- Eating Disorders - 

Mana Ake Workshop

Presenters - Louise Bennett, Clinical Dietician & Ursula McCulloch, Consultant Clinical Psychologist

Normal Eating - about 16% of NZers don't have breakfast and average 8 snacks a day.

When it becomes a concern - 

• weight
• nutrient deficiency
• restriction of food groups

Influences - 

• socio-economic
• food environment
• media/social media
• peers
• family/whanau environment
• teachers/educators

How to help build a positive relationship with food - 

• modelling, be aware of influence
• encourage a variety of food from the main food groups
• avoid labelling food as 'good' or 'bad'
• involve in food preparation and gathering

Picky Eaters - 

normal food stage for children 1&1/2 - 4 years old

concerns - 

• eating less than 20 different foods
• lack of nutrition
• missing out entire food groups
• particular about textures & stressed

The Whys of ARFID (Avoidant/Restrictive Food Intake Disorder)

• sensory issues
• super tasters
• association with negative events eg choking
• developmental concerns
• anxiety issues
• genetics
• environmental and management issues

The Whys of Anorexia (many unknown)

• low self-esteem
• anxiety. perfectionism
• genetics
• environmental issues

As a result of the struggles the parent - child relationship is often fractured

Parents/Whanau may feel - 

• like a failure
• judged
• manipulated
• over people giving them 'good advice'

Managing ARFID

What doesn't work

• force-feeding
• lengthy meal times
• dishing up guilt
• comparisons with peers
• punishments & threats
• ignoring
• tricking your child

It takes 20x of tasting to get used to a food.

Children need to know sometimes you have to eat foods that are ok but not your favourite.

Get the child to use their senses to learn about food and gradually build up to tasting and then eating ....

Images might help the child to visualise their progress ...

 Language

Challenge language around food. If a child says 'It's yucky," respond with "You are still learning about the taste. To me it tastes salty/or other." Say 'You can," rather than "can you." The child is a 'food explorer.

Implications for schools

• don't judge lunchboxes
• don't force feed or comparative shame
• don't offer advice
• do be empathetic
• do allow the child to bring their preferred food
• do celebrate success

Managing Anorexia

Myths around anorexia

• attention seeking
• passing phase
• mum's fault
• vanity etc

Externalise anorexia - it is in control not the child

Family Based Treatment - 3 Phases, generally lasts a year

1.    Phase 1 - weekly visits to home environment

• discussion
• family meal observation
• teach strategies

2.    Phase 2 - fortnightly sessions in home environment

• child gradually allowed to take more control
• finishes when ideal body weight is reached

3.    Phases 3 - monthly sessions

• address other related issues

 Gaming Addiction 

a Werry Workforce lunchtime seminar

Presenter - Caleb Putt, Portfolio Manager for Mental Health and Addiction

There is many conflicting information as to whether or not it really is a problem. But recently the WHO has added Gaming Disorder as an illness to its list of diseases, although they have also said that gaming is a good way to spend your time during a pandemic. It is all very conflicting and it is complex.

Caleb is a gamer so has an insight. There has been a shift from geek to mainstream in the last few years. Gaming is now mainstream.

- Geek is the new Black - 

The last few years have seen esports gain popularity. Drawing sports stadiums full of fans, with full fanfare. Eports games are generally shorter, have small teams playing each other and fast paced. In some countries high school give scholarships for gamers. NZ high schools have Esport competitions between schools. 

Another type of game is MMO (Massively Multiplayer Online) roleplaying games. These are set in fantasy worlds and you take the role of a customisable character. There are multiple storylines/quests that can take hours to complete and are highly social with people becoming part of clans. 

The gaming industry makes more money than movie and music combined. More people watch esport final than the NBA final. Some of the most popular games are free to play.

Gaming is mainstream. Most young people will game. Only a small percentage will develop Problem Gaming. Gaming might cause some problems eg, difficulty getting off but this does not mean a person is a Problem gamer. 

Games employ Psychological Techniques to keep people gaming and spending more money eg, levelling up is easier at the start and then gets harder and selling things in the game. Games continue 24/7 there is no end - FOMO, others are leveling up etc.. They are always been updated so they don't become boring. Sometimes things are made purposefully frustrating so you need to pay to get passed the obstacle. Less than 2% are the biggest spenders, the rest spend very little.

There can be 'binge' problems at time like when a new game is released. 

Why do people game?

Meet their needs; a sense of purpose, reaching goals, predictable, sense of achievement & mastery, sense of belonging, connections with others, friendships, freedom & escape, a sense of identity (more confident as your character, and as a confident gamer)

This becomes a problem if what you experience online is better than off line then that can be a problem. If a game meets needs we have outside of the game it becomes a problem.

Casual Gamer - Highly Engaged Gamer - Problem Gamer - Gaming Addiction

It's all about CONNECTION VS DISCONNECTION

Tips for tackling the problem; 

ask what they do, be curious

find out what needs the game is meeting, how else can those needs be met?

connect them in with groups eg, robotics clubs etc, archery 

promote connection over disconnection

educate them about problem gaming ie what do they think it is

if they identify that they have a problem put together a plan for them

What we see is the top of the iceberg - what sits underneath? self-worthlessness, confidence etc

Resources -

Gaming Questionnaire

Monetization Fact Sheet

Gaming Continuum

Parenting Tips

Problematic Gaming Factsheet

This was a brilliant and very informative presentation from Werry Workforce!!

Video - https://werryworkforce.org/professionals/training-and-events/lunchtime-learning-young-people-and-gaming

 Emotional Wellbeing Resources

for 13-17 yr olds

Notes from Werry Workforce lunchtime seminar - https://werryworkforce.org/professionals/training-and-events/lunchtime-learning-emotional-wellbeing-resources-13-17-yr-olds

Presenter: Sam Rodney-Hudson - Director of Programmes and Partnerships at Melon Health

Work for Melon - based in Wellington, an online service for people who are struggling with mental health, work alongside primary care for intervention and support.

Website for resources (for everyone) - https://www.melonhealth.com/manual/

Several animation videos with tips to support, also available on youtube

Melon worked with to with a company involved with teenagers and animation to ensure the      language piques the interest of 13-17 year olds. 

Each page has a whakatauki

There is research behind each resource, most based in cognitive behaviour therapy.

6 different areas; Brain Breaks, Little Reminders, Facing Fears, Mini Mind Workouts, Anxiety Toolbox, Mood Booster. A 7th -  Understanding Anger is being developed.

Anxiety Toolbox does not have animation videos but people talking about their experiences, it also has 

5 sessions to work through to talk through the worksheets.

There is also a podcast called The Flip Side that can be accessed through the site. Each week a different guest is interviewed about their experience with mental health.

Melon also have resources to help 18+ plus people as a response to Covid19. We can direct caregivers/whanau who are struggling to this resource - https://www.melonhealth.com/covid-19/

Once I am back at school I plan on printing out some of the relevant posters and worksheets to do with students. I will also let other colleagues know about the resource.

The Zones in Practice

Emotional Regulation

 Background:

One student I work with has difficulty regulating his emotions. As the year went on he became more difficult for his teacher in regards to his behaviour. I would like to support him this year with regulating his emotions.

Strategy: 

To watch the video resource on the Leading Lights website and apply any ideas I get.

The Zones in Practice by Lynne Hazeldine

Notes:

The Zones of Regulation was orginal developed for students who are neurodiverse.

It is a curriculum not a programme.

You could work through the book cover-to-cover OR pick out the bits you need for your learners.

No need to do a training course, anyone can pick it up to use.

Can be used with an individual, small group, class or school, and by parents.

Implications:

I will apply to join the NZ and USA Zones of Regulation Facebook groups

I will check out the resources on the Zones of Regulation webpage:

http://www.zonesofregulation.com/resources.html

Sticks and Stone - book review

Sticks and Stones - Defeating the culture of bullying and rediscovering the power of character and empathy

by Emily Bazelon

This book was set in the USA about a decade ago. Shortly after some well mediacised suicides in which bullying was a factor. There was a lot of controversy surrounding these cases and obviously feelings were high. Similar case had different outcomes. One case Bazelon dives into deeply is about Phoebe Prince.

Bazelon states that children have always 'bullied' in the past it was considered a part of childhood that you had to cope with. Nowadays things are different. However, some conflict in childhood is normal and helps children to gain the skills they need to survive as adults. Adults should not be supervising every incident of name calling etc as the children need to sort out strategies for themselves.

When bullying becomes a problem is when it involves unequal power, is repetitive, is deliberate and harms (even mentally or physically) - This is also how BullyFreeNZ define bullying on their site:

https://www.bullyingfree.nz/about-bullying/what-is-bullying/

Schools were teachers and administration staff turned a blind eye to bullying had become cesspools. After several headline worthy incidences schools needed to start to take notice and many different plans were instigated. Some involved small targeted programmes, many schools started up support groups but possibly the most effective was a school wide system PBIS . Which I can quite confidently say is the forerunner to our PB4L system where the emphasis is on teaching behaviours and acknowledging those who perform those behaviours. 

Social media can play a huge part in bullying and many children discussed in the book had had a difficult time due to social media. Schools are needing to spend a lot of time and resourcing following up on social media incidences which happen outside of school hours. Bazelon went to Facebook headquarters to discuss what they were doing to crack down on online bullying. She goes in to some detail in the book but basically they are not doing enough. They have improved their system but seem to take little responsibility for 'policing' their site. They did say, and rightly so, that the best thing is for the children to take responsibility themselves and do have a script of how to help yourself boxes when people report things on facebook. However they are very slow to work though complaints of bullying etc and do not always end up removing things that should be removed. There are millions of users so they feel the task is to big to deal with reports in a timely manner.

Bazelon concludes that whilst it is partly the schools responsibility that parents have a very importance role to play and as much as the build up their child's self esteem they should be also teaching them kindness and connectedness. The most important advice for a child according to experts is to tell someone they trust, ideally someone their age as well as a trusted adult. 

This book was an audio book of 10+ hours. It was very interesting and discussed may issues objectively. Bazelon talked to many different people and reported from all sides, consulting with those who were bullied, those who bullied, school staff, parents, social media companies and those involved in the court cases. It was thoroughly interesting although the stories at the start were heartbreaking to think of how some of the students suffered whilst the adults in power at school turned a blind eye or did not follow through after meetings with parents. 

It was interesting to note that while many are bullied the percentage that take their own lives are small, these students are most likely to be suffering from mental illness ie anxiety. These are the students that need the most protection.

Supporting TAs effectively

From Te Kiti Ipurangi - Inclusive Education

The teacher brings knowledge of the curriculum, the TA has knowledge of what will work in that moment with that child.
Children respond to the TA in a way they do with the teacher, so they know they are as valued.
TAs get to know each child individually.
TA interactions should be supportive, positive  and help children to be as independent as they can be.
Positive relationship between TAs and teacher, high expectations 
Children respond to positive interactions between adults

"The area of research showing the strongest evidence for teacher aides having a positive impact on pupil attainment focuses on their role in delivering structured interventions in one-to-one or small group settings. Crucially, these positive effects are observed only when teacher aides work in structured settings with high-quality support and training. When teacher aides are used in more informal, unsupported, instructional roles, we see little or no impact on pupil outcomes."

Jonathan Sharples, Rob Webster, and Peter Blatchford

Questions to ask our TAs:
What do you see as your role in the school?
What do you see as your role in the classroom?
Do you have other school responsibilities?
How are you supported in your role?
Who provides support?
Do you get planning time with the teachers?
How are you involved in planning your programme?
Are you given a programme to use?
What have you done with students that you are proud of?
What is most satisfying in your work?
What is most difficult in your role?
Have you any frustrations or issues?
What else would you like to mention?



Skills for helping students learn - open ended questions, wait times, prompt and encourage students to work with other students, leave space for children to do things for themselves before jumping in,  use a quiet voice when supporting a student, communicate expectation positively and clearly, use non-verbal cues to demonstrate expectations, use 'when'-'then' and 'first' - 'then' commands, avoid negative commands, corrections, demands and yelling, redirect a disengaged student by using proximity, pre-arranged non-verbal signals, simple prompts, reminders, and pre-corrections and state requests or give directions to students, using brief descriptions of required positive behaviours.

Critical Thinking Questions

Teacher sitting alongside to model the teaching style - more consistency for the child is a a good thing

Ensure the teacher aide is positioned alongside students, not (unwittingly) creating barriers between students and their peers.

Helping students make friends - Teaching Friend Making Skills

Anxiety and Depression in Adolescents

Anxiety and Depression in Adolescents 

with Gail Phillips 

@ MHERC 18/04/19

What is mental health? It includes our social emotional and psychological well-being. It affects how we think, feel and act. It also determines how we handle stress, relate to others and make choices. It is important in all stages of life.

What is mental illness? When someone lacks the ability to manage day to day events and/or control their behaviour to that basic physical and emotional needs are threatened or unmet.

It is a result of a number of things:

Biological; poor physical health. low IQ, drug effects ...

Social; family disadvantage, trauma ...

Psychological; poor-social skills, poor copying skills ...

many of these things are interlinked.

Sometimes there can be a specific trigger

When does a mental illness become a disorder - when it impacts on daily life.

Is it depression, stress, distress or anxiety?

If the main problem is feeling down and miserable or that there is no interest or pleasure in things it may be depression.

If the main problem is having times of panic, or always being on edge and worrying it may be anxiety.

Depression

For resources visit:  https://depression.org.nz/

Common stressors - break up with boy/girlfriend, cyber-bullying, death of relative, divorce/separation of parents. family moves, peer pressure, poor performance at school, transition to high school

How common is it? 18-24 year olds have the highest prevalence of mental health disorders than any other age group. Youth suicide is the leading cause of death in 15-24 year olds.

It is circular - the person feels sad, which makes them focus on the negative, which makes them feel sad, which makes them focus on the negative ...

It is also a downward spiral:

How do you differentiate between teenage gloom and doom and clinical depression?

It is more likely to be depression if;

it lasts more than 6 weeks

there is a family history of depression

there are strong negative self-esteem factors

the behaviours being carried out (eg drinking, self harm) are causing danger

their personal history has trauma, lots of changes etc

personality type (not communicative on emotional matters, perfectionist

Signs and symptoms of depression - 

What can you do? LISTEN

• when you notice a change check to see if they're ok
• sit quietly and listen, don't offer advice
• if they don't want to talk about it, respect that
• let them know you are worried and want to listen to them when they want to talk or suggest someone else they could go to
• listen and respond in a non-judgmental and reassuring way
• if you are very concerned contact higher powers and parents

Focus on thoughts, feelings and actions;

• provide practical support, like help with homework or large projects
• listen and offer support when needed
• believe their experiences, don't downplay them
• help to identify stressful situations at school or home
• help to find other ways to solve practical and emotional problems
• keep a close eye out for changes in how the young person feels, thinks and acts
• encourage self-determination
• HOLD HOPE

Suicide/Self Harm

You must ask - "Are you thinking about hurting yourself or others?" If the answer is "yes" then ask questions - how, when, where etc       People thinking about suicide want you to ask this.

Ask "Have you looked up suicide or self-harm on the internet?"

A good resource to direct young people to is:

https://thelowdown.co.nz/

What next?

Assess the urgency of the risk

Remember lack of a plan doesn't mean the person isn't serious

Take ALL talk of suicide seriously

Crisis first aid  for suicidal behaviour;

• own safety first
• someone must stay with them
• seek immediate help
• minimise further substance use (if any)
• remove the means?
• listen
• just listen

self harm/self injury is;

• related to psychological pain and distress, difficulty in expressing emotions and harbouring negative feelings towards oneself such as; guilt, rejection, sadness, self-hatred, worthlessness, loneliness, panic, anger or sexual confusion
• self-injury brings the person momentary feelings of peace and calm and a release of tension
• the immediate feelings of relief are usually followed by guilt, shame and more painful emotions. Self-injury is a short-term solution that can lead to a long-term problem.
• self-harm might be tied to a psychological illness such as depression, anxiety obsessive-compulsive disorder, eating disorders post-traumatic stress disorder and border personality disorder
• self-injury often starts in the teenage years, when emotions are more volatile and can be tied to other impulse control issues, such as alcohol or drug abuse

Responding to Self-Harming

Is it an emergency? Get help immediately if the person:

• has deliberately injured themselves
• is acting in a highly aggressive or abusive manner
• is expressing thoughts of suicide or killing someone
• is disorientated (does not know who they are where they are or what time it is)
• has delusions or hallucinations
• is confused or not making sense
• is badly affected by drugs and/or alcohol and acting in an abnormal manner

If the person has any of these symptoms dial 111 or visit the emergency department at the hospital

(DO you know what is in the person's crisis plan?)

Treatments - 

• psychotherapy - cognitive behaviour - focuses on negative thoughts and changing them

                                    interpersonal psychotherapy - interpersonal relationships

• counselling
• peer supports
• family/whanau therapy
• medications
• professional psychiatric interventions

Anxiety

Definition and Facts - a feeling of apprehension and worry and it a normal reaction to stressful situations. If the feelings become excessive, irrational and everyday functioning is affected then it is of concern. Anxiety disorders are characterised by excessive feelings of panic, fear or irrational discomfort in everyday situations. It is a common disorder for young people. About 13 of every 100 aged 9-17 experience some kin of anxiety disorder. Girls are more affected than boys. About 50% of children with anxiety issues have a 2nd anxiety disorder or mental health condition. Anxiety disorders may coexist with physical health conditions as well.

Some common symptoms:

Signs and symptoms of Anxiety in Youth:

• recurrent fears and worries
• difficulty falling asleep or nightmares
• hard to relax
• difficulty separating from parents
• scared about going to school
• irritability, tearfulness, avoidance
• uncomfortable in social situations at school, restaurants, parties

Production of Fear and Anxiety

 - Amygdala: emotional memories are stored here and alerts the brain when a threat is present

- Hippocampus: encodes specific threatening events into memory

Types of Anxiety Disorders;

• Generalised Anxiety Disorder (GAD) - 6 + months of persistent, irrational and extreme worry causing insomnia, headaches and irritability
• Post Traumatic Stress Disorder (PTSD)
• Panic Disorders - unpredictable panic attacks
• Specific Phobias - intense fear reaction
• Social Phobia 
• Separation Anxiety
• Obsessive Compulsive Disorder (OCD)

Comorbid (meaning)diagnoses of depressive disorders, ADHD and other enxiety  disorders are common in anxiety patients. Symptoms that might appear to be ADHD - restlessness, feeling keyed up or on edge, difficulty concentrating, mind going blank, irritability and clinically significant distress.

What to do when a young person is experiencing excessive fear or worry:

Responding to someone who is panicking

• speak slowly and calmly
• encourage deep regular breathing
• use short sentences
• assure that they are safe and you are there to help
• explain all actions
• remove from noise and confusion

Effective Ways to Treat Anxiety - 

Cognitive behavioural therapy, relaxation techniques, biofeedback (to control stress and muscle tension), family therapy medication and mindfulness

General accomodations : - 

Additional suggestions:

• preferential seating, near door
• assign another person for support
  
• permit beverages
• video lessons
• early availability of teaching notes
• task considerations/safety
• text, assignments in alternate formats
• personal and private feedback
• strategies re managing days off

Share goal and strategies with home so there is consistency.

For URGENT HELP

Mental Health Crisis Line 0800 920 092 (24/7)

CAF Emergency - 0800 218 219 press option 2

or 111 or take to emergency room

Resources for students and families - 

Can join MHERC for free - https://mherc.org.nz/

Videos - 

The teenage brain

I couldn't go out even though I knew I should

https://depression.org.nz/

Therapy