Navigating Grief and Loss During the Holidays

I think that all of us can agree that 2020 has been a challenging year.  Many things have been difficult and unsettling, from the unrest in our country to the unprecedented Covid-19 pandemic. Under normal circumstances, the holiday season can be difficult for those who are grieving the loss of a loved one. The world may tell us that this season is full of joy, but it may not be that way for those that are grieving. The holidays may be a time that we wish that they could be with us. For many of us, the holidays are a time in which we cherish the time to be together, but this year, that may look different for many people.

Our friends at Trellis Supportive Care (formerly the Hospice and Palliative Care Center) have compiled a number of helpful resources for families to help to navigate the grieving process, especially during this holiday season. In addition, Trellis has a counseling and education center where trained bereavement counselors provide grief counseling free of charge to Forsyth County residents. Currently, sessions are provided through teletherapy. I can tell you from personal experience how kind, compassionate and helpful they are. 

A wonderful counselor I work with has shared a newsletter with me that (was written by her daughter, who is a Mental Health Clinician in California) talks about helpful ways for families to navigate grief and loss during this Holiday season. For me, it really shows how universal the experiences are that we are having right now.  

Read more

The Power of Possibility

Today marks the beginning of National School Psychology Awareness week!  The theme for this year is the “Power of Possibility.”  In the words of the National Association of School Psychologists ‘The word “possibility” implies hope, growth, resilience and renewal.  Possibility suggests that even some things as small as a seed can grow into something magnificent. The word “power” implies that things can and will happen. When we focus on what is possible, we have hope that students will grow, thrive and bloom.’

Although this year has been stressful, unsettling and different than what we were expecting (which I am sure you have noticed unless you have been asleep for the last 8-9 months) there is still the possibility for our students to grow and bloom.  We can encourage them to create, listen, learn, practice, encourage each other, speak up, explore and dream. So, what is a school psychologist?  I have heard it described as an educator who knows about psychology or a psychologist that knows about education.  Today, we are sharing a previous post who describes the role of a school psychologist.  Although the role of a school psychologist looks a bit different in these pandemic times, we are still here and supporting students, staff and families.
What is a School Psychologist?
“I promise no one grows up dreaming of being a school psychologist.  Well, maybe the children of school psychologists do (we actually have a staff member who can vouch for that) but  I know I certainly didn’t.  Something about a car so full of test kits that you can’t fit your groceries in it doesn’t scream “dream job,” but somehow it is. 
 
So what is school psychology?  I would describe school psychology as the perfect marriage between psychology and education.  School psychologists are trained in mental health, child development, learning styles, behavior, and intervention planning.  Sure, we do a lot of assessment, report writing, and paperwork but, believe it or not, all of those things can be fun.  Assessing a child is like putting together a puzzle of how a kid learns best, helping them see their strengths, and identifying where they struggle.  With that in mind, school psychologists assess for a number of academic and behavioral difficulties including learning disabilities, emotional problems, autism spectrum disorder, and intellectual disabilities.
 
While assessment is certainly a large component of the job, school psychologists are trained in skills beyond assessment. School psychologists are key players in intervention planning.  This allows us to provide quick, early help to children who are struggling.  School psychologists can help identify a child’s specific skill deficits in the classroom and consult with school staff and parents about appropriate interventions to be used within the regular education setting.  We assist teachers in implementing these interventions, monitoring the child’s response to intervention, and adjusting the educational goals accordingly. 
 
In addition to academic concerns, school psychologists also work closely with teachers, parents, and staff to support the behavioral and emotional needs of students.  We have specialized training in assessing the function of behaviors in order to prevent and ultimately eliminate the behaviors.
 
School Psychologists also have training in mental health issues.  Like school social workers and school counselors, we assist students by linking school supports and community resources to provide a continuum of mental health care.  Not only do we collaborate with community service providers, school psychologists can also provide counseling services related to interpersonal and family issues that interfere with school performance.  Another growing role and function of the school psychologist, unfortunately, is crisis prevention and management.  School psychologists are integral players in the development of crisis response plans and assessing levels of risk given in threat situations.”
 
The graphic below highlights the varied roles that school psychologists can play within the school environment.
Even in these different and difficult times, we are ready to help.  It’s what we do.

Read more

Unity Day 2020

Today is #unityday2020. According to Pacer.org, 1 out of every 5 children are bullied. Research indicates that bullying prevention can be successful when students, parents, educators, and community members are involved. 

Students – if you see bullying intervene and tell a trusted adult. If you are being bullied, talk to your parents/guardians and tell a trusted adult at school.

Parents – learn what bullying is and how to recognize the warning signs. If you believe that your child is a victim of bullying, listen to your child and try to find out what is happening.

Educators – work to establish an inclusive and safe learning environment. Respond when bullying happens. 

Community Members – learn what bullying is and what it isn’t. Learn how to respond. 

To learn more about bullying prevention, please visit: 

Wear and share ORANGE  (with us) to show your support of bullying prevention. 





Read more

Coping with a Lack of Control

 A common frustration for many right now is the feeling that life is out of control. We can’t control the fact that we are in the middle of a pandemic. We can’t control when school opens again, or how many days our children will attend. We can’t control what’s going to happen, in general. We don’t KNOW what is going to happen. In the words of that great sage Yogi Berra “Predictions are hard to make, especially about the future.” That being said, what can we do to bring back some sense of control?     

Stephen Covey, author of 7 Habits of Highly Effective People, is credited with developing the idea of the circle of concern and the circle of influence. The circle of concern contains everything that people could be possibly worried about, whether they can have an impact on it or not. The circle of influence is much smaller, that is, it consists of things we can change or have an influence on. He suggests that we focus our attention on things which we can change.  Easier said than done, but worth the effort. The below graphic was graciously shared by Kathy Fitzjeffries, Safe and Drug Free Schools Program Manager.

The below graphic suggests some additional ways to take back the control which we do have, and hopefully feel a little bit better.

Pick a few of these things and give them a try this week! Let us know if they help give you a better sense of control.
Read more

Cyberbullying & Remote Learning

The rapid growth of technology in our society has led to a new type of bullying…cyberbullying.  A surprisingly high number of students report being a victim of this type of bullying. According to a 2019 report from the CDC, cyberbullying among public school students is highest for middle school at 33%, followed by high school at 30%. Even 5% of elementary students report having been cyberbullied. Due to the impact of Covid-19 in 2020, many schools have had to switch to remote or distance learning. This situation has increased opportunities for cyberbullying since most learning occurs in virtual classrooms and other online platforms.  

Children and teenagers are often more tech-savvy than their parents/guardians which can make it challenging to monitor their online behavior. Like other forms of bullying, cyberbullying can cause significant stress and emotional problems for the child, so it is important for parents/guardians to know the different ways children and teenagers can be bullied online. Cyberbullying includes but is not limited to circulating or sending photos, sending or posting hurtful messages, hacking someone else’s account, pretending to be someone else online, and sending or posting threats. Cyberbullying can occur on social media platforms, through text messages/email/instant messaging, within online forums such as chat rooms and message boards, and even in online gaming communities.

Although all bullying involves intentional, often repetitive, hurtful behavior toward another person or group, according to Pacer.org, cyberbullying presents several additional challenges. First, given the easy access to technology, cyberbullying can happen any time of the day. It is also more difficult to detect because it isn’t as overt as physical or in-person verbal bullying. Since cyberbullying can be done anonymously, the victim may not know who the bully is, so no one is held accountable. Another unique feature of cyberbullying is that it enables the bully to spread information quickly to large groups. This makes it difficult to contain or stop negative information from being disseminated. Cyberbullying is also challenging because it is conducted at a distance from the victim and therefore, the bully may not see the harm it causes. In a sense, technology distances bullies from the damaging effects of their actions. Finally, the impact of cyberbullying can be permanent because it is difficult to remove or delete information once it is shared on the internet. 

So how can parents/guardians prevent and protect their children from cyberbullying without banning them from technology altogether? According to Stopbullying.gov, it is important for parents/guardians to initiate open and honest conversations with their kids about appropriate digital behavior. Those discussions should include guidance on how to view/post content, which apps they can and cannot use, and the parameters around how parents/guardians will check in/monitor their online use, browsing history, and communications. Other tips for parents/guardians include reviewing or re-setting your child’s phone location and privacy settings, following or “friending” your child on social media sites, staying up to date with the latest apps, online platforms, and digital slang, and knowing your child’s usernames and passwords. Parents/guardians  may also want to consider software options and apps that are available to help them limit/restrict content, block domains, and/or view online activities. 

Even if parents/guardians are following all of this advice, it is still critically important that they be aware of possible warning signs that their child is being cyberbullied. Sometimes the very best monitoring efforts might miss a potential problem. According to Stopbullying.org, some of the most common signs include:

  • Noticeable increases or decreases in device use, including texting.
  • Exhibits emotional responses (laughter, anger, upset) to what is happening on their device.
  • Hides their screen or device when others are near, and avoids discussion about what they are doing on their device.
  • Shuts down social media accounts or new ones appear.
  • Starts to avoid social situations, even those that were previously enjoyed.
  • Becomes withdrawn or depressed, or loses interest in people and activities.

So what should parents/guardians do if they discover cyberbullying? According to Stopbullying.gov, the most important step is to document and report the behavior so that it can be addressed. Instead of responding to or forwarding cyberbullying messages, block the person who is cyberbullying. More specific and complete information regarding how and where to report cyberbullying can be found at Stopbullying.gov. During this time of remote instruction, it is more important than ever to communicate with your child’s school if you suspect cyberbullying is occurring. To anonymously report an incident of bullying, the WSFCS has set up an anonymous bullying tip line. Visit Bullying Tip Line or call 336-703-4193.

Read more

September is Fetal Alcohol Spectrum Disorders (FASD) Awareness Month

Fetal alcohol spectrum disorders (FASDs) is an umbrella term used to describe the range of effects that can occur in an individual with prenatal alcohol exposure. These effects can have lifelong implications including physical, mental, behavior, and/or learning issues.


The term FASD encompasses the following conditions:

  • Fetal Alcohol Syndrome (FAS)
    • FAS is on the most severe end of the FASD spectrum. It describes people with the greatest alcohol effects, causing signs and symptoms so distinct that the diagnosis is based on special measurements and findings in each of the 3 following areas:

      • Three specific facial abnormalities: smooth philtrum (the area between nose and upper lip), thin upper lip, small palpebral fissures (the horizontal eye openings)

      • Growth deficit (lower than average height, weight or both)

      • Central nervous system (CNS) abnormalities (structural, neurologic, functional, or a combination of these)

  • Partial Fetal Alcohol Syndrome (pFAS)
    • When a person does not meet the full diagnostic criteria for FAS but has a history of prenatal alcohol exposure and some of the facial abnormalities, as well as a growth problem or CNS abnormalities that person is considered to have partial FAS (pFAS)
  • Alcohol-Related Neurodevelopmental Disorder (ARND)
    • People with ARND do not have abnormal facial features or growth problems, but do have problems with how their brain and nervous system were formed as well as how they function. These individuals may have:

      In particular, a 2011 federally convened committee that reviewed the science noted that these children are most likely to have problems with neurocognitive development, adaptive functioning, and or behavior regulation.

  • Neurobehavioral Disorder Associated with Pre-Natal Alcohol Exposure (ND-PAE)
    • In addition to confirmed prenatal alcohol exposure, these individuals have impairment of neurocognition, self-regulation, and adaptive functioning. ND-PAE combines deficits is these three areas in conjunction with the following:

      • Evidence of prenatal alcohol exposure

      • Childhood onset of symptoms

      • Significant distress or impairment in social, academic, occupational, or other important area of function

  • Alcohol-Related Birth Defects (ARBD)
    • People with ARBD have problems with how some of their organs were formed and or how they function, including:

      • Heart

      • Kidney

      • Bones (possibly the spine)

      • Hearing

      • Vision

      These individuals also may have one of the other FASDs.

FASDs can happen only when a pregnant woman consumes alcohol. The alcohol crosses the placenta and enters the baby’s blood where it can damage the developing brain and other organs leading to an FASD. Developing babies have the same blood alcohol concentration as their mother, but they lack the ability to process or metabolize alcohol. 

No amount of alcohol use is known to be safe for a developing baby before birth. Any amount of alcohol, even a glass of wine, passes from the mother to the developing baby. Wine, beer, or distilled spirits (vodka, rum, tequila, etc.) all pose a risk. FASDs are 100% preventable if a woman does not drink alcohol during pregnancy.

Alcohol causes more harm than heroin or cocaine during pregnancy. The Institute of Medicine says, “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” 

1 in 100 babies have FASD, nearly the same rate as Autism.  FASD is more prevalent than Down Syndrome, Cerebral Palsy, SIDS, Cystic Fibrosis, and Spina Bifida combined. Alcohol use during pregnancy is the leading preventable cause of birth defects, developmental disabilities, and learning disabilities.

The National Organization on Fetal Alcohol Syndrome (NOFAS) has created some fact sheets to educate people about FASDs. Some of these fact sheets that may be of interest are:

No one treatment is right for every child, as FASD and its constellation of symptoms differ from one child to another. FASDs need a medical home to provide, coordinate, and facilitate all the necessary medical, behavioral, social, and educational services.

  • Many types of available treatments include but are not limited to:
    • Developmental services
    • Educational interventions
    • Behavior modification
    • Parent training
    • Social skills training
    • Medications and other medical therapies
    • Transition planning
    • Advocacy in school and the workplace
    • Referral for community support services
    • Coordination across the specialists, partners, and needed supports
    • Primary care in a high quality medical home setting with care integration

Treatment plans should be adaptable to the child’s and family’s needs, plus include close monitoring and follow-up.

FASDs last a lifetime. There is no cure for FASDs, but identifying children with FASDs as early as possible can help them reach their potential. Research has shown that early identification and enrollment in treatment can significantly improve an affected child’s development and life.

Read more

The Grief of Adjusting to “The New Normal”

Way back in the spring, when Covid-19 began, we were all in a state of shock. What do you mean my children are learning at home? What do you mean my job is in the dining room instead of my office? What do you mean I can’t go out to dinner or to the movies? At that time, I read an article called “ That Discomfort You’re Feeling is Grief” (published March 23, 2020) in the Harvard Business Review. I recently reread this article and it still resonates with me. The beginning of the school year has always been full of  joy and anticipation,as well as a healthy amount of anxiety. This year, I don’t think I’m alone in feeling an unusually high level of anxiety. This year is not starting as any of us would like it to. I have more questions than we have answers. When will my kids go back to school? When will I go to work? How do I balance all of this? When will the virus let up and let me get on with my ordinary life? So many questions! 

In this article, (That Discomfort You’re Feeling is Grief) the author interviews grief expert Dr. David Kessler, founder of the website Grief.com, who describes several common grief experiences. He notes that it’s important to acknowledge and discuss the grief that we are feeling because we will eventually find meaning in these experiences. He describes the “collective loss of normalcy,” along with the feeling that the world has changed, and not for the better. Many people are experiencing the fear of economic loss and the loss of connection to others. Dr. Kessler also mentioned something called “anticipatory grief.” He describes anticipatory grief as “the feeling we get about what the feeling holds when we are uncertain.” My goodness, there is a lot of uncertainty right now!  

The question is, how do we handle all of this grief?  First, he recommends trying to understand the stages of grief.  Elisabeth Kubler-Ross, an American-Swiss psychiatrist, first defined these stages of grief in 1969.Typically, the stages of grief are as follows: denial, anger, bargaining, sadness and finally, acceptance. During Dr. Kessler’s later work with Dr. Kubler-Ross, a 6th stage was later added, finding meaning. Dr. Kessler does point out, however, that the stages are often not linear. This graphic ( used with the permission of Caring Choices)  illustrates a more common grief progression. People don’t move smoothly between the stages, and that’s ok!

For handling this feeling of anticipatory grief, Dr. Kessler recommends acknowledging it for what it is, which is anxiety. He notes that trying to ignore these feelings isn’t effective, and probably won’t work anyway. He recommends striving for balance in our emotions and feelings about what might happen.  He suggests balancing our thoughts by picturing the best possible outcome, even when our minds want to run to the worst.  He also suggests that when fears of the future loom, we should try to come into the present. He recommends mindfulness practices, such as naming five things in the room or paying attention to immediate sensations. 

A good example of this immediate mindfulness is provided by Destress Monday:

Dr. Kessler suggests focusing on the things which you can control, such as your own behaviors in staying safe (e.g., handwashing, maintaining distance, wearing a mask). He also advises focusing less on the behaviors of others, which we probably can’t control anyway.

Dr. Kessler recommends that we “stock up on compassion.”  Many are struggling with their feelings of grief and anxiety, and may act in ways which aren’t typical.  People may be “Touchous,” as my grandma used to say, and need extra understanding from us if they snap or are moody.  He also encourages us to remember that this is temporary.  Although this uncomfortable situation may feel like it will last forever, it will not! (I need to keep telling myself this.)  

Finally, for people who are overwhelmed, Dr. Kessler recommends naming our feelings of grief.  It has been beneficial for me to acknowledge that I am struggling. Admitting to others that I had to quit watching the news because I couldn’t stop crying or because it was keeping me awake at night was healing.  Every single time I shared these feelings, the person I was talking to acknowledged similar feelings. It was comforting to know that I was not alone.  There is an old but accurate saying,  “A burden shared is halved.”  According to Dr. Kessler, we should allow ourselves to experience the feelings we are having without trying to talk ourselves out of them. He notes that too often people fear that if they admit to ‘bad feelings,’ they will be overrun.  But he also says, “The truth is a feeling that moves through us. We feel it and then we go on to the next feeling.”

Read more

Suicide Prevention – Scope of the Problem

 September is National Suicide Prevention Month. The Suicide Prevention Lifeline uses #BeThe1To – a message to help spread the word about what we can do to promote healing, help and give hope to save lives and prevent suicide.

Scope of the Problem

A recent Harris Poll national survey found that 81% of respondents believe that suicide prevention needs to be a national priority because of COVID-19. 93% of those surveyed believe that suicide can be prevented and 95% said that they would act if someone closed to them was in crisis. Most (69%) were able to list barriers to doing something, including: not knowing what to say; feeling they don’t have enough knowledge; and not feeling comfortable with the topic. According to the CDC (2020), long-term school closure may lead to an increase in mental health issues as students have fewer opportunities to engage with each other. Adolescents with pre-existing mental illness may be more greatly impacted and not have the same mental health services as available due to school closure.

Suicidal ideation is a major mental health risk among adolescents. Among adolescents ages 12 to 17, suicide is the second leading cause of deaths (The Centers for Disease Control and Prevention, 2016). The CDC also reports an increase of suicidal thoughts and suicide rates among adolescents over time. The 2019 Child Health Report Card highlighted the following:

  • The rate of youth suicide has doubled in the previous decade.
  • Factors leading to suicidal thoughts include mental health, trauma, persistent stress, family violence, bullying.
  • 12% of heterosexual youth reported seriously considering suicide compared to 43% of LGBTQ youth. 
  • African American youth were twice as likely as white youth to have attempted suicide in the past year and were significantly less likely to get treatment for depression.
It is worth noting that although African Americans may have lower suicide rates based on national statistics, there is concern about the rising rates among black youth. Historically, the undue burden of trauma and inequity among this population has received little attention.
Results of the 2019 WS/FC High School Youth Risk Behavior Survey, in comparison to 2017 results, show an increase in the percentage of students who reported that they (their): 
  • felt sad or hopeless continuously for two weeks or more in the past 12 months 
  • seriously considered attempting suicide during the past 12 months 
  • made a suicide plan during the past 12 months 
  • attempted suicide during the past 12 months 
  • suicide attempt in the past 12 months resulted in injury that required treatment by nurse or doctor
More Black youth reported planning suicide (19.4%) and making an attempt (16.2%) compared to White (14.4%, 7.7% respectively) and Hispanic-Latino youth (9.0%, 13.4% respectively). 6.0% of Hispanic-Latino youth reported an attempt requiring medical treatment compared to 4.9% Black and 3.1% White youth. The percentage of females reporting on all issues, concerns, and indicators is higher than males.
What to Look For
In a physical or virtual environment, youth suicide warning signs remain the same. These include:
  • Talking about or making plans for suicide
  • Expressing hopelessness about the future
  • Displaying severe/overwhelming emotional pain or distress
  • Showing worrisome behavioral cues or marked changes in behavior, including withdrawal from or change in social connections/situations, changes in sleep (increased or decreased), anger or hostility that seems out of character or out of context, recent increased agitation or irritability
In situations where there is forced separation, look for someone expressing feelings of isolation and interpersonal concerns related to social distancing. Withdrawing or shutting down might be manifested in someone not engaging in social media as usual or staying in their rooms. It is important to pay attention and listen to what the person is saying, especially the words and the tone of voice.
Resources and Supports
WS/FCS has specific protocols and procedures in place to respond to and manage suicide risk. School staff should reach out to their school-based mental health professionals (counselor, social worker, or psychologist) with any concerns. Parents may also communicate with these professionals or their child’s primary medical provider.
Note: Some of the information in this blog was previously shared by the author in the North Carolina School Psychology Association guidance document Crisis Response in a Virtual Environment. 
Read more