William O. Donnelly - Show, don't tell. How children and adolescents communicate about trauma or other mental health concerns


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Presented by William O. Donnelly, PhD, on September 27, 2013 at the fourth annual Center for Health Literacy Conference: Plain Talk in Complex Times.

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William O. Donnelly - Show, don't tell. How children and adolescents communicate about trauma or other mental health concerns

  1. 1. 1 Show, Don’t Tell: How children and adolescents communicate about trauma and other mental health issues Presented at Annual Conference of Center for Health Literacy Plain Talk in Complex Times 2013 September 27, 2013 Arlington, VA William O. Donnelly, Ph.D. Donnelly Community Psychology Adjunct Clinical Faculty, Psychology Department Bowling Green State University,
  2. 2. Mental Health for Children and Adolescents: the challenging context • 
  3. 3. Mental Health for Children and Adolescents: the US national context • Prevalence (12-month) estimates: 13—20% of children and adolescents experience mental health problems that cause them distress and/or interfere with their functioning • An estimated 5 to 8% of youth experience serious and persistent difficulties related to mental illness. 8% (ages 12-17) with 14+ “bad mental health days” past month. • http://www.cdc.gov/mmwr/preview/mmwrhtml/
  4. 4. Mental Health for Children and Adolescents: Suicide Risk and Mortality • Suicide was second leading cause of death for youth age 12-17 (NVDRS, 2010) • Seriously considered suicide: 16% (HS students, YRBS) • Attempted suicide: 8% (HS students, YRBS) • http://www.cdc.gov/mmwr/preview/mmwrhtml/ ss6104a1.htm
  5. 5. Mental Health for Children and Adolescents: •  Utilization: 3-5% get any mental health care at all (any care, ranging from a single contact to completed treatment) • Is any care the right care? evidence-based? culturally sensitive? delivered with fidelity to treatment protocol? meaningful outcomes? No reliable estimates of this. Best guess?
  6. 6. Children’s Mental Health Concerns: who speaks up? • Younger children do not self-identify or self-refer. • Adolescents are more likely to express concerns but unlikely to label them as a mental health need. Typically, they are not able to initiate (or pay for) care • As with physical health care, access to mental health typically depends on parent ability to recognize need (psychological distress) and seek help
  7. 7. Reasons for Referral • Youth are historically more likely to be referred for mental health care because of externalizing behavior problems (ADHD, conduct, hyperactivity, aggression, poor school performance) • Younger children: for conduct, self-regulation • Adolescents: risk behaviors, substance use, irritability • Less likely to be referred explicitly for emotional distress, psychological pain/suffering (e.g., depression, anxiety)
  8. 8. A Few of the Barriers • Financial • Transportation • Time commitment • Shortage of trained professionals • Stigma • Lack of knowledge, understanding about child and adolescent mental health • Prefer to get support from family and friends
  9. 9. What do we do about the suffering? • The daunting gaps between needs and utilization and capacity requires alternative strategies • Requires strategies for prevention • Universal prevention (e.g., stress, bullying) • Targeted prevention: children with increased risk, not necessarily symptomatic (e.g., exposure to natural disasters, community violence)
  10. 10. Mental Health Promotion • Prevention programs delivered in community setting, notably schools • Mental health promotion • Mental health literacy • Promotion of mental health as health • Attack stigma • Empowerment
  11. 11. Two approaches to MH literacy • Literacy regarding mental illness: its nature, neurobehavioral and psychosocial causes, consequences, scientific underpinnings. Dispel myths, promote illness identification. • Literacy regarding skill development for child and adolescent mental well-being: identify and express feelings; self-calming; problem-solving; seeking social support; appraising thoughts
  12. 12. Mental Health Literacy: Trauma • High rates of C/A exposure to traumatic stressors (violent accidents, physical/sexual abuse, DV, community violence, painful medical tx, war/terrorism, natural disasters, hunger/deprivation, suicide of friend or family member) • Youth can understand how non-verbal behavioral and emotional reactions to traumatic stress translate to “core symptoms” of PTSD (re-experiencing, avoidance, hyperarousal) and to other psychological effects
  13. 13. Mental Health Literacy: Trauma • There have been rapid advances in scientific knowledge, clinical application and improved outcomes regarding child trauma and anxiety. Interventions for trauma provide relief. • The “model” for traumatic stress explains it in terms of both brain and behavioral response within a normalized view of human adaptation and survival.
  14. 14. Trauma, no stigma? • Acceptability: This approach may weaken or eliminate the stigma-related connotations of “sick”, “crazy”, “something wrong with me”, “weak”, bad. • http://www.youtube.com/watch? v=0Cp90_vUDck
  15. 15. Psychological Trauma and Youth • Traumatic stress: Overwhelming life-threatening stressor • Experience of trauma: Horror Helplessness Threat • For children and adolescents, the life-threatening experience can includes event that threaten their family, their well being or their sense of belonging/safety
  16. 16. Trauma Reactions: Children and Adolescents •  Reactions vary according to development. Across ages: non-verbal behavioral reactions •  Preschoolers: regression, tantrums, disorganized behaviors, fears •  School age: angry/moody, sleep and somatic, worry, sadness, avoidance •  Adolescents: withdrawal, numbing; risky behaviors, can feel alienated
  17. 17. Trauma Informed Care • Asks about trauma exposure • Asks about personal trauma impact and reactions • Helps develop meaningful trauma narrative • Expresses concern and support • Shares information (about trauma and its effects)
  18. 18. Trauma Informed Care • Normalizes trauma reactions but educates about impact • Provide resources for help – what to do about it (evidence-based interventions) • Provides resources to help family, friends, and professionals understand youth experiences and provide support • Empowers youth
  19. 19. • 
  20. 20. Literacy: It’s OK to Talk •  National Association of Broadcasters Campaign to encourage youth mental health literacy • Promotional message: OK to Talk • Tumblr-based community campaign • Radio and tv ads, English, Spanish • Mental health stories of teens and young adults • Invites teens to share personal stories
  21. 21. It’s OK to Talk • Gordon Smith, NAB President, former US Senator •  Previously sponsored Garret Lee Smith Act in response to his son’s suicide. GLS funds SAMSHA programs for adolescent suicide prevention. What do you want to be when you are older?
  22. 22. Literacy: How to Talk
  23. 23. Literacy: How to Talk web-based interactive simulation games • How to talk (how to listen) about: • Psychological distress, including signs of suicide • LGBTQ issues related to respect, inclusiveness, stress, bullying • Who can talk: • Educators with students; teens with teens; teens with educators • www.kognito.com
  24. 24. Online Interactive Role Play • How to listen, understand, engage, support and encourage or refer to help • Web-based avatars talk to the one another and the learner • Learners role-play, practice, develop mastery • Brief, at your-own-pace
  25. 25. Literacy: Outcomes • Target skill set: Recognize, Approach, Refer (youth showing signs of psychological distress, including signs of suicide) • High school educators: increase in preparedness, likelihood, confidence • College, peer to peer: increase in skills, referral rates, likelihood of self-referral, satisfaction
  26. 26. Take Away • Child and adolescent mental health needs are infrequently and incompletely addressed in current system of US mental health care • Trauma-informed care provides a promising paradigm for child/adolescent mental health promotion
  27. 27. Take Away • Promising practices: internet, media, communication strategies that are ▫  evidence-informed * truthful * developmentally and culturally sensitive * empowering to youth * driven by compelling narratives * ecologically based, promoting peer and adult social support * interactive * linked to national and community resources * focused on literacy outcomes * evaluated
  28. 28. the end
  29. 29. contact information William O. Donnelly, Ph.D. Donnelly Community Psychology, LTD 429 W. College Avenue, PO Box 105 Pemberville, OH 43450-0105 billd@bgsu.edu (419) 287-7073
  30. 30. References Costello, E. Jane (08/2003). "Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence". Archives of general psychiatry (0003-990X), 60 (8), p. 837.