CONNECTING SCHOOL NURSING AND BEHAVIORAL HEALTH

SUSAN NELSEN, LISWESPANOLA PUBLIC SCHOOLS

CAROLE KIRBY, RN NMDREGION 2 SCHOOL HEALTH ADVOCATE

“Children are the messages we send to

a time we will not see.”

(Neil Postman)

NASP GPR/HCI

Mental health care should be part of a child’s general health care.

We must put mental health on parity with physical health in America !

Basic Beliefs

Students must be safe and healthy to be successful in school. This is supported in NCLB, IDEA and the President’s New Freedom Commission report.

Schools are primary care/public health settings.

Every community has a school district.

Basic Beliefs…cont.

Mental /Behavioral health services should be an available component for every child’s school experience.

Schools offer easy access and familiarity to children & families.

Children & teens in this country are in dire need of expanded mental health services according to a variety of reputable sources.

Why Choose Schools? Schools are the logical point of entry to increase the

efficacy of mental/ behavioral health services to children and adolescents.

For nearly half of the children with serious emotional disturbances who receive mental/behavioral health services at all, the school system has been the sole provider.

Schools are already the primary providers of mental /behavioral health services for all children.

Offering services in the schools improves access to treatment.

Other Reasons to Choose Schools

Social & Emotional health is directly linked to educational outcomes.

Schools are the optimal place to develop psychological competence and to teach children about making informed and appropriate choices concerning their health and many other aspects of their lives because schools are the only organization in our society to which virtually all children and adolescents are consistently exposed for extended periods of time. Schools are vital and central community institutions.

Other Reasons to Choose Schools

As multidisciplinary entities, schools are the best places to integrate and to coordinate the efforts of teachers, families, behavioral health service providers, and administrators to foster the behavioral health of students.

Accessible, affordable behavioral health services are most easily and consistently provided in the educational setting. Problems of transportation, accessibility, and stigma are minimized when such services are provided in schools.

Why is Behavioral Health in Schools an Imperative?

Accessing students and their families who need behavioral health services is facilitated by contact through and at schools

Addressing psychosocial and mental and physical health concerns is essential to the effective school performance of some students

WHAT’S TRAUMA GOT TO DO WITH IT

Research shows: Today’s school communities have the potential to face many

more crisis situations than ever before The nature & severity of the types of crisis/disasters & trauma

that can develop today were non-existent 30 yrs ago

WHAT IS TRAUMA Exposure to a sudden or drastic change in an individual’s

familiar environment

What is Trauma?

TRAUMA is the set of physiological, cognitive, emotional, behavioral, spiritual, and relational symptoms that result from events that can overwhelm the nervous system.

TRAUMA is in the Nervous system

and not in the event !

Trauma First Aide Associates© 2007 www.TraumaFirstAide.com

OBVIOUS MAJOR TRAUMATIC EVENTS

High Rates Of Teen Motor Vehicle-related Deaths Homicides Youth Suicides Bomb Scares Natural Disasters Immigration To A New Country Substance Abuse In The Family Abuse& Neglect Physical, Sexual, Emotional Witness to Domestic Violence Terrorist & Sniper Attacks Hostage Taking

NASP GPR/HCI

All children face some behavioral health problems/issues, including:• Anxiety about school performance• Problems dealing with parents & teachers• Unhealthy peer pressure• Common developmental, adjustment problems• Fears about starting school• School phobia• Feeling depressed or overwhelmed• Worrying about sexuality• Facing tough decisions• Considering dropping out of school

The ANS has very important functions in 2 situations:

1. In emergencies that cause stress and require us to

fight or take flight or freeze

2. In non-emergencies that allow us to rest, digest, heal and socially engage

The Autonomic Branch of the PNS

Trauma First Aide Associates© 2007 www.TraumaFirstAide.com

OverwhelmingExperience!

Stuck on “High”

Stuck on “Low”

RageHyperactivityHypervigilanceElation / ManiaAnxiety / Panic Hi Risk Behavior

DepressionDisconnectionHopeless/HopelessExhaustionNumbness

No

rma

l Ran

ge

Tachycardia TachypneaDyspepsiaMuscular TensionHyperstartle HypertensionHot/flushed

Muscle WeaknessHypotension ConstipationSleepingSluggishCold/pale

Trauma First Aide Associates© Trauma Resilency Institue

TRAUMA CAN IMPAIR LEARNING

SINGLE EXPOSURE TO TRAUMATIC EVENTS MAY CAUSE JUMPINESS, INTRUSIVE THOUGHTS, INTERRUPTED SLEEP & NIGHTMARES, ANGER & MOODINESS, and/or SOCIAL WITHDRAWAL – ANY OF WHICH CAN CAUSE LACK OF ABILITY TO CONCENTRATE

CHRONIC EXPOSURE TO TRAUMATIC EVENTS, ESPECIALLY DURING A CHILD’S EARLY YEARS, CAN: Adversely affect attention, memory and cognition Reduce a child’s ability to focus, organize and process

information Interfere with effective problem solving and or planning Result in overwhelming feelings of frustration & anxiety

Recent Research Shows That Brain Function Can Be Severely Affected by Trauma

System Overwhelm

When the nervous system becomes overwhelmed: Individuals can lose the capacity to stabilize and

regulate themselves

Results in feelings of helplessness, hopelessness and a sense of being out of control

Cognitive processes are disrupted by survival responses

Trauma First Aide Associates© 2007 www.Trau ma FirstAide.com

Toe to Head: triage and assessment

Examples of waving red flags:

Frequent flyers – physical and emotional Multiple absences Unkempt look Stomach aches Soiling/Wetting Sadness Crying

IMPORTANCE OF UNDERSTANDINGTHE EFFECTS OF TRAUMA

Young people with histories of trauma are at risk for:

Depression with 3 to 5 times more prevalence.

Suicide attempts at a rate 12 times greater than their peers without abuse/neglect histories.

Alcohol and drug addiction at a rate 18 to 21 times more frequency than their peers.Anna Nelson, DOH

Trauma TriggersCommon Trauma Triggers include:

• Smells, sounds, or other environmental stimuli (i.e. school bells)• Being in environment where trauma occurred

• Anniversaries of traumatic events

• Body gestures, voice intonation, or eye contact or looks

• Seasons

• Pattern of events reminiscent of traumatic event

• Being asked to relinquish personal controlAnna Nelson, DOH

TRAUMATIZED CHILDREN MAY EXPERIENCE PHYSICAL & EMOTIONAL DISTRESS

Physical Symptoms Like Headaches & Stomachaches Poor Control Of Emotions Inconsistent Academic Performance UNPREDICTABLE , IMPULSIVE BEHAVIOR Over Or Under Reacting To Bells, Physical Contact, Doors

Slamming, Sirens, Lighting, Sudden Movements Intense Reactions To Reminders Of Their Traumatic Event Others Are Invading Their Space Blowing Up When Being Corrected Or Told What To Do By An

Authority Figure Fighting When Criticized Or Teased Resisting Transition Or Change

Effects of Trauma on Academic Success Trauma disrupts students’ ability to:

•Learn

•Process verbal information

•Use language to communicate

•Develop literacy

•Develop social-emotional skills

•Self-regulate. (Helping Traumatized Children Learn, 2005)

Effects of Trauma on Academic Success“Traumatized children cannot simply remove their “trauma glasses” as they go between home and school, from dangerous place to safe place...

Sadly, (attempts to avoid trauma) often sabotage their ability to hear and understand a teacher’s positive messages, to perform well academically, and to behave appropriately.”

(Helping Traumatized Children Learn, 2005)

TRAUMA FACTS FOR EDUCATORSTrauma Can Impact School Performance

Lower GPA Higher Rate Of School Absences Increased Drop-out More Suspensions And Expulsions

• Trauma can happen to anyone, regardless of gender, age, socioeconomic status or ethnicity.

Prescription for Success

Actively pursue relationships with all school personnel, especially those with disciplines in the total healthy student well-being

Provide consistent all staff trainings on positive reinforcement

Set-up a Wellness Committee in your school: key players involved (nurses, counselors and social workers)

Early morning check-in for students to speak without judgment

Prescription for Success…cont.

Weekly debriefing of existing students Grouping students if at all possible Problem solving difficult cases with Wellness Staff

and parents when appropriate Selecting ‘graduating’ students for mentorships Teaching staff to do a morning check-in Empower students and parents with positive

reinforcements, ex. phone calls, letters home, tea parties, nature walks and reading circles.

Public School Stories

Death of 3rd grade child

Santa Fe Ski Bus Accident

911

NASP GPR/HCI

The Cost of Doing Nothing……

Our failure to prevent or intervene early in a child’s mental health problems results in:

$ Higher K-12 education costs and dramatically lower graduation rates

$ Increased use of expensive “deep-end” mental health services

$ Increased health care costs$ An increased number of children in the juvenile justice

system & other out-of-home placements$ Suicide - the 3rd leading cause of death among children

ages 10 and up

HOW SCHOOLS CAN HELP & BENEFIT BY BECOMING MORE TRAUMA INFORMED

RAISE AWARENESS OF SCHOOL STAFF, PERSONNEL,PARENTS of the IMPORTANCE OF BEHAVIORAL HEALTH SERVICES

MAKE REFERRALS CREATE A SUPPORTIVE SCHOOL ENVIORNMENT

MODIFY TEACHING STARTEGIES ANSWER A CHILD’S QUESTION * LISTEN TO THE ANSWER

SUPPORT FAMILIES

IT ONLY TAKES ONE CARING ADULT TO LISTEN TO A CHILD TO MAKE A REAL DIFFERENCE

We know that the outcasts and misfits are the children most likely to become violent, so it only follows that we must pull them into the arms of love and/or acceptance, and find a place where they fit. If our system doesn't have a place where a child fits, there's something wrong with the system, not the child.

~WILLIAM G. DEFOORE, Anger

Thanks and Gratitude

Our thanks to the two authors of this original presentation and for their permission to personalize the information.

Ted Feinberg, Ed.D; NCSP Ralph E. Cash, Ph.D., NCSP

TRAUMA RESILIENCY INSTITUTE TRAUMA FIRST AID ASSOCIATION

References Leatherman & McCarthy (2004). Quality of Health Care for Children and Adolescents: A Chartbook.

The Commonwealth Fund.

MacKay, A.P., Fingerhut, L.A., & Duran, C.R. (2000).Adolescent Health Chartbook: Health, United States, 2000. Hyattsville, MD: National Center for Health Statistics.

Marx, E. & Wooley, S.F. (Eds.). (1998). Health is Academic: A Guide to Coordinated School Health Programs. New York: Teachers College Press, Education Development Center, Inc.

Nastasi, B.K., Pluymert, K., Varjas, K., & Moore, R.B. (2002). Exemplary mental health programs: School psychologists as mental health service providers. Bethesda, MD. NASP.

Nastasi, B.K. (Ed.). (1998). Mini-Series: Mental Health Programming in Schools and Communities. School Psychology Review, 27 (2).

Position Statement on Mental Health Services in the Schools (2003). Bethesda, MD. NASP.

U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

U.S. Public Health Service. (2000). Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. Washington, DC: U.S. Department of Health and Human Services.