1. ADDRESSING MENTAL HEALTH ISSUES: STRATEGIES FOR TEACHERS
Toni R. Tollerud, Ph.D. LCPC, NCC, NCSC, ACS PEL
Distinguished Teaching Professor Emerita
Northern Illinois University
VALEES In-service Day, March 1, 2019

2. Getting Started
How does your school address social/emotional learning?
What challenges have you faced as an educator with students experiencing mental health challenges?
Share your questions about supporting and addressing student emotional regulation needs?
How are these topics connected?

3. Mental Health Issues have been referred to as an Epidemic in our Schools!
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4. Why is this so important to Address?
Students are dealing with enormous pressures
The statistics are overwhelming
Mental health problems are common and prevelant
Many problems develop during childhood and adolescence
They are treatable
Early detection and intervention strategies work
Addressing them improves resilience and the ability to be successful in school and in life
Why is this so important to Address?

5. Statistics

6. More Statistics….These are OUR Kids….
The Department of Health and Human Services (2016) documented 12.8% of teens ages 12 to 17 experiencing at least one major depressive episode in the past year, and approximately 31.9% have had an anxiety disorder.
The 2016 report also indicated increasing levels of suicidal ideation and suicide attempts among adolescents.
Starting with the tragedy at Columbine High school, over 187,000 students have experienced gun violence during the school day (Cox & Rich, 2018).
Students will emotional and behavioral disorders have the worse graduation rate of all students with disabilities (40% compared to 76%).

7. Teachers Play an Important Role in Mental Health
Teachers observe students
Front line each day
Every classroom has some students struggling
Not enough counselors or mental health professionals
Students are unique
Teachers integrate social-emotional learning into class
Teacher attitude is critical in the student’s success
Teachers have a direct line to school counselors, social workers, psychologists and administrators to recommend a student in need

8. Multi-tiered Systems of Support
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9. Tier One School culture Expectations for all students
Social Emotional Learning integration in class (intentional)
Restorative Practice
Trauma-Informed Schools
Intentional connection
Identifying points of disconnection

10. Trauma-Informed The Problem
1. Many students have traumatic experiences
2. Trauma can impact learning, behavior and relationships at school
The Solution
3. Trauma-sensitive schools help students feel safe to learn
How we get there
4. Trauma sensitivity requires a whole- school effort
5. Helping traumatized children to learn should be the focus of educational reform
See

11. Restorative Practices
A positive school environment that is safe, welcoming, and inclusive is critical for student success
See Restorative practices in Education- Videos

12. Tier One-Social Emotional Literacy
Emotion regulation skills develop over the course of infancy and childhood and continue to mature during adolescence. These skills are critical to mental health, academic achievement, and good social relationships. Poor emotion regulation skill (called emotional dysregulation) is viewed as a core feature of emotional problems and maladjustment. Such dysregulation has been linked to problems like depression, substance abuse, cutting, poor performance and aggressive behavior, to name a few.
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13. What are the Core SE Competencies?
Recognizing one’s emotions and values as well as one’s strengths and limitations
Managing emotions and
behaviors to achieve
one’s goals
social &
emotional
learning
Self-awareness
Social awareness
Relationship
Skills
Responsible decision-making
Self-management
Making ethical, constructive
choices about personal and social behavior
When we are Self-awareness, we are able to recognize our emotions, describe our interests and values, and accurately assess our strengths and opportunities for growth. We have a well-grounded sense of self-confidence and hope for the future.
When we have good Self-Management skills, we are able to express and regulate our emotions effectively. We are better able to manage stress, control our anger and impulses and persevere in the face of setbacks. We can set and manage their goals.
Being Socially Awareness means we are able to take the perspective of and have empathy for others. We can appreciate individual and group differences and similarities. We are aware of resources that can help us meet our goals.
Relationship Skills include the abilities to establish and maintain positive, healthy and rewarding relationships. We can resist inappropriate peer pressure and constructively prevent, manage and resolve interpersonal conflict. When we have good relationship skills we know how and do seek help when needed.
Responsible Decision-making is the ability to make decisions based on ethical and safety considerations, appropriate social norms, respect for others, and the possible consequences of their choices.
Applied to learning, students who are self-aware and able to manage their emotions, can calm down, focus, and spend more concentrated time on learning tasks. Socially- aware students can recognize the impact of their behavior which is the basis for treating others with respect. When students have good decision-making skills, they know how to pause long enough to make appropriate choices before acting which leads to more positive behavioral norms.
Competencies are inter-connected; none stands alone
Audience will see later how Illinois’ SEL goals interface with these competencies
Forming positive relationships, working in teams, and dealing effectively with conflict
Showing understanding and empathy for others
Graphic: CASEL

14. Illinois Social and Emotional Learning Goals
Self- Awareness
Social Awareness
Responsible Decision-making
Self-Management
Relationship Skills
Goal 31: Develop self-awareness and self-management skills to achieve school and life success.
Goal 32: Use social awareness and interpersonal skills to establish and maintain positive relationships.
Goal 33: Demonstrate decision-making skills and responsible behaviors in personal, school and community contexts.
Big idea – We’ve been talking about SEL and have alluded to the SEL standards. The primary purpose of the professional development project is to help schools implement the SEL standards. At the same time, we know that implementing SEL as a framework for how we do school enhances the positive impact of aligning school practices with the standards, so we work with schools to develop SEL climates/cultures as well as focus specifically on the standards.
Point out the SEL competencies in blue to underscore the relationship between the state goals and the competencies outlined by CASEL. Can mention that among those on the committee who created the standards were representatives from ISBE, CASEL, the Partnership, ROEs.
Ten standards have been written to address these three goals. Then there are 100 benchmarks (10 for each of the 10 standards) that illustrate what these standards look like at different developmental levels: early elementary, late elementary, middle/jr. high, early high school, and late high school
More specifically there are more than 600 performance descriptors that delineate SEL skills that students should have at each grade level. Teachers use the performance descriptors to help design lesson plans; Parents can also use them to align what they are teaching at home with what is being taught at school. The descriptors can provide source of conversation between parent and teacher about how well as child is developing, socially and emotionally.
Graphic: University of Illinois Extension

15. Check in
What Tier 1 practices does your school have in place for behavior and/or social/emotional learning?
Restorative Practices?
Trauma-informed sensitivity?
Programs/Policies?
Mental Health Issues?

16. Students in the Schools
There is a stress and anxiety crisis in our schools. More than 25% report some unusual stress within a school year.
It is suggested that even kindergarten students experience higher levels of perfectionism and anxiousness but often lack the ability to share feelings.
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17. Adolescents and Anxiety
According to a 2015 study by the Child Mind Institute, 80% of kids with a diagnosable anxiety disorder and 60% with depression are not getting treatment.
Kids experience fear, nervousness, and shyness, start to avoid places and activities
NIMH estimates that 31.9% of adolescent have an anxiety disorder, higher for females than males

18. Increase of youth with anxiety but not able to handle it
Increased anxiety seems even more rampant in special groups: LGBTQ, women, immigrants, disabled
What’s out there?
experience feeling paralyzed by news
strong impact from social media
More suspicion toward outsiders
negative emotional climate
significant apathy
sense of hopelessness
results impact weight gain, relationship issues, family dysfunction, sleeplessness
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19. What is Stress?
Stress is defined as a process that exists over time. When it continues, it can often lead to a debilitating outcomes as it accumulates.
Stress affects all aspects of ones functioning
Stress is manifested in a person as ANXIETY when there is a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.
When a threat to their safety, their brains trigger a complex set of chemical and neurological events known as the “stress response”.
Stress generally causes a release of stress hormones in the body and can develop into serious issues from suicide ideation to isolation. IF left unaddressed in can morph into an anxiety disorder and follow a youth into adulthood.

20. How do you respond to students who come to you and are experiencing heightened ANXIETY?
Additional Suggestions:
Reassure youth
Emphasize safety
Encourage talk and questions
Let them know they can express their real feelings
Answer questions honestly
Avoid discussing worst case scenarios
Protect them from what they don’t need to know
Suggest they not watch so much TV or use social media
Help youth stick to their daily routine
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21. General Responses
Anxiety and Depression Association of America recommend that parents and caregivers do the following:
Pay attention to youth’s feelings
Stay calm when the youth is anxious
Recognize and praise small accomplishments
Don’t punish mistakes or lack of progress
Be flexible
Modify expectations
Anxiety is NOT a sign of poor parents but it often adds to family stress

22. How to Help in the school Context
Practice stress reduction strategies
Develop self-regulation skills
Make students stress smart
Increases mindfulness (see anxiety as helpful and not the enemy)
Learn and develop coping skills
Collaborate with students
Help identify students from internaling anxiety to bring it out
Provide a supportive environment
Involve teachers and other school staff in addressing anxiety
Address high anxiety times in the schools

23. Explicit and Implicit Memory
CORTEX:
higher level thought processes, planning, problem solving
HIPPOCAMPUS:
Explicit memory - governs recollection of facts, events or associations
Cortisol
AMYGDALA:
Implicit memory – No conscious awareness (procedural memory – e.g., riding a bike and emotional memory- e.g., fear)
Cortisol
Adrenal gland
Not only is the amygdala responsible for many of our emotions, it is also what allows us to interpret emotions in others by reading their facial expressions. According to a 2001 study, people with damage to the amygdala were not able to “read” the emotions of another person’s face. (Schmolk, H. & Squire, L., Neuropsychology, vol. 15(1), pp. 30 – 38).
The three parts of the brain that we are concerned with here are the cortex, hippocampus and the amygdala. The cortex is used in higher level cognitive functions like processing, planning and problem solving. The hippocampus is responsible for your explicit memory. That is the memory that you use to remember facts, events and make associations. The amygdala controls your implicit memory which is the memory that controls that which has no conscious awareness like riding a bike or driving home from work without thinking about it. The amygdala also is responsible for emotional memory like fear, happiness or distrust.
When an individual has chronic stress the amygdala get over stimulated resulting in the ongoing over productions of cortisol which floods the brain. The outcome is possible shrinkage or atrophy of the hippocampus and cortex. Even without the possible outcome of shrinkage or atrophy, those areas of the brain are not able to function well during the flooding of cortisol lessening a student’s abilities to read, compute, process information or control emotional responses.
Chronic stress = overstimulation of the Amygdala, resulting in the release of cortisol, possible shrinkage or atrophy of the Hippocampus and Cortex, affecting memory and cognition, and leading to anxiety or depression.
(Adapted from: Brunson, Lorang, & Baram, 2002)

24. The Impact of Extreme Trauma on Brain Development
1997, Bruce D. Perry, M.D., Ph.D.

25. Development of the Prefrontal Cortex
In the prefrontal cortex two major areas are being affected:
Myelination: Where the nerve fibers pick up a covering of myelin, a substance that insulates these nerve fibers so that the signals in the brain can be transmitted more effectively
Synaptic pruning: nerve growth is pruned back so that the remaining nerves are more capable of transmitting signals in the brain more effectively
Young Adult Development Project, 2008
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26. Understanding The Signs of Depression
Use this checklist to document behaviors/moods that you have observed for the past two weeks or more:
Sad, depressed or irritable mood Loss of interest in favorite activities Significant weight loss or gain Restlessness, agitation or anxiety Feelings of guilt Trouble concentrating or making decisions Frequent headaches and stomach-aches Cutting or other self-injury Extreme aggressiveness Inattention to appearance Excessive risk-taking behavior Drop in school performance Low tolerance for frustration Lack of motivation, apathy Disrespect Misbehavior Unable to store or retrieve information Forgotten materials/assignments Frequent absences, trips to school nurse Social withdrawal
Low Self Esteem
Fatigue or loss of energy, including sleeping in class
Repeated thoughts of death or suicide, expressed verbally or in writing

27. “Be aware of changes in behavior and ask if something is wrong.”
When asked what they want teachers to know about depression, students responded:
“Students perceive school to be very competitive and believe that this environment contributes or worsens depression. Be aware of the pressures students are under.”
“Despite the school size, it is easy to feel alone when you are depressed.”
“Students don’t always seek treatment at school, but that does not mean that they don’t get it outside of school. Some students want to keep this separate.”
“Be understanding about the difference between laziness and depression, especially in regard to homework. Depression can take a lot of a student’s time and energy.”
“Be aware of changes in behavior and ask if something is wrong.”
“Know the symptoms of depression, but understand that there is no one typical look.”

28. Self-Injury
Young people self-harm to deal with overwhelming feelings for which they may have no other effective coping strategies.
Educators of all types are in a unique position to help kids. Many students may not have all of their basic needs recognized and met within their home environments. Do not assume that parents or caregivers are noticing and taking care of your students’ needs.
ww.mindmatters.edu.au/spotlights/self-harm
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29. Self-Injury (NSSI-Non-suicidal Self-Injury)
Educators of all types are in a unique position to help. Many students may not have all of their basic needs recognized and met within their home environments. Do not assume that parents or caregivers are noticing and taking care of your students’ needs.
Don’t ignore it- trust your gut
Extend an attitude of calm and understanding
Be willing to be a link with a school counselor/nurse/social worker
Refer to the school nurse, counselor, psychologist or social worker-check policy
Schools should develop a specific policy for dealing with self-injury cases
Self injury should not be treated solely within the school environment
Involvement of parents
Limitation of confidentiality
Consultation or counseling from an outside professional
Collaboration between all people involved to assist in the ongoing needs of the student

30. Teachers and Self-Injury
Self-harm is mostly about coping
Self-harm is a risk factor for suicide
Know the warning signs
School staff play an important role
A whole school approach is key

31. Returning from Hospitalization
How could we prepare and encourage all the students in a classroom or school to welcome with sensitivity and empathy a peer returning from hospitalization?
Young people undoubtedly have questions when a classmate is mysteriously absent, and we need to have honest conversations with them about mental-health challenges.
We also need to respect each student's right to privacy while negotiating the occasional need for shared information among school, family, and medical personnel.
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32. Teachers and Hospitalization
Strategies for Schools and School Personnel:
Identify a point person
Conduct meetings using a mental health strengths-based approach
Note that the goal of hospitalization is to stabilize the child or adolescent, not “fix” her
Develop a crisis plan
Set a clear plan for addressing long-term absence and missed work, and allow for adjustments in classwork/homework upon return
Implement daily check-ins with the student
Provide regular feedback to all school personnel
Provide family and peer-to-peer support, if available

33. Handling Mental Health Issues
Connect with students….daily if possible
Create good relationships if possible, even with the difficult students
Create opportunities where students have a chance to talk
LISTEN
BE respectful of the student (disapprove of their behavior)
Remember that mental health IS more important than academic performance
Alter assignment and homework as needed
Connect and work closely with counselors and mental health professionals regarding student mental health needs and YOUR OWN
Handling Mental Health Issues

34. We Need to Talk… I notice. I care. How can I help?
“Is everything okay? I’ve noticed you have been….”
I care.
“I’m concerned because I know this isn’t normal for you.
How can I help?
“What can I do to help? Let's come up with a plan together.”
Ask questions and listen
Be prepared for the truth
Validate feelings
Listen to your gut
Take action and follow up
Let your student drive the ship

35. Classroom Accommodations
Expect a certain level of disorganization, forgetfulness or trouble concentrating.
Be flexible - balancing the enabling paradigm
Find the good - Build on strengths
Work to build good relationships with all your students, even the difficult ones
Exercise compassion
Validate and encourage

36. Build on Feelings
Learn how to recognize when anxiety is escalating and have a plan on what to do
Stress room—or allow breaks or time to destress
Acknowledge feelings as real
Classroom time out
Send student to counselor

37. Ask for Continuous Training
Request help from school administration for training on dealing with mental health in the classroom
Review your own personal values
Work collaboratively to be a part of the system of care in school
Practice being a trauma-informed school
Use restorative practices when possible
See guidance and help through school policies
Remember you are never alone…refer a student for help to the school mental health professionals

38. Summing It Up! Processing resources to address mental health
Curriculum and Classroom Ideas and Strategies I intend to takeaway!
Personal Goals I Can Set to Address Mental Health in my Classroom

39. References and Resources
Bray, B. (June, 2017). Living with Anxiety. Counseling Today, Vol. 59 #12,
Meyers, L., (September, 2017). High anxiety. Counseling Today, Vol 60, #3, pp
MaCormac, M. (September, 2016). Address student anxiety. ASCA Schoolcounselor ASCA. pp. 1-4.
Thompson, E. H., Robertson, P., Curtis, R., and Frick, M. H.. (January, 2013). Students with anxiety: Implications for professional school counselors. ASCA Professional School Counseling, ASCA, pp
nami.org/Find-Support/NAMI-Programs/NAMI-Ending-the-Silence
CASEL.org