Prevention science leads to success in school. Let's focus on what is behind the symptoms

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Morning Zen Guest Blog Post ~ Kevin Dwyer

About six years ago I wrote a chapter on mental health promotion and prevention (with a professional colleague Dr. Erica Van Buren) in a book titled “Handbook of Youth Prevention Science” (Dole, B., Pfohl, B. & Yoon, J. Eds. (2010) New York & London: Routledge). Our chapter began with a scenario about an 11-year-old boy we called Jeremy who was being “disruptive, fighting, and calling his teacher a “mf.” He was an angry, lost soul who was academically way behind and had a record-breaking number of suspensions. Everyone in the school knew him including the principal, counselor, social worker, school psychologist, school secretary, cafeteria manager and community liaison police officer. The school labeled him as a “high flyer” who consumed staff time and energy to no avail. He actually spent more time in in-school suspension than in class.

He lived with his grandmother who was willing to do whatever the school recommended including “therapy” and “pills,” as well as “behavior contracts.” She took him to the mental health clinic that “wait-listed him as a priority for services.” So far behind academically, he was retained, making him older and bigger than his classmates. The school had many meetings about Jeremy, did evaluations and wrote and re-wrote an Individualized Education Program (IEP) placing him in special education services diagnosed as “seriously emotionally disturbed.”

The school’s social worker met with Jeremy and his grandmother at school and in his home. He told the social worker he hated school. His grandmother also told the social worker that Jeremy, “couldn’t read.” It took the social worker a little longer to find out from his grandmother that he had nightmares, no friends and “felt bad” about giving her grief.

In looking at his school history in kindergarten, he was described as a more anxious, frightened preschooler, not joining the group, not benefiting from the pre-reading instruction as easily as his peers. Although these problems were noted the social worker and school team could not find any documentation of the school’s interventions to provide him direct instruction or diagnostic instruction in those early years.

He started acting out late in first grade and the school’s focus moved quickly from the academic problems to addressing the disruptive behaviors with interventions such as “time-out,” behavior contracts class removal and, by second grade, in-school suspension.

In that chapter we wrote, “Academic and behavioral problems like those experienced by Jeremy often place students on a road that is paved with school adjustment difficulties, gradual disengagement from school and inevitable school failure and dropout.” (Ibid. page 45).

Good people with multiple sets of knowledge started what they saw as intensive interventions for Jeremy – but too late in this student’s educational history and even those interventions were still provided in a usual sequence of intensity, too little to make a dent in the complex of issues this student and his family faced. It is like doing an X-ray when the injury is muscular and an MRI is needed. It doesn’t show the depth of the injury and, therefore, results in misdiagnosis and therapies that will not work! With human behavior there is no MRI, there is no genuine diagnostic tool that can tell us what the problems are and what might work to address those problems. We only see want is on the surface, the behavior problems, defiance, anger, resistance to our interventions.

In that chapter, we called this pattern the “Domino Effect” of failure in learning that, when un-remediated, makes school so abhorrent to a child that he/she becomes a behavior problem. The fight-flight coping strategy kicks in and time after time the frustrated child says or does offensive things, off-putting things to those who want help him learn and behave.

The school does not understand his anxiety, and his inability to cope with failure. Rather than show he cannot read he fights with defiance and is then removed from toxic embarrassment in front of his peers.

He has so many strikes against him. His mother is in jail; his father is unknown. His caregiving grandmother is his only supportive connection. She can keep him safe from the violence and pain of his neighborhood but not from the frustration and pain of not learning to read.

In that chapter, we talked about the school’s responsibility to seeing that for some, for Jeremy, intensive school mental health services are essential to learning as are social emotional learning skills. And these services must be aligned with equally intense reading support. We cannot continue to let the Jeremy’s in our schools fall off the cliff.

In that chapter, we noted the good news! Schools are doing better for Jeremy. We talked about the tremendous improvement in school communities using best practices to prevent problems and promote academic and social emotional skills. We talked about the successful initiatives, programs and practices that are making a difference in children’s functioning. In fact the theme of that book and our chapter is success, a litany of components of successful mental health promotion, prevention and risk reduction as well as early and intensive interventions, all aligned to reap benefits for our children and families, and yes, even ourselves. Yes, systems are improving services and many more schools are providing successful initiatives that are reaching many more Jeremys before they become defiant lost souls.

Now, several years later a serious problem remains. We do not know how many schools are providing this array of effective best-practices to improve mental wellness and academic success of our children. Is the number 50% or 25% of our schools? Who is monitoring the necessary growth and effectiveness of these critical initiatives? Is this a responsibility of CDC, NIH, SAMSHA, Department of Education, States, universities, professional organizations, and advocacy groups? We have some good data on children’s physical health and our physical health promotion and prevention. We have loads of assessments of their academic progress and some information about its relationship to instruction. We have little data on the nation’s schools provision of the needed array of services that promote social emotional skills, effectively address early interventions and ensure that wraparound services the Jeremys need are provided. Although we have made strides in improving the availability of mental health service to these children we may still be using the least-to-most intensive continuum ineffectively. We may still be doing the too little - too late intervention model because we are focused upon the symptoms rather than the why behind those symptoms. Let’s start effectively measuring our success and how universal that success is for our nation’s children. 

Our children deserve to benefit from what we know works for all grade levels. Pre-school and kindergarten is where to start!     

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dwyerKevin P. Dwyer, M.A., a Nationally Certified School Psychologist, is an education and child mental health consultant.  He recently served as a principal research associate for the American Institutes for Research. For over 30 years he practiced school psychology in public schools and held several local, state and national leadership positions in the fields of mental health and education, being responsible for the design, development, implementation and evaluation of programs and practices, for improving school climate, safety, and wellbeing for the education, and mental health of children.  He has helped school staff in many districts use data to inform decisions on improving caring and connectedness with students and professional peers.  His work, publications, presentations, and practices have influenced public policy and the development of efficient, family-focused collaborative child service systems.  During his 30 years as a public school psychologist, he worked directly with over 10,000 children and their families as well as trained over 6000 educators. He provided psychological services to children, including those with disabilities and those whose anxiety and mental health problems blocked learning and adjustment.  He assisted teachers and staff in supporting a caring, inclusive school climate for all children.  In 2007, the Maryland Coalition of Families awarded Mr. Dwyer and his wife for their work in making schools more family friendly.  He served as president of the National Association of School Psychologist and was given its highest honor, the Life-time Achievement Award.  In 2000, he received the Tipper Gore “Advocacy award for improving the lives and mental health of America’s children” from the National Mental Health Association.

Comments

  1. Kevin Dwyer's avatar
    Kevin Dwyer
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    Barb asked for resources. Resources for implementing a true continuum of prevention, early and intensive services to improve the mental health of children can be found in the book noted in the article or similar books. For social skills programs CASEL has a current list. SAMHSA has many connections to proven programs. Safe Schools Healthy Students also has proven programs. There are many more and some connect with others. It is so critical to set up a task force that can support the selection of the initiatives you would like to implement and ensure that your staffs are trained effectively. Monitoring the fidelity of implementation is a must as well was having measurable outcomes for pre and post implementation.
  2. Dennis Embry's avatar
    Dennis Embry
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    Kevin, again thank you for this powerful essay. When wearing my clinical hat as child and developmental child psychologist, I've lived through many stories like the one you've told. Most of the IEP recommendations by many schools have devoid of any good science or outcome. When I've detailed very simple things known to work, the objections were very sad and frustrating.

    The truth is that we have the best prevention science in the world-- well documented in the 2009 Institute of Medicine Report on the Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. The sad thing is that our country lags way behind other OECD countries in implementing this science. Part of the problem is that law and regulations on prevention in America focus on adolescents, when your essay solidly points out that the problems and predictors as well as potent opportunities are way much earlier in life.

    The need for comprehensive action is well documented, especially since data in 2009 IOM report show that 1 out of 2 young people in America will have one mental, emotional, or behavioral disorder by age 18. We need a universal approach that is potent sooner rather than later. We cannot screen and refer our way out of this problem.
  3. Barb's avatar
    Barb
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    can you provide the link to the website that has resources to download?
  4. Gayle Grass's avatar
    Gayle Grass
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    Please visit our website to download our free EBooks dealing with children's mental health topics
  5. Rita Thrasher's avatar
    Rita Thrasher
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    Kevin Dwyer puts the weight where it belongs! This retired reading specialist turned community mental health advocate just before retirement. Retired teachers are a promising voice to move the mountain!
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