“GO TO” Core Trainers Toolkit Supporting Mental Health Literacy Edmonton Public Schools

This toolkit provides resources, tools and information for District trainers.

October 2016

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Table of Contents

ACKNOWLEDGEMENTS ..................................................................................................................................... 3

DISTRICT TRAINERS .......................................................................................................................................... 4

PREPARING TO PRESENT THE GO-TO EDUCATOR WORKSHOP ........................................................................... 5

PART 1 - INTRODUCING THE GO-TO EDUCATOR WORKSHOP ............................................................................ 6

PART 2 – ADDRESSING SEMANTIC CONFUSION ................................................................................................. 8

PART 3 – CHILD & ADOLESCENT MENTAL DISORDERS: .................................................................................... 10

PART 4 – STIGMA ............................................................................................................................................ 14

PART 5 – HOW CAN I TELL? IS IT A MENTAL DISORDER? (SLIDE 28) .................................................................. 15

PART 6 – BRAIN FUNCTIONING AND MENTAL DISORDERS ............................................................................... 17

PART 7 – MENTAL DISORDERS OF COGNITION AND PERCEPTION .................................................................... 20

PART 8 - MENTAL DISORDERS OF EMOTION AND FEELING .............................................................................. 23

PART 9 – MENTAL DISORDERS OF SIGNALING ................................................................................................. 28

PART 10 – MENTAL DISORDERS: PHYSICAL ...................................................................................................... 34

PART 11 – MENTAL DISORDERS OF BEHAVIOUR .............................................................................................. 34

SUBSTANCE DEPENDENCE AND ABUSE ........................................................................................................... 36

PERSISTANT SELF-HARM ................................................................................................................................. 36

PART 12 - HELPING – GET WELL, STAY WELL, KEEP WELL ................................................................................. 36

CLOSING THE TRAINING SESSION .................................................................................................................... 39

APPENDIX I – DR. STAN KUTCHER: BIO ............................................................................................................ 40

APPENDIX II – PARTICIPANT SURVEYS ............................................................................................................. 41

APPENDIX III – DISTRICT GUIDE: LOG ENTRIES FOR COUNSELLING MOMENTS ................................................. 51

APPENDIX IV- EVALUATION FORMS ................................................................................................................ 52

APPENDIX V – INCLUSIVE LEARNING AND EDMONTON ZONE SUPPORTS ........................................................ 60

APPENDIX VI – BACKGROUND INFORMATION: ANXIETY ................................................................................. 66

APPENDIX VII – BACKGROUND INFORMATION: ADHD .................................................................................... 72

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ACKNOWLEDGEMENTS“GO TO” Educators Identification of Mental Disorders in the Secondary School Setting©

Developed By: Dr. Stan Kutcher, MD, FRCPC, FCAHSSun Life Financial Chair in Adolescent Mental Health & Director, WHO Collaborating Centre, Dalhousie University and the IWK Health Centre. Dr. Stan Kutcher has edited and approved this document for instructors (October 2016).See Appendix I – for Dr. Stan Kutcher’s bio.

COPYRIGHTThe GO-TO Educator material is under copyright. This material cannot be altered, modified or sold. Teens, parents, educators and health providers are welcome to use this material for their own purposes (information, teaching or health provision). Permission for use in whole or part for any other purpose must be obtained in writing from: Dr. Stan Kutcher (skutcher@dal.ca).

KEY CONTACTSProvincial SupportsAndrew BaxterProject Coordinator for Mental Health Literacy & Mental Health Therapist, School Based Mental HealthAlberta Health Services

Divinea Miller, 403 297 3216Mental Health Literacy Project AssistantSchool-based Mental HealthCambrian Heights School, 640 Northmount Drive NWCalgary, AB T2K 3J5

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PREPARING to PRESENT the GO-TO EDUCATOR WORKSHOP1. Call ahead to the site where you are presenting and make sure they have presentation technology you are

familiar with.2. Back up your presentation. For example, the presentation can be accessed through the Google Plus

Instructor Community and then kept on a USB stick or a laptop desktop.3. Supplies for presenting (contact CSH unit if you need access to supplies):

2 blank pieces of paper for each participant for Activity 1 Pens/pencils for each participant Nametags Sticky notes Pre-and post-evaluation surveys Instructor mobile kits*

4. Make sure that your YouTube settings ARE NOT in safe mode so that your videos play. You may want to use a converter to download this video and put on your desktop or embed into powerpoint.

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PART 1 - INTRODUCING the GO-TO EDUCATOR WORKSHOPBefore You Start:Do the pre-survey (found in Appendix II). Collect all surveys.

Presentation Slides – Instructor background informationPlease note: Not all slides are included in this toolkit. Click here to go to the most up to date GO-TO workshop powerpoint presentation. (https://drive.google.com/file/d/0B4nyTj0zxm1xTnR0U2pydkNsVXc/view?usp=sharing)

Key messaging to share in the introduction:

Purpose of this training (presentation slide 4)

Provide a knowledge update for participants and build on what they know.

Address questions about applying the “GO-TO” training at individual school sites.

Evaluation of the training sessions.

Who are “Go-To” Educators? What do they do? (slides 5 and 6) Educators whom students naturally go to for help

in the school setting. May be subject teachers, teacher-counsellors,

school psychologists, social workers, health nurses, administration staff, or other school support staff identified by school administrators.

Note: Remind participants that anyone that works with children can take the GO-TO training. It was initially designed with junior high school (JHS) and high school (HS) staff in mind but elementary staff can benefit from the information.

Highlight: That compared to clinicians and doctors, educators have valuable contextual information. They get to see students across multiple settings and demands (i.e. math vs PE classes) and, unlike parents have a large “sample size” of students to compare any individual to.

Participants should not diagnose following this training! (slide 7)

In Canada, communicating a diagnosis is a “controlled act” under the Regulated Health Professions Act (or local equivalent).

Only psychologists, psychological associates or clinical social workers and physicians can diagnose mental disorders.

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PART 1 continued…What to Do: Addressing mental health concerns (slide 8) Describe what you see! (encourage staff to

record and pay attention; watchful waiting) Example: “John is having difficulties paying attention and staying seated in class.” Refrain from saying things like: “John has ADHD”.

Note: Participants should be instructed to refrain from using diagnostic labels and focus on recording descriptions with as much detail as possible. Remain as objective as possible. (Refer to Appendix III – District Document: Log Entries for Counselling Moments) important to share this info with school staff.

An Integrated Pathway to Care Model for Secondary Schools (slide 9)

This slide shows how schools sit in larger communities. Each school is unique and can influence its population as well as its surrounding community. The Go-To training is “gatekeeper” training. Schools and Go-To educators play an essential role in helping identify students who may be at the risk of having a mental disorder and linking them with appropriate services within or outside of schools, and support them back to school in a seamless approach.

Note: This may be a good time to question staff to see if they know where to go when student/colleagues are in need of intervention (Refer to Appendix IV– District Mental Health Inclusive Learning Services).

Reference: The upcoming Mental Health curriculum professional learning opportunities in Winter 2017. The Go-To training will support effective implementation of the curriculum and support students that reach out following the teaching and learning at their school sites.

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Semantic Confusion (slide 10)

All the words on slide 10 have been pulled out of academic literature and government document to describe mental disorders. This slide demonstrates how much confusion there is around the topic of mental health and mental disorders.

By calling mental health anything else – we perpetuate stigma.PART 2 – ADDRESSING SEMANTIC CONFUSIONWhat Do These Words Mean? (slide 11)

Highlight the importance of this slide. The terms on this slide represent a comprehensive understanding of what the different components of mental health are.

Everyone in the population fits on the pyramid. The bulk of individuals are at the bottom and fewer are towards the top.

An individual CAN exist in all of the mental states (listed below) at the SAME time. Most importantly, mental health IS NOT a continuum. We all experience mental distress but not all of us end

up developing a mental disorder. Worldwide, 15-20 % of the population will have mental illness. Youth with mental disorders/illnesses need rapid access to trained professionals for proper diagnosis and proven effective treatments.

Go over the definition of each term:

1. Mental distress is everywhere and unavoidable. It isnecessary and life-skills promoting. It builds resilience!Example to share: “I backed my car into a concrete pole. It caused me to experience mental distress.”Point out: Mental distress is a signal from our brain that we need to adapt to our environment, that there is a problem that we have to solve. When we solve the problem the distress goes away, and we are left with a new skill that we can use to help us solve future problems. Mental distress is necessary for growth and development. We ALL have the ability to mitigate and this is how we learn to problem solve and develop.

2. Mental health problems – Also arise in response to anenvironmental stressor, but one of significantly greater magnitude, such as loss of a loved one, loss of a job, immigration, etc. When faced with such a large stressor our capacity to mitigate it may be overwhelmed for a time. This doesn’t mean there is an illness. On the contrary, what we are experiencing is an expected response to a significant stressor. Mental problems are an indicator that we are having difficulties adapting to the environment and may need external help (e.g. counselling, additional family and/or community support). .

A good example is grief which is: a normal response to a significant change in a person’s environment.

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PART 2 continued…3. Mental Illness - Occurs when there is perturbation (disruption) in usual brain functions. These occur as a

result of a complex interplay between genetic and environmental factors beginning from the time of conception and continuing across the lifespan.

It is essential to note that people can have good mental health and a mental illness at the same time! Indeed, people can be in all categories at the same time. An example is when a person has ADHD (a mental disorder), they can grieve the loss of their dog (a mental problem) and they have to complete a homework assignment that is overdue (mental distress).

Alternate example: Or people can have Depression and good mental health at the same time if Depression is appropriately treated and managed.

Clarity is Essential! (slide 12)

Depression is used as an example to express the importance of clarity when using terms related to diagnosed illnesses.

Using the right language for each of these states is essential. Remember that you don’t have to move through the states in any order.

They are not a continuum they are places to exist.

Mental Health State & Type of Action Required (slide 13)

How to explain health promotion and school-based mental health teaching and learning:

System responses at each of these mental health categories are different!

We can help build resilience and teach how most stress is positive and problem solving skills that support the lower levels of the pyramid (through health promotion).

We can implement preventative measures to ensure a mental health problem doesn’t escalate into a disorder (unhealthy environments and relationships CAN escalate disorders).

Mental disorder/illness requires informed school staff to make quality referrals in order to effectively support students in receiving effective interventions (accessing ILS supports).

IMPORTANT TO NOTE: This slide has been updated by the CSH unit to correlate with previous slides.

(This slide is reversed from the original

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image)

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PART 3 – CHILD & ADOLESCENT MENTAL DISORDERS: HOW COMMON are THEY?(slide 14)

Direct participant attention towards the 20% (highlighted in pink at the bottom of the table). That is the number of children between 12-18 who would qualify for any diagnosis at any time. The rest of the numbers demonstrate the proportion of disorders. Notice what isn’t listed: psychosis, eating disorders, personality disorders. This is because they are so rare in occurrence.Trouble shooting response: Note that the black numbers DO NOT add up. This is because of co-morbidity (i.e. the simultaneous presence of two chronic diseases in a patient).

Cross-national comparisons of the onset of psychiatric disorders (slide 15)

These graphs show people that are diagnosed over their lifetime with various disorders. This shows the age of onset. Note when we 'identify' 50% of those that will be diagnosed (anxiety is around age 5, depression around 12, and substance abuse around 13): this "S" curve or "jump" starts at different ages, typically during adolescent years. The age of onset mental illness is similar across the world and about 70 % of all mental disorders can be diagnosed prior to age 25 years.

Age of Onset of MAJOR Mental Disorders

(slide 16)

Adolescence is a period during which many mental disorders, such as schizophrenia, bipolar disorder, depression and anxiety disorders appear. State that 70% of all the disorders have an onset window between 12-25. Note: This slide shows similar information as slide 15 (age of onset), presented in a different way.

This age range is a critical period of brain development. This is why the Mental Health Literacy curriculum (coming Winter 2017) is targeted at Grade 9 and 10 students, at the early part of this period onset.

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PART 3 continued…Number of Suicides by Age Group in Canada, 2007-2011 (slide 17)

This slide shows over the years the prevalence of suicide by age groups is relatively consistent. In fact, if we put more years on the slide the same line would repeat from 1950 (when data collection was started) till present

Engage participant discussion: What do they notice about this slide and what is their theory as to what these numbers represent?

Allow for time to discuss. Instructor response: Connect to slide 14 that shows that suicide rates during adolescence correlates with the onset of mental illness.

Canada Suicide Rates Per 100,000 (1950-2009) (slide 18)

Note that the suicide rate has fallen during the ten year period between 1995 and 2005.

Question the participants: What is their perception/ messaging that they are getting from the media?Allow time to discuss. Instructor response: It is good to say that we have never been able to predict where this line goes. There are too many confounding variables to state what causes the fluctuations. Simplistic answers such as the economy or social funding or bullying does not address the complex dynamics of suicide.

Participants may ask why the rate seems to be increasing since 2005. ANSWER: We do not know but there is a concern that public “talk” about suicide and media sensation (social and main stream) may be associated with this trend.

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PART 3 continued…Prevalence of Mental Disorders in Young People: Who is in Your Classroom? (slide 19)

This slide is used to give teachers an idea of how prevalence rates translate into the classroom, over a period of 2-3 years- not every year! This is an average JHS or HS classroom of approximately 30 students. This isn’t a specialized classroom such as BLAP (behavior learning assistance program) OR vocational schools where statistics would show higher rates.

Highlight that this data reflects the prevalence of mental disorders within a regular learning environment.

The Complexity of Mental Disorders/Illness and Symptom Expression (slide 20)

IMPORTANT GO-TO SLIDE! We don't know the specific reason(s) as

to why any one person gets a mental disorder, but we do know that it is a complex interplay between genes and environment. It is always both factors.

There may be sensitive periods during our development (prenatal and early childhood and adolescence etc.) in which these different factors may play different roles. Examples: maternal alcohol abuse while in utero may lead to FASD; a head injury in adolescence may lead to Depression.

Psychiatrists/scientists are learning about Epi-genetics- meaning “above/around genes” to better understand the causes of mental illness/disorder. Epi-genetics means that the environment can shape how your genes are expressed. For example: good food or good sleep may influence genes to turn on or turn off, thus affecting how they make proteins which then may impact different aspects of human emotions, cognition and behaviour. In some cases, these impacts may leave markers on your genes which may be passed on to the next generation. These can be positive or negative effects and they can be demonstrated in studies with rats and mice to "echo" or continue into future generations. Not every environmental impact is "echoed” in future generations and much work remains to be done to understand this process fully. Therefore, it is important to understand that this impact MAY occur, but it is not useful to identify any current situation and assume that this impact did occur. For example, because a student becomes depressed, it does not mean that the Depression is a result of his grandfather’s/grandmother’s exposure to war.

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Some people may have some signs or symptoms without a full disorder (mental health problems). For example: sadness without clinical Depression while others may develop a full blown illness.

PART 3 continued…All symptom expression happens in a culture that can influence the impact or outcomes or even the types of commonly expressed symptoms themselves.‘Take Homes’ (Important for Mental Health Literacy) - slides 21 and 22

Most of psychiatric disorders (about 70%) can be diagnosed during the 12 to 25 years age range, following the onset of puberty.

Generally they affect about 20% of young people. Globally, these mental disorders contribute about 1/3 of the burden of disease – mortality,

morbidity! More than: HIV/AIDS; TB; respiratory diseases; cardiovascular diseases and war/violence COMBINED!

In Canada and USA most who need care do not receive it –the health care systems are not set up to meet the mental health care needs of young people.

Early identification, diagnosis and proper effective treatments have substantial positive effects: RECOVERY and PREVENTION!

Addressing mental disorders effectively requires participation of those who parent and those who work with young people: schools, civil society organizations and health providers.Highlight: While mental health has one of the biggest impacts on health and wellness in Canada, it receives a very small amount of funding compared to other illnesses (i.e. cancer or stroke).

Most individuals who suffer from a mental illness have good outcomes with treatment. Like all chronic medical conditions we do not have the capacity to sure the the disorder. Rather we manage symptoms and promote recovery. Early effective intervention and prevention helps improve outcomes similar to most other treatments in medicine.

PART 3 continued…Activity 1: Reflective Exercise (slide 23):

1. Ask the audience to take two pieces of paper. 2. On the first piece ask them to write two words (the first two that come to mind) that describe an

individual with an illness or a disorder, then collect it.3. After all papers have been collected, on the second piece of paper ask them to write two words that

describe a teacher.4. Collect the second batch keeping them separate. Have two volunteers read the words allowed and

chart them as being either negative, positive or neutral. 5. Discuss the results.

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PART 4 – STIGMAWhat is stigma? (slide 24)

In the context of mental health, stigma is the use of negative labels to identify a person living with mental illness. It is about disrespect and keeps mental illness in the closet. Stigma is a barrier and discourages individuals and their families from getting the help they need. It closes minds and fuels discrimination. Many say that living with the stigma is worse than living with the illness itself (CMHA).

Let participants know that CMHA stands for the Canadian Mental Health Association. CMHA sets the guidelines and provides certification for the District’s Mental Health First Aid (MHFA) Professional Learning opportunities. District instructors for MHFA are certified through CMHA.

Highlight: Stigma can be a huge barrier that we face in the identification assessment and treatment of mental illness.

Some Things You Can Do To Fight Stigma & Discrimination (slide 25)

Hand out the resource from Appendix IV – evaluating appropriate resources to supporting teaching and learning about mental health)

Staff need to be informed and up to date(i.e. GO-TO trained) in order to effectively teach about mental health and mental illness

Media plays a large role in creating the stigma Encourage staff to provide a supportive space for youth

(review Alberta Ed’s The Walk Around: Teacher’s Companion Tool - https://education.alberta.ca/media/142742/the-walk-around_teacher.pdf) – also in Appendix IV.

Highlight: We often find that there are many headlines about the violent acts of individuals with a severe mental illness (usually psychosis) ... "Man cuts head off on bus". This event receives more press than millions of individuals with schizophrenia living successful lives in their community while receiving effective treatment and support.

Educators play a significant role in helping reduce the

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stigma of mental illness among students.

PART 4 – STIGMAFighting Stigma: Stella’s Story (slide 26) Click here to review the video (https://www.youtube.com/watch?v=DQZdl4yAudI).Video length: 6:56minNote: Make sure that your YouTube settings ARE NOT in safe mode so that your videos play. You may want to use a converter to download this video and put on your desktop or embed into powerpoint.

Mental Illnesses: Myth Busters! (slide 27)

Most youth with mental disorders will go on to be successful at school and live productive and positive lives when receiving proper treatments for their mental illness.

Some youth have severe and persistent mental disorders, which respond poorly to current treatments (as in all other illnesses) and may require greater supports.

Mental illness does not respect any boundaries of race, class or geography – poverty does not cause mental illness but it can have negative impact on outcomes.

Young people with mental illness are more likely to be victims not perpetrators of violence.

Youth with mental illnesses have difficulty accessing best possible health care and face substantial stigma socially and in school.

Early identification and provision of best evidence treatments and social and educational support can substantially improve outcomes

Highlight: Poverty DOESN’T cause mental illness, but it is a barrier to getting treatment.

PART 5 – How Can I Tell? Is it a MENTAL DISORDER? (slide 28)

Overarching message of this section: We have to make sure that we don’t hide from addressing mental disorder (the ostrich) we can’t over respond to it (the sky is falling) and we have to make sure we have accuracy in identification (we don’t want to cry wolf when there isn’t a disorder).

Identification may be Difficult in the School Setting (slide 29)

Point out factors that hinder identification: If the student is using drugs it may be difficult to get a

baseline on the student. In high school students may not spend a lot of time with

any one teacher so identification may be challenging Students many not want to talk about their symptoms for

fear of "sounding crazy"

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PART 5 – continuedMental Disorders : Persistent Symptoms + Impairment (slide 30)

Highlight: Symptoms start before the functional impairment of an illness. Impairment and symptoms reach a point where an individual would qualify for a diagnosis.

Any point below the red circle (where we have some symptoms and some impairment but not enough to consider a diagnosis) we can consider as the prodromal period.

Explain the definition of prodromal: a prodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur. It is derived from the Greek word prodromos, meaning "precursor".

It is important to remember that many people who show prodromal features do not develop a mental disorder!

Identification Keys (slide 31) This slide is about supporting staff in ascertaining the likelihood of a mental disorder.

When addressing the question of : Is the patient likely to have a psychiatric diagnosis? The clinician (note that it DOES NOT say ALL school staff) must consider the following: A “yes” to two or more of these questions should raise the probability that the patient may have a psychiatric disorder and should then trigger the next steps in the diagnosis and intervention cascade available within the health care system.

Review the questions on this slide. Point out this is what clinicians do (it is not the educator’s job to diagnosis). But, these features should be kept in mind by teachers to help them identify youth at high probability for having a mental disorder.

The Quick Screen Method:

QUICK SCREEN FOR MENTAL DISORDER

Is the patient’s emotional state, cognitive function or behaviour very distressing or caused significant problems to them or to those around them?

Does the patient exhibit a lack of social convention that he/she is unaware of?

Are the patient’s emotions, reasoning or behaviour markedly different than his/her social, cultural and economic peers?

Are those people who are closest to and most caring of the patient seriously concerned that the patient may be ill, even if they attribute the problems to an environmental condition?

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PART 6 – BRAIN FUNCTIONING and MENTAL DISORDERSNOTE: The slides have been rearranged from the original powerpoint. Click here for the most up to date version of the powerpoint - https://drive.google.com/file/d/0B4nyTj0zxm1xTnR0U2pydkNsVXc/view?usp=sharing

Functions of the Brain (slide 32)

The functions of the brain can be described within six primary domains:

1. Thinking or cognition2. perception or sensing3. emotion or feeling4. signaling5. physical or somatic6. Behavior

Brain Growth & Development (slide 33)

Highlight: The brain doesn’t stop developing until the late 20’s or early 30’s. This may take even longer in men than in women.

In some ways, the brain is never fully developed because it is constantly reshaping to meet the demands of everyday life, as well as being shaped in part by its current environment. There is a complex and continuing bi-directional interaction between brain development and environment that persists across the life span.

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PART 6 – continuedCHALLENGING SLIDE!!

Proliferation of Grey Matter Through Development (slide 34)

1. This image is the brain developing over time. The purple colour represents areas of high connection (meaning high development) and red is low connection (low development).

Activity: Have the audience note what happens.

2. The brain develops from the back to front (generally) and the brain is not completely developed until later in life. The final section of the brain to mature is the pre-frontal cortex which is responsible for “higher-order” functions of cognition such as complex problem solving and moral reasoning. Linking of different brain areas (such as the limbic system and prefrontal cortex discussed above) also improves during these years (these linkages are not shown on this slide as they are what is called “white matter”) and this results in better brain function. Researchers suggest that a mismatch of maturation timing between the limbic system (maturation often in early adolescence) and the still developing prefrontal cortex is what makes adolescents more prone to risk-taking behaviours, but also promotes creativity and more flexible adaptation to their environment.

Highlight: The teen brain is different from the adult brain.

The CSH unit has requested a new image of this – however this image comes straight from the research and so cannot be changed.

Mental Disorders are Brain Disorders: Overview of Common Mental Disorders (slide 35)

Highlight: It is only recently that researchers have been able to look inside the brain with imaging technology (Magnetic Resonance Imaging – MRI, Positronic Emission Topography – PET Scan and Computer Axial Topography – CAT scan).

These technologies have been able to link brain development and mental disorders.

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PART 6 continued…Mental Disorders are Associated with Disturbances in the Primary Domains of Brain Function (slide 36)

We can use the brain functions to classify the mental disorders. This classification isn't perfect but it can act as a framework for teaching them.

When perturbations arise in the different cell circuits that underlie each of the brain functions, this may lead to a mental disorder.

Brain Injury Resources for the GO TO Educator (slide 37)

Ensure this is linked to your presentation and that you show participants how to access the resources listed below. Share the resource site: http://teenmentalhealth.org/product/brain-injury-guide-youth/

Highlight: These are free e-books on the teenmentalhealth.org website. One is geared for the individual with the brain injury, the second for the people supporting the individual with the injury.

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PART 7 – MENTAL DISORDERS of COGNITION and PERCEPTIONWhat is Thinking or Cognition? (slide 38) These are all the skills we use at school.

Disturbance in Thought Content (slide 39)

When we have disturbance in though we may have a delusional belief.

Use the slide – Is this a normal thought for a cat?

(Meant to represent delusional belief)

What are Delusional Beliefs? (slide 40) Delusions are fixed, unbending beliefs that are incompatible with the beliefs held by the majority of people in the individual’s culture or subculture.

What is Perception? (slide 41) Here are the five senses. There are other senses such as proprioception (our ability to sense our body in space) or synesthesia (the overlap of two senses i.e. seeing colours when you hear music)

Disturbances of Perception (slide 42)

How to explain this slide: Top line- a person looks and sees leaves and there are leaves that are normal.Middle Line- a person looks at the leaves and sees faces - that is an illusionBottom Line- There is nothing there and the person sees leaves. This is a hallucination. Hallucinations can be in any sensory modality and arise spontaneously from within the brain without any external stimuli.

Remember that illusions and hallucinations can occur in healthy brains at times and these can be normal (optical illusions or seeing a person who has died while grieving).

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PART 7 – continued(slide 43)

Psychosis definition – a severe mental disorder in which thought and perceptions are so impaired that contact is lost with external reality.

What is schizophrenia? (slide 44)

Schizophrenia is a chronic psychotic disorder that occurs in approximately 1% of the population. Schizophrenia interferes with a person’s mental functioning and behaviour, and in the long term may cause changes to their personality.

The onset of schizophrenia is usually in adolescence or early adulthood. Some people may experience only one or more brief episodes of psychosis in their lives, and these may not develop into schizophrenia. Others develop schizophrenia, and experience ongoing psychosis or episodic episode over their lifetime.

Positive symptoms refer to symptoms that appear in an acute psychotic episode such as delusions, thinking things that aren’t true, or hallucinations, seeing or hearing things that aren’t there.

Negative symptoms refer to things that are taken away by the illness, so that a person has less energy, less pleasure and interest in normal life activities, spending less time with friends, being less able to think clearly, having difficulty with usual activities of daily life, limited motivation, lack of volition and apathy. These symptoms continue over the course of the entire illness and can be punctuated by periods of “positive symptoms”.

What are the symptoms of schizophrenia? (slide 44 continued)

Positive symptoms of schizophrenia include:

Delusions – false beliefs of persecution, guilt or grandeur, or being under outside control. These beliefs will not change regardless of the evidence against them. People with schizophrenia may describe outside plots against them or think they have special powers or gifts. Sometimes they withdraw from people or hide to avoid imagined persecution.

Hallucinations – most commonly involving hearing voices. Other less common experiences can include seeing, feeling, tasting or smelling things, which to the person are real but which are not actually there.

Thought disorder – where the speech may be difficult to follow, for example, jumping from one subject to another with no logical connection. Thoughts and speech may be jumbled and disjointed. The person may think someone is interfering with their mind.

Other symptoms of schizophrenia include:

Loss of drive – when the ability to engage in everyday activities such as washing and cooking is lost. This lack of drive, initiative or motivation is part of the illness and is not laziness.

Blunted expression of emotions – where the ability to express emotion is greatly reduced and is often accompanied by a lack of response or an inappropriate response to external events such as happy or sad occasions.

Social withdrawal – this may be caused by a number of factors including the fear that someone is going to harm them, or a fear of interacting with others because of a loss of social skills.

Lack of insight or awareness of other conditions – because some experiences such as delusions or hallucinations are so real, it is common for people with schizophrenia to be unaware they are ill. For this and other reasons, such as medication side-effects, they may refuse to accept treatment which could be essential for their well being.

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PART 7 continued… Thinking difficulties – a person’s concentration, memory and ability to plan and organize may be

affected, making it more difficult to reason, communicate, and complete daily tasks.

Facts about Schizophrenia:

One in ten people with schizophrenia dies by suicide People who have Schizophrenia are not violent unless they are acutely ill Schizophrenia runs in families

Psychosis: What to Look for? (slide 45, Schizophrenia continued)

Schizophrenia is not related to multiple personality disorder, now called Dissociative Identity Disorder (DID)

DID is very rare and there is little evidence to suggest it even exists, no matter what Hollywood says. It would be more linked to Trauma than schizophrenia if it is real.

Psychosis: What to do? (slide 46 Schizophrenia continued)Highlight: 1. Get the young person psychiatric care

immediately (emergency room) with the help of professionals at the school.

2. Remember not to be confrontational with the student. Instead the message should be "I am really concerned that you are experiencing that, I think we need to get you help".

3. Don't argue with the delusional beliefs or deny the hallucinations.

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PART 8 - MENTAL DISORDERS of EMOTION and FEELINGEmotions and Moods – What am I Feeling Inside? (slide 47)

Note: Leading into addressing depression.

Highlight: One of your brain's key jobs is to regulate your emotional state.

Normal Mood Graph (slide 48)

Highlight: Everyone's mood changes overtime no matter what is going on in the environment. Your mood changes over the day (circadian rhythm) it changes over a month (both men and women) and it changes over a year. Your body works to maintain a set point through homeostasis.

A Baseline Shift to the Negative Pole – Depression (slide 49)

Highlight: When the homeostatic mechanism is broken we have a depression. Notice that there are still changes in mood but the overset point is lowered.

A Baseline Shift to the Positive Pole – Mania

(slide 50)

If the regulatory system is broken we may also see Bi- polar disorder.

What this slide doesn't show is a crash to the negative later after a manic episode.

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PART 8 continued…Depression: What to look for (slide 51)

Highlight: Three common cognitive themes are often Hopeless, Helpless and Worthless.

Remember that withdrawn isolated teens are not healthy teens. This is likely a sign that something is wrong! Depression may be one of the reasons – but there are other reasons as well.

Depression What to Ask? (slide 52/53/54)

Activity: Go over the questions on slide with participants.

Video: Ellie’s Depression - 4:04 min

(https://www.youtube.com/watch?v=i8EPzkxAiVw)

After going over the questions on slide 52, you could play this video (time permitting).

Depression: What to do? (slide 55)

Highlight: When the brain is depressed it isn't just the mood of the individual that is impacted. When you are depressed across multiple domains academic function is impaired. A student who is depressed is depressed in their social life, depressed in math and depressed in english! The body may be depressed and suffer from aches and pains.

Depression is highly treatable (medications and evidence based psychological therapies): referral to health provider as soon as possible KNOWLEDGE

All treatments decrease risk for suicide and decrease suicide rates – essential to support youth in access to care.

Academic expectations may need to be modified due to Depression effects on motivation and cognition.

Mood enhancing activities (prescription – YOU CAN DO THIS). Be aware of the risk of suicide – discuss with health providers

what the role of educators should be in each individuals case. Develop a youth supporting educational/health collaboration

with appropriate consents. Clarify role of school with regards to potential crisis situations.

Depression: What to Know About Treatment (slide 56)

Remind participants that treatment for Depression takes time (often 10-12 weeks) and even though a student feels better after 3 or 4 therapeutic sessions, they need to continue treatment to prevent relapse.

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PART 8 continued…Depression: What not to Miss (slide 57)

You may want to make this slide clear:

Always ask about suicidal thoughts and suicide plans.

If you are not sure an individual is depressed – ask someone with clinical expertise to evaluate immediately (i.e. clinical intervention).

Substance abuse.

YOUTH SUICIDEYouth Suicide (slide 58)

Highlight: To impact and lessen the occurrence of youth suicide, adults must work together to provide effective treatment for mental illness. There is no statistical evidence or Randomized Control Trials (a science-based preferred method for research) that demonstrate that any of the popular community suicide prevention programs (such as SafeTALK) can reduce the number of completed suicides. Adults often over respond because there are calls to action after a youth suicide. So-called programs are expensive and not likely to work. Some may increase suicide risk. Early identification of youth with mental illness and provision of appropriate treatment is considers as a useful strategy to prevent suicide.

Powerpoint link for instructor background info: This is a link to Stan Kutcher’s Suicide Prevention workshop (many instructors attended this in April 2016) that provides research to support the statements above. Kutcher uses RCT trials to evaluate suicide prevention programs. He has found that universal programs have little or no impact and may potentially cause a suicide contagion or cluster effect.

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YOUTH SUICIDEYouth Suicide: Well Established Risk Factors (slide 59)

Highlight: This slide presents the best research supported risk factors that impact suicide rates. There are other risk factors (such as being male and being from the FNMI and/or LBGTQ community) that may be at play.

ESCe means: Effective, Safe, Cost-effective – suicide prevention programs MUST show all three and MUST show decrease in suicide rates as a result of their application. NONE of the popularity used school and community suicide awareness programs have demonstrated this.

Youth Suicide: Treatment Works (slide 60)

Allow time for participants to thoroughly read and understand this slide (as this slide contains new info for District staff). Discuss with participants so that feelings and thoughts are shared.

ESCe means: Effective, Safe, Cost-effective – suicide prevention programs MUST show all three and MUST show decrease in suicide rates as a result of their application. NONE of the popularly used school and community suicide awareness programs have demonstrated this.

The Suicide Risk Identification Interview (slide 61)

Highlight the process - This strategy in this slide is usually for mental health professionals or school counsellors/ psychologists to use. Go-TO Educators who are not mental health professionals need professionals to intervene when they are concerned about student suicide ideation/attempts/behaviours.

Make apparent: This process does not predict suicide – it only provides evidence for intervention and identifying risk.

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YOUTH SUICIDETool for Assessment of Suicide Risk (TASR-Am) – hyperlinked (slide 62) (https://drive.google.com/file/u/0/d/0B4nyTj0zxm1xTFg0WTQtbmM1RFE/view?usp=sharing)

Highlight: This instrument cannot predict suicides. NO INSTRUMENT CAN! Science has yet to develop such a level of sophistication. This tool can be used to identify risk factors and ensure that appropriate assessment questions have been asked. Also, this is a tool for mental health professionals, not for Go-To Educators to use.

Kutcher Adolescent Depression Scale – hyperlinked (slide 63) (https://drive.google.com/file/d/0B4nyTj0zxm1xSnBiU2JHVlA5Vjg/view?usp=sharing)

Highlight: The KADS is a useful tool to assess Depression. It can be found on the teenmentalhealth.org website. Although it does not need professional training to implement it, we need mental health professionals to decide upon and communicate the diagnosis. Dr. Kutcher recommends that it be used by student support staff and health care professionals, NOT Go-To Educators

Bipolar Disorder: What to Look for - Review points on the slide.Highlight: Features of bipolar disorder often present in person in a manic state.

Bipolar Disorder: What to Know about Treatment (slide 65)- Review points on the slide.Highlight: SSRI’s (Selective Serotonin Re-uptake Inhibitors or anti-depressents) are an effective treatment in adolescent depression

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PART 9 – MENTAL DISORDERS of SIGNALINGIntroduce this topic by asking, ‘What is signaling?’ (slide 67)

Answer: Signaling is not the complex interpretation of ideas. Rather, it is a quick neural process to warn us about risk and danger when there is one.

‘Normal Anxiety’ (note preference: refer to ‘healthy anxiety’ in lieu of ‘normal’) – slide 68- is a term which describes a normal feeling people experience when faced with threat or danger, or when stressed (e.g. first date, giving a public speech, performing at a concert, exams) . It is transient, a normal stress response and doesn’t interfere with a person’s well-being, and does not prevent a person from achieving their goals. (slide 68)

Feelings of anxiety are related to experiences of life, such as a new relationship, a new job or school, illness, accident, etc. Feeling anxious is appropriate in these situations and usually we feel anxious for only a limited time. These feelings are not regarded as clinical anxiety, but are a part of everyday life.

When people become anxious, they typically feel upset, uncomfortable and tense and may experience many physical symptoms such as stomach upset, shaking, headaches, etc.

Ask: ‘What is anxiety?’ (slide 69)

The” Signaling” function of the brain is used to alert us to any potential problem in our environment. This is the mechanism we call the stress-response. It is the signal that adaptation is needed and that when adaptation happens (that means the problem is solved) the signal goes away and the person has a skill that they can use in other circumstance. The brain system involved in “Signaling” also is the same as that which alerts us to immediate and severe danger – and causes the fight or flight response. This has evolved over centuries to keep us out of harms way.

We ofen use these words interchangeably which is not very helpful and can cause confusion. Often we just lump them under the category of “stress”, without noting whether the condition is acute or chronic (the impact is different) or whether the condition is “positive”, “tolerable” or “toxic” (this matters – see the distinction from the Harvard Center for the Developing Child: http://developingchild.harvard.edu/wp-content/uploads/2015/07/JAMA-summary.pdf). We also often use the word “anxiety” to mean a stress-response created by something in the environment that is not likely to be harmful. We can differentiate this concept of anxiety as healthy and resilience building or as negative and resilience impeding. This depends on how we think about and act in response to the anxiety (or stress – response) signal.

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PART 9 –continued…Anxiety Disorders (slide 70) – are persistent, excessive, inappropriate, causes impairment and leads to dysfunctional coping such as withdrawal and avoidance.

Symptoms: Physical Symptoms:InsomniaPalpitations Increased heart rate Suffocation Dizziness Shaking or tremors Shortness of breath Stomach upsetRestlessnessDiarrheaChange in appetite FlushingBlushingSweatingFaintnessChest pain

Thinking/Cognitive Symptoms:

Worry/ApprehensionDifficulty making decisionsPoor concentration Repeatedly thinking the same distressing thoughts Obsessions & RuminationsCatastrophic thinkingIncreased or Decreased awareness of one’s surroundingsConfusion

Behavioral Symptoms:AggressionAvoidance AgitationRestlessness (Compulsions)Substance use: AlcoholSleep MedicinesSocial WithdrawalRepeated behaviors (compulsions)

Inverted U-Shaped Relationship Between Arousal and Performance (slide 71)

Ask participants if they can interpret that relationship.

After discussion share:

1. The bottom left hand side of the curve represents an individual who doesn’t have enough arousal to perform well (e.g. a baseball player who is sleep when he/she gets up to bat).

2. The bottom right hand side of the curve represents an individual who is over-aroused (e.g. the baseball player is too nervous to grip the bat and he/she is shaking and worried about losing the game).

3. Individuals need to have an optimal level of anxiety in order to improve our performance on a task. Too much anxiety and we are paralyzed; too little and we’re unmotivated; but just the right amount of anxiety (everyone has their own optimal level and it needs practice to find it) keeps us alert and focused so we preform to the best of our abilities.

Highlight: Although some anxiety can be motivating, anxious students generally find it more difficult to operate at optimum levels.

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PART 9 continued…Exposure Curve (slide 72)

Highlight: Anxiety grows each time we avoid a stimuli and the period of habituation (i.e. avoiding the activity in order to diminish the physiological responses and/or feelings/emotions that arise) becomes longer. If an individual can complete a task that makes the feelings/physiological symptoms emerge, then the anxiety and habituation will diminish. Eventually it will go away all together.

Examination/Test Anxiety (slide 73)

IMPORTANT SLIDE: District students frequently report anxiety. Schools are constantly requesting strategies to address text anxiety.

Highlight: Accommodations are fine, so long as they don’t allow the student to avoid or withdraw from the stimulus or event that they are anxious about.

Dealing with Exam Anxiety (slide 74)Key point: Test anxiety is what motivates an individual to do

well (this statement is in reference to bullet point 1). To be optimally stimulated to perform well, anxiety must be present. If students are reporting anxiety during test taking it DOES NOT mean they have a disorder.

Highlight: If you have two groups where one is rewarded for outcome (getting the right answer) and the other group you reward for hard work, eventually group two will out-perform group one.

Key strategies on this slide:

Prepare students at the beginning of the year – praise hard work not being “smart”.

Allow time for stress response interventions – exercise, healthy eating, box breathing, focusing attention strategies, muscle relaxations, sleep routines.

Remind participants: Failure can be adaptive – some people need to have this experience to work harder.

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PART 9 continued…Anxiety disorders -

The Anxiety Disorders are a group of illnesses, each characterized by persistent feelings of intense anxiety accompanied by functional impairment. There are feelings of continual or extreme discomfort and tension, and may include panic attacks.

People are likely to be diagnosed with an Anxiety Disorder when their level of anxiety and feelings of panic are so extreme that they significantly interfere with daily life and stop them from doing what they want to do. This is what characterizes an Anxiety Disorder as more than normal feelings of anxiety.

Anxiety Disorders affect the way the person thinks, feels and behaves and, if not treated, cause considerable suffering and distress. They often begin in adolescence or early adulthood and may sometimes be triggered by significant stress.

An Anxiety Disorders are common and may affect one in twenty people at any given time.

All Anxiety Disorders are characterized by heightened anxiety or panic as well as significant problems in everyday life.

Generalized Anxiety Disorder (GAD): What to Look for (slide 76)

Go over key points and highlight: Generalized anxiety disorders along with specific phobias, panic disorder and social anxiety disorder are the most common forms of signaling mental disorders.

GAD: What to ask and What to do (slides 77&78)

Slide 77: contains questions that are targeted at determining if there is something specific or a wide array of stimuli that the student is worried about.

Slide 78: GAD is a good School Based Mental Health referral. Why is it a good referral? - Slide 77 questions can guide educators to a good referral and GAD is quite common.

GAD: What not to Miss (slide 79) Highlight: Nicotine acts as an anxiolytic (i.e. anti-panic medication or intervention)

Introducing Social Anxiety Disorder (SAD) - slide 80 People with Social Anxiety Disorder (sometimes called Social Phobia) fear that others will judge everything they do in a negative way. They believe they may be considered to be flawed or worthless if any sign (SAD) of poor performance is detected.

They cope by either trying to do everything perfectly, limiting what they are doing in front of others, especially eating, drinking, speaking or writing, or they withdraw gradually from contact with others. They will often experience panic symptoms in social situations and will avoid many situations where they feel observed by others (such as in stores, movie theatres, public speaking, social events, etc.).

Social Anxiety Disorder doesn't occur as the results of a negative social event.

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PART 9 continued…Understanding Social Anxiety Disorder (SAD) (slide 81)Video Link - https://www.youtube.com/watch?v=kitHQUWrA7s

SAD: What to Look for (slide 82)Highlight: Students may retreat to avoid situations (sometimes even in the educational program selection such as online schooling or homeschooling). Students may avoid crowded places at school (the hallway at class change, the lunchroom or library).

SAD: What to ask (slide 83)- Review questions with participants

SAD: What to do (slide 84) - Review steps with participants.

SAD: What not to Miss (slide 85)

Highlight: - Students with SAD often want social contact but are too anxious to initiate contact. - Prolonged social isolation may result in depression. - Alcohol misuse may occur as it helps reduce the feelings of anxiety in the short term. Thus, students

with SAD are at risk for substance misuse.

Panic Attacks (slide 86)Panic attacks are common and most people will have 2-3 or even more, over the course of their lifetime. This does not mean that they have a Panic Disorder. People with Panic Disorder have frequent random panic attacks and they fear future attacks. These individuals will avoid or withdraw from situations that they are afraid of getting a panic attack in.

Understanding Panic Disorder (PD) – slide 87Video Link - https://www.youtube.com/watch?v=R3S_XYaEPUs

PD: What to Look for (slide 88)-Review symptoms/features of the disorder

PD: What to do (slide 89)- Review points

PD: What not to miss (slide 90)

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PART 9 continued…Post-Traumatic Stress Disorder (PTSD) – slide 91Highlight: Some people who have experienced major traumas such as war, torture, hurricanes, earthquakes, accidents or personal violence continue to feel terror long after the event is over.Individuals may experience nightmares or flashbacks for years. The flashbacks are often brought about by triggers related to the experience. The individual will attempt to avoid any thoughts or situations thatmight trigger memories of the event. He or she may also have difficulty remembering parts of the event, a distorted understanding of the causes or consequences of the event, a persistent negative emotional state, significant loss of interest in important events, feelings of detachment or estrangement from others, inability to produce positive emotions, and persistent exaggerated negative beliefs about him- or herself and the world (e.g., “No one can be trusted”).

The Acute Stress Response (slide 92)The good news is that our brains are designed to handle acute stress events. This involves a process where cognitive memory and emotional memory are paired. Over time, the emotional memory becomes less attached to the cognitive memory of the experience. Eventually, most individuals will be able to cognitively recall the stressful event without fully having to re-experience it (i.e. feeling the emotions, physiological symptoms). PTSD (slide 93) Highlight: In trauma, the cognitive and emotional memories remain connected. When a person is triggered OR spontaneously without any triggers, they re-experience all symptoms they had at the time of the event, sometimes even experiencing additional symptoms.

PTSD: What to Look for (slide 94)Children may have trauma that teachers are not aware of. Some behaviours may be a result of trauma. Triggers for trauma vary from individual to individual. There are no set triggers for PTSD. The popular use of the word “trigger” is often confusing as it usually refers to a memory of a negative event (and not to PTSD). This is normal, does not need to be policed and over time is associated with less and less memory of the event. Trying to extinguish triggers for normal negative event memories may have the impact of perpetuating them, not resolving them.

PTSD: What not to Miss (slide 95)- Review points

Traumatic Events and the School Setting (slide 96) – IMPORTANT!Critical Incident Stress Debriefing or CISD IS NOT the preferred method of intervention as it may continue to traumatize individuals. Instead, it is recommended that students use their natural embedded resources and get back to school routines as soon as possible. Counselling services can be offered to students who want to voluntarily come forward (outside of classes).Avoid – whole-school assemblies, universal whole-school activitiesRecommended – targeted counselling supports for individual students who come forward

Addressing Youth with Anxiety Disorders (slide 97)- Review points

Anxiety Disorders: What to Know About Treatment (slide 98)

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- Review points

PART 10 – MENTAL DISORDERS: PHYSICALEating Disorders (slide 99)

Important to highlight: When you don’t include the risk for suicide, this is the mental illness that has the worst outcomes for morbidity. Left untreated eating disorders significantly increase the risk of mortality. Eating disorders are hard to spot, secretive and treatment resistant.

Eating Disorders: What to do (slide 100)

- Review acronyms: AN – Anorexia Nervosa, BN – Bulimia Nervosa- Explain what cathartic expression (point 3 ) means – psychological release through the open expression of

strong emotions.Highlight: Point 5 – multidisciplinary collaborative approach is needed!

Eating Disorders: What to Know About Treatment (slide 101)

Highlight: We don’t have any medications that directly treat Anorexia Nervosa. Bulimia Nervosa can be effectively treated with some SSRI medications. For young people, various psychological interventions that include family participation may be helpful in both disorders. Hospitalization for forced re-feeding may be necessary if a young person’s weight falls below a critical level.

PART 11 – MENTAL DISORDERS of BEHAVIOURWhat are Behaviour Functions? (slide 102)

Behaviour defined:- Our ability to interact with others and our environment through ‘doing’.- Actions in response to internal or external stimuli.- We all use brain functions to drive our behaviours every second of every day and are largely unaware that

we are doing so. Our brains integrate all of these functions to enable us to do even the simplest task.

Obsessive Compulsive Disorder (slide 104)Highlight: This disorder involves intrusive, unwanted thoughts (obsessions); the performance of elaborate rituals

(compulsions) in an attempt to control or banish persistent thoughts or to avoid feelings of unease. The rituals are usually time consuming and seriously interfere with everyday life. For example, people may

be constantly driven to wash their hands or continually return home to check that the door is locked of that the oven is turned off.

People with this disorder are often acutely embarrassed and keep it a secret, even from their families.

Video Link – Understanding Obsessive Compulsive Disorder (slide 105)(https://www.youtube.com/watch?v=ua9zr16jC1M)

Obsessive Compulsive Disorder: What to Look for (slide 106) - Review points

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PART 11 – continued…Obsessive Compulsive Disorder: What to do (slide 107)Highlight: It is important to note that treatment for OCD is longer than many of the other disorders and takes at least 12 weeks before improvements are seen.With effective treatment of this disorder we see a 70% reduction in symptoms but usually the obsession and compulsions remain to some degree (that is, the symptoms never completely go away).

OCD: What not to Miss (slide 108)Highlight: Often tics and tic disorder are found with an OCD diagnosis – clinicians are still unsure as to why.

What is Attention Deficit Hyperactivity Disorder? (slide 109)Key points: Boys are two to three times more likely than girls to develop ADHD. Although ADHD is associated with children, the disorder can persist into adulthood. Children and adults with ADHD are easily distracted by sights and sounds and other features of their

environment,; cannot concentrate for long periods of time; are restless and impulsive; or have a tendency to daydream and be slow to complete tasks.

SymptomsThe three predominant symptoms of ADHD are:1) Inability to regulate activity level (hyperactivity)2) Inability to attend to tasks (inattention)3) Impulsivity, or inability to inhibit behaviour - NOT Oppositionality!!

ADHD Symptoms continued (slide 109)

Common symptoms include varying degrees of the following:

Poor concentration and brief attention span Increased activity – always on the go Impulsive - doesn’t stop to think Social and relational problems Fearless and takes undue risks Poor coordination Sleep problems Normal or high intelligence but under performs at school

ADHD: What to Look for (slide 110) Point out: We all have the ability to orient our attention and an ability to sustain our attention to one thing. However, children with ADHD are statistically different in their ability to sustain attention. Students with ADHD are two standard deviations away from the average when measured with psychometric tests. Remember that many youth (about 30%) with ADHD will also have a Learning Disorder. Therefore, schools should evaluate all students with ADHD for the presence of an LD.

ADHD: What to do (slide 111) Point out: Adults working with children with ADHD should utilize a strengths-based approach.

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PART 11 – continuedADHD: What to Know about Treatment (slide 112) - Review points on the slideTeens and Drugs (slide 113)Highlight: Substance use and abuse is far more common in adolescence than addiction!Addiction typically takes longer to form in the brain.

SUBSTANCE DEPENDENCE AND ABUSEWhat is Addiction? (slide 114)-Review the ABC’s of Addiction (the three features)Withdrawal defined: physical, cognitive and emotional sensations caused by the substance leaving the brain. Withdrawal is found in addiction/substance abuse. It is NOT synonymous with addiction/substance abuse.

Drugs: What to Look for (slide 115)- Review key points on slide

Adolescent Alcohol and Substance Use Screen (CRAFFT) – slide 116- Review the acronym with participants.- THE CRAFFT model is a tool used for the screening of alcohol misuse or abuse.

Drugs: What to do (slide 117) - Review the points on the slide.

Drugs: What to Know About Treatment (slide 118)- Review the points on the slide.

PERSISTANT SELF-HARM(slide 119)What we Know: Self Harm (slide 120) Persistent self harm is more prevalent in females compared to males. However, researchers may be underestimating the numbers for males. The challenge comes from how self harm is currently defined. Risk taking behaviours could also qualify as self harm but are often not considered in the research, which is why the numbers of males may be lower.

PART 12 - HELPING – GET WELL, STAY WELL, KEEP WELL (slide 121)

What is Evidence-Based Medicine (EBM?) is an e-book that empowers people to ask the right questions with their doctors when considering treatment. There is a check list to make sure that patients understand their treatment options. E-book Link - https://drive.google.com/file/d/0B4nyTj0zxm1xT2tYM1NoVDR3d3c/view?usp=sharing

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PART 12 –continued…Evidence is Hierarchal (slide 123)

Randomized control trials (RCT) are robust research design to find whether an intervention, a treatment, or a program work. Although the RCT methods are usually applied in clinical medicine and increasingly in public health, this methodology is now informing social science and economics as well. RCT methods divide participants randomly into two or more groups. One of the groups is given the experiential treatment/intervention and the other is given either an alternative treatment/intervention (a previously established and known effective treatment/intervention) or a placebo treatment/intervention (a treatment/intervention with no therapeutic effects. The key is that participants must be divided into groups absolutely randomly, to ensure that the groups are comparable right from the start and that the only difference between groups is treatment/intervention. At the end of the study, the differences in outcomes between groups are statistically analyzed from group data. Information from RCT studies (if they are properly done) trumps data from studies that are lower in the evidence hierarchy.

Information About Treatments (slides 124 and 125)Highlight: Time is needed to evaluate if treatments are effective. At times, the symptoms may get worse for a short period even though the treatment is working. It may not be immediate.

The Psychotherapeutic Support for Teens (PST)© model (slide 126) - Read over all points!

Taking Charge of Your Health: E-book Resource (slide 127)E-book link: https://drive.google.com/file/d/0B4nyTj0zxm1xVjAwWkl6UTdWNDA/view?usp=sharing(contains a checklist that supports healthy lifestyle planning)

Non-Specific Interventions: Basic Self Help (slides 128- 130) Highlight: There is evidence that two types of vitamins may be effective in some disorders: Omega 3 and vitamin D. For neuronal growth to happen, cardiovascular training (reaching 80% for maximal cardiac output) for at least 30 min a day for at least 4 days a week must be part of a weekly routine. This type of exercise is very difficult for an individual suffering from Depression or Anxiety Disorder. Lesser amounts of exercise can also be helpful for overall health but do not have the same neuronal regeneration impact.

Acting on Your Concerns: Triage; Support; Referral (slide 131)

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PART 12 –continued…CLASPP Model (slide 132)The CLASSP mnemonic is a tool for adults working with students. The most important aspect of this slide is to listen and not solve the child’s problem too quickly.

Slides 133 -134 – Supportive Helping Principles and Assessment

Read over: All points, discuss with participants.

Confidentiality: Common Issues – slide 135

Important: Educators cannot keep confidence if the individual is suicidal, homicidal or showing signs of psychosis. Refer to Appendix V– Inclusive Learning and Edmonton Zone Supports.

Have I Considered These? Supports – Slide 136

Important to read over and discuss.

Talking with the Parents – Slides 137-142

Read over all points with participants – discuss challenges. How can central services be of support?

Collect responses from participants and share with CSH leads.

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CLOSING THE TRAINING SESSIONEvaluation: Appendix I

Do the post-survey with participants. Spend considerable time on this. Go over answers with the key once complete. Collect all surveys in and send to Regan Holt (regan.holt@epsb.ca) at the Centre for Education. This is important for the research that funds this training!

Share slide 143 – Teen Mental Health Contacts

Attendance: Ensure that you have done attendance and have a complete list of all participant names. Please submit these names to Regan Holt (regan.holt@epsb.ca) following the training OR add the names to the master participant list on the Google Plus Community (if you use this option be sure to include the date of training, your name as the instructor, the participants full name as well as their current school site).

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Appendix I – Dr. Stan Kutcher: Bio

Dr. Kutcher is an internationally-renowned expert in adolescent mental health and a national and international leader in mental health research, advocacy, training, policy, and services innovation working at the IWK Health Center and Dalhousie University. He has previously served as Department Head of Psychiatry and Associate Dean for International Health at Dalhousie University. Dr. Kutcher has received numerous awards and honors locally, nationally and internationally for his work including: the Order of Nova Scotia; Excellence in Education Award (CACAP); a Best Doctor in Canada; Doctors Nova Scotia Health Promotion Award; Dr. John Savage Memorial Award for outstanding humanitarian contributions to global health; Canadian College of Neuropsychopharmacology Gold Medal; Lifetime Achievement Award of the Canadian Psychiatric Research Foundation and the Ruedy Award for Innovation in Medical Education, Association of Faculties of Medicine Canada. He is a Distinguished Fellow of the Canadian Psychiatric Association and a Fellow of the Canadian Academy of Health Sciences. He has been honored by the Canadian Psychiatric Association with the JM Cleghorn Award for his contribution to mental health research and the Paul Patterson Award for his innovations in psychiatric education. He is and has been a member of numerous boards and national organizations

Dr. Stan Kutcher ONS, MD, FRCPC, FCAHS, Sun Life Financial Chair in Adolescent Mental Health and Director World Health Organization Collaborating Center in Mental Health Policy and Training.

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including the Institute of Neuroscience, Mental Health and Addictions of the CIHR; Interhealth Canada; Mental Health Commission of Canada (CYAC committee); the Canadian Society for International Health; the Canadian Coalition for Global Health Research, the Sandbox Project, a He is the recipient of over 100 research grants and awards, author of more than 300 scientific papers and the author/co-author of numerous medical textbooks. Locally he contributes to the work of Laing House, Immigrant Services and Integration Services and the Boys and Girls Clubs. Internationally he has been involved in mental health work in over 20 countries. One of his recent projects was leading the development of a national child and youth mental health framework for Canada: Evergreen. Currently his focus is on knowledge translation pertaining to improving mental health literacy and mental health care in schools and primary care as well as the development, application and evaluation of electronic youth mental health engagement, self-care and personal health record. He continues his innovative youth mental health development and research across Canada, and globally – including China, South America, Latin America and Africa.

Appendix II – Participant SurveysPre-Survey / Post-Survey (also available through the Google Plus Community)

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Section A: For each of the following statements select True, False or Do Not Know by marking an X in the appropriate box.

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Question True False Do Not Know

1. School mental health has been a focus of agencies such as UNESCO since the 1950’s.

2. About 70 % of all mental disorders can be diagnosed prior to age 25 years.

3. Canadian rates for youth suicide increased significantly between 1995-2005.

4. The prodrome of a mental disorder refers to the premonition that something may be wrong with the health of the person.

5. Poverty and other social determinants of health are well established causes of most mental disorders.

6. The brain function of signaling is a method by which individuals learn to interpret the meaning of complex ideas.

7. Social isolation if combined with lack of motivation is usually a sign of academic difficulties and not a sign of a possible mental disorder.

8. Mental disorders arise as a result of perturbation/disruption of usual brain function.

9. A hallucination occurs when a person believes something that is not real.

10. Schizophrenia affects about 1% of the population, with males and females equally represented.

11. A split personality is a sign of schizophrenia.

12. Every person’s mood will change over time, even in the absence of an external event.

13. The Kutcher Adolescent Depression Scale (KADS) is a useful tool in the assessment and diagnosis of depression in adolescents.

14. The Tool for Assessment of Suicide Risk (TSR-A) can be used to help predict which teenagers will die by suicide.

Question True False Do Not Know

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15. Adolescent depression can be effectively treated with some Selective Serotonin Reuptake Inhibitors (SSRI) medications.

16. Post-Traumatic Stress Disorder is one of the two most common types of anxiety disorders during adolescence.

17. Because it is a chemical that decreases anxiety, nicotine abuse may be a consequence of untreated anxiety disorder in young people.

18. Social anxiety disorder usually occurs as a result of a stressful social event.

19. Major Depressive Disorder or alcohol misuse can be a consequence of untreated Social Anxiety Disorder.

20. The panic attacks of Panic Disorder usually occur at times when the person is in a situation that makes them anxious.

21. Critical Incident Stress Debriefing (CISD) is the preferred method for schools in dealing with a tragic event such as suicide.

22. The CRAFFT mnemonic tool is useful for the screening of young people who may be at high risk of alcohol misuse or abuse.

23. The three domains of ADHD include inattention, hyperactivity and oppositionality.

24. Withdrawal from a drug is the defining feature of addiction.

25. Initial treatment for Obsessive Compulsive Disorder usually lasts 12 weeks before substantial improvement can be expected.

26. It is useful to assist a young person struggling with psychosis by being a friend and keeping confidence when necessary.

27. Substance dependence is the most common type of substance problem found in teenagers.

28. Features of psychosis such as delusions and hallucinations are usually present during a manic episode.

Question True False Do Not Know

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29. The CLASP mnemonic is a useful tool to help students remember a variety of treatments for mental disorders.

30. A complementary treatment is one that is applied instead of usual physician recommended interventions.

Section B: This section of the survey is designed to find out about your attitudes towards each statement. For each of the following statements please mark X in the box that you feel best describes your attitude toward the statement. Please select only one answer for each statement.

Strongly Disagree

Disagree Disagree a little

Not sure

Agree a little

Agree Strongly Agree

1. It is easy to tell when someone has a mental illness because they usually act in a strange or bizarre way.

2. A mentally ill person should not be able to vote in an election.

3. Most people who have a mental illness are dangerous and violent.

4. Most people with a mental illness can have a good job and a successful and fulfilling life.

5. I would be willing to have a person with a mental illness at my school.

6. I would be happy to have a person with a mental illness become a close friend.

7. Mental illness is usually a consequence of bad parenting or poor family environment.

8. People who are mentally ill do not get better.

Answers and Slide references

46

Section A: For each of the following statements select True, False or Do Not Know by marking an X in the appropriate box.

Question True False Do Not Know

1. School mental health has been a focus of agencies such as UNESCO since the 1950’s.

X

1990’s

2. About 70 % of all mental disorders can be diagnosed prior to age 25 years.

X

Slide 16

3. Canadian rates for youth suicide increased significantly between 1995-2005.

X

Slide 18

4. The prodrome of a mental disorder refers to the premonition that something may be wrong with the health of the person.

X

Slide 30

5. Poverty and other social determinants of health are well established causes of most mental disorders.

X

Slide27

6. The brain function of signaling is a method by which individuals learn to interpret the meaning of complex ideas.

X

Slide 36

7. Social isolation if combined with lack of motivation is usually a sign of academic difficulties and not a sign of a possible mental disorder.

X

Slide 52

8. Mental disorders arise as a result of perturbation/disruption of usual brain function.

X

Slide 20

9. A hallucination occurs when a person believes something that is not real.

X

Slide 42

10. Schizophrenia affects about 1% of the population, with males and females equally represented.

X

Slide 44

11. A split personality is a sign of schizophrenia. X

Slide 44

12. Every person’s mood will change over time, even in the absence of an external event.

X

Slide 49

13. The Kutcher Adolescent Depression Scale (KADS) is a useful tool in the assessment and diagnosis of depression in adolescents.

X

Slide 63

14. The Tool for Assessment of Suicide Risk (TSR-A) can be used to help predict which teenagers will die by suicide.

Slide 62 X

Question True False Do Not Know

47

15. Adolescent depression can be effectively treated with some Selective Serotonin Reuptake Inhibitors (SSRI) medications.

X

Slide 57

16. Post-Traumatic Stress Disorder is one of the two most common types of anxiety disorders during adolescence.

X

Slide 91

17. Because it is a chemical that decreases anxiety, nicotine abuse may be a consequence of untreated anxiety disorder in young people.

X Slide 82

18. Social anxiety disorder usually occurs as a result of a stressful social event.

X

Slide 80

19. Major Depressive Disorder or alcohol misuse can be a consequence of untreated Social Anxiety Disorder.

X

Slide 79

20. The panic attacks of Panic Disorder usually occur at times when the person is in a situation that makes them anxious.

X

SS 87-88

21. Critical Incident Stress Debriefing (CISD) is the preferred method for schools in dealing with a tragic event such as suicide.

X

Slide 96

22. The CRAFFT mnemonic tool is useful for the screening of young people who may be at high risk of alcohol misuse or abuse. X

Slide 116

23. The three domains of ADHD include inattention, hyperactivity and oppositionality.

X

Slide 109

24. Withdrawal from a drug is the defining feature of addiction.

X

Slide 144

25. Initial treatment for Obsessive Compulsive Disorder usually lasts 12 weeks before substantial improvement can be expected.

X

Slide 107

26. It is useful to assist a young person struggling with psychosis by being a friend and keeping confidence when necessary.

X

Slide 46

27. Substance dependence is the most common type of substance problem found in teenagers.

X

Slide 113

28. Features of psychosis such as delusions and hallucinations are usually present during a manic episode.

X

Slide 51

Question True False Do Not Know

48

29. The CLASP mnemonic is a useful tool to help students remember a variety of treatments for mental disorders.

X

Slide 132

30. A complementary treatment is one that is applied instead of usual physician recommended interventions.

X

49

50

51

Appendix III – District Guide: Log Entries for Counselling MomentsInformation adapted from: Keeping Records and Anecdotal Notes – October 2016

Further information: Maryann Hammermeister, District FOIP Coordinator

Still under review and waiting approval from Director of IL.

52

Appendix IV- Evaluation Forms

53

54

55

Appendix V – Inclusive Learning and Edmonton Zone SupportsThe Inclusive Learning Supports and Contacts are updated regularly. Refer to the ILS website (must be inside District firewall to access) for the most up-to date copy.

Inclusive Learning

Kent Pharis SchoolsSupervisor: Maureen RoszellCentre for Ed (780 429 8022)

Supervisor: Brenda GiourmetakisCentre for Ed (780 429 8022)

A Blair McPherson, Aldergrove, Belmead, Callingwood, Centennial, Donnan, Elmwood,

Glendale, Hilcrest, Jackson Heights, James Gibbons/Stratford, Jasper Place, Julia Kiniski, Laperle,

Lynnwood, Michael A Kostek, Ormsby, Patricia Heights, Rio Terrace, Rutherford, S Bruce Smith,

Sherwood, Talmud Torah, Thorncliffe, Velma E Baker

Afton, amiskwacy, Argyll Home Ed Centre, Aspen Program, Avonmore, Bessie Nichols, Bramear, Clara Tyner, Forest Heights, Glenrose, Gold Bar, Hardisty,

Holyrood, Institutional Services, Kenilworth, Lymburn, McNally, Meadowlark, Meadowlark

Christian, Metro, Ottewell, Outreach Programs, Vimy Ridge Academy, Waverley, Westlawn, Winterburn

Staff name

New hire

Heather Auschrat

Lisa Curial

Linda McFalls *

Nicole Hnatiuk

Jennifer Blair

AHS

Shantelle Joevanazzo

Discipline

Ed/Beh

PSY

PSY

Social Work

OT

OT

Mental Health

Staff name

Kevin Schaffler

Donna Granson-Heise

Lisa Najdziak

Karon Dragon

Leslie McKinnon*

Chris Moo-Young

Jacqueline Prins

Mina Lee

AHS

Vacant

Greg Gorda

Discipline

Ed/Beh

PSY

PSY

PSY

Social Work

OT

OT

OT

Mental Health

Mental Health

Programming for Student Differences and Instructional Processes Consultant: Trish Clare

*shared

**leave

56

Inclusive Learning

Mike Suderman SchoolsSupervisor: Brenda Gummer

Parkallen (780 431 5481) Supervisor: Chris Harris

Parkallen (780 431 5481)Balwin. Donald Massey, Duggan, Edith Rogers,

Edmonton Christian NE, Greenview, Harry Ainlay, Hillview, Horse Hill, J A Fife, John Barnett, Kameyosek,

Keheewin, Kildare, Lee Ridge, L Y Cairns, McLeod, Menisa, Meyokumin, Meyonohk, Michael Strembitsky, Old Scona, Roberta McAdam,

Steinhauer, Sweet Grass, Tipaskan, Westbrook, York

Alberta School for the Deaf/Tevie Miller Heritage, Belvedere, DS McKenzie, Dan Knott, Delwood, Ekota,

Ellerslie, George P Nicholson, Grace Martin, Greenfield, J Percy Page, Johnny Bright, Londonderry,

M E Lazerte, Malcolm Tweddle, Malmo, McKee, Millwoods Christian, Princeton, Richard Secord,

Rideau Park, Sakaw, Satoo, Steele Heights, Vernon Barford

Staff name

Alexis Renwick

Carolynn Archibald

Linda Foti-Gervais

Rachel Rogers*

Donna Mondor

Kiersten Walls

Sandra Sveinunggaaard

AHS

Monica Falconar

New hire

Discipline

Ed/Beh

PSY

PSY

PSY

Social Work

OT

OT

Mental Health

Mental Health

Staff name

Jaime Clark

Jennifer Curry

Joe Racz*

Rhonda Wizniak

Ian Cunningham

Carrie Hait

Cindy Tom

Cindy Wedge

AHS

Christin Ferber

Linda Forbe*

Discipline

Ed/Beh

PSY

PSY

PSY

Social Work

OT

OT

OT

Mental Health

Mental Health

Programming for Student Differences and Instructional Processes Consultant: Wendy Malanchen

57

Inclusive Learning

Kathy Muhlethaler SchoolsSupervisor: Treva LunanNewton (780 472 4498)

Supervisor: Leah FraserNewton (780 377 4881)

Baturyn, Brander Gardens, Brookside, Caernarvon, Calder, Dickinsfield, Dr. Margaret-Ann Amour, Earl

Buxton, Evansdale, Florence Hallock, George H. Luck, Glengarry, Killarney, Lago Lindo, Lauderdale, Lillian Osbourne, Lorelei, Major General Griesback, Mary Butterworth, Mee-Yah-Noh, Northmount, Queen Alexandra, Queen Elizabeth, Riverdale, Rosecrest,

Rosslyn, Scott Robertson, Windsor Park

Academy at King Edward, Allendale, Avalon, Belgravia, Centre High, Delton, Dunluce, Esther

Starkman, John A McDougall, Garneau, Grandview Heights, Hazeldean, King Edward, Lansdowne,

Lendrum, McKernan, Mill Creek, Mount Pleasant, Nellie Carlson, Norwood, Oliver, Parkallen, Riverbend,

Spruce Avenue, Strathcona, Victoria

Staff name

Kelly Proudfoot

Kim Unrau

Billie-Jo Scott

Jimi Ogunfowora*

Angie Lorentz (Cerra)

Fadia Moustarah

AHS

Vacant

Jennifer Kwan*

Discipline

Ed/Beh

PSY

PSY

Social Work

OT

OT

Mental Health

Mental Health

Staff name

Susan Miller

Mike Dreimanis

Deb Hunter

Jenifer Fontaine

Paula Blashko

Teresa Pucci-Devost

Ines Cesar

Shila Klann

Ann MacDonald

Carrie Riddle

Lilian Dam

AHS

Vacant

New hire*

Mental Health Team

David Skakoon

TeenaTojo

Danielle Pawliuk

Discipline

Ed/Beh

Ed/Beh

PSY

PSY

PSY

PSY

Social Work

OT

OT

OT

OT

Mental Health

Mental Health

PSY

Social Work

Nurse

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Programming for Student Differences and Instructional Processes Consultant: Jon Carlsen-Sinha

Inclusive Learning

Ron MacNeil SchoolsSupervisor: Laurie CliffordNewton (780-472-4477)

Supervisor: Sharon WoodNewton (780-472-4477)

Athlone, Brightview, Britannia, Coronation, Crawford Plains, Crestwood, Daly Grove, Dovercourt, Edm Christrian West/High, Elizabeth Finch, Glenora,

Grovenor, Inglewood, Kensington, Laurier Heights, Mayfield, MacArthur, Parkview, Prince Charles, Ross

Sheppard, Westglen, Westminster, Westmount, Youngstown

Abbott, Bannerman, Beacon Heights, Belmont, Bisset, Eastglen, Fraser, Highlands, Homesteader, John D Bracco, Kate Chegwin, Kirkness, Lawton, Minchau,

Montrose, Mount Royal, Overlanders, Pollard Meadows, R J Scott, Rundle, Sifton, TD Baker, Virginia

Park, WP Wagner, Weinlos

Staff name

Charlene Roberge

Chrissi Stribling

Pamela Lamash

Tamara Dorn*

Bob Howard

Denise Rice

Karen Kurshed

Angela Rath

AHS

Carla Soto

Discipline

Ed/Beh

PSY

PSY

PSY

Social Work

OT

OT

OT

Mental Health

Staff name

Mike Dreimanis* (All Newton)

Victoria Kish

Christie Ladouceur

Denise Moulder

Mary Fiakpui

Frances Sharon

Jade Bateman

Shannon Ahlskog

AHS

Krista Austin

Mauren Tanyi*

Discipline

Ed/Beh

Ed/Beh

PSY

PSY

Social Work

OT

OT

OT

Mental Health

Mental Health

Programming for Student Differences and Instructional Processes Consultant: Lawana Titiryn

59

Alberta Health Services: Mini-Guide to Community SupportsAddiction and Mental Health - Edmonton Zone

Crisis Services

Community Urgent Services & Stabilization Team

Children’s Mental Health Crisis Line & Response Team

Support Network Distress Line

Family Justice Services

Mental Health Help Line

Kids Help Phone

Bro Talk

Referral Treatment Services

Children’s Mental Health Regional Intake

Adult Addiction & Mental Health Clinic

University of Alberta Psychiatric Treatment Clinic

Information and Support

Health Link Alberta Learning

Canadian Mental Health Association – Edmonton Region

Mental Health Patient Advocate

Catholic Social Services

Schizophrenia Society of Alberta - Edmonton Chapter

Seniors Association of Greater Edmonton SAGE

Family Centre

Aboriginal Consulting Services Association

Mennonite Centre for Newcomers

Multicultural Health Brokers Coop

Caregiver Support

Bipolar Education Group Intake

Anxiety and Depression Group

The Support Network

Family Support Network

780 342 7777

780 427 4491

780 482 4357

780 427 8343

1 877 303 2642

1 800 668 6868

1 866 393 5933

780 342 2701

780 342 7700

780 407 6501

780 408 5465

780 414 6300

780 422 1812

780 432 1137

780 452 4661

780 423 5510

780 424 5580

780 448 0378

780 424 7709

780 423 1973

780 757 0900

780 757 0900

780 482 0198

780 414 6311

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Alberta Health Services: Mini-Guide to Community SupportsAddiction and Mental Health - Edmonton Zone

Alcohol and Other Drug Treatment Resources

Addiction Services

Adult Outpatient

Adult Detoxification Centre

Youth Community Service Outpatient

Youth Detox and Residential

Oploid Dependency Clinic

Alcoholics Anonymous Central Office

Al-Anon/Alateen Information for families and friends

Poundmakers Lodge

Shelters

YMCA

Hope Mission/Herb Jamison Centre

WEAC

George Spady Centre

Edmonton YWCA

Youth Emergency Shelter Services – YESS

Day Treatment Programs

Canadian Mental Health Association – Edmonton Region

Community Geriatric Program – HYS Centre

Eating Disorder Program at the University of Alberta Hospital

Excel Society

Recreation and Social Programs

Canadian Mental Health Association CMHA

Programs for Adults

Challenge by Choice

780 427 2736

780 427 4291

780 422 7383

780 644 1535

780 422 1302

780 424 5900

780 433 1818

780 458 1884

780 421 9622

780 429 3470

780 423 5302

780 424 8335

780 423 9922

780 468 7070

780 414 6300

780 424 4660

780 407 6114

780 455 2601

780 414 6300

780 342 7936

For more information, or if you cannot find the service you want, please callWithin Edmonton – 211

Note: Pocket guides with this info will be in the GO-TO instructor kits. These guides can be handed out to participants.

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Appendix VI – Background Information: AnxietyInformation from: Children Youth and Families – Addiction and Mental Health Education Team, Edmonton Zone

Supporting Students who Experience Anxiety

Anxiety – is the fear about future danger or problems accompanied by unpleasant feelings or physical symptoms. Fear is the emotional response to real or perceived imminent threat. Anxiety is a natural, adaptive and development response.

‘Normal worries’ or anxiety by development stage

Infancy

- in response to a growing ability to differentiate familiar faces (parents) from unfamiliar

- stranger anxiety (clinging and crying when a stranger approaches) – 7-9 months

Early Childhood (1-6 years of age)

- separation anxiety: 1-3 years of age

- new and unfamiliar situations- real and imagined dangers

(e.g. big dogs, spiders, monsters

- age 3-6: what is real and what is not: costumes, ghosts, supernatural beings

- Dark spaces, closet, under the bed, sleeping alone

School aged children (aged 6-12_

- fire drills, burglars, illness, drugs

- social comparisons, social status

- academic/athletic performance

- social group identification- physical and mental health

diseases- safety- moral issues, global issues- future successes

When should you be concerned?

Anxiety is considered a disorder not based on what a child is worrying about, but rather how that worry is impacting the child’s functioning. Help is needed when a child is experiencing too much worry or suffering immensely over what may appear to be insignificant situations, and when worry and avoidance become a child’s automatic response to many situations.

( info retrieved from: http://www.worrywisekids.org/node/70)

Anxiety has three parts: the thought process, the physical reaction and the behavioural response.

Common signs of anxiety:

Thought - If I go to school the kids will laugh at me- Separation is scary- I can’t do this, No one likes me, What’s wrong with me?

Physical

- Red or hot face, bathroom needed, blurry eye-sight, dry mouth, sweaty hands, difficulty breathing, heart racing, upset stomach, trembling

Behaviour

- Tired, crying, needs lots of reassurance, irritable, angry outbursts, selective mutism

- Skips school to avoid embarrassment

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Test Anxiety – is a psychological condition in which people experience extreme distress and anxiety before and during a test. Test anxiety is very common and can interfere with studying. Test anxiety may block performance and make it difficult to recall information that you know.

Appropriate strategies for test anxiety (teach strategies when students are NOT in highly anxious states):

- more tests and more practice with tests in low risk situations- step by step progressions to face fear of test taking- addressing thought processes of “I can’t” - remove disruptive practices during test taking (for example: time-frame reminders, constant of test

expectations throughout the test)- take care of yourself (be aware that teacher anxiety can set off student anxiety)- in non-anxious times challenge anxious thinking: use Thinking Traps and Test Anxiety on page 4 from

anxiousbc.com: https://www.anxietybc.com/sites/default/files/Test_Anxiety_Booklet.pdf- allowing at least 6 months to pass to evaluate if a strategy is working for a students- support physical tensions before test taking through: focal breathing, body checks, exercise- reward brave behaviours when students face their fear of test taking

Anxiety Disorders:

Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioural disturbances.

Anxiety disorders differ from developmentally normative fear or anxiety by being excessive or persistent beyond developmentally appropriate periods. (Note: the anxiety is not developmentally appropriate)

They differ from transient fear or anxiety, often stress-induced, by being persistent (e.g. typically lasting 6 months or more)

Many of the anxiety disorders develop in childhood and tend to persist if not treated.

An anxiety disorder is diagnosed only when the symptoms are not attributable to the physical effects of a substance/medication or to another medical condition or are not better explained by another mental disorder. – DSM-5

Anxiety Disorders and Substance Use – Some people with anxiety disorders use alcohol or other drugs to cope with their symptoms. Anxiety disorders are made worse by the use of stimulants such as amphetamines, ecstasy, cocaine or caffeine.

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Watchful Waiting for School Professionals: Anxiety

- Is the anxiety interfering with the functioning of the individual in various areas of their life?- Are the strategies in place being monitored over a 6 month time frame to assess effectiveness?- Are others reinforcing/strengthening the anxious pathway? Example: giving reassurance in the wrong

way such as – “Yes you are anxious during tests – that’s awful!”- Are the strategies developmentally appropriate?- Is the anxiety developmentally appropriate? - Refer to any psychological/academic testing – be mindful

of cognitive levels and the developmental stage of the student; just because a student is in grade 9, developmentally the student may be functioning at different level

- Are the parents disclosing explosive behaviour at home? Is the student exhausted/ explosive after a long day of school where they have been overly-focused on self-regulation?

Self-reflection for educators: Consider your personal comfort in dealing with students with anxiety. Your personal comfort will impact the effectiveness of the strategies you employ with your students.

How to Support an Anxious Student (adapted from www.anxietybc.com)

(The goal is to reduce anxiety to manageable levels and improve every day functioning.)

- Take care of yourself. Engage in regular self-care. You will be better able to help your students if you take care of yourself first.

- Be aware of your own anxiety; face your own fears and model brave behaviour.- Understand that some anxiety is expected and developmentally appropriate. Educate yourself and your

students about anxiety, including symptoms and impact on learning. - Do not discount a student’s feelings. Learn to recognize anxiety symptoms (e.g. reluctant to raise hand,

ask for help, or do group work; test anxiety; school refusal; clinging to the teacher; reassurance seeking; constant worry) and try to identify possible stressors (e.g. separation, bullying, tests, social difficulties)

- Be supportive. Never minimize a student’s fears or make the student feel bad. Instead listen to the student; let the student know fears are normal and that you will help him/her face the fears. Make sure the student knows it is okay to talk about feelings and help the student use coping strategies.

- Advocate for an assessment of your students to rule out underlying issues, such as learning difficulties. Review the student‘s profile for previous testing, diagnoses or IPPs. Early treatment can reduce the negative effects of the disorder or complications. For example, loss of friendship, failure to reach social and academic potential, feelings of low self-esteem.

- Do a daily check in with anxious students. Provide them a pleasurable activity, of their choosing, when they arrive at school

- Help the student identify a “safe person” in the school that he/she can go to for help managing anxiety if needed. The person should have a good understanding of the student’s difficulties and the coping strategies that the student finds helpful.

- Be aware of community resources that the student’s family may want to access.

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Anxiety: Practical Strategies for School Professionals

Building Assets

- Create a plan with the student and family. It is ideal if the student can identify what they want to work on. Maintain regular, open communication with parents.

- Be realistic with expectations. Remain flexible with the student and help them be successful. Take small steps and do not push the student too hard or too fast. Too much pressure may make anyone more anxious. Support progress, even if it is slower than you expect. At the same time, support your student to push through/face fears.

- Use relaxations and attention-focusing (mindfulness) tools.- Help to challenge negative self-talk.- Use rewards and praise for facing fears. Be clear about expectations, limits, and expectations, and follow

through with appropriate consequences. Give praise when students follow expectations.- Gradually expose student (e.g. partner work, then small group) to anxiety provoking situations.- Modify programming as needed (e.g. extra time) without allowing the student to avoid.- Encourage students to discover creative interventions.- Encourage coping behaviour; discourage avoidance – a negative coping strategy.- Build skills and challenge negative thinking: replace self-critical or perfectionist thoughts with more

realistic and helpful statements: “ Nobody is perfect”, “All I can do is my best”, “Making a mistake does not mean I’m stupid or a failure. Everyone makes mistakes!”

Relaxation Activity: 5.,4,3,2,1

See 5 things, feel 4 things, hear three things, smell 2 things, taste 1 thing. (Seat activity).

Realistic Thinking Worksheet

Situation I’m in a class discussion, and everyone has to contribute.

Worry Thought I’ll say something stupid and get laughed at by the other students.

Worry Rating Worry Rating: 7

Detective Questions (Gather evidence vs. worry thought; use questions below)

What are the facts?

What else could happen?

What happened when I worried before?

What is likely to happen?

What has happened to other people?

I did the reading and I know what the story is about.

Most of the students are not even paying attention and they probably won’t even listen.

If they laugh, it could be that I was actually funny.

Even if they laugh at me, in three days they won’t remember.

I will look even sillier if I don’t say anything.

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Helpful/Realistic Thought I know what I am talking about and the other students probably won’t even notice if I mess up.

Worry Rating Worry Rating: 3

Some Useful Questions for Gather Evidence against Worry Thoughts

From: Helping your Anxious Child: A Step-by-Step Guide for Parents (2008) by Ronald Rapee

Directions: Ask as few or as many questions as you need to gather enough evidence to prove that the worry is unrealistic or unhelpful. Be sure to come up with a helpful thought based on the evidence.

What is the evidence that supports this worry? What is the evidence against this worry? What do I know about the situation? What are the facts? What are the chances that this will happen? (Do some actual calculations) What is the most likely thing to happen? Could I cope if the worst happened? What is the best that could happen? What has happened before when I had the same worry? What has happened to other who have had the same worry? How will this look in a few days, months, years? Are you underestimating your ability to cope with the situation? Can you really control what happens in this situation? (Will your worry make a difference to the

outcome?) What would you say to your friend if your friend was in this same situation

Activity: Perspective Taking: Garbage Can

The goal of this activity is to move rigid thinkers towards thinking outside of their rigid boundaries.

Directions: With a group, describe other ways a garbage can could be used.

Practicing with Students

Promote Coping Skills

Students need to be taught coping skills. Teach organizations skills, problem solving, test taking strategies, teach homework strategies, teach skills for dealing with bullying and teach positive self-talk. Do not assume students know how to cope with these situations. Whole class instruction when possible.

Encourage students to use coping strategies rather than give excessive reassurance. Encourage physical activity. Exercise can help students relax and reduce anxiety.

Transitions

Be consistent; prepare students ahead for change and give plenty of warning time for transitions. Provide anxious students with transition time at the start and end of the day, as well as when their

routine is disrupted.

Exposure

Encourage independence and independent risk taking. Build self-confidence.

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Have realistic expectations. Help the student face fears gradually. Use a step-ladder approach to gradually face fears. Link: http://youth.anxietybc.com/build-fear-ladder

Resources for School Professionals of Students with Anxiety

1. Anxiety BC https://www.anxietybc.com/2. The Relaxation and Stress Reduction Workbook for Kids: Help for Children to Cope with Stress,

Anxiety and Transitions, Lawrence Shapiro, Robin Sprague, and Matthew McKay (2009)3. Teen Mental Health http://teenmentalhealth.org/4. Anxiety Disorders Association of Canada http://www.anxietycanada.ca/english/5. American Academy of Child and Adolescent Psychiatry http://www.aacap.org/6. School Phobia, Panic Attacks, and Anxiety in Children, Marianna Csoti, Jessica Kingsley Publishers

(2003)7. Your Anxious Child: How Parents and Teachers Can Relieve Anxiety in Children, John S. Dacey, Jossey-

Bass (2001)8. The relaxation and stress reduction workbook for kids: Help for children to cope with stress, anxiety

and transitions. Lawrence Shapiro, Robin Sprague (2009)9. Supporting Minds: An educator’s guide to promoting student’s mental health and well-being (2013).

http://www.edu.gov.on.ca/eng/document/reports/SupportingMinds.pdf10. Making a difference: An educator’s guide to child and youth mental health problems (2011).

https://contactbrant.net/wp-content/uploads/files/Professionals/9%20-%20Making%20a%20Difference%204-0.pdf

11. Stressfreekids.com https://stressfreekids.com/12. When Something’s Wrong Handbook from the Canadian Psychiatric Research Foundation (one for

teachers, one for parents). Download or order from http://www.kidsmentalhealth.ca/documents/res-cprf-teachers-2007.pdf

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Appendix VII – Background Information: ADHDInformation from: Children Youth and Families – Addiction and Mental Health Education Team, Edmonton Zone

ADHD – is a neurodevelopmental disorder that affects children, adolescents, and adults. It is a developmental disorder of self-regulation (self-control) and executive functioning resulting in symptoms of inattention and /or hyperactive impulsive behaviour.

- Brains of those impacted by ADHD are neurobiologically different. Considered to be a genetic-based disorder however, environmental factors impact ADHD as well.

DSM-5 criteria:

Symptoms:

- Are present prior to 12 years old- Are present for at least 6 months- Affect functioning in 2 areas (e.g. home and school)- 6/9 symptoms for inattention/or hyperactivity/impulsivity- More frequent, persistent, and sever than what is normal

Students with ADHD are not lazy, bad or choosing to be off task. Their behaviour is a result of their neurobiological condition that hinders their self-regulation and executive functioning.

Signs of Inattention

- No attention to details; makes careless mistakes

- Trouble focusing- Does not seem to listen- Does not seem to follow instructions- Difficulty organizing tasks- Avoids complicated tasks- Often loses things- Easily distracted - Forgetful

Signs of Hyperactivity/Impulsivity

- Fidgets- Squirms- Runs or climbs excessively- Difficulty playing quietly- “On the go”- Talks excessively- Blurts out answers- Problems waiting for a turn- Often intrudes or interrupts others

Girls are often diagnosed later than boys as they often display less hyperactivity.

Executive Functioning and Self-Regulation

ADHD involves deficits in executive functioning and self-regulation. These functions occur in certain areas of the brain such as the frontal lobes and basil ganglia.

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Executive Functions: impacts functioning in social, emotional, behavioural and academic domains. They are “those capacities for self control that allow us to sustain action and problem solving towards a goal”. – Dr. BarkleyVideo link: https://www.youtube.com/watch?v=GR1IZJXc6d8

Executive function generally refers to the cognitive processes that enable individuals to engage in goal-directed or problem-solving behaviours. Executive functioning skills help us perform activities such as:

- Planning- Organizing- Strategizing- Paying attention- Remembering and working with details- Managing time and space

Self-regulation is closely related to executive functioning. Self-regulation is “the ability to manage your own energy states, emotions, behaviours and attention, in ways that are socially acceptable and help achieve positive goals, such as maintaining good relationships, learning and maintaining wellbeing.” Stuart Shanker

Self-regulation is a developmental process. Children will develop more capacity for self-regulation as they learn and grow. Children with ADHD will develop this capacity as well; however, this may develop later and less thoroughly that children without ADHD.

How can ADHD be treated? Treatments may include:

- Medication- Therapy- Behavioural Strategies- School Based Strategies- Supportive Activities

Often, the best approach is to use a mix of treatments that fits the child/youth’s needs.

Role of the School- Recognize the student’s strengths- Observe, document and describe the behaviours that are having a negative impact on the student’s

learning and relationships- Work with the parents/student to set academic and behavioural goals- Offer and support strategies- Monitor changes in behaviour in response to strategies, programming, accommodations or medical

interventionsSelf CareSelf-care is critically important for overall wellness. When a person lacks self-care, it can cause difficulties such as depression, lack of patience, low energy, isolation, disrupted relationships, sense of ineffectiveness, and burnout.

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Practical StrategiesNote: Not all strategies mentioned will work for all children, at all times and for all situations. Find the ones that work best for your students. Remember to work together will all caregivers as to be consistent.

The key to a supportive classroom environment is a teacher who is willing to establish a caring relationship with each student, learn about the student’s individual needs and strengths, and provide the support and encouragement each student needs to be a successful learning.

Students with ADHD will benefit from teachers who are highly organized, plan for challenges ahead, and establish predictable and effective classroom routines.

Look beyond the behaviour:Consider disruptive behaviour as a ‘code’ for something missing.

Problem behaviour = missing skill or unsolved problem

Teaching skills is not enough! The child is suffering from an inability to preform, not a lack of skill or knowledge. It is essential to create a “prosthetic environment and use behavioural strategies to compensate for executive functioning deficits.

Create a Supportive Classroom: Students with ADHD often have difficulties remaining motivated and focused – they need teachers who are highly organized, plan for challenges ahead and establish predictable and effective classroom routines. However, these teachers also need to be flexible and willing to try new ways to teach and assess. Along with flexibility, these students need teachers with high expectations who believe that all students are capable of learning and doing.

- Alberta Education (http://canlearnsociety.ca/wp-content/uploads/2014/10/focusing-on-success.pdf)

□ Be proactive in managing behaviour□ Establish, post, review class rules□ Monitor regularly□ Build relationships with student□ Catch being good: 4:1 praise ratio□ Assist during transitional times□ Agree on a behavioural cue□ Use problem solving approach□ Teach waiting strategies (like writing down questions you want to ask before asking)□ Avoid distracting stimuli□ Allow for time outs and breaks□ Movement breaks□ Appropriate fidget toys/headphones□ Wiggle seats□ Do not take away exercise activities as punishment

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Working MemoryWorking memory is the mental workshops where information is held processed, and manipulated for the purpose of achieving a goal. Deficits in working memory impact academic performance.

Working Memory Accommodation Strategies: Externalize□ Write main points/instructions/homework on board□ Provide written outline□ Have student repeat instructions/homework□ Reduce distractions when giving instructions□ Use multi-sensory cues in instruction□ Maintain homeworks assignments on e-teacher page□ Make eye contact□ Make instruction interactive – Use real life examples□ Teach memory strategies (mnemonics, rehearsal)□ Regularly review concepts taught/test more regularly using quick, short evaluations□ Give frequent reminders for due dates □ Encourage student to use checklists, to-do-lists, agenda and then check it!□ Externalize problem solving and make it ‘physical’ or hands on when possible

Time ManagementTime escapes children with ADHD as they struggle to use their internal sense of time to guide behaviour. This is often referred to as ‘time blindness’: it is hard to look back or forward because the NOW is more compelling. This causes students to struggle with the delaying gratification, organizing, planning and prioritizing.

Time Management Strategies: Externalize□ Teach organizational skills□ Have routines□ Practice time estimation□ Use analog clock□ Set a timer□ Identify punctuality as a goal□ Ensure student starts task as soon as possible□ Give transitional time warning□ Write to-do list□ Use agenda/planner□ Write out class schedule (visual cues)□ Plan according to attention span; plan breaks□ Organize workspace to reduce distractions.

External Motivation□ Can be non-verbal (reward) or verbal (praise)□ Add artificial/external consequences (rewards) often (can be done class-wide) - Token/points- Privileges□ Change rewards often; choose meaningful words□ Have student visualize the goal and reward

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□ Use pictures of goals and rewards

Reward systems can be one of the most powerful strategies that you can use. ADHD students are punished more often. Rewards are more effective than punishment.

Reward Strategies:□ Catch the student being good□ Provide regular feedback on behaviour/progress□ DO NOT take away recess as a punishment for student with ADHD□ Use external motivation through rewards

Praise:□ Praise will increase the likelihood they will repeat a behaviour again□ Label the behaviour you are praising□ Praise as close in time to the behaviour as possible

Social SkillsSocial skills are just as important as academic skills for success as they allow children to establish positive relationships, negotiate social norms, and learn from experiences. Social skills foster social-emotional development. We are not born with social skills. Some children may learn these skills naturally but others do not.

Link to the Collaborative for Academic, Social and Emotional Learning (CASEL): http://www.casel.org/

Social skills must be taught to EVERYONE:□ Demonstrate a skill□ Practice with student; role play□Observe student using skill; provide feedback□ Reinforce the use of positive social skills

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ADHD Resources

Alberta Education, “Focusing on success: Teaching students with Attention Deficit/Hyperactivity” Disorder (2006), http://canlearnsociety.ca/wp-content/uploads/2014/10/focusing-on-success.pdf

American Academy of Child & Adolescent Psychiatry, http://www.aacap.org/

Canadian ADHD Resource Alliance, http://www.caddra.ca/

Canadian Attention Deficit Hyperactivity Disorder Alliance (CADDRA), http://www.caddra.ca/

Collaborative Mental Health Care, http://www.shared-care.ca/

Dr. Russell Barkely; “Classroom accommodations for children with ADHD”, http://www.russellbarkley.org/factsheets/ADHD_School_Accommodations.pdf

Incredible Years, http://incredibleyears.com/

Ketly Mental Health Resource Centre, http://keltymentalhealth.ca/

Learn Alberta; “Medical/disability information for classroom teachers: Attention Deficit/Hyperactivity Disorder (ADHD)”, http://www.learnalberta.ca/content/inmdict/html/adhd.html

Learning Disabilities Association of Alberta: https://www.ldalberta.ca/

Books: ADHD: What Every Parent Needs to Know, American Academy of Pediatrics (2011) Executive Skills in Children and Adolescents, 2nd Edition, Dawson and Pegg (2010)Taking Charge of ADHD: The Complete, Authoritative Guide for Parents, Barkley and Russell (2011) Treating Explosive Kids: The Collaborative Problem Solving Approach, Ross Greene and Stuart Ablon (2006)Smart but Scattered, Dawson and Pegg (2009)

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