Challenges to Church Participation and Spiritual Growth in Students Affected by Mental Illness
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In this presentation for the Greater Cleveland staff of Youth for Christ, Dr. Grcevich discusses common obstacles to church participation among adolescents with significant mental health conditions.
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Challenges to Church Participation and Spiritual Growth in Students Affected by Mental Illness
- 1. Challenges to Church Participation and Spiritual Growth in Students Affected by Mental Illness Stephen Grcevich, MD Child and Adolescent Psychiatry President and Founder, Key Ministry Presented at Youth for Christ Cleveland, Ohio November 8, 2018
- 2. Building a bridge between two worlds…
- 3. Who’s missing from church? • Children with autism spectrum disorders are 1.84 times more likely to never attend church. • Children with depression are 1.73 times more likely to never attend church. • Children with Oppositional Defiant Disorder are 1.48 times more likely to never attend church. • Children with anxiety are 1.45 times more likely to never attend church. • Children with learning disabilities are 1.36 times more likely to never attend church. • Kids with ADD/ADHD are 1.19 times more likely to never attend church. Whitehead AL. J ScientificStudy Religion 2018;57(2)377-395.
- 4. Prevalence of common mental health conditions in teens 0 5 10 15 20 25 30 35 Anxiety Depression ADHD PTSD Prevalence Severe Impairment Source: National Institute of Mental Health
- 5. A different way of thinking about mental health ministry How do we connect churches and families impacted by mental illness for the purpose of making disciples of Jesus Christ? • Why mental illness is different from other disabilities • Why church participation is difficult • What would a mental health inclusion model for churches look like?
- 6. Can someone be “disabled” at church and function well in other life activities?
- 7. Why is church involvement so difficult? • Attributes of common mental conditions cause difficulty functioning in common ministry environments. • Church culture – our expectations for what people do and how they should act when we gather together
- 8. A foundation for a mental health inclusion ministry model • Recognition of how non-essential attributes of our ministry environments and practices interfere with participation for children and adults with common mental health conditions • Implementing a set of strategies across your ministry environments to help individuals and families join activities most critical for spiritual growth.
- 9. Seven barriers to including families impacted by mental illness at church… • Stigma • Anxiety • Capacity for self-control • Sensory processing differences • Social communication skills • Social isolation • Past experiences of church
- 10. Discussion Questions • What are the two or three most important ministry activities that serve as catalysts for spiritual growth in kids served by YFC Cleveland? • What are some challenges that a ninth grader with social anxiety might experience that would hinder them from connecting with YFC Cleveland or limit their ability to take part in activities most critical for spiritual growth?
- 11. What is ADHD? • A neurodevelopmental disorder characterized by an age-inappropriate degree of inattentiveness and disorganization, and in some, but not all instances, impulsivity and hyperactivity • Hyperactivity goes away first as children age • Impulse control improves next • Adults struggle with time management, task completion, organization, maintaining priorities
- 12. Executive functioning as the fundamental difference in persons with ADHD • Cognitive abilities involved in controlling and regulating other abilities and behaviors. • Kids with executive functioning weakness struggle to adapt to new situations and foresee outcomes of their behavior. HathawayWL, BarkleyRA. J PsycholChristianity2003, 22(2) 101-114
- 13. How might having ADHD affect a teen’s spiritual life? • Behavior inhibition: Sitting respectfully in an adult worship service, waiting their turn to talk in group, not interrupting others • Nonverbal working memory: finding their Bible when it’s time for church, group, getting lost on their way to group • Verbal working memory: applying Scripture in real-life situations • Emotional self-regulation: often display immediate, negative reactions to authority figures • Reconstitution: Struggles with managing time, setting priorities, delaying gratification, establishing, maintaining spiritual disciplines.
- 14. Unique ministry challenges presented by students with ADHD: • Ministry environments are often less structured than school • Ministry volunteers generally lack training as educators • Parents, physicians often withhold effective ADHD medication during evenings, weekends, many ministry activities occur when medication has worn off • Assumptions regarding ability to control behavior
- 15. The more they have to process, the less capacity they have for self-control
- 16. How instability of spiritual growth might arise from ADHD • Vulnerable to negative peer, environmental influences • Effects of intense spiritual experiences (VBS, retreats, mission trips) fade when context is gone • “Roller-coaster” spirituality • Shunned for volunteer, leadership opportunities if perceived as undisciplined, disorganized • Drawn to more participatory, action-oriented, relational religious contexts
- 17. Strategies for promoting ministry involvement, spiritual formation for kids with ADHD: • Engaging versus overstimulating environments • Mentors who offer accountability, promote use of gifts, passions for Kingdom purposes, • Active learners prefer doing to talking • Share your stories! • Resource parents for 1:1 conversations
- 18. What advantages might ADHD provide a follower of Christ? • Willing to take chances for God • Often energized by ministry activities that capture their imagination • Effective on ministry teams when others have complimentary skills • Good at scanning environment for trends • Overrepresented among senior pastors, student pastors?
- 19. How are teens with anxiety disorders different from their peers? • They misperceive the level of threat, danger in their environment • They think too much • Academics, family functioning, friendships, extracurricular activities are often compromised • They often ruminate, perseverate and struggle with indecisiveness, perfectionism
- 20. How anxiety manifests in teens Note: Kids may experience different manifestations of anxiety as they progress through developmental stages • Separation Anxiety Disorder • Specific Phobia • Generalized Anxiety Disorder • Social Anxiety Disorder • Panic Disorder Obsessive-Compulsive Disorder (OCD) is closely related to anxiety, but categorized separately in DSM-5 J Am Acad ChildAdolescPsychiatry,2007;46(2):267-283
- 21. The relationship between anxiety and depression in teens • Anxiety is often a precursor to depression • Depression generally more episodic • Anxiety (especially OCD) more chronic • Kids with depression often withdraw from previously enjoyable extracurricular activities
- 22. When is anxiety most likely to cause problems with ministry participation? • When kids are dropped off at age-appropriate programs (middle school) • If they’re made to be the center of attention • In non-routine activities (mission trips, retreats) • Transitions from one age- group ministry to another • Small groups where self- disclosure is expected
- 23. Common spiritual challenges for teens with anxiety • Propensity to misperceive God’s character, intentions • They frequently need to be “in control.” • May focus on performance for God as opposed to their relationship with God • Rule followers who may be drawn to legalism • Susceptible to questioning authenticity of their faith, salvation • Spiritual concerns often become fodder for obsessive thinking, compulsive behavior But… for some, God may use anxiety to draw them into a deeper relationship with Him
- 24. Strategies for ministry leaders serving teens with anxiety • Lots of pictures and video in preparation for new experiences • Very dependent upon electronic communication • Different expectations for self-disclosure in groups • Avoid putting them “on the spot” without getting their permission first • Sensitivity to allowing “preferred” roommates on trips
- 25. What might our mental health inclusion planning process look like? • Leaders in each ministry area might identify potential barriers, useful strategies within their area of responsibility. • An alternate approach might be to focus on a strategy (or several strategies) and implement the strategy across your ministry departments or environments. • Assigning responsibility for the plan (or components of the plan) with deadlines for implementation important.
- 26. Seven strategies for promoting mental health inclusion at church (TEACHER) • Assemble your inclusion team • Create welcoming ministry environments. • Focus on ministry activities most essential to spiritual growth • Communicate effectively • Help families with their most heartfelt needs • Offer education and support • Empower your people to assume responsibility for ministry
- 27. Discussion Questions • Are there changes we can make to the physical spaces where our ministry takes place to help promote learning and self-control? • What steps might we take to help students with common mental health conditions to enter into our Campus Life and City Life programming? • What role might students currently served by YFC Cleveland play in an outreach and inclusion strategy for peers with common mental health concerns?
- 28. Key considerations for an effective mental health inclusion strategy… • Inclusion is a mindset – not a program • A good strategy benefits everyone and doesn’t require anyone to self-identify • Ministry is owned by staff and students • No ministry will be able to include everyone with mental illness, but every ministry can welcome, serve and include more students with mental illness
- 31. Key Ministry promotes meaningful connection between churches and families of kids with disabilities for the purpose of making disciples of Jesus Christ. Free training, consultation, support and resources What Does Key Ministry Do?
- 32. Help from Key Ministry • Training • Conferences (Inclusion Fusion Live –April 5-6) • Video training • Book study • Consultation • Available to church, ministry teams • Resources • Networking with other ministries • Social media, sermon videos, research to support your ministry • Support
- 33. Connect with Key Ministry • www.keyministry.org • Twitter: @KeyMinistry • www.facebook.com/keyministry • www.keyministry.org/contact/
- 34. Additional Resources: Resource page on ADHD and spiritual development) http://drgrcevich.wordpress.com/teaching-series-adhd-and-spiritual- development/ Resource page on anxiety and spiritual development http://drgrcevich.wordpress.com/resource-page-anxiety-and-spiritual- development/ Resource page on Asperger’s Disorder and spiritual development (includes video of 2012 Children’s Ministry Web Summit presentation) http://drgrcevich.wordpress.com/resource-page-anxiety-and-spiritual- development/
Editor's Notes
- Far too many families from my work work find themselves unable to enter my church world. That’s tragic!
- Much of what we do in mental health ministry can be characterized as care and support for adults who are already in a church. But what if we saw mental health ministry as evangelism and outreach to families that struggle to be part of church?
- There are five key executive functions: Behavioral inhibition (critical to development of the other functions), non-verbal working memory, verbal working memory, emotional self-regulation and reconstitution. Behavioral inhibition involves the ability to delay one’s response to an event (allowing time to think), interrupt a chain of responses to an event and the capacity to keep competing events from interfering with the initial response. Without this ability a person would be entirely focused on the immediate consequences of any action or behavior and would be unable to develop the capacity for self-control. Kids in whom the development of this capacity is delayed will be unable to suppress the publicly observable aspects of behavior. Non-verbal working memory involves the capacity to maintain a picture of events in one’s mind. The ability to analyze situations for recurring patterns in order to predict future events is critical in anticipating consequences of behavior, managing relationships and planning complex, goal-directed behavior. Moral conduct and social cooperation are contingent upon this capacity as well the retention of events in sequence that allows one to estimate the time required to perform a task. Kids who experience delays in developing this capacity will have more difficulty remembering multi-step directions, more difficulty completing tasks (especially tasks that take a long time to complete), and will tend to underestimate the amount of time necessary to complete assigned tasks. Verbal working memory involves the capacity to think in words. Internalization of speech allows kids to internalize social norms and rules, facilitating moral development. As kids develop this capacity, they’re able to hold a thought in their mind without having to actually say what they’re thinking. A classic example is the inability of little kids to pray silently. Kids with delays in development of verbal working memory would tend to talk excessively compared to peers, have more difficulty organizing and communicating thoughts, struggle more with use of proper grammar and experience more challenges in following rules and directions.
- Spiritual issues related to specific executive functioning weaknesses…
- We expect (for the most part) untrained volunteers to work with kids at church on Sundays when they’re frequently without the medication that is indispensible to the teachers they work with during the week with Master’s degrees and many years of experience!
- Key points… Welcoming doesn’t have to be overwhelming...primary colors vs. jewel tones Middle school boys with ADHD may not do well sitting on stackable chairs for an hour-long group discussion. Because interest is a greater determinant of attention/motivation in kids with ADHD, personal stories are often a more effective strategy for communicating faith essentials. Kids with ADHD focus better in 1:1 situations... Family ministry approaches are especially important!
- Folks in the medical community raise concerns about ADHD being viewed as a positive, but one of two “high-risk, high-reward” genes is associated with ADHD. What’s the potential upside to ADHD, and how might the church benefit?
- Neuroimaging studies suggest that children and teens with anxiety experience patterns of brain activity in response to neutral images similar to those seen in kids without anxiety exposed to threatening images.
- Discuss the manifestations of each anxiety disorder…
- See the link to Anxiety and Spiritual Development under “Additional resources” for specific strategies with first-time attenders, kids attending overnight retreats, mission trips, etc.
- Discuss how the vast majority of kids referred to our practice because parents are looking for a Christian clinician are struggling with anxiety. Intrusive obsessions that kids will somehow be compelled to act in a manner antithetical to their faith – or their family’s faith.
- Emphasize the opportunity to visit in advance of the first Sunday at church, rehearsing responses to anxiety-inducing situations. Pearl…Jeremy Collins’ texts pictures between kids and parents when a child is struggling with separation anxiety. Discuss “looping” with small group leaders transitioning with kids from one age-group ministry to another. Importance of family ministry…kids with anxiety likely to have even more 1:1 time with parents.
- Reinforce Key Ministry’s Mission… Free Consultation service Training Front Door…online church Inclusion Fusion