10 Strategies for Addressing the Child Mental Health Crisis

Hey there, everybody. And welcome to Today's presentation on 10 strategies to address the child mental health crisis. I'm your host, Dr. Donnelly Snipes. In this video, we're going to identify the scope of the problem. We'll explore some possible causes of the problem and define 10 practical strategies that families, schools and communities can implement to address the mental health crisis in children. The scope of this problem is almost mind boggling, or maybe it is mind boggling for adolescents aged 12 to 17 years in 2018 and 2019. And the reason that date is important is because we know that children's mental health has gotten significantly worse since 2019. But during this snapshot from 2018 to 2019, 15% of adolescents age 12 to 17 years had major depressive episode. 37% had persistent depression. So it wasn't necessarily enough to qualify for a major depressive episode, but they always felt flat blue, low energy. Add the two of those up, you've got 37, 12, 52% of adolescents. That's more than half of adolescents experience depression in the past year. 5% had a substance use disorder. So 1 in 20 adolescents aged 12 to 17 years qualify for a diagnosis of a substance use disorder. And 19%, or approximately one in five, seriously considered attempting suicide. Just let that sink in and let your heart break for a minute. Suicide for kids over the age of 10 increased by 20% from 2019 to 2020. I told you, the stats are getting worse, not better. In 2021, 10% of youth, that's one out of every 10. 10% of youth between the ages of 12 and 17 had at least one major depressive episode. So we are seeing that a lot of youth that are in our schools, that are in our world are really, really struggling right now. Why? Just why? Why? And there are a lot of reasons, and I'm not going to cover all of them here, but I think there are some major factors that we can look at and start figuring out. How can we address these things in order to improve the likelihood that our children can grow up h happy and healthy? So first one is, well, the cause in general is trauma, and it can come from abuse due to caregiver stress. We've seen an increase in physical abuse, but we've also seen an increase in verbal abuse. And a lot of times verbal abuse does not get reported, but it exists. There's also abuse from peers in real life and online now more than any other other time in history. Youth are constantly plugged in and their peers can be bullying to them 24 hours a day, seven days a week. There is no place that they can go and kind of get away, get away from it. And you may think, well just turn it off. Sounds great. But the youth is thinking in their mind, well, if I'm not aware of what's being posted, I can't respond to it, I can't defend myself. So they are regularly struggling with this whole fomo and it's not necessarily FOMO for good things. Fear of missing out on something positive or a party or something. It could be fear of missing out on an opportunity to defend myself. They are regularly, if not constantly feeling unsafe. They're waiting for the next troll to come along. They may experience neglect due to caregiver stress. And in this video I use the term caregiver very broadly. That is anyone who interacts with children, whether it's a daycare provider, a teacher at coach or a, I'll call a primary caregiver. And that is the person that the youth lives with. It could be a foster parent, a parent, a guardian, a grandparent, whomever. But caregivers are exactly what the word sounds like. Anyone who is charged with providing care to these children. Anxiety and depression due to caregiver modeling. And what do I mean by that? I mean that a lot of caregivers are under a ton of stress right now and experiencing a lot of depression, a lot of anxiety. And when children see that they don't feel safe, they don't feel like they know what to do. Their caregiver is having difficulty struggling or difficulty coping with life. So oh my gosh, how am I, a child, supposed to care, cope with life? If my caregiver is feeling unsafe, then oh my gosh, I must be unsafe. So it the child picks up on it. There's near constant gaslighting from both sides, from every direction. And I think it's really important to recognize that in our culture of Internet life and, and even to a certain extent the media and 24 hour media, ongoing coverage of the same thing, people need to find different things to say. And it appears a lot of times that the information coming out is polarized. And there's a lot of gaslighting. I mean from, from every angle, from every faction, there's a prominence of extreme, what I call dystopian messages online. People go on social media, people go on search engines, people go to news websites, and the headlines that are there tend to be of an extremely depressing, anxiety provoking nature. Why? Because that's what gets you to click. And this culture of clickbait leads people to believe that things may actually be a lot worse and they may be a lot more disempowered than they actually are. And there's a lack of healthy, what I call interpersonal skills. What what I've seen in my children's generation. I have children that are adolescents right now and one young adult and they have interacted so much on through text that they've lost the ability to really effectively read nonverbals. They've in many cases developed a lot of social anxiety because they don't know how to interact and in real life anymore. So when they have to go to jobs, when they have to go to interviews, when they go out together, if they haven't been doing a lot of that, there's a whole lot of anxiety that goes along with that. We need to start asking, not assuming the things that were troublesome and stressful to us when we were growing up decades ago are not the same things that may be bothering the youth of today. Some of them may be very, very similar or the same, but there are also a lot of new things. It's important that we ask them. School counselors can anonymously survey children about what stressors they're experiencing. Tell me what's bothering you. The amount of sleep they're getting, their substance use and their adverse childhood experiences. This can be a really quick and simple anonymous survey, but it may give school counselors an idea of what the youth in their particular school is dealing with. We also want to ask youth what they think might help them and what methods they might use. Many youth would prefer text based interventions or video based interventions. A most youth that are interviewed now seem to not prefer in real life groups. They don't want to go to a face to face group therapy session. Back in my day they didn't want to do it either, but it's even more so now. So we need to ask them what methods might you use to access services and what services would be helpful and we can brainstorm with them. But youth often have an idea and we need to empower them to tell us what do you need? School counselors and teachers can also screen for what I call PACER issues that impair learning. Physical issues we've already hit on sleep, but nutrition, safety, those things that may be impairing learning. I don't know whether you want to put it under cognitive or physical, but we also need to do a better job of screening for things like ADHD and learning disabilities. We need to do a better job screening for anxiety, depression, cptsd and ptsd. Because when children are struggling with these things, they are not able to learn as effectively, they're not able to focus as effectively. They start experiencing chronic stress, which leads to emotional dysregulation, which leads to mood disorders, substance abuse and potentially worse. Communities can create work groups to identify and address stressors for children, tweens and teens. Each one of these groups has very unique needs. Obviously a five year old's going to have difficulty articulating what's causing them stress and what would help them. That's where we get parents involved or caregivers involved. Tweens do have the ability to articulate a lot of things and teens as well. When I say communities, this can be at community centers, this can be if you live in a neighborhood, this can be if you live in a, an apartment complex or a condo association with where interested adults, leaders in the, in that particular community can spearhead a work group to identify what can we do in this community to address the stressors and create connection between the youth and, and the community and the youth and the resources they need. And primary caregivers need to talk with their children and elicit families full sentence responses. If you say, hey Sally, how was your day? And Sally says fine. Nah, that doesn't quite get it because fine covers a whole host of problems. It's important that caregivers actually stop and engage with the youth. It doesn't have to be for a long period of time, but engage with the youth for a brief period, ideally making eye contact, but if not, you know, however you do it and really talk to the child. How was your day to day? What was the best thing that happened? What was the worst thing that happened? Is there anything that is stressing you out that's coming up. Ask them questions that they need to answer in order to keep, keep them from just kind of glossing over everything with a fine or okay, and regularly remind them that you're available. Sometimes youth is not are not ready to talk. But if you regularly remind them, you know, I'm available whenever you want to talk to me, you can tell me anything, just, you know, let me know and I will make the time. That goes a long way for youth feeling comfortable to come to you on their own volition when they're ready, when they feel they need to. Okay, so I haven't even gotten to the strategies yet. Those were just some overview things. Strategy one and I'm going to spend a fair amount of time on this because a lot of people minimize when I say Sleep is important, sleep hygiene is important and it really makes a huge difference in the mood, the learning ability as well as the emotional regulation ability of people, and especially youth. When people are sleep deprived, they have increased HPA axis or stress response system activity. When they're sleep deprived, the body says, oh, you need a little more energy, energy. So I'm going to give you more energy, I'm going to help you stay awake. So your body's kind of giving you an alternative to caffeine when it can. This increased HPA activity causes the person to feel more primed. So think about when you've been sleep deprived. You know, do you tend to be more primed, more irritable, more likely to react strongly to things? That's your HPA axis in the background going, you're tired. So I need to make sure that you're primed and ready to respond to threats that come along. There's also a ton of research out there that sleep deprivation leads to increased systemic inflammation. We know that systemic inflammation is connected to depression and anxiety. Increased emotionality and a reduced frustration tolerance is also very prominent, especially in adolescents. When they are sleep deprived, they have more difficulty regulating their emotions and they tend to get frustrated or irritable a lot easier. Increased major depression is directly associated with lack of sufficient quality sleep, as is impaired emotional working memory and accuracy. So when people are sleep deprived, they not only have difficulty learning, but those emotional memories, things that happen when and and cause them to feel extremely emotionally charged. A lot of times those memories don't get encoded accurately and can lead to increased fear, increased anger, increased sense of threat. They've also found, and this is fascinating, that when people don't have sufficient quality sleep, there's impaired fear extinction, which leads to increased anxiety. When people don't have adequate REM sleep, that eye movement sleep that we talk about, a lot of it actually impairs their ability to get over stressors, to extinguish or get rid of their fears about certain things. And another fascinating thing that has nothing to do with mood is that when people are sleep deprived, they have an impaired ability to effectively communicate during complex individual and collaborative tasks like group work at school, or problem solving or dealing with life as it comes at them. They can do the basic things like get up, you know, make coffee, make something to eat, sit down, watch tv, those basic things. But when you start getting into complex areas, it becomes much more difficult for them to communicate with others about what needs to be done or what they need. We also see cognitive decline when people aren't getting enough sleep. They have impaired learning, reduced attention, brain fog, and an impaired ability to suppress unwanted thoughts. How many times do we work with people who have anxiety disorders or depressive disorders that talk about their ruminations, that talk about these unwanted thoughts? Well, if they're not getting adequate quality sleep, research has demonstrated that it actually prevents them, impairs their ability to stop those thoughts to quiet that monkey mind. They hypothesized that sleep deprivation disrupts the prefrontal control. That's your executive higher order thinking over your medial temporal lobe structures that support memory and emotion. So the emotional aspects of your brain kind of run rampant because the executive control functioning, the higher order functioning is. They're just, it's too tired to engage, if you will. Why am I bringing this up? Because parents, teachers, communities, school systems all, all have a part to play in helping ensure that youth have adequate sleep. Sleep quantity 9 to 11 hours until high school. If you work with a child who is 13 or younger, you know, not in high school yet, they need nine to 11 hours of sleep a night. I don't think any or definitely not many students get that. And in high school they still need 8 to 10 hours per night. And I dare say I don't know any high school students that are getting that right now. That is a huge problem. We are creating an environment that promotes mental illness, that promotes problems in communicating, that promotes emotional dysregulation. What can we do? We need to help them learn about how to set their circadian rhythms. We need to help them prioritize sleep. We need to help educate them about sleep hygiene, including light exposure and blue light exposure, especially two hours before bed. Maintaining relatively stable schedules, avoiding stressors like social media, games, video games, and even homework right before bed. If they start doing homework and they start getting frustrated, then they're going to have a much harder time getting to sleep than if they had spent 30 minutes trying to do something that was helping them relax and getting get into that state where they're ready to sleep. They need relaxation and decompression time throughout the day, but definitely before sleep. They need to cut back on the caffeine within ideally 12, but definitely eight hours before bed. And we need to address noise issues that may be keeping them up, whether it's your noisy neighbors or your dogs that are barking half the night, whatever it is, noise issues that keep them up and their sense of safety. And I mentioned earlier that youth have a hard time feeling safe anywhere anymore, Even if they feel safe from physical harm in their own bed. They may not feel safe while they're laying in that bed because their social media profiles, their online life could be quote attacked at any time. And I don't know how to solve this problem. And I'm hoping in the discussion we have after this premiere that we can brainstorm some ideas. But a lot of youth are constantly dreading what is somebody going to say about me online? What is somebody going to do to me online? Interventions caregivers we need to model sleep hygiene. We need to manage for younger children sleep hygiene. We need to set those bed times and say, you know what, you gotta go to bed. There's just, it's non negotiable. As caregivers, we need to make sure we don't over commit youth. We don't want them staying out until 8, 9 o' clock every night doing this lesson, that lesson, this team sport, that team sport and then having to come home and do homework. Don't get me wrong, team sports are very beneficial but we don't want students having being over scheduled so they have to sacrifice sleep in order to get their homework done. Now teachers manage that homework load. So students are expected to complete no more than about one and a half hours per class per week. And what I've seen both at the primary school level, the high school level and the college level is it's about three or four times that right now. A lot of students have an hour or more of homework per night per class and that is just not manageable, it's just not doable. We need to start examining what is the student getting out of this homework, what is our goal for this student doing home doing this activity and how can we teach more efficiently? Can they have a chapter to read and 10 questions to do? Sure, but that's an hour and a half and that should be per week. So we need to really examine and get clarify our goals for learning. What is it that they need to learn? How can we do it most efficiently, most effectively for the student if they're staying up until 11:00 o'clock or 12:00 clock doing homework and only getting four hours of sleep? Guess what? Even if they got the homework done, they probably didn't retain squat. School counselors need to regularly connect with students to assess their cumulative homework time and advocate for the students with the principals, with the school board, with the pta, with the teachers to ensure that or to try, try to ensure that the youth actually have time to sleep. And if you haven't had children in school for a while, you may Think that I'm exaggerating. However, based on my experience with my children, my daughter just graduated and my son is getting ready to finish college. They, their friends, all had hours and hours and hours of homework every single night. It was oppressive. Strategy two. So strategy one, if we help them get sleep, we're setting a foundation where they actually have the energy and the neurological basis to learn to communicate, to manage their emotions. So we're helping their body factory be primed and able to do something. Strategy two has nothing to do with kids. This is caregiver mental health. Caregivers with uncontrolled mental illness or addiction issues. Notice I said uncontrolled. Often experience impaired sleep, increased pain, and they're frequently in stress mode. So they're frequently either in fight, flee, fawn, freeze, or forget about it. Why do we care? How does this impact children's mental health? Well, when they are having difficulty dealing with life on life's terms, when their sleep is impaired, it has all the same effects that we just talked about. When they're in pain, when they're stressed out and they're fighting, fleeing, freezing, or, or depressed, they are inconsistently aware and responsive not only to their own needs, but also to the child's needs. And this is where we see what I call inadvertent neglect. The caregiver is doing the best they can to survive, to keep a roof over their head. They don't. They can barely handle their own stuff. They are just not even emotionally available to the youth, at least not most of the time. When they're in this state, when they're in this chronic state of anxiety or stressed out, they have an inability to teach emotion management skills partially due to their own distress. They're like, if I find a skill that works, I'll let you know, but right now I'm drowning. Or they may not have the skills. They may never have learned the skills. Assuming that this mental health crisis started with this generation is foolhardy, look back to last our generation, the generation before us. Where were caregivers at? How were people being taught coping skills and distress tolerance skills and those sorts of things? Or were they being taught caregivers who are frequently, constantly, whichever you want to use, stressed out, often struggle with frequent emotional dysregulation. They go from being flat. You know, they're, they're functioning. They're kind of going through the motions on autopilot to frantic or furious, and there's kind of nothing in between. That's scary for a child. Not only is it scary for a child. But when a caregiver is dysregulated, when they're flat, they don't have the energy or ability to really tune in. Most of the time it's just kind of all a haze. When they are in frantic or furious mode, then they are desperately trying to respond to threats in their environment which may include the child. And they may become verbally or physically abusive under stress. Now not all caregivers do this, but it is important to recognize that high levels of stress, high levels of conflict, high levels of feeling disempowered and unsafe in your environment often leads to irritability, anger and aggression. Children form their schema or their understanding of how the world works and what to expect based on the caregiver's guidance. They learn from the caregiver who is safe, what is safe versus what is unsafe. So if a caregiver is dealing with anxiety, feeling disempowered, feeling unsafe, dealing with trauma, CPTSD or ptsd, they may be communicating to the child that it ain't safe out there, nobody's safe, nothing's safe. So the child internalizes this and they start feeling very fearful and disempowered themselves. Children pick up on caregivers mood and often personalize it or feel unsafe if the like I just mentioned, if the caregiver is feeling unsafe and disempowered, if they're feeling traumatized, then the child is likely going to feel similarly unsafe and disempowered. If my caregiver, who's supposed to, you know, protect me, can't handle this or is struggling, I'm screwed. If the caregiver is feeling anxiety, the child may pick up on that and worry about whatever's happening. You know, if the caregiver's worried, then there must be something I need to worry about too. Or they may start feeling fearing abandonment. If the caregiver is angry or depressed or burned out and either irritable or what we'll call non responsive children personalize these things. The caregiver feels this way, it must be my fault or the caregiver feels this way, I must have some, there must be something I need to be concerned about. We need to do a better job of making sure that services are available to promote caregiver mental health. Caregivers first off, caregivers need to prioritize their mental health and not sweep it under the rug. Not say oh I'm fine, not say I don't have time for counseling. Stephen Covey talks about sharpening the saw for and if you've never used a saw, think about a steak knife. If you're trying to cut with a dull steak knife, it goes really slow and it often kind of tears the meat and doesn't do a good job of making a nice cut. If it's a sharp. If you take the time to sharpen the steak knife, then it does exactly what you need it to do. And the same thing is true for our mental health. If we don't sharpen the saw, then we may muddle through things and we may get them done. But is it effective? Is what we're doing nearly as effective, nearly as helpful as it would have been if we were sharpened? Communities need to ensure affordable and yes, that's bolded and italicized for a reason. Counseling resources are available and accessible. Affordable does not mean 60 bucks an hour for most people. You know, affordable is more like 15, maybe $30 per hour and 30 still pushing it for a lot of people because that's like just that is two hours of pay for them. Not to mention the amount of time they lose driving to and from the appointment and child care and everything else. Affordable, accessible mental health services need to become a priority. We need to promote these things through doctors, churches. Print information about it on the bottom of grocery receipts, on the bottom of electric bills, tv, radio, commercials. If these services are available, then you need to make sure people know that they're available and how to access them. Services like group psychoeducation online can be provided very affordably. Television or video based psycho education like on YouTube and telephonic case management. And I could go on a whole diatribe about why case management is essential to help people actually find and access the resources they need. But we don't have time for that today. It's important to remember if you are promoting something, if you want the caregivers to do something or people in your community to do something, you must always make a compelling case why it is worth their precious, precious energy. Most of us these days feel like we ain't got enough hours in the day. So if you're asking me to take on something else, I need to know why it's important enough for me to take that on. Because it means I'm going to have to give up something somewhere. Businesses also need to provide counseling and coaching to employees, including onboarding with training in mindfulness, assertiveness without defensiveness, distress tolerance, understanding trauma in the workplace, and verbal crisis de escalation. A lot of people are talking about being in burnout work environments and yes, I believe some of these environments are extremely toxic, but I also believe that some of that toxicity is caused by people coming to work and they're already stressed out, burned out, anxious, angry, overwhelmed, and it. They feed off of each other. The person that is already struggling comes to the. Comes to the business and the business is not meeting their needs and they don't know where to get their needs met. So they kind of spiral. Mindfulness is helpful to promote commun. Effective communication, as is assertiveness without defensiveness. So creating a safe, empowering work environment can be. Can go a long way to helping people not only learn the skills and tools they need to manage stuff outside of work, but also develop the skills and tools to better manage things in the workplace and hopefully reduce stress there. We've got kids and caregivers hopefully getting better sleep. We are trying to address caregiver mental health issues so they can be present and emotionally and physically responsive to the needs of the child. Now we're moving on to secure attachment. The lion's share of people that I've seen in the past five years. One of the core issues contributing to whatever diagnosis they're presenting with has often been trauma or abandonment anxiety as a result of insecure attachment. Secure attachment means having consistency in their emotional awareness and physical presence. Being there. That, that's what we mean. Responsiveness means not only being there and being kind of aware of what's going on, but then responding to the feelings, thoughts and needs of the child. I see that you're feeling angry or anxious or I see that you're bored right now. Let's talk about what that looks like, what we can do. Attention that's positive and proactive validation of the child's present experience. Even if you don't agree, even if you think they're overreacting, that's how they feel right now. So acknowledging it and then saying, okay, how can we improve the next moment? What strategies do you have? What are the facts in this situation? Encouragement to explore and practice skills they're learning. And that may mean using scaffolding to allow them to cope as much as they can until they get to the point where they can't. And then helping them the rest of the way and providing safety via unconditional positive regard. I love you. Even if you make a mistake. I love you. Even if you fail. History. I love you. I may not like what you did or like the situation, but. But I love you. Interventions for primary caregivers, teachers, including daycare teachers, coaches, counselors. We need to Help promote secure attachment. Have online library and community center resources that teach mindfulness, distress tolerance skills, child development basics, how to use scaffolding to support children, age appropriate coping skills, and how to provide unconditional positive regard. If we have these resources out there for caregivers, teachers, coaches, counselors, then we have a army of people, if you will, who have been provided the resources and tools to promote secure attachment and to support youth. Strategy four is mindfulness. We need to help people, but especially youth, start becoming mindful of their own feelings, thoughts, wants and needs. A lot of times children are not asked to check in with themselves. They just kind of sit with this icky feeling or they don't have words to put to it. We need to help them develop that emotional vocabulary to become mindful of what it is and what their needs are. And then we'll get to learning how to communicate that in a minute. They also need to start becoming mindful of other people's feelings and needs. Empathy is huge. Helping people empathize and recognize that, okay, this person's upset right now. It may not be all about me right now. Let me just empathize and be mindful that this person is feeling angry or scared. They need to be mindful of their own impact on other people. And this is sort of a trauma informed perspective, recognizing that maybe they did do something that caused this person to get angry, but maybe the person got angry because it triggered a trauma memory for them. It's not, you didn't intend to harm them, but what you did triggered a trauma memory. So now they're reacting from that place. It can go so far if people start recognizing depersonalizing things and getting curious about the reactions in themselves and others. Why am I feeling this way? What's going on right now in this particular situation? And you know, is it something about the now or is it something that's being triggered from the past? And then just mindfulness of the present moment? What do they see, hear, smell, what's going on right now? Not worrying about, you know, tryouts next week or what's going to happen this weekend or what happened last weekend, but what's going on right now? What's going on right in front of you? Interventions. We can use video, audio and text based lessons. And I encourage you to make PDFs available on library websites to teach youth mindfulness strategies. You can have optional, what I call municipal push notifications. I'm signed up on our city's website to get push notifications about upcoming city meetings and events and stuff. Well, we could just as easily add in a push notification every day to remember people to check check in with themselves for mindfulness. They can unsubscribe from it. They don't have to subscribe to it. But if they want that push notification, then it's there. During the school day before class changes, for example, or defined periods during the school day, having a mindfulness reminder where students are told over the loudspeaker, you know, we're going to take one minute and and do a mindfulness check in and give them one minute to check in with themselves. Some teachers already do that in their classes, which is fabulous. Strategy 5 Emotional Awareness we need to help youth start developing that emotional vocabulary and understand what emotions are. They're not scary. Anger is there for a reason. Anger and anxiety fight or flee. They're part of your stress response. It's your body's smoke alarm that tells you there might be a threat and gives you energy to check it out. When you feel angry or anxious. It doesn't necessarily mean there is a threat. And it's important for students to recognize youth to recognize that. It's important for youth to recognize what triggers anger and anxiety and depression and confusion for them so they can, when they're mindful, they can more effectively intervene early. But right now on this one, we're just talking about learning about emotions so they're not so scary. So youth can start identifying them, putting words to them, and saying, I feel this way. All right, I feel this way. Why? And what response options do I have? But I also have on here curiosity, happiness, safety, and empowerment. It's important for youth to be able to identify the positives, too. If I'm feeling anxious, that may mean I feel unsafe and disempowered. So what can I do to trigger feelings to help myself feel safe and empowered and encourage them to think about it. That's how they can start identifying what their needs might be in the moment. Interventions for Emotional Awareness show me is what I call it. Have young children show you what something looks like. What does anger look like? What does fear look like? What does happiness look like? You can have youth identify the emotion in TV characters and guess about triggers. Just let them watch a particular show that may be popular and pause it occasionally and say, all right, what emotion might that person be feeling and why? Identify three times that you have felt and identify the emotion. Identify three times you felt anger and what caused it. So encourage youth to look backwards and identify, you know, what makes me feel angry? If you wanted to feel fill in the emotion, what could you do? If you wanted to feel empowered? If you wanted to feel curious or motivated, what could you do? Do a collage to show the emotion. What does anger look like? What does curiosity look like? Older children can write a story about someone experiencing the emotion and how they effectively coped. Now cool way to use this. Obviously the teacher has to proof it first but is to have high school youth write these short stories with the in mind for the younger students. So they write a story about I'm going to use the characters from my my age, Dick and Jane. But they can write a story about young people experiencing something and what they can do to cope with it. Those essays from the high school students can be illustrated in art class and then put together as a PDF, collated as a PDF and provided to youth in younger grades to use to practice reading. Oh my. And if they do the drawings for these, you can even leave them as just line drawings so the youth can color them. How awesome. Strategy 6 distress tolerance when we talk about distress tolerance and I have a lot of videos on that but it's important because a lot of youth when children are up until the age of 25 or so, when your brain finally finishes developing, your prefrontal cortex is not fully developed, the emotional part of your brain tends to be more powerful. So adolescents especially may feel more overwhelmed by their emotions. Distress tolerance skills helps them learn that they can sit with these emotions and it won't overpower them, it won't destroy them, it won't completely suffocate them. Distress tolerance is not about avoiding feelings, it's about tolerating them until that adrenaline and all those other chemicals kind of dissipate a little bit and they can get into their wise mind. So thoughts that are tolerant of the distress. I can do this. This really sucks. But it'll be over in a minute. Whatever thoughts they want to have and encouraging thoughts. You know you've got this. You're lovable even if you don't win. At least you tried whatever word distress tolerant thoughts they want and I encourage them to write them down. They're not going to have a lot of luck thinking of distress tolerant thoughts when they're steeped in distress activities unhooking from the feeling. I'm having the feeling that I'm angry. I'm having the feeling that I'm depressed. I'm having the thought that I'm a failure. This is something you have, you have and you hold. Now what you do with it is your choice. Instead of saying I am angry, I am, am a failure, which is part of you. And you know, how do you get rid of that? So if you're unhooking and you're holding it, breathing, slow breathing. Inhale for four, hold for four, exhale for four, hold for four,. Do that a couple times. Can help. Grounding five things you see, four things you hear, three things you smell, two things you feel, and maybe one thing you taste. Encouraging people to just turn their attention to the present moment, get out of their head and into the moment. Hugs. And I've mentioned this in a few of my others and I don't mean necessarily from other people, although with small children that they may ask for a hug and that's cool, but they can also give themselves a hug, wrap one arm around the rib cage and the other army grabs onto the opposing shoulder and just squeezing. And you know, some people will do this and rock. It helps them feel calm. It releases oxytocin. It can actually help trigger the vagus nerve and the relaxation response. And some people, like journaling guided imagery, envisioning themselves successfully getting through whatever this is, or envisioning themselves enduring it, you know, getting through it, not being overcome by it, or envisioning something that would help them feel safe in the moment, whether it is a guardian angel or a bubble or a superhero that's at their back, whatever it is for them and sensations. Splashing cool water on your face. Wall sits are very helpful at school because you can go into the bathroom, go into the stall, close the door, and then lean up against the wall of the bathroom stall and slide down until your thighs are parallel with the ground and hold that so you're kind of sitting like you're in an imaginary chair. That gets very painful very quickly, but it also turns your attention to what you're doing and it gets your mind from out of your head down to your legs. Some people will snap a rubber band. Not my favorite activity. And for some people, absence can also be helpful when they feel they're in distress, when they feel overwhelmed. Sometimes they just need to get somewhere that is quiet, where they don't have visual stimulation, where they don't have noise. They just need absence interventions. For youth. We can put posters on the walls at school that remind them of these skills in art. Or we can have them do these as lessons in art class. With handwriting, they can practice tracing different words that are distress tolerant. Or through storytelling, they can have proactive and reflective discussion with caregivers where the caregiver says, you know, I know you felt anxious about that test. I know you feel anxious about that test tomorrow. What things can you do to manage that anxiety? So proactively helping youth figure out what they can do and more, maybe more specifically, what their fears are. Caregiver and reflective. When that happened, you got really mad and screamed at him. What could you have done differently? Not criticizing the youth, but saying, okay, you made a less than optimal choice. What could you have done differently? And what will you do differently in the future? Instead of screaming at somebody. And caregivers model distress tolerance. Talk about, you know, today I got upset when I this happened at work and I had to go outside and take a walk around the building that shares with youth that number one, you struggle too. But these tools do work. See, this is what I did. It worked for me. We're great. Strategy 7 Heartiness Encourage children of all ages to define a rich and meaningful life. What do they need to be happy? What makes them happy? Create a collage. When things start going badly, then you can look at that collage and say, okay, these are all the things that are important to you. Which ones are still going well, and then which ones are not going so well. So it gives a visual perspective, control. Once you've done that, figuring out, okay, the things that are not in your control, what can you do to address the situation? Can you turn it off? Can you let it go? Can you assertively confront it? Maybe there's nothing you can do to address the situation. So what can you do to control or address your reaction to the situation? And then finally, challenge. Encourage the youth to just brainstorm ways that somebody, anybody could resolve this. So they're viewing it. Instead of a barrier, this thing is here and I can't do anything about it. Encouraging them to view it as a challenge. How could I creatively address this? Helping people identify the rich and meaningful life for characters in a story and apply the hardiness principles can be helpful. Reading through a story saying, okay, what was important in for Tom in his rich and meaningful life and how many of those things are going well for him. Review the rich and meaningful life collage for the child and help them gain perspective. Create. Another tool you can use is to create a balance which with a hanger, hang it on a door handle. Tie a cup to either end of it. So you've got a little makeshift scale, a little makeshift balance. Get 10 large and 20 small marbles. The large marbles are for things that are super important and the small marbles are for things that are important but not super important. One side are the things that are going well. So they put marbles in representing the things that are going well, and the other side, things that are not going so well. And ideally, we want to see the going well side to be a lot heavier than the not going well side. Strategy 8 boundary setting and I know I'm running short on time here. We need to help children learn what healthy boundaries look like and how to maintain the boundaries once they're set. Interventions for this can include caregiver scaffolding and modeling. For setting and maintaining boundaries, caregivers are going to scaffold by helping the child identify, you know, what is your physical boundary here? What feels safe, what feels and what feels uncomfortable to you? Okay, that's your physical boundary. Now that you've defined it, let's talk about how can you maintain that boundary? What do you do? How do you communicate to others in order to maintain that boundary? And you can do that through role playing. That probably the most effective way. Listening without defensiveness we want youth and everybody to learn how to listen, to hear all of what's actually said instead of trying to formulate their response halfway through the other person talking. We want them to separate rejection of a thought, feeling, or behavior from rejection of them. And I see that as a big problem right now. We want to help them recognize defensiveness as a reaction to a threat and improving mindfulness of threat triggers so they can recognize when they might be feeling threatened. And then they can ask themselves, am I safe and what triggered my threat smoke alarm to go off? And then the ability to use distress tolerance to get into their wise mind for this. The best way to learn how to listen without defensiveness is role playing and or debating or arguing the opposite point of view. So assigning people the other person's point of view and having them argue that point of view in a way that they both are assertive, don't become aggressive, and can respect one another's cognitive boundaries and emotional boundaries. And finally, assertive communication mindful awareness of their feelings, thoughts, and needs in the moment. Using I statements that respect other people's feelings, thoughts and needs, not using the you should do this or I should have done that, recognizing what their feelings, thoughts and needs are in the moment and that those are theirs and other people may have different ones. We want to make sure that youth have safe places to practice assertiveness and provide scaffolding when necessary. When they start to become more aggressive using shoulds, providing unauthorized or unwanted advice, we're able to gently redirect them and Help them step back and start respecting that other person's boundary again. Roleplay assertiveness for emotional topics. If they need to have a discussion with a friend about something, role play it ahead of time so they feel more confident that they can have this discussion without it deteriorating into something not so good. And providing caregiver encouragement of assertive communication. Regularly eliciting from youth what are your thoughts? Thoughts on current events, what are your thoughts on moving or where we're going on vacation so they can start feeling safe to assert their opinion. Even if they don't get their way, even if don't others don't agree, they're able to put it out there and feel respected and heard. Today's youth are bombarded by stressors like no other time in history. The caregivers are often exhausted and overwhelmed. Annually, 10.5% of adults experience depression, 4% have diagnosable PTSD and 22% of adults that are in the age where they're probably raising children, 22% of them have a diagnosable anxiety disorder. So we're not talking about just run of the mill stress. We are talking about clinical mental health issues. Caregivers with uncontrolled mental health issues often struggle to form secure attachments with their children. Lack of secure attachments prevents children from developing a sense of safety and trust in their environment if they don't feel like their caregivers got it or got their back. Emotion management Kids don't know how to label these feelings, which is why we need to be part of present and help them start labeling them early on so they can start connecting what this feels like with a word. Cognitive processing to address those cognitive distortions that may contribute to them feeling less safe and empowered. Problem solving boundary setting Communication skills are also learned through secure attachments where the caregiver is being responsive and sitting with the child and saying okay, how can we solve this? What are your thoughts? And I'll tell you my thoughts. So we share our thoughts but we we respect each other's boundaries and we're communicating assertively. All of this helps a child develop a sense of competence in managing their emotions, relationships and achieving goals. And it helps them develop self esteem because they start feeling like they're important, that their caregiver wants to take time to interact with them. They start feeling competent and safe and efficacious within their own skin.