1. Modifying Risk and Protective Factors

2. What can I do as a school-based health provider? In the context of an established relationship with a child/adolescent and his/her family, health and other professionals can intervene to reduce risk factors and increase protective factors for the youth they serve.

3. Not all factors can be “modified” Not all risk or protective factors are directly modifiable. School-based health providers cannot change the fact that a child has a family history of a mental health disorder. However, even those factors that are not modifiable might be appropriate for related interventions.

4. Example If a child presents with a family history of a mental health problem it might be possible to: –provide affected family members with mental health treatment information –educate the child about his or her risk for having the mental health disorder –build child’s coping skills to deal with a family member’s mental health disorder

5. Intervention Strategies: Example – Student with Depression Augmenting Protective Factors: Community: Interventions were targeted toward... –1.... building social support School: Interventions were targeted toward. –4…. working with student in school-based education/ intervention program

6. Intervention Strategies: Example – Student with Depression Augmenting Protective Factors: Family: Interventions were targeted toward... –2.... strengthening ties between family members –3.... increasing parental support

7. Intervention Strategies: Example – Student with Depression Augmenting Protective Factors: Individual/Peer: Interventions were targeted toward... –5.... building internal locus of control –6.... education re: healthy diet/good health practices –7.... building a more positive self-appraisal –8.... increasing social self-efficacy

8. The Asset Framework Administer the Assets checklist with students during intake. Problem solve with them on areas that could be improved that are not presently in place. Pick two of these a week to enhance.

9. THINGS YOU CAN DO TO INCREASE ASSETS: Encourage student to participate in extracurricular activities Empower parents to be actively involved in child’s schooling, to set clear rules and consequences, and to monitor child’s whereabouts Increase student’s commitment to learning: encourage reading for pleasure, schedule homework, increase connection to school Train student in critical skills: Peaceful conflict resolution, Planning and decision making, Interpersonal competence, Resistance skills Act as a positive adult in student’s life and identify other positive adults to support student

10. The Power of Positive Adult Relationships The Ad Health study (Resnick et al. 1997) emphasizes that positive adult relationships powerfully shape the life trajectories of youth in a positive direction. Are you smiling at, encouraging, developing positive relationships with youth in the school?

11. Life Trajectories in Treatment Planning/Brief Intervention Draw a timeline with the beginning representing birth and the middle representing now (e.g., age 15). From the middle line to top right corner draw one line, and to bottom right corner draw another. Have students (individually or in groups present their “dream life” at top right, and worst it could be at bottom right).

12. Life Trajectories in Treatment Planning/Brief Intervention Have them present strategies to go to the top right (e.g., study, come to school on time, avoid negative peers) and strategies that will push them to the bottom right (e.g., skipping school, using drugs). Write these on the paper along the appropriate lines. Ask students to list risk/stress factors that push them toward bottom right, and protective factors that push them toward the top right. Write these on the paper.

13. Life Trajectory Best life could be/goal List protective factors Birth Age 15 List risk factors Worst life could be

14. Life Trajectories and Adolescent Mental Health Mark Weist, 12.04, csmha@psych.umaryland.edu School On time Pay attention Do work study Health Exercise Nutrition Sleep Athletics Positive Friends Faith/Churc h Having Goals Support from Positive Adults Thinking Skills Helping Others A thousand possible future lives depending on the daily choices you make Age 15Birth Age 25 Great wife, kids, job, house, car Jail, sickness, addiction, death Roaming the halls Not doing school work Alcohol and drug use Wrong friends Skipping school Being in the wrong places Exposure to violence Violent media

15. Role Play Pair up with a partner. Each will have the opportunity to be a student and a provider. Administer an assessment tool. Conduct a Life Trajectory Exercise.

16. School/community level… Focus group/Survey Analysis of school/community data

17. Focus group/Survey Stakeholders (e.g., students, family, teachers) should provide their perspectives on: 1) the most significant stressors encountered by youth in the community, 2) the most common emotional and behavioral problems presented by youth in the school, 3) the types, availability, and ease of access to social, health, mental health, and other programs (e.g., recreational), 4) how mental health services should be delivered in the school, and 5) other frequently accessed resources to support students

18. School/Community Data Socio-demographic data obtained from the school or school district can assist in identifying general stress and risk factors for students –Community: number of children in poverty, uninsured, on probation community crime statistics

19. School/Community Data - School: truancy rates percentage of students receiving free and reduced lunch percentage of English Language Learners percentage of mobility achievement scores grades staff turnover and satisfaction reports retention rates number of special education students and patterns of special education reviews

20. HOMEWORK: You are the focus group – Identify the most salient risk factors for youth in your schools/communities. What protective factors are in place to buffer students from these risks? What protective factors need to be implemented? What, if any, role does your SBHC have in reducing these risks?