KSOC-TV: Behavioral Health Concerns in Classrooms

KSOC-TV: Behavioral Health Concerns in Classrooms


Good afternoon, everyone, and welcome to KSOCTV, I’m Stephanie Dukes filling in for today’s host Gary Blau. We’re working to share timely, relevant techinal assistance on a whole host of issues, relating to mental health, needs of children, youth and families. Today we’ll focus on both the behavioral health challenges and opportunities found in elementary schools and classrooms, specifically grades k through 5. We know that educators play critical role in enhancing the mental health of the students they see every day and they also experience challenges related to behavioral health needs in the classroom. So we’ll talk about strategies for identifying and addressing mental health needs in the classroom. And ways to help students and their families find support and guidance. We’d like to especially welcome the teachers and educators joining us online. We hope you find useful tools and insights from our discussion. You can join our discussion by tweeting your questions to hash tag KSOCTV, clicking on the “Ask a Question” icon on the top of the screen. Or call 800-527-1401. Our conversation is just ahead, but first let’s take a big picture look at some issues surrounding the behavioral health of children k through five.>>Video: We’ll begin by learning some educational advantages to being “mindful”, evolved from a set of ancient meditation traditions, “mindfulness” is act of paying attention to the present moment with a nonjudgmental attitude. According to a recent article in the Atlantic Magazine efforts are underway to help improve students’ attention and ability to regulate emotions as many educators are introducing mindfulness or meditation into the classroom. It’s a practice that is says to have much in common with the social and emotional learning movement. The approach is growing in the U.S., where school administrators have launched more than a dozen programs, one of the largest, “mindful”, reports meditation helps students focus and helps lessen teacher stress and burn out. While initial qualitative results are promising, critics say further research is needed. And another promising school mental health approach, this time from Chile. A national school-based mental health program called Skills for Life has documented significant improve NMENT academics and behavioral health. In the study, 40,000 studentss were screened in the first grade. Four thousand were identified as “At risk” and they, their families and teachers were offered personalized interventions. By the third great, students who participated showed significantly greater improvement in academic and behavior skills than those who did not. The findings also provided evidence that nonfarm can logical intervention can be effective in school settings. Currently, skills for life reaches 25% of all elementary students in Chile. The program is expanding to include 400 additional schools there next year. Now, more on mental health in the classroom, a little closer to home. First, let’s keep some numbers in mind. One in five children has a diagnosable mental disorder. One in 10 has a serious enough problem to impair how they function at home, school or in the community. A study from the National Alliance on Mental Illness finds half of mental illness begin by age 14. And in any given year, only 20% of children with mental disorders are identified and receive mental health services. Left untreated childhood mental disorders lead to experiences with school failure, limited employ SXMENT poverty in adulthood. Classrooms are often where children show health problems and key place for identification. The child’s mind institute points out that in a typical classroom of 20, chances are good one or two students are dealing with serious stressors relating to poverty, domestic violence, abuse and neglect, trauma or psychiatric disorder. Their problems make it difficult for them to regulate behaviors and sometimes even recognize their own actions. This can make it challenging for teachers to manage a classroom. Surveys show coping with disruptive students is a teacher’s number one problem. One child with a disorder can derail an entire lesson. Today we’ll look at programs and strategies helping teachers and students manage classroom behavior, including a game that teaches children how to self monitor and self-regulate their behavior. Time now to get to our discussion.>>Stephanie Dukes: We have a lot of ground to cover this afternoon, so to help us do that, we welcome our guests, Dr. Kimberly Becker of the University of Maryland school of Medicine in Baltimore, Inglet, Chief of the Mental Health Promotion Branch at SAMHSA and Q&A a third grade teacher at dc public schools, welcome all of you, pleased to have you here today, it is an important discussion and we’re glad to have you here joining us to kind of flesh these things out and discuss the issues. Quay, we were discussing earlier today, there are a variety of experiences a teacher encounter when is he or she walks into the classroom. You teach elementary school, elementary schoolchildren are vibrant and creative, interest everything and interested in everything and have behavioral issues in terms of it is just DWMENTSal pressing boundaries, they are learning, what kind of things do you observe in the classroom related to this?>>Quay Dorsey: I think one of the biggest things that we are working on in our third grade classroom is atentativeness and the lack there of can cause other issues because we can get off track, I think. There is also a need to talk all the time. And there is also a need to just move and like not stay the traditional staying in your seats for an hour or at time or two hours at a time, doesn’t really work for third grade.>>Stephanie Dukes: Yeah, exactly. Those are things that I think are common among third graders across the country and I think sometime its might be a bit of a challenge for either teachers or parents to discern what developmentally appropriate or to be expected and then all it is different between that and what might be an issue. In terms of behavioral health challenges, I will ask Dr. Becker, Kim, and ingrid, what might indicate something is going on?>> I think this is a great question, quay, as a teacher really has great insight to share and teachers in general, you know, whenever they see one child with a classroom of students they can measure the child’s behavior against. Behavior that is developmentally inappropriate, things it you see a separation anxiety such as children don’t want to go to school that is typically normal in young children N. Quay’s third grade classroom that is considered inappropriate. Behaviors problematic across different settings. In one classroom setting we see the problematic behavior carries across multiple settings in other classrooms or home, as well. Behaviors that are causing some sort of problem, either for the child, the behavior is interfering with the work they need to get done or interfering for the class — with the teacher being able to conduct lessons or interfering being able to do the work they need to do, as well.>>Stephanie Dukes: And ingrid, what would you say are the root of the challenge areas in terms of behaviorior? Don’t>>Ingrid Donato: Sure. What we see early in elementary school, externalizing issues that come up. So like quay and Kim were mentioning, kids starting to exhibit symptoms of ADHD, Attention deficit or hyper activity disorder. Anxiety disorder, disorders starting early on in a child’s life at that time period. So what could be happening at that time, that kind of we should be thinking about that triggering what are causes that might be struggles at home, what are the risk factors. We have disruptives in the community, if there is a violent community, that is always a problem. Genetics plays in it, as well, is this something that is exhibited through the parent, something they struggled with when they were children? Connections with families, is there struggle with the family dynamics? Are they going through a divorce or a separation? Issues with drug use in the family? These are all things that are risk factors that can lead a child on the pathway of developing a mental illness, so as educators, as parents and as teachers, these are things you should be thinking about with children in general to see if they may be surfacing issues.>>Stephanie Dukes: Right, quay, I can imagine these types of things create challenges around classroom management and make it sometimes tough as a teacher. Can you talk about that perspective?>>Quay Dorsey: Yeah, as a teacher, think about what you signed up for, you signed up to teach, to create engaging lessons and engage with the curriculum to make sure they will be well prepared for life. I think one thing that is really important is that we consider that we have to consider in order for me to get to that point, to my point as a teacher, I have to also consider the entire child, they might be coming from a place where there is something else that is getting in the way of allowing them to fully receive first me and secondary my lesson.>>Stephanie Dukes: You said something interesting when we were preparing for the show. The issue of gaining relationships with students and how that piece plays a critical role in the management of the classroom. Can you talk more about that?>>Quay Dorsey: Sure, oftentimes we are tasked to teach and kind of just go off of that and protocol put in place, we have to have protocol, but for me and I think for a lot of effective educators, you know that you have to go beyond that point and get to know the student. The student for you as a teacher, that isn’t as important for them as you as a person.>>Stephanie Dukes: Uh-huh.>>Quay Dorsey: How do you receive them, how do you know them, how do they know you want to know them. You have to really build that relationship first in order to get into the meat of again, with your point is and that is to teach engaging lesson to prepare them for life.>>Stephanie Dukes: Absolutely. Things can support tools, resources that can support you doing that. We will talk about that more. We’ll start talking about that in terms of strategys and for positive classroom climate, really starting with an evident-based program called the PAX Good Behavior Game. Now in the short term, PAX games show 75% fewer disruptions, 60% fewer discipline referrals and 20 to 30% drops in identification for special education services. So what is the Good Behavior Game? Take a look at the story from Seattle Public Schools.>>Video: What do the fractions say?>> One of the greatest challenges teachers face is student behavior during instructional and transitional time. The PAX Good Behavior Game addresses this concern by providing teachers with an easy to use research based strategy that reduces disruptions and allows students to focus on learning. (music playing) Thank you, ladies and gentlemen, that signals our Good Behavior Game. I’m looking for super quiet hands in the air.>> First grade teacher Matt has been using the Good Behavior Game for six months and he play its with his students three times a day.>> What would a spleen look like if we were looking in the math book?>> Talking to your neighbors.>> Definitely a spleen.>> And to your friends.>> Saying shhh, to your friend. Quick game before PCP, so eight minutes on the clock.>> You start playing the game, you create PAX for your classroom and the PAX division is how you want your classroom to look, to feel and to sound.>> The students help decide what they wanted the atmosphere of their classroom to be. Unwanted behaviors are called spleens, while positive behaviors such as staying in your seat or raising your hand are called PAX behaviors. The classroom has been divided into three teams and the goal of each team is to behave in ways that will result in fewest number of spleens.>> Spleen table three.>> During the game, teachers continue with their regular classroom instruction, keeping an eye out for potential spleens. When teachers notice a student is being disruptive or off task, being distrusted, they will just mark a point against that team without identifying the student in a very nonemotional tone and they will continue to teach.>> Spleen table three. What do all these subtraction equations have in common?>> Mrs. Adrian?>> They all have 9s. They all have 9s, exactly right.>> Before playing the game, students were taught different PAX cues, which are nonverbal strategies like the quiet sign. PAX hands and PAX voices.>> Three-foot voice, please. Three foot is normal talking, 60 minus 9 equals? 7, thank you very much.>> Positive impacts of the Good Behavior Game are evident throughout the school day. For example, Matt can give short, verbal reminders that help students self-manage behavior during instruction.>> Go back, nice work, buddy.>> And transition time.>> Super responsible PAX hands, keeping them to themselves.>> The students have become more responsible, more respect SXFL more caring to each other since playing the Good Behavior Game.>> One tool that contributes to this good will is tootles notes, tootles are written compliments given to students or staff to acknowledge kind behavior.>> Give one tootles out to Mr. Garel, for being super responsible and doing his work the whole time.>> One concern expressed when we were introduced to the Good Behavior Game was that it would take time away from class time and decrease student time on task. But I think it is safe to say it has done the opposite.>> Something aim, I just learned how to put my eyes on it is teacher, on the board when he’s talking to us. A lot of stuff.>>Stephanie Dukes: So this is fascinating, harmonicas, spleens, tootles, a lot going on here. Long-term outcomes are impressive showing by age 21, PAX game students show 50% reduction in drug dependence, 68% less tobacco use and 35% less criminal activity. This is really important and Ingrid, back to you for a moment. Can you tell us about why the Good Behavior Game seems to work so well?>> I have to admit, I love the Good Behavior Game very much. We have invested in it, as well, one of a number of excellent evidence-based programs. As you mention, you implement this in early elementary grades, Kindergarten, first, up through 5th grade. In the short term, you have wonderful outcomes just in classroom management. You have children that respect one another, that the respect of teachers that are unhappy to come into the class and are open to learning. Then you have long-term outcomes that are amazing, as you mentioned, we have reduction in the development of depression, anxiety, of suicidalideiation, we have kids that are really prepared to be wonderful citizens as they move on. All by doing this wonderful program early on.>>Stephanie Dukes: How do teachers get involved in this resource?>>Ingrid Donato: Sure. This is a training they would go through. If you go to SAMHSA.gov, you will see the national registry of evidence-based programs and practices and there is an entry for the Good Behavior Game and you can learn all about it and there is links to go and find out more information. Teachers are trained, there is a coaching model, so someone comes into the school and helps the teachers in administering this while they are doing it. So it is a curriculum, teacher guess through, they have fidelity checklists, they make sure they are viewing the game with fidelity, adhering to this to get wonderful outcomes.>>Stephanie Dukes: Right. Right. Amazing program, we see it is rather effective and the program that touches all the students in the classroom, whether or not they may have been identified as having a specific behavioral challenge, Kim, over to you in terms of this question. When it comes to making those identifications and really looking at for educators, teachers and classroom, looking at perhaps the student or couple students are dealing with something more serious, how does a teacher educator know? What should #245I be looking for?>>Kimberly Becker: Sure, a couple things I mentioned earlier, in context of the classroom, is that child displaying behavior out of the range of what other children are displaying, problematic behavior across multiple classrooms and across home and school settings and things like that, is that behavior causing problems? So first taking a snapshot of that child in the context of the school environment is really important. But comparing notes across teachers is important, as well, and gathering information as parents, we want to engage parents in the discussion about child behavior to really understand is that behavior problematic?>>Stephanie Dukes: Sure. Quay, I know you have experience in this. We talked earlier about your experience with students coming from challenging circumstances. How do you handle that as a teacher? What has been effective in terms of tools you feel have been effective for you in dealing with things, you mentioned Susan and Kevin, what has been effective for you?>>Quay Dorsey: The relationship piece, the importance of getting to know that student. So I had a student who I didn’t know much about, if you don’t mind this example.>>Stephanie Dukes: Sure.>>Quay Dorsey: I didn’t know much about, I just assumed they were constant behavior problem, I didn’t get in, didn’t realize constant crisis happening in this child’s life and then about the seventh week of school, in passing by, finally got to talk to his guardian and found out of like boatload of issues that were — including homelessness and displace SXMENT things that he could not control and he was limited and I was quite frankly ignoring because I didn’t know about it, but I wasn’t doing anything to get to know about it, get to the issue. I think things I have been working for me, a relationship and things like having students reflect on what — on how the behavior affects the class. I have classroom called reflection corner and on it, there is thinking clouds posted on the wall above the chair where you sit. What they say are things like, how was my behavior today? What have I done? It doesn’t say what have I done good or bad, what have I done? How is that behavior affected class? Is there anything I can do differently to help affect the class in a different way or is what I’m doing okay?>>Stephanie Dukes: Uh-huh. Interesting. Interesting self-awareness piece on the part of the student and reminds me of the issue of mindfulness discussed in the piece we showed earlier and how that relates to a practice that benefits students and teachers and ingrid, I will ask you to respond to this question. It is a strategy related to the positive behavioral health intervention and support. And mindfulness from what we understands relates in that space, can you talk about that?>>Ingrid Donato: Sure. Positive behavioral intervention and support, PBIS is referred to as multi-tier behavioral systems. It is a work that school systems adapt and it is a whole school, whole school district on possibly strategy that they take to change the entire culture of this school. So you develop systems for monitoring what is going on in your school, what are the issues going on. You work with teachers and students to develop guidelines about what they feel are acceptable and good practices. They are all very positively focused and then you make sure that you have rules and guidelines that — and policies everyone adheres to. The students participate in this, so everyone has ownership and it is really as way to support the whole school environment to have just a more positive approach to addressing how they feel their school should be.>>Stephanie Dukes: Absolutely. Absolutesly. There is also dynamic that plays in this space, has to do with the issue of culture. And the different cultural experiences and context from which students are coming from and teachers are coming from, as well. Kim, I’ll ask you this, in terms, we’re talking about that, how does that play out in each of these in terms of identified child solutions and using them?>>Kimberly Becker: Sure. Needs to know when as a teacher, for example, you might need if you’re coming from a different culture than the students you’re teaching, might be to reach out to colleagues or the students themselves to understand the culture they are coming from and interpret the behavior in the context of the culture. So, for example, different cultures actually have different tolerances for kind of disruptive, active behavior. So if we put our own cultural constraints on behavior or lens on that behavior, might be misinterpreting the sis cans of that behavior within that culture.>>Stephanie Dukes: All right. Quay, you come from a school district there are schools and there are many students of color, even in that space, differences among those who are within a certain community, how do you encounter that playing out on your campus?>>Quay Dorsey: Yes, I think if I understand your question correctly, I think that when I think about students who are coming from a different sort of different cultural background, one student in particular, my student, his name is Joseph, he comes from a family that speaks mostly Spanish. And I speak all English, most of my students are English.>>Stephanie Dukes: Right.>>Quay Dorsey: In the very beginning, I remember asking myself, what — how am I going to connect with him. I had a mission of connect WG my studentss in order to keep the classroom moving. One way that has been effective for me, we do character education in my school and I’ve been teaching my students how to say different character words and character information in Spanish and in English as way to tackle that.>>Stephanie Dukes: Right. Absolutely.>>Quay Dorsey: That is one example.>>Stephanie Dukes: Yeah, and something students can get involved in, be in a relationship and for it to be active and interactive in terms of the students and how they relate to piers, which is just as personality as we know in terms of the experience at school. Want to talk a little bit more about issues related to if a child or more than one child in the classroom is experiencing or demonstrating a certain behavior, how does a teacher like quay know, okay, it’s time to seek, to get — make a connection with the parents and have a conversation about this particular behavior. Kim, what would you say there?>>Kimberly Becker: One way, consider if the behavior is a change in the child’s functioning. You might see children who are normally kind of energetic and participating in class and they become withdrawn or notice there are other changes in their socializing with or other behavioral pattern changes might be indicator something is going on and that could benefit from some intervention. Another thing is looking for behaviors that are interfering with their functioning, their ability to carry out the task, required of them, in school. So inability to do schoolwork, homework and difficulty functioning with peers.>>Stephanie Dukes: What kind of suggestions, ingrid, do you give teachers for taking the first step? That might be intimidating to go to a parent, there may be something going on here.>>Ingrid Donato: The first thing, going back to positive school climate, coming from a very positive approach. You know, parents probably know that there might be an issue going on. If it is a struggle that is causing different environments, there is probably stuff going on at school, as well. Probably know. Coming from a caring perspective, say I care about your child, I’m invested in him or her being the best student he or she could be and really engaging parents to say, I’m on your team, we’re in this together, it really helps break down the walls. Those parents are probably going to be really defensive, probably going to think, what did I do wrong, they are blaming me. Things that might be going through their mind. Engaging with them as allies is going to be the best first step that you could take. Really framing it with caring for their child.>>Stephanie Dukes: Quay, have you found yourself in that situation, you nodded your head when I said teachers might feel awkward.>>Quay Dorsey: I think family engagement, first, it is really important. Really important. It is hard to you don’t want it to ever come off you are making judgment about someone’s child and you especially don’t want to do that to their parents. And so it is hard, for me, I’ve always had to think about how do I most professionally and empathetically, convey what I have to say, I need to say exactly what I have to say, it needs to come out, right? Describe the behavior to the parent, however, it needs to be thoughtful and needs to go back to Kim’s point, am I considering how their culture might be different than to what I’m used to before I approach them. Maybe they are used to being so active and I want them to sit still and we have to figure out how to work together on that and make sure what I say comes across in that way.>>Stephanie Dukes: Absolutely. We are beginning to get questions from the audience, I want to go ahead and go to a question right now. This specifically relates to ADHD, and the diagnosis. We’re interested in what you have to say about that. The question, you mentioned ADHD being more common occurrence in students today. My question is: Are there signs to look out for in those students who have not yet been diagnosed? So that is the first part of the question, we’ll take that and then a follow-up question to that. Signs and symptoms and in child/student who may not necessarily have received diagnosis. Kim, do you want to start off on that?>>Kimberly Becker: Sure. Two major one problem focusing on schoolwork. Childrens have different levels for tolerance sitting down and doing schoolwork and that changes over time, as quay was mentioning, children younger might have more difficulty sitting still and as they get older, they are better able to sit, but the inattention, difficulty focusing, difficulty completing schoolwork, you might find when you talk to a child and even ask them what the instructions were for an assignment they are supposed to be working on, they have trouble repeating back the instruction, that might be another signal and way to test if they are focusing on what the teacher is say WHG giving instruction and certainly the level of hyperactivity, motor restlessness, you know, constantly moving around and fidgeting, touching things, touching other people, those are all good indicators that are really easily observed.>>Stephanie Dukes: Right. Next part of the question, interact WG parents or caregivers in the space, if you suspect based on what you have described there might be an issue with ADHD. What is the best approach if you have that concern to approach with the students and their parents to get them support, to find out exactly what is going on. And Ingrid.>>Ingrid Donato: I want to add more to symptoms Kim was out lining. When dealing with children, we saw in the opening segment, up to 50% of mental illness starts to show, diagnosed before age 14. These are things starting when children are young. There is a window of opportunity that we feel in prevention field where children are starting to exhibit symptoms before they reach full-blown diagnostic criteria. So keeping an eye on how they’re doing and trying to build those support early could change their trajectory. So how do we go about identifying that? What we’re trying to do, we hear the expression, we try to have everyone out there understanding the signs and symptoms. We really think we need to make more doors. So there is a number of things that you can do, first, we want to train up every adult who is interact WG kids to understand the signs and symptoms of when a child is experiencing an emotional crisis or they are struggleing and there are a number of curricula out there, one of the ones that we do a lot of funding of is called Youth MELTHal Health First Aid. This is curriculum where we train teachers, we train parents, we train police officers, people working in the lunch room, bus drivers to understand where, if a child is starting to experience crisis, so they understand it. Built into that training is how to refer a child or to work with a family to identify services that might be helpful. So there are steps and exertions throughout this curriculum that help a person who may be worried that a child is experiencing these symptoms to know what resources are available and to develop those competencys to start the referrals. Great first step is just understanding, basic understanding. We have everyone trained in first aid in CPR, and what is more penitentiary than behavioral health? Get people trained in understanding what it is.>>Stephanie Dukes: Absolutely. There are obviously services and sports and programs out TLA that can be helpful to teachers. Quay, I will ask you this. You’re still taking care of the academic needs of students in addition to everything else. The issue of fitting it all in, you know, what is your experience on that, being able to obviously fulfill your role as a teacher and seeing the children are learning and also seeing they are supported in mental health behavioral health space?>>Quay Dorsey: Absolutely. At our school, we’ve been intentional about it. Right? It can’t be, in my opinion, it cannot be just principle thing saying to a teacher, make sure you’re building character. It needs to be more of a — I’m a principle, I’m going to provide a program for you, so in our school, we use a program, PBIS system, but we also have a program that supports that called Second Step, a building prevention program. And that within that program we also built character with our students, right? I think that is way that we help intentionally use a program, a curriculum to help guide us through helping kids handle trauma, but also more importantly for me, at least, helping them be resillient and most, if not all situations.>>Stephanie Dukes: Looking for intersections where you have opportunities to do a couple things at once in order to really fulfill what you’re trying to fulfill and gaining relationships and teaching students. Kim, did you have thoughts on that, teachers have a lot going on, a lot they are trying to do.>> I want to bring it back to the PAX Good Behavior Game which provides touches on many things Quay is doing with Second Step. The PAX Good Behavior Game provides way for classroom management, but also teaching children self regulation. So in the context of the game, they are focusing on academic instruction or participation or whatever educational activity it might be and they are learning to really regulate emotions and behavior during a certain period of time there is prize afterward, they get to have a brain break, a nice break for them, but they come back to the academic instruction and it again gives them practice controling and regulating and bringing themselves back to the academic task at hand. The other thing that is really great about Good Behavior Game is that it provides really fun way for teachers to not only manage the classroom, teach self-regulation, but connect with students. You can see the children in the video were having a lot of fun, teachers love it and getting involved in those prizes helps the children observe their teachers really having fun and connecting with them in a way teachers don’t always have the opportunity to do in the classroom.>>Stephanie Dukes: Absolutely. We have actually another question from the audience related to the Good Behavior Game. That has to do with cost. The question is: How much do the approach SXOFT how do you get it funded, started?>> I don’t know off the top of my head how much it costs, but I do know — There is work being done to support schools in getting started?>> Absolutely. At SAMHSA, we were able to support 21 grants to school districts across the country to implement the Good Behavior Game. So funding went to the school district to help with that, to pay for the curriculum, to pay for the substitute teachers because you need to have them in place in order to train them and to have the coaches, as well. It is something we’re trying to build into bigger packages, one of the things we hear struggles from teachers a lot is I like this, but I don’t have the buy in with the superintendent or whomever to support this work. So we’re trying to figure out how we can provide funding to a larger state program to the school districts if they are investing in this kind of work, they can use funds to pay for them. Because we do believe they have a lot of value.>> All right. You anticipated my next question, SAMHSA is doing a lot around this type of service and support for teachers and educators, we talked about Good Behavior Game, mental health first aid, are there other SAMHSA funded resources that people can tap into?>> Sure. We have this has been kind of exciting and so glad that I’m part of this panel because when we’re realizing, what is SAMHSA’s mission? Improve behavioral HELT of our nation, right? How do we do that? We need to get in — start with kids, we know there is developmental connector, we have to work with kids and where are those kids locate SND they’re at schools. We’ve started over the past several years in funding schools, which is kind of new for SAMHSA. We usually give funds to behavioral health clinics or behavioral health authorities, we’re trying to, we’ve issued a series of funding opportunities to state education agencies, and required to partner with state behavioral health authorities to make them partner together. So we need guys to work together, we need behavioral health in school and so here is some money to help you do that. So there is funds that go to states, they go and pick pilot school districts within their state to work out these and funds go to them, as well, to help do that because it is hard work. It’s breaking down top long-standing silos, but it’s essential, so we have funding opportunities that go to school districts and to behavioral health organizations, widespread training of MELTHal health first aid F. They look on SAMHSA.gov grants, look at the state and see where those grantees are and reach out to them as they are out there to try to do this work.>>Stephanie Dukes: Absolutely. Absolutely. We’ve got a lot of questions coming in, we’ll try to get through as many as possible. Just really speaks to the need out there for these kind of services and support for teachers and communities. Question for you, Dr. Becker. What about using internal or co-located mental health staff in the school or linking with outside agencies to push mental health services in support of schools and in teachers? What kind of work –>>Kimberly Becker: I love that idea, I’m at the University of Maryland, we put mental health clinicians in the schools and that is exactly how we leverage the resources and we work with school psychologist and social workers, as well, where they can not only provide the indicated intervention, that is for kids that are showing problems, but helping teachers use different classroom based prevention programs, as well. We just completed work, we did train school clinicians to be coaches for the PAX Good Behavior Game and support teachers in elementary schools.>>Stephanie Dukes: And the programs and support is often the first point of access that families might have with this kind of service, I would think that would make it particularly critical.>>Kimberly Becker: Yes, 20% of kids receive mental health services and 70% of those receive services in the school. This kind of work is really interval.>>Stephanie Dukes: Absolutely. Another question for Quay, and IngrOOISHGS d, what can be done if the child faces risk factors you know outside in the community risk factors, stress, violence, life difficulties, maybe bullying in the classroom, even if self-awareness in preventing positive attitude are taught in school, but not being reinforced at home or in the community, what kind of strategies or solutions have you discovered can be effective that once the child leaves the classroom, leaves campus, goes back to the same situation, can be supportive of them?>>Ingrid Donato: Want me to start? All right. I didn’t tell you what grant programs I was talking about in my last response. So these are our project aware grant programs and our safe schools healthy grant programs. Make sure they go and look, they can reference those on SAMHSA.gov/grants. So how do we go about and I’m getting back to the question here.>>Stephanie Dukes: Really reinforcing, you have all of these positive behavioral strategies of good things going on in Quay’s classroom. You have a student who is benefiting from that, but has to go out and deal with home, deal with the community and have all the stressors in place.>> I talked earlier about the risk factors and you were just mentioning some of them. But one of the most profound protective factors are people like quay, that one adult who has that connection will a child, it is so profound, that is why when you’re dealing with, you have a child, they are living in, you might have chaotic family situation, they are living in a chaotic community, they go and you hope like Quay is doing, developing a school that is supportive, it is nurturing nest for them, that is protective factor that will help buffer that child and protect that. So you mentioned going and that is a big issue that we’re having, too. So how do we, we can do a lot of work about building bully-free environments in the school system, what do you do when you are seeing this in the school, in the home environment and that is tough nut that we’re trying to crack now is to develop those tools that are easily adaptable and uptick is easy for parents to learn about how do we model good behavior with our children at home. So we’ve actually developed an app, no bullying know-bullying, free app parents download to give them all sorts of tips about how to address bullying, how to understand the signs and symptoms maybe if a child is experiencing it, what do you do if your child may be exhibiting bullying behavior and walks parents through steps how to intervene.>>Stephanie Dukes: Absolutely. Quay, I’m interested in your thoughts on this.>>Quay Dorsey: Sure.>>Stephanie Dukes: You talked about resilience earlier, we have tools, when the child leaves the classroom and campus.>>Quay Dorsey: Sure thing, you make a good point, there really isn’t something concrete that is so concrete, there are some resources, but one thing that I find very useful is to teach kids a, self-awareness piece, but also teach them self-accountability, right? Teaching them self-accountability isn’t something you do inside of school behavior, it is life behavior. I think for me, because we don’t have these programs that Ingrid said are necessary, I continue to teach my kids, what I am helping you do is be a better person. If you are going to be a person outside this classroom, guess what, these are the same behaviors you have to exhibit. And I think as we continue to grow, there is one of an older teacher told this to me and I didn’t quite agree with it, but she said, a lot of our job is unteaching and then teaching. And I don’t necessarily agree with that, that is not considering the culture of where our kids are coming from, but I do agree with the idea we need to teach them to teach them behavior may not be modeled outside of the classroom, but still teach them they are behaviors that are desirable and they are behaviors that show good citizenship and good person — What I’m hearing, there is a real issue of empowerment and allowing and giving students the tools to empower themselves to emulate what Quay is talking about. What are your thoughts on that?>> I think that is a great strategy. That is what we want to do when doing economic instruction, we’re teaching children to reflect on the process of learning and to really think critically, you know, with regard to their academics and that is what we want them to do with regard to emotional and behavioral health, as well, helping them reflect and take ownership for behavior and relationships and their ability to be good citizens OUZ of the classroom.>>Stephanie Dukes: Let’s shift gears a little bit and talk about, you teach elementary school third grade, quay, seven, eight years old, in that space. Let’s shift and talk about younger children. You know, early childhood and a question that has come in for you specifically, Kim, what are the most frequent types of mental illnesses, behavior health challenges that maybe a Kindergarten or preschool teacher might encounter with a student in the classroom?>> That’s a great question. What we see are a lot of behaviors like tantrums when children aren’t getting their way or feeling frustrateed with academics or social situations, children at that age have a hard time navigating social situations so there is a lot of conflict. I would say tantrums we see a lot. The noncompliance and noncompliance is really important risk factor actually for later behavior, noncompliance is considered as behavior that starts kids on kind of early trajectory toward problems with peers and also academic problems in their academics and also it sets them on trajectory toward more problematic conduct problems such as aggression and even more serious behavior.>> By the time they reach quay’s classroom, age eight, if not addressed on early childhood level can be a real challenge, a problem. Can you talk a little bit about and this is a question for each of you, is the approach in dealing with very young children, different in terms of addressing whatever challenges or situations these young children will find themselves in? They are not verbal or verbal in the same way, rather, as third grader might be. How would a teacher approach it differently with a younger child?>> That is a great question. With a younger child, we’re thinking how to structure the environment to change the contingency for the behavior. For example, the contingency or the consequences that happen after the behavior or also the things that come before the behavior. In a tantrum situation, for example, we might help a teacher or a caregiver not give in to those types of behaviors and typically what we see, which children don’t get their way after the tantrum, the tantrum strategies are used less frequently over time. It is about structuring consequences, giving more attention for appropriate behavior and less attention for inappropriate behavior. You’re RIERT, we would talk, engage the child less in a discussion about the behavior and you know less reflection from a Kindergarten or pre-kind KINTD about behavior and focus on environmental contingency.>>Stephanie Dukes: Ingrid, did you have thoughts on that?>>Ingrid Donato: I did, I wanted to share an exciting initiative SAMHSA is just kicking off with our friends at ACF, and HRSAn is looking at emerging field of infant and early childhood mental health consultation, looking at bringing mental health professionals into early childhood setting so into Head Start, daycare settings, working with pediatricians to have a behavioral health lens infusing them so they understand the appropriate ways of intervening with children, doing the developmental screenings that might be necessary, understanding how to do those interventions that they are doing. If you have a child tantruming, what is going on that we can be teaching them to help them with mental health focus on addressing that. So we just launched our Center of Excellence for infant and early childhood mental health consultation, you’ll be hearing more about this. You can go to SAMHSA.gov, learn more about it, but really trying to build that — the adults working around them and make them as informed as possible about what might be going on in a child in that early developmental stage. Your childhood period, the brains are developing, is so critical making sure that we are really understanding what is going on makes such a tremendous difference.>>Stephanie Dukes: Absolutely. Absolutely. Let’s shift back a little bit. Interesting question relates to in-school mental health services. This is a little different in terms of the way or the context in which the question has come up. It says, how can teachers and their administrative partners or how can they partner with in-school mental health services without teachers believing that it is a way out of class, for students? It sounds like this perspective is coming from a place where maybe a teacher has had some questions about, okay, is this something that is really critical or is this something that maybe the student is trying to get out of class or not in class during that time for another reason? So like I said, interesting question, interesting perspective, quay, do you find that this is a challenge, either for your peers or yourself?>>Quay Dorsey: Yes. So — yeah, I think that is a challenge. I think oftentimes because our social workers and our mental health professionals in the school building, their job is to make sure that when a student comes to them, they get them to a place where they are calm. Their job is to deescalate. Their job, so, oftentimes for that student who was in trauma in class, that trauma could simply be, they couldn’t — didn’t know how to sit still, they don’t want to do the work, they can’t focus, probably something else going on with them. But what they think is the last time I had this issue, I went to the social worker and it was a fun place to be. So if I can get out of this work by going to that fun place, I can get out of work. I think two things can happen there, I think a, the teachers need to figure out how to make their classroom more of a fun place so kids stay in, right? And by some kids feeling more comfortable and stable and that teacher attend to them and on the other hand of that is how can these mental health professionals and schools really truly partner with teachers to share strategies, to say, here is what I’m doing when I pull student X out, I am working with him or her on this, that really gets them excited. If you take two minutes out of your day and do that, you might get a different response. Or if I practice this strategy, I think because there is a high level of at the school in which I teach and we have been intentional by making sure the social worker helping teacher think about the teacher is not necessarily trained from a perspective deescalate trauma. Some teachers go to special training, that is not something required to become a third grade teacher, perhaps.>>Stephanie Dukes: You reflected question that came up as follow-up, the issue of the relationship building between teachers, educators and social workers who might be in the school, other mental health or mental health professionals who may be in the schoolworking with the student, I’ll put this question to you, Ingrid, you can, as well, strategies for building bridges and creating relationships that Quay just spoke of.>> I think one thing is getting simply getting to know each other, we enKOUSHLG our school clinicians to sit in and teach classrooms, get to know them, there is period of time before school actually starts where clinicians go into the classroom and help the teachers prepare classrooms and things like that. During that time, they have time to talk about mutual topics, about vacation or what you like to do, it is basic relationship building. The education point that Quay brought up is important, as well, when school and health provider consist do professional development workshop and help teachers understand what it is they are doing when they are meeting with parents, that can build a big bridge, teachers understand the relevance of that to their own work in the classroom. The other thing I would add to what Quay was mentioning, school clinicians are well aware, they are sometimes the preferred setting for students. But you know, what really effective school clinicians do, they do meet with children in their own offices, but they bring the children back quickly and help them practice the coping strategies in the classroom.>>Stephanie Dukes: Ingrid, our time is — I want to get your thoughts –>>Ingrid Donato: The key to any successful partnership, you need to have trust, you need to have share ownership and have shared vision. So really pulling back and if you want to have improved school climate, you all have to be partnering together to work together and really even goes beyond the school setting because a child doesn’t just live in school. So making sure parents are actively involved in setting this overall vision is imperative and all of those other folks that also are invested stakeholders in the well being of children.>>Stephanie Dukes: Absolutely. One overarching question I want to put to each of you and ask each of you to answer is the investment and the importance of this investment to take the time and to take the resources and the creativity and the energy that is takes to really read this into what happens in the classroom, the strategies, ideas, attitudes, activities, I’ll start with you, Kim. Why is it worth the invest SNMENT what is so important?>>Kimberly Becker: The investment cannot be you shouldstated in terms of the benefits. There is large body of literature and prevention science showing how effective preventative intervention can be and most of those preventative interventions have been tested in classroom or school settings. It’s huge. It is certainly worth investing in prevention and school mental health resources or interventions, as well, because of the fact that is the best place to catch students.>>Stephanie Dukes: Absolutely. Ingrid.>>Ingrid Donato: I agree, we appreciate the struggle that schools and teachers are going through when you have budgets that are shrinking, you have so many different things you have to — priorities going on, all of these testing and trying to help to build on reports returns on investment that really tie it to dollars, they can be submitting to school board and people giving them their budget and really if you make that investment now, it pays so many amazing dividends in the long-term, I am hopeful we’re at the tipping point where people will understand that, but we’re trying to do that ourselves by trying to build the argument for importance of really addressing mental health in schools.>>Stephanie Dukes: How have you seen, Quay, the investments veer out in your experience?>>Quay Dorsey: I mentioned this to you all earlier, when I first started teaching at my school, the literacy rate was alarming and that in itself when I think about what hasn’t been able to happen in classrooms for time period and then you think about what is affecting the lack of — it is not just bad teachers coming in, there has to be something else, no way for years there has been that many bad teachers where literacy rate is so low. Instead, you think what hasn’t been happening and you think about, well, what about second step program, this is the first year since I’ve been here, haven’t been here that long, first year we’ve used Second Step, way to know now the investment is worth it because I’m seeing kids focus more and kid consist focus more will pick up strategies quicker, kids who pick up strategies quicker become better readers, kids who are better readers go to college. You start thinking about how communities around the country start to change when we as teachers we decide to focus on character, as well as academic piece.>> Absolutely.>>Stephanie Dukes: Thank you. Thank each of you so much, a wonderful conversation, we’ve ran out of time. Plenty of things we could talk about in addition, hopefully we can do that again later to continue this conversation. Thank you again, we appreciate you being here, we want to thank everyone participating today, not only the guests but all of you watching at home. Thanks for the comments, questions, you heard us talk about resources and services and support help to feel teachers, for a list of resources and to find out more about behavioral health in the classroom, go to SAMHSA.gov/children/multimedia. And be sure to join us after the new year when we kickoff the Season 3 of KSOCTV, we look forward to seeing you and thanks for watching.

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