Health Is More Than A Physical: An Occupational Therapist’s Perspective

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May is National Mental Health Awareness Month, so it is a great time to do a check up on your child’s mental health.  I have a unique perspective on children’s health, because I am a mother, and I also work with children professionally as a pediatric occupational therapy practioner (OTP). Although OTPs are mostly associated with physical health, we play a critical role in promoting physical and mental health and well being of children, as they are very much interrelated (Cahil, 2016).  As a mother, I have benefited from my professional background in many ways, and I would like to share what I have learned with other parents.screen-shot-2017-05-30-at-9-26-09-pm

Culturally, we put enough emphasis on maintaining physical health. The first day of school, we arm our children with notes for the nurse reviewing allergies and medications, and try to pack the healthiest choices for snacks and lunches. We research to make sure that the schools we choose have a long enough recess, so that our children can move and be active.  We teach our children to put a bandage on a cut, to wash their hands to prevent infection, and to brush their teeth every night. What is missing, however, is teaching them how to maintain their mental health and what proper mental health hygiene looks like. I recently listened to a TED talk on why we all need “to practice emotional first aid” (Winch, 2014) , and it hit me that many of us do not teach important mentally healthy soft skills to our children.  What do they learn from us about how to deal with feelings of loneliness, rejection, loss, or failure?  What do we teach them about how to heal their minds when they are hurting? It is important that we teach our children how to take care of their bodies, but it is even more crucial to teach them how to care for their minds.

In the United States, nearly 5 million children have some type of mental health challenge that significantly interferes with daily life (Salamat et al., 2015).  When we hear statistics like this or the term mental health, we tend to think only of mental health disorders, such as attention deficit hyperactivity disorder (ADHD), anxiety or depression, but mental health covers so much more. Positive mental health, which is developing and maintaining mentally healthy habits, applies to all children with and without mental illness (Bazyk et al., 2015). Some characteristics of positive mental health, or mentally healthy children include: positive affect, positive social interactions, and the ability to adapt to change and cope with life challenges (Bazyk et al., 2015; CDC, 2017).

So what can we do to start fostering positive mental health in our kids? As parents, we can ensure that we are preparing them to be well-adjusted, mentally healthy people. I am sure your next question is how?  It can feel overwhelming to add one more skill to work on with a child at the end of a long day, but my professional background has helped me to understand that teaching our kids how to deal with the wounds of the mind can build resilience and can even save lives. Although strategies can vary widely based on the age, lifestyle, and personality of a child, the following suggestions might offer you some guidance. Keep in mind that spending just minutes a day on any of these strategies before they are needed can make a significant impact:

TALK

  • Talk to the child on a consistent basis
  • Ask open ended questions about the child’s day, beyond “how was school” (i.e. what did you play at recess? Who was a good friend to you today and why? What were you curious about today?)
  • Ask relevant follow up questions such as what was difficult that the child persevered through or what was the child’s proudest moment
  • Talk about what you notice and identify the emotion the child seems to be experiencing (i.e. “you seem so excited/joyful/sad/frustrated right now, what happened?”)

SHARE

  • Share about similar experiences you have had when the child faces a difficult emotion, such as failure or loss. Share what may have helped you get through that challenging time (when appropriate).
  • Share how to get through difficult feelings by having a positive self-talk, especially during the worst moments
  • Share that these are feelings that everybody has felt before and acknowledge that it hurts to feel some emotions, but that the feeling is not permanent.

TEACH

  • Teach the child to acknowledge the positive emotions that they experience and what that feels like to them
  • Introduce and teach calming strategies (for when they are upset) before the child needs to use them: deep breaths, count to 10, take a quiet moment in a special cozy corner or talk to someone about how they are feeling when they are calm and ready.
  • Teach the child to have self-compassion by being an encouraging and positive friend to themselves, especially when something bad has happened, instead of ruminating (going over and over) on flaws and insecurities.
  • Teach the child to distract themselves with a book or a video when they find that they are ruminating on negative feelings or memories until the feeling has passed.
  • Teach the child how to communicate when the “heart hurts” and talk about what that means (i.e. feeling one of the painful mental wounds like loneliness or rejection and how to heal it (see heal)

PRAISE

  • Praise the positive things you see in the child or that you see the child doing; encourage and celebrate those moments; oftentimes as parents we tend to only address the negative and the parent’s negativity becomes the child’s inner voice.
  • Positive emotions such as gratitude, joy, curiosity and awe have been shown to broaden a child’s thinking habits, reduce negative emotions and encourage resilience (Bazyk et al., 2015).
  • Praise the process over the outcome – thoughtfully comment on the work the child has done to complete a task over only praising the end result.

HEAL

  • Teach how to heal a mental wound; this is best done through sharing (see share)
  • In those “hurt” moments lies the best time to be kind to yourself and to focus on how capable you are.

BUILD

  • Build up the child’s inner voice (see praise) by encouraging them often and catching them doing well; saying things like “I know you can do it” or “You worked so hard on that” and “I love how creative you are” or “I love how you think”
  • Many times feelings are relegated to “sad” “mad” or “happy”, so build and expand the child’s vocabulary to include frustrated, curious, excited, anxious, nervous, scared and worried etc.
  • Build on the expansion of different emotions and what they may feel like

LEARN

  • Learn to recognize what the child’s “normal” is and when something seems off
  • Learn from your child by role-playing different situations to apply some of these lessons
  • Take turns and have the child come up with some situations too
  • When role-playing, reverse the roles: the parent can play the child in the situation, and the child can play the parent. This is telling, as you may see how the child interprets or perceives the adult in a situation.
  • Attend community forums and after school workshops to learn more about mental health
  • Become active in your school parent organization, so that you can address the importance of physical AND mental health initiatives
  • Continue to read about mental health using the resources for parents included
  • Seek professional help if your concerns are not resolved or if the child’s difficulties seem extreme

In addition to parents supporting children’s mental health needs at home, there are many collaborative approaches practiced in schools and the community (American Occupational Therapy Association [AOTA], 2016).  As an occupational therapy practitioner (OTP) in the school setting, I help students participate in meaningful activities, or occupations, using my background mental health (AOTA, August 2016). I also teach proactive strategies for maintaining mental health, which includes engaging in self-help strategies, teaching about how to prevent mental health disorders, recognizing signs of becoming unwell and learning how to ask for help (AOTA, 2009). Some examples of classroom wide strategies, may include:

  • Establishing a problem solving wall to help children identify their feelings along with appropriate solutions or actions they can take to solve their problems
  • Developing peer problem solving groups or peer mediators for conflict/resolution
  • Collaborating with teachers to accommodate different learning styles
  • Positive behavior support, such as positive phrasing, which lets the child know the positive effect of using appropriate behaviors (i.e. “You finished your math, so we can all go play outside” vs. “If you do not finish your math, you will miss recess.”)
  • Teaching about respect, responsibility, accountability and justice
  • Creating group activities that can bridge academics and student needs for socio-emotional growth
  • Designing a “quiet area” within a classroom for students who need to calm themselves
  • Organizing a lunchroom or playground buddy group for social skill development
  • Recommending schedule modifications to reduce stress or anxiety for students
  • Developing a meaningful activity for greater self-efficacy and social participation
  • Modifying classroom environments and activities as needed to encourage and support student learning

As parents, we provide emotional support to our children when they are in need, but sometimes needs become more serious and we need support. In addition to the stress of the child being affected by more serious mental conditions, family members also face the financial stress associated with additional mental healthcare and are exposed to the stigma associated with more serious mental health needs. This can mean rejection by friends or relatives, and can increase the family’s sense of isolation. For these reasons, it is important to learn how to recognize the more serious mental health problems in the child and to get help immediately. Early detection and intervention are key. The following signs would suggest the need for professional help (U.S. Department of Health and Human Services [DHHS], 2010):

  • Behavior seems to be very extreme and unpredictable
  • Demonstrates inappropriate response to a situation
  • Cannot control their responses in a situation; appears “out of control”
  • Frequently causes issues in personal and social relationships
  • Talks about wanting to die or to kill oneself
  • Talks about feeling hopeless or having no reason to live
  • Acts anxious or agitated; behaving recklessly
  • Sleeps too little or too much
  • Withdraws or feels isolated
  • Displays extreme mood swings

Making the commitment to improve our health literacy, including how to foster positive mental health in our children, is a reality of life in modern society (Pizur-Barnekow, Darragh & Miller, 2016). Having open discussions with our children and teaching them mentally healthy habits helps provide them with a good foundation at home. Engaging in conversations with other parents and community members, as well as sharing information about the importance of mental health is beneficial to us all. Lastly, seeking support from professionals at the school or in the community, particularly if you see any warning signs, is crucial in effectively addressing problems. If everyone works together with a common understanding, we can support our children and ensure that they will live both physically and mentally healthy lives.

 

     Resources for Parents:

  • Federation of Families for Children’s Mental Health – FFCMH.org
  • Everymomentcounts.org
  • Mentalhealth.gov
  • Children’s System of Care
  • NAMI.org
  • www.cdc.gov/childrensmentalhealth
  • www.zonesofregulation.com

 

– Erin Rose- Quinnipiac University- is a school based occupational therapist who has worked in Florida, Georgia, California and Connecticut. She currently lives in Mystic, CT with her husband and 2 boys with a baby girl on the way.

 

References

American Occupational Therapy Association [AOTA]. (August 2016). Occupational therapy

services in the promotion of mental health and well-being. American Journal of Occupational Therapy, 70(Supplement_2),15. http://dx.doi.org/10.5014/ajot.2016.706S05.

American Occupational Therapy Association [AOTA]. (2016). Occupational therapy in school

settings fact sheet. Bethesda, MD: AOTA Press. Retrieved from http://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/CY/Fact-Sheets/School%20Settings%20fact%20sheet.pdf

American Occupational Therapy Association [AOTA]. (2009). Raising the bar: Elevating

knowledge in school mental health. Retrieved from http://www.aota.org/PractitionersProfDev/CE/Aota/Webcasts/School-MH.aspx

Bazyk, S., Demirjian, L., LaGuardia, T., Thomspon-Repas, K., Conway, C., & Michaud, P.

(2015). Building capacity of occupational therapy practitioners to address the mental health needs of children and youth: A mixed-methods study of knowledge translation. American Journal of Occupational Therapy, 69(6), 3-10. http://dx.doi.org/10.5014/ajot.2015.019182

Cahil, S. (2016). AOTA Societal Statement on Youth Violence. Retrieved from

https://www.aota.org/~/media/Corporate/Files/AboutAOTA/OfficialDocs/AOTA-Societal-Statement-on-Youth-Violence-final-for-web-posting.pdf

Centers for Disease Control and Prevention. (2017).  Children’s mental health. Retrieved

from: https://www.cdc.gov/childrensmentalhealth/basics.html

Pizur-Barnekow, K., Darragh, A. & Miller, C. (2016). AOTA’s societal statement on health

literacy. Retrieved from http://www.aota.org/~/media/Corporate/Files/AboutAOTA/OfficialDocs/Health-Literacy.pdf

Salamat, A., Javaherian-Dysinger, H., Krpalek, D., Parikh, S., Lee, K., Christensen, B., Liu, A.,

Ngo, K., Goya, Y. (2016). Perspective of school-based occupational therapy practitioners in addressing students’ mental health needs. American Journal of Occupational Therapy, 70 (4 Supplement 1), 1. http://dx.doi.org/10.5014/ajot.2016.70S1-PO5121

U.S. Department of Health and Human Services [DHHS]. (2010). What to look for. Retrieved from https://www.mentalhealth.gov/

Winch, G.  (2014).  Why we all need to practice emotional first aid [Video file].  Retrieved from https://www.ted.com/talks/guy_winch_the_case_for_emotional_hygiene