from hearing or talking about difficult topics
Shutting down discussions involving violence, race, gender, oppression, etc.
Has anyone had experiences with teaching potentially sensitive topics/material? How did you handle that?

16. Classroom Tools Five Core Values of Trauma-Informed Services
Safety – physical and emotional
Trustworthiness
Choice & Control
Collaboration
Empowerment
Cultural Responsiveness

17. 1. SAFETY Safety is not just eliminating imminent physical harm
Folks with trauma histories are often hypervigalent, constant low-level fear, see threats everywhere
Students my request seating near the exit (or ask you to intervene on their behalf)
Content warnings for potentially difficult topics & encourage self-care
Allow students to opt-out of certain discussions/give alternative work
How to you communicate yourself to students? Authoritarian vs. partner

18. 2. TRUSTWORTHINESS Follow-through and Clarity Confidentiality
Do you make yourself available? Do you treat students as individuals when possible? Do you answer s promptly?
Clear and concise directions/information
Confidentiality
Be VERY CLEAR about your reporting obligations
Have resources available for confidential support
Boundaries
Maintaining appropriate boundaries is the instructor’s responsibility
Acknowledge your role – you are not their friend/counselor/advocate
Beware of self-disclosure – this is a delicate balance, ask yourself if the disclosure primarily benefits YOU or the student

19. 3. CHOICE & CONTROL
Students are the experts on their lived experience and what works best for them
When possible, give options for assignments (group/individual, written/typed format, presentation/essay)
Are rules overly rigid? Are consequences necessary or arbitrary?
Understand that not every student has the same choices available or access to the same resources
Many students also work, have families, are caretakers, etc. (cannot attend office hours that are at one specific time)

20. 4. COLLABORATION
Do you elicit student opinions or feedback about specific assignments, formats, content?
Be aware of power dynamics – Instructors inherently have more power. Survivors can be particularly reactionary to this dynamic
Resistance – student may be combative or uncooperative
Overly compliant – student may be fearful of stating true feelings/concerns
Self-Reflection: do you view the student/instructor relationship as collaborative?

21. 5. EMPOWERMENT (restoring power)
Strengths-based approach – acknowledge that each student has different skills and abilities
provide formats that can showcase this variety
Express realistic optimism about students’ capacity
Encourage students to seek out help and provide multiple resources
Encourage student to prioritize themselves – there is strength in a survivor choosing themselves over any outside expectation
Do not focus or linger on any “unhealthy” skills or behaviors you identify as problematic
Remember your role, remember boundaries

22. 6. CULTURAL RESPONSIVENESS
Does not require that you are an expert in every culture
Acknowledge that culture has direct and lasting impact on how students…
Interact with instructors/perceive authority
Ask for help
Disclose personal experiences
Interpret various forms of communication (physical, facial, verbal)
Instructors’ worldview has been shaped by their culture
If you are not sure what a student needs, ASK: “what would be helpful for you?”
Do not make assumptions about a student’s identity
Be aware of your own verbal and non-verbal comments/reactions (e.g. a male student discloses sexual assault—what is your reaction?)

23. TAKEAWAYS
•A trauma-informed educator never forgets that students bring their entire lives into the classroom every day
•Trauma experiences, especially at critical times in brain development, have varied but often profound impacts on the individual 
•The college lifestyle/regime often requires the very skills that are underdeveloped in student with a significant or recent trauma history
•Giving students options, maintaining clear expectations and boundaries, and acknowledging their lived experiences is not hand-holding, it teaches the student that it is beneficial to advocate for themselves

24. Supporting Student Wellness and Assisting Students in Distress

25. Can We Talk To Students About Their Emotional Health?
Yes. 
Approved by all for governance bodies and administration​
Some would argue that we “should”​
Get permission from student and be aware of power differential​
Be cautious

26. Should we talk with students…? Pros
Might be only one who will assist student​
Could be a student at risk​
Could be very good outcome for student​
Could break down stigma and resistance​
Personal satisfaction

27. Should we talk with students? ( more Pros)
The big picture of need​
Higher levels of distress in national studies​ 
HS Senior Study (UCLA, 2014)
CIRP College Freshman, Senior surveys (2010, 2014)
Anxiety  #1 issue for students seeking treatment
High levels of distress locally (UWM)​
NCHA survey (2015) 12.3% seriously considered suicide in the last year​
Healthy Minds survey (2013)  half of the students screening positive for depression or anxiety not getting services​
Higher acuity of UWM students seeking counseling (broader?)

28. Should we talk with students…? Cons​
Takes time and effort​
Might need to develop a skill set ​
Must overcome any fears/anxieties​
There may not be resolution…resulting in anxiety or frustration
We may be burnt out!

29. Should we talk with students…? Risks
Opening Pandora’s Box?​
Student continues to seek support from you despite referral​
Find yourself with a suicidal student​
Continuum of suicidal thinking
Most with suicidal ideation do not pose any immediate risk

30. Recommendations for Intervening​
Do intervene or find someone else who can​
At least express observations, concerns and willingness to provide some resources​
Doesn't have to be a lengthy conversation​
Be open and honest if unable to provide more
 Direct to those that can

31. Special Issues with Online students​
Very difficult to have sensitive conversation online or via ​
Time period between communications can be long​
Trouble knowing available resources for students at a distance​
Student may know​!
See cards and handout for national phone resources​
University Counseling Services can look up local resources​
Online only students not eligible for UCS (or Norris) services

32. Should I talk with student(s) at this point?​
Start with two questions:
Am I in a state of mind that I can respond? ​
Can I set and keep appropriate boundaries?

33. Reaching Out to Students in Distress (video clip)

34. Campus Resources & Referral Information
University Counseling Services (UCS) 
confidential short-term services, including: individual counseling; couples or relationship counseling; alcohol and drug screening/counseling; eating disorder screening/counseling; crisis intervention; and psychiatry services
UCS Groups
Adult Survivors of Sexual Assault Coping Strategies Support Group
Stress Reduction 4 Week Skills Building Group
Tuesday Mindfulness Meditation Break – Tuesdays at 12:15 in Union 179
Dissertators’ and Thesis Writer’s Support Group
General Therapy Group
Let’s Talk
Provides brief, walk-in consultations
Norris Health Center
University Counseling Services
NWQ 5th Floor

35. Additional Campus Resources
Norris Health Center
Medical services - convenient, & affordable
UWM Psychology Clinic
Psychotherapy and psychological and neuropsychological assessments for the UWM and wider community
Dean of Students
Uwm.edu/reportit
DASH Emergency Grant
UWM Studio Arts and Crafts Centre
BASICS :Brief Alcohol & Other Drug Screening & Intervention Programs
Mobile market/UWM food pantry
UREC
Fitness classes
Yoga

36. Logic Model Keep in mind, each situation is unique.
This framework provides a general guide in assisting students in distress using campus and community base resources.
Seek additional support if unsure of how to respond to a certain situation

37. Campus Trainings & Educational Resources
UWM Mental Health Resources Website
Faculty and Staff:
Campus Connect Gatekeeper Training
Reaching Out to Students in Distress Presentation
Students:
Student Connect
Bringing in the Bystander

38. Some Do's and Don'ts ​ Be yourself, attitude is key​
Share your behavioral  observations​
Share concern, caring, desire to help​
If questioning suicidal thinking, ask directly and be specific​
When needed, provide referrals and encouragement to go
Don't promise complete confidentiality ("except if danger")​
Don't make promises about what the outcome of the appointment will be. ​
Don't make promises that you may not be able to keep​
Be very careful about going too deep

39. And a couple more Do's and Don'ts ​
Explain free and confidential services​
Reduce stigma (1500 students went last year). Self disclose, if appropriate​
Acknowledge the courage involved in talking and taking the next step​
Follow dept. protocols
Don't express judgments, diagnoses, interpretations

40. The Importance of Boundaries
Two most common boundary problems:
developing a peer relationship
blurring of roles (e.g. faculty vs therapist)​
Keep relationship professional-- prof/student​
Not become a therapist​
Avoid being the only one offering assistance to a struggling student​
Keep the responsibility for problem resolution on the student​
Be careful of 'you are the only one who can  ____________ me'

41. Self Care: In handling student problems
Self Assessment​
"How full is my kettle."​
Am I overextending?​
How do I "fill my kettle" and/or de-stress​
Don't handle alone challenging students​
Seek consultation​
If frequently being overly stressed or overwhelmed with students' emotional needs, reflection is needed (personal and/or w/ a professional) 

42. Self Care: In my life, in general
Do I practice self care on a regular basis?
If not, why not?
Not needed
No time
Not deserved
Don't know how
Start with what you already do-just do it more, or longer
Add things that nurture, soothe, relax, "fill your kettle" 
Schedule it and be faithful to the schedule
Get a partner
AND IF YOU NEED JUSTIFICATION TO TAKE CARE OF YOURSELF...

43. Click to add text

44. Questions? Comments? Concerns?