CDC Concussion Fact Sheet

Concussions are arguably the most commonly referenced form of Traumatic Brain Injury. The CDC published a PDF Fact Sheet summarizing information about concussions, symptoms, and some tips for improvement. This fact sheet would be an ideal resource to hand to parents or a teacher of a student who has recently suffered a concussion, whether at home, during a sport, or on the playground.

The tips listed, for quick reference, are:

  • Get plenty of sleep at night and rest during the day
  • Avoid physically demanding or high concentration activities
  • Ask your doctor about your limits for dangerous activities (e.g. driving, biking)
  • Do not drink alcohol

http://www.cdc.gov/traumaticbraininjury/pdf/fact_sheet_concusstbi-a.pdf 

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Evidence-Based Screening Tools for Substance Abuse

DrugAbuse.gov has compiled a list of no-cost and easily available screening tools for drug and alcohol abuse. This list is relatively frequently updated (last update was Sept. ’15) and includes direct links to the screening measures, as well as a mark as to whether it is appropriate for adolescents and whether it is self- or practitioner-administered.

These tools include prescreen and full measures:

  • NIDA Drug Use Screening Tool (Prescreen and Full)
  • CRAFFT (Prescreen and Full)
  • Alcohol Use Disorders Identification Test (AUDIT) (Prescreen and Full)
  • Opioid Risk Tool (Prescreen)
  • CAGE and CAGE-AID (Adapted to Include Drugs) (Full)
  • Drug Abuse Screen Test (DAST-10) (Full)
  • DAST-20: Adolescent version (Full)

This chart is available at:

https://www.drugabuse.gov/nidamed-medical-health-professionals/tool-resources-your-practice/screening-assessment-drug-testing-resources/chart-evidence-based-screening-tools-adults

 

Evidence-Based Approaches to Adolescent Substance Use Disorders

Though as school psychologists and teachers, we will likely not be undergoing a large amount of actual treatment for substance abuse disorders, it is important to know what the evidence-based treatments and interventions are.

The National Quality Forum published a document (link below) called “Evidence Based Treatment Practices for Substance Use Disorders” outlining recommended practices, background, and much more, which may serve as a starting point for research on the topic.

http://www.apa.org/divisions/div50/doc/Evidence_-_Based_Treatment_Practices_for_Substance_Use_Disorders.pdf 

This document recommends that treatment for SUDs is part of a continuum of services that includes screening and assessment, active treatment, and continued engagement as part of a long-term plan

Important recommendations included in this document include:

  • Screening: whenever there is an opportunity
  • Initial Brief Intervention: and then referral as needed
  • Treatment Plans: written recommendations for further care and the quantity/time/etc of the service
  • Psychosocial interventions: motivational interviewing, motivational enhancement therapy, CBT, structured family/couples therapy, contingency management, community reinforcement therapy, and/or 12 step facilitation therapy
  • Pharmacotherapy: in addition to psychosocial, if needed for withdrawal/detox
  • Patient Engagement and Retention: both of which are crucial
  • Recovery/Post-care: on-going follow-up and management is also crucial

An “Initial Brief Intervention” may be the extent of our role as school psychologists in many cases. This involves (p. 6):

  1. Give feedback about screening results, relating the risks of negative health effects to the patient’s presenting health concerns.
  2. Inform the patient about safe consumption limits and offer advice about change.
  3. Offer to involve family members in this process to educate them and solicit their input (consent is required).
  4. Assess the patient’s degree of readiness for change (e.g.,“How willing are you to consider reducing your use at this time?”).
  5. Negotiate goals and strategies for change.
  6. Schedule an initial follow-up appointment in two to four weeks.
  7. Monitor changes at follow-up visits by asking patient about use, health effects, and barriers to change.
  8. If the patient declines referral to specialty evaluation or treatment, continue to encourage reduction or cessation of use and reconsider referral to specialized treatment at subsequent visits.

Specific DON’Ts include:

  • Detox as a standalone
  • Acupuncture, relaxation therapy, didactic group education, or biological monitoring as a standalone treatment (and may not be very helpful at all).
  • Individual psychodynamic therapy
  • Unstructured group therapy
  • Confrontation
  • Discharge from treatment in response to a relapse

 

 

Hard Choices: A Digital Comic (Spiderman & Fantastic 4 on Alcohol)

For a kid-friendly resource, one thing I found was the “Spiderman and the Fantastic Four in Hard Choices” comic book.

This comic book is a free giveaway from SAMHSA to promote substance abuse awareness, and may be valuable for a student who really enjoys superheroes but may not understand the social or physical ramifications of making poor choices, such as alcohol abuse.

This comic is available at: https://marvel.com/digitalcomics/view_white.htm?iid=23418 

A teacher’s guide for this comic is available at: http://www.elks.org/dap/pdfs/teachersguide.pdf

The Elks Kid Zone (http://elkskidszone.org/) is a larger affiliated website about Drug Awareness, including comics, videos, and information in a kid-friendly format.

Hopefully it is not our students who are abusing drugs and alcohol, but these resources may also be valuable as a preventative factor, along with supportive relationships at school, that may offset risk factors in their home or community.

Ohio Resources for Heroin Addiction

Resources recommended by the professionals from Operation Street Smart include:

  • mha.ohio.gov (Providers by county)
  • drugabuse.com (Abuse/addiction treatment)
  • recovery.org (Recovery process/ratings/major cities in Ohio)
  • InterventionAmerica.com (National Resource on Recovery)
  • Rehabhotline.org (Rehab referral/placement)

The HeroinHopeLine website (http://www.heroinhopeline.org/) is a great local resource that breaks down a lot of the specific locations of rehab facilities and resources in Southwest OH and parts of Indiana. Their phone number for contact is 1-877-695-6333 for Warren and Clinton Counties, and 1-844-427-4747 for Butler County.

Their website also breaks down the types of heroin treatment:

  1. Medically Supervised Detoxification
  2. Rapid Detoxification
  3. Residential Rehab Program
  4. Medically Assisted Treatment
  5. Naltrexone

Other resources include the Butler County Coalition, which has its own page of resources at http://butlercountycoalition.org/resource-links/.

 

Operation Street Smart – Notes and Resources

Drug and Alcohol Abuse is an area of interest to me, and thus I recently attended a professional development seminar on the topic called “Operation Street Smart.” This presentation was hosted by the sheriff’s department of Franklin County (Columbus). Information about this program can be found at: https://sheriff.franklincountyohio.gov/programs/operation-street-smart-drug-education.cfm, but its general format covered alcohol, marijuana, synthetics (K2/Spice), and then moving into prescription medication and heroin. The whole presentation is often as long as a few days according to the speaker, but we attended the condensed, 3 hour version. If you are a parent or administrator interested in learning more, particularly about signs of abuse and concealment, I would recommend this presentation, though I wished it provided more information about interventions.

Web sites they recommended:

  • Urbandictionary.com
  • erowid.org
  • bluelight.com
  • odh.ohio.gov
  • dancesafe.org
  • streetdrugs.org
  • projectghb.org
  • drugabuse.gov
  • inhalants.org
  • nida.nih.gov
  • samhsa.gov
  • teens.drugabuse.gov
  • DrugFreeActionAlliance.org
  • drugfree.org

Ohio-Specific Resources will be a separate post, as I believe that is worthy and crucial.

Some of the notes I took from this presentation, that others might find helpful, include:

  • Alcohol is by far the most abused drug, and causes by far the most deaths
  • The absurd amount of prescription drugs used by Americans above the rest of the country – 75% of all pharmaceuticals, according to the presenters. These legal drugs often are abused and then lead to heroin addictions, as heroin is a cheaper form.
  • Approximately 80% of all heroin addicts began with pharmaceutical drugs.
  • The prescription drug and opioid epidemics are continuing to grow
  • Heroin often comes in little balloons, or balls of foil.
  • Things to look for that I wouldn’t have known about were: ped eggs (foot files), oil clamp rings, and sandpaper, all of which are used to shave pills. Also, for heroin, things like aluminum foil and spoons, needles, tie-offs, melted straws, or “cookers” (e.g. the bottom of an aluminum can). Lumps from missed veins also last 10-14 days, and can be noticed.
  • Common terms for Xanax including “footballs,” “school busses,” and “ladders”
  • Percocets are the instant release form of Oxycodone
  • Some apps for identifying drugs are Pillbox and iPharmacy
  • Narcan is growing in importance as a drug that reverses the effects of an opioid, commonly used as a “Lazarus” drug to reverse an overdose. Now available OTC.

 

Olweus Bullying Prevention Programs

As mentioned in the last post from the Dear Colleague letter, bullying prevention programs have some significant positive effects. Therefore, I wanted to post some of the research behind this claim, and provide an example of one of these programs.

In terms of documentation that bullying prevention programs have somewhat positive effects, Merrell, Gueldner, Ross, & Isava (2008) conducted a meta-analysis and found that across 16 included quality studies, there is SOME evidence that these programs have positive effects. Their “results lead us to conclude—somewhat tentatively—that there is some evidence supporting the effectiveness of school bullying interventions in enhancing students social competence, self-esteem, and peer acceptance; in enhancing teachers knowledge of effective practices, feelings of efficacy regarding intervention skills, and actual behavior in responding to incidences of bullying at school; and, to a lesser extent, in reducing participation by students in bully and victim roles” (Merrell et al., 2008, p. 38). However, many of the effects were weak, and may not be clinically significant. Further research is needed, especially in specifically impacting bullying behaviors.

One example of a bullying prevention program that is commonly used and well-known is the Olweus Bullying Prevention Program, which comes out of Clemson University, and has been used and evaluated at all grade levels. According to their website (http://www.clemson.edu/olweus/index.html), “the program’s goals are to reduce and prevent bullying problems among schoolchildren and to improve peer relations at school. The program has been found to reduce bullying among students, improve the social climate of classrooms, and reduce related antisocial behaviors, such as vandalism and truancy. The Olweus Program has been implemented in more than a dozen countries around the world, and in thousands of schools in the United States.” Training in the Olweus method involves a 2-day training by a certified trainer, and repeated trainings occur every year. However, this program is rather expensive (up to $3000 + travel costs and ongoing consultation fees as needed), unless you pay to have your own trainer certified.

A link to current trainers in Ohio is available at: http://www.clemson.edu/olweus/trainers/Ohio.pdf. For other states, you can select your state from the dropdown at http://www.clemson.edu/olweus/trainers.html.

 

Reference:

Merrell, K. W., Gueldner, B. A., Ross, S. W., & Isava, D. M. (2008). How effective are school bullying intervention programs? A meta-analysis of intervention research. School psychology quarterly, 23(1), 26.

Bullying EBIs – Enclosure to OSERS Dear Colleague Letter

In August 2013, the U.S. Office of Special Education Programs (OSEP)/ the Office of Special Education and Rehabilitation Services (OSERS) released a “Dear Colleague” letter to address bullying of all students in schools. This letter is available in full at http://www2.ed.gov/policy/speced/guid/idea/memosdcltrs/bullyingdcl-8-20-13.pdf. However, below I will summarize what are, in my opinion, the most important parts for educators. In addition, the “Enclosure”attached with this letter, available at http://www2.ed.gov/policy/speced/guid/idea/memosdcltrs/bullyingdcl-8-20-13.pdf, is a great resource regarding EBIs related to bullying, as it is descriptive and straight from the government.

Important takeaways from the “Dear Colleague” Letter:

  • Bullying is not an “ordinary part of growing up” and cannot be tolerated, it must be addressed immediately.
  • Bullying is associated with a wide variety of negative outcomes, including low academic achievement, higher truancy rates, poor relationships, and depression.
  • Students with disabilities are more likely to be a target of bullying
  • Any bullying of a student with a disability that affects their FAPE must be remedied, regardless of if it is due to their disability or not. Any changes to their placement must be made in accordance with their IEP team.
  • If the student doing the bullying is an individual on an IEP, the team must meet to determine if additional supports or environmental changes are needed.
  • Consider re-evaluating your district policies if needed.

Enclosure Notes:

  • There is no one-size-fits-all approach/solution to bullying, but it is part of a system-wide multi-tiered framework, including a process of setting clear expectations for behavior and supporting the positives, as well as data-based decision making.
  • School bullying prevention programs have a large body of evidence.
  • The PBIS framework is specifically mentioned as a recommended practice
  • The other recommendations described in this document are:
    • Teaching appropriate behaviors and how to respond to bullying
    • Active adult supervision
    • Ongoing and sustained student and staff training
    • Clear policies and procedures
    • Monitoring and tracking of bullying
    • Parent notification
    • Addressing ongoing concerns
  • Resources are also listed at the end of this document

 

Measuring Bullying: Assessment Compendium

The CDC’s Compendium of Assessment Tools (cited below) is a great resource if you are looking to assess bullying victimization, perpetration, and bystander experiences. It includes bully-only scales, victim-only scales, combinations of both, and bully, victim, AND bystander scales. Each scale is included in the compendium guide, along with guidelines and scoring instructions.

Bully Measures:

  • Aggression Scale (11 items)
  • Bullying-Behavior Scale (6 items)
  • Children’s Social Behavior Scale – Self Report (15 items)
  • Modified Aggression Scale (9 items)

Victim Measures:

  • Gatehouse Bullying Scale (12 items)
  • Multidimensional Peer-Victimization Scale (16 items)
  • “My Life in School” Checklist (40 items)
  • Perception of Teasing Scale (22 items)
  • Peer Victimization Scale (6 items)
  • Retrospective Bullying Questionnaire (44 items)
  • Victimization Scale (10 items)
  • Weight-Based Teasing Scale (5 items)

Bully and Victim Scales

  • AAUW Sexual Harrassment Survey (14)
  • Adolescent Peer Relations Instrument (36)
  • Child Social Behavior Questionnaire (24)
  • Homophobic Content Agent Target Scale (10)
  • Illinois Bully Scale (18)
  • Introducing My Classmates (8)
  • Modified Peer Nomination Inventory (26)
  • Olweus Bullying Questionnaire (39)
  • Peer Interactions in Primary School Questionnaire (22)
  • Reduced Aggression/Victimization Scale (11)
  • School Life Survey (24)
  • School Relationships Questionnaire (20)
  • Setting the Record Straight (30)

Bystander, Bully, and/or Victim Scales

  • Bully Survey
  • Cyberbullying and Online Aggression Survey (52)
  • Cyber-Harrassment Student Survey (15)
  • Exposure to Violence and Violent Behavior Checklist (135)
  • GLSEN National School Climate Survey (68)
  • Participant Role Questionnaire (15)
  • Peer Estimated Conflict Behavior Inventory
  • Student School Survey (70)

Hamburger, M. E., Basile, K. C., & Vivolo, A. M. (2011). Measuring bullying victimization, perpetration, and bystander experiences: A compendium of assessment tools. Center for Disease Control and Prevention: National Center for Injury Prevention and Control – Division of Violence Prevention. Retrieved from http://www.cdc.gov/violenceprevention/pdf/bullycompendium-a.pdf.

StopBullying.Gov

StopBullying.Gov (http://www.stopbullying.gov/) is the United States government’s response to bullying, complete with a variety of resources on the topic. This should arguably be one of your first stops if you are looking to find resources on bullying intervention and prevention.

It includes an online training course in bullying prevention, tips for how to talk about bullying, information about those at risk, tips for prevention, tips on how to respond, and much more.

Specifically, I found the section on “how to respond to bullying” very valuable and a simple list of do’s and don’ts.

Do’s:

  • Intervene immediately. It is ok to get another adult to help.
  • Separate the kids involved.
  • Make sure everyone is safe.
  • Meet any immediate medical or mental health needs.
  • Stay calm. Reassure the kids involved, including bystanders.
  • Model respectful behavior when you intervene.

Don’ts:

  • Don’t ignore it. Don’t think kids can work it out without adult help.
  • Don’t immediately try to sort out the facts.
  • Don’t force other kids to say publicly what they saw.
  • Don’t question the children involved in front of other kids.
  • Don’t talk to the kids involved together, only separately.
  • Don’t make the kids involved apologize or patch up relations on the spot.

http://www.stopbullying.gov/respond/on-the-spot/index.html