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Developmental Discussion on Trauma- Discussion Board Post #1

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Developmental Discussion on Trauma- Discussion Board Post #1

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Hi everyone! I know this course has stirred up my emotions over previous traumatic experiences. I hope you all are all doing okay both mentally and physically! I found the Unit 2, Assignment 2, course resources to be extremely interesting. I strongly believe that adverse childhood experiences (ACE's), depending on severity and when left untreated, can lead to insurmountable negative mental and physical health conditions later in life. The Centers for Disease Control and Prevention performed a study, the CDC-Kaiser Permante ACE study, from 1995 to 1997 to evaluate the connection between ACE's and adult mental and physical well-being (CDC, 2021). I think that the study was well intended and provided valuable information to prove that there is a connection between ACE's and adult mental and physical health issues. While the study included a large number of people, 17,000, all of the study participants were Health Maintenance Organization members from the same area of the state, southern California. I think it would have been more beneficial to the study to have included a more diverse population.

The three types of trauma that I found most interesting are secondary trauma, complex trauma, and vicarious trauma. Secondary trauma is indirect trauma experienced by those directly impacted by a traumatic event occurring to a loved one (Oklahoma Department of Mental Health and Substance Abuse Services [ODMHSAS], n.d.). This is interesting to be because I have both witnessed this happen to my parents and experienced it myself. My brother was involved in a very serious work accident that resulted in him losing his right leg at the age of 19. The accident occurred in 1998, my parents, especially my dad, suffers with severe OCD and generalized anxiety due to going through the trauma of having a child severely injured. The trauma my brother went through directly impacted my parents, me, and my other close family members and it forever changed our thought processes and who we were. Complex trauma is the result of numerous traumatic events occurring during early childhood due to caregiver neglect or abuse (ODMHSAS, n.d.). An example of this would be a young child being molested by a parent, sibling, or other close family member or trusted adult. Vicarious Trauma occurs from hearing victims talk about their traumatic experiences (ODMHSAS, n.d.) An example of this would be a detective investigating a traumatic crime involving a child being severely abused. During the interview process the detective will hear all of the awful things that happened to the child from the child's own mouth.

I think children are more susceptible to trauma due to several reasons, they are totally dependent on others for survival, have no control over their surroundings or those around them, and their brains/nervous systems are still developing; making it hard for them to understand and cope with negative experiences. As a mental health and wellness counselor in an educational setting, I would support students who are experiencing grief and trauma by talking openly about emotions and how they make us feel and by creating a safe, quiet place where the students can practice relaxation techniques such as visualization and breathing exercises (Cohen & Mannarino, 2011).

I think that all health professionals should receive education about the effects of trauma and how to access for trauma because the effects of trauma impacts physical and mental health. Patients who are suffering physical ailments due to trauma could benefit greatly from receiving mental help to overcome trauma. When health professionals have the ability to recognize and access trauma they can truly help the person to heal starting from the root of the problem.

Centers for Disease Control and Prevention. (2021). Violence Prevention: About the CDC-Kaiser ACE Study. United States Department of Health and Human Services.

Cohen, J.A. & Mannarino, A.P. (2011). Supporting children with traumatic grief: What educators need to know. School Psychology International, 32(2) 117–131.

Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS). (n.d.). Categories of Trauma.

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Introductions & Assessing Prior Knowledge Discussion Board Post

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Introductions & Assessing Prior Knowledge Discussion Board Post

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Hello everyone, my name is Rainey Tucker. I'm starting my 3rd course in the Mental Health and Wellness program. I plan to get an LPC license upon completion of the program. I currently work at Ranger College in Ranger, Texas. Ranger College is a small two year college that has three locations in Texas, Ranger, Brownwood, and Stephenville. I was recently promoted to the Dual Credit Coordinator position. Previously, I worked as an advisor for a federal grant program at Ranger College called Trio Student Support Services. As an advisor, working closely with young adult students, I realized that mental health services were severely lacking both on our campus and in our community. I decided that I wanted to get more involved to help our students and others who were struggling with mental health needs.

I plan to use my training and skills obtained through this course and the Mental Health and Wellness program at Ranger College working with an outreach program that we have established called Ranger Reach. The Ranger Reach program/committee was developed to provide strategies and services to address basic need hardships experienced by Ranger College faculty, staff, and students. Upon completion of the program and LPC licensure, I will begin offering set counseling services free of charge for our faculty, staff, and students. I also plan to offer low cost or free counseling services to young adults, ages 17-25, in Eastland County.

My goal for this course is pretty basic, to learn more about identifying mental health illnesses and substance abuse, the resources available, and how to offer help. My biggest "take away" from reviewing Unit 1 resources was that mental health is an incredibly important part of overall health and the ever increasing population is struggling with growing mental health needs. I was shocked to learn that suicide is now listed, by the Centers for Disease Control and Prevention Agency, as the second leading cause of death in 10-24 year olds. That fact brought tears to my eyes. I'm from a very small town and our community has experienced numerous teen suicides over the last few years. Last year a popular athlete, that was a teachers son, left school early and never returned. A friend told his mother who worked at the school that he was worried about her son not returning due to his state of mind before he left. His mother left school immediately and found her son with a self inflicted gunshot wound to his face. He passed away hours later. The death of this young man left a hole in our entire community. My own children were friends with this young man. I felt powerless during this difficult time because I had no training on how to help those struggling. All I could do was listen to those hurting and offer a shoulder for them to cry on. I learned that even with no skills or training just showing empathy for those struggling helped them a lot. Many of my kids friends came to me because their parents were cold and told them death is a part of life, they needed to get over it, that the kid went to hell for killing himself, etc. I personally believe it was due to the painful nature of the topic and the parents didn't know what else to say or do.

In my future role as a mental health counselor, knowledge of substance abuse and mental illness identification as well as the resources available will allow me to reach and help numerous students and young adults that are struggling within my community. A resource that I have found to be useful for professional development/training purposes is Texas Suicide Prevention.org. I will provide the link to the Texas Suicide Prevention Symposium 2023: Coming Together to Care page that has numerous expert presentations packed with valuable information on topics from suicide prevention to school safety planning.

Link to Texas Suicide Prevention Symposium 2023: Coming Together to Care:

https://texassuicideprevention.org/txsp23/

Link to the Ranger College Ranger Reach page, more info will be added in the near future.

Picture is from the West Texas Food Bank Event on the Ranger Campus.

https://www.rangercollege.edu/student-services/ranger-reach/index.php

Rainey RCDC Pic.jpg (1.739 MB)

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Developmental Discussion on Trauma- Discussion Board Post #2

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Developmental Discussion on Trauma- Discussion Board Post #2

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I chose to examine the 2017 documentary, Kingdom of Us, that is available on Netflix. This documentary follows a mother of seven children as they cope with the grief and trauma of the husband and fathers death by suicide. I chose this documentary because it will give a true portrayal of what children and adults go through when dealing with grief and multiple types of trauma such as primary, secondary, complex, and vicarious.

My intial thoughts before watching this documentary are this is going to be very heartwrenching to watch but very informative; kind of like a "looking glass" into what children go through in this experience. Watching all seven individuals cope and go through the trauma will help me identify how certain age groups and different personalities might think and respond to this type of incident. I do not have any prior knowledge about this video, I just heard about it while discussing this assignment with co-workers.

Cohen, L. (Director). (2017). Kingdom of us [Film]. Netflix.

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Trauma & Crisis Resource: (Eastland County)

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Trauma & Crisis Resource: (Eastland County)

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Eastland County Crisis Center:

Crime Victim Assistance Center

Children Advocacy Center &

Education

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A 501(c)3 non-profit agency offering immediate, short term, and long term free and confidential services to victims and survivors of domestic violence, sexual assault, and child abuse in Eastland County.
Click an image to learn more about our services, resources, and events.

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A 501(c)3 non-profit agency offering immediate, short term, and long term free and confidential services to victims and survivors of domestic violence, sexual assault, and child abuse in Eastland...

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Trauma & Crisis Resource: (Central Texas Area)

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Trauma & Crisis Resource: (Central Texas Area)

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Central Texas MHMR Service Eastland County:

Behavioral Health Services

Early Childhood Intervention

Intellectual & Developmental Disabilities

Mental Health First Age

Mental Health Intake

Veterans

Youth Empowerment

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As part of a Local Planning and Network Development (LPND) process, Texas Health and Human Services Commission requires Local Mental Health Authorities (LMHAs) to develop biennial plans for expanding provider networks when interested and qualified providers are available. Central Counties Services is a LMHA that is required to complete this...

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Suicide Prevention Service: (National Service)

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Suicide Prevention Service: (National Service)

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American Foundation for Suicide Prevention

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Learn about suicide, how you can help prevent it, and resources for those affected, from the American Foundation for Suicide Prevention. Our mission: save lives and bring hope to those affected by suicide

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Suicide Prevention Service: (Texas Service)

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Suicide Prevention Service: (Texas Service)

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The Texas Suicide Prevention Collaborative relies on generous contributions from community members like you to support our work. The fact is that persons who are impacted by mental illness or who need support for suicide prevention, suicide loss, or a previous attempt rarely come into contact with the public mental health system. Many go without treatment or support at all.

To help communities, we must build and support locally available resources for those who may be at risk of suicide-and that's the essential work of the Texas Suicide Prevention Collaborative. Given the size of Texas, this task is challenging, but with your support, we can accomplish it-together.

We now accept crypto donations along with traditional monetary donations. Please support those who need help in your community today.

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Texas Suicide Prevention | Know the Signs. Save a Life.

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The Texas Suicide Prevention Collaborative relies on generous contributions from community members like you to support our work. The fact is that persons who are impacted by mental illness or who need support for suicide prevention, suicide loss, or a previous attempt rarely come into contact with the public mental health system.

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Crisis & Emergency Service: (Texas Service)

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Crisis & Emergency Service: (Texas Service)

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Mental Health Statistics in America (US) (Statistics, Facts, and Data)

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Developmental Discussion on Trauma- Discussion Board Post #3

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Developmental Discussion on Trauma- Discussion Board Post #3

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The Kingdom of Us documentary, directed by Lucy Cohen in 2017 on Netflix, follows a family of eight after the 2007 suicide death of their husband and father. The fathers name was Paul Shank, the mother is Vikie Shank, daughters are Jaime, Kacie, twins Lorie and Mirie, Nikita and Pippa Shank, and the son is Osborn Shank. The film provides an inside view of the personal trauma and grief the family experienced 6, 7, and 8 years after the suicide. This allows the viewer to witness the impact of adverse childhood experiences in seven different children of differing ages. Adding to this knowledge, five of the seven children were diagnosed with differing levels of Autism. The families daily grief struggles are shown as well as one-on-one interviews and personal home videos of their previous life with their husband and father. A timeline of the fathers declining mental health and the way the young children responded is also observed in the home videos.

The family of eight's long term bereavement provides the viewer with an upclose look at the impact of different types of trauma, adverse childhood experiences, and the many different stages of grief. The film showed the family enduring many different types of trauma and stages of grief that led to other mental health issues. The mother developed the habit of hoarding due to her mental need to hold on to her past life and everything in it. The youngest daughter, Pippa, developed severe depression and struggled with anorexia. The son, Osborn, struggled with the meaning of life and stopped participating in normal life activities at year six. Daughter Nikita struggled with boughts of anger and the thought of growing older leading to death. The family finally entered therapy, on year eight, after Pippa was hospitalized due to her mental health struggles.

I found the mothers strength, patience, and determination to help her family go through the trauma and long term grieving process utterly amazing. As the children aged, she helped them to find answers to all of their questions; even the painful ones. In the documentary, the family uncovered the fathers suicide note and plans to kill his entire family one by one and then himself. This led to further trauma. Pippa dealt with this by thinking her father battled two worlds and decided to kill himself to save his family because he loved them. The other children were devastated by their fathers plan to kill them. Vikie continued to help her children through their pain and grief. After the documentary was released, Vikie was asked to participate as a Ted Talk speaker and later became a regular Ted speaker. She has devoted her life to helping parents with autistic children, those struggling with mental illness, and families impacted by suicide. The most interesting part of the documentary was watching how the children with autism reacted to grief over the three year period. Their responses shifted between fear of death, hopelessness, periods of dissassociation, explosive anger, disbelief, saddness, acceptance, and calmness.

I highly suggest this film to others, I have saved it as a resource to reflect upon in my future work. This film supports everything we are learning about in this class such as types of trauma and the stages of grief. The film 100% met my expectations on understanding how different age groups experience grief and trauma.

Cohen, L. (Director). (2017). Kingdom of us [Film]. Netflix.

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Developmental Discussion on Trauma-Discussion Board Post #4

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Developmental Discussion on Trauma-Discussion Board Post #4

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In the film, Kingdom of Us, the mother and seven children experienced mulitple different types of trauma from their husband and fathers mental health battle and suicide. The mother and children experienced primary, chronic, complex, and vicarious trauma. Primary trauma due to the sudden and traumatic loss of their husband/ father. Chronic trauma was experienced by the mother and older children because they were constantly dealing with Paul Shanks mental instability, mood swings, and suicide as well as the children being left with a grieving mother, family financial changes, parental changes, and societal changes. The children experienced complex trauma due to the fathers ongoing mental illness and suicide during their developmental years as witnessed in the home videos and the eldest daughter stated, in the film, that her father would become verbally abusive to her during his mood swings, for example telling her she "looked like a crack whore" (Cohen,2017). The mother and the children both experienced vicarious trauma through witnessing and listening to each others grief and recollections of the fathers mental instability and plans to murder the family. The mother experienced burnout which led her to stop cleaning her home and to start hoarding possessions.

The children all developed mulitple symptoms of trauma from irritability, saddness, anger, depression, etc. There was evidence of adverse childhood experiences affecting the children, most of which already had disrupted neurodevelopment due to autism. All of the children of differing age groups, after 6-8 years, displayed social, emotional and cognitive impairments. The youngest child, Pippa, developed anorexia and severe depression which became a health risk which she had to be hospitalized for several months to received mental health treatment.

The trauma that each member of the family experienced impacted the other members of the family. At the end of the film, year eight after suicide, the family started attending therapy and Pippa was hospitalized to receive deeper therapy. The type of therapy was not discussed; however, I would think that they were participating in "CTG treatment: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)" which is therapy that is recommended for those struggling with a sudden loss of a family member and helps to develop healthy coping skills (Cohen & Mannarino, 2011). According to Judith Cohen and Anthony Mannarino's article in the School Psychology International Journal, this type of therapy should have occurred as soon as the children returned to school or as soon as possible after the death occurred (Cohen & Mannarino, 2011).

As a school counselor I would have the children set up to receive mental evaluations with a psychiatrist as soon as they returned to school, set up meetings with the childrens teachers and coaches to help them to understand cues that might upset the children, and have the children participate in Trauma-Focused Cognitive Behavioral Therapy to help them address their fear, grief, confusion, and anger over their father suicide. I would reach out to the mother as well and help her to receive individual counseling with a licensed therapist, as well as offer family counseling for her and her children.

Cohen, L. (Director). (2017). Kingdom of us [Film]. Netflix.

Cohen, J.A. & Mannarino, A.P. (2011). Supporting children with traumatic grief: What educators need to know. School Psychology International: 32(2), 117–131.

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Hello! My name is Rainey Tucker and I am in the Mental Health and Wellness program at Angelo State University. I have numerous personal and professional goals. I will share one of each with you. I run in the afternoons to relieve stress and tension, my personal goal is to run a half marathon by the end of 2024. My professional goal is to become a Licensed Professional Counselor working with students in the 17-25 year age group at Ranger College. At Ranger College, I will help students through Title IX situations such as dating violence and sexual assault. I hope to learn more about trauma assessments in the Crisis and Trauma Resources Course.

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Title IX Resources
If you believe your school, college, or university has violated Title IX, learn more about how to file a complaint with the Department's Office for Civil Rights. Technical assistance inquiries, including questions regarding compliance with the new Title IX Rule, may be submitted to:
Fact Sheet: Final Title IX Regulation

1. Recognition of Sexual Harassment as Sex Discrimination

Sexual harassment under Title IX includes - dating violence, domestic violence, and stalking.

2. Protections for Survivors

Survivors are in the position of control to decide what happens after an incident of sexual harassment, including sexual assault, occurs.

Schools must respect a survivor's decision to file, or not to file, a formal complaint and must offer supportive measures either way.

Schools must respond promptly in every instance by offering to provide supportive measures like dorm reassignments or class schedule adjustments

Schools are forbidden from pressuring a survivor into filing or not filing a formal complaint or participating in a grievance process.

To protect younger students, K-12 schools must respond promptly when any school employee has notice of sexual harassment, including sexual assault.

The regulation extends to all aspects of a school's education program or activity and applies to any building owned or controlled by a student organization recognized by a college or university.

If a survivor chooses to participate in a grievance process, the regulation protects survivors from inappropriately being asked about prior sexual history (also known as "rape shield" protections), and the survivor must not be required to divulge any medical, psychological, or similarly privileged records.

A survivor never has to come face-to-face with the accused during a hearing, and an accused is never allowed to personally ask questions of a survivor.

Survivors are protected against retaliation when they choose to report sexual misconduct or not, file a formal complaint or not, participate in a grievance process or not.

Survivors are protected against bullying or harassment throughout the grievance process.

3. Campus Processes and Procedures

The regulation provides students with a right to written notice of allegations, the right to an advocate, and the right to submit, examine, and challenge evidence.

All students have the right to a live hearing where advisors conduct cross-examination.

All students have the right to an impartial finding based on evidence using a standard of evidence - either the preponderance of evidence standard or the clear and convincing standard - that applies to all members of the school community, including faculty.

Schools must offer both parties an equal opportunity to appeal the finding.

The regulation gives schools flexibility to conduct Title IX investigations and hearings remotely.

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If you believe your school, college, or university has violated Title IX, learn more about how to file a complaint with the Department's Office for Civil Rights. Technical assistance inquiries, including questions regarding compliance with the new Title IX Rule, may be submitted to: 1.

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My biggest "take away" from reviewing Unit 1 resources was that mental health is an incredibly important part of overall health and the ever increasing population is struggling with growing mental health needs. I was shocked to learn that suicide is now listed, by the Centers for Disease Control and Prevention Agency, as the second leading cause of death in 10-24 year old's.

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In my future role as a mental health counselor, knowledge of substance abuse, mental illness assessments, types of trauma, as well as the resources available will allow me to reach and help numerous students and young adults that are struggling within my community. A resource that I have found to be useful for professional development/training purposes is Texas Suicide Prevention.org. The link above is to the Texas Suicide Prevention Symposium 2023: Coming Together to Care page that has numerous expert presentations packed with valuable information on topics from suicide prevention to school safety planning.

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The learning continues with our Learning Intensive Series. Experts in their field are offering in-depth trainings throughout the fall. Register today to reserve your spot!

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It is estimated that about one in five Americans will experience a diagnosable mental disorder in any given year (NAMI, 2019).

Working with students in the 17-25 year age group, I will encounter numerous individuals who are struggling with mental health disorders. Becoming familiar with common mental health disorders will help me to support and assist these students.

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According to the National Council for Behavioral Health (2013), "70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. That's 223.4 million people" (para. 2).There are different categories of trauma, primary trauma, secondary trauma, acute trauma, chronic trauma, complex trauma, burnout, vicarious trauma, as well as organizational stress and trauma. Many adults mental health struggles are a result of adverse childhood experiences which occur during their formative and developmental years in childhood. These experiences can be the result of neglect, abuse, trauma, etc. The four discussion board post from this week over documentaries that exhibited trauma experiences helped me to identify multiple different therapy plans to help future clients such as CPT, CBT, holistic, play, etc.

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Fast Facts: Preventing Adverse Childhood Experiences |Violence Prevention|Injury Center|CDC

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As the nation’s health protection agency, CDC saves lives and protects people from health, safety, and security threats.

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Racial violence and discrimination are woven into the fabric of the United States. The way policies and laws are implemented. The weaponization of Whiteness and privilege. Disparities in education and health care. The horrible and senseless killings of Black people throughout our nation's history and into the present day.

How do daily acts of racial violence, injustice and discrimination affect the mental health of Black Americans? What is it like to work and live beside people who don't value you as a human being? What is it like to live in a country where your rights are frequently threatened?

DominiqueHammonds, an assistant professor and testing coordinator in the Department of Human Development and Psychological Counseling at Appalachian State University, provides a quick glimpse into the complexities of being a Black woman and counselor in a racist society. Hammonds, wearing a shirt that read "Black and Educated," was shopping in Walmart recently when a White woman passed by her and casually said, "You're disgusting." In that moment, Hammonds felt powerless. She feared the consequences of saying or doing anything in response.

Hammonds left the store and shortly thereafter went into a counseling session where her client recounted feeling powerless, angry and upset because of injustices they were experiencing in their life. Hammonds had to compartmentalize her own feelings of powerlessness to help the client.

Counselors play an important role in helping Black Americans cope with and heal from racial stress and trauma, but they can do more. Namely, they can also take steps toward changing an unjust and racist system that powerfully and negatively affects the mental health of Black Americans.
A distrust of mental health
Research indicates that Black Americans are 20% more likely to report serious psychological distress than are White Americans, yet they are less likely to use mental health services.

LoniCrumb and Janeé Avent Harris, who are both assistant professors of counselor education at East Carolina University (ECU), examined, along with two of their colleagues, the negative perceptions of mental illness and treatment among Black Americans. They found that stigma, a lack of trust in mental health care and a mislabeling of Black people's presenting concerns make this group more apprehensive to seek counseling. Financial constraints and a lack of access to culturally responsive mental health care are additional barriers, explains Crumb, a research and innovation associate with the Rural Education Institute in the College of Education at ECU. (See their article " African Americans' perceptions of mental illness and preferences for treatment" in the Journal of Counselor Practice for a more detailed discussion of their findings.)

This distrust is not unfounded. Black Americans have been misdiagnosed and overdiagnosed with schizophrenia for decades, for example. (For more, read " The historical roots of racial disparities in the mental health system " by Tahmi Perzichilli at CT Online.)

Angie D. Cartwright, an associate professor of counseling at the University of North Texas (UNT), stresses the importance of looking at how and why the mistrust of mental health began in the Black community. "Institutional and systemic racism is the foundation of a lot of our medical treatments, including mental health counseling," Cartwright says. "And, historically, when [Black people] invite others into [their] homes and communities, then problems happen."
Sitting with discomfort
Counselors, not clients, should be the first to broach issues of racism. This isn't necessarily easy or comfortable.

Counselors often conflate comfort and safety, but they are two different things, insists Cartwright, a licensed professional counselor and licensed sex offender treatment provider who is the clinical director and owner of North Texas Counseling and Wellness.

As she explains, being comfortable enough to broach the topic does not mean the topic itself will be comfortable. "It's not comfortable to say, 'I was discriminated against,' 'I had a gun pulled on me' or 'I was fired because my boss is racist,'" she continues. "There are some conversations we will always feel some discomfort talking about. And that's OK." But clients should feel safe enough to share their experiences - ones that will often be uncomfortable for counselors to hear, she adds.

"You have to get comfortable with being uncomfortable," says Hammonds, a licensed clinical mental health counselor (LCMHC) in North Carolina. "Part of the [counseling] skill set is learning how to have these discussions in a way that feels comfortable." For example, can counselors say the word Black, acknowledge their own ethnic identities or discuss racism knowledgeably? If not, then clients know they won't be able to go beyond a surface-level discussion with them, Hammonds explains.

What counselors say doesn't even have to be overly complicated, notes Hammonds, an American Counseling Association member. They can simply say, "I just want to check in. There's a lot going on around us right now. What's that been like for you?" or "I'm curious how you as a Black American might be affected by racial violence and oppression."

Being open and brave about this topic will likely result in some missteps. That's part of the process, says Hammonds, who encourages counselors to use those mistakes as opportunities to learn.

One misstep may be getting defensive when clients express anger, distrust or sadness about their experiences. "If you find yourself getting defensive - trying to explain away the client's experiences or identifying with client experiences and feeling like you have to apologize ... on behalf of the system - don't," Hammonds says. "All you're doing [in getting defensive] is communicating to the client that you're still not comfortable and haven't done your own personal work around this." And apologizing just puts clients in a position where they feel obligated to say, "Oh, it's OK," she adds.

Instead, she advises counselors to reflect on their own internal experience and to tune in to what might be prompting that response. Perhaps it's a case of the counselor wanting to protect their own ego, or maybe they are masking their own discomfort or lack of knowledge. If counselors find themselves becoming defensive in session, they can tell the client, "I feel like I'm reacting to something right now, and I recognize that I need to do some self-reflection. But I don't want to heap that on you." But do this briefly, Hammonds says, or else the session becomes about the counselor rather than the client.

Building trust and rapport also becomes critical to creating a sense of safety for these clients. Too often, counselors jump to diagnosis and treatment because the mental health system encourages them to have a solid plan and work toward a goal fairly early in treatment, Hammonds points out. She encourages counselors to slow down and first invest time in establishing good relationships with their Black clients.
Context matters
As Avent Harris, an ACA member, points out, counselors won't be aware of needing to broach the topic of racism unless they understand its historical and political context. Put simply, they have to know what to look for and ask about.

"You don't learn this context or gain this cultural awareness by just reading the DSM [ Diagnostic and Statistical Manual of Mental Disorders]," says Avent Harris, who specializes in multicultural considerations in counselor education and the role of spirituality in Black mental health help-seeking behaviors. She advises counselors to move beyond reading only counseling texts to explore the works of Black scholars, theologians and authors.

Counselors may also need to adjust a technique or approach to better fit with their clients' experiences. For example, the thought of going for a run in the evening sounds straightforward, but for many Black people, and Black men in particular, it can evoke a sense of fear. They question whether they will be safe or if their choice to run could cost them their life.

If a client brings this fear up in session, it could be dangerous for the counselor to use a thought-stopping technique, with the aim of interrupting, removing and replacing the client's "problematic thoughts," Hammonds explains. Suggesting that the client simply stop thinking that running could harm them ignores their experiences and the existence of the racism embedded in society, she says.

Instead, Hammonds, president-elect of the North Carolina Counseling Association, says the counselor should consider the context around the client's fear of running alone at night. Where does that fear come from? How does society contribute to or perpetuate this client's fear and anxiety?

"Those are the types of discussions that we need to be making space for," she says.
Self-awareness and honesty about biases
Hammonds stresses the importance of counselors reflecting - honestly - on their own experiences and biases. As she points out, counselors often like to think, "I took this multicultural course, or I've worked with clients from diverse backgrounds, so I'm doing OK." But it may not mean that at all, she emphasizes.

This self-awareness starts with counselor training. Working with diverse clients is the best way to learn to appreciate differences and to examine one's own biases and beliefs, says Crumb, an LCMHC in North Carolina.

This diversity should also extend to counselors' consultation groups. Avent Harris, an LCMHC associate in North Carolina, looks for colleagues who will provide honest feedback and challenge her own thoughts and beliefs. She says that if she has an uncomfortable moment in session, these colleagues would ask, "So, what made you uncomfortable in that moment? What questions do you need to ask yourself to reflect on that moment?" They wouldn't just echo her thoughts or tell her "not to worry about it," Avent Harris says.

Hammonds recommends that counselors continue to record and watch themselves in session just as they did during graduate school and supervision. "There's so much value in replaying your words and listening from that outsider's perspective," she says. The process affords counselors a chance to (re)consider their words, think about the purpose of their statements or actions, and evaluate whether they really listened to and heard their clients.

Counselors should also get their own counselor. "Some of this stuff is deep-rooted. It takes time to dig up those roots, to understand them, to untangle them and to repot them," Cartwright says.

She jokes that her mother always told her, "Never trust a beautician with bad hair." This same principle applies to counselors, she says. They have to make sure they take care of their own mental health before working with clients on their well-being. "And clients will be able to tell if you ... have done your work," she adds.

Cartwright, the project director for UNT Classic (a program that addresses disparities in mental health services for Black and Hispanic populations in the Dallas-Fort Worth metro areas) and UNT ICBH Project (a program that supports graduate students during clinical training), suggests that her colleagues, especially those who hold identities associated with privilege, work with a counselor who identifies with a marginalized group or with intersections with which the privileged colleague struggles.

They should also intentionally put themselves in a position in which they are the minority, continues Cartwright, a member of the ACA Advocacy Task Force and president of the International Association of Addictions and Offender Counselors, a division of ACA. For example, she suggests that White counselors attend a Black church one Sunday. "If you are uncomfortable for that short time that you're there, imagine what your Black clients feel like on a daily basis when they are constantly in spaces dominated by White people," she observes.
Finding voice and value
Black clients report to counseling with the same common presenting concerns that other clients have. But in addition, Hammonds says, they often seek counseling because of issues of "voice and value." They have experiences that either minimize their voice or communicate - overtly or covertly - that their ideas, opinions and problems don't matter or don't matter as much as those of others, she explains. Feeling undervalued, dismissed and unheard can lead to anxiety, depression and other mental health issues, she adds.

Cartwright specializes in underserved populations in counseling and counselor education, mentorship in counselor education, and offender and addictions counseling issues. She once worked with a client who was experiencing racism and discrimination at her job. The former client was the only Black woman on a large corporate team, and she noticed that meeting times would suddenly change without anyone alerting her. She also got the sense that her co-workers were talking about her behind her back. At first, she internalized this discrimination and started thinking that she must be bad at her job. She felt like an impostor.

But after another colleague confirmed the woman's suspicions of racial discrimination, the former client filed a lawsuit and won. The win came at a cost, however. She learned that co-workers had purposely changed meeting times without letting her know. Other colleagues whom she had thought were well-intentioned had made racist and hurtful remarks about her that were uncovered during the lawsuit and investigation.

As a result, the client began to question her judgment and worth. Cartwright helped the client learn to feel valued and trust herself again. They worked on challenging the client's thoughts that she wasn't good enough. For instance, they used self-affirming techniques such as daily affirmations and "I" statements that allowed the client to identify and acknowledge her strength and resilience.

Even if counselors can't relate to being discriminated against at work, they probably can identify with feeling like their voice hasn't been heard, Hammonds says. With that perspective, counselors can take intentional steps to empower these clients in session.

For example, Black clients often feel like they can't or shouldn't tell counselors if they didn't like the way the counselor phrased something or if a moment in session made them uncomfortable, Hammonds notes. But they should be made to feel comfortable voicing those thoughts, she continues, and it's up to counselors to create a space that invites that feedback.
Hidden struggles
A May 31 article in the Washington Post reporting on protests in the wake of the killing of George Floyd described a less visible impact of racial violence: "the private weariness and anguish felt by many [B]lack people in the country." In other words, many Black people are exhausted.

Emotional exhaustion is another reason that Black individuals often seek counseling, Hammonds says. Besides being fatigued from the discrimination and injustices that they experience daily, they often find it necessary to code-switch - changing the way they talk and express themselves when they are outside of their homes and Black communities.

To help explain this concept, Hammonds uses the analogy of counseling professionals switching their "hats" or roles. They may go from teaching to supervision to having a counseling session with a client and back to teaching again, all in the same day, which can be taxing.

"Switching roles, having to constantly pause and reconsider how much you can share and what is your role in this new context, and always being aware of what you can and can't say and what you can and can't do is exhausting," Hammonds says. "And that's an emotional labor that many White Americans aren't required to do."

Black women often face an extra burden. As Avent Harris explains, "Black women are expected both inside and outside their community to not be vulnerable, to not share emotions and to carry the weight of everything on their shoulders."

This unrealistic expectation can take a toll on mental health. In fact, many of Cartwright's clients struggle with the " Black superwoman syndrome " - the myth that Black women are impermeable. They feel pressure to do it all and to do it well. Although this isn't really a syndrome, it does help explain the chronic stress these women endure while trying to juggle multiple roles and keep up with the daily demands placed on them by family, work and community.

Cartwright's clients often discuss feeling misunderstood at work and how co-workers minimize their experiences. Cartwright normalizes these experiences for her clients, but she also expresses how sad it is that this is their "normal."
The trauma of racial violence
Instances of brutality and violence against Black people are not new, and neither are the racial disparities that regularly confront them. The main difference today is the ability to easily document such instances, says Hammonds, whose research interests include technology in counseling, multicultural counseling and community determinants of mental health. Almost everyone today has a smartphone in their pockets, and more people are using them to record acts of race-based violence and to demand justice and accountability.

These videos also continually expose others to these traumatic and heinous acts. This can be particularly traumatizing for Black people, who often internalize the traumas they witness because they know it could have easily happened to them, Hammonds says.

The disparaging comments on social media can also be traumatizing and triggering for Black Americans, Crumb adds. For instance, they may read a racist comment made by a supervisor or colleague. Then they have to return to work and sit beside that person, knowing how that person really feels about them.

"And so often, [Black people] are expected to move through the world, to hear all this, to see all this, and have no emotional reaction or response," Avent Harris says. Counselors can help change this by validating clients' emotional reactions to racial violence and discriminatory remarks, she adds. This involves letting them know that it's OK to feel disappointed, sad, angry, scared, anxious or whatever else they are feeling.

The trauma of being exposed to racial violence and remarks also has a collective effect. "Collective trauma is exposure to stressful events that threatened a sense of safety on a group level," Hammonds explains.

On a recent episode of The Thoughtful Counselor podcast, Hammonds described how repeated exposure to racial violence and discrimination operates like a wound that won't heal: "That spot's been nicked so many times. We can go about the process of healing, but before you know it, there is another nick. Then you're walking around doing your best to cope, shielding that spot, anticipating situations that might nick you again. ... You are always on edge. You're withdrawing. Your trust is slow to build in other people and situations. You feel angry and sad. And you start to think, 'Is there something wrong with me? Why can't I get out of this cycle?'"

This collective trauma correlates with symptoms of depression and posttraumatic stress disorder such as avoidance, reexperiencing, numbing and hyperarousal, she adds.

If a community experiences stress together, then counseling approaches that draw on the power of relationships are helpful, Hammonds says. These approaches include relational therapies, psychodrama, drama therapies, creative approaches and group therapy.

Hammonds often incorporates music into her sessions with clients. She describes music as being akin to a picture book because it connects people to a certain memory, place, emotion or experience in their life.

When clients can't easily describe their thoughts, feelings or perceptions in their own words, she asks them to think of a song that best captures their emotions or that represents what they see around them. She then pulls up the song and plays it in session, asking the client, "What is powerful about this song? How do the lyrics or beat affect you?"
Impacts on Black children
In the summer of 2016, Philando Castile was fatally shot in his car by a Minnesota police officer during a traffic stop. Castile wasn't alone. His girlfriend, Diamond Reynolds, and her 4-year-old daughter witnessed the entire incident.

After the shooting, Reynolds, who was now in handcuffs, was understandably distraught and emotional. Her daughter tried to comfort her, exclaiming, "Mom, please stop saying cusses and screaming 'cause I don't want you to get shooted." A few minutes later, the girl said, "I wish this town was safer. ... I don't want it to be like this anymore."

The girl's words illustrate how racism and racial violence affect children even at a young age. "Black youth are just as affected as their Black parents are by systemic racism and injustices," says Crumb, an ACA member whose research interests include rural and school-based mental health services. Black children are affected directly and indirectly. They witness racial violence and discrimination themselves, and they hear adults talking about it at the kitchen table. "Then, they assume these thoughts, these fears ... [and] this distrust," Crumb adds.

Again, counselors should take the initiative to broach the topic of racism with these youth. Crumbs calls it "taking the temperature of the room" because counselors can check in to see how children are doing. For example, a counselor could say, "This has been a tough summer with COVID-19 and a lot of people getting harmed and dying. How are you feeling?"

Then counselors should let the children guide the conversations, Crumb says. Some may verbalize their feelings. Others may use play or draw a picture to express their emotions.

Crumb points out that school settings are often the only access that some Black communities have to counselors. But because of mistrust and fear, they may not view counselors and schools as "safe spaces." Crumb advises counselors to be mindful of current and historical racial inequities within school systems and to alter their approaches accordingly in attempting to connect with these children.

Younger children may not have the vocabulary to easily communicate their feelings. They often "speak" through play and toys. So, Cartwright recommends that counselors keep an assortment of toys, dolls and activities that will allow children to communicate in the way in which they feel most comfortable. If they want to use a brown doll, counselors should make sure it is available to them, she adds.

But as Reynold's 4-year-old daughter demonstrated, some Black children possess an early awareness of racism and a vocabulary to discuss it. They often have little choice. Black children will be exposed to inequities earlier than their White peers because of their parents' lived experiences and the conversations they overhear, Avent Harris explains.

Crumb encourages counselors, especially school-based counselors, to be courageous in advocating for Black youth. Black youth are often overlooked academically and are disproportionately suspended, she says. Counselors can be vocal in questioning why that is the reality. Likewise, if diagnoses of attention deficit/hyperactivity disorder and conduct disorders are disproportionate toward one ethnicity, counselors can ask questions and press for answers.

More than that, counselors can do something about such disparities. For example, they can lead professional development trainings for teachers, Crumb says.
Partnering with the Black community
Black people may rely on informal networks of support such as family, friends and their church communities when it comes to issues having to do with their mental health, Crumb says. She add that counselors should encourage clients to continue using these supportive networks because it is imperative that they have trusted individuals to whom they can turn to discuss their experiences of race-based trauma.

Counselors should also reach out and form relationships with stakeholders in Black communities. Crumb and Avent Harris recommend partnering with community organizers, historically Black Greek-letter organizations, those involved with the juvenile justice system, law enforcement personnel and faith leaders.

Faith leaders are often both spiritual and political leaders in the Black community, Avent Harris says, so collaboration with them is crucial. "A lot of times, how [Black Americans] conceptualize events, crises, pain and suffering is coming from [their] spiritual beliefs systems," she adds.

In an article written for CT Online after the 2015 church shooting in Charleston, South Carolina, that took the lives of nine Black people, Avent Harris suggested that counselors could meet with Black pastors and offer to speak in their Sunday morning services, co-sponsor a mental health day or provide referral resources.

Counselors should also think of these partnerships as a preventive measure. Counselors need to be invested and involved with Black communities before crises happen, Avent Harris stresses. She challenges her colleagues to name five contacts they have a working relationship with in the Black community and could reach out to immediately. If they can't name five, she says, then they have some work to do.
Less talk, more action
The words diversity and inclusion have steadily gained prominence in the counseling profession, but Avent Harris believes this has allowed counselors to largely become complacent and not move past thinking of "change" as simply including and hiring diverse individuals.

"It's not just diversity and inclusion. It's how we're doing equity work, how we are doing anti-racism work," she emphasizes. "What are our actions behind the words that we say? And do our actions align with what we say and who we say we are as a profession?"

Avent Harris, like many other Black people, is exhausted from having the same conversation over and over again about what the Black experience is like. "It's time to move beyond that talk and really implement action," she says.

Taking action doesn't mean that all counselors have to hit the streets and protest, but they can commit to influencing the spaces they are in, Crumb says. Maybe that's writing an article. Maybe that's offering a training. Maybe it's working to inform policy. Maybe it involves working toward making positive change in their communities or within themselves.

Cartwright also suggests one small step counselors could take that would have a huge impact: making their services more accessible to communities of color by offering one pro bono slot a week or having a sliding scale.

Although 2020 hasn't been the year we wanted, it may be the one we need. Every day, we hear the global rallying cry, "Black Lives Matter." Behind that cry are Black people who are suffering and dying because of systemic racism. We hear the refrain: Trayvon Martin, Tamir Rice, Eric Garner, Philando Castile, Charleena Lyles, Atatiana Jefferson, Breonna Taylor, Ahmaud Arbery, George Floyd, Tony McDade, Rayshard Brooks, and countless others who have died.

These are the tragic killings that make the news. But how many others die daily without drawing widespread attention? How many more face daily injustices or discrimination?

Yes, their lives matter. And their mental health does too.
****
On June 22, the ACA Governing Council issued a statement on anti-racism. As this article was being written, ACA leadership was listening to a cross section of members and volunteers to develop an action plan that would give life to the statement. For more, see tinyurl.com/ACAAntiRacism.
****
Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.
**** Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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Black mental health matters - Counseling Today

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Racial violence and discrimination are woven into the fabric of the United States. The way policies and laws are implemented. The weaponization of Whiteness and privilege. Disparities in education and health care. The horrible and senseless killings of Black people throughout our nation's history and into the present day.

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The National Child Traumatic Stress Network, Psychological First Aid (PFA) is an evidence-informed modular approach to help children, adolescents, adults, and families in the immediate aftermath of disaster and terrorism. Individuals affected by a disaster or traumatic incident, whether survivors, witnesses, or responders to such events, may struggle with or face new challenges following the event.

PFA is designed to reduce the initial distress caused by traumatic events and to foster short- and long-term adaptive functioning and coping.

The eight PFA Core Actions include:

Contact and Engagement: To respond to contacts initiated by survivors, or to initiate contacts in a non-intrusive, compassionate, and helpful manner.

Safety and Comfort: To enhance immediate and ongoing safety, and provide physical and emotional comfort.

Stabilization (if needed): To calm and orient emotionally overwhelmed or disoriented survivors.

Information Gathering on Current Needs and Concerns: To identify immediate needs and concerns, gather additional information, and tailor Psychological First Aid interventions.

Practical Assistance: To offer practical help to survivors in addressing immediate needs and concerns.

Connection with Social Supports: To help establish brief or ongoing contacts with primary support persons and other sources of support, including family members, friends, and community helping resources.

Information on Coping: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning.

Linkage with Collaborative Services: To link survivors with available services needed at the time or in the future.

National Child Traumatic Stress Network (2020). Psychological First Aid and SPR. https://www.nctsn.org/treatments-and-practices/psychological-first-aid-and-skills-for-psychological-recovery/about-pfa

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Regardless of the professional setting, appropriate strategies for prevention and intervention of crises must be identified and a plan must be in place.  We tend to think of crises as large-scale incidents of natural disaster or large-scale school violence. These tend to be some of the cases; however, there are other crises for which counselors and other professionals must implement appropriate interventions to help reduce risk factors for violence.  This section will explore crisis prevention and intervention response, specifically focusing on strategic planning for crisis situations in counseling settings valuable for all those who plan to work in a counseling role or alongside individuals in the counseling profession.

Why Create a Prevention and Threat Assessment Plan?

A crisis is any traumatic event that is typically sudden, unexpected, dramatic and forceful and may even threaten survival. Crises can be large scale events (e.g., severe violence, sniper attack, hostage situations, natural disasters, mass transportation accident, fire or chemical spill, etc.).  Other crises may be on a smaller scale (e.g., friend or relative is diagnosed with cancer, car accidents, sudden unexpected death, etc.)

Traumatic experiences can affect an individual's mental health and the ability to be fully present in activities of daily life. Having a comprehensive system of mental health services and supports already in place will assist various stakeholders in being better prepared to address the ensuing mental health needs that arise with any crisis.

Through an educational lens (and still significant to other professional counseling roles):

Although requirements may vary from state to state, Texas requires that threat assessment teams are in place for school campuses within a district.  These teams are charged with “determining the appropriate method for the assessment and intervention of individuals who make threats of violence or exhibit threatening behaviors on the campus” (TEC 37.115).  Someone with expertise in counseling is to be appointed to this committee. Some of the potential threats covered under this section include violence to others, suicide, and substance abuse.

In addition, other types of violence and risk factors that individuals may encounter leading to the need for counseling and intervention include youth gangs, human and sex trafficking, dating violence, etc.  In addition to the threat assessment teams that are required on school campuses, districts must also have strategies in place for trauma-informed care. Students who have experienced trauma will need supports in place to be successful not only academically, but also emotionally and psychologically.  Partnerships with local mental health authorities will be key to serving these students.

Through a lens beyond education (and, again, still significant to other professional counseling roles):

Threat assessment teams/behavioral intervention teams are also used in higher education and corporate environments. Regardless of your role and/or environment, it is highly likely there is a threat assessment protocol in place, which would make you an asset to that team.

Teams are “small groups of school (or organization) officials who meet regularly to collect and review concerning information about at-risk community members and develop plans to assist them.” (NaBITA, 2018a, p.4). One of the important roles and areas of expertise needed on the team is a mental health expert/counseling representative. Another growing position related to these teams are case managers who have expertise in mental health and related concerns.

Behavioral Intervention Teams (BIT), CARE Teams, or Threat Assessment Teams are a research-based, best practice for the prevention of violence by entities such as the United States Secret Service (National Threat Assessment Center, 2018).

Prevention is an ongoing effort that promotes physical, mental, and emotional wellness necessary for positive growth and development.  The key to prevention is reducing incidents and managing behaviors before they escalate. Awareness, knowledge, and practices that promote sound mental health can greatly reduce and often prevent a crisis.

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Every individual experiences a crisis moment at one point in his/her life. Crisis can be defined as one’s perception or experience of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms.

A crisis can refer to any situation in which the individual perceives a sudden loss of his or her ability to use effective problem-solving and coping skills.

A number of events or circumstances can be considered a crisis: life-threatening situations, such as natural disasters (such as an earthquake or tornado), sexual assault or other criminal victimization; medical illness; mental illness; thoughts of suicide or homicide; and loss or drastic changes in relationships (death of a loved one or divorce, for example).

Crisis intervention is the urgent and temporary care given to an individual in order to interrupt the downward spiral of maladaptive behavior and return the individual to their usual level of pre-crisis functioning.

Crisis intervention also refers to the methods used to offer immediate, short-term help to individuals who experience an event that produces emotional, mental, physical, and behavioral distress or problems.

Crisis intervention has several purposes. It aims to:

Reduce the intensity of an individual's emotional, mental, physical and behavioral reactions to a crisis.

Help individuals return to their level of functioning before the crisis.

Improve functioning above and beyond this by developing new coping skills and eliminating ineffective ways of coping, such as withdrawal, isolation, and substance abuse.

Assist individual in coping with future difficulties more effectively.

Through talking about what happened and the feelings about the situation, while developing ways to cope and solve problems, crisis intervention aims to assist the individual in recovering from the crisis and to prevent serious long-term problems from developing. There are a number of theories that are believed to be helpful in the event of a crisis. One effective theory is the ABC Model of crisis intervention.

Kanel, K. (2015). A Guide to Crisis Intervention (5 ed.). Belmont, CA. Brooks/Cole.

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4.3 If You Are in An Abusive Relationship

Know that statistically, the abuse will not stop, and it will likely get worse. As much as we may love our partner, we cannot heal or fix them. We did not cause them to be abusive and we cannot stop them from being abusive. As a reminder, there is nothing that we can do, or not do, to cause us to be a victim. The ONLY person who is responsible for abuse is the person exhibiting abusive behavior.

Change is possible, but that person must truly want to change. It takes a lot of effort and work, and it needs to be done with the help of a licensed mental health provider. Although you may love that person and want to be with them, your physical safety and emotional health are most important.

"Staying in an abusive relationship out of love or fear while hoping that things will get better only means being hurt longer. "

Staying in an abusive relationship out of love or fear while hoping that things will get better only means being hurt longer. Things don't get easier over time; they get harder. If you think you are seeing warning signs of abusive behaviors, don't wait until it turns into an abusive relationship. Get out now.

Tell someone. We need to tell friends or trusted adults what we are going through so that they can support and help us. Some of us may not want to tell our parents what we are going through because we don't want to hear a lecture or get in trouble, and we want them to trust our judgment and decisions. The last part of our brain that develops is the part that is responsible for impulse control, decision-making, and problem-solving. That part of our brain continues to develop until around age 25. This doesn't mean that we can't control our impulses or make good decisions until then, it means that when it comes to solving problems, we may see one or two ways to solve a problem where an adult may see twenty. What feels like a forever problem to us is one that an adult recognizes is temporary and can help us work through it to see that it really is solvable. Most adults are trying to prevent us from experiencing the pain they went through. They know and want us to believe them when they say that things will get better, even when we feel that they won't.

If our parent isn't someone who we feel safe talking to, then we can talk with an aunt, uncle, grandparent, family friend, neighbor, coach, or other school staff member we trust. What matters is that we tell someone, preferably several people, who can help us identify available options, keep us safe, and determine the next steps. It can be helpful to say something like, "I have some concerns about my relationship. Can you please just listen to me and then help me determine my next steps?" Adults can't always promise confidentiality, because they may need to tell someone to ensure we are safe. They care about and are concerned for us, and they may not have the expertise that is needed.

Safety planning

If you decide to leave the relationship, time and thought must be given as to how to do it as safely as possible. The most dangerous time for you is when you try to leave the relationship. Research has shown that the risk of homicide escalates when the victim of abuse decides to leave the relationship. The danger can exist long after a breakup takes place, and those around you can also be at risk of harm. Being aware of safety practices is important.

A safety plan includes actions and strategies to ensure your safety while in an abusive relationship, during the plan to leave the relationship, and after the relationship ends. Anyone can create a safety plan. You can create one on your own or with help from a friend, parent, or staff member. A safety plan can be created for various locations and situations including school, online, home, work, and other places.

Safety planning helps us think through and plan for the steps we need to take to maintain safety. For example, we may have the same friends as our abusive partner, and we may even go to the same school. Our partner may know our social media and email passwords, have keys to our house or car, know where we work, have items we want back. In addition to changing social media and email passwords, it may be safest to avoid asking for the items and keys to be returned and instead change the locks to the house and car. The plan may include asking the school to change our schedule, so we don't have the same classes as our partner. It is a good idea for the school counselor and other school staff, including the school resource officer (SRO), to be aware of the abuse, especially if our partner attends the same school. Abuse and violence often get worse, even at school.

Your safety is more important than someone else's feelings!

If the abusive partner goes to the same school or same district as us, there are certain things in place that can help.

School Behavioral Threat Assessment

Dating violence is an example of "harmful, threatening, or violent" behavior. As such, it falls under the Safe and Supportive School Program (SSSP) team, commonly referred to as the threat assessment team. One of the team's responsibilities is to conduct behavioral threat assessments. School behavioral threat assessment and management is a proactive and evidence-based approach for identifying people who may pose a threat and for providing interventions before a violent incident occurs. Every school campus (public school and open-enrollment charter school) in Texas is required by law to have a threat assessment team.

Dating violence is a school safety issue. Violence from a partner can take place at school or impact the victim at school even if the violence doesn't occur on school property. As school safety is a shared responsibility, you play an important role in keeping your school safe and free from violence. You can report concerns through your school's anonymous reporting system or by telling a school employee.

Title IX

Title IX is a federal civil rights law that protects people from discrimination in an educational setting based on their sex. It applies to all students in elementary, secondary, and post-secondary schools regardless of the student's identity.

In Texas, minors have rights under Title IX and the Texas Family Code. The Texas Council on Family Violence created a tip sheet with an overview of minors' rights.

Ask for help. There are resources and people who can help. Even if wefeel that no one cares, the truth is that many people do.

If we are, or have been, in an unhealthy or abusive relationship, it is a good idea to talk with a mental health provider so that we don't keep getting into the same kinds of relationships in the future. We aren't aware that we are doing it, but it is easy to repeat patterns and get into similar relationships because it is what feels familiar and comfortable.

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Recognizing and Responding to Teen Dating Violence Toolkit

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Recognizing and responding to teen dating violence requires an awareness of the prevalence of dating

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Teen dating violence (TDV), also called, "dating violence", is an adverse childhood experience that affects millions of young people in the United States. Dating violence can take place in person, online, or through technology. It is a type of intimate partner violence that can include the following types of behavior:

Physical violence is when a person hurts or tries to hurt a partner by hitting, kicking, or using another type of physical force.

Sexual violence is forcing or attempting to force a partner to take part in a sex act and or sexual touching when the partner does not consent or is unable to consent or refuse. It also includes non-physical sexual behaviors like posting or sharing sexual pictures of a partner without their consent or sexting someone without their consent.

Psychological aggression is the use of verbal and non-verbal communication with the intent to harm a partner mentally or emotionally and exert control over a partner.

Stalking is a pattern of repeated, unwanted attention and contact by a current or former partner that causes fear or safety concern for an individual victim or someone close to the victim.

Teen dating violence profoundly impacts lifelong health, opportunity, and wellbeing. Unhealthy relationships can start early and last a lifetime. The good news is violence is preventable, and we can all help young people grow up violence-free.

Teens often think some behaviors, like teasing and name-calling, are a "normal" part of a relationship. However, these behaviors can become abusive and develop into serious forms of violence. Many teens do not report unhealthy behaviors because they are afraid to tell family and friends.

Teen dating violence is common. Data from CDC's Youth Risk Behavior Survey in 2019 indicate that among U.S. high school students who reported dating during the 12 months before the survey:

About 1 in 12 experienced physical dating violence.

About 1 in 12 experienced sexual dating violence.

Some teens are at greater risk than others. Female students experienced higher rates of physical and sexual dating violence than male students. Students who identified as lesbian, gay, bisexual, transgender, or queer (LGBTQ) or those who were unsure of their gender identity experienced higher rates of physical and sexual dating violence compared to students who identified as heterosexual.

Unhealthy, abusive, or violent relationships can have short-and long-term negative effects, including severe consequences, on a developing teen. Youth who are victims of teen dating violence are more likely to:

experience depression and anxiety symptoms

engage in unhealthy behaviors, like using tobacco, drugs, and alcohol

exhibit antisocial behaviors, like lying, theft, bullying, or hitting

think about suicide

Violence in an adolescent relationship sets the stage for future relationship problems, including intimate partner violence and sexual violence perpetration and/or victimization throughout life. For example, youth who are victims of dating violence in high school are at higher risk for victimization during college.

Supporting healthy, nonviolent relationships could reduce TDV and prevent its harmful, long-lasting effects on individuals, their families, and their communities. During the pre-teen and teen years, it is critical for youth to begin learning skills to create and maintain healthy relationships, including managing feelings and communicating in a healthy way. Research also highlights the need for prevention efforts that address the unique needs of teens who are at greater risk of experiencing teen dating violence.

CDC has developed resources to help communities focus their prevention efforts on what works to address risk and protective factors for violence. CDC's Dating Matters®: Strategies to Promote Healthy Teen Relationships focuses on 11-14-year-olds and includes multiple prevention components to promote healthy relationships and reduce behaviors that increase the risk of dating violence. Please visit the Dating Matters website to learn more.

CDC also developed Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices pdf icon [4.52 MB, 64 Pages, 508] that describes strategies and approaches based on the best available evidence for preventing intimate partner violence, including teen dating violence. The resource includes multiple strategies that can be used in combination to prevent intimate partner violence and teen dating violence.

See Intimate Partner Violence Resources for articles, publications, data sources, and prevention resources for Teen Dating Violence.

1. Breiding MJ, Basile KC, Smith SG, Black MC, Mahendra RR. (2015). Intimate partner violence surveillance: uniform definitions and recommended data elements, version 2.0. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

2. Basile KC, Clayton HB, DeGue S, Gilford JW, Vagi KJ, Suarez NA, ... & Lowry R. (2020). Interpersonal Violence Victimization Among High School Students-Youth Risk Behavior Survey, United States, 2019. MMWR supplements, 69(1), 28.

3. Walls NE, Atterberry-Ash B, Kattari SK, Peitzmeier S. et al. (2019). Gender Identity, Sexual Orientation, Mental Health, and Bullying as Predictors of Partner Violence in a Representative Sample of Youth. Journal of Adolescent Health; 64(1): 86-92, https://doi.org/10.1016/j.jadohealth.2018.08.011external icon .

4. Dank M, Lachman P, Zweig JM, and Yahner, J. (2014). Dating Violence Experiences of Lesbian, Gay, Bisexual, and Transgender Youth. Journal of Youth and Adolescence; 43(5): 846-857, https://doi.org/10.1007/s10964-013-9975-8.

5. Foshee VA, McNaughton Reyes HL, Gottfredson NC, Chang LY, Ennett ST. (2013). A longitudinal examination of psychological, behavioral, academic, and relationship consequences of dating abuse victimization among a primarily rural sample of adolescents. Journal of Adolescent Health; 53(6):723-729.

6. Roberts TA, Klein JD, Fisher S. (2003). Longitudinal effect of intimate partner abuse on high-risk behavior among adolescents. Archives of Pediatric Adolescent Medicine; 157(9):875-881.

7. Exner-Cortens D, Eckenrode J, Rothman E. (2003). Longitudinal associations between teen dating violence victimization and adverse health outcomes. Pediatrics; 131(1):71-78.

8. Smith PH, White JW, Holland LJ. (2003). A longitudinal perspective on dating violence among adolescent and college-age women. American Journal of Public Health; 93(7):1104-1109.

9. Niolon PH, Kearns M, Dills J, Rambo K, Irving S, Armstead T, Gilbert L. (2017). Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies and Practices. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

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Teen dating violence (TDV), also called, "dating violence", is an adverse childhood experience that affects millions of young people in the United States. Dating violence can take place in person, online, or through technology.

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24 hours a day, seven days a week, 365 days a year, the National Domestic Violence Hotline provides essential tools and support to help survivors of domestic violence so they can live their lives free of abuse.

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Healthy relationships for young adults can be confusing. Love is more than just the way you feel, and we’re here to help.

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Behavioral Threat Assessment and Management for Educators and Administrators | Texas School Safety Center

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Behavioral Threat Assessment and Management provides a proactive, evidence-based approach for identifying individuals who may pose a threat and for providing interventions before a violent incident occurs. This toolkit introduces the concept of threat assessment and outlines how a threat assessment program functions in a school setting.

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Choosing to continue your education is a big deal. Whether you're going for your AA, BA, AS, BS or an industry-specific license, you're doing a lot more than just hitting the books. You're making big, hard decisions, stepping out of your comfort zone, embracing new challenges and - at least sometimes - making mistakes.

That's a lot of growth and change for one person to handle. And the stress can be overwhelming at times, for sure. So, how are you supposed to tell the difference between pressure that's productive and pressure that's destructive? How do you tell when you've crossed the threshold into mental illness?

Psychologist Susan Albers, PsyD, explains why there's a mental health crisis in higher education - and what to do if you or somebody you love is struggling.

How extreme is the mental health crisis in college students?

While the word "crisis" sometimes gets overused, Dr. Albers believes it's accurate in the case of mental health in higher education. And the data suggests she's right.

Gallup and the Lumina Foundation released the results of their 2023 State of Higher Education report in March. Many of us expected that the easing of COVID-19 restrictions in 2022 would have a positive impact on data around enrollment and retention. But that's proven not to be true. In fact, students are more likely to consider "stopping out" of a certificate or degree program now than they were in 2020 and 2021.

Forty-one percent of students currently enrolled in a degree or certificate program described staying enrolled as "difficult" or "very difficult." That answer is slightly more common for Black, Hispanic and Asian students than for white students. It was also slightly more common for male-identifying students to report staying enrolled was difficult.

"Difficult" is a pretty vague description. But when you put it in practical terms, the numbers are truly staggering. The Gallup/Lumina study found that 44% of associate degree students and 36% of bachelor's degree students are considering stopping their coursework for at least one term. Of those students, 55% cited emotional stress as one of the reasons - 47% cited "personal mental health reasons."

Mental health also prevents enrollment

Mental health is also a major factor preventing people from accessing higher education. The Gallup/Lumina study also examined barriers to enrollment in higher education. In their survey of the top reasons why adults haven't enrolled in a degree or certificate program, 30% cited emotional stress and 28% named "personal mental health reasons" as "very important" factors that informed their decision.

The results suggest women and Black and Hispanic adults are the most impacted populations.

Broken down by age, over 40% of young adults - people between the ages of 18 and 24 - say mental health and emotional stress are significant barriers to attending secondary school.

Why are college students struggling with mental health?

There are a lot of factors contributing to the proliferation of mental health issues on college campuses. In some ways, the biggest issue is also the most obvious, according to Dr. Albers. "The primary issue is that the number of students that are entering college that have mental health issues is greater than the resources available to help them," she explains.

There is a silver lining to that particular cloud. There was a time in the United States where individuals living with mental health or cognitive issues weren't considered "college material." The system we have today is under-resourced, in part, because higher education is accessible to a broader range of students than it used to be.

Another silver lining: The stigma around mental health is slowly diminishing. More students are using campus resources like disability services, counseling and support groups. And it's increasingly common to talk about emotional health concerns with friends, professors and staff. In other words, the mental health crisis in higher education is easier to see now, because of this generation's willingness to speak up and get help.

Of course, that's just one facet of the situation. There are a lot of reasons college students are struggling. Dr. Albers highlights the following issues.

Timing

Many students start their higher education journey while still going through the physical and developmental changes that come with puberty. "It's a common time for mental health issues to either occur for the first time or be exacerbated due to all the transition," Dr. Albers notes.

Academic pressure

Regardless of what higher ed path a student takes, their ability to pursue a career in their chosen field may hinge, in part, on their academic performance. And for many students, transitioning to college-level coursework can take time, and some not-so-great grades.

Financial stress

In the United States, higher education isn't free - in fact, it's prohibitively expensive for most people. While many people take out student loans to relieve some of the financial pressure, most still have to work at least part time to make ends meet.

But even that's often not enough. While rarely discussed, housing and food insecurity are such common problems on college campuses that many now have food pantries on site. And, of course, those student loans have to be paid back, whether you leave with a degree or not.

Even students who aren't paying for their own education can feel pressure to make sure the people or organizations investing in them "get their money's worth."

Fear of the future

Dr. Albers notes that even the most self-assured individual will likely face anxiety about their future in college. Fear of making the wrong decision can be paralyzing under the best of circumstances ... and many students aren't in the best of circumstances. They're overtired, overworked and under stress. This can all lead to what is known as "catastrophic thinking." This is a thought or worry that spirals quickly into the worst case scenario. For example, "If I don't get a good grade in this class, I wont graduate with honors, I will never get a job and I will end up homeless."

Loneliness and changing support structures

College is a time when the support structures you've relied on all your life may become a bit more remote. Being away from parents, mentors, therapists, churches and high school friends can leave you feeling disconnected from your community.

As Dr. Albers puts it, "You have people and relationships that help you during times of transition and mental health issues. And those can become lost or fragmented when you go to college." The sense of dislocation can be especially acute for students from marginalized groups, international students, veterans, parents, part-time students and commuters.

Physical health concerns

It's probably fair to say that, as a population, undergrads tend not to be the healthiest bunch of people on the planet.

"Diet, exercise and sleep often fall low on the priority list," Dr. Albers says. "Students feel like they don't have time for them. But those three things are the cornerstones of mental health." When you add stress to the equation, she adds that, "It's like pulling the rug out from underneath someone who's already struggling to stay balanced."

Substance use and abuse

"Substance use can exacerbate or trigger mental health issues," Dr. Albers states. You don't have to have a substance use disorder (SUD) for substance use to impact your mental health. That said, there's a clear relationship between dependency and mental illness. The National Institute of Mental Health explains the relationship this way:

Substance use can trigger changes in the structure and function of the brain in a way that makes individuals more likely to develop a mental illness.

People who have a mental illness sometimes self-medicate to relieve their symptoms. While it can sometimes seem misusing substances helps in the moment, it actually exacerbates symptoms in the long run.

Brain changes in people with mental illness can sometimes amp up the reward effect of a mind-altering substance, which may make a person more likely to use it again.

In other words, the relationship between substance abuse and mental illness isn't necessarily one of cause and effect. Instead, think of them as mutually reinforcing.

Trauma

"Sometimes, people have high levels of tr a uma - invisible wounds that they arrive to college with," Dr. Albers notes. For people in that situation, the stress of transitioning to college can be extremely destabilizing.

Still others experience trauma on campus. Campus sexual violence (CSV) is a particularly pervasive problem.

The American Psychological Association reports that 43% of the crimes committed on college campuses fall into the category of sexual assault (CSA). The mental health impact of campus sexual violence is significant. Not only is it associated with poor academic performance and dropping out, but it's also linked to alcohol use and mental illness.

How much stress is 'normal' in college?

Here's the thing about college: It's supposed to be stressful. To a point.

"Stress is built in," Dr. Albers clarifies. "It is normal and it is to be expected. A little bit of stress helps to prevent boredom and is also a sign that you're being challenged. So, if stress isn't there, that would be a little odd."

So, how do you tell the difference between healthy and unhealthy levels of stress?

According to Dr. Albers, the following changes in day-to-day functioning are red flags:

1. Sleeping too much or not at all.

2. Losing one's appetite or eating emotionally.

3. Isolating oneself from other people.

4. Missing classes, practices, work and social engagements.

"Basically, you're too stressed out when the ability to learn is being overshadowed by the mental health struggle," Dr. Alberts states.

Varsity blues: Mental health in college athletes

Most college students experience stress of one sort or another during their tenure. But researchers have noticed that student athletes are particularly prone to mental health issues. Here's why:

Sleep deprivation. Because of scheduling issues, student athletes often have to practice early in the morning or late at night.

Less time. Practices, travel, competition: That stuff takes a lot of time and energy that might otherwise be spent studying, sleeping, socializing or earning money.

High stakes. For students on athletic scholarships, their ability to attend school is frequently tied to both academic and athletic success.

Physical health concerns. Athletes need nourishing food and sleep to fuel their performance, but they're just as likely as any other student to see their diet and sleep schedule suffer during college. Depending on the sport in question, they may also be more vulnerable to injury.

Fear of seeking help. Dr. Albers notes that college athletes often worry about the consequences of accessing student support services. "They think that that if they reveal they've got a mental health issue that it will be held against them, or that there will be assumptions made about their athletic performance." The data from the 2022 NCAA Student-Athlete Well-Being Study bears that out. The survey found that only 47% of student athletes would "be comfortable personally seeking support from a mental health provider on campus."

Mental health tips for college students

Reading all of this information, college could easily start to sound less like a great educational opportunity and more like a psychological trap. But that doesn't have to be true. Dr. Albers offers these tips for protecting your mental health in an academic pressure cooker.

Eat, sleep and move

Have you ever heard of Maslow's hierarchy of needs? It's a psychological model of human motivation. It's shaped like a pyramid; you have to satisfy the needs at the bottom of the pyramid before you can move up.

Guess what comprises the base of the pyramid? Physiological needs. That's food, water, clothing, shelter and sleep. If you're struggling on any of those fronts, you aren't going to be able to take care of higher-order concerns like grades or career preparation. In other words, prioritizing sleep, nutrition and exercise is one of the best things you can do to ensure you get the most out of your education.

If you don't have enough food to eat, clothing to wear or a safe place to sleep, that's something you should talk to a counselor, dean or professor about. They have those conversations much more often than you might realize. And even if they can't personally help you, they will know who can.

Stay connected with friends and family

Who are the people that know you best? That are most likely to notice when something's not quite right? To have tough conversations? They're not always going to be your peers in your degree or certificate program - especially when you're just starting out. That why it's a good idea to keep in touch with your friends and family, even if you're living on the other side of the world.

Of course, not all people have healthy of safe relationships with their biological families. If staying connected to the people who raised you will harm more than help, then focus on your maintaining your relationship with your chosen family or finding a mentor.

Join student organizations

Combatting isolation can be fun! That can be especially true on college campuses, which are teeming with opportunities to meet new people and try new things. Join an intermural sports team, an affinity group, student government or a volunteer organization. (And try not to worry too much about whether the activities you choose will look good on your resume. The best thing you can possibly do for your future is to focus on your health and well-being.)

Know your resources

No matter where you go to school, the first couple weeks will be like drinking from a firehose. You'll get lost, you'll forget people's names and you'll be lucky if you remember even half of the things you learn about during orientation.

That's why it's important to be proactive when it comes to learning about the mental health resources available to you on campus ... all of them. You might not end up needing them, but somebody else might.

Having a list of the school-specific, local and national resources saved in your phone means you won't be caught flat-footed in a crisis. Here are a few phone numbers for students in the U.S. to get you started:

988 Suicide and Crisis Lifeline: 988

The Trevor Project: 1.866.488.7386 or text START to 678-678

Transgender Suicide Hotline: 1.877.565.8860

National Domestic Violence Hotline: 1.800.799.7233 or text LOVEIS to 1-866-331-9474

The Crisis Text Line: Text HOME to 741-741

The Veter ans Crisis Line: 1.800.273.8255 and Press 1 or text to 838255

Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1.800.662.4357 or send your zip code via text message to 435748 (HELP4U)

Disaster Distress Helpline: Call or text 1.800.985.5990

National Sexual Assault Hotline: 1.800.656.HOPE (4673)

Register with disability services if needed

If you have a documented mental health, physical health or learning issue that requires disability accommodations, register with your school's disability services department as soon as you get to campus. Depending on your mental health diagnosis, you may be entitled to accommodations like a reduced courseload, single housing, flexible attendance, extended time on tests ... the list goes on.

Remember: Having accommodations and using them are two very different things. It's possible you'll never need to use any of your approved accommodations. But here's the thing: Accommodations are never granted retroactively. And getting them involves meetings and paperwork, which takes time. That's why it's important to have them set up before you need them.

Focus on what you can control

If you're feeling overwhelmed, Dr. Albers suggests making a list of the things that are stressing you out. "Some of those things can probably be addressed and some things are out of your control. Identifying what they are and taking action on the things you can change can be really helpful," she explains. Prioritize problems that are fixable, or that you can get help from other people on.

Look for the helpers - and be one, too!

Higher education institutions can be unkind in many ways, but the "helpers" (as Fred Rogers put it) tend to be pretty easy to find. Whether it's a professor, coach, counselor, a residential adviser or even a fellow student, there's always somebody who's going to be willing to hear you and help you.

Helping other people can also be healing. Volunteer for an afternoon once a month at the local children's hospital. Take an hour to chat with a friend who's going through a rough time. Send a high school friend a hand-written letter to let them know you're thinking of them. Set up a study group for that final exam that everybody's so worried about. Stepping outside of yourself and making a difference in other people's lives can really help put things in perspective.

When is time to consider a medical leave?

"Muscling through" your problems can be a good thing, but only to a point. But where exactly is that point? How do you know when it's time to consider taking some time off to focus on improving your mental health. Dr. Alber's checklist looks like this:

Are you so depressed that you're not getting out of your bed, or leaving your room?

Are you isolating yourself from other people?

Are you missing your classes? When you are in class, are you struggling to absorb the information you're learning?

If your answer to those questions is "yes," Dr. Albers says it's probably time to take a medical leave of absence. "You need to make getting help a top priority because there's no point in being in college if you are unable to learn the information and really take it in. Instead, take a pause, address your mental health and return when you are truly ready emotionally and physically."

Word to the wise

It's a truth broadly acknowledged: There's a mental health crisis in higher education. Need has been outstripping resources for years. And the COVID-19 pandemic has only made matters worse.

The good news is, there are lots of resources available to help students, whether they just need a little extra support, or find themselves in a full-blown crisis. Getting and staying well can be difficult, but it's more important than any class, grade or degree will ever be.

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Tested: College Students and Mental Health

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A psychologist explains why there's a mental health crisis in higher education - and what to do if you or somebody you love is impacted.

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ACA Code of Ethics and Title IX are applicable to my role as a Mental Health and Wellness Counselor at a college because I will be required to offer counseling services to students. Working directly with students requires following the ACA Code of Ethics.

Title IX applies to schools, local and state educational agencies, and other institutions that receive federal financial assistance from the Department. A recipient institution that receives Department funds must operate its education program or activity in a nondiscriminatory manner free of discrimination based on sex, including sexual orientation and gender identity. Some key issue areas in which recipients have Title IX obligations are: recruitment, admissions, and counseling; financial assistance; athletics; sex-based harassment, which encompasses sexual assault and other forms of sexual violence; treatment of pregnant and parenting students; treatment of LGBTQI+ students; discipline; single-sex education; and employment. Also, no recipient or other person may intimidate, threaten, coerce, or discriminate against any individual for the purpose of interfering with any right or privilege secured by Title IX or its implementing regulations, or because the individual has made a report or complaint, testified, assisted, or participated or refused to participate in a proceeding under Title IX.

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Therapeutic healing sometimes takes a village. Each one of us can benefit from a multitude of supports that help us navigate through tough times. For this reason, it can be useful to incorporate many types of helping professionals to achieve a client's goals for treatment. Throughout the counseling process, counselors often elicit the help of professionals within their workplace and beyond to benefit their clients' care.

When you consider a referral for your client, know your reason for making the referral. It can be helpful to discuss this with your supervisor or a trusted colleague to receive another opinion and a list of contacts.

Next, do your homework. Know your referral source and be prepared to explain how this source will benefit your client's treatment. It can be helpful to personally reach out and gather more information about how this referral source works.

Giving Your Client the Referral Information

Present this information to your client, explaining why this referral source will benefit your client's care.

Allow the client to express his or her thoughts and feelings about the referral. The client may feel resistant to seeing a new or additional person. Validate any concerns and encourage your client to seek this additional help.

If the client does not wish to use the referral source, the counselor must decide whether to continue treatment without the additional support(s) or end treatment in certain cases.

If your client wants to go to the referral source, have your client sign a release of information form. This allows you to communicate with the referral source.

Signing a Release of Information Form

Confidentiality must be broken if your client is in imminent danger or a court order mandates a release of information. Outside of these rare circumstances, any type of communication or information cannot be shared without a signed release of information:

The HIPAA Privacy Rule, from HHS.gov US Department of Health & Human Services (2022):

...establishes national standards to protect individuals' medical records and other individually identifiable health information (collectively defined as "protected health information") and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The Rule requires appropriate safeguards to protect the privacy of protected health information and sets limits and conditions on the uses and disclosures that may be made of such information without an individual's authorization.

The Rule also gives individuals rights over their protected health information, including rights to examine and obtain a copy of their health records, to direct a covered entity to transmit to a third party an electronic copy of their protected health information in an electronic health record, and to request corrections.

A signed release form can vary from counseling practice to practice, although in general, it shows the counselor's name, address, and phone number and the referral source's name, address, and phone number. There is an expiration date that can be set by the client and counselor. The client can also rescind the release of information at any time.

Lastly, the release can specifically state the exact information to be shared. For some clients, it may be a diagnosis, for others, it could be symptoms. This depends on the circumstances of the referral and the client's case.

The signed release also facilitates communication between the two sources. This ensures both parties are working in collaboration rather than opposing goals, which could impede treatment.

The Primary Care Doctor Referral

One of the most important first referrals for clients who experience anxiety or depression can be to their own primary care doctor. Many medical issues can cause anxiety and depression. It is best to rule out anything medical with a blood test and physical exam. Once the client is treated for any underlying medical issues, you can see a clear presentation of his or her symptoms.

Types of Referral Sources

The list of referrals goes well beyond what is listed below. Through this listing, you can get an idea of some of the many sources of support:

Couples Therapy - If your client's issues involve an interpersonal or romantic relationship, couples counseling may be more appropriate than individual services.

Crisis Referrals - When a client is in danger of harming oneself or others, a crisis referral is warranted. Examples of crisis referrals include the ER, police, shelters, the Department of Social Services, and Elder Services.

Family Therapy - If your client's issues involve family dynamics, a family therapist may benefit him or her.

Group Therapy - These are therapeutic groups run by counseling professionals to address various client needs. A counselor can work with multiple individuals at once, utilizing group dynamics. Some examples of group therapy are coping skills, expressive arts, and cognitive-behavioral.

Medication Management - A psychiatrist or nurse practitioner can be referred to assess the client's mental health symptoms and determine if medication could be helpful. Both of these providers can prescribe and monitor medication management.

Self-Help Groups - These groups bring together people who share similar challenges to help support one another. These are not led by a licensed professional but by peers, who have lived experience. Examples include 12-step groups, Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Adult Children of Alcoholics (ACOA), Al-anon, Alateen, etc.

Specialists - Specialists are professionals with a specific skill set. Some examples are those that hold certifications or licensure in art therapy, vocational counseling, or financial counseling.

Support Groups - These groups are often run by counseling professionals who bring people together with similar experiences. Support groups can be found in counseling agencies, hospitals, or clinics. Some examples are sexual abuse survivors, bereavement, parenting classes or groups, and caregiver groups.

Psychological Testing & Assessment - A referral to a psychologist can help with diagnosis through the use of tests and other assessment tools.

In the example of psychological testing, information about the client is needed for the referral source to understand which instruments would most benefit the client.

The American Counseling Association Code of Ethics ACA E.6.b. Referral Information states:

If a client is referred to a third party for assessment, the counselor provides specific referral questions and sufficient objective data about the client to ensure that appropriate assessment instruments are utilized.

Referrals During the Counseling Process

At times, a counselor will recommend an adjunct to the current treatment. In this instance, counseling takes place, but the client also partakes in additional services. If you are continuing individual counseling with your client, it is recommended another counselor be assigned to see your client if they desire couples, family, or group therapy, to avoid any ethical or possible boundary issues.

During the experience, contact the agency for periodical follow-ups and progress. Also, ask for your client's feedback about the encounter. After the experience, process the client's feelings and experiences. Note any and all progress toward treatment goals.

Referrals Before the Termination of Services

A referral is done before ending counseling to ensure those clients who wish to continue services with a different provider can do so, uninterrupted. The client may request a referral if they do not feel the therapeutic relationship is a good fit. Counselors may initiate a referral when they do not have the skill set to work with a particular client issue, feel unsafe with the client, or have a conflict of interest. Keep in mind, a referral should be the last resort.

If a counselor does not have the skill set to work with a client, first seek to increase your knowledge through education, consult with colleagues, and seek supervision. Even if the client has seen the counselor for a short amount of time, a therapeutic relationship has been established. Any type of referral disrupts this connection and could cause harm to the client.

When a counselor feels unsafe with a client, seek supervision for guidance. If it is necessary to meet with the client, have at least one other counselor who is aware of this issue, near the vicinity of your office, when treatment takes place. You can also sit close to the door and leave it open slightly during your session.

The counselor may also recommend referrals when leaving a place of employment. In all of the above scenarios, the counselor must not abandon the client and may need to continue to provide services until the referral has been completed.

Ethical Codes from the American Counseling Association (2014) Regarding Referrals

A.11. Termination and Referral

A.11.a. Competence Within Termination and Referral

If counselors lack the competence to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors discontinue the relationship.

A.11.b. Values Within Termination and Referral

Counselors refrain from referring prospective and current clients based solely on the counselor's personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor's values are inconsistent with the client's goals or are discriminatory in nature.

A.11.c. Appropriate Termination

Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling.

Counselors may terminate counseling when in jeopardy of harm by the client or by another person with whom the client has a relationship, or when clients do not pay fees as agreed upon. Counselors provide pre-termination counseling and recommend other service providers when necessary.

A.11.d. Appropriate Transfer of Services

When counselors transfer or refer clients to other practitioners, they ensure that appropriate clinical and administrative processes are completed and open communication is maintained with both clients and practitioners.

A.12. Abandonment and Client Neglect

Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.

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The Use of Referrals in Therapy & Counseling

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Therapeutic healing sometimes takes a village. Each one of us can benefit from a multitude of supports that help us navigate through tough times. For this reason, it can be useful to incorporate many types of helping professionals to achieve a client's goals for treatment.

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Ahmad, N.S. (2018). Crisis Intervention: Issues and Challenges. Advances in Social Science, Education and Humanities Research (ASSEHR), 304.

https://padlet.com/rtucker5_/crisis-and-trauma-resources-ja8bsf8ag179znv7/wish/2908535945

American Counseling Association. (2014). APA Code of Ethics.

https://www.counseling.org/docs/default-source/default-document-library/ethics/2014-aca-code-of-ethics.pdf?sfvrsn=55ab73d0_1

American Foundation for Suicide Prevention. (2024). American Foundation for Suicide Prevention.

https://afsp.org/

Association of Traumatic Stress Specialists. (n.d.) The ABCD Model of Crisis Intervention.

https://padlet.com/rtucker5_/crisis-and-trauma-resources-ja8bsf8ag179znv7/wish/2908534271

Bradley, L. (n.d.). Counseling Skills. Counseling Skills Resources.

https://padlet.com/rtucker5_/crisis-and-trauma-resources-ja8bsf8ag179znv7/wish/2908535072

Centers for Disease Control and Prevention. (2020). Ace Pyramid. United States Department of Health and Human Services.

https://padlet.com/rtucker5_/crisis-and-trauma-resources-ja8bsf8ag179znv7/wish/2880395470

Centers for Disease Control and Prevention. (2023). Fast Facts: Preventing Adverse Childhood Experiences. United States Department of Health and Human Services.

https://www.cdc.gov/violenceprevention/aces/fastfact.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Ffastfact.html

Centers for Disease Control and Prevention. (2023). Fast Facts: Preventing Teen Dating Violence. United States Department of Health and Human Services.

https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastfact.html

Centers for Disease Control and Prevention. (2021). Violence Prevention: About the CDC-Kaiser ACE Study. United States Department of Health and Human Services.

Central Counties Services. (2024). Central Counties Services.

https://centralcountiesservices.org/

Cleveland Clinic. (2023). Tested: College Students and Mental Health.

https://health.clevelandclinic.org/mental-health-in-college-students

Cohen, J.A. & Mannarino, A.P. (2011). Supporting children with traumatic grief: What educators need to know. School Psychology International, 32(2) 117–131.

Cohen, L. (Director). (2017). Kingdom of us [Film]. Netflix.

Eastland County Crisis Center. (2023). Eastland Country Crisis Center.

https://www.eastlandcrisis.org/

Hargraves, J. (n.d.) Introduction to Trauma Concerns: Unit 3, Assignment 1,2 & 3.

Angelo State University.

Healthery. (2018). Mental Health Statistics in America (US) (Statistics, Facts, and Data).

https://www.youtube.com/watch?v=aCyd_3zqkhY

Hutchinson, L. (2022). The Use of Referrals in the Counseling Process. Counseling Schools.

https://www.counselingschools.com/blog/counseling-referrals

Mental Health America. (2017). The State of Mental Health in America.

https://www.mhanational.org/issues/state-mental-health-america

National Child Traumatic Stress Network (2020). Psychological First Aid and SPR.

https://www.nctsn.org/treatments-and-practices/psychological-first-aid-and-skills-for-psychological-recovery/about-pfa

National Domestic Violence Hotline. (2024). Love is Respect.

https://www.loveisrespect.org

National Domestic Violence Hotline. (2024). The Hotline.

https://www.thehotline.org/

Oklahoma Department of Mental Health and Substance Abuse Services . (n.d.) Categories of Trauma.

https://padlet.com/rtucker5_/crisis-and-trauma-resources-ja8bsf8ag179znv7/wish/2880395072

Puleo,S. & McGlothlin, J. (n.d.) Overview of Crisis Intervention.

https://padlet.com/rtucker5_/crisis-and-trauma-resources-ja8bsf8ag179znv7/wish/2908536909

Phillips, L. (2020). Black mental health matters. American Counseling Association.

https://ct.counseling.org/2020/07/black-mental-health-matters/

Schulman, M. & Maul,A. (2019). Screening for Adverse Childhood Experiences and Trauma.

Center for Health Care Strategies.

Substance Abuse and Mental Health Services Administration. (2016). Improving Cultural

Competence: QUICK GUIDE FOR CLINICIANS. United States Department of Health and Human Services.

https://padlet.com/rtucker5_/crisis-and-trauma-resources-ja8bsf8ag179znv7/wish/2908591853

Substance Abuse and Mental Health Services Administration. (2017). Tips for Survivors: Coping with Grief After a Disaster or Traumatic Event. United States Department of Health and Human Services.

https://padlet.com/rtucker5_/crisis-and-trauma-resources-ja8bsf8ag179znv7/wish/2872862130

Texas School Safety Center. (n.d.) Behavioral Threat Assessment and Management for Educators and Administrators. Texas State University.

https://txssc.txstate.edu/tools/tam-toolkit/developing

Texas School Safety Center. (n.d.) Recognizing and Responding to Teen Dating Violence Toolkit. Texas State University.

https://txssc.txstate.edu/tools/tdv-toolkit/4-3-abusive-relationship

Texas Suicide Prevention Collaborative. (2023). Texas Suicide Prevention Symposium 2023-

Coming Together to Care.

https://texassuicideprevention.org/txsp23/

United States Department of Education. (n.d.) Title IX Policy.

https://sites.ed.gov/titleix/policy/

United Way Worldwide. (2024). 211.org.

https://www.211.org/services/crisis