OTS 200: School-Aged Mental Health in a Post-COVID World
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- 33 min read
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Welcome to the show notes for Episode 200 of the OT Schoolhouse Podcast.
This course explores the evolving landscape of school-aged mental health in a post-COVID world and the expanding role of occupational therapy in supporting students’ emotional, behavioral, and functional participation.
Dr. Monica Keen examines current mental-health trends, trauma-informed care, behavior changes following the pandemic, and evidence-aligned OT strategies for school settings.
Participants will learn practical, occupation-based approaches for addressing emotional regulation, engagement, and school participation within a tiered model of support.
This course is part of the OT Schoolhouse Collaborative Community, where school-based practitioners come together to deepen clinical reasoning, explore meaningful topics, and translate evidence into real-world practice.
If you’re looking to earn CEU’s for this course and access a full library of professional development opportunities, you can join the community here 👉 https://www.otschoolhouse.com/collab
Learning Objectives
—Learners will identify three mental illness diagnoses of school-aged
children.
—Learners will identify reasons/events for childhood mental illness
and how it impacts occupational engagement.
—Learners will recognize the role of OT in addressing these mental
health issues in the school setting
Guest Bio
Dr. Monica Keen is the Program Director of the Doctor of Occupational Therapy Program at Presbyterian College and has been a licensed OT for 36 years. After a long career spanning mental health, acute care, skilled nursing, and 27 years in school-based practice, she transitioned to full-time academia in 2022. She also teaches pediatrics and mental health labs as an adjunct at Baylor University and previously taught for seven years at MUSC.
Dr. Keen has authored book chapters and presented widely on school-based OT, mental health, and handwriting, including multiple webinars and a doctoral capstone on OT’s role in supporting children’s mental health. She has been featured on the OT Schoolhouse Podcast and presents nationally on school-based mental health. She currently serves as Co-Chair for Mental Health within the South Carolina Occupational Therapy Association.
She holds degrees from MUSC, Boston University, and the University of St. Augustine. Her professional passions include mental health, trauma-informed care, pediatrics, and autism. Dr. Keen lives in Greenville, SC, and enjoys running, hiking, college football, and spending time outdoors with her two Boston Terriers.
Quotes
“Trauma results in fundamental reorganization of the way the mind and the brain manage stress.”
—Dr. Keen
“Adversity is not experienced the same by all people.”
—Dr. Keen
“A mass exodus… and people not wanting to go into teaching because of low pay and the burden from the pandemic.”
— Jayson Davies, M.A., OTR/L
Resources
👉The Body Keeps the Score (Book) on Amazon:
https://amzn.to/4s4CiUm (affiliate link)
👉 Collab
Episode Transcript
Expand to view episode transcript
Jayson Davies
Hey there. And welcome to episode 200 of the OT school house podcast. It is great to have you here today. And wow, I have been waiting to say episode 200 ever since, like, Episode 185 about and I hope it would happen, you know, during ot month. But we're close enough, you know, just the beginning of May. And today, I am super excited to hit this milestone with you all, whether you've listened to all 200 episodes or this is your first one, I'm happy to be here to celebrate with you, and I'm also excited to share a very special episode with you. Today, we're dipping into the school based ot collaborative professional development archive to share with you a fantastic a ot a approved course by Dr Monica keen. In this course, Dr keen dives into the world of post covid school age mental health, and she explores how we can use what we learned from the covid era and continue to use those strategies in our schools. Today, you'll get practical tips on supporting students emotional as well as their functional participation. And trust me, this episode is packed with insights, and Dr King's energy is like just inspirational. Trust me, you will be fired up by the end of this episode. Now what you're about to hear is the audio version of Dr King's presentation, and if you are a member or decide to become a member of the school based ot collaborative. You can actually hit pause right now head on into the collaborative and catch the video version with all the slides and resources directly inside the community. Or you can continue listening and then go into the community and take the quiz to earn your CEU certificate for this audio version. We've snipped out the Q and A for you know, privacy, but our community is buzzing with experts like Dr keen and others ready to answer your questions all about ot inside our OTP lounge. I also want to give a big shout out before we get started, to every single person who joined us at a ot a inspire, as well as the school based ot meetup that Jamie from Miss Jamie OT and I hosted. It was fantastic. Getting to meet so many of you. I wish I had the opportunity to have like, a 10 minute conversation with every single person. There just so many good things there, talking about case loads, talking about things that are going great, as well as some of the things that are not going as well. I like talking about all of it, your stories, your support. They mean the real to me, and you all made me blush a little bit every now and there, when you talked about how this podcast, how the articles, how the collaborative even have really helped you in your school based ot journey, I cannot thank you enough for coming up, having the courage to say hi and and sharing with me everything that's going on in your school based ot career. You made my weekend a blast. So thank you, and I have to give one more final thank you to everybody who came to my session at a ot a you know, we talked about services in the least restrictive environment, which is not always the most fun topic to talk about, but I appreciate you being there. We had a packed house. Really had fun with it, and I hope you all had fun, as well as learned a lot about helping students or helping you to determine services in the least restrictive environment. All right. Well, we are going to jump in with Dr keen right now. Thank you so much for being here again. Appreciate it. Happy 200th episode to all of those of you who will celebrate it. And yeah, enjoy this episode. I'll catch you at the end.
Amazing Narrator
Hello and welcome to the OT school house podcast. Your source for school based occupational therapy tips, interviews and professional development. Now, to get the conversation started, here is your host, Jayson Davies, CLASI is officially in session.
Jayson Davies
Please help me in welcoming Dr Monica Keen.
Dr. Monica Keen
Hey, how's everybody doing? Thank you so much for tuning in. Tonight. I am coming to you guys from Greenville, South Carolina, so there is a huge time difference. And as you can see in the background, my Christmas tree is all lit up and it is dark outside. So it's really cool to know that I am reaching you guys where you're still experiencing sunshine over in California. So thank you so much for having me. It's always a pleasure to to partner up with Jayson and to talk about school age, mental health, children, children mental health in general. Just a brief little disclaimer before we get started. I always the day of my presentations, I get into this frame of thought about, you know, what do I really want to focus on? What is a point that I really want to get across? And in this particular presentation, you know, I find that occupational therapists are always looking for an. Activity, an intervention, you know, something hard and tangible that they can do to address something, and I appreciate that more than people will ever know. However, I am going to challenge you guys tonight to think about how we need to start modifying our approach with our clients, particularly our children. I'm still focusing on mental health in a post covid world, because when I began this research, it was during the covid crisis, and I've been eagerly awaiting the results of how mental health is in a post covid world. And so as I was sharing with Jayson, as I was preparing for this, I learned a bunch of new stuff about how mental health has changed in a post covid world, for our children well, and really for the world at large. So without further ado, let's jump in. We're going to do a brief review. Let me see come on in advance, would you? There we go. All right, so some learning objectives for tonight. I want you to be able to walk away from this presentation to be enlist three significant mental illness diagnoses that our school day children are facing at this point. And let me be clear that when I say school aged, I am talking about ages three, from the time when children can start in public education all the way up to age 21 and of course, when we start at the age of three, we are coming in with some special needs. We have qualified to be able to come into school practice. Number two, I want you to be able to identify reasons and events that impact child mental illness and how that impacts their ability to engage in occupation. And then, number three, recognize the role of occupational therapy and addressing these mental health issues. So covid, 19 has had some lasting impacts on everybody, and I know that some people are probably feeling that, oh, my goodness, you're still talking about covid. Yeah, I am, because it is still having great impacts, not only on our children, but public education as a whole, when I retired, it was in 2022 and I was really excited, because that was the year in 21 everybody was coming back into the school, and I was excited to have everybody back. And I was like, things are going to be back to normal. And oh my goodness, how wrong I was. That was the year that I saw the most challenging behaviors, not only in special education, but in regular education as well. And it was because of that that my desire to learn more about what is going on here, to make these significant changes in behavior, what's going on, and that is what got me to studying about how did covid impact our kids so but in order to do that, we have to look at three different sets of people. So I want you to envision, if you will, a triangle, and at the top of the triangle we're going to have teachers. In the middle of the triangle, we're going to have parents, and then at the bottom of the triangle, we're going to have children. And as I talk about this, I want you to understand that the anxiety and depression that's happening in our teachers rolls down to our parents. The parents picks up what is going on with our teachers, along with their anxiety and depression and stress, and it's coming down on the shoulders of our our school age children, and so just bear that in mind as we talk. So mental health continues to be a challenge again for all three of these groups of people, teachers, parents and students, and because of that, we are continuing to struggle both with things that have happened in the past as well as new issues that have arisen because of the changes that have come along because of covid. So new considerations have been surfacing, and it really does help us to better understand why there has been a shift in behavior. And I would love to know, you know, for those of you who are school based practitioners. Have you seen the same thing? And if so, I would love to hear what in particular that you're seeing. So let's do a little bit of review. Let's go back to March of 2020, when covid just literally stopped the world on its on the dime. Life as we knew it was no more. I mean, it would. I'll never forget. You know, I come home from work on a Friday, and then I get notified over the weekend that the school is closed indefinitely, that we're going to online learning, and they'll let us know when we can go back in the building. And as you sit. Process that you have to remember that none of us had a say in what was going on. So from teachers to parents to kids, we lost all control through no fault of our own, and as a result, too, public education took a massive hit because of covid, and because of that, it impacted mental health. Because think about it, where do our school age children spend the majority of their time? That is their occupation, that is their job. Is going to school. And so picture, if you will, that occupation has been taken away from them through no fault of their own, and they have no control. So as we were talking, the world has stopped. One day you're at work, the next time you're isolated, to be in your home for an indefinite amount of time, you've had no say in what is going on. You've had no control. You've lost it. And what do we like to do as human beings? We like to be in control of what we can be in control of, and that's very little. But when we've lost what we lost during covid, that's going to impact our income, that's going to impact our health, that's going to impact our socialization, and again, we had no say. Times were at best, uncertain. Parents were wondering, you know, am I going to continue to be the breadwinner? And on top of that, they also had to take on the responsibility of being the teacher, to ensure that while they're doing their job within their home, they also have to ensure that their child is on the computer, remaining engaged and getting and understanding the lesson that the teacher is doing through hybrid means. Children's occupation, again, school has been taken away, and now new norms and routines were thrown upon society. And to think about, you know, you've been clipping along all of your life, doing the same routine week after week, day after day, and all of a sudden you've got to come up with something new. Is really challenging. It's very stressful. So I know I'm just touching the tip of the iceberg, but please try and appreciate all of these challenges that happened. So everything's changing. What happened to our teachers? Our teachers were forced to transition. Let me move this over here. Transition in an erupt in an abrupt, short period of time, very little training on how to use digital resources, and in most cases, did not even have the equipment to adequately be able to do online teaching. Of course, I can only talk about the district that I was in, but you know, the teachers, they didn't have a choice. It was, you're going online, you're going to remain on the standards that we're expecting you to maintain. You're going to teach everything. And sorry, we don't have all the resources we're working on getting that out. Just a mess. And that was just in the district that I was in. I can't imagine what was going on in your part of the world. Research does show, and this was from one of my previous presentations, in order to master the art of teaching in a hybrid means typically takes a year and a half to master all of those skills, and we were told to have it mastered over a weekend. So let that sink in and give you some perspective. Okay, so as a result, I think this teacher's face pretty much says it all. We have our teachers who are now retiring and resigning at higher rates because of covid. One of the studies done by Rand in 2024 out of 1500 participants, a quarter of those teachers were still dealing with stress again. This is post covid. 60% of those 1500 are quote, unquote, burned out. Many report that stress and disappointments of teaching just simply is not worth it anymore. 59% of teachers reported being stressed, versus 78% in 2021 so it looks like the stress might have gone down a little bit, but nonetheless, greater than 50% that's a significant amount. Female teachers have more stress than their male counterparts. I found this really interesting, that teachers of color are less likely to report difficulty with stress or coping. Don't know the the reasoning behind that, but I thought that was a very interesting statistic. 22% are probably going to leave their job at the end of the year. 17% they're just going to stop teaching, that career, that profession, altogether, which just really hurts my heart. And then overwhelmingly, there was just a quote of. Quote, deep undercurrent of discontent. If you can get into the chat, tell me, do you still feel that there is an air of discontent in our schools today? This is going to be frustrating.
Jayson Davies
No worries. Money, money. I got you, um, I personally, I was just writing into the chat that like, in addition to all this, you also have inflation, and teacher wages not necessarily keeping up with inflation, so you had a mass exodus, and then people just being, like, not wanting, I think, to go into the teacher industry as much because lack of pay, plus the burden that they know teachers had during the pandemic,
Dr. Monica Keen
you are so right, and we're actually going to talk about exactly that in just a few slides. We're still in review, and we're talking about how the prevalence of anxiety skyrocketed from 10 to almost 50% in our teachers. Depression went from almost 16% to almost 30% and then stress overall from 12.7% to almost 51% those are gargantuous leaps and some very important mental health areas. So what about our families and again, iceberg for the teachers. Now let's go on to our families. The middle of that triangle. Here are some questions that I thought many parents were probably thinking about and just appreciate how this impacts their ability to keep a household up and running. Do I have a job? Am I going to work from home. How am I going to pay the bills? Am I going to work and be my teacher, my child's teacher? Am I How am I going to maintain the structure and routine now that everybody is home under the same roof, 24 hours a day, seven days a week, how am I going to take care of my family members that are sick? Why can't I go and be with my spouse who's in the hospital? How many of us know of friends or family who lost family members to covid while they were in the hospital and we could not even go in and visit with them? I miss my kids, or the children aren't handling this well, how am I going to be able to help them? Just think about this, if we as adults were so unsettled within our own selves, can you imagine how unsettling it had to be for our children? Some concerning statistics about what was going on in our families. In our homes, there was an increased concern about domestic violence. There was increased anxiety within the home, increased depressive symptoms, and 8.3% actually reported having suicidal thoughts and feelings. The increased negative interactions between our kids, including conflict, was higher and it resulted in the maltreatment of our children in the forms of yelling and shouting disciplining when disciplining was not needed, and the use of harsh words. And let me tell you something, as a person who has under you know, been verbally abused over my lifetime, the use of harsh words can be very devastating, and so here we are again, stuck in a home with these people, 24/7, no means of escape or a break. So let's talk about our little ones. Seven years and younger, increased clinginess and fear, not being cooperative, misbehavior, boredom, needing more attention. And we have to remember attention comes in both positive and negative forms. They just wanted more attention and then increase in anxiety. But yet, our children going into the teenage world, the puberty age, look how high the anxiety skyrocketed, almost from 2% to almost 24 Depression, depression in the ages of seven to 13, from 2% to almost 12% Post Traumatic Stress Disorder, three, 3% I Think that is significant simply because we're talking about an age bracket of seven to 13. Most problematic with our kid OTs were the changes in behaviors, the need for constant attention and reassurance, difficulties with academics. Let's talk about that for a minute. I can tell you that I am not the best hybrid learner. I'm a kinesthetic learner, where I need to see it, touch it, manipulate it, smell it, feel it, whatever, in order to get the best learning experience for myself. Well, that's not the case during covid at hybrid learning, our children were not able, some of them. We're not able to grasp the concepts. And I don't know if you have found this over the course of your career, but when you have a child who is not able to keep up with what's going on the in the classroom, I've noticed one of two things happen, either they shut down or they misbehave, and so we're having a situation where the children are also being advanced to the next grade when they haven't even mastered the concepts of the grade before them, and so once they get into that next grade, it just continues to pile on, on, on, putting more stress on our children, resulting in increased anxiety, increased depression, so on and so forth, and that is going to result in the misbehavior, anxiety, social isolation, when they just simply shut down and depression. All right, let's move on up into age adolescence. You know, during this time of adolescence, this is when they need the more most, quote, unquote, normalcy, right? And that was the least of what they were given during the times of covid. Studies showed that in our adolescence during covid, they were showing increase in depression, again, anxiety, PTSD, misbehavior, poor attention, increased impulsivity. You're going to see over and over, how these the areas of anxiety and depression just keep going up the ladder. So what is research showing? Now? This is where I got excited, because I've been waiting for this for a long time, and this is what I found out so far. All right, let me preface this by saying this is not, this is not a political agenda that I'm about to go over. When I did this in my last presentation, I forget where one of the comments said I think she was pushing her political agenda. And no, this came right out of research. So this is what our teachers are facing the end of federal pandemic relief funding. And so that means that the financial burden for them to bring supplies and resources into their classroom, a lot of it continues to fall on them. A new political agenda targeting public education, as we know, the Department of Education shut down, and that is where we get a lot of our help. For our educators. We are committed as educators to diversity and equity and inclusion, and especially as OTs, that is what we are driven to do. And so you know that has been threatened, deepening of inequities and access and support, and then evolving teaching as a profession. What Jayson was just talking about many of our teachers, again, they're just saying it's just not worth it. I'm finding over and over again that the support for our teachers is just becoming less and less, which, if they're not getting the support that they need, that is eventually going to bleed over into the classroom and with our students again. If you've got some comments about that, I would love to hear what you're noticing in your area of work. For our parents, our research is showing now that they're bringing in this concept, the reality of aces, adverse childhood experiences, and they are finding that if our parents had history of having had adverse childhood experience, and we're going to go over these specifically more in just a little bit that was going to directly impact how they handled themselves during the covid 19 pandemic. These adverse childhood experiences can have an impact on the individual's resilience, ability to cope, and how they regulate, how the parents regulate during their times of stress. Those who experience child maltreatment as an adverse childhood experience was more likely to carry out that same type of behavior on their children experiencing re traumatic events reported to have an increase during the isolation phase of covid, and mothers who experienced adverse childhood experiences were more likely to have less resilience, yeah, poor resilience during the covid experience. So now let's look at our children and our adolescents. Okay for our children, if they did not have a mental health diagnosis prior to covid, they were point one 5% more likely to develop one within two years post covid. If. They had a mental health diagnosis before covid, they were point 2.026% more likely to acquire a new one. And for our children, those usually played themselves out in developmental disorders and anxiety disorders, specifically ADHD and in some cases, conduct disorder. But when we looked at our adolescents again, if they did not have a mental health disorder prior to covid, they were point one, 9% more likely to develop one within two years. If they had one, they were more likely to acquire a new one in point zero 5% and for our adolescents that came in the form of anxiety disorder, substance abuse disorder, mood disorder, ADHD and increase in suicide attempts, that's very sobering, in addition To what this previous slide has shown you, in addition to depression and anxiety, again, our children, adolescents and teenagers, the gamut of the of our kids during their school, school age, time, PTSD, loneliness, I think that that is a very significant one that We need to pay a lot of attention to because how often do we hear children telling us that they're lonely? Psychological distress, anger? It's no to me, it's no wonder that these children do have anger, especially if they're not able to keep up in the classroom, especially if they have experienced something traumatic while they were forced to be home all of the time, and we have to remember as well that our young children do not have the verbiage to be able to express verbally how they're feeling, and so many of The times that expression is going to come out in the form of behavior. And we all know as OTs, behavior is a huge form of communication. There was an increase in irritability, increase in boredom, increase in fear and stress. And I thought this was fascinating as well. Eating disorders may have been reactivated secondary to covid, and that is because covid could have been a triggering event for those who had eating disorders previously, increasing the anxiety and the stress, thus causing them to fall back into what was familiar being their eating disorders. Any questions so far Jayson?
Jayson Davies
no questions. There's been some comments in there, but I was just going to say also, kids were at home all day. They were, you know, a stone's throw away from all the cupboards with all the food in it, as opposed to having to find eating times and defined school time.
Dr. Monica Keen
Exactly, and the parents as well. We have to remember, you know, they're trying to do their job. They're trying to make sure the kids are at, you know, sitting and attending in the classroom. It was just really chaos for a lot of homes. So I found this study, this meta analysis to be absolutely fascinating, notice, if you will. It was a cross sectional or a longitudinal study between America, Greece, Norway, Australia and Canada. They looked at children between the ages of eight to 18. They specifically looked at what were the levels of anxiety, pre covid and then post covid. So for anxiety, they gave specific results for America, Canada and Greece. And I'm not going to go over the numbers, simply because you can, you can read, but in each one, they increase. So for USA, 4.67 to 5.37 and then the same for Canada and Greece, it went up for depression, pre covid and post covid, they looked at America, Norway, Greece and Australia. And again, across the board, we are still seeing increased percentages in depression in all of those countries. So our children are not getting the interventions that they need to learn how to regulate and deal with the events that happened during covid, and they're still processing that.
Jayson Davies
All right. I hope you are enjoying this episode with Dr Monica keen. We're going to take a quick break, but when we return, Dr keen is going to dive into updated research as well as some practical strategies that we can use in the schools right now. Stay tuned.
Dr. Monica Keen
Okay, so now we're going to break into looking at aces trauma and resulting behaviors. And this is where I really got interested, because prior to the new statistics coming out about anxiety and depression, nothing was ever mentioned about adverse childhood experiences or traumatic events. It was this is what's going on, and this is why we're seeing an increase in anxiety and depression. But now they are saying that adverse childhood experiences did play a direct role in how our children were impacted during covid. So what is an adverse childhood experience? It is a preventable, potentially traumatic event that occurs in childhood. Now, when I read the word preventable, I read it as the child may not been able to prevent it, but it is something that did not have to happen, if that makes any sense. Some examples would be sexual abuse, verbal abuse, emotional and physical abuse, neglect, domestic violence, etc, etc. And there is an association when there has been a conglomerate accumulation of adverse childhood experiences and poor mental health, that goes to reason. But let's look at some specific things that happen when there is a buildup of those aces, emotional abuse, sexual violence and physical violence during dating was associated with increased substance abuse. If you experienced one to two aces during the pandemic, it doubled and possibly tripled your chances of falling into substance abuse. And if you experienced four or more of some aces during the pandemic, you had a higher chance of alcohol use, higher chance of binge drinking, and then a higher prevalence of increased alcohol during the pandemic, as well as a higher use of using marijuana. Now, thought this was really interesting as well. I learned that there are 10 original aces, and we now are looking to add more, which is going to be in the next slide. But let's look at what the original aces are, physical abuse. And again, these were labeled as preventable activities, not by the child, but the adult could have not done these things, physical abuse, emotional abuse, physical neglect and emotional neglect, two totally different things, but both carry impacting results. Parental separation, then divorce again, two things that are alike, but yet so totally different, domestic violence against the mother. Now, yeah, I'm sure that it is important if there's domestic violence against the father, but there's something more specific when the children witness it happening to the mother that it impacts them at a deeper level, substance abuse of a household member, mental illness of a household member, or incarceration of a household member. So these are the 10 original aces. And if we go to the previous slide that we looked at, remember we were talking about, if individuals had experienced these in an accumulation four or more, one or two or one, it will impact and increase their chances, as we talked about for alcohol abuse and substance abuse. So here are the ones that they are considering adding peer victimization. What does that boil down to? I think, for a child that's going to be bullying, whether it's cyber bullying, whether it's in person, peer victimization, battering, gambling problems in the household discrimination. And I want to kind of sit on discrimination for just a few minutes. Discrimination goes so far beyond the color of one's skin. In the previous presentation that I've done, there were specific statistics about the LGTBQ community for our adolescents and teenagers during the covid time, which pointed out that they had increased suicidal not only attempts, but also suicidal ideation. Because that community found its comfort and found its socialization and its peer connections in school, and so that was taken away, and they were back in a home where probably a lot of the parents didn't agree with the lifestyle, and so they were being judged, they were being condemned on a pretty consistent basis. And so when we see that word discrimination, let's make sure that discrimination covers a lot of different areas and not just race. The next two that we're going to talk about are really gaining a lot of traction in the world today as it relates to how it impacts our children's mental health. So contact with protective services that's not even talking about when they remove the child from the home, the mere fact that child protective services have come in into a situation in the home, again, where the child has had absolutely no control, and here they are being threatened to be removed from the home, even though that might be in that child's best interest, that is still the environment that that child is used to. That is their norm. That is where they have consistency, even though it might not be, probably is not positive consistency, the mere fact that that is being threatened and they're going to be removed from their parents, that is now considered an adverse childhood experience, foster care placement, again, being taken away from something that is so familiar to these children being put in an environment where they don't know anybody. They don't again, don't know the rules, the regulations, the schedule, the routine, and they are expected to adapt so very stressful poverty they want to add to the list of adverse childhood experiences, because poverty is going to directly impact their ability, the family's ability to get to resources, the things that they need, whether it's health care, food, being able to keep the lights on in the home, Being able to keep the water on when I talk to my students, when I'm teaching or when I'm presenting, especially to school practitioners, I always try to zone in on the fact that for children, for some children, school is the only place where they're going to get hot meals. Two of them, school may be the only place where they have electricity and running water, and so school is a safe haven for them. And so it's no wonder that poverty does play a role in being an adverse childhood experience. And then lastly, neighborhood violence is going to be added to the list as well. And I think that, you know, when we think about neighborhood violence, that comes in so many different ways, whether it's drug dealing, whether it's, you know, where active shooting is going on all the time, just neighborhood violence, where they see a lot of fighting in the streets, a lot of murders, neighborhood violence is going to be considered and with good reason to be another adverse childhood experience. All right, so in this particular study, mercera et al was looking at not only American children, but also Dutch children, and I found these statistics to be pretty disturbing as well. Almost 63% of high school students have experienced at least one adverse childhood experience out of the original framework that we talked about, the original 10 by the age of six, approximately 70% of children that from the US study longitudinal had experienced three or more out of eight of the 10 original aces for Dutch children nine to 13 years of age and regular ed. Regular ed reveal that approximately 45% had experienced at least one ACE in their lifetime, and 11% of those had experienced three or more of the 10 original aces. So again, we're not even looking at the other ones that are going to be added to the list, that for sure, we're going on in addition to the 10. So I put this in red because it's so important, adolescents who reported aces were more likely to experience depression, anxiety, drug abuse, antisocial behavior, suicidality and cognitive difficulties. All right, did you know that covid is now. Considered to have been a traumatic event. And I think that it should go without reason that that qualifies as a traumatic event. What I've done on this slide, and if I had the book with me, I learned it to one of my students. If you have not read the book, The Body Keeps the Score, oh, my goodness, please go get your copy tomorrow. That book was life changing for me, because it validates the fact that exposure to chronic trauma literally changes the biology of our brain. It alters our neural pathways and it causes different wiring within the brain, not that it can't be reversed, but to know that exposure to this trauma literally changes the makeup of our brain truly does validate why and how behavior is being impacted. So these were some of the direct quotes that I took from the book that I thought really hit home. Trauma results in fundamental reorganization of the way the mind and the brain manage stress. Recalling an emotional event from the past causes us to actually re experience that trauma, and we go back to the original sensations that we felt during the original event. Suppressing those inner cries for help doesn't stop our stress hormones from mobilizing the body when something terrifying happens, we will retain an intense and largely accurate memory of that event for a very long time. And lastly, and we've already spoke about this briefly, finding words to describe what has happened to you can be transformative, but it does not always abolish or stop the flashbacks or improve concentration. So again, think about our little ones who do not have the words to be able to talk about what happened to them and not express what happened to them and how that made them feel. So again, if you've not read the book The Body Keeps the Score, please get you a copy and check it out. So covid and trauma. As I said, covid 19 is now recognized as a traumatic event in the lives of some children, not all children, but some. And so with trauma comes trauma informed care, and I'm not certified in this form of intervention as of yet, but the components of trauma informed care are things that we can do at any given time in our interventions. And one of the things that I think is so wonderful about trauma informed care is that no longer do we look at the individual and in our situation, our children in the schools and say, What's wrong with you? Instead, we are now taking that approach of Tell me what happened to you. And that is such a huge shift in the approach that we're taking with our clients in order to make that relationship with them so that we can help them get past or deal with and better regulate their emotions trauma. Informed care also wants us to focus in and promote the resilience of our clients. We need to help them get back in touch with their ability to get better, their ability to regulate their emotions and their feelings, we need to get them back in touch with their ability to be to remember that they are resilient. The other wonderful thing about trauma informed care is that it really is client centered, and so you know, just like from Question one, we want to know what happened to them so that we can find out how that impacted them as a client specifically, and as OTs, when we pull on our mental health education and Our experience, we're going to help them to be be able to better navigate through that trauma, hopefully be able to give them some better cognitive strategies on how to reframe and rethink how they handled the trauma. So again, client centered care, it prioritizes a trauma. Informed care promotes and prioritizes trust and collaboration and so again, in order to have this with our client, we've got to build that relationship, and building relationships with individuals who have had trauma go on in their life is not and it's not meant to. Be an easy thing. We have to go back into our intentional relationship model and build that trust with that individual so that they feel comfortable sharing with us what's going on, and then we also you when we use trauma informed care, we want to promote the client's strengths. So instead of focusing on what they're having so many challenges with which is bringing down their resilience and it is causing increased anxiety and stress, we want to find and zone in on the things that they're doing well. We want to look at the things that they are strong in, and help them focus on that so that the other areas will come and improve with time. All right, the other thing about trauma informed care, and I know we're almost finished a trauma, informed care also has an acronym called cares, and it stands for context. We always want to understand what is the context of where our client is coming from, and so in this presentation, the context was, How did covid impact them? We want to ask questions. We we want to talk openly about the event so that they can identify the things that happen to them which are directly impacting their behavior or impacting their ability to engage in occupation and again, that's not going to come overnight. That is going to come from us using that intentional relationship model through therapeutic use of self to build that trust, respect and that friendship with our clients. Resiliency and resources is what R stands for, and we need to again, remember that we are focusing on their strengths, and we want to reinforce the resilience so that that, in turn, will decrease their stress. E stands for educate, and this is so incredibly important y'all, we have the privilege of being able to educate not only our clients, but the caregivers as well about how the trauma has impacted our clients, ability to engage in occupation, how it's impacted their behavior, If we don't understand why we're doing what we're doing. It makes it very difficult to appreciate the strategies that we are offering to our caregivers and our clients as to why they need to do certain things that that makes sense so by understanding or appreciating what our clients are going through as a result of an adverse childhood experience, as a result of trauma, that is going to help us better appreciate or understand what they are going through, and we can help open their eyes to the situation that they're in and teach them how To better regulate themselves. And again, this is for any age. School Based three to 21 we can we can work with any of those ages and educating and then self care. We want our clients to recognize that that trauma does produce stress, but we also need to remind them and empower them that engaging in self care, engaging in leisure activities, is going to help them better face the challenges that they are having, because self care always helps us feel better about ourselves. My question to you guys is, are you doing your self care, especially at this busy time of year? All right, wrapping things up, we're going to talk very quickly about internal versus external behaviors, and I do feel that we as practitioners probably cue into these things better than a lot of other professions internalized behavior. That is, of course, when we keep everything inside and we don't verbally express what's going on within ourselves, but it does come out in the form of being fearful, somatic complaints. I've got a headache. I've got a tummy ache, my neck hurts. You know, how many times have our kids in school come up to the teacher and said, on a daily basis, my tummy hurts, and we put two and two together, and we realize it's happening during a time when they're covering a subject that they don't understand. So somatic complaints are big worrying withdrawal, withdrawal and isolation, those are all examples of internalizing behaviors, whereas externalizing behaviors are going to be disruptive, aggressive, impulsive behaviors, and again, these are the children expressing how they're feeling through their behavior, and not so much through their verbiage. And what we need to do as the practitioner is not to react, but to respond and. And instead of getting upset to take that step back and to think about, what has this child gone through? What are they dealing with on a day to day basis, we need to be more aware of what is going on in our clients lives, so that we can better meet their needs through our interactions with them. And then lastly, what is our role as OTs? And so these are the things that I thought are so very important. Number one, please remember that every interaction is an intervention. I feel that we as OTs sometimes think that if we don't do an assessment or a test on a particular thing, then we're not addressing it, and that is so far from the truth. Every time we work with our kid OTs, we are addressing their mental health needs. Anytime you are hanging out with your friends, you're addressing their mental health needs. Every interaction that we do, we have the privilege of being able to know that we've done an intervention number two, that intentional relationship model be intentional in your relationships with everybody, but with our clients, especially those who have gone through trauma, when we're intentional and they can sense and that they know that we are truly interested in what's going on in their lives. That's where the trust is built, and that is where the relationship is formed using that therapeutic use of self. So so very important, we are the masters at that understanding the value of occupation. Now there's a difference in understanding what the value of occupation is versus engaging in occupation. Our goal is to get our clients to engage in occupation. So always know there's a difference between the two, but both of them are very important. What occupation is important to our clients? And once we've identified that, let's get them engaged in it. Know the occupation of your clients, and of course, we're going to figure that out through the occupational profile. And I would dare Gander to say that every time you go to get that kiddo out of the classroom to work with them, you need to be updating that occupational profile, because every single time you go to see that kiddo, they're not going to be the same. Their likes and dislikes might be the, you know, the same. They might vary a little bit, but we don't know when we open that door to get Johnny what kind of morning he's had. We don't know what Sarah had to deal with before she got to school. We don't know how Larry did on that test, and that just absolutely he bombed, and that's ruined the rest of his day. Always have that occupational profile being updated, become certified in tic trauma, informed care. I'm one that needs to fill that goal, but we can educate ourselves about what trauma informed care is, and we can go ahead and implement those the principles of trauma informed care. Always update the occupational profile and then lastly, but I think this is so important, appreciate the totality of your client's situation, being mindful of how the totality of what our little ones are dealing with will impact their behavior, and we can help them navigate beyond that journey. Help them to become successful in regulating their behavior and their emotions, but we must first understand, appreciate and gather the totality of what our kid OTs are going through with that the importance of occupation. This is the last slide. Occupations are the activities that people do every day to give their life meaning and purpose. Those can be done alone or with family or with friends. They can be done at home, at work, at school or in the community. Again, occupations are everywhere we go. Persons respond through adapting and innovation, whether occupations have been challenged or been threatened. This next one is so important, Adversity is not experienced the same by all people. That's one of the beautiful things about being an individual is that we experience things differently, and just because we experience things differently does not make our experience any less or any more than anybody else's. We as ot play a huge role in helping our clients adapt to their to occupations, as well as we are their biggest cheerleader to engage to participate back in those occupations, especially during their time of hardship and loss of OT, loss of engagement and occupation will not can it? Will impact the psychosocial well being of all individuals. So with that, I say thank you, and I am really interested in knowing if anybody has comments or questions.
Jayson Davies
All right, that wraps up episode number 200 thank you so much for tuning in to this special episode with myself and Dr Monica keen every time we have Dr Monty on the podcast. I love hearing from her. She teaches me something every single time, whether it is here on the podcast or in the collaborative like you just heard her presentation from plus, you know the knowledge is fantastic. I love it, but she is just also so inspiring, like she wants, she makes me want to do really cool things after every single time that I hear from her. Remember, if you want to dive deeper into this topic, and you want to earn one hour of a ot a approved professional development and access all the slides and resources from this course, you can do so by joining the school based ot collaborative at OTSchoolHouse.com, slash collab, you'll get this course as well as over 30 other courses, along with unlimited resources, our goal bank, our AI tools, everything to help make your life as a school based ot practitioner easier. Plus, if you do decide to join impact tier members also get full access to our back to school conference coming up this August that is packed with even more great content and more presentations to help you kick start your school year. Thank you one more time to Dr keen for sharing her expertise and for everything that you do for the school based ot community, and thank you for being a part of this 200th episode celebration. Thanks for tuning in. Really appreciate you being here, and I'll see you next time in Episode 201. Until then, take care.
Amazing Narrator
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