Thursday, September 14, 2017

New Tools for Difficult Conversations with Youth

It’s never easy to know what to say when a child is in an emotional crisis, but the counselors at three YMCA summer camps may have added some tools to their belts after a training by Samantha Thomas and Lance Metayer of Northwestern Counseling & Support Services. There were about 100 counselors in attendance from Camp Abnaki in Grand Isle; Camp Koda with locations in Burlington, Georgia, Waterbury, and Essex; and Camp Greylock in Ferrisburgh. The training focused on mental health in youth and traumatic stress in childhood, topics that are all too often unexplored and misunderstood.
One of the most powerful messages behind the training was in the way we think about mental
Samantha Thomas presents to the group
illness and mental health crises. Samantha Thomas, Team Leader for the Children’s Initial Response Team at NCSS, phrases it as a paradigm shift.  When we alter our questioning from “What’s wrong with you?” to “What happened to you?”  and “Why are you acting that way?” to “Why are you reacting that way?”, we respect each individual’s experiences.  A child’s behaviors may suggest intent, yet often the behaviors of traumatized children are not intentional; they are reactions, or stated differently, these behaviors are coping mechanisms learned over time.

These coping mechanisms can be misperceived as manipulation, intentional defiance, and aggression for example, says Thomas. A child with complex trauma—multiple traumatic events overtime, often within the childcare-giving system—may act out due to a trigger in their immediate environment.  These behaviors often stem from a child’s trauma history.  Behaviors that are rooted in traumatic experience, such as name calling, can appear to be plain old aggression. It is certainly challenging not to take it personally when someone is yelling and calling names, but these behaviors are what the child has learned to do in the moment to navigate their experience and feel safe.
Other questions and approaches become more natural when one makes that paradigm shift.
Lance Metayer presents to the group
Thomas and Metayer would like counselors to use language that expresses clearly what they want the child to do in the midst of an outburst or crisis, not what they want the child to stop doing. In moments of crisis, a child may not know what an adult expects of them. “We’d like adults to ask questions like ’What is it going to take to help this child regulate and get in a better space? What are some strategies I can use to help calm them so they can process?’” explains Thomas.

Some common triggers for traumatized children may seem banal: transition from one setting to another; noises such as slamming doors or ringing bells; redirections from teachers and peers. While many young people have developed coping skills to manage these everyday situations, children who have experienced complex trauma are acting in whatever manner they have determined will keep them safe within an environment they assume will cause them harm.  Some possible Adverse Childhood Experiences, known as ACES, are exposure to domestic violence; parental substance abuse; sexual or physical abuse; neglect; poverty; caregiver incarceration.  The prevalence of Vermont children who have experienced one ACE is 50.6%, compared to the U.S. prevalence of 47.9%. The prevalence of Vermont children who have experienced more than one ACE is 23.3%, compared to the U.S. prevalence of 22.6%, according to  

ACEs often last a lifetime, but they don’t have to. Healing can occur. The cycle can be broken. Safe, stable, nurturing relationships can heal the caregiver and child. “One misperception about mental illness is that there is no recovery,” says Lance Metayer, who works for NCSS as the project manager for Aware Vermont, a statewide initiative that brings no-cost Youth Mental Health First Aid training to educators and communities throughout Vermont. Many of us might think of traditional talk therapy as the only treatment, “but the truth is, everyone can help,” Metayer says. While that may be true—that we can help—talking about mental illness is not always easy. Trainings like the one recently offered at Camp Abnaki may make those conversations feel a bit less intimidating.  
Other more physical health issues are comfortable topics for everyday conversation in ways that mental illness is not, and the difference is not always explicable. Going to the doctor for a
swollen knee, chronic migraines, or high blood pressure is often something people are more than willing to share with their family, friends or co-workers. But mental illness is not viewed through the same lens. It’s rather shocking to consider the level of stigma related to mental illness, given that 1 in 5 people will experience a mental health condition in their lifetime. There are two kinds of stigma: public stigma and self-stigma. Public stigma is the reaction the general population has to those with mental illness. Self-stigma, which can be very damaging, is the prejudice one turns against oneself. And what is more powerful than the things we believe about ourselves. Stigma often prevents people from accessing care and talking about what is going on. Yet, talking about mental illness is just the way to normalize it.

Trainings like this can be particularly helpful in helping people feel more comfortable talking about suicide. “There’s a big misperception that if you ask someone about suicide, you will drive them to it,” Metayer says, “and that’s not true.” Another myth is that if someone speaks about suicide, they are not serious about their thoughts; in fact, talking about suicide may reveal the true depth of someone’s feelings. There are some common warning signs of suicide: withdrawing from family or friends, having a dramatic change in mood—sometimes an individual with a plan will appear extremely happy. Other warnings signs may be sleeping all the time, being unable to sleep, and giving away prized possessions. In the training, the counselors were reminded of the importance of asking the question directly, learning the warning signs, and reaching out to the crisis system if a situation seems dire. One should not avoid the direct questions. Asking, “Are you having thoughts of suicide?” with confidence can actually be reassuring for an individual with suicidal thoughts.

The reality is that camp is inherently a healing structure, Thomas points out. “The routine is established; the expectations are clear.” At camp, the counselors build strong, personal relationships with the campers. And with that, “counselors are sometimes the best people to provide an intervention,” notes Metayer.

Thomas and Metayer with Sara Robertson Ryan, Director of School Aged Programs
and Jon Kuypers, Director of Camp Abnaki
The training also touched on ways that leadership can approach policy from a trauma-informed care lens. There are guidelines or policies that businesses, schools, or camps might have held for a long time, and so they feel customary and comfortable. Metayer explains that looking at those policies through a trauma lens pushes leadership to ask questions about current processes: Does this process feel comfortable for everyone? Does it cause any harm? Does it call anyone out? Does it make anyone feel unsafe?
Thomas and Metayer were impressed by the counselors who took this training. They were a very thoughtful group who genuinely cared about the kids they worked with at camp. Several counselors asked pointed questions about kids they had worked with before and what a meaningful intervention would have looked like.
It is never easy to have difficult conversations with loved ones, friends, strangers, or those we meet at camp. Talking about mental illness makes it feel just a little more normal, which is powerful, since it is all around us.

 Written by Meredith Vaughn


AWARE VERMONT is a statewide collaboration between state designated mental health agencies (DA’s), identified youth serving community partners, the Vermont Cooperative for Practice Improvement and Innovation and Vermont Care Partners.  

The development and implementation of AWARE VERMONT is made possible by a grant from Substance Abuse and Mental Health Services Administration (SAMHSA).  For more information about AWARE VERMONT or to sign up for a training near you, contact Lance Metayer at or 802-582-8039.



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