COVID-19 Impact on Mental Health in our Schools

Hello, everyone. We appreciate you taking the time to join our webinar. I'm Greg Peterson, Content Manager for CrisisGo. Today we have Jeffrey Wellington of Hamilton Township Schools in New Jersey here to share his school safety knowledge. Jeff will introduce himself in a moment, but first I want to share that all the slides used in the presentation will be emailed to webinar participants after the webinar has concluded. We'll also be having a quick Q&A session with Jeff at the conclusion of the presentation. Everyone can submit questions via the questions panel on the GoToWebinar menu, and you can submit your questions throughout the presentation or during the Q&A itself, and we'll address as many questions as we have time for. So without further delay, I'll let Jeff take it from here. Thank you.

Thank you, Gregg. So, hello, everybody. Welcome to COVID-19 Impact on Health and our Schools. As Greg said, I'm just going to briefly introduce myself. Again, my name is Jeff Wellington and I work in the Hamilton County Public Schools in Mays Landing New Jersey. I’ve been with the district for about 28 years now. Served in many different capacities over that time. I've been a special education teacher, school psychologist, mental health crisis counselor. I'm currently the supervisor of special projects. My main focus in the district is on our mental health initiative, incorporating suicide prevention, social-emotional learning, bullying prevention, positive behavioral interventions, and supports. More recently, I've been instrumental in writing our districts pandemic plans as a result of COVID-19.

Switch the slides here. By way of outline or agenda, we're going to be talking about a couple of different things. The first I want, I want to start off with the prevalence of mental health disorders, In our children, prior to COVID-19, kinda build a little context of what was going on for our kids, with regard to mental health. Before the virus. I also want to talk about that the confluence or interplay of adverse childhood experiences, including domestic violence, child abuse, substance abuse, and how those experiences are exacerbated or are made worse by the social distancing that we're kind of being forced into at this point. That's definitely a double-edged sword, that social distancing. I also want to talk about the emotional and behavioral responses to trauma and the uncertainty of what to expect from our students only when we come back to school. Whether that, you know, that, what that looks like when we come back, and as you were in school full day, or if it's, uh, continues to be virtually or some kind of hybrid a mix of the two. Wanna kinda talk about what that might look like and what we can do to help our kids in any one of those situations. And then at the end, I'm gonna kinda finish up with talking a little bit about mental health, and how that might lead into suicide talk about risk factors and warning signs of suicide. And finally, I want to finish up with a talking about a specific assessment tool that we've used in the district. After years of tried to develop something, and they're talking about that. That tool that we use and, and how CrisisGo was developing kind of a similar tool along the line, along the same lines. And how we've kind of joined forces a little bit to bring you a really great, powerful tool to assess students who might be in crisis, talking about suicide research things, will say that, that piece to the end. So that's kind of our agenda for today.

Moving on to the next slide, you can see the number of cases of COVID-19 around the world. And certainly the coronavirus has been, to say the least, stressful for people around the globe. Just that fear of death alone, even if you haven't contracted the virus or come into contact with the virus, the fear, the virus can be very traumatic, especially for individuals who don't have the coping skills or resources or supports to navigate that fear. So taking a look at those, numbers there, coronavirus worldwide, you can see that I have numbers in black, and then there's also numbers in red. When I was putting this presentation together last week, I was putting those numbers in those numbers from last week or in red. You can see the increases in the black numbers for this morning, those numbers are, directly from this morning, over five million, almost six million cases worldwide, 350,000 deaths worldwide. And that recovered number. That's a great number. I'd like to see that number. I'd like to see that jump up, here, you know, by leaps and bounds. That's really important. Is that recovery number? Then you can see the numbers. in US cases, 1.73 million at this point and you know, the deaths is 100,000. Again, that recovery number hopefully, you know, continues to skyrocket, so people are recovering being better. Our students are going to come back to school forever changed by this time in history. Their experiences are going to help them to either build resilience in the face of adversity or caused them chronic stress and trauma. That's going to impact them socially, emotionally, behaviorally, and academically. It's my hope that by sharing this short time together today, you'll leave me with some additional ideas How to make your work with students. in particular. Those students were whose mental health has suffered during this time, a little easier for a little more effective when we returned to school. Again, this isn't, you know, a huge puzzle that we're trying to work on, and, you know, today's conversation, and talk is just one small slice of one piece of that huge puzzle.

So, moving on to the next slide, I'd like to talk about the prevalence of mental health disorders in the United States prior to COVID. And so it kinda, again, gives you that context of, you know, where we're coming from, and the impact on the virus on mental health conditions. So the prevalence of mental health, and in the US ADHD, behavior, problems, anxiety, and depression is the most commonly diagnosed mental health disorder in children, but you can see, additional diagnoses there. 9.4% of children ages 2 to 7 have an ADHD diagnosis. That's nearly six point one million youth in our country, have a diagnosis of ADHD. 7.4% of children aged 3 to 17 years have a diagnosed behavior problem, four-point five million, 7% of children in that age range of diagnose anxiety, 4.5 million. 3.2% of children aged 3 and 17 have a diagnosed depression disorder, It's almost nearly two million people. And approximately 50% of students, ages 14 and older, with a mental illness. Kinda like those I just listed, drop out of high school, and that's a huge loss for our children and our country as a whole.

If we go to the next slide, I want to talk about how early mental health disorders begin in youth, and we talk about that in terms of the median age of onset for mental disorders. When you look at all the people diagnosed with a specific mental illness, the median age of onset is the midpoint. The median age indicates that half of the cases of a specific mental illness occurred before that age. Half the cases of the same diagnosed mental illness began after that age. So, those are the symptoms, and the manifestations of those that disorder half of those start before that median age of onset, So, if we take a look at anxiety disorders, the median age of onset is age 11, that early kids are being diagnosed with anxiety, and half of the cases are being diagnosed prior to age 11, So earlier than that age. Eating disorders, half of the eating disorders, manifestations, and symptoms, are beginning before the age of 15, then half of those are diagnosed after the age of fifteen. You can kind of continue to see that the median age of onset for substance use disorders age 20, schizophrenia 23, bipolar is 25, and depression age 32. So you can see that, you know, our data diagnoses are starting really, really early in our children.

Moving on to the next slide. Here's some additional prevalence information regarding mental health. Half of all lifetime cases of mental illness begin by age 14, and three quarters begin by age 24. The average delay between symptom onset and treatment is estimated between 8 and 11 years, so that child who has anxiety at11 years of age. They take anywhere from 8 to 10 years or 11 years before they get the help that they need. So it might be they might be in their early twenties, before they're actually getting some assistance for that anxiety disorder that started at age 11, or even prior. People will get treatment in a given year, 51% of youth, with a mental health condition. That means 49% of our youth aren't getting any treatment in any given year for the mental health disorders that they have been diagnosed with. Suicide is the second leading cause of death, where people 10 to 24 years of age. We'll be talking about suicide a little bit later. Research has found that 46% of people who die by suicide had a known mental health condition, so these mental health conditions are really, really serious, and, you know, can actually result in someone taking their life, committed suicide.

Moving on here. Many of our kids are really struggling with mental health. Now with the lifestyle imposed by stay at home mandates, school closings, and the fear and anxiety we manage on a daily basis. Due to COVID-19, we're looking at adding layers of stress, fear, and anxiety to those kids who are already struggling. Everyone is at risk and everyone reacts differently to stressful events. Fear and anxiety about a disease can be overwhelming and cause very, very strong emotions. Our brains see this virus as a threat, just as surely as if we were to encounter a bear in the woods, or someone held a gun to our head. That fear response and our brain, same happens in our brains that this was the same mechanism. It's fight, flight, or freeze. That fear of the virus is the same as those real fears out in the world, just that fear of thinking about it. When we feel threatened, we need to move. We need to run away or protect ourselves, You know, we kind of kick into action. That's fight or flight. When threatened, we seek out others, like friends and family for protection. When threatened, we seek out an environment that is safe and predictable. Predictability is really key And feeling safe, knowing what's going to happen next, is, always, is a key element of your fight or flight, and making sure that we're safe. This virus threatens our survival brain. It embodies all the elements of a stress response that limits our ability to move about in our community. With confidence and safety, it reduces our connections with others and it's unpredictable. We can't predict when things go, will go back to normal. So that limiting, our ability to move, cutting off connections with others. And the unpredictability can be a recipe for trauma within our bodies.

I want to take a look at the slide about ACEs. Talk about trauma and aces. ACEs is actually the Adverse Childhood Experiences Study was a study that was done in the mid to late nineties by a doctor Vincent Felitti of the Kaiser Permanente Health Organization in California and doctor Robert Anda, of the CDC. And it speaks directly to chronic stress and trauma in children and the lifetime effects of what happens to kids during childhood and how these experiences shape who they become as adults later in life. This study of over 17,000 people demonstrated an association of adverse childhood experiences. Things that happened to children prior to their 18th birthday with health and social problems across the lifespan. This study has generated a survey. We call it the aces Survey. The tallies different types of abuse, neglect, and other powerful hallmarks of a rough childhood. There are 10 types of ACEs, and I just wanted to review those on the next slide.

They include neglect, abuse, and household dysfunction. There are two types of neglect physical and emotional. See those pictures there? Then there are three types of abuse. There's physical abuse, sexual abuse, and emotional abuse. And finally, on this slide here, there are five types of household dysfunction, including mental illness of a family member, divorce, a member of the family that has been incarcerated, domestic violence, and substance abuse. According to the ACE Study, the Adverse Childhood Experiences, the rougher your childhood, the higher your ACE score, the higher your ACE score, the more susceptible you are to a variety of physical and mental health issues, both long and short term. So this impacts us short-term when, you know, when they're happening, but also long term.

Next slide. Taking a look at adverse childhood experiences, those effects are supported. Those effects that, whether that was just talking about are supported in subsequent studies, It's not just the one, ACE study that was conducted in the late nineties, there have been other studies that have followed up and reported the same thing. Individuals with an ACE score of four or more. There's a bunch of bullets here, indicate some outcomes long term outcomes for individuals. So, they, might, they would be, so ACE score of four or more. If you have four of these ACEs. Again, they were abuse, neglect, and household dysfunction. You are two times more likely to smoke across your lifespan. seven times more likely to be an alcoholic. six times more likely to have sex before the age of 15. two times more likely to be diagnosed with cancer. two times more likely to have a heart disease. five times more likely to experience intimate partner violence or rape, 10 times more likely to have injected street drugs. And you're 12 times more likely to have attempted suicide as a result of these ACEs, these adverse childhood experiences that occur prior to your 18th birthday. With an ACE score of six or more, your life expectancy is shortened by 20 years. An example of a child who may have had ACEs. And, therefore, a score, it could be something along these lines. And, you know, a child whose parents divorced because the father maybe drank heavily and was physically abusive to the mom. And as a result, the mom became depressed and often neglected the child's care. That would be four ACEs, that would be a score of 4. And all of those things that I just read, you're more likely to engage in those types of behaviors or have those things happen over your lifespan. From this research, we know that toxic stress and trauma, from ACEs, can change brain development and affect how the body responds to stress in adults and children alike. We're gonna talk a little bit about chronic stress and aces in brain development, a few more slides, but before I do, I want to talk more specifically about several of these ACEs. Several of these different types of ACEs and the impact social distancing is having causing these ACEs to be worsened during the pandemic.

So let's take a look at the next slide on social distancing. I want to look at the break down of the word pandemic for a moment here. The pandemic refers to the possibility that the disease or virus could affect anyone and everyone around the globe. It's not localized. It's not, it's not one community and state or country, it's around the globe. It also suggests that everyone is affected. It does not suggest, however, that everyone is affected in the same way by the virus. So what I mean by this, well, the COVID virus is, it's insidious, and that it can cause us to get ill, and it can kill us. And the best defense we currently have against it is social distancing. Yet that social distancing, that protection from it can also cause great harm, so that's what I mean by its insidious, you know, it really kind of gets us from both ends. Now, that harm caused by social distancing may not be as rapid, but it's just shortly going to impact people. In particular, our students. We hope to lessen the spread of the disease through social distancing isolating ourselves from others, but social distancing can be that double-edged sword. If we observe it and practice it effectively, they can mitigate and maybe even prevent the spread of the virus. And that's good. That's a good thing. However, the isolation that accompanies social distancing will most likely force an increase in areas of social concern. Areas of social concern that impact the mental health of everyone, including our children, either directly or indirectly. When we returned to school faced significant mental health concerns, no doubt in our students. Most likely brought on by an increase in the following: ACEs or social issues. Number one is domestic violence, child abuse and substance abuse, and maybe resulting in, you know, higher suicide rates. All of which are all of those are our ACE scores, and indicate risk factors that can impact our mental illness. But each of these factors could be a precursor to more suicidal ideation, suicide attempts, and completed suicides by our students. I'm going to talk a little bit about suicide again, a little bit later, and how we can better assess that risk of level or that level of risk for our students in crisis situations at the end of the presentation. But, for now, let's talk specifically about domestic violence, child abuse, and substance abuse.

So, on the next slide. What we're looking at? Domestic violence, and as we grapple with the spread of COVID-19, we're being told to go home and stay there. For personal safety and everyone else's, stay home. But for victims and survivors of domestic violence, including those children exposed to it, if they're not necessarily the victim, being home is definitely not a safe option. In many cases, the additional stress of the pandemic could breed unsafe home environments. Think about it. It can increase stress due to job loss or strained finances, forcing an uptick in domestic violence in the home. It can reduce access to resources, such as shelters, or those who need to flee or leave their abuser, or try to go to emergency rooms for the victims who may have been, you know, injured violently in domestic altercations. So they're not able to get to the hospitals and maybe get the emergency care that they need. It can also reduce safety options for them. And before the pandemic, a survivor or victim could flee the situation by staying with a family member or which they can't, or they might not have access to now because of the social isolation quarantine. They might have filed a protective order with the police. So, a lot of these different options that were available prior to COVID-19 aren't necessarily available to everybody right now. So that reduction in services of them being able to reach out and connect it, has been reduced. That's going to impact domestic abuse.

Moving on to the next slide, it's about child abuse. And since the mandated COVID-19 restrictions occurred, reports and if you look at the news reports, indicate, we're seeing fewer cases of child abuse. So that's a good thing right? No, it’s now. What's happening is, there's a reduction in the reporting of child abuse. So it's still happening. It might even be happening more because of the close quarters that we're in. And the inability to get away from those that are abused, you know being abusive. But there's less contact with mandated reporters, such as school staff or coaches and club activity advisors. So those incidences aren't being reported as much. Now we know that underreporting significantly increases the risk for trauma to an abused child. Child abuse can have a very pervasive, long term effect. It's one of those ACE scores on various developmental aspects per child. It's imperative that we detect this early because unchecked abuse can impede a child's ability to regulate emotions, behaviors, and social skills. Post-traumatic stress brought about by child abuse can negatively impact academic potential and achievement as well when we're thinking about an abused child sitting in our classrooms, trying to learn. So definitely, we're going to probably be seeing some increases in child abuse, but we're getting a lower reported write up because the mandated reporters aren't in close proximity of the children that are being abused.

Moving onto the next slide: If I only want to take a look at substance abuse and addiction. Which is another ACE score that's being impacted during this time. Definitely. Those people with addictions and substance abuse that know their feelings of depression, anxiety, fear, uncertainty, loneliness, and board and can easily escalate as a result of the quarantine and social distancing at this time. Isolation and emotional distress can be significant triggers to relapse into that addiction And, you know, canceled alcoholics anonymous meetings and narcotics anonymous meetings, you can reduce the help that people are able to get right now that they are so desperately seeking during this time. So, definitely, substance abuse and addiction abuse is probably going to increase during this period.

Moving onto the next slide, I want to share with you a little bit more about the ACEs and this concept of a pair of ACEs. This picture, as you can see, the tree was created by doctor Wendy Ellis, was created to illustrate the relationship between childhood, its childhood, adverse experiences within a family, and the adversity when within a community. You can see two parts, the upper and lower part there. The leaves on the tree represent the symptoms of those ACEs previously discussed: domestic violence, emotion, emotional, sexual abuse, depression, divorce, incarceration, etcetera. You also see the tree is planted in extremely poor soil that's filled with systemic inequality: poverty, discrimination, poor housing, violence in the neighborhood these equity's, marginalized, disconnect, and disenfranchised individuals families, an entire community sometimes. That poor soil robs them of their ability to be healthy and thrive. Just like it would a tree, you know, the being planted in poor soil. Now add to this picture, in the soil down below there, social isolation brought on by the pandemic. It adds to this pair of ACEs and makes the context. We live in even more of a struggle for mental wellness or folks who are struggling with mental health issues and trying to be well. The pandemic adds stress because it creates a lack of access to technology, which is needed now more than ever with our school children being, taught online. A lot of our kids that don't have access to technology, so that the divide becomes greater, it can be very difficult for them to learn. The technology divide also impacts those who cannot work from home, due to the lack of technology and internet services, so the parents are struggling. You know, they're having a hard time working to think about those people who have jobs, where they can't work from home. That's just not an option. It definitely impacts there, too. So, that's part of that subsidy. That the soil that, these ACEs, or are being rooted in. It creates food insecurity and a lack of access to health care for those that are sick physically and unwell mentally. So, we don't have access to healthcare because of this right now. and there's definitely higher rates of risk factors due to chronic disease, to people have chronic disease, impact ACEs. So, the pandemic of social isolation is mixed in with other adverse community issues that impact our mental health. So you can see it's just this cocktail a recipe for, in some cases, disaster for folks.

Moving onto the next slide. If you take a look at our children's brains and what they're faced within a classroom and, human development/brain development. If you look at the picture on the left with the brain there in the two triangles, upside-down triangle, you can see that the typical development where things are going well for kids. And they're going through normal development, typical development, that top of the pyramid is pointed down to survival. Now, kids, you know, the thing they need is basic needs to survive, and that bottom picture there kind of represents that OK, this, is definitely important, but it's not the root of everything. And it is a smaller base that there has to be less for, that. Typically, a developing child is, less focused on survival because they have those needs being met. But on the second triangle there, the Developmental Trauma, you see that, that survival piece is huge. It's the base of everything. they're always struggling for those basic needs, food, water, air, but also things like recognition and safety and connectedness with others. So it's important to remember that the stress of ACEs can keep a child in a state of fight or flight survival mode, which can damage their developing brain. When a child is in survival mode, the brain, the behavior in the classroom, is significantly impacted and can be problematic for the student, their peers, and the teacher. For the student, that stress causes problems with things like language and memory, figuring things out or problem-solving, making predictions, planning, and organizing, all of which reduces their ability overall to learn. That's what stress does to the brain, which reduces your ability to learn. Chronic stress and trauma increases our difficulty in making friends and getting along with others as well, especially in kids. The stressed traumatize child can seem on edge all the time, little things set them off, those little things that set them off can cause problems with their classmates and before you know it, other kids don't want to be around them. And that isolates them, even more, sets them apart, or isolates them even more from the peers. The higher ACEs scores can lower our tolerance for everyday stressors. Little things can seem insurmountable to the stressed brain. Think about it for kids for a moment. You know, little things like lining up in the classroom, putting your name on a paper or finishing a math problem. Someone accidentally stepping on your foot or pushing your chair accidentally. Those things are triggers. Sometimes it seems like something very innocuous, very simple, but they could set off a crisis response. You think about a situation where you're already stressed, and then you're asked to figure out a difficult problem. Think about a kid, and they're already stressed. And they have to figure out a difficult problem like multiplication and division. Maybe they're asked to analyze a piece of poetry or summarize a paragraph you just read. The challenge is that work on top of an already stressed brain can result in what feels like a threat to your ego and your self-esteem. And that's strong emotion, that feeling of threat to the self can feel like a threat to your safety, to your physical being, as well. It's the same mechanism in your brain, that's responding to that threat, Whether it be a physical threat outside your body, or that internal threat inside your body. What happens is the students, it results in the fighting back, being, argumentative maybe, checking out, and not paying attention, losing their focus, and attention, and being defined, and ignoring roles and classroom expectations so that trauma affects our kids in the classroom. And that's trauma can become a pattern of that frequently stressed brain being triggered by seemingly not innocuous expectations, causing the child to engage in disruptive behavior. This brings out a consequence from the teacher, which in turn, stresses the child out even more. And they get that consequence for that behavior. So, over time, these patterns of destruction cause the child and the teacher to feel helpless, tired, overwhelmed, and burned out, absolutely, no learning is occurring, and this is going on. So, it's not only impacting the child, the peers, the teacher, its the whole classroom that can be impacted. You know that child's not learning the rest of the children aren't learning and the teacher is becoming extremely frustrated. As we think about returning to school, we need to be intentional now about incorporating routines that give our students that predictability and control back. Ways to help them regulate their emotions and help build and maintain relationships. So you got these kids that are impacted by trauma. They're disrupting the classroom for themselves, and for others. We have to be intentional about what we're going to do when we come back to school. So, I want to talk a little bit about, maybe some techniques and things like that in a few minutes.

So, moving on to the next slide. Taking a look at brain development and behavior. Just that one picture on the left, 90% of a child's brain development happens before the age of five. So, when we talk about adverse childhood experiences, these are things that are happening early on in a child's life prior to the 18th birthday, and that, you know, there are very young children were, all that development is going on, it's definitely more impactful. This pair of ACEs that we talked about, the adverse childhood experiences, an adverse community experiences, significantly impacts the developing brain of a child. As we know, through research, the development of the human brain is not complete until sometime in our mid to late twenties. So, we, as educators are never, ever working with a student with a fully developed brain. The brain develops. You can see from the picture there at the top, the brain develops from the bottom to the top, and from the inside out. When the experiences of trauma are stored in those lower regions of the brain, that red and blue part of the brain, that's the survival state and the emotional states of the brain. So, that makes it because the language is in that executive section up there, that green section, it's very difficult for kids to talk about their traumatic experiences, because the memory of those experiences are stored in those lower regions, and entire regions in that green area, you know, aren't artwork. And so, they're not able to converse and talk about their trauma. So, a lot of times, they acted out. Those experiences of acting it out, or telling us something and communicating to us. In red, you see the survival brain as part of the brain, seeks out, basic needs, food, water, safety, those types of things. The blue part of the brain is our emotional brain. In the emotional brain, that blue part of the brain, there's an alarm system. It's part of the brain called the amygdala. The amygdala alerts us to danger, and when it's activated, by a threat, it can trigger a stress response that pushes us into that fight, or flight, or even freeze response. That response, that fight, flight, or freeze response. Set off by that alarm. It's kinda like hijacking the executive state, the green part of the brain, we call it an emotional hijacking, it can hijack the green part of the brain, called the executive state. The executive state of the brain is where most of our focus attention, language, imagination, and abilities to predict happen, All of those things equate to our ability to learn. So there's no learning going on when we're in this emotional state, when this alarm has been triggered. So if that stress response is triggered and emotional centers of the brain over again due to chronic stress, trauma our students are not going to learn. They get emotionally hijacked no matter how good a teacher's lesson plans and they're just not gonna be picking things up in the classroom. Our brains work best in a state of relaxed alertness. To learn we need an environment that feels safe and predictable to us. So, as we think about returning to school, and what that looks like, we not only need to think about physical safety. We need to be intentional in creating classroom environments that are psychologically and emotionally safe, classrooms that are calm, and predictable. Strategies we use to achieve that, need to work on the brain, from the bottom-up, from that survival state, that emotional state. Those strategies need to focus on routine, which is really important. Emotion regulation. What's kind of controlling your feelings and relationship. Building relationships with other people. In this particular case, building strong relationships between students and teachers.

Move on to the next slide. If you look at this picture of a healthy, nervous system. What you know also incorporates the brain. You can see the normal range of typical stressors in like and it goes up and down, but it stays within that normal range. If you look at the next picture, this nervous system is impacted by traumatic events, such as ACEs, that stress response goes haywire and is well outside the normal range and experiences, you can see it bounces up and down. And sometimes our kids get stuck in that on position. Up really high. Sometimes our kids get stuck in that the off position down low behind below the normal range of response. Kids who get stuck in the on position are more anxious. They are more prone to panic attacks, hyperactive behavior. They're unable to relax or they're constantly restless. They have an exaggerated startle response so they scare really easily and they're hypervigilant they're constantly looking around. And they tend to have a lot of somatic complaints, the justice problems, chronic pain, sleeplessness. They tend to be more hostile and even sometimes engage in rage outbursts. Those kids stuck in the off position, experience more depression, fatigue, exhaustion, they tend to be more disoriented and disassociated to kind of what's going on around them in the environment and they're disconnected from other people.

Moving on to the next slide. So enough bad news. We're all sitting there. Oh, my goodness, this is so traumatic. When we start thinking, how do we heal from this? What do we do to make ourselves feel better, to feel less stressed, and one of the things we have to keep our sense of humor about us. And you know that sense of humor sometimes can be very powerful survival through the face of adversity. We can find humor in the world around us. If we can do that, life seems a little easier, so I do encourage people to keep their sense of humor around them. I love these to doodle pictures about isolation. Moms asking about you know what our needs are, the child wants their friends. And let's go back to school and those types of things, but moms talking about the grocery store, what she needs, she wants bagels. And the other thing is, you know, the things like just simple things you know. haircuts. And my wife, do I cut my hair a couple of times. Now, at each time, it's been a very humorous experience. And that would be something that would never happen if we weren't in social isolation. So I think we need to keep our humor about us. We need to move forward and be able to smile and try to find the silver lining in all situations.

Moving onto the next slide. I want to share this quote from Stephanie Grant about returning to school. Thinking about this quote after I read it, it's important to remember that behaviors are signals often communicating what we can't communicate in words. So I want to read this to you. In the fall, I will remember schools that I will remind schools that some of our children will tell us in their behaviors. Our body remembers the pandemic. The body remembers the grief, loss, isolation, fear, hunger, and danger. I was alone. My body remembers when the school that I trusted suddenly disappeared. I don't know if I can trust you. What happens if it happens again? I need to keep myself safe. Now, that's, that's coming from a child, any child, quite honestly, their life has been turned upside down. But especially for those children who have already experienced trauma, we talked about, you know, mental health conditions prior to COVID. Think about those kids who were already disenfranchised marginalized as a result of their mental health conditions, but now that they had this on top of it. Besser Vandercook writes a lot about trauma in the body, and he has a book called The Body Keeps the Score. It talks about emotions and physical sensations imprinted on the brain when we experienced trauma in the past. And a lot of that trauma that we've experienced in the past, comes out in physical and behavioral reactions now, in a moment. So, we got to expect that from our kids that there's going to be, they're gonna be playing out some of this trauma, that they've accumulated during this closure in the classroom. We sometimes act out our trauma. So, what can we do as schools to regain that trust in our kids? How can we re-establish our schools, and our educators are safe, places to be, and safe people to be with, when we return to school? What can we do? We have to be intentional in that. So, let's take a look at a couple of brief examples of things that we can do. Now, these are just a few things. I wish I could share. You can share with you like an anthology of these kinda give you some direction on where you can find more of these types of exercises and practices strategies you can use with your students towards the end and they're also in the resources at the end.

This next slide talks about brain breaks and focused-attention practices. Brain breaks are breaks that create a state of relaxed alertness for our kids. There's a doctor Lori DeSautels, and she's an Assistant Professor in the Butler University in Indiana. She also has a co-author, they write books together about trauma and resiliency. She has a co-authors name, is Michael McKnight and he's from right here in New Jersey. He's a past, a Special Education director, and the two of them do a lot of lecturing and write books about trauma and building resiliency. And they have a great presentation that they present to schools. They call them resiliency building teams. But they have a lot of different strategies that help kids deal with stress and trauma while helping to focus on learning. These techniques can be used with our students, now, during virtual learning. These can actually be done, if you're using Zoom meetings or Google Meet or whatever, those types of things. You can do them virtually with these kids with a little bit of imagination and you can use these when we return back to school. I'd like to share a few of their techniques. They're called brain breaks and focused-attention practices. Now, brain breaks again they create a state of relaxed alertness. And, focused attention practices help students slowdown focused on a stimulus, and that, that's slowing down and focusing, enhances their executive functions, that green part of the brain, if you recall, that learning part of the brain. And it helps with sustained attention and emotional regulation. These practices address discipline proactively before any problems arise. So, basically, what they're doing, these practices, the brain breaks, and focused attention practices kind of cut off some of that behavior before it happens. So it's proactive with regard to discipline, You're teaching kids how to be disciplined themselves as opposed to providing discipline or consequences after the fact after a behavior. So that's why I love this work. by Lori DeSautels and Michael McKnight. It is a proactive discipline for our kids, teaching them to be selfless. So, the first brain, exercise, or brain break, that I'd like to talk to you about, is rock, paper, scissors. And so, their adaptation of that is called rock, paper, scissors, math. After players say, rock, paper, scissors, the last call-out is math. With that call students layout 1, 2, 3, or four fingers? In the palm of their hand, the first player, to say the correct, some of both players fingers win. So number one, it's a fun game. It’s something that the kids like. It's short, it doesn't take a whole lot of time. And, what it does is helps to relax the brain. In order to learn we have to be in a calm state of relaxed alertness and these little brain breaks help us do that. Helps us focus better, gives us a little bit of a break during instruction.

So, moving on to the next slide. Focus attention practices are also quick little classroom exercises to combat stress. That's what we're talking about is combatting stress. What can we do to help our kids be less stressed in the classroom? Focus attention practices calm the brain's stress response and stimulate sustained attention and emotion regulation. Keep in mind, a regulated and calm brain is a brain that's ready to learn. We have to be calm with our emotions in our brains so that we can learn. When we consciously use sensations such as breath, movement, and body awareness. We activate those areas in the brain that pay attention to what is happening in this moment. And it also supports areas we need for learning, like attention and engagement. So here's a focused attention practice that you could use. And again, Doctor DeSautels and Michael McKnight have dozens and dozens of these. And I'm going to give you a resource for them. So, this one's called not chewing gum. What you do, you give each student a piece of gum and have them hold it in their mouth for one minute without chewing. They're focusing on just the feeling, that sensation, that gum in their mouth. Not chewing forces them to pay attention to the sensation. That's what we're talking about is the sensation of the moment, which activates attention, and calms the brain. After that one minute, you ask the child, what did they notice, did they notice the taste of the gum? Well, you know, without chewing, did they notice the texture of the flavor? Did they feel that anticipation of chewing gum without being able to chew it? So these different techniques, kind of, help with brain focus, help calm the brain, help address those lower regions of the brain so that the higher regions of the brain can engage in more learning. So these are definitely regulation techniques that we need to be focused on.

If we can back up to slide 22. I also wanted to talk about routines as a way of helping children in the classroom. Sorry, folks, I kind of jumped over this one, I want to jump back to Greg, it's slide 22, talking about routines and procedures. Routines and procedures are really, really important for kids. They create a sense of safety and predictability. When we feel safe, our brains are more available for learning because that's really important. Good teachers have daily routines and rituals already in place and any good teacher has daily routines in places, for example, you know, reviewing the daily schedule, the routine of how do you sharpen your pencil? When do you sharpen your pencil? How do you raise your hand to ask a question. So, all of those, you know, those types of routines, good teachers have those built-in, but we need to come September in the fall, or when we come back to school. We need to kind of add to that list of things that we do and that's in the routines throughout the day. We need to add things like personal hygiene. Our younger kids, we already teach that, you know how to wash your hands and things like that. You know, blow you know, stuff. But we need to now teach these to all kids and remind all kids at these personal hygiene techniques are going to be very, very important, as part of our routines, hand-washing, sneezing and coughing into the elbow, that kind of thing. Here's one not sharing food or snacks, or even pencils and paper. That's kind of opposite what we teach our kids. We teach our kids to share things, right, you know, to share with others. But we're going to be asking them, come September when we get back into close proximity again, not to share things. So it's kind of the opposite of what we want to teach, because, you know, you might be, you know, passing that virus through things that you're handing back and forth to each other. So we're going to be asked not to share. I think that's important to keep in mind. Social distancing will just add that into our routines and procedures for the day. You know, a lot of times I see teachers, they greet the kids at the door and they shake their hands. We can't do that. So you might have to change that up a little bit left to do an elbow bump or an air high five. But you do need to continue to greet them because that's really, really important that's making connections and I'll talk about that in a few minutes. We might have to talk about social distancing with regard to lining up or getting on a school bus or in the lunchroom or on the playground. So it could be a lot of different expectations that would have to teach in and build into our routines and procedures. We know we're gonna have to talk to our kids about safety precautions and we're gonna have to have classroom meetings and talk about these things so that they know what to expect and what we might have to talk about wearing the mask. What does that look like? Having our temperature taken at the door, before we walk into the building, we may have to introduce them to like, maybe our custodial staff, maybe it might put their minds at ease. Custodial staff is a big reason. Why custodial staff? Well, think about it. You know, you have a dedicated person to keeping that classroom virus-free for young kids, it might be important to let them know that that's somebody's job, is to keep them safe, in school, to keep them safe from the virus, they're gonna be cleaning that room every day daily. So I'm not an important piece to incorporate into your routines. Morning meetings, you need to discuss the schedule for the day, discuss general goals for the day. In the morning meetings help the brain with predictability so they know what's coming. Remember, our kids have been in a, you know, possibly in a quarantine situation from March until September seven months, without you knowing what's going to happen next with this virus. So they need predictability, you gotta build that into the morning routines. They know what's going to happen throughout the day. It just makes, it gives them the feeling of safety and control, when they know what's coming next. Also, in these routines and procedures, you want to build in emotional check-ins with our kids. A lot of teachers already do this, great teachers, do! This goes along the lines with social-emotional learning, but doing morning check-ins to gage their emotional or upset levels. A simple technique for this: You could do a thumbs up, thumbs down, or thumb sideways, and, you know, do it in a group. You know, as you can tell you feel today, thumbs up, thumbs down, sideways, and, you know, those that show a thumbs up, they're good to go for the day. You probably don't need, you'd probably have to be overly concerned with them in their behaviors. But then there's a thumb sideways, and you can recommend that they share with a friend what their issues are and then, you know, thumbs down, make sure you check in with them throughout the day. If they're giving you a thumbs down and they're showing you some concerns, some upset there, they may need an adult checking in with them, so teaching and practicing these expectations can provide a sense of safety. When we feel safe, there's lower regions of the brain where survival and emotional lives can be less active. And we can engage the upper parts of the brain, executive functions that are all required for learning.

So I'm going to jump ahead there, Greg, to slide 25, ideas for building relationships, jumping back, trying to get back in the sequence now. Relationships are really important for mental health, also in and learn. It is really important for kids to have a relationship with the teacher from the person that they're learning from. Harvard University Center on Developing Child Research shows that every child who winds up doing well has had at least one stable relationship with a supportive adult. And that's our teachers. Are there other workers and co-workers in schools, knowing this we should be more intentional with building relationships, with our traumatized, stressed youth. There's one approach called the 2 by 10 Strategy, where we spend two minutes per day for 10 days in a row. Talking with an at-risk student about anything, she or he wants to talk about two minutes, and the results are showing that, you know, it improves that child's behavior and their academics over time. Another relationship-building technique is dual journaling or dual drawing. And, again, these techniques with a little bit of imagination could be used on virtual learning right now, and when we come back in the fall. So, dual activities can help build and maintain connectedness. They create touchpoints things that you share with your students, for example, you might write your student a note, and have them write back, and then, you write back, and then they write back and forth. You're kind of creating that dialog with them, bringing that touchpoint. You can create a story together. You know, as the teacher, you might say, yeah, once upon a time, you know, the green giant, whatever. And then have the kid student. Write the next sentence. And then you write the third sentence, and so forth, back and forth. Again, you're creating those touchpoints, Maybe you draw a picture. you draw a line, they draw a line, you draw a line, they draw a line. So you're creating something together. You're building that relationship. Making that connectedness and sharing those points, those touchpoints. And another one more technique for building relationships is called the brain scavenger hunt. This is kinda fun, you can, you can, again, you could do this virtually or in the classroom. You can look for things in your home, do the following, for example, something that evokes a happy memory. If I look around my home, I see pictures of my family, I can't picture books a happy memory. So you ask the child and you show it if you're online or if you're in the classroom, bring stuff to you with you to the classroom. You could show that picture. Have the students the night before and bring their bring a picture or something that evokes a happy memory for them. Maybe something that stresses you out, you can, you can do a scavenger hunt for something like that in your home. You know, for me, you know, I walk in. I see on the kitchen table there's a bunch of bills there that stresses me out. I can share that. So what's something that stresses the child up? Something that's calming and relaxing, you can do that. You know, incorporate that into your scavenger hunt that I do a lot of cultivating bonsai trees and things like that. My bonds, I choose, they helped me. It's very common for me, it's a hobby for me, so that's relaxed so I see a Bonsai tree. I relax, OK, so find out what it helps relax the child. Again, you're building relationships here. Those relationships can be done in the classroom again or in the little imagination can be done virtually.

So, moving onto the next slide. We talked a little bit about, you know, different techniques they can use with kids who, who are struggling, who may have been exposed to trauma, and they're dealing with chronic stress. one of the things that sometimes results, unfortunately, with a lot of chronic stress, a lot of other different factors, risk factors, and things like that is youth suicide. So I do want to take a few minutes here towards the end of this presentation to talk about youth suicide in the tool that you might be able to use when you come back to school, either in the fall or actually we use this tool now, even in the virtual world. So, as our time today comes to an end, I want to shift a little bit, to take a quick look at the potential of increased suicide in our youth. Some risk factors and warning signs and useful tool to help assess a student's risk level or kind of incorporate in this last section. It's likely that mental health issues that lead to risk for youth suicide attempts and deaths will increase during the time our schools were closed because of COVID-19. If you look at the news, mental health call centers have large spikes in calling over the last few months. And in our local hospitals, emergency rooms. Emergency room visits have lessened, actually decreased because people don't want to go to the hospital because of the illness. People, there might be sick, but those people that are going to the hospital, they need the number of visits has the type of visit has increased the mental health visits, the psychiatric crisis visits have increased even though the overall numbers of decreased psychiatric crises situations have increased. I'm suspecting, as, you know, I think, some of our medical folks with would also suggest that, you know, it's a result of isolation and the pandemic and the fear surrounding it. So, as we know, that youth are not immune to suicide. Some, of the risk factors for suicide include: having a psychiatric disorder, including depression, loss of, or conflict with close friends or family members, history of physical or sexual abuse, problems with alcohol or drugs, physical and medical issues, being the victim of bullying, being uncertain of sexual orientation, exposure to suicide of a family member or friend, being adopted, family history of mood disorder, or suicidal behavior. Now, all these risk factors, any one of these in and of themselves are most likely not going to cause suicide, but when you start combining some of these things, you know, the risk of suicide is increased. And many of these factors are worsened right now, considering the isolation and loneliness and the lack of access to supports as a result of social distancing in quarantine due to COVID-19. If you take a look, one of the tools that we use, I was going to say, hold on a second, I'm sorry, Greg. I think we just went through risk factors. I want to talk about warning signs, also.

Um, this is slide 27. Studies by the American Academy of Pediatrics indicate that suicide is the second leading cause of death among 10 to 24-year-olds. One in five adults adolescents have thoughts of suicide each day. One in five adolescents are diagnosed with a mental illness which can lead to suicide. At any given time, 25% of adolescents feel depressed. My time in our district, unfortunately, we've had five student deaths by suicide in children as young as 10 and 12 years old. So this is definitely something that we need to be watchful for at this time. Some of the warning signs to look for include appearing depressed, withdrawn, or lacking energy, expressing feelings of hopelessness, distress and overwhelm, talking about death or finding difficulty finding reasons to live anger, hostility, agitation, irritability, expressing feelings like they're a burden to others, making a suicide plan, use of alcohol and drugs, and seeking suicide means, such as seeking out how can I get a hold of a firearm, or pills in order to take my life?

One of the tools that we use in our district is something that we've been developing probably the past 10 years in many different ways. one point was a PDF of the points. You know, it was a computer program that we tried to develop. Most recently, we have a workflow, we call it TAP the threat assessment protocol and we use that to do assessments. And, the CrisisGo company has been working with us, and they've taken some of our ideas and ideas from other school districts, from around the country, and they've expanded kind of what we had working on in our district to a much higher degree. They're very comprehensive threat assessment tool that you can use with children, And I know at the end of this webinar, Jim, from CrisisGo, we'll talk a little bit about this. But from our perspective, this threat assessment protocol that CrisisGo is developing to help us out with these situations with students is a very flexible, secure data management system. And, you know, to use in conducting, and storing that sensitive risk assessment information. It provides a comprehensive PDF report to share with others when you need it. It gives us a variety of risk assessment templates that we can kinda use. You can modify those templates, or create a threat assessment screening tool from scratch, if you want, the threat assessment app can be used on it on a computer, or tablet, or a smartphone. It's really, really flexible in that, in that regard. It stores multiple assessments for individual students, and provides easy access to those previous risk assessments for future use, so you can always look back at previous risk assessments. The student has multiple assessments, and at the end of the CrisisGo has developed this so much at the end, there's, there's a lot of comprehensive charts and graphs that are available, and those charts and graphs can help you analyze that data that you have over time for things such as mandated state or local reporting on board of education interview reports, those types of things or presentations. But it also, that the data gives you actionable data you can use to aid in the design of interventions to reduce and mitigate future threats. Either you know, students talking about suicide or, or threats towards others. And you can use that data to, to provide interventions, either on the individual level for a student or grade level, or, you know, building level. You can use that data. It's actionable. That's great. So, it's a wonderful tool that the CrisisGo has developed. So, in conclusion, here, I've talked a lot about a lot of different things. I just wanted to go over some important takeaways in our hour here together.

COVID-19 will definitely affect everyone. In this slide, 29, COVID-19 will affect everyone around the globe, either directly or indirectly. The fear and anxiety surrounding this virus can have a significant impact on the mental health of our students. Children with preexisting mental health conditions will now be at even greater risk due to social distancing in isolation. Educators need to understand the impact of the virus on the mental health and support students. On mental health and support students through teens, regulation, and relationships, I'll give you a few of those techniques, before learning can occur in the classroom. that nothing's going to happen in the classroom. If we're not dealing with chronic stress and trauma in our kids. Suicidal risk factors, ideation behavior can increase in children during this time. And school mental health workers need to be prepared with effective tools, kinda like the threat assessment protocol that CrisisGo has to respond to students who are in crisis situations as we move forward.

Here is my contact information, if you have questions, you can reach out to me. I'm gonna leave you with one final thought. Students often don't care how much you know, until they know how much you care, and we show them we care by setting them up for success by establishing those predictable routines, helping to regulate their emotions, and developing a lasting relationship with our educators or staff or teachers. So that kind of concludes my presentation. At this point, I would like to hand it over to Jim from CrisisGo. Jim.

Thank you. What a great presentation. Um, and seeing Jeff talked about the student threat assessment manager. I'm not gonna, I'm not going to spend any time there. Thanks, Jeff, for sharing that. So, I just want to move on. First of all, I want to thank everybody for attending, and I also want to mention that CrisisGo, has just released the COVID-19 Return-to-School kit. You know, this software kit is more than just a bunch of recommendations. This kit provides prebuilt forms and tools to capture data trends for decision making, like what teachers are planning to return to school this fall. Use it for family health status, during the flu season, various forms, covering those things, like temperature checks, absence, symptoms, personal protective equipment in the supply chain. All of the challenges you're gonna face on that road back to school, that actually start before the back to school process, as we set up for COVID-19. This toolkit is free to all school districts in the United States until December 31 of this year. And you can see on the screen, if you come to CrisisGo, we have an offer page, return -to-school kit. Please, for those of you that need to get set up and have tools to help you accelerate back to school and ideas and practices that we picked up from our COVID-19 crowdsourcing project, we wanted to make these available to you so that we can jumpstart your return to school. So, again, thank you! I'm gonna pass it back to Greg, and I appreciate everybody attending today.

Thank you, Jim, And thanks again, Jeff, for your presentation. We can move right along into the Q&A. And just a reminder, everyone can submit questions via the questions panel. And I'll just knock out the most popular question, all of the conference materials, recording of the webinar, as well as Jeff slides, will be sent to everyone after the webinar. So don't worry about that. Our first question is: When working with teachers and school staff, dealing with their own toxic stress, yet consistently targeting kids as the problem, how can we get them to see their own stress reactions?

That's a great question, and, Greg, you and I were talking about this prior to the workshop, and another hour workshop, quite honestly, talking about the stress levels that teachers are going through. I think school districts need to provide time for our teachers to kinda debrief and talk about this. A couple of my colleagues, administrators, we're talking about, what we might be doing coming up soon with our staff, is, is some of our professional learning communities. And having them kind of setting up a question and answer kind of thing. Where they can go and prepare a little bit, talking about, you know, their, own experiences with this situation. Because teachers are experiencing just as much as kids are, you know, the chronic stress, that trauma, as a result of the virus, And, on top of the fact that they're trying to re-invent the wheel, when it comes to education, and teach virtually from home, instead of going into the classrooms. And now, they don't have all the materials, and they're learning new programs. And so, it's a whole new learning process to which can be very stressful. So, I think the best thing that we can do is give our teachers some time to connect with each other. Talk about there, you know, their experiences with this, maybe, like I said, through professional learning communities or virtual meetings. Maybe that we set up administratively and kind of have a facilitator for, that, give them a little bit of time to talk about that. But then also give them the opportunity to participate in, in this recovery, and asking them what they think would be best for their students. They know their kids the best, and I think given the opportunity to talk about it and share some of their ideas on what we need to be doing moving forward would be a great opportunity for teachers and to help them with their mental illness.

Thank you. Our next question is I believe about changing school schedules. It says that their school is looking to change their entire middle school schedule in the fall, which will be a major change for students. The principle is pushing for the change, and the teachers feel it might be too much for students to handle, given the current situation with online school. Just curious on your thoughts of whether changing a whole middle school schedule is a good idea, or be better for students to return to what they knew prior to distance learning?

I think what's gonna work best in individual schools is really important when you're talking about changing schedules, middle school is definitely something that we've been conversing about in our district and what our schedule might look like. Certainly, change can impact no stress. I think that the best thing that you can do is decide what's best for your district, But also let the kids know ahead of time and give them as much information ahead of time before they come into that environment with a different schedule. You know, we've talked about trying to keep our kids in the middle school schedule, which historically, you know, they trend, you know, the transition every 42 minutes, or 45 minutes. For one class to the next, we've talked about, You know, keeping those students in one classroom with one teacher all day long. You know, that's a huge change. You know, that, that historical traditional model of the middle school is to learn how, to, you know, have that independence and move about. But we might not be able to do that right now, as we transition back to school, in order to reduce the spread of the virus. So I think if you're going to make that change, you need to prepare your staff and your students as much as possible, as to what that change is gonna look like, and give them that predictability. I think that's really important, is making sure that they have predictability and know what they're stepping into when they come in that first day. I think it's probably best practice there.

Our next question is: Is there anything custodial and maintenance staff can do to help with kids seeing structural safety?

Like I said earlier, talking about there's morning routines. I think what they can do. You know, that's a little bit outside my realm of expertise. I want to stay in my lane. Certainly, we've had conversations about, you know, sanitizing and cleaning and things like that. That's not my area of expertise. But, I do think that, you know, kind of incorporating those maintenance and custodial folks into some of your conversations with kids when they come back is, is really important, because number one, it makes those folks feel a part of the community. Your custodial maintenance, which I think is important to always build the community they're part of our school district or important, or our schools don't go on without custodial maintenance support. So I think incorporating them into that process, but also letting the kids know who they are, you know, that maybe that morning meeting, introduce them to the person that you know there's going to be cleaning their classroom and keeping them safe. And keeping that now that room sanitized and clean, virus-free, I think, is really important. So, that would be my guidance in that area. Again, it's not my expertise, but that would be my suggestions.

I think this might be the last question we have time for. How would you suggest taking lessons learned from other tragic situations? Katrina, Sandy Hook, California fires to facilitate? Or does this pandemic cause a completely different situation for targeted specific tragedies?

I think the difference there is there's a term called collective trauma where, you know, everybody experiences the same, same traumatic events. Um, and, you know, things like Sandy or 911 well-known level is even bigger. But things like, Sandy, you know, that was kind of contained to certain areas, it wasn't nationwide, it wasn't worldwide, but certainly it was impactful and horrific for people. Um, this is a larger collective trauma, everybody across the globe is feeling this and so that, you know, things like, Sandy, 911, any lessons learned from those around trauma and chronic stress, I think, can certainly be applied to this current situation. And then, some, because, again, this collective trauma is everybody across the globe. So, I think definitely, yes, you can, You can take experiences. Learn from those other tragedies and apply those here for, you know, for COVID-19.

Thank you, Jeff. If anyone had questions that are unanswered, I believe Jeff to provide this email and you can contact can him well as CrisisGo. You can email us at marketing@crisisgo.com and we will make sure that you can get that information, Jeff will help us with that. We will be sending out a recording of this webinar, so you can share it with your colleagues, and friends, so please look forward to that. Thanks, everyone, for joining us, Jeff. Thanks for your presentation. Stay Safe. Thank you, Greg. Thank you.