ECCChild & Adolescent Mental Health Crisis ServicesMonday, April 26, 20211:45 P.M. ETRemote CART/Captioning

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>> KELLE MASTEN: Good afternoon and welcome to today's webinar titled Child & Adolescent Mental Health Crisis Services. Sponsored by SAMHSA and presented by Mental Health America.

My name is Kelle Masten from the National Association of State Mental Health Program Directors. And I would like to thank you all for joining us today.

Before we begin, I would like to go over a few housekeeping items. Today's webinar is being recorded. The recording, along with the PowerPoint presentation slides, will be sent to you via email within three to five days to all of those who registered. However, you may download the PowerPoint presentation slides now for your convenience. At the top of your screen where it says PowerPoint presentation.

Please click on upload file to download the slides. Please know that all lines are currently muted. If you are having any technical difficulties during this webinar, please type your comment in the Q&A pod on the right side of your screen and someone will be able to assist you.

Please also type your questions for the presenters in the Q&A pod. And at the end of the presentation, we will ask as many questions as we can.

At the end of the webinar, we ask that you take a few moments to complete a short evaluation for us.

Please know that we do not offer CEU credits for our webinars but we'll send you a letter of attendance upon request. My email address will be available at the top of the screen during the evaluation.

I would like to thank SAMHSA for allowing us to share this information with you today. And again, thank you for joining us.

Today's presenters are Ali Martinez, director of Alachua County Crisis Center. And Dr. Amanda DiLorenzo-Garcia, Mobile Response Team coordinator at Alachua County Crisis Center and our moderator today is Theresa Nguyen chief mental health officer. Thank you to today's moderators and now we will begin the presentation.

>> Thank you, Kelle, for that introduction we're really excited to be here with you all today a little bit about our learning goals today we're looking to talk about mental health professionals and what we need to talk about effective mental health treatment for suicidal youth. We'll talk a bit about non-suicidal self-injury. A large component is about what we want to talk about today is how families can support their child at home after a mental health crisis. And then how we in communities can work together to provide care for youth in crisis.

>> Yes, we are really thrilled to be able to share this information with everybody today. This is a topic that we're very passionate about. And really excited to share our expertise and our experience in working with youth and families.

On our agenda today we'll be talking about the Alachua County Crisis Center a bit and the services that we have for youth. We'll be going through and talking about the prevention services, the intervention services, post intervention services. And each piece in there and how they fit into the broader puzzle of working with families. And you'll hear us referencing a lot about the continuum of care. And how important it is to have large wrap-around services for families working with youth in crisis. It's not just one piece of the puzzle. We have to look at the whole thing. A little bit about the Alachua County Crisis Center and where we're located we're in Gainesville, Florida which is in North Central Florida we are County is approximately 270,000 and we're a university town, go Gators. Within that that comes with all of the things that a college town comes with. You'll hear some about our volunteers who do a lot of our direct services at the Crisis Center. And many of them are involved with the university in one way or another. But we're also surrounded by a lot of rural communities that don't have access to many services. And especially mental health services.

So we're really serving a broad varied population in our area. And we are always having to be very mindful about what that means.

Some people have a lot of access to resources. And other families have almost none.

We're really thrilled that the Alachua County Crisis Center is able to serve our community and all of the services that we offer are free. To go through a bit of the services, we are a 24/7 crisis line. We are a part of the National Suicide Prevention Lifeline. The 24/7 youth families anybody in any kind of distress can reach out to us. That's really important to us. Crises don't just happen, you know, business hours. They happen at all times. And one of the most important aspects of crisis intervention is that

people be able to Access Services immediately. And so with that crisis line, people can reach out to us and have a trained crisis counselor respond right away. And really hear out what's happening for them and what they need.

From there we're able to offer quite a bit. We do have our Mobile Crisis Response Team, which we'll talk more about in depth later we also offer free clinical services, counseling, family counseling, we have a survivors of suicide support group.

And then we do quite a bit of outreach and education on crisis intervention and suicide prevention in our community.

So we really believe in providing a full continuum of care in our community, both on the very upstraight side and making sure people are having conversations about crisis, about mental health, and then making sure that when people are in distress, they have a place to reach out to. And that we are making sure that we can work collaboratively with them to provide the right kind of service at the right time.

And that is really key. The collaboration piece. And we'll talk quite a bit about that. What it looks like for us in terms of, you know, our traffic and how busy we are, we

get approximately 3500 calls a month on those hotlines. Like I said our phone counselors are volunteers. They go through really extensive

training three times a year. And provide a minimum of six months commitment. And it's a really amazing thing. We really find people who are passionate about helping others.

And what we found as our call volume from youth has really gone up over the last five years. Is that we're having to focus much more on child and adolescent mental health issues. And really focus a lot of our training and conversations on how do we work with kids who are in crisis. How is it different? How do you respond to a youth who is in distress and struggling and does not have the same power or resources that an adult might. And that is a really critical part of this conversation. Is making sure that we know how to respond in what ways we have to respond differently to a child that's in distress. We also provide mobile crisis response. Which again we're very proud of that program and you'll hear quite a bit about that today.

Amanda.>> DR. AMANDA DiLORENZO-GARCIA: Yeah our work really begins before crisis

or incident occurs. Part of our work is really connecting with the community beforehand so we have some type of rapport or trust so we can reach people in those difficult moments.

What that looks like is we have really strong connections with school personnel. We stay really well connected to the lead guidance counselor in the School District through Alachua County through my role at the center and other peoples' roles at the center we really keep communication with school counselors who reach out to us. Sometimes that looks like a consultation call when they are concerned about a student, before an intervention takes place, and sometimes that looks like a call after some type of session takes place where that school counselor or school personnel can debrief

about what has occurred it builds their trust with us and our rapport with them to know what they are worried about specifically. We work to build relationships with co-responder teams in the area which are law enforcement that have a mental health professional that go out with them. So we keep relationships with those folks, as well.

And so they are really good about calling us for continued care or for care teams to come out to people when they feel like that's appropriate.

Then we do other outreach, as well, so we'll do presentations at schools or at community events. Then we have something that we're really proud about is we have a symposium that we do every year. It's usually focused on youth mental health.

This past year in 2020, we expanded it to be about wellness, health and wellness in the age of COVID-19 and it was a virtual platform for the symposiums we had over -- we had over 300 people attend through the week we hope to continue that as well to get mental health information out to the public for free.

>> ALI MARTINEZ: I'll jump in here, what we have found when we started really digging into how we want to focus on child and adolescent mental health in our community is the importance of collaboration. And communication.

That we can't go at this alone. And we have to learn how to communicate amongst the partners and communicate with kids. Really providing the space. I think oftentimes we're so much about trying to figure out what the answer is and how to fix it and we forget to really focus in on just having conversations whether it's among mental health partners and organizations or with the families themselves.

>> DR. AMANDA DiLORENZO-GARCIA: Absolutely. Yeah, there's many parts to this. And a little bit more about what we do in terms of

prevention is education and psychoeducation. So as Ali mentioned before, we have incredible volunteers that work for the center

who are highly committed, have a six-month commitment minimum but often connected to our center for years. So they go through a six week Training Program built about psychoeducation and lecture materials as well as role plays and hands-on activity for experiential learning. These volunteers start off on the phones. And as they spend time with the center and get more mentorship and training they have the opportunity to go out into the community as well and be part of our Care Team for crisis incidents that might happen so they are responding to the community, as well, alongside more trained volunteers and staff.

Another initiative that we have is our critical -- our Crisis Intervention Training for law enforcement. This is something our center has been doing for many years. And it's typically a week-long Training Program which again includes lectures and experiential learning scenarios. Our volunteers help to run this program as well as staff and oftentimes the law enforcement officers that we work with, we see them grow quite a bit in this week in terms of how they respond to the role plays that we do, which is an incredible thing to watch and observe.

Part of that work is so that volunteers and our law enforcement are all trained and aware about how to respond to youth, as well in crisis so it's a general training in terms of all community members. But we also have specific components that are for youth for them to be aware of.

So in terms of intervention as Ali has mentioned is our mobile crisis response teams. And this is something I'm personally incredibly proud of that we do. So we have 24/7 care teams as we care them or Mobile Crisis Response Teams that can go out to the community. So we offer ondemand crisis intervention services in any setting so it can be at a school, at someone's home, outside in public sitting on a curb, wherever a person is that they need support is where we'll go.

And so even in the midst of COVID-19 this has changed and it's continuing to change in what it looks like but we offer both in-person services like I said at a school, at Publix wherever the person is and needs support and telehealth services and that's been amazing to be able to access people in the moment so oftentimes our schools might reach out to us or a school counselor might reach out to us saying hey I really want someone to meet with the student however our last bell rings in 40 minutes in order taking the time to drive there we are able to jump on a independent living health visit with the student and have that full 40 minutes to spend with them which is incredible to be able to do that and I'm not sure a year ago we would have thought about doing it that way so our Mobile Crisis Response Teams are really valuable in terms of how they get to reach the community both in-person and through telehealth.

We also have -- we look at our care terms in terms of postvention as well sometimes being out there with folks and responding to a student or a person in the moment of a crisis is actually preventive of a larger crisis.

A person being able to talk about their suicide ideation or their grief or whatever is occurring for them in that moment can be preventive in nature in that they feel like they have a space. They are now connected to a resource. And they can get their hands on more resources too in that time. It's a beautiful way to look at our teams going tout and responding to people in our community, especially youth who may not know about the resources or feel comfortable about talking with certain topics with our mobile crisis response we always have follow-ups within 72 hours so that can look like a phone call or a clinical session. For example I worked with a student last week on Friday and scheduled between the school and the parent a follow-up, a clinical follow-up session, for today. So those are common to get follow-up sessions to check in with them to feel supported and discuss next steps of care we also provide debriefings to communities so after large community events, it could look something like gun violence or suicide completion where we need to respond to a business or to a school, we'll go out and do that, as well, to be present with people in that time. In case they want to talk or need to process what's occurred.

>> Yeah this is something we're really passionate about, as well in terms of not only

looking at the individual response, the family response, but the broader community, the broader system.

And making sure that our entire community feels helped and supported when they are experience crisis within their family or whenever there's a community crisis. And this is -- this has included COVID-19. We have a Disaster Hotline. That has been up and running since last March to provide people support and information regarding COVID-19 in our community so for us regardless of what the event might be we find it critical part of prevention intervention and postvention to make sure that families, individuals, organizations know there's a place they can go to to have a conversation and get support around whatever trauma might be happening.

>> Absolutely. And something that we're really big on, too, is connecting youth and the community at large with any other referrals or resources that might be helpful for them. So we have an incredible system within ourselves in terms of being able to respond in the moment to crisis. Having the phone lines. And then having clinical services, family services. And suicide survivor support groups.

However, we also do other referrals, as well, to other community agencies. And so ways that we do that are people -- agencies that we do that with at times we do use crisis stabilization units if it's absolutely necessary. We'll recommend people to our counseling services at the Crisis Center. If they are open to that rather individual counseling or family counseling. Oftentimes when I'm working with an adolescent or youth, I have a conversation around family counseling. Oftentimes that youth does want their family to be a part of it. Whoever their family is so that they can be better understood within their context. Sometimes, however, individual counseling is best for that person. And so that's what we recommend or talk about.

We'll also refer to organizations like NAMI for support. Often when I'm working with a youth who is going through suicide ideation or any other type of mental health crises when I have the opportunity to talk to their parent or caregiver, it's very hard to hear about their child or the person that they care about going through this. So I like to make referrals for them, as well. And NAMI has wonderful parent support groups. And so I talk about that with them. Any way to support this system of a youth is really important to us. So we'll connect them to whoever, whatever agency in our community can best do that.

>> We want to move on and talk about effective mental health treatment for suicidal youth and youth in crisis in general.

And this is a question that comes up often is, you know, where do we direct youth and families to get the right kind of help? And as we were preparing for this, one of the things we were talking about is that we found the most important thing is getting the youth and the family engaged in services to begin with.

Once they are engaged with services from there, there may be more specific recommendations that have them. But oftentimes, lack of resources, in the community,

or if there are financial challenges, it's often that families don't necessarily have a choice on the type of services that they are seeking out but it's just critical that they get something.

And so that may happen through the school. That may happen through other community mental health agencies.

But what's critical is that we establish care early for youth that are in crisis that are suffering from a mental health concern. Having suicidal ideations.

And that can start as individual counseling. That can lead into oftentimes family counseling is really important so that the youth feels supported in navigating their stressors, their struggles, with the entire system.

There are other types of programs like intensive outpatient programs. As there may be times where hospitalization is indicated.

Or psychiatric services. We've seen sometimes that people may lead to the idea that a child has to be hospitalized or some other kind of intensive program and that's why our Mobile Response Team and crisis intervention services are really, really lovely. Because we can respond to the crisis situation, really do a thorough assessment with that child, with that family. And establish some safety planning. Establish some immediate care. And really only look to inpatient hospitalization as kind of a last resort. Are there times that that's indicated? Absolutely. But oftentimes with the appropriate risk assessment and support, we can keep kids at home with family support as they are navigating their crisis.

There are other types of therapy approaches that may be helpful. Especially younger kids, play therapy can be a wonderful way to get a child engaged into therapy services. And in general there's much more of a shift towards trauma-informed approaches. Along all kinds of treatment. And we'll talk more about trauma and the impact on the child and the family and the importance of recognizing that as part of what may be happening for that child.

Questions to consider when referring a child or family to treatment. What is the acuity? What's the need for immediate care and assessment? What is the child and family saying they need? I think this is a piece that's really easy to miss and often gets missed. I think we're used to working with children in such a way that the adults get to dictate that's what happens and oftentimes that's what needed but we really forget to listen to that child. We work in such a way that we try to honor the child's voice as much as possible, get them as much space as possible to tell us what is happening for them, what they feel like they need. And sometimes they don't know but oftentimes creating space for that conversation leads to some really important information about the type of care that they need.

So creating as much space for that as possible. And what resources are available. Again, sometimes you know it may be -- you

may be limited about what is available in that community, by finances.

There are times where schools are able to offer some more expensive mental health or social work services. And then looking at what kind of follow-up care is available. As Amanda spoke about our follow-up program is a really key part of what we do. We really believe in making sure we are connecting up with families after we have intervened. To make sure that they are getting connected to the right services. And that they feel held and supported. Not just in the moment. But in the long term.

And what type of counseling would be best whether it's individual family and what might -- at what the patient has indicated what might be the possible benefits and risks and impact of hospitalization. Again all of this takes time. We know we are really lucky in our community and in the Crisis Center to be able to have the space and time to be able to have these conversations and really think thoughtfully and collaboratively about mental health care for each child we're seeing. We know we're lucky with that but a lot of our training and for law enforcement and with schools and so forth is helping systems figure out how to take that time to establish good collaborations of care from the beginning. So we're not rushing through to make decisions that may ultimately not be helpful for that youth or that family.

So we want to take some time, too, to look at what youth are facing. As we are working with kids today and seeing what they are having to navigate, it really blows my mind what they have to carry.

We all in the past year have had to deal with the stress and struggle of COVID-19 and youth are certainly not an exception to that we are seeing that stress from families absolutely trickle down. Seeing that show up in youth in different ways. And even for youth themselves, navigating -- doing school online or hybrid. Being disconnected from friends from their own community. The difficulties that come with that.

And then in addition to COVID, just in general the divisions that we have seen and the impact of systemic racism. Financial issues with families. Family stressors. Bullying and cyberbullying, that's huge and that's something we hear quite a bit about when we're working with youth, the impact of those stressors, those struggles with other kids, with their peers.

And cyberbullying. What it means for kids when that can happen 24/7. In the past you came home from school and anything that happened in school stayed in school. But not anymore. With the internet, with social media, kids are vulnerable 24/7 to potentially be in emotionally stressful situations via the internet. And then increased academic pressure.

Those are the types of things that we are hearing from kids. And we know that this list could have gone on and on.

And this is one of those places where we really want to pause to say, take the time to listen to youth. Take the time to hear what they are struggling with. It's not easy to listen to kids and their pain. And we'll talk about that. But this is one of the most important aspects of mental health treatment for youth. And often what we have seen is

the most difficult for both providers and for families is sitting down and having these conversations about what they are facing.

We know that youth are also struggling with mental health in addition to the crises facing their families and their environment, there are also mental health problems they may have facing including mood disorder, anxiety, ADHD. And eating disorders. These are common disorders that we see in youth. And often go undiagnosed and unaddressed for a variety of reasons.

Oftentimes youth may be not quite understanding what it is that they are experiencing. What they are feeling. They may feel a lot of shame around it. So they may not be talking about it. This is, again, it goes back to the importance of having conversations with youth early about their emotional well-being and their health. Really from the beginning, from when they are very young, having time taken to develop emotional literacy.

Help them talk about good feelings, bad feelings, confusing feelings. Help them have voice and language. So that if they do have struggles, they have

foundation on which to have a conversation and reach out for help. >> DR. AMANDA DiLORENZO-GARCIA: We want to be aware of Adverse

Childhood Experiences or ACEs which are potentially traumatic events that occur throughout someone's childhood. So on the screen there are examples of those. Oftentimes it's youth experiencing violence or neglect it can be a parent or loved one who is institutionalized or in prison or someone who has mental health issues of their own within their household. There's many examples of what ACEs are but it's important to understand contextually what this child or youth has experienced throughout their life thus far so we can be supportive in all means. And this can really go into how we look at their mental health holistically and how we look at their referrals, as well. So you might reconsider things and talk to the school about mentorship programs. Or having school social workers meet with them throughout the day at school, if that's going to be supportive for the youth. We really want to be more aware of what they have gone through to have a trauma-informed approach to the work we're doing with any individual youth.

And we also have to be aware of what that trauma can lead to. So there's some examples up here of what happens in trauma. Oftentimes when I work with a youth in immediate crisis or acute crisis situations I let them know about some of these impacts that are trauma impacts because oftentimes within the first 30 days of experiencing a crisis, some of these are relevant for that youth.

So things like nightmares or feeling more inclined towards self-harm or behavioral changes. Feeling sleepy throughout the day. Not being able to pay attention in the ways that they normally do.

So being aware of this after an acute crisis is important. And also being aware of these as trauma responses so that when we're working with them and advocating for

them in terms of how we talk to their school counselors or school teachers and personnel that we can bring up some of these are trauma responses for a student how it might be affecting them in their work and schoolwork and other systems that they are in, how they engage with their family. How they engage with sports teams that they are a part of or whatever it might be. Being trauma informed kind of seeps into other parts of this youth's life and helps us be able to discuss with them how it affects them and discuss with their systems as appropriate how it's affecting.

We're going to take some time to talk about youth non-suicidal self-injury. To begin, this topic has a lot of taboos surrounded by it as adult mental health professionals, as parents and caregivers some of us ourselves or while we're working with parents and caregivers or working with teachers in the community or those that are encountering a youth who is engaging in non-suicidal self-injury it's scary it's really scary to think that a youth is harming themselves and not being aware of why or how it started or when it started.

So that taboo that's around it that it's bad, that it means a certain thing, all of that stops us from having a really fleshed out conversation about what's going on for this youth. So that's the most important thing is that when we find out that a youth is engaging in non-suicidal self-injury or just self-injury in general, self-harm behaviors that we want to have a holistic conversation about what's going on for this person.

What does this mean for the youth? And that's commonly what I end up talking to them about is, hey, what's going on for you? What does this behavior mean for you? And I tell them I can't put words to it for you. It means something different for everyone. So I can't assume what it means for you, either.

And usually that really opens up a door to talk about what it means. For some of the youth I talk to it's relief from the pain inside. Some of them it's them wanting to hurt themselves to kind of punish themselves in some way. There's all different types of narratives around this so exploring that narrative is powerful and door opening and often relieving for the youth to engage in that conversation to know it's okay to be talking about this to a safe adult.

We want to explore what triggers the behavior so they can become more aware of what's causing them to engage in it. Over time we can't expect them to disengage in this behavior immediately. We want to make sure that they are safe and that they are not going to -- it's not going to lead to suicide. But we also can't take it away immediately. We have to talk to them about what the triggers are, what other healthy coping there is to replace this behavior over time.

So for me and the work I've done it's a very explicit conversation around these things. It's also a conversation about what is their intent or non-intent for suicide risk. Are they looking to die is that something that they desire because of the pain they are in or how they are suffering or is this a behavior that helps them to deal with their life in some way.

So it's a really hard conversation. Most of the time it's scary initially. It's terrifying for the parents and caregivers the ones I work with to hear about oftentimes school counselors are also really worried about it when it comes up but this conversation in and of itself is just so important and powerful to have. And from there when we collect information about what this behavior means for the person and what their intentions are behind it and what they are actually doing and engaging in, from there we can make decisions about safety and next steps with them. And take -- go along with them on their journey for healing.

>> ALI MARTINEZ: Absolutely. And it's something that really requires immediate and professional care just because we want to make sure that that youth is safe and even if there's not an intent of serious harm, just the concern that they may accidentally really hurt themselves. It is important that any sort of self-injury is taken very seriously.

>> DR. AMANDA DiLORENZO-GARCIA: We don't want to overlook anything like that.

And while we're talking to youth, kind of to move into this, the things we want to be listening for are self-harm we want to be listening to what that looks like for them to open up a door for conversation of course. We want to be listening for apathy. Apathy, it's really scary when someone is engaged with themselves. We want to be paying attention to that. A preoccupation with death and dying is also important to be aware of. And as you look at this screen and see some of these things listed a lot of these will come up in general conversations about with open-ended questions about what's going on, what are some things that you're feeling or going through right now.

And so these are context clues to say, hey, there's some red flags here. Let's talk about suicide ideation. Let's talk about if they are thinking about killing themselves, let's open the door to that.

Because some of these things can really lead to that conversation and awareness of them pouring into that conversation.

And when we're working with youth, it's so important to build trust quickly with them. I often start conversations with them as I know I'm the stranger to them that they have met their school counselor before probably. They know their parents and caregivers in the house. I know it's weird to be talking to a stranger. And I'm also asking them to do that.

So usually they really appreciate that honesty or they will crack up or laugh a little bit about that because I'm just being honest you're here to talk to a stranger we're told from when we're really young not to talk to strangers and here I am a stranger asking you to talk about really scary things so it's intuitive so let's start with the honesty around that and start to build a relationship. I use a lot of empathy and I think we all at the Crisis Center use a lot of empathy in the work we do. With youth especially I feel like that comes in. Using empathy even more to kind of get them to understand that we're there with them. in their moment of difficulty we're not there to judge them or make a

plan without them we are there for the moment and we are holding space for them. Be a witness for whatever they are going through and just bear witness to it with them.

Using compassionate curiosity. This is a phrase we really love at the Crisis Center. That we're wondering. We're curious. We'll make statements around, I'm really curious about this thing that you might have said. I'm really curious about this aspect.

And it's just to open the door to more conversation and understanding between us and the person that we're working with.

We want to of course use open-ended questions to let the person express themselves freely and then also addressing taboos. Especially when I work with youth. But also the population in general, our general population, it's naming taboos that come up.

So oftentimes it's saying, are you thinking about killing yourself or committing suicide? Let's talk about self-harm. I noticed this. Or your school counselor said you might be engaging it in this way. So it's naming some of those taboos because it's really hard for folks to name them for themselves or know it's okay to talk about so we can be the ones to put it on the table and look at it, talk about it and have a conversation around it.

>> ALI MARTINEZ: So we want to address a little bit the barriers to listening to youth in pain. And again, you notice the theme probably in terms of really pushing the idea of connection. Empathy. Conversation with youth who are struggling.

The other side of that is for adults, for family members, for healthcare providers, for mental health professionals. What it really means to sit down with a youth and listen to their struggle. Listen to their pain. Listen to the things that they have had to carry. And how difficult that could be.

You know, so that often, the impact of the stories sometimes leads us to want to sort of shortcut the conversation.

So these are some conversations to listening to youth or really to anybody in crisis. One is we sometimes come in with assumptions. We come in assuming maybe right away what that child needs to be able to feel better. Right? That ties in with the last one our desire to fix. Sometimes we come in just sort of quick with our ideas about what might be happening. And those ideas may be right. You know, we may have a pretty good handle on what's happening and what the kid may need.

But if we jump on that too quickly, we're going to shortcut that conversation. We're really not going to get that kid the family the time they may need to talk through what is happening for them. So we have to really be careful with the assumptions and the impact of our assumptions.

There's also just the stigma. The stigma that comes with talking about suicide. The stigma that comes with talking about self-harm the stigma that comes with talking about mental health in general.

I think that's shifted over time somewhat. But it's often really difficult. And we have

found with families that they sometimes really struggle with breaking through old ideas and old narratives about what it means to talk about mental health, what it means to talk about feelings.

So it's important that we ourselves are aware of what are the narratives that we have around talking about suicide. About talking about mental health. And how do those help us or hurt us when we're talking to kids who are struggling.

And also looking at and being aware of our own fear, just our fears of talking with kids who are struggling. Our fears of saying the wrong thing. Our fear of the worst outcome.

How does our fear get in the way? And again, shortcut us from those conversations?

And what may be in our own story. Perhaps our own trauma. Our own paths might come up to keep us from fully engaging and fully having empathy in these conversations.

And our desire to fix. Again, our desire to kind of make something happen quickly. We all struggle with these barriers. And it's important we take a look whether we're

a mental health provider or family member, whatever our role may be to really take a look at so what might make it difficult for me to listen to my child, to my client, what are the things that sometimes get in my way to really opening up space for full conversations. As Amanda was talking about building trust, sometimes with kids that takes a little bit longer. You know, sometimes it's sitting in silence for an hour before that kid is going to feel comfortable opening up. And that silence can be really uncomfortable.

But it may be exactly what that kid needs to be able to work up to sharing what's happening for them.

If you imagine a child living in a very chaotic unstable environment where they have had to really hide their feelings. They have really had to hide their struggle. Just to survive. And suddenly we're trying to open up a conversation about all of those feelings.

And all of those things that they are going through. That's going to be a big leap. And so we need to be aware of the context of what that child may be experiencing

and how it may impact them as we're opening up those conversations. So slowing things down, having an awareness of where we're coming from. And

really making sure that we're addressing those barriers so that we can create as much space as possible for that child.

And then for us, we're always then looking at how we bring in the family. And when we're bringing in a family to work together with that child, and look at the

whole system. One of the things that we found is sometimes families are going through their own struggle. Their own crisis.

And it may take some time and a lot of support for that family to just have the space

and the bandwidth or the conversation. If getting a call from the school that your child is really struggle and is talking about

self-harm or suicide, it's terrifying. And so we have to have empathy for, you know, what that means for that family, for that caregiver, to hear that news. And really, again, slow down. Take time to help that caregiver and that family build the bandwidth, build the space to be able to engage in that conversation. Hear what is happening. And begin to develop a plan for next steps.

We find that that's a key piece. Again, we can't go in with assumptions about what this kind of conversation means for the family. We really have to go in with the same care and empathy that we give to that child, go in with that same care for working with that family and help them sort of know that they are held and supported as we navigate this and help the child.

>> DR. AMANDA DiLORENZO-GARCIA: If I could add, oftentimes when I talk with the parent or caregiver about what's going on, I always let the youth know first that something really important about how we approach youth is we talk with them about the conversation we're going to have with their caregiver or parent. And if possible, have them be a part of it. And lead that conversation. So kind of summarize what's already been talked about talk about the next steps that we have talked about whatever it might look like or whatever but whenever we have to have a one-on-one conversation with the families or caregiver oftentimes powerlessness and the desire to control and fix comes up because some of the phrases that we'll hear is I never wanted this for my child or I can't believe this is happening. I do the best I can. Those types of things.

So we really want to be there for the parent and guardian, caregiver, as well, and sometimes that looks like making referrals, also, so I'll suggest that counseling is not just for someone who is having a hard in terms of their child or youth. But also for them who are trying to cope with all of the responsibilities for their life and being there for other people.

So we kind of encourage a whole system of support, again, while we do those check-ins and bring in the family to surround and support the youth.

>> ALI MARTINEZ: So we want to make sure to also remind everybody to consider sociocultural considerations. And the different ways in which a family may look.

So we really want to be careful with our language to not make assumptions about who lives in the home. Who the caregivers are. And you know what that youth -- how that youth may define family. They may define family, parents, caregivers, as people who don't live in the home.

Who are not their biological parents. So we really have to -- part of listening, part of connecting, is making sure we understand who is in this child's life. Who do they consider the people who trust and care for them. And of course we're having to navigate sort of legal guardianship. And permissions. And all of that.

But we want to honor also who this child may feel plays an important part of their

life. And just language in general. We want to make sure that we're not making assumptions about gender or sexuality.

Really offering as much space and broaden out our language so that that child feels that regardless of their identity, what they may be facing that there is all of the space in the world. You know, if we lead with making assumptions with gender or sexuality or family, we may lose rapport pretty quickly on the front side.

So really making sure that that youth knows that regardless of who they are, what their family is like. And how they identify that there's space for all of that.

They will be honored. And caring for a suicidal youth and youth in crisis this will be a little bit of a review of

some of the things we've been talking about. And you've heard of stress, the importance of collaboration that for us making it client focused and collaborative when possible.

That just because we're the experts doesn't mean that we have to come up over top of that child or that family. To tell them what is best. We may have recommendations. But we really as much as possible want to build that relationship with them so that the care is collaborative. And youth in the family are much more likely to engage in services when they have been a part of that process.

And we want to make sure that we're doing all we can to be culturally competent. And again, careful with our language. It's systems based. We're look at the entire picture. Not just the child. But the child within the family. Within the community. And within the broader world. You know, we can't -- for example, we can't ignore what's happening with COVID when we're talking about a family that is in crisis. We have to look at sort of how does that system -- how is that system managing this broader crisis. And how does it fit within the system.

Empowering and educating families. This is really key helping families feel -- have the knowledge and feel empowered to be able to help that youth navigate that mental health crisis.

Looking at counseling and psychiatric care/assessment, as needed. Collaborative safety planning, again working with the youth, with that family, with the school, altogether to figure out next steps and what's going to keep that child safe.

We want to do thorough response and assessment. For us that looks like working with the youth, working with the family, working with the school.

School Resource Officer. Dean. Teachers. We want to know who are the people in this child's life that may have important

connection and information to help us do a very thorough assessment. And safety plan. You know, we may not think about say a child's teacher, their science teacher, as

being sort of involved in their mental health care. But if we ask the questions and we give time for it, we may find out that that science teacher is a key mentor for that child. And keep part of the piece of keeping that child safe. And that child feeling supported.

We want to make sure our care is trauma informed, keeping in mind what have been the experiences of that child what traumas may they have experienced and how has that trauma impacted them.

And again, follow-up care. This isn't just here now. It's what's the next step, staying in touch with that family whether it's the provider, the school. How are we going to make sure that they don't fall through the cracks and they get the care that they need long term.

Amanda do you want to talk about supporting the child at home? >> DR. AMANDA DiLORENZO-GARCIA: Absolutely. So after a mental health crisis

and after we get the opportunity to work with the youth, we want to make sure that we prepare the family and the youth for what's to come. Being aware of their triggers is at the forefront of that of what brings the behavior on or what's causing them to feel like they want to self-harm or be in this predicament that they are in. So helping them to understand it. Helping their families to understand it. We want to safety plan collaboratively with them and their family. Oftentimes this looks like a conversation with the parent or guardian or caregiver about removal of means that the youth might be considering in terms of self-harm or suicide ideation. It's a really hard conversation to have but we talk about how to do it in the household, what's possible. All of which the goal is to keep the youth as safe as possible and I really want to talk about the idea of going the extra mile when working with a youth in terms of their support and ongoing care after a mental health crisis so what this looks like for us after initial contact and doing a Care Team or mobile crisis response and engaging with a youth that we provide them with our phone line so they can call us if they want to.

Sometimes I do a practice run with them where they do a call-in just to see what it's like. So they feel a little bit more comfortable with that. That's usually really helpful for youth. We also talk about the next steps with their parent or guardian. Caregiver about counseling. But sometimes a counseling appointment isn't available rather with us or another agency for a week or two. So that's where the follow-up really becomes helpful. And so in terms of the work that we do, we'll go the extra mile for these youth that are going through these hardships around mental health. So it looks like doing a follow-up session to our initial Care Team or crisis response. And sometimes it looks like doing two of those until they can start to see a counselor more consistently and of course it's with the awareness that it's a short-term working relationship whatever that helps them feel supported so whatever that looks like for them to feel supported, connected and supported after the mental health crisis between the professionals that come into the picture and their family we want to make sure that we're engaging in that way.

And oftentimes when I work with families, we try to use this as prevention. But it's also postvention and intervention of how do we talk about self-harm and suicide ideation. That's the common question I get from caregivers and parents. So we use an acronym called FACES. And it's just to help us to remember what to look for. This is

really good after a mental health crisis as well as things to be looking for when a youth returns from being in inpatient care or as they are going through outpatient ongoing care so things tore aware of so FACES stands for feelings, actions, changes, expressions and situations. We'll talk through what those mean. And usually as I work with parents and talk through this in outreach and presentations it's how do we open the door to conversations. And this acronym is a really good way on how to do that.

And so the F of FACES stands for feelings. So we want to talk about things to be looking for in terms of feelings. So hopelessness, helplessness, emptiness or worthlessness. I worked with a child under ten recently who used the term uselessness. So those types of feelings we want to be aware of them. We want to help name them for youth who might not have the language yet to name them.

And then to be able to talk about what's causing the feelings or where they are coming from or how scary it is to even just have these feelings. Even if there's nothing we can do about them, we can be aware and together with them so I usually talk to parents and -- I usually talk parents and guardians through that conversation.

The other aspect of it is actions to be aware of. So usually being aware of behavioral changes and someone's language as it might change. So observations around this would be things like observing self-harm behaviors. If you're noticing any type of self-harm for your youth. Bullying or being bullied is usually something that's an indicator around having trouble and wanting to -- networking the extra support in life and then drugs and alcohol engagement, as well. So just being attentive to behaviors and adjustments in that way can be really helpful in addressing a mental health concern before it maybe becomes a crisis.

The C stands for changes. So when talking about this, there's developmental changes of course so thinking

about youth that go through puberty and how their attitude might change and that's a developmental aspect. That's typically normal.

But we're looking for things that are not necessarily developmental. So mood swings have no real context to them. Looking at disengagement from

activities that they really love to do without engagement in something new like finding a new hobby or social group to be a part of but just instead isolating.

We want to be aware of those things. So that's usually helpful for parents to be paying attention to that or caregivers to be paying attention to that. So we give some indicators of that such as the ones on this slide.

And then expression, so these are things that youth might say. So any time they make an expression like this or like the examples here or others we want to take them seriously so the youth knows we are paying attention and we do take them seriously this is an indicator you're probably desiring help and support so things like I don't want to live anymore. Or I'm sad all the time or I want to kill myself, we want to address those immediately and talk about it. We also want to be aware of what youth are

posting on blogs or social media and this changes frequently but there are hashtags that we might want to be aware of if they are using that could indicate suicide ideation or depression so being aware of how they are communicating their feelings in multiple contexts are really important.

Then situations. So situations in life happen. We have transitions. We want to be looking at how transitions in life are affecting our youth so when they are going through loss of relations through others or a concrete loss like death or a best friend moving cities or in COVID-19 not seeing their friends anymore at school and, therefore, losing connection and relationships, we want to be looking at those situations and how they are affecting the youth to have a conversation about how it feels. What they are going through. What support they might need. And situations can cause loss of hope or a sense of normalcy. All of those things that youth and adults alike grieve and it's helping youth understand that they are allowed to go through a situation and grieve it and to have emotions around it. Have conversations about it. Before it becomes a crisis necessarily.

>> ALI MARTINEZ: You know as Amanda was speaking, I was thinking about what it means to go through these steps and really listen to a child in distress. Really having to step into their world. And oftentimes that means educating ourselves on social media and educating ourselves on sort of what are the things that that child may be facing that I didn't have to face as a child. I think even with our best intentions and helping guide youth, it's hard not to work from the place of what was the work like when I was growing up.

And the world couldn't be more different, right, for adults now and for children now. So we really have to take a look at, you know, what is the impact of social media.

And it's ever changing. And it takes a lot of time. It takes some energy to really be interested in all of those things but to be able to know what it means to be a kid in school. Dealing with the peer pressure. What it looks like today. Dealing with bullying and what it looks like today I think really helps us be able to kind of have those conversations. And it could mean just curiosity over the dinner table. Like tell me what talk is like and what are the types of things that are on there.

And really showing interest in what the world looks like for kids today. Before there is even a crisis. I just wanted to add that.

So school and community collaboration. You know, this is one thing that you're really lucky to have incredible partners here in our area that we have been able to all come together at the table to look at how we can help youth in this community that was part of the inspiration for the conference and symposium that we started.

And we really want to stress the importance of this. We know not all communities have these kinds of mental health collaborations.

But taking a look in your community and asking the question, sort of where are the experts? Where are the people who are working with kidneys? Either they are the

family therapist, researchers, crisis centers, schools like -- and trying to pull them together. I think if that's not already happening, it's really important.

Even at the minimum to provide a listing for what are the resources in our community for youth who are going through a mental health crisis.

Who are the people that we can reach out to. Creating listings and spreading the word. Oftentimes one of the biggest struggles

around mental health partnerships and communities is that people don't know what the other is doing. So at the minimum getting people together and talking about what each organization is doing. What efforts they have that are focused on youth mental health. And what are the gaps. What are the things that are needed in that community to be able to address youth mental health in a really whole community-wide way.

Tap into those experts for workshops, trainings, for schools, for the community, for caregivers, for youth. Creating meetings, coalitions, you know, PTA is a really good place to tap into PTA organizations collaborating with mental health, with NAMI with crisis centers. That's a really lovely way to start and just get people together talking about what are youth in that community facing. What are the resources and what are the gaps.

We really want to encourage that. Because that's been really key for us. And we have the face of mental health and the resources available. It changes all the time. So we find that as strong as the collaborations are in our community, we're constantly having to come together and keep each other updated on what's happening.

And same thing with trends in mental health concerns in our community. Making sure we're talking with one another about what seems to be happening for kids, what they are facing. And how we can address it together.

So some key takeaways from today, again community wide effort. We feel really lucky that our center, the Alachua County Crisis Center can provide the breadth of services that we can offer to the community but we can't do it alone. It takes our collaboration with the schools, with law enforcement, other mental health organizations to fully support youth in our community.

We found the importance of follow-up and warm handoffs. The continued care. That it's not just a within-time contact. That we need to make sure we're following these youth and families to make sure they are getting the care that they need and sometimes navigating the systems are not easy especially if a family is having to tap into insurance and things like that. We want to make sure the support is there so families don't debt discouraged from seeking the help that they need. Let's make sure they are getting the support so that long-term they are connected to the services and have the care that that child needs.

And enhancing family support through education and empowerment. We can't leave the family out of the picture. Again, it can be an incredibly stressful thing for a family to know that their youth is really struggling, especially if it's news to them, if it's a

surprise. So making sure the family has as much support and space to learn about mental health concerns, to learn about suicide prevention, and to feel empowered to be learning how to connect with their child around these issues and support them as they navigate it.

So just some final thoughts from us about what we have learned. The importance of truly listening. We've said this a bunch today but we can't say it enough. Taking that time. Creating space. We work with incredible people in this community who give all their heart to working in mental health. To working with kids.

And the one thing that we have seen over and over again have the most impact is truly listening. You know it sounds simple. But the beauty of being able to honor that child's voice and really truly understand the world from their perspective, what they are facing from their perspective, can do so much to help us figure out what is the right kind of treatment they need. And how do we support this child and family going forward.

So slowing down that process. Working again as a team. Coming in with no assumptions. Coming in truly open mind and open heart to really

listen to what's happening for that youth, for that family. And know your community's resources. Again, really knowing what your Crisis

Center is locally. Who are the youth experts. Who are the family therapists. Who provides pro bono services.

Knowing all of those things so that families can be connected quickly when they need care.

Then we just listed some resources that we use all the time. And having these at the ready, whether you're a provider or family member, a teacher. Anybody, if you have a child in your life, if you have anybody in your life, knowing these resources. Because the reality is that crisis is a normal part of our lives actually. We're all going to go through it. And so for both ourselves and for youth, knowing at the ready right away who the resources are that we can reach out to so we can get that immediate support.

And we thank you very, very much. And we are here to answer any questions you may have.

>> Hi everyone it's Theresa from MHA thank you Ali and Amanda so much I'll moderate our Q&A section and I'll start from the top and go down. The first question is from Kiah, they ask, I don't live in the USA so can a person access your six-week training for crisis intervention if they are not local to Florida? I'm not sure who wants to take that Ali maybe.

>> ALI MARTINEZ: Yeah, I can take that. So we're happy to have you reach out to us that six-week training is for people who want to work on our hotline.

We do have a geographic requirement for people who are wanting to work on our hotline. But we do provide training and education. And we are happy -- we love doing this stuff.

So if you reach out to us, we would be happy to provide training, develop trainings,

tailored specifically for people. That's a little bit of the beauty with being able to do things online is we can provide

those kind of trainings regardless of where people are. >> Excellent. Bianca wants to know how many people are on a team and what are

the roles of each person on the team? I think this question came early on in so it might be in response to Crisis Teams that you presented on in the beginning.

>> DR. AMANDA DiLORENZO-GARCIA: Do you want to go back and forth on this one.

>> ALI MARTINEZ: Sure I'll let you go.>> DR. AMANDA DiLORENZO-GARCIA: There's quite a bit of information. So we

have our mobile crisis response teams and internally we call them care teams. So if a staff member is responding sometimes during the day staff will respond individually it's not uncommon for staff to do things in pairs, as well.

And then we have our system of volunteers who, as we said, we're a 24/7 system so we certainly rely quite a bit on our amazing volunteer community. That's very well trained. So there's almost tiers of that in a sense of people with experience. So in our on-call cycles we'll have staff that are on call. There's always a staff member that is on call around the clock. And we have shifts that that happens in. And then we'll have what we call consultants on call and those are well trained volunteers who have been with us oftentimes for a long time who are trained to answer the phones, who are trained in experience in terms of going out into the community. So they are a support of our system. And then we have associates that are also on call. In shifts. So those individuals are kind of like backup in case something happens to the immediate person on call and they can also go out with the consultant or staff on call if a Care Team comes in to respond to you.

And then of course 24/7 our phone lines are staffed is there anything you would add to that, Ali?

>> ALI MARTINEZ: No we have a very extensive mobile response program much of which is built around the safety of our team members.

And in addition we -- regardless of who may be responding, we work very much as our own very tight knit community so we have a lot of opportunity to be able to consult with one another and provide our own debriefing and support internally for each other.

Because of the nature of the work we're doing, it's often pretty intense. We feel so much honor around being able to do this work. And provide assistance. And we're also very aware of the impact for our team. So we do a lot of checking in and taking care of one another.

So our Mobile Response Team is also built with that in mind. >> Great. This one might be a short question. Christopher wants to know, do you

have any sort of coordinated intake specialist type positions? >> ALI MARTINEZ: This is Ali. Coordinated intake, I'm not quite sure what they

mean by that. Whoever is the provider sort of responding to that crisis intervention we'll do that initial assessment. And then from there we may coordinate with other agencies to connect them up if they are going for hospitalization or being referred for treatment. We'll coordinate as needed.

Hopefully that answers the question. >> Yeah. Kayla asks if there are parent training resources that they can provide to

parents who are navigating conversations with their clients. And I think that this was specifically in response to a crisis situation or a self-harm situation. Versus like a NAMI parent-to-parent referral.

Do you know if there are specific parent training resources for response to crisis? >> ALI MARTINEZ: Sorry I was having trouble unmuting. Yeah there are a lot of programs out there. I think taking a look at some of the

major organizations like American Association of Suicidiology. The Suicide Prevention Resource Center has an exhaustive library of information. And there are many programs out there for parents specifically if somebody wanted to kind of reach out and be able to provide a longer list. But there's definitely information out there for parents on how to connect with and talk with children about these issues.

>> Wonderful. Beccari asks can you share what the funding is like for the ACCC and where would you get that.

>> ALI MARTINEZ: This is Ali we're unique in that we're a county-funded organization. Our funding is built primarily around the infrastructure and our very small staff. We have a staff of eight. Most of our services are provided by crisis line and mobile response counselors that are volunteers. so -- we have 8 staff and approximately 100 volunteers.

So we are extraordinarily lucky in terms of being able to provide very extensive services to our community because of our volunteers. And it's also a benefit from being in a college town. So many of our -- not all but many of our volunteers are within the university seeking out education in either counseling psychology, premet, things like that.

So we're really lucky. In that we're county funded and supported and have been for almost 50 years and that we have an extensive volunteer system.

So in that sense we're lucky we're very unique. In terms of starting a program like this, I think it really depends on the nature of your community.

I would say that oftentimes United Ways are big source of support and foundation for these kind of programs.

So I think that that would really just depend on the community and the type of resources already available and the type of funding that might be available.

>> Thank you. Kayla asks, at an elementary level are there resources that can help guide an age-appropriate risk assessment for the mental health employees at the school site? I think that means that a mental health employee that is at a school could

utilize for elementary level risk assessment. >> ALI MARTINEZ: So I think it's interesting because we are seeing a rise in the

requests coming from elementary schools. And I think that the resources are still kind of catching up in terms of speaking to really young children about suicide and mental health.

So for us, we have kind of adapted our risk assessments to the developmental level of the child that we're working with. I'm sure there are resources out there that to be aware of. But for us we focus in on sort of using -- guided by the same assessments that we use for everybody else. But really changing up the language so that it's for that child.

So I think that there are probably resources out there that we may not be aware of. And there's probably a lot more work to be done to make sure that we are adapting our language for very young children. So being able to do an assessment with them.

>> Great, George has a similar question, which is do you think that teachers should be involved in the mental health crisis situation and how?

>> DR. AMANDA DiLORENZO-GARCIA: I think that this is -- this is Amanda. I think that that really depends on the situation and who the student or the youth that we're working with trust. So in terms of how we approach a situation, each one is -- each situation and each youth is unique. So if we arrive on scene to a school or join through telehealth one of the things we talk to youth about who do they want in the room do they want to talk to us one-on-one. Sometimes they do. Sometimes they prefer that someone else is with them. It might be the school's resource officer oftentimes they have really great relationships with their students it might be a school counselor or it could be a teacher. So if they have that trust there, I think that's important to honor in terms of the work that we're doing.

>> That's great. And do you provide seminar or education to schools? That are youth focused.

>> ALI MARTINEZ: Yes quite a bit. We do a lot of training both in crisis intervention, suicide prevention. To the schools so often in the summer, or on teacher work days, we're collaborating with the schools here to find time to just connect and check how things are going and also to provide training.

>> That's awesome. I see a lot of thanks from everybody so I just wanted you as speakers to know that.

(Chuckles).>> Susan from New York City wants to know, what geographical areas do you all

cover at the ACCC? >> DR. AMANDA DiLORENZO-GARCIA: We serve Alachua County. So that's in

Northeastern Florida. It's around the Gainesville area. >> Great. And does MRT include CPS? >> ALI MARTINEZ: So I'm assuming Certified Peer Specialist is what they are

asking and we do not. That is actually something that we are looking into. There are quite a few organizations locally that have Peer Specialists. And that is something we know that there's a lot of power in involving peers. So that is a world that we're looking into to see if there's a way for us to do that.

>> Awesome. That would be great. Crystal -- I'm going to keep going through. We're totally making great progress.

Crystal wants to know do you have any resources, programs or supports for clinicians who have lost a client to suicide?

>> ALI MARTINEZ: So the American Association of Suicidology website, somewhere in there there's a listing of clinician survivor resources. And there's been quite a bit of writing. And I know the American Association of Suicidology in their conference, which was actually just this past week, has a lot of support and almost always has conference programs dedicated to clinician survivors.

So I would start with their website, American Association of Suicidology. And looking into the clinician support side. I think there's wonderful resources for that, absolutely.

>> Great. And how do you assess school-age children who are having behaviors that are not suicidal in nature this question is from Cristianne.

>> DR. AMANDA DiLORENZO-GARCIA: I think Ali unless you understood this differently I'm curious if when that person asks what are we assessing for in that moment just so I can better understand the question.

>> Maybe you mentioned ADHD, anxiety, depression, maybe speak how do you assess school-age children for non-suicidal behaviors that might include other mental health conditions, what about that --

>> DR. AMANDA DiLORENZO-GARCIA: Absolutely. Yeah, so our first thing is to be there with the student and spend time with them. So one of the important parts is in terms of that crisis intervention work and crisis counseling. So we're not there to diagnose in that moment.

However in my work that I get to do with the schools and school counselors and families is that if I notice something that's a conversation that I can have then with a parent or caregiver after. And that goes into their referral process. And ongoing care.

>> Awesome. Just a note here for people interested in Certified Peer Specialists Jane from Georgia sass they do have those who are in a Response Team so if you're interested check out Georgia which I think is great and let's see here. A question from Jennifer a CEO at a peer driven agency so for the most part their organization is geared to services for adults. How would you recommend that they incorporate children and adolescents in their care? How might they start?

>> DR. AMANDA DiLORENZO-GARCIA: I'm not sure specifically what they do exactly. But I think one of the best ways that we've been able to incorporate and access youth in crisis is through the school system.

One, to get information out to parents and caregivers about us. So throughout -- for example, throughout the COVID-19 pandemic, they send flyers to families. To let them know they could call our crisis line and reach out to us for ongoing services when the students were less likely to be in brick and mortar school and also just to have access now that students are back or you know doing school online that they call us if a student is in crisis. Another partnership that was really important for us was School Resource Officers. So when they notice a student in crisis and they hear anything about suicide, oftentimes they are trained to -- in Florida it's called (inaudible) to hospitalize a youth but one of the amazing thing about our partnerships with school resource officers are they are leaning on us to do collaboration and do collaborative care with family so those have been powerful relationships to have access to youth so that would be my encouragement.

>> DR. AMANDA DiLORENZO-GARCIA: Yeah -- I'm sorry; Ali I was going to say as summer rolls around, summers are a great way to partner with the community to gain access to youth who might be in crisis.

>> ALI MARTINEZ: Yeah and you know getting together with who are the people who should be at the table in terms of schools and mental health who are the people already working with youth and getting folks to the table and addressing what are the services available and what are the gaps. What are the things that are needed in our community. And seeing is what would be the place of that organization to potentially kind of meet those needs.

>> That's really great. I think we have one more question. And it's great timing. Cristianne has another question related to supporting children I'm going to try to ask the question but it sounds like at their school at their team sometimes they get called out to a school because maybe a five or six-year-old is struggling and the school says that this child is out of control.

Maybe can you talk a little bit about what you're seeing for young people who might have school avoidance even at young ages, five or six. And what have you found that's super effective for kids like that, little kiddos.

>> ALI MARTINEZ: Yeah I think we both probably can answer this. So one thing when we're seeing kids that young who are struggling and in crisis and

having -- you know really not wanting to go to school, really slowing down and taking a look at the entire system. So creating space to really meet with that child and help them in their way try to sort of communicate as best as possible what might be happening for them.

But then really working as a team. Family getting together. The caregivers. Everybody may be having a really key of the puzzle. May find out that, you know, teacher witnessed some bullying that got missed that nobody knew about and that was impacting why that child didn't want to go to school. So it's tapping into everybody who is involved in that kid's life to find out potentially what the context may be about what's

happening for them. Why they are responding that way. Do you want to add anything, Amanda? >> DR. AMANDA DiLORENZO-GARCIA: Yeah, I think everything you said is really

important. And I think sometimes it's just being an outside third party to kind of connect communication between the youngster, the young child and the school or the school counselor.

So filling in some of those gaps just from a conversation can be really powerful. It can also be addressing I've worked with a lot of youth who have fear and separation anxiety from parents and caregivers or just kind of other things that come into play so it's working to address those concerns that come up so they can feel more comfortable an be more functional in the school.

>> That's really great thank you both today I'm going to turn it back to Kelle to close us out for today's webinar.

>> KELLE MASTEN: Thank you so much I would like to give special thanks to our presenters, Ali Martinez and Dr. Amanda DiLorenzo-Garcia.

From Alachua County Crisis Center. Thank you both so much for presenting today. And thank you Theresa for

moderating the questions and answers. I'm going to switch the screen now to a short evaluation and ask that you take some time to fill this out for us thank you SAMHSA for allowing us to share this information with you today and again thank you for joining us.

Enjoy the rest of your afternoon.