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Every day, adults are tasked with supporting young people showing behavioral changes or experiencing a mental health crisis. The problem? Many are unprepared to do so.

It’s a challenge Deborah Offner came up against so often, as a consulting psychologist for schools in and around Boston, she decided to write a guide. Urgency is only growing: a recent CDC report shows about a third of teen girls contemplate suicide, the second-leading cause of death for children.

Educators as First Responders: A Teacher’s Guide to Adolescent Development and Mental Health, Grades 6-12, published this winter by Routledge, delves into the adolescent brain. Offner pairs the science of what’s happening, at a given age or for those with a particular mental illness, with school-based examples she and educators have had over decades.

Through it all, she invites readers to take off their adult hats and to see youth behavior in the context of development. How are requests for nudes, for example, registering in a 14-year old’s brain? What are they seeing as the risk and rewards? What other information do you need to know to decide whether to pull a counselor or parent in?

“Teachers really are playing these significant roles, to help kids develop and manage their emotional lives. They should be a little more equipped and supported to be able to do that in a way that they feel confident about because they’re doing it anyway,” said Offner, who also treats children and young adults in her private practice.

In discussion with LA School Report, Offner reveals the best practices adults can keep in mind and how schools can meet some of students’ emotional needs beyond referral to talk therapy.

This conversation has been edited for length and clarity. Please be advised that some responses reference self-harm and suicide. 

LA School Report: As somebody who’s done this work for decades, is thinking of educators as first responders in this way a new paradigm or shift? Why write this now?

When I tell teachers, and other mental health professionals who work in schools, it seems very intuitive. Of course, kids go to their teacher when they’re upset. But it’s not recognized or acknowledged as being such a central part of the role.

In part I wrote the book to call attention to the fact that teachers really are playing these significant roles, to help kids develop and manage their emotional lives. They should be a little more equipped and supported to be able to do that in a way that they feel confident about because they’re doing it anyway. What are some things I can do and say? I understand these kids as learners, but how do I understand them as people?

You spend the first good chunk of the book with the social contexts that shape adolescence and the psychology behind kids’ actions. Why is that understanding critical and how might educators’ actions change as a result? What’s the danger of what you call an “adult-centric lens”?

One of the things I like to do when I work with schools is to help build empathy in adults for what kids and also parents go through. When teachers understand what’s behind the behavior, there’s a couple of things that change. You don’t take it personally when a kid isn’t paying attention, can’t remember to do something, or has a certain attitude. You recognize that it’s not something you’re necessarily doing wrong, or something that if you just were different would change. It’s what they’re going through, and also, it’s normal.

There’s great benefit to the increased awareness of mental health issues in kids, but at the same time, there’s a lot of things that all kids do that can look a little crazy if you don’t recognize why it is. They don’t have the same controls, the same ways of thinking or organizing themselves and behavior that adults do. So it normalizes some of the funny things that can be perplexing or frustrating; it helps you to have perspective on them.

I’m curious if you have an example from talking to a teacher about this. Any light-bulb moments to share, from when you explained the underpinning of a behavior?

There’s an example I use in the book about a boy who looked really indifferent, kind of lazy, like he didn’t care about his work or about his teachers expectations of him. Teachers would ask him to meet after class and he would just disappear, slink out of the room. He was getting behind and seemed really disengaged.

As the school counselor, I got an opportunity to speak with a therapist he was working with outside of school and learned from her that he had the worst case of social anxiety she’d ever seen. And once I understood, oh, that’s why he’s avoiding his teachers. That’s why he seems shut down. It’s actually called social phobia, a specific disorder. It’s not being shy or not wanting to talk to people exactly. It’s about worrying that other people are gonna think something critical of you, or bad. He was actually so exquisitely sensitive to feeling like he was letting his teachers down that he was avoiding them.

Once they knew that, rather than just being angry and taking it personally, they were more sympathetic and could put some plans into place. I helped him to agree to what would work for him so that he could connect with them and do better. It wasn’t a magic solution, but the energy in the room changes when you explain to faculty why a kid is struggling, right?

It’s funny you bring up that example because it’s one I wanted to ask you about. What would you have done if there wasn’t yet a therapist to consult in that case? How would you have gone about finding or meeting his needs without the context?

That’s a great question because in so many cases, kids don’t have one, let alone one that knows them so well that they can offer you that kind of input. What I recommend to anyone who’s in a counseling role, or even like a Dean or administrative role, is to try to sit down with a student and hear their point of view about what’s going on. Often, kids will tell a counselor things that they might not share with a teacher. With the kids permission, you can, in some ways, act as a liaison. Even if the kid doesn’t want you to share everything they’ve told you, if you come to a better understanding of what’s going on, you can share that.

What factors adults can look out for to keep a pulse on a student’s well being while maintaining their boundaries?

Every student has different boundaries. There’s some kids, as we all know, that will tell you everything from what they ate for breakfast to a fight they had with their best friend whether you want to know or not. And there’s other kids that keep their cards really close to their chest. You have to — this is the beauty of teachers — get to know your students. Sometimes it can be as simple as asking, how are you doing? Kids can be almost surprised and even kind of touched that a teacher is interested. That is always a starting point. It doesn’t mean that a kid is going to tell you in the moment about a serious problem they’re having, but showing that you want to know it’s an important step in the direction of kids feeling they could open up to you if they wanted to.

Obviously if you notice any change in behavior — like a kid who’s usually alert who suddenly seems sleepy — it’s okay to say, are you feeling okay? You seem a little different or not quite yourself today, or you’re quieter than usual.

You mentioned earlier that sometimes teachers are unsure of when to not fly solo and involve a professional clinician or let the family know. What are some considerations that a teacher can think through?

The bright lines that I draw have to do with any physical or potential harm to the student. If a kid is talking about suicide, cutting themselves, or other things that have to do with concrete harm, it’s really important that you not be the only one who knows that, especially when you’re not trained to assess the seriousness, gravity or reality of such a situation. Sometimes kids cut themselves and it doesn’t mean anything other than that they’re trying to manage their distress. It’s not a good sign, but it doesn’t mean that they’re going to necessarily attempt suicide.

In situations where there’s the possibility of self harm, whether it’s happened or might happen, it’s really important to let the student know that you need to let their parents know or let the school counselor know. You can give them a choice about how you tell their parents, whether they want to tell them and then have them loop back to you, there’s different ways to negotiate the process, but that’s again the bright line.

Otherwise, I think if a kid tells you something and you find yourself thinking about it after you go home, it’s always great to run it by a mental health professional at the school, even without a name if you want to protect the kids privacy, just to get someone else’s take on it. Someone who’s trained and knows maybe a little more about the specifics of what’s worrisome.

What are some best practices to keep in mind when a young person discloses something traumatic or difficult for them?

One of the first things that you always want to say if a kid confides in you about something traumatic is to thank them for letting you know, that you’re so glad that they were able to tell you, that you wouldn’t want them to be alone with this experience. Ask, have they told anybody else? Oftentimes kids will confide in a teacher, and it will be the first person they’ve told about something like this. Find out so you’re aware if you’re the only person holding this fact, or if in fact the parents already know. That’s a really different scenario, if you know that another adult is kind of taking responsibility.

Certainly in that first conversation, do not jump to issues of reporting or filing charges are anything administrative or procedural, but focus more on how they’re doing and to maybe ask for a little bit more detail. Say something like, if you feel comfortable telling me, could you let me know a little more about what happened, is there anyone else who would like to know, or anything else that I can do to be helpful?

Of course, if someone under 18 tells you they’ve been sexually assaulted, you’re a mandated reporter. There are those requirements, legally. But again, I wouldn’t bring that up in the first meeting. Generally speaking, you should go to your school administration and potentially the school counselor to talk about how the school wants to make the report and certainly not to do it without involving the student and potentially their family. In the moment, it’s just important to be there and sit with the kid and absorb whatever they’re feeling.

Another issue you raise in the book is this idea of compassion fatigue that some educators face. Can you share how that might show up in school and what educators can do to best avoid it or manage it when it comes?

This is a huge theme right now in schools, as we as a culture and country recognize the prevalence of trauma, of being sexually assaulted. So for example, a kid tells you they were sexually assaulted, there’s sort of a vicarious traumatization that happens when you hear a story like that, but it could also be more subtle things like their parent mistreating them or them going through a difficult depression.

As we bring an empathic response to supporting that child, and the more we do that, it can take a toll on us. The ways to address it have to do with building a network or community, finding a mentor or supervisor or someone that you can share some of the weight. It’s sharing it with another adult or a small group and also taking care of yourself in all the ways that we’ve been told to throughout the pandemic, whether it’s exercise, sleep, making time for yourself, to prevent the kind of fatigue that can happen.

When you saw the latest findings from the CDC about the frequency of sexual assault and suicidal ideation, what was your reaction personally?

On the one hand, as a human as a parent, I was horrified. As a psychologist who works with many girls in high school and college, I wasn’t surprised at all. I would say, and I don’t think I’m exaggerating, that virtually every girl in my practice over the age of 18 has been either sexually assaulted or coerced into sex at least once. Now, I have a small practice but these are girls from all different backgrounds and different schools. It’s really pervasive in a way that continues to shock me, even though I also know it’s reality.

You’ve also worked with youth interfacing with the foster care system and underserved youth in Boston more generally. For educators whose student populations are disproportionately impacted by poverty, homelessness, or adverse childhood experiences, are there specific things you recommend keeping in mind when they take on this first-responder approach?

There are ways to be sensitive and thoughtful if you’re a person who doesn’t come from a background of poverty and you’re not familiar with some of the sort of coping strategies that families may have to use. It’s important to be sensitive, both to the economic strain on families and also to cultural preferences for ways of talking about and dealing with mental health.

A common thing for our families from Beacon Academy — who are all students of color and low-income, some have parents who have immigrated fairly recently — is that older kids will take care of younger kids on a regular basis. They may spend many, many hours caring for their siblings in a way that more privileged families may not, and often that could interfere with following through on a commitment to an extracurricular activity or something at school. It’s important, if you find a kid who is having trouble meeting a certain expectation, to gently explore and understand. Are there family commitments that are taking up their time? That’s really different than if someone doesn’t feel like getting up in the morning. Maybe their mom had to go to work and they couldn’t afford a babysitter.

That goes back to the idea of building empathy you mentioned earlier. We also know that suicidal ideation, depression and anxiety symptoms are more common in particular marginalized student groups — girls, students of color, queer students. Are there particular supports to keep in mind for them? 

The thing to keep in mind about these identities is that they may make kids more vulnerable, or more worried about sharing information for fear of people judging or criticizing them or not being accepting. What I always have in mind for myself is the kid’s identity, as I understand it and as they claim it, and also my own identity — what the differences are in those. Then I can see and mind the gap.

How can schools be more affirming right now outside of offering traditional talk therapy, particularly because a lot of students might have family contexts that still stigmatize care or can’t access it? 

I think mental health awareness days are always helpful. I was in a school last week that had a wellness day for the middle and high school. Kids could go to all kinds of workshops; I did one on perfectionism for high school students. They had a dance group come and other speakers to talk about things like body image and dieting. That was a very popular talk because a lot of kids have concerns about that. I think it started off as kids being skeptical and now it’s like a day that nobody wants to miss. They have therapy pets come, someone doing caricatures, but it celebrates that wellness is important for kids. It’s not just about being high achieving academically or athletically.

There’s other ways to offer support in-school that aren’t therapy, per se. For younger kids, and this could even go through middle school, lunch groups may be held with either a school counselor or someone savvy about kids. They can talk about mental health, relationships; kids could come together and be able to chat with each other and with a teacher for no particular reason. It doesn’t have to be only kids that are having trouble.

At the school where I am, we had someone come in — he’s not a therapist, more of a coach, who’s going to do some art projects with the kids and provide a safe space for kids to chat with him if they wish. It’s activity-based, but it’s a time for them to just be there for themselves and not have any expectations on them. Doing things that show that you value their well being can be really important and parents never have to pay or give permission for it.

Lastly, are there particular storylines, or aspects of youth mental health that you feel are being misrepresented, over- or underrepresented?

What I feel is probably not addressed enough is family life and the importance of supporting parents so that they can effectively support their kids. You see a lot about either the sort of fetishization of motherhood — maternal love as this kind of ideal, special, gendered state — or parents who are abusive. The extremes of parents. Most parents are obviously somewhere in the middle, either themselves struggling with mental health issues or ambivalent about the pressures that parent parenthood puts on them.

For today’s kids, there’s so much about social media and the effects of that in terms of mental health, but in my experience, a lot of what determines how kids feel about themselves and how well they do is their relationship with their parents. I wish there was more attention to helping parents be more present in better ways for their kids.

If you or someone you know is having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline. Additional resources are available at SpeakingOfSuicide.com/resources. For LGBTQ mental health support, you can contact The Trevor Project’s toll-free support line at 866-488-7386.

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