Presented by William O. Donnelly, PhD, on September 27, 2013 at the fourth annual Center for Health Literacy Conference: Plain Talk in Complex Times.

1. 1
Show, Don’t Tell:
How children and adolescents
communicate about trauma and
other mental health issues
Presented at Annual Conference of
Center for Health Literacy
Plain Talk in Complex Times 2013
September 27, 2013 Arlington, VA
William O. Donnelly, Ph.D.
Donnelly Community Psychology
Adjunct Clinical Faculty, Psychology Department
Bowling Green State University,

2. Mental Health for Children and Adolescents:
the challenging context
•

3. Mental Health for Children and Adolescents:
the US national context
• Prevalence (12-month) estimates: 13—20% of children
and adolescents experience mental health problems
that cause them distress and/or interfere with their
functioning
• An estimated 5 to 8% of youth experience serious and
persistent difficulties related to mental illness. 8% (ages
12-17) with 14+ “bad mental health days” past month.
• http://www.cdc.gov/mmwr/preview/mmwrhtml/

4. Mental Health for Children and Adolescents:
Suicide Risk and Mortality
• Suicide was second leading cause of death for youth age
12-17 (NVDRS, 2010)
• Seriously considered suicide: 16% (HS students, YRBS)
• Attempted suicide: 8% (HS students, YRBS)
• http://www.cdc.gov/mmwr/preview/mmwrhtml/
ss6104a1.htm

5. Mental Health for Children and Adolescents:
• Utilization: 3-5% get any mental health care at all
(any care, ranging from a single contact to completed
treatment)
• Is any care the right care?
evidence-based? culturally sensitive?
delivered with fidelity to treatment protocol?
meaningful outcomes?
No reliable estimates of this. Best guess?

6. Children’s Mental Health Concerns:
who speaks up?
• Younger children do not self-identify or self-refer.
• Adolescents are more likely to express concerns but
unlikely to label them as a mental health need. Typically,
they are not able to initiate (or pay for) care
• As with physical health care, access to mental health
typically depends on parent ability to recognize need
(psychological distress) and seek help

7. Reasons for Referral
• Youth are historically more likely to be referred for
mental health care because of externalizing behavior
problems (ADHD, conduct, hyperactivity, aggression, poor
school performance)
• Younger children: for conduct, self-regulation
• Adolescents: risk behaviors, substance use, irritability
• Less likely to be referred explicitly for emotional distress,
psychological pain/suffering (e.g., depression, anxiety)

8. A Few of the Barriers
• Financial
• Transportation
• Time commitment
• Shortage of trained professionals
• Stigma
• Lack of knowledge, understanding about child
and adolescent mental health
• Prefer to get support from family and friends

9. What do we do about the suffering?
• The daunting gaps between needs and utilization
and capacity requires alternative strategies
• Requires strategies for prevention
• Universal prevention (e.g., stress, bullying)
• Targeted prevention: children with increased
risk, not necessarily symptomatic (e.g., exposure to
natural disasters, community violence)

10. Mental Health Promotion
• Prevention programs delivered in community
setting, notably schools
• Mental health promotion
• Mental health literacy
• Promotion of mental health as health
• Attack stigma
• Empowerment

11. Two approaches to MH literacy
• Literacy regarding mental illness: its nature,
neurobehavioral and psychosocial causes, consequences,
scientific underpinnings. Dispel myths, promote illness
identification.
• Literacy regarding skill development for child and
adolescent mental well-being: identify and express feelings;
self-calming; problem-solving; seeking social support;
appraising thoughts

12. Mental Health Literacy: Trauma
• High rates of C/A exposure to traumatic stressors (violent
accidents, physical/sexual abuse, DV, community violence,
painful medical tx, war/terrorism, natural disasters,
hunger/deprivation, suicide of friend or family member)
• Youth can understand how non-verbal behavioral and
emotional reactions to traumatic stress translate to “core
symptoms” of PTSD (re-experiencing, avoidance,
hyperarousal) and to other psychological effects

13. Mental Health Literacy: Trauma
• There have been rapid advances in scientific
knowledge, clinical application and improved
outcomes regarding child trauma and anxiety.
Interventions for trauma provide relief.
• The “model” for traumatic stress explains it in
terms of both brain and behavioral response
within a normalized view of human adaptation
and survival.

14. Trauma, no stigma?
• Acceptability: This approach may weaken or
eliminate the stigma-related connotations of
“sick”, “crazy”, “something wrong with me”,
“weak”, bad.
• http://www.youtube.com/watch?
v=0Cp90_vUDck

15. Psychological Trauma and Youth
• Traumatic stress: Overwhelming life-threatening stressor
• Experience of trauma:
Horror
Helplessness
Threat
• For children and adolescents, the life-threatening experience can
includes event that threaten their family, their well being or their sense
of belonging/safety

20. Trauma Reactions:
Children and Adolescents
• Reactions vary according to development. Across ages: non-verbal
behavioral reactions
• Preschoolers: regression, tantrums, disorganized behaviors, fears
• School age: angry/moody, sleep and somatic, worry, sadness,
avoidance
• Adolescents: withdrawal, numbing; risky behaviors, can feel
alienated

21. Trauma Informed Care
• Asks about trauma exposure
• Asks about personal trauma impact and reactions
• Helps develop meaningful trauma narrative
• Expresses concern and support
• Shares information (about trauma and its effects)

22. Trauma Informed Care
• Normalizes trauma reactions but educates about impact
• Provide resources for help – what to do about it
(evidence-based interventions)
• Provides resources to help family, friends, and
professionals understand youth experiences and provide
support
• Empowers youth

25. •

26. Literacy: It’s OK to Talk
• National Association of Broadcasters Campaign
to encourage youth mental health literacy
• Promotional message: OK to Talk
• Tumblr-based community campaign
• Radio and tv ads, English, Spanish
• Mental health stories of teens and young adults
• Invites teens to share personal stories

27. It’s OK to Talk
• Gordon Smith, NAB President, former US Senator
• Previously sponsored Garret Lee Smith Act in response to
his son’s suicide. GLS funds SAMSHA programs for
adolescent suicide prevention.
What do you want to be when you are older?

28. Literacy: How to Talk

29. Literacy: How to Talk
web-based interactive simulation games
• How to talk (how to listen) about:
• Psychological distress, including signs of
suicide
• LGBTQ issues related to respect,
inclusiveness, stress, bullying
• Who can talk:
• Educators with students; teens with teens;
teens with educators
• www.kognito.com

30. Online Interactive Role Play
• How to listen, understand, engage, support
and encourage or refer to help
• Web-based avatars talk to the one another
and the learner
• Learners role-play, practice, develop mastery
• Brief, at your-own-pace

31. Literacy: Outcomes
• Target skill set: Recognize, Approach, Refer
(youth showing signs of psychological
distress, including signs of suicide)
• High school educators: increase in
preparedness, likelihood, confidence
• College, peer to peer: increase in skills,
referral rates, likelihood of self-referral,
satisfaction

32. Take Away
• Child and adolescent mental health needs are
infrequently and incompletely addressed in
current system of US mental health care
• Trauma-informed care provides a promising
paradigm for child/adolescent mental health
promotion

33. Take Away
• Promising practices: internet, media,
communication strategies that are
▫ evidence-informed * truthful * developmentally
and culturally sensitive * empowering to youth *
driven by compelling narratives * ecologically
based, promoting peer and adult social support *
interactive * linked to national and community
resources * focused on literacy outcomes *
evaluated

34. the end

35. contact information
William O. Donnelly, Ph.D.
Donnelly Community Psychology, LTD
429 W. College Avenue, PO Box 105
Pemberville, OH 43450-0105
billd@bgsu.edu
(419) 287-7073

36. References
Costello, E. Jane (08/2003). "Prevalence and
Development of Psychiatric Disorders in Childhood and
Adolescence". Archives of general psychiatry
(0003-990X), 60 (8), p. 837.