1. Where we goin'? Outta here!!!!

2. Back to Class for Frequent Fliers Why, oh why, are you in the office again??? Sheila V. Rose, MS Psychologist Youth Health Services, Inc.

3. Where are they? You know who we are talking about – the students who are never where they are supposed to be. If someone comes to pick them up, no one can find them. So where are they? Legitimately, In the Secretary's office In the Principal's office In the Guidance Counselor's office In the School Nurse's office

4. Where are they? And often illegitimately, In the bathroom In the hall In the gym/library At their lockers In the band room/theater/auditorium In another teacher's room

5. And why do they say they are there? To get make up work To get a band-aid or medicine or cough drop..... To call mom about practice, field trip... To use the phone for some other reason To talk about a bully To ask a question – it's private To get a pad/tampon

6. And why do they say they are there? To get my book, homework, ruler, calculator..... To talk to _____ - it was important! To ask about After-School Tutoring. To change clothes To calm down – I don't want to hurt anybody.... To find out where to go after school I GOT KICKED OUT OF CLASS!!!!

7. But why are they really here???? Because they don't know how to be anywhere else! So many times, these kids are told to get back to class, and I better not see you in here again! But they have not been taught the skills they need to cope. So what are they trying to cope with – it can't be that bad, can it? Yes, it can....

8. But why are they really here???? Standard school issues that are tough for kids to deal with include, but are not limited to: Bullying Learning disabilities, diagnosed or not... perhaps due to frequent changes in schools that leave embarrassing knowledge gaps Sexual harassment Peer conflict

9. But why are they really here???? Substance abuse Dating violence Self-harm Issues related to family in the military Family problems Boredom (are the classes too long or not challenging enough? Undiagnosed gifted?)

10. But why are they really here???? And my two areas of interest: Mental illness Trauma drama Both of these areas can be caused by some of the former reasons for leaving the classroom, and both can be exacerbated by such normal school issues. Sometimes, it's impossible to know whether the school issues caused the mental illness/trauma, or if the mental illness/trauma caused the school issues!

11. Mental Illness What mental illnesses contribute to poor school performance? Many children have been diagnosed, and many more suffer but are not diagnosed, with mental illnesses. Children can be diagnosed with many of the same mental illnesses as adults, as well as some specific to children. Major categories include the following:

12. Mood and Anxiety Disorders Major depressive disorder/Dysthymia Bipolar disorder Generalized anxiety Separation anxiety Posttraumatic stress disorder Obsessive-compulsive disorder Social or specific phobias

13. Behavior Disorders and Other Common Childhood/Adolescence Diagnoses Attention-Deficit Hyperactivity Disorder Oppositional Defiant Disorder/Conduct Disorder Eating Disorders Substance Abuse Disorders Pervasive Developmental Disorders Tic Disorders Reactive Attachment Disorder

14. And, Childhood Trauma I call it TRAUMA DRAMA. It is what happens to kids who experience awful things, things you would never imagine. It has a huge impact on their psychological health, and is probably quite often responsible for the mental illnesses and behavior problems you see in school- children.

15. Childhood Trauma Sadly, children can be traumatized even before they are born. Studies have shown that being exposed to domestic violence in the womb can alter the development of neural pathways. And we all know what prenatal exposure to drugs, alcohol, and cigarettes can do to children. Many of your frequent fliers have been exposed to such prenatal trauma. And, many have also been exposed to trauma vicariously, through television or even through family stories passed down.

16. Childhood Trauma Examples of trauma include but are not limited to: Physical or sexual abuse Car wrecks/house fires Medical procedures Domestic violence Death of someone – either known or unknown to the child Deployment of parent Natural disaster – flood, tornado, hurricane.... Man-made disaster – bomb, shooting, war...

17. How do you get them back to class? So, you know who they are and why they are in the office. Now what? Get them back to class!!! Three steps: Calm them Problem solve Teach skills And be sure to document your interaction!

18. Calming techniques Relaxation techniques: Belly breathing, visualization. Cognitive grounding techniques: Name everything you see; count backwards by 3s. Sensory grounding techniques: Stand up and shake it out; splash water on your face; eat a mint or cinnamon candy; worry stone.

19. Problem Solving The STAR Method - Encourage students to be a STAR: Stop: When you first notice you are upset, BREATHE! Think: Whose problem is it? Mine or not?????? If mine, generate and evaluate possible solutions. Act Responsibly: Pick one that will most likely give positive results, and go for it! Then, look back and decide: Did it work?

20. Teach and/or review skills Teach the child several tools to use when the thought first comes into their head to leave the classroom: Impulse control skills Traffic light, Write it down, Big deal/little deal Calming skills Breathing, grounding as used earlier

21. Document the Visit Create a log-in sheet for all students to complete when they come to your office. It should include name, day, date, time, and the teacher's and student's best memory of what was happening in the classroom at the time. If possible, have the student complete it himself. Once completed, the log should be filed in that student's folder. *Note: A calming activity may be for a student to personalize and decorate a manila folder in which to file the log sheets.

22. Now What? If a student has a pattern of leaving the classroom repeatedly, then someone needs to step up and be responsible for finding out why! So, whose job is it? Ideally, the School Counselor's. However, many school counselors are overwhelmed by the extensive problems in students' lives today and the burden of administrative tasks they are required to carry out. So, Expanded School Mental Health has been created. The ESMH provider would be the next logical choice, if available.

23. Now What? A Student Assistance Team, the School Nurse, or an Administrator would also be appropriate choices. A SAT would definitely be necessary during the process of developing and implementing a plan to address the problem behavior. The classroom teacher is the one most likely to notice the pattern in elementary children who stay in one class. For middle/high school, the secretary is more likely to notice.

24. How do you keep them in class? Six steps Identify triggers Make a plan Pass it on Obtain the necessary tools Put it in action Assess effectiveness

25. Identify triggers What started it? Review your folder and log sheets to check for patterns of repeat visitors. Review with the student to point out the frequency of visits. Look for patterns!!!! May include leaving at a certain time of day, if a substitute teacher, if a certain student is present, if a test, if did not complete homework... Note: This step is crucial and may require help from mental health professionals, school counselors, etc.!

26. Make a plan Once you have identified a pattern, develop a system to cope with the triggering events. Find ways to prevent the triggers from occurring. Find ways to help the student cope with them when they do occur.

27. Make a plan - Prevention Examples of prevention steps: Moving a student away from a peer Not using certain words that trigger reactions Removing a certain picture or sound from the room Not wearing a certain perfume/cologne Changing the surface of the chair/desk Eliminating a certain color from the room

28. Make a Plan - Coping Develop a specialized plan to deal with triggers that cannot be removed. The teacher may need to remind the student to use them. Examples include: Allowing the student to put their head down after signaling the teacher that class is too loud. Have teacher calmly state You are safe when student appears frightened. Keep a list of cognitive coping and relaxation skills posted.

29. Pass it on Make sure that all parties involved get a copy of the coping plan: Parents Student All teachers, including those on duties where issues may come up Principal Secretary School counselor Nurse Bus driver Mental health professionals involved

30. Obtain the necessary tools Does the student's plan involve any materials that need to be made available? Examples include: Copies of the coping skills sheets and of plan Stress ball Headphones/music Silly putty or play-doh Sketch book or journal Mints/cinnamon candy

31. Put it in action Make sure everyone knows the date of implementation. A SAT meeting is ideal to assure all parties involved get the information they need to help the student succeed. However, make sure you do not leave out the first responders, such as secretaries and bus drivers. These personnel are a critical piece of the plan.

32. Assess effectiveness Monitor the effectiveness of the plan by tracking the number of times the student leaves the classroom. Check in with the staff, student, and family separately to see what each think about the plan. Is it too hard to implement, or are the coping skills not working?

33. Questions and Answers Feel free to contact me by email at: srose796@yahoo.com

34. Additional Resources National Child Traumatic Stress Network http://www.nctsn.org/ Positive Behavioral Interventions and Supports www.pbis.org Association for Positive Behavior Support www.apbs.org/

35. Additional Resources Center on the Social and Emotional Foundations for Early Learning http://csefel.vanderbilt.edu/ What Works Clearinghouse http://ies.ed.gov/ncee/wwc/ National Association for School Psychologists http://www.nasponline.org/