{"id":150054,"date":"2022-08-25T07:31:33","date_gmt":"2022-08-25T11:31:33","guid":{"rendered":"https:\/\/effectsofanxiety.net\/?p=150054"},"modified":"2022-08-24T22:04:01","modified_gmt":"2022-08-25T02:04:01","slug":"part-1-anxiety-school-identifying-anxiety-and-what-to-do-about-it-2","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/150054","title":{"rendered":"Part 1: Anxiety &#038; School – Identifying Anxiety and What To Do About It"},"content":{"rendered":"<div class=\"jetpack-video-wrapper\"><iframe loading=\"lazy\" title=\"Part 1: Anxiety &amp; School - Identifying Anxiety and What To Do About It\" width=\"660\" height=\"371\" src=\"https:\/\/www.youtube.com\/embed\/kHqPWVGRzBs?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\r\n\r\n&nbsp;\r\n\r\nKelcey Schmitz: We want to\r\nwelcome you to our presentation today which is part of a series\r\non anxiety and the return to school. My name is Kelcey\r\nSchmitz and I work for the University of Washington at the\r\nSchool Mental Health Assessment, Research and Training Center or\r\nSMART Center, as the School Mental Health, leads to the\r\nNorthwest Mental Health Technology Transfer Center, our\r\nthe center is located in Seattle. So, whether you are returning\r\n100%, virtually, hybrid, or all in person, we do think you’ll\r\nfind this session relevant to your situation. Our funder\r\nSAMHSA has asked that we provide this disclaimer that the views,\r\nopinions, and content expressed in this presentation do not\r\nnecessarily reflect the views, opinions, or policies at the\r\nCenter for Mental Health Services, the Substance Abuse\r\nand Mental Health Services Administration, or the US\r\nDepartment of Health and Human Services.\r\n\r\n&nbsp;\r\n\r\nThe University of Washington\r\nSMART Center The Northwest MHTTC acknowledges that we learn, live\r\nand work on the ancestral lands of the Coast Salish people who\r\nwalked here before us, and those who still walk here, we’re\r\ngrateful to respectfully live and work as guests on these\r\nlands with the Coast Salish and Native people who call this\r\nhome. We encourage you to learn about the ancestral lands you’re\r\njoining us from. On the next slide, I want to\r\nspend just a moment to tell you about the Mental Health\r\nTechnology Transfer Center Network.\r\n\r\n&nbsp;\r\n\r\nIt was funded by SAMHSA\r\nin late 2018. The MHTTC network includes 10 Regional Centers, a\r\nNational American Indian and Alaska Native Center, and\r\nNational Hispanic and Latino Center and a Network\r\nCoordinating Office. We know that many of you may be joining\r\nus from outside of our region, and we want to make sure that\r\nyou know about the MHTTC where you are located.\r\n\r\n&nbsp;\r\n\r\nYou can visit\r\nthe MHTTC Network to find a center near you or to check in\r\nwith other centers across the nation. So just briefly, I want\r\nto introduce those of you who are new to our center. The\r\nNorthwest MHTTC supports the School Mental Health workforce\r\nin Alaska, Oregon, Washington, and Idaho, and on this slide, you\r\ncan see a variety of ways that you can get in touch with us.\r\nYou can see our website and email on how to reach us, a link\r\nto sign up for our newsletters, and social media accounts for a\r\nvariety of ways that you can connect with us. We do send out\r\nmonthly newsletters, as well as training and resource blasts.\r\nSo, please sign up and be in the know about what we’re offering.\r\nSo, at this point, I want to invite our guests to come on\r\nvideo. Dr. Kendra Read and Dr. Jennifer Blossom will be\r\nspending the rest of our time with us today.\r\n\r\n&nbsp;\r\n\r\nThey’re going to\r\npresent some amazing content and then have generously offered to\r\nanswer any questions that you might have during our Q&amp;A\r\nsession. So again, at this point, I am going to turn it\r\nover and want to give a warm welcome to our guest presenters\r\ntoday. Thank you. Kendra Read: Thank you so much\r\nKelcey for that warm introduction. So, appreciated.\r\nSo as Kelcey mentioned, my name is Kendra Reed. I am a clinical\r\npsychologist and the director of anxiety programs at Seattle\r\nChildren’s Hospital and Jennifer blossom is also a clinical\r\nthe psychologist was recent with us at Seattle Children’s as a\r\npostdoctoral fellow and is embarking on her new academic\r\ncareer as a professor at the University of Maine.\r\n\r\n&nbsp;\r\n\r\nAlright,\r\nhere we go. Here’s more about our introductions here. Both of\r\nwe hold expertise in the assessment and treatment of\r\nanxiety and mood disorders, including OCD in youth. So that\r\nis what we are here to talk about with you all today. As our\r\ndisclosure, we don’t have any conflicts of interest. We won’t\r\nbe discussing any off-label product use, and we have no\r\ncommercial support or sponsorship. This is not a\r\nco-sponsored talk, so nothing to disclose here. Our objectives\r\nduring our presentation, today are to review how anxiety\r\npresents in educational settings, to discuss and learn\r\nmore about the empirically supported strategies to address\r\nproblematic anxiety in educational settings and to\r\ndescribe school-based approaches for anxiety that encourage and\r\nreinforce those empirically supported strategies of approach\r\nversus avoidance.\r\n\r\n&nbsp;\r\n\r\nWe’ll get more into that shortly. Okay, so I like to start here\r\nwith everybody. I am sure all of you have experienced anxiety and\r\nsome form or another in your lives, because anxiety is a\r\nhuman emotion, we all have it. So, I’m going to describe\r\nanxiety to you all like I would to a family coming in to seek\r\nservices with us because I think it’s really helpful to hear how\r\nwe would describe it so that you can implement this in your work\r\nwith families but what I want everybody to know, kids,\r\nadolescence, parents, and you all as educational providers is\r\nthat anxiety is a normal, adaptive, and protective feeling.\r\nThis is our body’s natural alarm system. It’s the system that\r\nsays “Hey, watch out for danger, danger, danger, get out of\r\nhere”, when something is a threat to our safety.\r\nSo, it’s an important feeling that we have, it is a good thing\r\nand then often, in many cases, it can be kind\r\nof a performance boost for us.\r\n\r\n&nbsp;\r\n\r\nIf I didn’t feel anxious at all\r\nabout an upcoming test, I might not even crack the book for it.\r\nSo, anxiety isn’t all bad and I like to start there with\r\neveryone because anxiety gets a really bad rap. We hear the word\r\nanxiety, we’re like, oh, no, must not feel that but in\r\nreality, anxiety, as I said, is a human emotion. We all have it,\r\nand it is often a really important one. Though anxiety\r\ncan become problematic when it causes significant\r\ndistress or interferes with the functioning of youth or their\r\nfamilies. So when it grows, when that natural alarm system grows\r\nto be too big for the situation, and I use this example a lot\r\nwith the families that I’ve worked with, but if we go back\r\nto that natural alarm system, I use this analogy of a smoke\r\nalarm or a fire alarm in somebody’s house.\r\n\r\n&nbsp;\r\n\r\nThat is a\r\nuseful tool. We want them installed in fact that it helps\r\nour homes be up to code and we need fire alarms and sometimes\r\nthose fire alarms go off when there’s no fire, right? So, I\r\ntell this story of how in my old house, the smoke alarm would go\r\noff every time someone took a shower, which is true and was\r\nvery problematic because we also have a husky. So it was very\r\nloud all of a sudden, and during the shower, the last thing you\r\nwant to do is get out to like deal with the loud things that\r\nare happening but that’s kind of like what happens in the bodies\r\nof people who have problematic anxiety. Their body and their\r\nmind is going “fire, fire, fire! Oh, no!” but there’s no fire.\r\nThere’s no smoke, right? There’s, no, there’s no true threat to\r\ntheir well-being. There is a perceived threat that is\r\ninaccurate, right? but we don’t want to, quote-unquote gets rid\r\nof anxiety, I’m not in the business of curing anxiety,\r\nbecause that would be problematic.\r\n\r\n&nbsp;\r\n\r\nThat’d be like\r\nuninstalling all of the fire alarms in folks’ homes that\r\nwould, houses would start to burn down. Those alarms are\r\nthere for a reason. So, we don’t want to uninstall those alarms.\r\nWe don’t want to take the batteries out but instead we\r\nwant to recalibrate that alarm to take a second to say, wait for a\r\nminute, is there smoke? we need to stay in the situation\r\nto see if is it as bad or as problematic, as I am assuming in\r\nthis moment. So, I’ve, we’ve also included here a table of\r\nsome common fears and worries that crop up at several\r\ndifferent developmental stages and these I think are\r\nimportant to note just to point out how anxiety is super common\r\nand pops up all the time and in fact, we see themes for, for\r\nyouth throughout their developmental stages for when we\r\ntypically see anxiety about this or that. All of that to say\r\npre-school on, you can still meet the criteria for quote-unquote,\r\nanxiety disorder, or have problematic anxiety in the\r\nspecific topics if kids are starting to pull away\r\nfrom their peers, in terms of the amount of distress and\r\ninterference they are experiencing about\r\nthese topics.\r\n\r\n&nbsp;\r\n\r\nSo, the main takeaway point from this is\r\nanxiety is normal. We don’t want to get rid of it\r\naltogether. I always tell kids; that you’d end up at the hospital for\r\na different reason. That would be bad, but our job is to help\r\nthem stay in this situation to recalibrate that false alarm\r\nthat’s going off. Say, wait a minute, is this as bad, is this,\r\nis there smoke? We’ll hand it off to you Jen.\r\n\r\n&nbsp;\r\n\r\nJennifer Blossom: Great, thank\r\nyou. So at this point, we’d like to welcome everybody to use the\r\nchat function and let us know from your perspective what\r\nyou’ve seen in your students and kiddos, what anxiety looks like.\r\nSo, if you wouldn’t mind taking a moment to enter the chat,\r\ndifferent behaviors or different things that you’ve heard from\r\nyour students, school avoidance, it looks like is the first thing\r\noff the bat that is something that Kendra and I see\r\noften stomach aches, I’m seeing a lot of withdrawal and\r\nisolation.\r\n\r\n&nbsp;\r\n\r\nSome tears, shutting down, sometimes aggression. We\r\nsee anger, outbursts, and aggression that can come up as a\r\nway to avoid it. Covering face, crying, this is great. Thanks so\r\nmuch for jumping right in here and keeping them coming. So a\r\nlot of fear. Some I’m seeing sometimes that people are seeing\r\nself-harm or suicide ideation, suicidal ideation, the withdrawal\r\nthat there’s a lot of reaching out to parents that kids are\r\nafraid to participate or they’re not answering questions,\r\ndifficulty regulating. Something that we often see particularly\r\nin a school setting is kids going to the nurse excessively,\r\nand having difficulty paying attention. That’s a very common one.\r\nSometimes looking for substance use or using substances as a way\r\nof avoiding anxious feelings, and sleep disruption. Somebody\r\nmentioned, seeing that kids are on their phones a lot and that’s\r\nparticularly common, right? because if we’re focused on our\r\nphones and looking down at the screen in front of us, then that\r\ndoesn’t mean we do not have to interact with those\r\naround us or face things that might be anxiety-provoking in\r\nour immediate environment. Great. Excellent. Thank you so much for\r\nsharing.\r\n\r\n&nbsp;\r\n\r\nSo, you’re mentioning a lot of the things that you’ll\r\nsee on the slide here are things that you’ve just mentioned. So\r\nin particular, one of the things as we were preparing for this\r\ntalk to think about how is anxiety manifesting. How is\r\navoidance manifesting now that a lot of schools or a lot of\r\nclasses are remote, so kids are meeting via, zoom or some\r\nother video conferencing platforms and one of the things\r\nthat we’re thinking of is that there are in some capacity, it’s\r\nmaybe easier to fully avoid participation in school.\r\n\r\n&nbsp;\r\n\r\nSo,\r\nschool avoidance is definitely a common problem. The hallmark of\r\nanxiety, just as Kendra was describing, initially,\r\nthe hallmark of anxiety is that our bodies react when there’s a\r\nthe situation in which we were worried about an immediate threat\r\nor danger and the automatic response to that is avoidance.\r\nRight? If there is a fire in my house, I want to get out of the\r\nhouse. That’s how I stay safe. The problem is that when that\r\nthe alarm system is going off for things like talking in class or\r\nasking teacher for help, then avoidance becomes really\r\nproblematic because you’re avoiding situations that allow\r\nyou to participate in the classroom or learn what you need\r\nto do or get the help that you need and so oftentimes, what we\r\nsee is avoidance when kids are physically in school, it might\r\ninclude going to the nurse’s office frequently, a lot of, you\r\nwere mentioning stomach aches, others might have complaints\r\nlike headaches.\r\n\r\n&nbsp;\r\n\r\nAvoidance might be asking to leave the classroom\r\nfor a short period of time, excessive bathroom use, either\r\ndue to semantic distress or because that’s an opportunity to\r\nleave classroom. When thinking about the class meetings via zoom,\r\nthis avoidance can be not joining the zoom session or\r\njoining, but not responding verbally to questions, not\r\nparticipating verbally, using the chat function instead, or\r\nusing the chat function and only responding to the teacher, so\r\nnot responding so that all students can see. This might\r\nalso be, you know, avoiding using (and we’ll talk about this\r\non the next slide) but avoiding using the zoom camera function,\r\nthere might be a lot of missed class or participation due to\r\naches and pains or complaints about illnesses and oftentimes\r\nwhen we think about this from an anxiety perspective, is\r\nthat when there’s additional medical workup, there’s\r\nadditional testing that there’s not an underlying organic or\r\nmedical cause for these semantic complaints.\r\n\r\n&nbsp;\r\n\r\nSo, frequent stomach\r\naches without an underlying medical etiology are commonly\r\nassociated with anxiety and in some ways, this is because of\r\ncultural differences and emotional expression. So, just\r\ndescribing anxiety as more of a somatic experience is more\r\ncommon, particularly in Latinx cultures and so this is\r\nsomething that we might see more commonly there’s a there can be\r\na lot of distress related to sleep, or eating difficulties.\r\nSo, students may be less likely to eat while at school. This\r\nmight not be something we’re seeing when we’re all on zoom\r\nbased, but definitely something that’s pretty common when we’re\r\nin the brick-and-mortar schools. Additionally, excessive\r\nreassurance seeking is something that’s pretty common and this is\r\nsomething that we see with students in the classroom\r\nhappens very frequently with parents but certainly with\r\nteachers and other school personnel as well and this is\r\nyou know, the kind of thinking about your typical student that\r\nis on top of classwork but still asking very frequently about due\r\ndates are making sure they’re getting the rules just right are\r\nthey fully understand the expectations for a specific test\r\nor project, and that they’re asking excessively and possibly\r\neven repeatedly asking the same question.\r\n\r\n&nbsp;\r\n\r\nAs Kendra was just describing,\r\nwhen there’s an alarm going off when there’s an alarm system\r\ngoing off in your head or your body, it can be really hard to\r\nfocus, right? If I was standing here trying to talk to you all\r\nand there was a smoke alarm going on, behind me, trying to\r\nkeep track of what I’m supposed to be saying and which side\r\nwe’re on would be really hard. So oftentimes, anxiety can look\r\nlike in-attention and this can impact school performance and in\r\nsome ways appear more commonly like symptoms of ADHD, but it’s\r\nactually, anxiety that’s getting in the way because it’s really\r\nhard to focus when you’re feeling anxious. So school\r\navoidance, this is something that I saw very commonly in the\r\nchat. So, this can include excessive tardiness up to an\r\nincluding chronic absenteeism, particularly when thinking about\r\nZoom meetings. I started to talk about this on the last\r\nslide, but showing up late to Zoom meetings are not showing up\r\nat all showing up and not turning the camera on and I do\r\nwant to pause here for a moment and just make note of that\r\nthey’re very valid reasons which some students are not\r\ncomfortable turning a camera on, it might be unsafe for them to\r\nshare information about their school environment, or their\r\nhousing environment, or where they’re living and that might\r\ndrive, drive them to keep the camera turned off and in som\r\ncases, it might be because o anxiety and worry around ho\r\nthey look or where even though you know, they’ll see, they’ll\r\nsay something about that they’ll say something silly or wrong o\r\npeople will laugh at them.\r\n\r\n&nbsp;\r\n\r\nthink you know, there’s on\r\nthe thing that I’ve thought pull up here is when if you all\r\nwere on camera right now there would be little panels of ove\r\n300 people showing up on the screen and when students are\r\njoining as part of a classroom there might be 20 or so 30 or s\r\nstudents showing up on the screen but in, in somebody’s\r\nsomebody’s mind who has anxiety they’re thinking about it. Like\r\nwhat’s happening right now, I’m the only camera on screens that\r\nmeans everyone’s looking at m and that can really drive a lo\r\nof avoidance. I also saw a lot in the chat, that there’\r\nangry outbursts, or there’ difficulty regulating emotions\r\nSometimes, what can happen I somebody feels really anxious\r\nabout completing a specific task, and they refuse t\r\ncomplete the task, or if they get upset or dysregulated, cr\r\nor yell, they’re sent, they’re sent out of the room or they’re\r\nasked to leave the area so that doesn’t disrupt other\r\nstudents and what happens over time is that kids learn.\r\n\r\n&nbsp;\r\n\r\nIf\r\nget really upset or I yell and say that I’m not going to do it\r\nthen I don’t have to do that thing that feels really hard an\r\nit makes me scared and anxious So over time, those angry\r\noutbursts can actually be driven by anxiety even though the\r\nmight on the face look more oppositional or quiet Sure and I just wanted to note,\r\nthere was one question in the Q&amp;A that I felt was really\r\nrelevant to this moment of noting that some school\r\ndistricts are only having students use their names in the\r\nthe video function of zoom and not have their video on and there’s\r\nconcern that students might be zoning out or not connecting, if\r\nthat’s happening all the time and from my perspective, I think\r\nthat’s certainly possible.\r\n\r\n&nbsp;\r\n\r\nI think it’s hard for us to really\r\nknow there’s a lot of uncertainty for us and I also\r\nwant to reflect on how you, we have, you know, roughly 315\r\nparticipants joining right now and so much engagement, even\r\nthough I can’t see any of you, so hard to know, for sure. I\r\nthink there’s a lot of uncertainty and there might be,\r\nas Jen pointed out, there might be some good reasons for\r\nstudents to have their videos off. In terms of an equity\r\nperspective, both in terms of like Internet bandwidth and the\r\nhome environment and safety concerns around that and it does\r\ncertainly allow youth who are anxious about being seen on zoom\r\nto avoid the situation. So, I have sort of mixed feelings\r\nabout it from that perspective. Thanks for jumping in there. So, what we know about the\r\ncauses and factors that maintain anxiety, it’s complex,\r\nthere’s not one cause or likely one general issue that\r\ngoes on when a child experiences problematic anxiety.\r\nDid you know that kids can be genetically predisposed to\r\nanxiety? So oftentimes, anxiety runs in families, so there might\r\nbe an anxious parent or an anxious grandparent, and then\r\nwe’re more likely to see anxiety in kids and the ways that that’s\r\nexpressed come up and up in a couple of different ways.\r\n\r\n&nbsp;\r\n\r\nSo,\r\nthere are temperamental factors, kids who experience behavioral\r\ninhibition, they are less likely to engage with novel situations,\r\nthey’re more cautious and careful in novel situations and\r\nthis is, these are temperamental factors that we can actually\r\nobserve as young as children as young as a few months old, that\r\nyou can start to see these characteristics. They tend to\r\njust be more careful and cautious. This is not the kid\r\nwho’s running out at recess on the first day of school, the new\r\nschool just checking out all the gym equipment. This is maybe the\r\nthe kid who’s kind of carefully following their other classmates\r\nand looking around to kind of get a lay of the land before\r\njumping into anything and we also know that anxiety can be\r\nlearned through observing others in the child’s\r\nenvironment.\r\n\r\n&nbsp;\r\n\r\nSo, we think a lot about social learning about\r\nanxiety and in particular thinking about the ways that\r\nadults and other kids might model anxious behaviors for\r\nkids. So, watching as somebody appears overly cautious or if\r\ntheir – kids might be – observing their parent’s\r\navoidance in certain situations, and that they learn that over\r\ntime. There’s also a big factor of kids might be getting\r\nreinforced for avoiding. So, there might be inadvertent\r\nsituations where well-meaning adults, teachers, parents, and\r\nother adults are trying to help a child feel better and be able to\r\nmanage a situation and they’re actually reinforcing the anxiety.\r\nSo, one of the ways that we think about this calmly coming\r\nup is that is excessive reassurance provision.\r\n\r\n&nbsp;\r\n\r\nSo,\r\n“You’ll be okay. You’ll be okay. There’s nothing to worry\r\nabout.”. Oftentimes, that’s really communicating the\r\nfeeling of anxiety that kids are learning that they can’t handle\r\nit and that they really need that help from other others in\r\ntheir environment. We also know that for kids with\r\nanxious brains, that alarm system again, as Kendra was\r\nsaying, it’s really sensitive. So, that means that it’s really\r\npicking up on potentially nuanced or minute indicators in\r\nthe environment that suggest that there might be something\r\nthreatening. So, I’m walking into a room of 50 people and I\r\nhear one person laugh, and I, I’m automatically thinking,\r\n“They must be laughing at me. My shirt is so stupid. I can’t\r\nbelieve that, that I decided to wear this today.”. You know,\r\nthey’re walking, they’re walking through on the bus to go home\r\nfrom school and somebody starts whispering to a neighbor.\r\n\r\n&nbsp;\r\n\r\nThey\r\nmust be whispering about me, anxious brains are really detail-oriented. It’s a strength and it can mean that if they’re really\r\ndetail oriented, they’re picking up on things that could possibly\r\nbe threatening, especially at school that comes up frequently\r\nwalking in, you’re often in large groups of people.\r\nSometimes you’re meeting new people you’re changing\r\nclassrooms. Each class may have a different group of students.\r\nAt the start of school, you’re thinking about where we all are\r\nright now, students are just trying to get up to speed on\r\nwhat different teachers expect.\r\n\r\n&nbsp;\r\n\r\nIn particular now, in the\r\na learning environment that we’re all managing, figuring out how\r\nto manage expectations and what is needed. There’s a lot of\r\ninformation to process and anxious, anxious feelings to\r\nreally pick up on the things that suggest that there might be\r\nsomething dangerous or threatening. We also know so in\r\naddition to attending to those things, we also know that\r\nthere’s a higher likelihood of misinterpreting things as\r\nthreatening. So, you know, walking, walking past someone in\r\nthe hallway or if you’re in a zoom meeting, and look at\r\nperceiving that maybe the teacher frowned for a moment and\r\nkind of a subtle shift in facial expression, that somebody\r\nwith anxiety is more likely to interpret that negatively and\r\npersonalize it. So that you know, the teachers disappointed\r\nin something that I did, or oh, they thought what I said, was\r\nsilly or wrong.\r\n\r\n&nbsp;\r\n\r\nSo, there are a number of things that come up in\r\nterms of processing information in the environment that can\r\ncause anxiety and then, in addition, thinking about\r\nenvironmental and life stressors, and that’s certainly\r\nsomething that is relevant for all of us in the current\r\nsituation and when we think about this as a causal factor\r\nfor anxiety, we distinguish it from traumatic experiences. So,\r\nexperience of a specific trauma is considered something separate\r\nfrom anxiety and the treatment looks a little bit different\r\nfrom anxiety and what we know about most anxiety disorders and\r\nkids who experience some kind of problematic anxiety are many\r\nof them do not actually have a specific traumatic event related\r\nto that, their experience of anxiety. Oftentimes, what\r\nhappens is that there’s a constellation of factors right,\r\nthey might be predisposed to this experiencing anxiety\r\nbecause of genetics that they got from their parents and then\r\nif they exhibit some behavioral inhibition, they’re more\r\ncautious in new situations and then they’re reinforced for that\r\nthe cautious approach in those situations but over time, this\r\nbecomes problematic, and can lead to problematic anxiety.\r\n\r\n&nbsp;\r\n\r\nGreat. So when we think about\r\nhow this plays out, and how over time, these factors can\r\ncontribute to the cycle of avoidance, so that it continues\r\nand becomes truly impairing. So looking at the picture on the\r\nthe left hand of the screen, the cycle of avoidance, what we\r\nthink about using that information to figure out how we\r\ncan intervene and help move the child to the cycle of approach\r\nwhich is the right-hand, right-hand side of the screen. So the goal is to use this\r\ninformation about how we understand that anxiety is\r\nlearned and maintained over time to figure out what can we do and\r\nwhat can well-meaning adults in the child’s life do to help them\r\naddress problematic anxiety.\r\n\r\n&nbsp;\r\n\r\nSo, if we start with the example of\r\nthe cycle of avoidance, what oftentimes happens is that child\r\nthe child may encounter a situation and they notice,\r\nanxious feeling. So, they start to notice that their heart rates\r\nincreasing, they might notice a kind of tightness, they notice\r\nthat their shortening of breath, and they, they have this\r\nnaturally occurring experience of anxiety and what the body and\r\nthe brain is telling you to do at that moment is avoid, is to\r\nleave the situation. So, the child experiences that anxiety,\r\nanxious emotions and physical experience, and then they avoid\r\nand what happens after they avoid is that somebody, some\r\nwell-meaning adults again notice what’s happening,\r\nnoticing a child having a hard time and jumps in and says “Oh,\r\nare you okay? Hey, what’s going on come here” what you know,\r\ncomfort to them, you’re not feeling well.\r\n\r\n&nbsp;\r\n\r\nI want to make you\r\nfeel better, completely understandable he jumps into\r\nsay, Oh, you know “what’s going on? tell me what’s going\r\non?” and the child then experiences anxiety reduction,\r\nright anxiety goes away. And what they’ve learned because of\r\nthat is that if I feel anxious, I can’t handle it, what I need\r\nto do is a void and when I void, then I get comforted for that I\r\nget reinforced for avoiding and when this pattern plays out over\r\ntime, and what happens that anxiety symptoms start to creep\r\nin earlier and earlier, the avoidance becomes more and more\r\nproblematic. If this is something that the child was\r\nexperiencing, walking into a specific class, this can begin\r\nto escalate to the point of you know, it’s the fifth period and\r\nThe fifth period really hard for me, and then avoiding fifth\r\nperiod and then more and more relief that they experienced by\r\navoiding the fifth period might try out to help I don’t even go to\r\nthe school then I never have the risk of attending the fifth period.\r\nThis is how anxiety and avoidance can play out over time\r\nand become really impairing.\r\n\r\n&nbsp;\r\n\r\nSo with that in mind, we take that\r\ninformation and we figure out okay, so what do we need to do\r\nto help the child, approach the situation and learn the goal? As\r\nKendra said we don’t want to get rid of anxiety, anxiety is\r\nreally helpful. What we want them to do is learn that they\r\ncan handle and they can tolerate anxiety. Over time in some of\r\nthese situations are not objectively life-threatening or\r\nrisk of injury, that they are better able to handle it and\r\nover time, their anxiety in those situations might decrease\r\nbut we really want to focus on tolerating that initial fear and\r\nbeing able to function even when feeling those anxious feelings. So, when we work to help kids\r\novercome anxiety, overcome problematic anxiety. We want\r\nthem to actually practice doing the thing that makes them\r\nanxious and oftentimes, this can seem surprising or\r\ncounterintuitive, when we’re talking with people\r\nabout how we think about anxiety but if you think about it, this\r\nis, you know, this is a common, a common colloquialism that we\r\nhear, right? Face your fear.\r\n\r\n&nbsp;\r\n\r\nThe idea is, that we want you to practice\r\nexperiencing this so that you can learn you’ve got this, you\r\ncan do it and that means we typically take gradual steps.\r\nSo, we want to think about what’s the thing that makes the\r\nchild really anxious and then we want them to bring on that\r\nanxiety. So, take a step toward that situation. So, can you\r\nthink about a child who’s really scared about getting shots. It\r\nmight be that first, we’re going to ask you to look at pictures\r\nof a needle and then you’re going to work, work towards\r\nwatching a video of somebody getting a shot up to an\r\nincluding getting a practice shot and until you notice you\r\nknow what, oh, I noticed I feel a little anxious, but I can do\r\nit. I can do what I need to do. So that I can go to the\r\ndoctor when I need to so that I can get the vaccines when I need\r\nto. When we work on the cycle approach, we bring on that\r\nanxiety.\r\n\r\n&nbsp;\r\n\r\nWe encourage the child we validate this is hard, but we\r\nknow you can do it, we ask them to face that fear, and then\r\ninstead of providing comfort, instead of providing comfort\r\nafter the child has left a situation or has avoided the situation, we\r\njump in and provide lots of reinforcement, and praise about\r\nbrave behavior. Right. So, “this was so hard for you, and you\r\nstill walked into that classroom, I’m so proud” and\r\nwhat, what the child learns in that situation, is that they’re\r\nactually able to handle more than they thought they\r\ncould, or if the worst possible situation that they thought was\r\ngoing to happen happened that they were still able to handle\r\nit and do it and over time by reinforcing that bravery, we see\r\nless and less impairment, related to anxiety and\r\npotentially over time, reduced anxiety in those situations.\r\n\r\n&nbsp;\r\n\r\nSo, from here I really wanted to\r\ngo over what we know are the evidence-based interventions for\r\nanxiety, problematic anxiety, or anxiety disorders. So, because I\r\nthink what we want to do is take the components that we know work\r\nfrom evidence-based therapy and talk about how we can apply\r\nthose to educational settings. So, we know that the evidence\r\nbased intervention for anxiety the most helpful thing is\r\ncognitive behavioral therapy and cognitive behavioral therapy\r\nhas, it looks at the common connection between thoughts,\r\nfeelings and behaviors. So for example, if you hear you’re\r\ngoing to an amusement park and you think I love roller\r\ncoasters, you’re going to feel really excited, and you’re going\r\nto ride them, and then all that’s gonna feed back to next\r\na time where you’re like, loved it. It was so much fun. Can’t\r\nwait to do it again but if you hear you’re going to an\r\namusement park and you think I’m going to die on a roller\r\ncoaster, you’re probably going to feel anxious, probably try to\r\navoid it, sit on the fence, and not go at all.\r\n\r\n&nbsp;\r\n\r\nI’m sick, I can’t go,\r\nright and all that’s going to feed back to the next time you\r\nhear you have to go to an amusement park, you’re like, the\r\nthe only reason I lived is that I never stepped foot on those\r\ngrounds, even though everybody else probably lived or you\r\nprobably wouldn’t be revisiting that amusement park, right? So,\r\nwe really want to help people tackle changing the cycle in\r\nthat thoughts, feelings behavior cycle in two places. That and\r\nthat is thoughts and behaviors. A lot of times, people come into\r\nour offices because they have problematic feelings. They feel\r\nreally anxious and that’s the problem but we actually don’t\r\ntarget that directly because our whole point is that I actually\r\nthat’s a really normal feeling, right? but so we want to change\r\nhow we think about situations that are kind of bringing about\r\nthat feeling of anxiety, and we want to change our behavioral\r\nspots what we do in those situations in order to reduce\r\nproblematic anxiety over the long run, and that changing the\r\nbehavior part is exactly what Jen was talking about that\r\nfacing your fear part and that in CBT is called exposure or\r\nfacing your fears and exposures that we know are the most\r\na critical piece of treating anxiety disorders, it’s the most\r\nthe important thing you can do.\r\n\r\n&nbsp;\r\n\r\nIt’s helped kids of kids approach\r\nanxiety-provoking situations, rather than avoid them so that\r\nthey can have new learning experiences and realize this\r\nisn’t as bad as I thought it was going to be and or I am much\r\nmore capable of handling this than I’ve ever given myself\r\ncredit for or the anxiety has given me credit for. So that’s,\r\nthat is the most evidence-based treatment and the most important\r\na component within that treatment. So, as we move on, we’ll be\r\ntalking about how you do exposures in a school setting. I\r\ndo want to take a very quick note to say, a lot of times,\r\nhistorically, treatments for anxiety have focused a lot on\r\nrelaxation strategies and more recently, our field has moved\r\naway from focusing on using relaxation strategies for\r\nseveral reasons.\r\n\r\n&nbsp;\r\n\r\nOne, and kind of, you know, really importantly\r\nto me is that it’s really a contradictory message to send\r\nkids, you know, we’re starting off by saying anxiety is totally\r\nnormal but calm your body down, you’re starting to feel anxious,\r\ntake those deep breaths, right? So, that’s a really confusing\r\nmessage and it starts to build and reinforce this fear of this,\r\nthose somatic symptoms that start to build when kids feel\r\nanxious. So, we want to avoid that contradictory message and\r\ninstead, help them build mindfulness of the situation.\r\nYou know, mindfulness not being synonymous directly with\r\nrelaxation, but just building awareness without judgment of\r\nlike, oh, there’s my stomach again. Oh, I’m doing that thing\r\nwhere my hands are shaking because I’m feeling nervous.\r\n\r\n&nbsp;\r\n\r\nSo,\r\nawareness without judgment of those feelings of anxiety\r\nwithout feeling like they have a responsibility to tamp it down\r\nto bring it down. Kendra Read: The other really\r\nthe important thing to note is that relaxation strategies have been\r\nshown to not contribute to two outcomes for problematic\r\nanxiety. So, these strategies are not helping kids in the long\r\nrun, so we no longer focus on them and I think that’s really\r\nimportant to note because I hear from a lot of schools, where\r\nthat is the primary focus of their anxiety intervention in\r\nthe school setting and I would rather than move more toward\r\nfocusing on how we do exposure in this situation. Jennifer Blossom: So, the other\r\na piece about empirically supported treatments for anxiety\r\nin school settings are around or I mean, not necessarily schools,\r\nbut empirically supported interventions for anxiety are the\r\nmedication side.\r\n\r\n&nbsp;\r\n\r\nSo, there are medications that we know are\r\nhelpful to youth experiencing problematic anxiety, primarily\r\nSSRIs, or Selective Serotonin Reuptake Inhibitors. It’s not\r\nrecommended that anxiety or that medication is the primary or\r\nthe only line of treatment for anxiety and we do know that\r\nyouth with CBT and medic who’ve received both CBT and medication\r\ntogether, respond to the best intervention.\r\n\r\n&nbsp;\r\n\r\nSo, oftentimes\r\nfamilies will start with CBT and then consider medications if\r\nthey’re not responding as we’d like because anxiety is just too\r\nhigh for them to benefit from treatment and then when we bring\r\nmeds on board, they seem to get a boost so they’re able to\r\nengage more in the treatment and benefits. So, that’s just\r\nsomething to note is that kids the research show that kids who get\r\nthat combined treatment does the best and kids who get just\r\nmedications or just therapy, do about even not statistically\r\ndifferent. All that’s better than a placebo pill and all\r\nthat’s way better than nothing.\r\n\r\n&nbsp;\r\n\r\nKendra Read: So, how do we\r\nsupport students with anxiety? and at the risk of sounding like\r\na broken record here, I just want to emphasize that the best\r\npractices to consider in a school setting are those that\r\nencourage approach instead of avoidance. So, I think what\r\nbecomes really, really hard about this is that it means that\r\nyou will experience anxiety. As we do exposures. We help\r\nfamilies bring on the anxiety. If we are not experiencing\r\nanxiety, anxiety during an exposure. We’ve picked the wrong\r\nexposure. We need to have that alarm kind of going off. So it\r\ncan have a moment to say, wait a minute, so my alarm is going\r\noff. Is there smoke, right? Is there something bad that’s\r\nhappening? What is the other evidence in the situation?\r\nRather than just evacuating, right? So, it’s hard to watch\r\nkids experience anxiety, it feels like we’re doing something\r\nwrong.\r\n\r\n&nbsp;\r\n\r\nIt goes against our instincts as parents, as\r\neducators, as compassionate people. It’s hard for Jen and I\r\nstill, even though we do this as a job. So, I think it’s just\r\nreally important to note that, this can feel\r\nuncomfortable for everybody. If I go back to the cycle that\r\nJen was talking about, you’ll notice that as adults come in,\r\nor peers come into rescue youth who are experiencing anxiety,\r\neverybody’s anxiety goes down. So, we are also reinforced for\r\nkids avoiding and we want to watch out for that trap because\r\nwe really need for them to have those new learning opportunities\r\nin situations where they experiencing anxiety. Jennifer Blossom: Kendra, I want\r\nto just jump in here because I noticed a question that popped\r\nup in the question and answer I think, is particularly\r\nrelevant when we think about encouraging approach and\r\nencouraging exposure and facing your fears. There was a question\r\nthat came in asked about how anxiety intersects with racial\r\nmicroaggressions or experiences racism and thinking about how\r\nIn those situations the alarm is picking up on a real threat to\r\nsomebody’s well-being or invalidating them and how\r\noftentimes when people are experiencing that they’re faced\r\nwith invalidation.\r\n\r\n&nbsp;\r\n\r\nThey’re told that it’s not a real threat. So\r\nI’m curious how you see that intersecting with the decisions\r\nto pursue exposure, what other options there might be? Absolutely. So, I think as I\r\nread that question, I think one thing that I want to think about\r\nthere is that we are not telling kids whether or not the threat\r\nis real and I think that’s where people tend to fall into that\r\nthe trap of gaslighting, right? because in for gaslighting\r\nsomebody is like, oh, this is a threat, this is a problem and\r\nother people are dismissive of it and say, “No, it’s not\r\nwhat are you talking about.” right? and when it comes to\r\nanxiety for you, we are not weighing in on whether something\r\nis threatening or not. Our job is to better help them be able\r\nto examine the evidence themselves. and sometimes we do\r\ncome to the conclusion jointly that actually, this is a\r\ndangerous situation.\r\n\r\n&nbsp;\r\n\r\n<img decoding=\"async\" src=\"https:\/\/images.pexels.com\/photos\/6505027\/pexels-photo-6505027.jpeg?auto=compress&amp;cs=tinysrgb&amp;h=650&amp;w=940\" \/>\r\n\r\nThere is a real threat here, in which case,\r\nthere’s a different intervention that needs to happen in order\r\nto, to ensure one’s safety, right, but I think that is\r\nreally key. We do not want to fall into the trap of weighing\r\nin and saying, This is no big deal. Just get over it. That is\r\nproblematic if there is a true threat and it is very\r\nproblematic, even if there is not a true threat, right,\r\nbecause it’s also super invalidating for people who are\r\nlike, actually, this is really hard for me, right? So either\r\nway, that’s problematic for us to say, this is no big deal.\r\nThis isn’t a problem. We want to – our goal is to help them\r\nevaluate the situation and really pull in more evidence. Kendra Read: One of the things\r\nthat Jen noted earlier is that youth and actually people with\r\nproblematic anxiety tends to interpret the information around\r\nthem in ways that are either extra picking up on threatening\r\nsituations or misinterpreting things, so we just want to be\r\ncareful and for into – for when we think about racial\r\nmicroaggressions, this may not be misinterpretations and often\r\nare not misinterpretations.\r\n\r\n&nbsp;\r\n\r\nSo, we want to be really fair and\r\nsaying, in laying out the evidence for what’s, what’s\r\nhappening. So, we can be really clear and not be having\r\nconversations where we’ve already arrived at a decision\r\nand we’re just teaching you, that’s where, or dismissive in\r\nsome way. Anything you would add to that,\r\nJen? Jennifer Blossom: I think, to\r\nthe point that you’re making one of the things that we think\r\nabout when approaching a situation that kiddo or family\r\nis describing as anxiety provoking, just kind of a\r\ndecision tree that we work through and initially you ask is\r\nthe fear realistic? So when I think about the question that\r\nwas asked, and the consequences of racism? The answer to that\r\nwould be yes. Right? The fear is realistic in that situation and\r\nwhen that situation arises, then we work on figuring out if is this\r\nsomething that the kiddo should know how to manage. If there are\r\nspecific things that we want them to know how to manage, then\r\nwe want to give them the skills to do that.\r\n\r\n&nbsp;\r\n\r\nSo, that’s kind of\r\nour initial decision point there and I think that that’s where we\r\nwant to be thoughtful of experience of racism, there’s\r\nthe very real reason why that would be immediately threatening to\r\nsomebody. So that’s, that’s the lens through which we would approach\r\nit. Yeah, totally agree. Totally\r\nagree. All right. So, in terms of what teachers can do,\r\ntruthfully, we want teachers to work with students and families\r\nas issues come up to encourage this idea of the approach\r\ninstead of avoidance.\r\n\r\n&nbsp;\r\n\r\nI think Jen and I have both read a lot\r\nof different, you know, IEP or 504 plans that have clauses in\r\nit that end up accidentally reinforcing avoidance and then\r\nour feedback is, is around how to turn this piece around so\r\nthat we’re actually moving toward the feared situation and\r\nlearning more adaptive responses, rather than\r\nencouraging avoidance, just in order to reduce that experience\r\nof anxiety and in many ways, we use a school-to-home note, which\r\nI’ll show you in a second. I’m sure many of you have used\r\nvariations of these notes for different behavioral concerns\r\nthat have come up in classrooms and the application of this to\r\nanxiety is not really so different but as you work with\r\nyouth with anxiety, I really think about how to be supportive\r\nand what it actually means to be supportive to somebody with\r\nanxiety and that means approaching situations with this\r\nan important combination of both validation and confidence.\r\n\r\n&nbsp;\r\n\r\nIt’s\r\nthe “I know it’s hard and I know you can do it.” combination.\r\nOftentimes, we see people fall into traps where they’re just,\r\nyou know, holding on to one of those two pieces of that\r\nequation. So either just validating like this is so hard\r\nand kind of getting stuck in the admiration of the difficulty, or\r\nholding on to the confidence piece of like, buck up, kid,\r\ncome on, you can do it, this is no big deal, and both of those\r\nalone are problematic and in terms of moving anxiety\r\nintervention forward, so we really need the combination of\r\nboth of those to build a supportive environment. Kendra Read: So just, you know,\r\nas I mentioned, this is an example of a school to home\r\nnote, as we apply it to anxiety and I would imagine, you know, I\r\nkind of took the framework from this directly from our ADHD\r\ndisruptive behaviors clinic, which shows you just how similar\r\nthe behavioral approaches can be.\r\n\r\n&nbsp;\r\n\r\nSo essentially, we just want\r\nto set a behavioral goal with a family around anxiety, obviously\r\nthis example is for a younger child. If you look at the smiley\r\nfaces and all of that, we want to set like a really specific,\r\nobservable, time-limited, you know, smart goal around an\r\nanxious anxiety or brave behavior. So for this child,\r\nthis example child, their goals are around, walking into class\r\nindependently, whispering to the teacher three times throughout\r\nthe day, and raising their hands during specials and then we want\r\nto make sure that we’re giving them opportunities to reach\r\nthese goals, tracking their progress and then finding\r\nhaving some way of coordinating that information back to parents\r\nso that they can or other caregivers, so they can really\r\nreward and reinforce their youth progress toward more brave\r\nversus avoidant behaviors in the school setting.\r\n\r\n&nbsp;\r\n\r\nJennifer Blossom: Kenda, if you\r\ncould just go back to the last slide there is relevant to one\r\nof the questions that came in asking about what age you can\r\nuse these principles with kids and, as noted, Kendra noted\r\nhere with the smiley faces, this is a school-to-home note that’s\r\nreally designed for, you know, kiddo as young as in\r\nkindergarten, what we know is that you can employ these\r\nstrategies, you can use these approaches with kids as young as\r\nthree, you know, oftentimes, we’re then talking more to the\r\nadults in the kid’s life. So, talking to the teachers, talking\r\nto the parents or other caregivers, that these skills\r\nand these strategies still work well, even with really young\r\nkids and that oftentimes, if we can catch them that early, we’re\r\njust setting them up for better success so that we can really\r\nleverage the strengths of that of those brains that are wired\r\nmore towards anxiety and help them meet their goals.\r\n\r\n&nbsp;\r\n\r\nAbsolutely, thanks, Jen and I\r\nwould say that actually our anxiety programs go down to age\r\ntwo at Seattle Children’s, and all the way up through age 18\r\nand beyond. I mean, not at Children’s but these principles\r\nare universal, regardless of age and there are just some\r\nadaptations in terms of exactly how you would apply this for\r\ndifferent age groups. So as Jen mentioned, for kids, I would\r\nsay roughly seven and younger, I’d be working much more with\r\nparents than with kids directly. That’s really different than\r\nthose than you know, it’s a different kind of story or\r\nopportunity for those of you in school settings. So we can talk\r\nmore about that in the question and answer period if you would\r\nlike.\r\n\r\n&nbsp;\r\n\r\nKendra Read: Okay, as I\r\nmentioned, in terms of supporting youth with anxiety in\r\nschool settings, we tend to see some common pitfalls, of tending\r\nmore toward accommodation versus approach in anxiety-provoking\r\nsituations in formalized 504\/IEP plans and I -accommodation is\r\nthis good word, bad word. In a school setting, it tends to have\r\na really positive connotation. In the anxiety world, it has a\r\nreally negative connotation. So, accommodation means essentially,\r\nyou know, being complicit with a child’s anxiety and helping them\r\navoid anxiety-provoking situations. So when Jen and I\r\ntalk about accommodating anxiety, we’re thinking of, you\r\nknow, parents who will never ever go out on a date night\r\nbecause their child doesn’t want to be alone or will never\r\neat at the same table as their kid because their child can’t\r\nhandle it, different things like that. So just want to note that\r\nwe use that word really differently across our different\r\nsettings but in general, it has it all goes back to that\r\napproach versus avoidance difference. So, a lot of problematic\r\npitfalls that we run into are things like these\r\ncontra-indicated accommodations, like extra time, not calling on\r\na student or allowing, directly allowing avoidance of certain\r\nspecific activities.\r\n\r\n&nbsp;\r\n\r\nExtra time is a really tricky one and I\r\nknow, we have a lot of conversations about this all the\r\ntime, it comes from a good place of wanting youth who may be\r\ndistracted by their anxiety to have more time to, you know,\r\nmanage that, when in reality, what tends to happen when we\r\ngive you extra time, when we give youth with anxiety extra\r\ntime is that they tend to spend that time worrying or engaging\r\nin more anxious behaviors more avoidance, so it ends up not\r\nbeing a helpful intervention in the end.\r\n\r\n&nbsp;\r\n\r\nMy internet connection is a\r\nlittle unstable. So, apologies if I’m breaking up. As I mentioned, things like\r\nrelaxation strategies, strategies, and journaling are\r\nnot bad things to do, but they’re also not helpful. So we\r\nwould not want those to be considered the primary\r\ninterventions for anxiety in any setting and really, it also\r\ncomes down to really requiring this partnership from all\r\nparties, from teachers, specialists, and caregivers, so that\r\nthere is a clear plan for what we’re working on and how we’re\r\ngoing to be approaching this in a situation that is supportive\r\nto the child, so involving that combination of confidence and\r\nvalidation. The “I know it’s hard, and I know you can do it,\r\nand here’s what we’re going to work on” and I think sometimes\r\nwe’ve, you know, heard from school-based personnel who feel\r\nkind of reticent to approach exposures in their setting thing\r\nlike, “Well, I’m not a therapist, maybe I shouldn’t be\r\ndoing this.” but in reality, we all have ownership and agency in\r\nthis in this behavior change and this change in problem\r\nproblematic anxiety, even if you’re not a quote-unquote\r\ntherapist or psychologist, we need youth to practice exposures\r\nin all settings in order for this to generalize to all\r\nsettings.\r\n\r\n&nbsp;\r\n\r\nSo, it’s really important that these things are\r\npracticed in the school setting as well. Okay, Jen, come back on for our\r\nQ&amp;A. Jennifer Blossom: So, we have\r\nbeen working with a lot of people internally at Seattle\r\nChildren’s, as Kendra mentioned, I was there. The working\r\nremotely, as I’m sure many of you are just over a month ago,\r\nas well as many, many people throughout the greater WWAMI\r\nregion and there’s been a few common questions that have come\r\nup that we opted to highlight here and I’m also aware that\r\nthere have been a number of questions that may have been\r\ncoming in over the Q&amp;A section. So, thank you so much for\r\nsending those in, please feel free to continue sending those. So, my thought is that we’ll\r\njust jump right into the question and answer questions\r\nthat are coming in. So I think one, one question in which I’m\r\nseeing kind of a few iterations are going back to this idea of\r\nthe 504 plan and how we develop a 504 plan that acknowledges and\r\nintegrates the evidence-based recommendations for anxiety and\r\none of the ways that I think about that is really getting\r\nconcrete on some of the goals in the school setting and instead\r\nof providing, providing kind of a blanket statement, like more\r\ntime to finish something is figuring out where the child\r\ncurrently, what are they currently able to do, and where\r\ndo we want them to be? and then how do we find those steps to\r\nget them towards that ultimate goal? So, how can we phrase\r\nsomething that allows them to take steps towards participating\r\nin the class? You know, being able to complete that assignment\r\nwhen they’re asked to, in particular, think about a\r\na child who might have difficulty speaking in the classroom, one\r\nof the questions that came in was relevant to whether we can\r\napply these principles to selective mutism and the answer\r\nis certainly yes, Kendra and I do this a lot.\r\n\r\n&nbsp;\r\n\r\nKendra has a\r\nspecialty clinic that specifically works with families\r\nand helping kids learn how to speak in settings that they feel\r\nuncomfortable doing so. So, thinking about a 504 plan in\r\nparticular with a selective mutism kind of focus, if you\r\nhave a child who is completely nonverbal, who is not able to\r\nspeak out in the classroom, oftentimes what happens is we\r\nfind that teachers are jumping in or providing answers for\r\nthem. Other students might recognize again, well-meaning\r\ncompassionate people jumping in providing answers for them, what\r\nwe want to do is help, help encourage the child to start to\r\nbe able to answer the question themselves. So, a 504 plan might\r\nsay something like – initially might say something like respond\r\nto nonverbal. So, being able to shake your head yes or no,\r\nthat’s still providing some kind of information in engaging in\r\nsome kind of communication.\r\n\r\n&nbsp;\r\n\r\nIf there’s the complete absence of\r\ncommunication, then it might be being able to whisper an answer\r\nto the teacher. So we can think about what is the\r\nsteps and how can we integrate them into the 504 plan? So that\r\nwe’re getting the student and supporting them to\r\nbe able to answer a question in the middle class when, when\r\nother students’ peers are there. I would just add that, you know,\r\nI know that 504 plans often we can’t change them as quickly as\r\nwe would like to change behavioral goals. So, sometimes\r\nI encourage schools to phrase a 504 accommodation or an IEP\r\nthe goal, you know, honestly, IEP s with their, like the goal\r\nframework kind of lends themselves a little bit more to\r\nthis idea but the idea that we’re going to gradually be\r\napproaching and, you know, moving from totally not speaking\r\nto respond, you know, 80% of the time to the teacher in at\r\nleast a voiced response. So, you know, if you put your hand on\r\nyour throat, you feel your hand vibrating, right, and we just\r\nstate in the plan that we’ll be identifying weekly goals.\r\nThe teacher will be providing, enough opportunities for the child\r\nto reach their goal, and we’ll be providing support for the\r\nchild to try again and just kind of discuss what the\r\ncommunication plan from school to home looks like because that\r\ncan – that looks different for every school that I’ve worked\r\nwith, depending on what’s feasible.\r\n\r\n&nbsp;\r\n\r\nThere’s no one exact\r\nthe right way to do it and that gives us a little bit more\r\nflexibility to work on those successive shaping steps of\r\nmoving from, you know, just, you know, shaking our head, no, to\r\nmouthing no, to then whispering, to then talking. So, the\r\nexposures in school said that’s one example. Kendra Read: There are exposures\r\nin school settings that can look so many different ways. It just\r\nreally depends on the different situation. So sometimes we are,\r\nyou know, as the adults in the situation, setting up some\r\nsocial opportunities, for one child to talk to another,\r\nsometimes it’s like, okay, just so you know, I’m going to call\r\non you during this part of the day or sometimes I – a lot of\r\nkids have, are so anxious about making any mistake or they redo\r\nand redo and redo their work or they, you know that, or there\r\nwork has to be perfectly neat.\r\n\r\n&nbsp;\r\n\r\nSo, then we have them turn in\r\nwork that they finished with their non-dominant hand or they\r\ndefinitely made a mistake in there on purpose and they’re\r\ngoing to turn it in and see what is so bad about this, what is\r\nthe worst thing that happens when I turn in a mistake? So\r\nthere are all sorts of different exposures that you do in a\r\nschool setting and it just so depends on the specific fears\r\nthat the child is endorsing. Okay, so let’s, there was a\r\nthe question at the top about PTSD and anxiety, and whether or not\r\nthey can co-occur or would not be concurrently diagnosed,\r\nand absolutely PTSD and anxiety disorders can co-occur 100% they\r\ncan be diagnosed at the same time, we just want to be careful\r\nthat we’re not to double counting the same symptoms and\r\nwe want to be clear that not every anxiety disorder, you\r\nknow, anxiety disorders don’t come about because someone\r\ndefinitely experienced a traumatic event.\r\n\r\n&nbsp;\r\n\r\nRight. You\r\nknow, fear of spiders doesn’t mean they’ve definitely\r\nexperienced a horrible situation with spiders, for\r\nexample, or for selective mutism. This is one of the big\r\nones, where there’s this myth that they’ve experienced a\r\ntraumatic event and that’s why they’re not speaking. Not true,\r\nbut for PTSD, you know, that is like one of the only DSM\r\ndiagnoses where we know exactly that there was an event that\r\nprecipitated the onset of this disorder. So, it is common for\r\nyouth who have are just get like anxious. Pre-traumatic events say\r\nthey have social anxiety. A traumatic event happens they get\r\nin a really bad car accident and they can’t get back in the car\r\nanymore.\r\n\r\n&nbsp;\r\n\r\nThey have true PTSD related to the car accident, and\r\nthey have social anxiety. So these two things were not\r\ndouble counting, but they are happening at the same time. Okay, Jen, I’ll let you pick\r\none. Jennifer Blossom: So, I’m seeing\r\na lot of questions and just getting some clarification\r\naround skill building and why we are recommending against using\r\nstrategies like relaxation or journaling and so in particular,\r\njust thinking about why and Kendra talks about relaxation in\r\nterms of the message that sends or the threat of the physical\r\nexperience of anxiety and the general idea is that we want\r\nkids to have that physical experience of anxiety and know\r\nthat does not automatically mean that the worst is going to\r\nhappen or that they’re not able to handle those feelings.\r\nThere are many situations we’re experiencing that physical\r\nanxieties, really helpful.\r\n\r\n&nbsp;\r\n\r\nIn the beginning, Kendra was\r\ntalking about, you know, if you’re preparing, if you have a\r\ntest on Friday, and I have no anxiety about that, then I’m\r\nprobably outside playing with my dogs not sitting – in front of a\r\nbook trying to understand the material, right? In some ways,\r\nanxiety is really helpful and adaptive. What can become\r\nproblematic is when anxiety is so high about the test that I\r\ncan’t even think about opening the book, because I’m so worried\r\nthat I’m not going to be able, to learn what I need to\r\nlearn. So, we really want to help, help kids and help\r\nstudents figure out that I can notice that I’m experiencing\r\nsome of that anxiety but I can still do the things I need\r\nto do. I feel anxious about the test but I’m still able to sit\r\ndown and focus on the material and study the way that I need\r\nto.\r\n\r\n&nbsp;\r\n\r\nWhen we tell them, “Oh you\r\nnotice that your heart is racing or you notice that your muscles\r\nfeel tense. Let’s take a moment and sit back and spend some\r\ntime breathing.”. What we’re doing is we’re sending the\r\nthe message that bad anxiety is really something to be worried\r\nabout or scary that they aren’t able to handle those feelings\r\nand then what happens is when they walk into class to take\r\nthat test and they’re feeling those same feelings, they think\r\nthey can’t handle it.\r\n\r\n&nbsp;\r\n\r\nSo, we want them to do is practice\r\nhandling and practice tolerating. When I think about a\r\nstrategy, like journaling, one of the things that I think about\r\nis that, you know, anxious brains again, they do a really\r\ngood job of thinking. They’re constantly thinking, they’re\r\nconstantly coming up with the what ifs, what if, what if,\r\nthat’s what gets in the way of sleep, that’s what gets in the\r\nway of paying attention in class. So, if we ask somebody to\r\nwrite down all of those thoughts, and those what-ifs,\r\nwe’re not necessarily giving them the skills or the\r\nstrategies to still be able to do what they need to do and in\r\nIn some cases, we may be letting those what-ifs allow for\r\navoidance because now they’re writing about those what ifs\r\ninstead of doing that thing, that’s hard and this is\r\nsomething Kendra and I have just recently started talking about\r\nkind of how can we rephrase and reframe thinking about exposure\r\nand practice based on your fear as a coping skill.\r\n\r\n&nbsp;\r\n\r\nI think\r\nthat’s one of the things that can get lost or is confusing is\r\nthat when we think about facing your fears that we’re ignoring\r\nthat, that is still is learning a coping skill because what I’m\r\nlearning is that when I feel anxious, I can still do what I\r\nneed to do. When I feel anxious, I can still pick up that book\r\nand sit down and read the first paragraph when I feel anxious, I\r\ncan still open my computer to start writing that essay. That’s\r\ncoping skill and the way that you build that coping skills by\r\ntaking those smaller steps until you’re able to do that thing\r\nthat’s really hard. What would you add to that? Kendra Read: I would just want\r\nto add about there’s this piece that we call expectancy\r\nviolations. We also want kids to have those learning experiences,\r\nto see that the thing that I expect to happen, really doesn’t\r\nalways happen or even if it does, it’s not as bad as my\r\nthe brain is assuming it is.\r\n\r\n&nbsp;\r\n\r\nThis is the coping skill and I think a\r\nlot of people get wrapped up in the toolbox, and I need to give\r\nkids all these other things to do when they feel anxious but\r\nthe thing we need them to do is to practice staying in the\r\nsituation, and quote-unquote, riding the wave. So, I’m seeing\r\nsome other questions about like, what do we do in situations?\r\nLike when a kid is anxious, what do I do? and really, when that\r\nhappens for me, like all day long, I just want to – I sit\r\nwith them and I say, okay, so you’re experiencing anxiety,\r\nwhat’s happening in your body right now? How are you feeling\r\nit? What’s your number? and so I want them to practice rating on\r\na scale from say, zero to 10, how anxious they feel. So,\r\nthat’s one way that they can build some mindfulness of saying\r\nlike, okay, I’m at like a seven right now and I’m noticing that\r\nmy stomach really hurts and that’s like, okay, so what are\r\nyou thinking at this moment? I’m thinking, I’m totally going to\r\nfail this presentation, I’m going to bomb it, everybody’s\r\ngonna laugh, etc, etc.\r\n\r\n&nbsp;\r\n\r\nAnd say like, okay, well what is\r\nhappening in this situation is anybody laughing? Like, well, I\r\ncan’t hear that anybody’s laughing. So maybe they’re not.\r\nMaybe they are in their own homes, but nobody’s mics are on\r\neverybody’s automatically muted. So, if I don’t know, if they’re\r\nlaughing, how will it ever change my life? So, just some\r\nthinking through some different situations like that to think\r\nthrough that expectancy violation, violating what we\r\nexpect – the anxious anticipation of what’s going to\r\nhappen. Okay. Jennifer Blossom: I see, I think\r\nwe, I hope we answered some of the questions about the Final\r\nFour Planner IEP is about how we can approach it. I see some\r\nquestions about like homeschooling and one on one\r\nthe school supports, and how do we help families understand this\r\nand man, is it hard, you know, I just want to validate that like,\r\nas much as we do this for a job, we don’t convince every family\r\nthat this is the important way to go and we really try to, to\r\nbring them in and discuss how, you know, you know, one of the\r\nother programs run at Children’s as a school avoidance program,\r\nwhich is not running this fall because most schools are remote.\r\nSo, there’s no brick-and-mortar school to avoid for most of our\r\nstudents, but what I tend to see is that the families that pull\r\nout into homeschooling because of anxiety, those kids tend to\r\nhave really escalating very problematic anxiety, very\r\ninterfering anxiety that continues for years.\r\n\r\n&nbsp;\r\n\r\nSo it does\r\nbecome a really big problem and so I just want to describe that\r\nthe trajectory that I see for them before they make that decision\r\nand be very clear that homeschooling online homeschool,\r\nThat like we’re all pigeonholed into that right now\r\nbecause of COVID or most of us are, so we’re not making that\r\ndecision because of anxiety but when we do make that decision\r\nbecause anxiety is contraindicated. It is\r\nproblematic in terms of changing this cycle. So it’s very, very\r\nmuch not recommended. ] Kendra Read: Jen, do you have a\r\nthe question you wanna? Jennifer Blossom: Yeah, I was\r\njust searching through the Q&amp;A and I see a lot of questions and\r\nthinking about how we can adapt some of these recommendations\r\nand approaches, particularly for older students.\r\n\r\n&nbsp;\r\n\r\nSo, thinking\r\nabout high school students, and thinking about it, there were some\r\ncomments about the student kind of report card can be more\r\nchallenging with a high school student and I think, you know,\r\nin some ways, really just kind of working, working with the\r\nstudent and figuring out kind of what’s going on for them at\r\nschool and at home. I think one of the things that we know that\r\ncomes up commonly when working with families is that oftentimes\r\nparents are not necessarily as attuned to some of the things\r\nthat may be coming up at school for their kiddos, Kendra and I\r\nhave worked with families where, you know, after kind of years of\r\nschool difficulty and some anxious avoidance in high\r\nschool, that’s when the parent found out about kind of what was\r\ngoing on.\r\n\r\n&nbsp;\r\n\r\nSo I think, really making sure to work as a team.\r\nIn some capacity, I think something that can happen\r\ndevelopmentally when working with younger kids that there’s a\r\ntendency to exclude them completely as if they can’t\r\nunderstand these principles. When, as Kendra says two and\r\nthree-year-olds, even if they’re not coming in for the treatment\r\nthe session, they get the idea that was brave, awesome job, right?\r\nSo we can still be working with them directly and integrating\r\nthese strategies with really young kids and in the same way\r\nwhen you’re working with high school students, just as you\r\nwould reach out to parents for, other types of concerns, if\r\nyou were seeing chronic absenteeism or if there was a\r\nlot of missed work but bringing parents in to support high\r\nschool students are a really helpful and a great opportunity\r\ntoo as much alignment as we can get with practicing some of\r\nthese strategies both in and outside of school, I think can\r\nbe really helpful and effective and when we think about some of\r\nthe types of anxiety that we see, more commonly, social\r\nanxiety is much more common in adolescence.\r\n\r\n&nbsp;\r\n\r\nBy very definition,\r\nadolescence is a time period where we are more prone to peer\r\nevaluation and judgments and that’s an opportunity that’s\r\nripe for the onset of social anxiety and fears, and really\r\ncoming up with creative ways to practice bringing on that\r\nanxiety, like answering a question, just wrong,\r\npurposefully making a mistake or having a long pause in the\r\nmiddle of a presentation. Wearing a t-shirt to a zoom\r\nmeeting with a huge stain across the front, you know, thinking\r\nabout ways that you can help bring that on because one of the\r\nthings I know from working with lots and lots of teams with\r\nsocial anxiety is that it’s really hard for them to be in\r\nthese situations and they really want those peer relationships\r\nand connections. So, figuring out how we can work with their\r\nown goals and use their own motivation to help them take\r\nthose steps, towards doing the things that they want\r\nto do.\r\n\r\n&nbsp;\r\n\r\nWhat would you add to that\r\nKendra? Kendra Read: You know, I’m not\r\nsure that there’s a whole lot more I would add to that, Jen. You know, one of the things that\r\nI’m noticing a lot of the questions are just like, yes,\r\nbut how do we do exposures? Yeah, how does what does it look\r\nlike? and so I just wanted to give a couple of more examples\r\nfor different kinds of areas that kids are anxious, about and how we can\r\ndo that in a school setting. So, we’ve talked a little bit about\r\nhow to set up, you know, brave talking exposures for selective\r\nmutism. So, really, it’s setting a goal for Okay, so today we’re\r\ngoing to whisper three times and so I’m going to give three\r\nopportunities for you to whisper with me one on one, or I’m going\r\nto get five opportunities and your goal is to do three out of\r\nfive. So, I’m going to come by your desk and say, what was the\r\nanswer to number four? and you’re going to tell me to\r\npractice whispering to me the answer to number four.\r\n\r\n&nbsp;\r\n\r\nA lot of\r\ntimes as Jen was noting, we need some kid involvement in some\r\nyouth involvement in setting this goal. We need them to know\r\nwhat the goal is, so that they can practice reaching it and\r\nthey can, we can give them some forced choice of like, okay, so\r\nit sounds like from your parents that, you know, we’re going to\r\nwork on, you know, saying hi to a peer. So do you want to\r\npractice that? This time of day or this time of day? Do you want\r\nto do that with you know, you sit next to Johnny and Susie, do\r\nyou want to practice with Johnny or Susie first and I’ll be\r\nlistening. So just some, some different examples like that.\r\nPracticing making mistakes, practicing, turning in imperfect\r\nwork.\r\n\r\n&nbsp;\r\n\r\nI think I’ve said those already. Jen, do you have any other\r\nspecific exposure examples? I don’t want to overcomplicate\r\nreally what exposure is it really is simple. So like I’m\r\ntelling a kid, okay, let’s go do some trivia with some people\r\ndown the hall. Here’s a list of trivia questions I’m going to\r\ngive them I want you to get two of those wrong and then we just\r\ngo do it.\r\n\r\n&nbsp;\r\n\r\nIt’s really as simple as that. Jennifer Blossom: Yeah, I think\r\none of the things that come to mind, particularly when we think\r\nabout the context of COVID-19, is that everyone is managing a\r\nlot of uncertainty right now and not being able to tolerate\r\nuncertainty is a hallmark of anxiety, right? Anxious brains\r\nwant to plan they want to know they want to be able to\r\nanticipate what’s going to come up, that’s where worry comes\r\nfrom. Worry is a maladaptive coping strategy that if I think\r\nabout something enough, or if I think about all the possible\r\noutcomes, then I’ll be prepared to handle them. So, when we\r\nthink about the current situation, in particular for\r\nkids, maybe who didn’t have, didn’t have much anxiety before\r\nwasn’t really getting in the way but right now with COVID and\r\neverything and that there’s been a lot of back and forth, of not\r\nknowing what to expect for school and as they get used to\r\nthe startup school still having, you know, trying to navigate\r\nwhat’s going to be expected in terms of grades or things like\r\nthat is really opening up opportunities to practice\r\ntolerating uncertainty.\r\n\r\n&nbsp;\r\n\r\nSo in going with the example that\r\nKendra had just had, of asking them to go answer questions that\r\nthey’re not going to know what the questions are in advance and\r\nbeing prepared to answer questions that they’re\r\nunexpected for, or having, you know, coming up with a plan\r\nthat’s not shared and advanced so that they can they can\r\ntolerate being in a situation where they weren’t able to think\r\nabout and plan for really thinking about what are ways\r\nthat we can think about some of the uncertainty that is typical\r\nof everyday life, COVID-19 is causing a lot of stress and a\r\na lot of realistic anxiety for people, particularly when we\r\nthink about the disproportionality of COVID risk\r\nand consequences of COVID we know that there are going to be\r\nsignificant mental health concerns for particularly\r\ncommunities of color. So we want to think about, what are the\r\nthings happening right now? How can we, again, assess,\r\nunderstand the full context for this kiddo? What are things that\r\nare coming up? What are the objective risks that they might\r\nbe facing? and then what are ways that this anxiety might be\r\ncreeping in that it’s getting in the way of them being able to do\r\nthe things that they are able to do right now that they are able\r\nto participate in staples that are going to keep them connected\r\nto some of those, those social supports? and how can we\r\nleverage some of the strengths that they might have currently,\r\ncertainly, Zoom meetings, Zoom parties, and Zoom classrooms are not\r\nthe ideal setting for many people, but there are ways that\r\nwe can still encourage that participation and get creative\r\nwith getting kids involved.\r\n\r\n&nbsp;\r\n\r\nSo I think, you know, the uncertainty\r\npiece is one that I think comes up a lot. In particular, I think\r\nagain, we think of that as the – perhaps more commonly with older\r\nkids, but certainly right now with COVID, because it’s just a\r\nprime situation for us all to be thinking about it. So, think\r\nof just different creative ways that you can help kids\r\nexperience situations that they’re not able to prepare for. I’m curious Kendra, have some\r\nother ideas that you might have about thinking in a new school\r\ncontext or particularly in the online school context? What are\r\nways to introduce uncertainty that would allow students to be\r\nable to better tolerate that? Well, I think there are just a\r\nlot of natural opportunities that come up that we can\r\ncapitalize on.\r\n\r\n&nbsp;\r\n\r\nSometimes I set up like more contrived\r\nsituations of like, okay, we’re going to do exposure and\r\nyou’re not going to know what it is or sometime this weekend,\r\nyour parents are going to change their plans. You don’t know when\r\nyou don’t know how you don’t know what it is. So different\r\nthings like that and their job is to tolerate that meaning to\r\nkeep their behavior within you know, appropriately behavioral\r\nbounds, they can still experience anxiety and\r\nfrustration and so I would just note like, there are so many\r\nnatural opportunities coming up for us to tolerate uncertainty\r\nevery day with COVID and remote learning, and will we have\r\nInternet connection? and will this work and, and all the other\r\nthings happening around us like, the wildfires, like there’s so\r\nmuch uncertainty, and so much we don’t know and, and just sitting\r\nin that place of like, what if we don’t know? What if there’s\r\nno answer? and that feels really anxiety-provoking, but we just\r\nneed to sit in that place.\r\n\r\n&nbsp;\r\n\r\nSo I see a lot of questions like,\r\nbut what do I do during the exposure? What do I say to them?\r\nand I really, especially when they’re starting to get really\r\nanxious, and I really just say I want them to check in with them\r\njust repeatedly to say like, hey, what number you at, what do\r\nyou – what are you doing? I know this is hard, but I know you can\r\ndo this. So just keep going back to that supportive statement of\r\nI know this is how I think you can do it. I know you can stick\r\nwith this situation, and then point out all the little ways\r\nthat they are already doing it. Like, life is uncertain, and you\r\nsurvived every moment of uncertainty up until today. So,\r\nis there any evidence that you’re not going to survive the\r\nuncertainty hereafter? No, we have no evidence that that’s\r\ntrue. Might we have evidence that the opposite is true? So\r\nthe truth is, we all survive uncertainty every minute of the\r\nday.\r\n\r\n&nbsp;\r\n\r\nI don’t know what, I don’t know actually what’s going to\r\nhappen in the next hour of my life. I have some things that\r\nmight, you know, help me predict that but I don’t actually know.\r\nSo I think just pointing out all these little successes that they\r\nmay not be giving themselves credit for during the exposure\r\nof like, you’re still here, you’re doing it like we’re just\r\ngoing to ride this wave. You don’t have to do anything to\r\nmake this feeling come down. You are not responsible for that. It\r\njust will. It is what it is. So we just need to stay in this\r\nsituation. So I really want everybody to release themselves\r\nand have the responsibility to make themselves calm down, but it’s\r\nnobody’s responsibility. It’s just what goes up will come down and\r\nwe’re just going to ride that wave. If you think about it\r\nlike you’re in the ocean and like the waves are coming and\r\nyou’re trying to push them back, like calm down waves, like\r\nthey’re just gonna knock you over, right? So instead if we\r\nride that wave, and we accepted remindful of it, and we’re like,\r\nokay, like, how hard is this? What number is this? Okay, this\r\nis a really big wave, oh, I’m going up really high.\r\n\r\n&nbsp;\r\n\r\nWow I’m\r\ngoing really fast into the shore, right? We just want to\r\nobserve what’s happening. We’re more likely to experience\r\nimprovement and greater success in the situation than if we’re\r\nlike, must calm down, got to force this down. So, I really\r\nwant to let go of that sentence. Kendra Read: I’m jumping around\r\na lot, but I’m feeling the Jen, what did you want to\r\nadd? pressure of time. So, I just\r\nwant to note that there are some Jennifer Blossom: Yeah, so I\r\nthink just to kind of end and questions in there around\r\npartnering with PCPs and other medical professionals. I want to\r\nsay that Jen, and I do have an ongoing connection with PAL or the\r\nPhysician Access Line here in the Northwest and we are creating\u00a0and together\u00a0 we call laboratory Nat Young Bluth in into\r\nconnection for primary care for anxiety and OCD. So that is forthcoming\r\nfor those of you who are school nurses, I just want\r\nyour job to be is to help to connect some of\r\nthe somatic feelings that address some of the questions\r\nthat come up with how to help how we’re experiencing anxiety\r\nand being a part of the goal setting with others around like may-\r\nbe their goal is to not check in at the nurse so much, which me\r\nannoys that they’re avoiding the classroom, potentially\r\navoiding the thing that’s anxiety-provoking, and potentially\r\ntrying to just exit altogether.\r\n\r\n&nbsp;\r\n\r\nThat’s less so happens\r\nin the times of COVID but just in terms of like what we typically\r\nsee. support when kids are in the\r\nthick of the anxiety, while anxious brains do a really good\r\nthe job of being detail-oriented, those details tend towards the\r\nthreat. So, sitting with them and commenting on what they are\r\ndoing while they’re feeling anxious is really a way\r\nan effective way to be supportive of students and help get them\r\nengaged in exposure situations. So, if you notice that they are\r\nfeeling anxious, or they share with you that they’re feeling\r\nanxious, commenting on what they’re able to do in that\r\nmoment, finding what it, finding, even if it’s a small\r\nstep, something that they are doing at that moment that is\r\nhelping them be effective in whatever the strategy is.\r\n\r\n&nbsp;\r\n\r\nSo,\r\nthinking back about participating in a zoom class,\r\nif a student went from not participating at all to using\r\nthe chat, jump on that, that’s the first step towards talking\r\nin class and joining via video and joining the class. So, an\r\nan effective strategy is really focused on what they’re doing\r\nwell because at that moment, it’s hard for them to see it and\r\nthat’s going to be a really rewarding opportunity for you\r\nand for them to be able to continue taking these steps\r\ntowards facing their fears.\r\n\r\n&nbsp;\r\n\r\nThis has been really great. I’ve\r\nso appreciated all the questions that you’ve raised. Kendra, and\r\nI love doing these types of presentations and as she’s noted\r\nmultiple times, it’s a bit of a different situation not\r\nseeing any faces, but we’ve really appreciated the\r\nengagement and so looking forward to working with you and\r\nmeeting with you again, in just a few weeks, and with that, I’ll\r\nturn it, Kelcey. Kelcey Schmitz: All right, thank\r\nyou. A huge thanks to Kendra and to Jen for their presentation\r\ntoday. I know for me, personally and professionally, I couldn’t\r\ntake notes fast enough and for those of you who have\r\nparticipated today, just a reminder that we will have the\r\nrecording up for you who like me will probably be watching this\r\nand sharing it with other people who need to see this.\r\n\r\n&nbsp;\r\n\r\nOn the next slide, it’s just a\r\na reminder of how you can get in touch with us. We have many\r\nopportunities for you to participate in live webinars, we\r\nhave many recorded School Mental Health webinars that you can\r\ncheck out. We have a newsletter, that we send out monthly\r\nnewsletters and event blast to you. So, we just highly\r\nencourage you to connect with us, especially if you’re in our\r\nNorthwest region but you’re also welcome outside of our region,\r\nas well as reaching out to your local regional center to get\r\nmore support and then our last slide is to thank you and a\r\na reminder that part two, managing anxiety during COVID-19 will\r\nhappen on October 20.\r\n\r\n&nbsp;\r\n\r\nSo we hope that you will register for that.\r\nI will say this, this session sold out so if you haven’t\r\nregistered already for session two, it might be a good\r\nopportunity for you to take care of that now. We know we still\r\nhave lots of questions in the Q&amp;A and we will carry those\r\nforward to future events that we have with Kendra and Jen. So,\r\nhuge thanks to Kendra and Jen. Huge thanks to our Northwest\r\nSchool Mental Health team that is been working behind the\r\nscenes to help with the chat and the Q&amp;A and just keep this\r\nwebinar running smoothly with that, we will officially\r\nend the webinar but keep the room open for just a few\r\nmoments. So, you can take down those links and complete the\r\nevaluation but at this time, I want to thank everyone and we\r\nwill end the webinar.\r\n\r\n<a href=\"https:\/\/www.youtube.com\/watch?v=kHqPWVGRzBs\" target=\"_blank\" rel=\"noopener\">As found on YouTube<\/a>\r\n\r\n<a href=\"https:\/\/685955rp8zuj0r6-wa06xakucy.hop.clickbank.net\/\">FUNNELIFY is a new, first-of-its-kind, groundbreaking app \u27af\u27b1 \u27ab \u27aa\u27ac which finally allows you to deliver separately auto-generated mobile pages with unheard before lighting speed. Plus it skyrockets \u27af\u27b1 \u27ab \u27aa\u27ac After using the Funnelify product, you will recognize a great increase in your leads and sales. This product shows methods to boost your traffic without using any shortcuts. The best thing is that you can build unlimited \u2026<\/a>","protected":false},"excerpt":{"rendered":"<p>&nbsp; Kelcey Schmitz: We want to welcome you to our presentation today which is part of a series on anxiety and the return to school. My name is Kelcey Schmitz and I work for the University of Washington at the School Mental Health Assessment, Research and Training Center or SMART Center, as the School Mental &hellip; <a href=\"https:\/\/effectsofanxiety.net\/archives\/150054\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Part 1: Anxiety &#038; School – Identifying Anxiety and What To Do About It<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":150052,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[1,5,4771,111,7,3438,365,988],"tags":[696,59763,42366,59725,59724,59723,6369,4172],"class_list":["post-150054","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anxiety","category-causes-and-prevention","category-disasters-accidents","category-diy","category-getting-help","category-ice-skating","category-music","category-news","tag-anxiety","tag-back-to-school-2","tag-covid-19","tag-remote-learning","tag-return-to-school","tag-school-mental-health","tag-students","tag-teachers"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/effectsofanxiety.net\/wp-content\/uploads\/2022\/08\/htmlF_IMG_6306c31744b58.jpg","_links":{"self":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150054"}],"collection":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/comments?post=150054"}],"version-history":[{"count":3,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150054\/revisions"}],"predecessor-version":[{"id":150067,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150054\/revisions\/150067"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media\/150052"}],"wp:attachment":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media?parent=150054"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/categories?post=150054"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/tags?post=150054"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}