"Mental Health Struggles in Adolescence: How SLP's Can Identify Signs, Take Necessary Action, and Administer Therapy Effectively. " Sharon Baum MA, CCC-SLP
Learner Outcomes Students will be able to flag a mental health crisis, and separate it from a mental health challenge Students will be able to identify 3 signs and symptoms of a mental illness that we can identify as SLP’s Students will be able to explain 3 strategies that can be utilized when administering speech-language therapy to students with mental illness
What to Expect from This Course - A n overview of how mental health and illness presents in adolescence - Distinguishing a mental health issue from an illness - How can SLP’s flag a mental health challenge in speech and language sessions - How an SLP, one of First Responders in the school setting, follow an effective action plan during a suspected crisis situation of their adolescent student - How can an SLP deliver and modify speech-language therapy when a student is simultaneously dealing with a mental health struggle or illness - How can SLP’s better advocate for and collaborate with other professionals on behalf of mental health struggles of students
What is Mental Health First Aid? - A training developed through the NYC Department of Health and Mental Hygiene, as part of the Thrive NYC Initiative - Addresses behavioral health challenges in a positive way by empowering educators with the confidence to tackle these challenges of students collaboratively - This training inspired my article in the ASHA Leader, and further exploration in how to work more effectively with students struggling
Mental Illness and Adolescence: Definition “Anything that impacts a student’s ability to live, love, laugh, and learn” (ThriveNYC Mental Health First Aid Training, 1/22/18)
Mental Health and Adolescents Overview Adolescence is a critical time •20 percent of youth age 13-18 experience severe mental disorders per year (Substance Abuse and Mental Health Services Administration Program) •Suicide was the second leading cause of death in 2016, ages 10-34 • one-half of all chronic mental illness begins by age 14 (Kessler, R.C., et al. (2005) Many adolescents hide symptoms and don’t seek help Lack of motivation sometimes confused for laziness
Signs that it is a mental health disorder, and not just a challenge Adolescents often withdraw from parents Naturally become more private Concern: extreme privacy and withdrawal from everyone Those with developmental disorders, including ASD and intellectual disabilities are at a greater risk
A Crisis Situation Suicidal thoughts Nonsuicidal self injury Psychosis Aggression Traumatic event
Common Mental Health Challenges/ Disorders in Adolescence Depression and Bipolar Disorder Anxiety ADD Trauma Eating Disorders
Common Mental Health Challenges/ Disorders in Adolescence Substance Abuse Aggression Suicidal Thoughts There can be comorbidity
First Line Responders: Helpful Tips for Assessment and Intervening Be on alert for life circumstance changes • Financial troubles, Parent’s divorce, Moving from their house Be extra vigilant with a student who expresses anguish consistently • Frequent crying spells, anger outbursts etc. T ake student’s perspective to learn about best communication style
First Line Responders: Helpful Tips for Assessment and Intervening (Cont’d) We can all be first line responders Empathize but don’t offer false promises that you can’t guarantee Be culturally sensitive ● Some parents don’t approve of “counseling” and prefer family centers ● Some cultures express mental health distress with physical symptoms We ARE NOT diagnosing or providing treatment, just helping
Identifying Signs and Symptoms as an SLP Has there been a recent medication change? (Rule it out) Social role in the group has changed drastically • The overtalker may be more reluctant to speak •The shy student may be speaking with intensity and frequency Expressive language alterations • Simple responses instead of long narratives
Identifying Signs and Symptoms as an SLP Increased delays in processing or breaking down information Cognitive changes •Reduced ability to generate inferences or make connections Pragmatic language changes •Might be more resistant to interacting with peers
What Should We Say and NOT Say? Show Empathy “Are you OK?” , “I am concerned about you , “It’s hard for me to understand exactly what you are going through, but I can see that it’s distressing for you.” “Something seems to be bothering you. Do you want to talk about it?” DON’T Offer False Promises or Tell the Student to Move ON “I understand exactly what you are going through, that happened to me two years ago,” “ You’ll get over it. You’ve just got to ignore it and get on with your life, “You’ve just got to face up to reality. Life is not a bed of roses,” “ “You’ll feel differently tomorrow.”
Mental Health First Aid Action Plan Action A: Assess for risk of suicide or harm ● Red flags: Increased rage, alcohol drug abuse, sleeping pattern, hopelessness, writing about death ● Contact guidance counselor immediately - reports to 911 Action L: LISTEN nonjudgmentally *** Action G: Give reassurance and information. Action E: Encourage appropriate professional help. Action F: Foster self-help and other support strategies.
How Do We Successfully Administer Speech and Language Therapy? First Step: Develop positive rapport, use positive language Second Step: Build Trust (Visual attached) Third Step: Use strengths and interests to target goals in therapy
Visual 1: Building Trust
How Do We Successfully Administer Speech and Language Therapy Progress isn’t linear, so take the pressure off Give them a purpose! - Peer Mentoring, - “experimental group” to help others struggling Mindfulness exercises to help with trauma and current conflicts (ie. headspace)
How Do We Successfully Administer Speech and Language Therapy Keep things fun; reduce stressful burdens - different types of fun ( http://pebbleshoo.com/3-types-fun/) - evaluate which type of fun will be most compatible Always keep their interests at the center (ie. video games) Keep a sense of humor (if it doesn’t bother student)
How Do We Successfully Administer Speech and Language Therapy -Form a “genuine connection” https://www.edutopia.org/article/connections-go-long-way-students-trauma “Interactions with individuals we trust, who see and notice our strengths, interests, passions, and challenges, and who understand us, affirming our stories, our belief systems, and the cultures in which we have developed.”
How Do We Successfully Administer Speech and Language Therapy - Center treatment around them (including using their oral narratives about their life) - Let them share stories from their life and culture (multi-purpose) Behavior management system may NOT be effective: inconsistency - Informal rewards based on what is going on - Avoid a rigid behavioral system
It Takes a Village: Collaboration! Speak to guidance counselor or school psychologist if there is a red flag Include teacher’’s and other providers perspectives which may be different Parents may be hesitant - don’t give up Parent meetings can be very effective Don’t forget to stay in contact with any outside services
SLP: Becoming an Advocate for Mental Health Give presentations Publish information (ie. My article) SLPs can highlight bulletin boards with information Go to professional development opportunities that focus on mental health (ie. ThriveNYC) Bridge networks with educators and services outside of your school to broaden the impact
Resources ThriveNYC Mental Health First Aid Training (1/22/18) Mental Health First Responders (Sharon Baum, ASHA Leader, August 2018) ife$me prevalence and age-of-onset distribu$ons of DSM-IV disorders in the Na$onal Comorbidity Survey Replica$on. Kessler, R.C., et al. (2005). https://www.samhsa.gov/ https://www.nami.org
Handout #1: Questions for Homework 1. As an SLP, what are 2 examples of communication changes in our students that may be indicative of a mental health challenge? 2. When suspecting a mental health challenge based on recent student performance in speech sessions, how can we communicate our concerns in order to prevent alienating student from accepting help/building trust? 3. What is the difference between a mental health challenge and mental health crisis? 4. What should you do if you suspect an immediate crisis? 5. Who is best to collaborate with if there are signs and symptoms of a mental health struggle? 6. What is the general process for assessing and taking action according to Thrive NYC? 7. Do we evaluate the student who is presenting with mental health challenges? If not, who does? 8. What can be a positive course of action if the parent is not following up with our suggestions to help an adolescent who is struggling? 9. What should our speech sessions focus on in order to motivate students struggling with mental health? 10. What should we especially be mindful of could look like al health challenge, when it is not? (hint: think developmental stages)
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