SupportingMinds

An Educator’s Guide to Promoting Students’ Mental Health and Well-being

Government of Ontario Draft 2013

Note that dealing with mental health problems among students is highly complex and challenging. Often students are not responsive to using mindfulness and self-regulation strategies as their significant mental health needs require the support of professionals such as doctors, psychologists, and therapists. Educators cannot diagnose mental health issues.

As stated below, educators can support their students by observing and documenting possible triggers and behaviours.

How to Use Supporting Minds Document

The Supporting Minds document is presented in two parts.

Part One provides an overview of mental health and addiction problems and guidance about the role of educators in supporting students’ mental health and well-being.

Part Two contains eight sections, each dedicated to a particular mental health problem. Each section is structured to first provide educators the information they need to recognize mental health problems in their students and offer appropriate support (under such headings as “What Is Depression?”, “What Do Symptoms of Depression Look Like?”, and “What Can Educators Do?”). Background information about the particular type of mental health problem is given towards the end of each section. Hyperlinks to resources that provide more detailed information are included throughout.

Please refer to the Supporting Minds document for more in depth information.

Knowing Your Students

A first step in recognizing whether a student has a mental health problem may be simply documenting the behaviour that is causing concern. School boards may have their own forms on which to record this information. Once several observations of the particular behaviour have been gathered, educators can share these with others who can help to develop a plan to manage the behaviour.

Educators should look for three things when considering whether a student is struggling with a mental health and/or addiction problem:

Frequency: How often does the student exhibit the behaviour?
Duration: How long does the behaviour last?
Intensity: To what extent does the behaviour interfere with the student’s social and academic functioning?

Highlighted Mental Health Challenges

1. Anxiety in Students

COMMON SIGNS OF ANXIETY

Although different signs of anxiety occur at different ages, in general, common signs include the following. The student:

has frequent absences from school;
asks to be excused from making presentations in class;
shows a decline in grades;
is unable to work to expectations;
refuses to join or participate in social activities;
avoids school events or parties;
exhibits panicky crying or freezing tantrums and/or clingy behaviour before or after an activity or social situation (e.g., recess, a class activity);
worries constantly before an event or activity, asking questions such as “What if …?” without feeling reassured by the answers;
often spends time alone, or has few friends;
has great difficulty making friends;
has physical complaints (e.g., stomach-aches) that are not clearly attributable to a physical health condition;
worries excessively about things like homework or grades or everyday routines;
has frequent bouts of tears;
is easily frustrated;
is extremely quiet or shy;
fears new situations;
avoids social situations for fear of negative evaluations by others (e.g., fear of being laughed at);
has dysfunctional social behaviours;
is rejected by peers.

(Based on information from: CYMHIN-MAD, 2011; Hincks-Dellcrest-ABCs, n.d.) Note: This list provides some examples but is not exhaustive and should not be used for diagnostic purposes.

STRATEGIES TO REDUCE STRESS FOR ALL STUDENTS

Create a learning environment where mistakes are viewed as a natural part of the learning process.
Provide predictable schedules and routines in the classroom.
Provide advance warning of changes in routine.
Provide simple relaxation exercises that involve the whole class.
Encourage students to take small steps towards accomplishing a feared task.

(Based on information from: CYMHIN-MAD, 2011; Hincks-Dellcrest-ABCs, n.d.)

See Supporting Minds document Table 1.1 for Specific strategies for supporting students with anxiety-related symptoms

2. Depression in Students

COMMON SIGNS OF DEPRESSION

Some common signs associated with depression include the following:

ongoing sadness
irritable or cranky mood
annoyance about or overreaction to minor difficulties or disappointments
loss of interest/pleasure in activities that the student normally enjoys
feelings of hopelessness
fatigue/lack of energy
low self-esteem or a negative self-image
feelings of worthlessness or guilt
difficulty thinking, concentrating, making decisions, or remembering
difficulty completing tasks (e.g., homework)
difficulty commencing tasks and staying on task, or refusal to attempt tasks
defiant or disruptive behaviour; getting into arguments
disproportionate worry over little things
feelings of being agitated or angry
restlessness; behaviour that is distracting to other students
negative talk about the future
excessive crying over relatively small things
frequent complaints of aches and pains (e.g., stomach-aches and headaches)
spending time alone/reduced social interaction; withdrawn behaviour and difficulty sustaining friendships
remaining in the back of the classroom and not participating
refusal to do school work, and general non-compliance with rules
negative responses to questions about not working (e.g., “I don’t know”; “It’s not important”; “No one cares, anyway”)
arriving late or skipping school; irregular attendance
declining marks
suicidal thoughts, attempts, or acts
change in appetite
loss of weight or increase in weight
difficulty sleeping (e.g., getting to sleep, staying asleep)

(Based on information from: Calear, 2012; CYMHIN-MAD, 2011; APA, 2000; Hincks-Dellcrest-ABCs, n.d.) Note: This list provides some examples of symptoms or signs but is not exhaustive and should not be used for diagnostic purposes.

STRATEGIES THAT CAN HELP ALL STUDENTS DEVELOP AND MAINTAIN A POSITIVE OUTLOOK

Support class-wide use of coping strategies and problem-solving skills.
Provide all students with information about normal growth and development and ways to cope with stress (e.g., ways to address peer pressure, build friendships, address depressive feelings, maintain good sleep hygiene, build exercise into each day).
Write instructions on the board to provide a visual cue for students who are having trouble focusing on spoken information.
Model and teach optimistic and positive attitudes, language, and actions.
Work with students’ strengths and build on them when they complete activities in class.
Provide students with responsibilities and tasks that they may enjoy (e.g., allow students who enjoy computer use to incorporate a computing component into tasks; allow art-loving students to choose illustrated reading materials).
Provide a space in the classroom for students to go to when they are feeling overwhelmed.
Help students to chunk assignments and prepare for tests well in advance of deadlines.

(Based on information from: Evans et al., 2002; Hincks-Dellcrest-ABCs, n.d.)

See Supporting Minds document Table 2.1 for Specific strategies for supporting students with depression-related symptoms

3. Bipolar Disorder in Students

COMMON SIGNS OF BIPOLAR DISORDER

Some common signs to watch for include the following:

extremely abnormal mood states (generally lasting weeks or more) and involving a depressed or manic mood
depressive symptoms (see the section on depression)
manic symptoms, including:
feeling extraordinarily self-confident, in a manner that is out of character for the student
extreme irritability or changeable, “up and down” (labile) moods that are not typical for the student
grandiose and illogical ideas about personal abilities (e.g., the student believes he/she has supernatural powers)
extremely impaired judgement compared to usual ability
a perception that thoughts are racing
extreme changes in speech, particularly very fast speech or talking as if he/she can’t get the words out fast enough
explosive, lengthy, and often destructive rages that are out of character for the student
new or marked hyperactivity, agitation, and distractibility
“dare-devil”, risk-taking behaviour

(Based on information from: CYMHIN-MAD, 2011) Note: This list provides some examples but is not exhaustive and should not be used for diagnostic purposes.

In addition, the cognitive functioning of students with diagnosed bipolar disorder may be affected, so that they have difficulty:

paying attention;
remembering and recalling information;
using problem-solving skills;
using critical thinking skills and categorizing and organizing information;
quickly coordinating eye-hand movements;
staying focused on a topic.

See Supporting Minds document Table 2.2 for Specific strategies for supporting students diagnosed with bipolar disorder

4. Students with Attention and Hyperactivity and/or Impulsivity Problems

SUBTYPES OF Attention Deficit Hyperactivity Disorder

The following three subtypes of ADHD have been identified:

(1) predominantly inattentive (without symptoms of hyperactivity/impulsivity)

(2) predominantly hyperactive/impulsive (without symptoms of inattention)

(3) predominantly combined (symptoms of both inattention and hyperactivity/ impulsivity)

(Eiraldi et al., 2012). The combined type (inattention and hyperactivity/impulsivity) is the most common of the three. (Based on information from: APA, 2000)

COMMON SIGNS OF ATTENTION DISORDERS

Some common signs of attention problems and/or hyperactivity/impulsivity include the following:

Attention problems: The student:

is easily distracted;
fails to pay attention to details and makes careless mistakes;
forgets things (e.g., pencils) that are needed to complete a task;
loses things often;
has difficulty organizing tasks;
finds it hard to concentrate;
follows directions incompletely or improperly;
frequently doesn’t finish tasks;
does not listen to what is being said when spoken to;
avoids or shows strong dislike for schoolwork or homework that requires sustained mental effort (dedicated thinking).

(Based on information from: CYMHIN-MAD, 2011; APA, 2000; CAMH, 2007)

Hyperactivity/Impulsivity: The student:

has difficulty sitting still or remaining in seat;
fidgets;
has difficulty staying in one place;
talks excessively or all the time;
is overly active, which may disturb peers or family members;
has difficulty playing quietly;
is always on the move;
has feelings of restlessness (for adolescents);
is unable to suppress impulses such as making inappropriate comments;
interrupts conversations;
shouts out answers before the end of the question or without being called on;
hits others;
has difficulty waiting for a turn;
is easily frustrated;
displays poor judgement.

(Based on information from: CYMHIN-MAD, 2011; APA, 2000; CAMH, 2007) Note: This list provides some examples but is not exhaustive and should not be used for diagnostic purposes.

STRATEGIES THAT PROMOTE A CALM CLASSROOM ATMOSPHERE TO HELP ALL STUDENTS PAY ATTENTION

Provide a structured environment and a consistent daily routine.
Provide advance warning of changes in routines or activities.
Establish a routine and set of rules for moving from one activity to the next.
Establish procedures that allow all students equal opportunities to participate in activities (e.g., establish rules for turn taking; arrange for everyone to get a chance to be first).
Provide easy-to-follow directions and instructions (e.g., explain one step at a time; chunk multi-step directions).
Post rules where everyone can see them.
Reinforce positive behaviour such as raising a hand before speaking, engaging in quiet work.
Provide opportunities to learn by doing to give students an outlet for excess energy.
Limit visual and auditory distractions in the classroom as much as possible while considering the needs of all students.
When talking to students, address them directly and use eye contact. Wait until a student is paying attention before continuing a conversation.
Avoid a focus on competition, as students’ urge to win or be first can increase the likelihood of impulsive behaviour.

(Based on information from: House, 2002; CAMH, 2007)

See Supporting Minds document Table 3.1 for Specific strategies for supporting students with attention and hyperactivity/impulsivity problem

5. Behaviour Disorder in Students

COMMON SIGNS OF BEHAVIOUR DISORDERS

Some common indicators of problem behaviour include the following:

defiance (persistent stubbornness; resistance to following directions; unwillingness to compromise, give in, or negotiate)
persistent testing of limits (by ignoring, arguing, not accepting blame)
persistent hostile mood
lack of empathy, guilt, or remorse, and a tendency to blame others for his/her own mistakes
low self-esteem that may masquerade as “toughness”
acting aggressively
disobedience
oppositional behaviour (e.g., challenging or arguing with authority figures)
bullying, threatening, or intimidating others
initiating fights or displaying physical violence/cruelty
using weapons
stealing
deliberate destruction of property
frequent lying
serious violations of rules (e.g., in early adolescents, staying out late when forbidden to do so)
skipping school often
outbursts of anger, low tolerance for frustration, irritability
recklessness; risk-taking acts

Signs that the problem may be serious include the following:

The student shows problems with behaviour for several months, is repeatedly disobedient, talks back, or is physically aggressive.
The behaviour is out of the ordinary and is a serious violation of the accepted rules in the family and community (e.g., vandalism, theft, violence).
The behaviour goes far beyond childish mischief or adolescent rebelliousness.
The behaviour is not simply a reaction to something stressful that is happening in the student’s life (e.g., widespread crime in the community, poverty).

(Based on information from: APA, 2000; CPRF, 2005; Hincks-Dellcrest-ABCs, n.d.) Note: These lists provide some examples but are not exhaustive and should not be used for diagnostic purposes.

STRATEGIES THAT PROMOTE POSITIVE BEHAVIOUR AMONG ALL STUDENTS

Provide predictable schedules and routines in the classroom.
Focus the students’ attention before starting the lesson.
Use direct instruction to clarify what will be happening.
Model the quiet, respectful behaviour students are expected to demonstrate.
Create an inviting classroom environment that may include a quiet space, with few distractions, to which a student can retreat.
Be aware of the range of needs of the students in the class in order to provide an appropriate level of stimulation.
Communicate expectations clearly and enforce them consistently. Use clear statements when speaking to students: “I expect you to …” or “I want you to…”.
Focus on appropriate behaviour. Use rules that describe the behaviour you want, not the behaviour you are discouraging (e.g., Instead of saying “No fighting”, say “Settle conflicts appropriately”).
At the beginning of the school year, clearly and simply define expectations for honesty, responsibility, and accountability at school. Repeat these expectations often to the entire class, especially when violations occur.
Don’t focus too much attention on children who blame others, since that might inadvertently reinforce the behaviour.
Begin each day with a clean slate.
Facilitate the transition from the playground to the classroom by calmly telling students when there are five minutes left and then one minute left in recess, encouraging them to prepare to come in, and helping them settle in class when recess is over. Schedule a predictable classroom activity that most students will enjoy to follow recess, to help provide a smooth transition.

(Based on information from: CYMHIN-MAD, 2011; Hincks-Dellcrest-ABCs, n.d; Lee, 2012)

See document Table 4.1 for Specific strategies for supporting students with behavioural problems in classrooms

Please see the Supporting Minds document for further information on

Eating and weight-related problems in students
Substance use problems in students
Gambling in students
Self-harm and suicide in students

Taking care of self as an educator

(Supporting Minds, Appendix C: Mental Health Action Signs)

Your behavioural health is an important part of your physical health. If you are experiencing any of these feelings, let your doctor know.

Feeling very sad or withdrawn for more than 2 weeks
Seriously trying to harm or kill yourself, or making plans to do so
Sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing
Involvement in many fights, using a weapon, or wanting to badly hurt others
Severe out-of-control behaviour that can hurt yourself or others
Not eating, throwing up, or using laxatives to make yourself lose weight
Intense worries or fears that get in the way of your daily activities
Extreme difficulty in concentrating or staying still that puts you in physical danger or causes school failure
Repeated use of drugs or alcohol
Severe mood swings that cause problems in relationships
Drastic changes in your behaviour or personality

Source: The Reach Institute, The “Action Signs” Project, p. 6. Retrieved from http://www.thereachinstitute.org/files/documents/action-signs-toolkit-final.pdf

Dealing with students with mental health needs can be very challenging and draining.

Be kind to yourself and practice self care.

Reach out for help and support if you need it.

Collaboratively Yours,

Deb Weston

Source: The Real Difference Between Tantrums and Meltdowns http://lemonlimeadventures.com/the-real-difference-between-tantrums-and-meltdowns/ via @lemonlimeadv

Dealing with Students Using

Behaviour Management Training

The purpose of Behaviour Management Training for ETFO Members is to deal with the growing incidents of violence in schools and workplaces.

As I wrote about earlier in December 2017, there is research to support my own anecdotal observations of increased violence in classrooms. Based on information from ETFO (Action on Violence in Schools), ETFO members are increasing facing violent incidents in schools and workplaces. This violence increases physical and mental harm to both adults and children. With violence, teaching and learning is disrupted. Teachers and students can develop anxiety that violence will occur again.

ETFO’s Professional Relations Services published a PRS Matters Bulletin #98 addressing training offered to teachers and education workers by school boards. I have not been “officially” trained in these areas but I have used some of the strategies. The programs mentioned in the bulletin are copied directly from the bulletin and are listed below:

Crisis Prevention Intervention (CPI) – This program has a focus on prevention and strategies designed to “safely defuse anxious, hostile or violent behaviour at the earliest possible stage.” “Disengagement skills” are demonstrated and practiced to train educators to remove themselves and others from dangerous situations. Participants are trained to recognize when it is appropriate to physically intervene and implement holding skills to manage aggressive behaviour.

My experience with CPI: I have removed myself and my students from my classroom due to hostile or violent behaviour. To prepared, the students and I talked about our classroom evacuation plan (without the student with special education needs present) and the students came up with the “retreat” signal word. We practiced getting out of our classroom and either lining up or going to a neighbouring classroom to be safe. This worked well and kept all safe and no students were physically touched in the process.

Behaviour Management Systems (BMS) – This program stresses early prevention and intervention techniques. It aims to teach effective and safe physical intervention techniques. The BMS training framework is made up of four phases, one of which is the “Action Phase.” During the action phase, practitioners can “intervene physically” through a series of blocks or releases or by containing the student (i.e., by wrapping “your arms around the student”). There are four written cautions in the workbook specific to containments that mention “positional asphyxiation” and students incurring “a dislocated shoulder.”

My experience with BMS: I have not had much experience with BMS. I have blocked students from leaving a classroom or running down a hallway but I have never touched any students. Personally, with or without training, I will never be comfortable using physical contact to intervene with student behaviour, especially when injury can happen to the student or to me.

ETFO believes that behaviour management training should be voluntary and should be done within the instructional day. Members are not required to sign any waivers with respect to training or in using physical retraints.

As noted in PRS #98, using physical components of BMS and CPT could put members are risk of a possible investigation from the Children’s Aid Society (CAS), and/or Ontario College of Teachers (OCT) or the College of Early Childhood Educators (CECE).

For further information, please contact your local ETFO president or Professional Relations staff in Professional Relations Services at 416-962-3836 or 1-888-838-3836.

I did come across a chart to help distinguish between Tantrums and Meltdowns Posted on Twitter @ONTSpecialNeeds

My best advice is to reach out to a supportive colleague for help as this is where I get the most help and support when dealing with challenging student behaviour!

And in the end, it’s up to you as an educator to use your professional judgement to keep your students and yourself safe.