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Resilience and Coping in Middle and High School:
The Roles of Parents, School staff, Peers
& Community
Resilience and Coping in Middle and High School:
The Roles of Parents, School staff, Peers
& Community
Shashank V. Joshi, MD, FAAPJeremy Wilkinson, MD
Lucile Packard Children’s Hospital at Stanford
Shashank V. Joshi, MD, FAAPJeremy Wilkinson, MD
Lucile Packard Children’s Hospital at Stanford
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Outline of this sessionOutline of this session
Present current barriers to identification and support of students
Propose strategies for collaboration
Describe coping and resiliency factors which may help to buffer stress
Present current barriers to identification and support of students
Propose strategies for collaboration
Describe coping and resiliency factors which may help to buffer stress
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Primary therapeutic relationshipsPrimary therapeutic relationships
peers
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When Normal Stress Becomes Unmanageable
When Normal Stress Becomes Unmanageable
Counselors, psychologists, teachers and other personnel may be unsure of their roles
Students may find it hard to ask for help
Peers may be unaware of signs and symptoms of depression
Parents may be afraid to ask about depression and self-harm
Counselors, psychologists, teachers and other personnel may be unsure of their roles
Students may find it hard to ask for help
Peers may be unaware of signs and symptoms of depression
Parents may be afraid to ask about depression and self-harm
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Other challengesOther challenges
School personnel may experience parents and doctors as barriers to health, rather than as partners
Parents and Doctors may hold similar views of school personnel
Psychiatrists and other mental health providers are often difficult to reach
School personnel may experience parents and doctors as barriers to health, rather than as partners
Parents and Doctors may hold similar views of school personnel
Psychiatrists and other mental health providers are often difficult to reach
Risks &Vulnerabilities
Assets &Protective Factors
Frances J Wren MD
DevelopmentalDevelopmental
Thoughts:Hopeless
Self-criticalGlass half-full
Brooding
Relationships:
WithdrawnIrritable
Pessimistic
Emotions:Sad
BoredJoylessAnxious
Easily upset
Body:Disturbed sleep
Disturbed appetitePoor concentration
Low energy
Less fun
Fewer successes
Missed opportunities
Less social support
Withdrawal from activities
Loss of relationships
Hard to start, finish, learn
Frances J Wren MD
Pathways to adolescent depression
Genetics Brain
How easily upset?How intensely?How long?Capacity for joy, humor?
Emotional regulationEmotional regulation
Anxiety/ArousalAnxiety/Arousal
Cognitive style
Cognitive style
How easily worried? How fearful?
Body stress/arousal? Sleep?
Life Experience
How flexible?How positive?
Easily discouraged?Believes can change things?
Frances J Wren MD
Risks &Vulnerabilities
Assets &Protective Factors
Community, Family, Teen
RESILIENCE
Frances J Wren MD
Protective factors for Kids:Protective factors for Kids:
Positive emotions: optimism, joy, humor
Flexible thinking
Sense of meaning & value
Active coping style
Social support
Positive emotions: optimism, joy, humor
Flexible thinking
Sense of meaning & value
Active coping style
Social support
Frances J Wren MD
Protective Factors for TeensProtective Factors for Teens
Effective parenting, with mutual respect between teen/parent
Connections to other competent and caring adults
Connections to pro-social and competent peers
Problem-solving skills
Positive self-perceptions & Talents valued by self and society
Beliefs that life has meaning/hopefulness
Community/School safety and effectiveness Frances J Wren MD
Buffer zones (Riera, 2004)Buffer zones (Riera, 2004)
Stress buffer zone
Stress tolerance level
Sedimented Stressvia Traumatic Events:
Divorce, Death of a loved one, Prolonged Illness,
Financial Stress, Poverty, or other factors
Girlfriend/boyfriend rejection
Exams College Apps Graduatio
n
Girlfriend/boyfriend rejection
Exams
College Apps
Graduation
Safe, effective
communities
Safe Responsive
Opportunities to develop talents and skills Connections with caring
competent adultsConnections with competent peers
Loving, effective families
Love, joy, humorCommunication, responsiveness, flexibility
Consistent, rational disciplineRealistic expectations
Resources to obtain services and opportunities
Emotionally skilled kidsManaging negative feelings
Problem-solvingMaking and keeping relationships
Recognizing and valuing own talents and skills
Finding opportunities for fun and joy
Frances J Wren MD
What about the vulnerable teen?What about the vulnerable teen?Challenging temperament
Exposed to trauma
Family troubles - including parental depression
Frances J Wren MD
The teen with a challenging temperament
The teen with a challenging temperament
Active teaching of skills
Early intervention: if interfering with life, if exposed to trauma
Planning: finding strengths and talents
Attend in particular to: anxiety, sleep, social skills
Take care of ourselves as friends and parents
Frances J Wren MD
Resilience in the face of trauma or loss
Resilience in the face of trauma or loss
Putting the experience into words:naming, education, putting together the story
Learning skills and strategies
Becoming active in reality and in memory
Early intervention
Frances J Wren MD
Resilience in the face of family troubles
Resilience in the face of family troubles
Putting the experience into words:naming, education,
putting together the story as an individual and as a family
Able to see things from others’ points of view
Realistic about the troubles; Active problem-solver
Not alone in the midst of the trouble or afterwards
Parental self-care
Frances J Wren MD
Resilient children are not super children; resilience comes from hard slow growth, mastering obstacles and developmental
challenges
William Beardslee: Out of a Darkened Room
Frances J Wren MD
ResourcesResources
Please see the Project Safety Net website for books and Internet resources related to coping and resilience
Frances J Wren MD
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Primary therapeutic relationshipsPrimary therapeutic relationships
peers
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Primary therapeutic relationshipsPrimary therapeutic relationships
peers
Adapted with permission from Feinstein, Fielding, Udvari-Solner, & Joshi: Amer Jnl of Psychotherapy, 63(4) 2009, in press
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You Can Help!Adapted with permission
from the Washington Youth Suicide Prevention Program
You Can Help!Adapted with permission
from the Washington Youth Suicide Prevention Program
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You can help. . . You can help. . .
Know warning signs
Conduct intervention
Know warning signs
Conduct intervention
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You can help. . . You can help. . .
Most suicidal people don't really want to die – they just want their pain to end.
About 80% of the time people who kill themselves have given definite signals or talked about suicide.
Most suicidal people don't really want to die – they just want their pain to end.
About 80% of the time people who kill themselves have given definite signals or talked about suicide.
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Warning Signs
Observable signs of serious depression Unrelenting low mood Pessimism Hopelessness Desperation Anxiety, psychic pain, inner tension Withdrawal Sleep problems
Increased alcohol and/or other drug use
Recent impulsiveness and taking unnecessary risks
Threatening suicide or expressing strong wish to die
Making a plan Giving away prized possessions Purchasing a firearm Obtaining other means of killing oneself Unexpected rage or anger
Warning Signs
Observable signs of serious depression Unrelenting low mood Pessimism Hopelessness Desperation Anxiety, psychic pain, inner tension Withdrawal Sleep problems
Increased alcohol and/or other drug use
Recent impulsiveness and taking unnecessary risks
Threatening suicide or expressing strong wish to die
Making a plan Giving away prized possessions Purchasing a firearm Obtaining other means of killing oneself Unexpected rage or anger
You can help. . . You can help. . .
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Intervention Three Basic Steps
1. Show you care2. Ask about suicide3. Get help
Intervention Three Basic Steps
1. Show you care2. Ask about suicide3. Get help
You can help. . . You can help. . .
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Intervention Step One
Show You Care
Be Genuine
Intervention Step One
Show You Care
Be Genuine
You can help. . . You can help. . .
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Show you care Take ALL talk of suicide seriously
If you are concerned that someone may take their life, trust your judgment!
Listen Carefully Reflect what you hear Use language appropriate for age
of person involved Do not worry about doing or saying exactly the
"right" thing. Your genuine interest is what is most important.
Show you care Take ALL talk of suicide seriously
If you are concerned that someone may take their life, trust your judgment!
Listen Carefully Reflect what you hear Use language appropriate for age
of person involved Do not worry about doing or saying exactly the
"right" thing. Your genuine interest is what is most important.
You can help. . . You can help. . .
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Be Genuine Let the person know you really
care. Talk about your feelings and ask about his or hers.
"I'm concerned about you…about how you feel." "Tell me about your pain." "You mean a lot to me and I want to help." "I care about you, about how you're holding up." "I don't want you to kill yourself." "I'm on your side…we'll get through this."
Be Genuine Let the person know you really
care. Talk about your feelings and ask about his or hers.
"I'm concerned about you…about how you feel." "Tell me about your pain." "You mean a lot to me and I want to help." "I care about you, about how you're holding up." "I don't want you to kill yourself." "I'm on your side…we'll get through this."
You can help. . . You can help. . .
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Intervention Step Two:Ask About Self-harm and Suicide
Be direct but non-confrontational
Intervention Step Two:Ask About Self-harm and Suicide
Be direct but non-confrontational
You can help. . . You can help. . .
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Ask about self-harm and suicide
Don't hesitate to raise the subject.
Talking with people about suicide won't put the idea in their heads
Chances are, if you've observed any of the warning signs, they're already thinking about it
Be direct in a caring, non-confrontational way. Get the conversation started.
Ask about self-harm and suicide
Don't hesitate to raise the subject.
Talking with people about suicide won't put the idea in their heads
Chances are, if you've observed any of the warning signs, they're already thinking about it
Be direct in a caring, non-confrontational way. Get the conversation started.
You can help. . . You can help. . .
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You do not need to solve all of the person's problems;
Just engage them
Are you thinking about harming yourself or suicide?
Do you have a plan for harming yourself, ending your life?
What thoughts or plans do you have?
How long have you been thinking about suicide?
You do not need to solve all of the person's problems;
Just engage them
Are you thinking about harming yourself or suicide?
Do you have a plan for harming yourself, ending your life?
What thoughts or plans do you have?
How long have you been thinking about suicide?
You can help. . . You can help. . .
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You do not need to solve all of the person's problems;
Just engage them
Have you thought about how you would do it?
Do you have __? (Insert the lethal means they have mentioned.)
Do you really want to die? Or do you mainly want the pain to go away?
You do not need to solve all of the person's problems;
Just engage them
Have you thought about how you would do it?
Do you have __? (Insert the lethal means they have mentioned.)
Do you really want to die? Or do you mainly want the pain to go away?
You can help. . . You can help. . .
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Ask about treatment
Do you have a therapist/doctor?
Are you seeing him/her?
Are you taking your medications?
Ask about treatment
Do you have a therapist/doctor?
Are you seeing him/her?
Are you taking your medications?
You can help. . . You can help. . .
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Intervention Step Three:Get help but do NOT leave the student alone
Know referral resources Reassure the student Encourage the student to
participate in helping process Outline safety plan
Intervention Step Three:Get help but do NOT leave the student alone
Know referral resources Reassure the student Encourage the student to
participate in helping process Outline safety plan
You can help. . . You can help. . .
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You can help. . . You can help. . .
Know Referral Resources
Resource sheet
Hotlines
Know Referral Resources
Resource sheet
Hotlines
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Hotlines National Suicide Prevention Lifeline
1-800-273-TALKwww.suicidepreventionlifeline.org
911 In an acute crisis call 911
Hotlines National Suicide Prevention Lifeline
1-800-273-TALKwww.suicidepreventionlifeline.org
911 In an acute crisis call 911
You can help. . . You can help. . .
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Reassure the person that help is available and that you will help them get help. Together I know we can figure something out to
make you feel better. I know where we can get some help. I can go with you to where we can get help. Let's talk to someone who can help . . . Let's
call the crisis line now.
Encourage the suicidal person to identify other people in their lives who can also help. Parent/Family Members Favorite Teacher School Counselor School Nurse Religious Leader Pediatrician/ Family doctor
Reassure the person that help is available and that you will help them get help. Together I know we can figure something out to
make you feel better. I know where we can get some help. I can go with you to where we can get help. Let's talk to someone who can help . . . Let's
call the crisis line now.
Encourage the suicidal person to identify other people in their lives who can also help. Parent/Family Members Favorite Teacher School Counselor School Nurse Religious Leader Pediatrician/ Family doctor
You can help. . . You can help. . .
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Outline a safety plan Make arrangements for the helper(s) to
come to you OR take the person directly to the source of help - do NOT leave them alone!
Once therapy (or hospitalization) is initiated be sure the suicidal person is following through with appointments and medications.
Outline a safety plan Make arrangements for the helper(s) to
come to you OR take the person directly to the source of help - do NOT leave them alone!
Once therapy (or hospitalization) is initiated be sure the suicidal person is following through with appointments and medications.
You can help. . . You can help. . .
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Primary therapeutic relationshipsPrimary therapeutic relationships
peers
