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The 180 Podcast Mar 3, 2022

The 180 Podcast: Renee Prince: Educators as First Responders to the Youth Mental Health Crisis

Renee Prince: Educators as First Responders to the Youth Mental Health Crisis

In our previous episode, we discussed the national state of emergency in child and adolescent mental health. In the two years since the pandemic hit, young people have around the world have reported increased symptoms of distress, anxiety and depression. These feelings can interfere with focus, learning, friendships and the joys of life.  So how can adults see when a child is struggling and what can they do to help? 

Renee Prince, a licensed clinical social worker (LCSW), is the Director of Mental Health Integration for Turnaround for Children. Renee leverages research and trends in the mental health field to ensure that Turnaround’s tools and services are informed by current clinical knowledge of trauma-informed practices. As you’ll hear, she also has helped schools build and tailor Tiered Systems of Support to meet the needs of the young people and families they serve. 


Complete Transcript

Chris Riback: Renee, thanks for joining. I’m really looking forward to getting to talk with you.

Renee Prince: Thanks for having me. 

Chris Riback: I am looking forward in particular to discussing with you guidance and insights to address what pediatricians are declaring a national state of emergency in child and adolescent mental health. But before we get into that very extensive topic, I’d love to talk about you. How did you come to your work as a licensed clinical social worker, and more specifically, as the director of mental health integration at Turnaround for Children? Why is it meaningful for you?

Renee Prince: This is sort of full circle for me to be honest. So I actually started out wanting to be a teacher growing up. And I’m an older sibling, but very early on, I realized I was a little bit too nosy to just be a teacher. And I actually enjoyed listening to the problems of my friends.

Simultaneously, we also as a family were going through some personal challenges that led us to need the support of social workers and counselors. And that’s when I realized that’s it, that’s what I want to be. And so for me, this is definitely a calling. So I decided at the early age of 16 that I was going to be a social worker. And I became a clinical social worker so I was providing therapy to children and families.

What I noticed is that a lot of my referrals were because there were some children having difficulty in school. We were expected as counselors to reach out to the school to determine what the needs were, but that wasn’t always easy. Teachers have a busy schedule and so oftentimes you just kind of rely on the child or the parent to kind of share more deeply about what the difficulties were.

And somehow Turnaround, I think someone mentioned about the organization and that there was an opening. And when I learned more about what the mission and vision was, and their understanding about the integration between mental health, social emotional learning, and academics, it just made sense and just kind of felt like the missing piece for me.

I mean, this is being recorded, but I’ll say at one point I was student of the month and then I wasn’t and my grades were failing and I didn’t understand why. And it wasn’t until I came to Turnaround to be quite honest with you that I understood the science behind what was happening for me.

And so that’s how I came to Turnaround, both my personal life, my professional life allowed me to come here. And it’s absolutely meaningful. I mean, I’m a living representation of what it’s like to not only have adverse experiences, but then those important relationships to help you along and change your perspective on life.

Chris Riback: Well, in that intro of you and your background, it sounds like you have not only the experiences, but also that core skill which you described as listening. There’s a lot to listen to right now. This national state of emergency in child and adolescent mental health, I’d love to start by defining that challenge in terms of how you see it. You’ve written about a collective trauma that students are facing. What comprises that trauma, how significant is it and who’s most affected by it?

Renee Prince: I think typically when we think about trauma, we think about it as an isolated event that occurred and that it’s primarily experienced by an individual, but what’s unique or significant about the current state of affairs now is that both children and what we might call healers are also experiencing it.

So this is not an experience of just one or two individuals, but in fact, the world is experiencing this and this is really unprecedented. And so we cannot afford to not make it a priority particularly for children who might have the least resources accessible to them to mitigate some of the impact of this trauma. And so we have to make it a priority.

Chris Riback: Renee, when you talk about the collective trauma, what is that? What are the traumas that have made these times so especially stressful?

Renee Prince: So well for one, a significant change in school setting. Schools have transitioned to kitchen tables, bedrooms. In some cases, children may have to go to someone else’s home to be able to access their virtual learning so that’s one experience. And what’s happened with that is children have been unable to connect with their peers and their teacher. So that’s one piece of it.

Seeing people wearing a mask, right? That’s not something that we’ve done before. And so it can be a little off putting for students. Unfortunately, in the more severe cases, there may have been a parental loss due to COVID, being around family members that are ill, not being able to be around family members because of COVID. Some families unfortunately have experienced a loss of a job.

And then some of the hardships that come from not being financially stable, being homeless, food insecurity, the list goes on. I think some other challenges in the midst of that that aren’t always considered is that pre COVID there were homes where there was domestic violence, child abuse, neglect, sexual abuse. And so quite frankly, those adverse experiences that didn’t stop per se because of COVID and in many cases may have even been exacerbated. So those are just a few examples of what some of our students are going or many, sorry, our students are going through.

Chris Riback: It’s kind of an intimidating list.

Renee Prince: Yes, absolutely. And I hadn’t said everything, so I’m sure there are lot of examples that I have left out.

Chris Riback: What are the signs or symptoms signaling that a child may be in distress? Is it obvious to the untrained eye or even to a trained eye like yours?

Renee Prince: So I think from the perspective of someone with an untrained eye, a significant change in behavior might be the first indicator that something is going on for a child. Children are responsive to what occurs in their environment. And so if you’re noticing maybe a personality change or a loss of appetite, children might report difficulty sleeping.

They may come out and just frankly say that they’re feeling sad or worried about what’s going to go on, they’re noticing or experiencing the stress of the adults around them. And so oftentimes you’ll see it exhibited in their behavior. They may be a little bit more restless and, or, we don’t want to forget about children that might be more withdrawn.

I think sometimes students like that can get overlooked because they may not necessarily behave in a way that’s, that’s disruptive or that gets in the way of the routine, but we don’t want to leave them out because for those students or children, it’s unclear what might be going on one for them personally.

Chris Riback: So how does one know, as parents I know you know as well, we all can notice a change in our child’s behavior. We know that we can recognize maybe a change in the behavior a little bit, the appetite, maybe not sleeping so well, maybe a little bit of behavior, but how do we know the root cause? How do we define what’s trauma and what’s just a sign of a child going through a tough day or two or week or month?

Renee Prince: We don’t know. And as a matter of fact, if it is happening longer than a week or a day or two or a month, it’s definitely something that you do want to look into to get more of a deeper understanding of what might be going on for that child. But I think relying on mental health professionals and just simply asking listen, these are the behaviors that I’m noticing, I’m not quite sure what might be provoking it.

I think also having a conversation depending on the age group with your child about what are their worries, what are their thoughts, what are they thinking? I think in today’s world everything is so fast paced that we often don’t take the time to hear the voice of children about what’s on their mind. We might assume that they aren’t listening to the news or aren’t getting information from their peers. And so I think the first step for parents and teachers alike is really just to have a conversation with students and try to make some connections or develop a deeper understanding there.

Chris Riback: Do the levels of trauma differ among age groups?

Renee Prince: I wouldn’t say it differs. I think it may show up differently. I think for younger children, it shows up differently primarily because they may not have the words to say, “I know we’re in a pandemic and I’m feeling traumatized right now.” Right? They show it more in their behavior.

For many kids sometimes they are acting younger than their age. So for example, very young children like four or five years old may be regressing a bit and want to be maybe less independent and become more clingy to their caregivers. So again they’re not saying, “Well, I’m feeling fearful right now,” but in their behavior, it definitely shows.

For adolescents or the older group, I think that in terms of the development, they may have an increased capacity to rationalize some of what’s going on and to be able to articulate it. But that doesn’t mean that they’re less vulnerable to acting out as well. I think we also really need to think about behaviors particularly if they’re greater than two weeks, then that might be something that’s deeper beyond, oh, I didn’t have a good day or I failed a test, but something that we might want to talk more about.

Chris Riback: The surgeon general has described a national state of emergency in child and adolescent mental health. And that’s on one end of this discussion.

On the other end of this discussion is youth mental health services, people, services, capabilities there to support those children. What’s the gap between today’s demand for youth mental health services and the supply of care?

Renee Prince: One of the things that I thought about during this pandemic was those students that we don’t have access to that are experiencing abuse in the home, right? In terms of the gap that you talk about, unfortunately mental health in general is still rather underfunded. And so in some communities access to supports is limited.

There are families that may not have medical insurance, which is also required to be able to access mental health treatment. And quite frankly, the time to be able to leverage those resources given, and the fact that many families need two incomes to support a home. And so where does that leave children and their ability to get the support that they need?

Chris Riback: I’m afraid for the answer to this, but if there is an urgency out there, where’s the so called emergency room to help these students?

Renee Prince: So it’s an interesting way to phrase the question. I don’t think we considered quite before how much teachers are sort of the first responders. And so children spend, ideally spend most of their day at school and so that’s kind of unfortunately where the ER is. And Turnaround has developed tools to support schools and figuring out how to manage the significance of that point in understanding that teachers are on the front lines even when they themselves are also having challenge with managing their own trauma.

Chris Riback: What a way to characterize that as frontline responders. And not only does that ring true, but it also, I think, contributes to the complexity. Because, okay, it’s just exactly what our educators needed, wasn’t it? Was another hat to wear, was another layer of responsibility. I’m sure they already feel like they are first responders to the needs of their students. But man, we’re really layering on a whole other layer of complexity, aren’t we?

Renee Prince: Which is again, back to consideration of this being a collective trauma. Because again, what’s being asked is for the adults to mitigate or to manage their own stress while also managing the stress for students. I do want to say that while there’s risks in that, there are also opportunities in that as well. And so I think the beauty in it is that while this is a collective experience, what are some ways that we can leverage this experience to do things differently and to better support each other given the collective nature?

Chris Riback: And a question that might seem obvious to some of our listeners, but I think too many other listeners just might not. Why do schools need to be in the business of serving the mental health needs of their students? Isn’t their primary business supposed to be teaching and making sure students learn?

Renee Prince: Yes. Great question. Again not being a medical doctor, but when we don’t feel well, right? It’s very difficult to perform well. And so physically, right? We physically don’t feel well. And I think unfortunately, what hasn’t been considered is the health or our mental health and how that impacts our ability to perform.

And so for students, in order for them to access their learning, we really need to address their emotional needs in order for them to be able to receive the lessons and access to learning that teachers are providing. And so it’s absolutely important. Students spend a pretty significant amount of time there in school. Teachers in many cases are often the first ones that might recognize that a student is unable to learn and so how can they be supportive to those students?

One example I like to use is people… It’s sort of like people say, “Well, I did this for you,” right? Like, “I did this because I have a relationship with you.” And so we know that the power of relationships is something that we can’t forget about and so it’s important for teachers to connect with their students more deeply so that they can support them in their academic goals.

Chris Riback: What do you hear from teachers on that point? I could imagine teachers who feel so overwhelmed by their day to day requirements, it feels almost like another level. On the other hand, every teacher I know is in the business out of a drive, an internal drive to help children grow. What do you hear from teachers on that balance?

Renee Prince: I’m hearing it’s difficult, right? To be quite honest. Not having the space to really connect with students in a way that they know is important for their brain development and for their sense of safety, sense of belonging, addressing those basic needs to then be able to have students access to learning in a way.

So what are we doing at a universal level more proactively, freeing up teachers’ time so they can do the things that we know are healthy for students’ brains and ultimately creates less stress on the system if you will so that everyone, not only students, but teachers and staff alike can show up as their best selves as we all work towards the goal of positive academic outcomes for students.

Chris Riback: If I might, maybe we could even raise the degree of difficulty that we’re all facing, that these students are facing. Because you write about the trauma that many students feel from the COVID pandemic, we’ve been talking about that.

And you also highlight the impact of historical and ongoing biased and racist perspectives reflected in the traditional design of and ongoing practices within school settings. How do those connect? Many people might see them at their face as distinct.

Renee Prince: So yes, one of the things I want to say is that our actions reflect our beliefs and our perceptions. And so if we have unchecked biases, our practices and protocols and policies are going to reflect such, they don’t write themselves. And so when you combine that with the difficulties of COVID, it really, it does make the scenario much more complex.

And I think what can happen is that schools are in a place where they are responding to symptoms of a root problem, but not addressing the root problem, right? And so when we don’t address what may be contributing to the difficulty for many students, then we’re just kind of putting a Band-Aid and kind of seeing the same challenges happening over and over again.

This is an experience that is difficult for us all and I don’t think that unconscious bias and, or, racist practices or protocols only affect children of color, it affects all students. And so we need to be mindful as educators and mental health professionals alike to ensure that our intent or the way that we interact with students is a true reflection of what we want for them.

Chris Riback: How does that manifest itself and how is it lived by the children that you’re trying to support?

Renee Prince: We want children to aspire to be something when they become adults. And so in many cases, unfortunately in schools, children are in school buildings where the staff don’t look like them, staff are primarily white and the children attending that school, the community is filled with the community of people of color, or students are interacting with staff members that have lower expectations of them.

Studies have shown that students have also experienced more punitive ways of responding to them when they do show up to school with having difficulty focusing or being able to regulate their emotions. And so as opposed to responding to students in a way that’s more therapeutic, unfortunately, they are related to in a more punitive way that adds to a negative experience.

Another example of that, it’s just like with regard to language, right? There are students that might have a name that might be difficult for their teacher to pronounce. And so just kind of like shortening the name or changing the name or altering their name in a way that’s more comfortable for the teacher to pronounce and, or just not having staff members around that speak the language or represent the language of that student. 

Chris Riback: What about faith in the system? Are families generally supportive of accessing mental health services for their children whether that’s inside or outside of school? Do some worry about having their children labeled? 

Renee Prince: That’s a great question and something I really experienced a lot when I was a practicing clinical therapist. And what I can say to you is, I mean, across the board whether there were families of color or families that were a little bit more wealthier, there was this concern about children being stigmatized or labeled.

And so it was definitely conversations that I would have with parents to kind of walk them through what it was like to access mental health treatment. But I do understand and recognize that there is definitely a distrust. Going back to how people of color have been treated not only in health systems, but in mental health systems.

And in order to move forward or to move past that, I think changes in policies that have not been traditionally supportive of people of color and for this particular conversation, children of color, is something that needs to be had and shed a light on. Because I do believe that systems can change but it’s about being honest about what the context is in order to be able to change it.

Chris Riback: Renee, what is a tiered system of supports and how can schools use this approach right now to respond to the crisis that you’re describing that our young people face? How does the crisis response component work?

Renee Prince: So tier one or also known as universal supports is kind of implied in the name that these are supports that are provided for all students. And what I mean by that are just kind of the day to day routine procedures, norms that educators teach and provide for all students on a day to day basis so it’s just kind of part of school operations.

But then there are some additional supports that students may need. And some of that might look like you might refer a child that might need some extra support around reading or a student that might need some additional support in developing their skillset around managing or developing coping skills to manage their anxiety particularly in this current context. So their supports can be both academic and social emotional or one or the other. The other thing I’ll say is that in many cases at the tier two levels are an opportunity to consult with a service provider within the school building.

So for example, a school counselor, a parent may say, “I think my child’s having difficulty in the following areas. Is there support that the school could provide for this student?” And the teacher might say, “You know what, there’s a group of students that actually could benefit from that same experience.” And so that’s where you might see supports provided for groups as opposed to just an individual student.

And at the tier three level for concerns that are more significant that really have had a negative impact on a student’s ability to learn are more targeted individualized supports. The supports at this level are typically provided by a multidisciplinary team. So it could be a school counselor, there might be a coach if a child is involved in some extracurricular activities, obviously the teacher and the caregiver. So it’s really an opportunity to discuss the student more holistically and set some goals and provide some supports around them in that way.

And then you asked about the crisis component. So the crisis component is… I kind of akin it to a little bit of a sidekick to tier three, more like an aspect of tier three supports. And the reason I say that is because the crisis component is a way for students to receive supports sooner than later, right?

In a typical scenario, a student might be identified that they need additional support. It might have to wait a week or two before being discussed at a tier two meeting, right? But this crisis component of tier three allows students to receive support much faster. There are less that a teacher has to go through in order to access that support.

Chris Riback: Yes. That component of the design really jumped out to me. It jumped out that a teacher in this system is empowered at the most basic level to identify a “crisis situation” and then make a crisis referral, basically skip the line, don’t stop it, go, don’t stop it, just get straight to that tier three highest level crisis referral situation.

Renee Prince: To be quite honest with you, it’s something that should be a part of the program at any given time. I think the current context of the pandemic has pushed the need to place more emphasis on this. Schools may have already had to some degree based upon the requirements of their district a sort of team that manages crises. But I don’t think that it’s been thought of in this way with this degree of structures and practices that allow students to receive support.

And while yes, it is a fast track, there is still a process that teachers must go through, a streamline process that teachers must go to go through to accessing the support. And absolutely, as I mentioned earlier, the beauty in the difficulties that we’re all facing are ways to think about moving forward, how can we ensure that some of these practices or innovations or different ways of doing things can be a part of our regular day to day that we provide to students in general?

Chris Riback: Is there an example perhaps of a crisis that you have seen in schools and how it was handled? 

Renee Prince: Yes. I was a part of the team, the crisis team. And there was an incident that occurred at the school with one of the students who unfortunately passed away and it had impacted many students within the school community. And so there was a crisis team put together that ensured that there was consistent communication around the messaging, around the student’s untimely death, that students were aware that there were resources around that could support them beyond what they would normally see.

And what I will say about that is that we were able to determine other students that may not have necessarily been noticed or may have gone under the radar, that in fact we’re in need of additional support. So how amazing, right? That out of this challenge, we then were able to provide more resources and support to students that may not have even been considered even just for the traditional pathway for tiered supports.

Chris Riback: The image that all of a sudden went through my mind and I don’t… it just made me think about The Catcher in the Rye and that tiered system catching the children falling. That’s what I just felt you describing, that by putting in that system of supports and for the terrible situation that you described of the child having passed away, but then there were some subsequent children. And by having that system of supports in place, you, the educators, the school leaders were able to perhaps catch some of those other children before they completely fell.

Renee Prince: Yes. I mean, it absolutely allowed us to be proactive in this case. And I mean, if I’m being quite honest, we saw a few students that were just so strong also. I didn’t want to take away the strengths and the vulnerability that these students bring, but to step out on faith and be willing to, in some cases voluntarily say, “I need support.”

And I do want to touch for a moment on the rising statistics around suicide, and we were able in this scenario to connect with students who had thoughts of suicide. And I mean, I can’t imagine what would’ve happened had we not operated or put the system in place to your point to catch those students. And so it’s… I mean, it’s important and absolutely has to be a part of every system. We must be flexible because our children need it.

Chris Riback: What are the science of learning and development principles that help define what you’re doing?

Renee Prince: Recognizing that we need to support the needs of all children in a way that’s integrated, that it could be very easy to operate in silos within the school building, but it’s really important in order to create cohesion that we operate in a more collaborative way so providing supports that are integrated.

Part of why we were able to kind of catch these students because there was a collaborative effort and we created a system that was streamlined where there was communication that was ongoing and an understanding, which is yet another principle of our tiered supports, the impact of trauma as it relates to learning and development.

Chris Riback: And when you say support. What kinds of things are you talking about?

Renee Prince: So it can vary per student. When we say supports it could look like maybe supporting a teacher that is trying to support their classroom and developing calming strategies. Or just it could look like a particular student who might need ongoing counseling support from a school counselor.

The goal is for the student to have a voice and are just as significant in developing or determining what those supports are that work for them. 

Chris Riback: How does this kind of approach help to establish the proactive systems and structures needed to promote mental health and wellbeing for the long run?

Renee Prince: So glad you asked that because that’s one of the things that I think we don’t talk about often enough is about, right? Like what does the data tell us? What have we learned in this process? How can we make choices based upon hopefully documentation that was kept throughout this process to make more proactive decisions about how we can create a more supportive environment proactively for all students?

What does that mean in terms of training for teachers? What kind of skill sets do we want to continue to grow and develop in our students? And so yes, it absolutely creates an opportunity to continue to improve the way we show up for students moving forward.

Chris Riback: Are schools the only locations we should be discussing? Are educators the only professionals who should be actively thinking about these challenges?

Renee Prince: No, I think after school programs, parents, caregivers, any adult that is responsible for contributing to the development of any child should be taking this information into consideration.

Chris Riback: You’ve helped create a suite of tools and resources to assist educators in building their knowledge, shifting their mindset, designing their systems and refining their practices. I’m quoting a description of what you offer there. What do these tools and resources look like? Can any educator access and implement them individually or does an entire school need to implement them in order for them to work?

Renee Prince: So it’s a both, and. So I’ll say to answer the first part of your question, that the tools are… They’re accessible on our website one, but they are-

Chris Riback: And that website would be, wouldn’t it?

Renee Prince: Yes. And so our tools are meant to be guidance tools. There are a lot of good things that schools are already doing to support students. And so our tools, which many of which are in PDF format are there to provide guidance, some additional thoughts or strategies that might help enhance what they’re already doing. 

I think that some of our tools are concrete. And so when I say concrete, meaning an actual referral form, right? So it’s just ready to go. There’s not much thinking that has to go into it. And then there are some tools they’re a little more context oriented. And so helping schools kind of understand more deeply about what processes they might want to put into place or maybe they do have a process in place but just kind of need a little bit of a deeper understanding of the impact of trauma and learning.

I think there’s also an opportunity for district leaders or state leaders to maybe leverage a lot of the content that we have, tools and resources to kind of determine what approach they might want to take in their district or state and what resource is required to execute in the way that the tools are suggesting.

Chris Riback: What type of training is needed?

Renee Prince: So because the tools are online, you don’t need training. We provide support around how to get started when you’re using each of the tools. And as much as possible we’ve provided sample plans that have been completed so students can see an example of what this might look like in their building. But that’s not to say that we are not around to provide some additional support if schools were to reach out directly.

Chris Riback: Okay, good. I’ve seen where you’ve written that a tiered system of supports can promote and support both the mental health of students as well as drive towards equitable outcomes. How does promoting the mental or emotional wellbeing of students one student at a time also help drive equitable outcomes across an entire system? What’s the theory of action here?

Renee Prince: So tier supports, the messaging is around meeting students where they are, right? And providing needs accordingly. And so it’s not just about what are the gaps that we’re trying to address in the individual student or what their deficits are, but also what are their strengths and how can we use that to meet their needs?

One of the things I think about when I think about equity, there’s this graphic, there’s three people kind of looking over the fence but they each need a different size box to be able to do so, right? So the goal is to be able to see the game but each person needs something different to be able to do so.

And so while the goal… To say it vaguely is academic success, each child needs something different to be able to do that. And so that’s what I mean by equitable outcomes, giving students exactly what they need according to their unique profile so that they can be successful.

Chris Riback: What is the feedback then from educators or parents or students or administrators?

Renee Prince: So I’ve interacted quite significantly with leaders and support staff alike. And so the feedback has been thank you because there’s this kind of expectation on them to kind of know what to do, right? And not having something to refer to many or quite a few folks have actually have had something in place but needed some support kind of refining what already existed.

And it warms my heart actually when I hear that they already had something in place and just this… they were able to use our tools in a flexible way. Because again, when we understand that context matters, we want schools to access our tools in a way that they feel supportive to them and we want to model that so that they’re creating that same environment for their students.

So we’ve definitely have had some positive feedback. I think what gets tricky is every school has a different set of resources, right? Available to them. And so just being mindful of that as they’re leveraging the tool, which is why we encourage them to use our resources and the way that works for them.

Chris Riback: How fantastic to have received a thank you or two? That’s got to feel pretty darn good.

Renee Prince: Yes, it definitely does.

Chris Riback: Renee, to close out, I’m wondering what you see happening next, because in listening to you, I feel these competing forces. On the one hand, we have this declared national state of emergency in child and adolescent mental health. Simultaneously, we have trauma increasing situations that we hope are dissipating a bit but are not fully resolved by any stretch.

And yet countering that, we have people like you, we have programs like the ones you’ve designed. We have educators and administrators and caregivers who are becoming more aware of what’s going on out there. How does all of that resolve in your mind? What’s next?

Renee Prince: I think what’s next is again leaning into what can we learn from this moment? I mean, this might sound strange to say, but what can be celebrated? What strengths did we lean into and being innovative during this time?

Because I think while there was so much tragedy and adversity, there were also moments where folks were leaning to being creative and leaning to thinking about doing things differently than we have in the past. And so my hope is for that we take the lessons of now and use them to make better decisions moving forward in the future and that we work in ways that are more collaborative and that don’t work against each other, that’s my hope.

Chris Riback: Renee, thank you. Thank you for your time. Thank you for the work that you do with students and schools and educators and parents. 

Renee Prince: Thank you.

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