Associated Risk and Protective Factors for Mental Disorders in Childhood and Adolescence (Nursing)

00:01 What are the things that impact a child's development of emotional, psychological, mental health problems? Well, we have these two things: One is called a risk factor and one is called a protective factor.

00:17 And what we would like to be seeing is that we are building the protective factors and reducing the risk factors.

00:27 So what are risk factors? Risk factors are biological, psychological, family-based, community-based, or even culturally-based problems that precede and are associated with higher likelihood of negative outcomes for the child's well being.

00:47 So if we're talking biological, we're talking about if you have a mom or dad who has mental illness, there is a higher likelihood for the child to biologically be predisposed, or if they have a disease like heart disease.

01:09 A psychological risk factor is if you are living in a household with a person who has mental illness, and you have to deal with as a child, this is your norm.

01:22 Families in discord, or communities that are living without all the things that they need, if you're living in a very poor community or community that has violence in it, or even cultural, and cultural is when there is stigma against a certain group, or a gender.

01:46 And this kind of stigma, and this kind of negativity can actually increase the likelihood of negative emotional outcomes in the long run.

02:01 Why? Because we start seeing ourselves in that way of not being able to cope and looking for coping mechanisms that may not be very healthy.

02:14 So what are some of the risks? Substance use disorder, and having mental illness in the family.

02:23 If you have exposure to suicide and homicide, and we think about children who are growing up in neighbourhoods, where drive by shootings are common, where it is not unusual to lose a family member to suicide or homicide.

02:45 ACEs, as we just finished saying is a very big risk factor for mental health problems.

02:53 And toxic stress, living in a situation where you are unable to get away from the stress.

03:01 Low socioeconomic status, again, is a risk factor for mental illness.

03:08 Why? Because if you don't have the right amount of money, you can't have a home over your head.

03:15 Oftentimes, you'll find yourself being homeless, living in shelters, perhaps you don't have enough food, perhaps you don't have the right clothing in the winter.

03:24 Which brings us to bullying, the idea that children are being bullied, bullied for either the colour of their skin, their sexual identity, the clothes that they're wearing, whether they have money, or their parents have money, what kind of car are they're coming to school in? This kind of bullying really has a terrible impact on the child's emotional development.

03:50 But of course, it can't all be bad, right? So we have protective factors.

03:56 And the protective factors are these events and situations, that counter act, those negative risk factors.

04:06 We want to have the child be living in a supportive community, which might be school, it might be where they're going to after school, it might be their church, or their temple, or their cultural center.

04:21 We want to make sure that they have family support.

04:24 And that's not only to make sure that the child has a family that supports the child, but that we're looking to make sure that the family has the support that they need as well.

04:36 Faith religion is a very, very strong protective factor.

04:41 In a child's perception that their environment is safe is also a protective factor.

04:49 Bonnie Barnard used to say you could have one turnaround teacher in your lifetime, who could change the trajectory of your life.

04:59 Having one adult who the child totally trusts, and it may be a teacher, it might be the nurse.

05:08 Oftentimes we find that children with psychological and emotional disabilities and disorders are spending a lot of time in the nurse's office.

05:19 And that might be the trusting adult, that might be the person who is the turnaround person in this child's life.

05:27 We want these kids to have a sense that they can do it.

05:31 That is a sense of self efficacy, that they are capable of making a change that they are not helpless, that they have small ways they can change themselves, so that they are able to make a difference.

05:46 And I will share with you a story about a young man who was seven years old, and he had been diagnosed as having the defiant disorder.

05:57 And I worked with him and his parents.

06:01 So that what we understood was, it wasn't that he had Oppositional Defiant Disorder, he did have ADHD.

06:09 And he wasn't able to do what he was being asked to do.

06:13 Kids are making fun of him.

06:15 And so he started acting out, which looked like oppositional defiant.

06:20 But it was truly the fact that he had his ADHD that he wasn't able to do what he was being asked to do.

06:26 And he said, I'd rather be seen as being defiant than stupid.

06:31 And so we went ahead and we got him the referrals that he needed for all the extra help that he needed in school, including seeing the therapist at school, the social worker, two times a week.

06:43 When they had his IEP, which is an individual education plan.

06:48 When they had that individual education plan, he asked if he could possibly be part of that discussion.

06:55 And his parents said, Yes.

06:57 And his mom called me afterwards and she said, you know, Dr. Marshall, I actually heard you speaking through his mouth, because they told him that he was doing so well that he had turned things around so well, that they were going to have him see the social worker one time a week instead of two times a week.

07:17 And this little boy said, I just want to make sure I'm getting this straight.

07:23 Since I've been seeing the social worker two times a week, I'm not having any problems.

07:28 So it's working.

07:31 And now you would like to take away what's working? Am I getting this right? And his mother had to laugh.

07:39 And the school said, No, you're right, we'll keep you at two times a week, if that's what you need.

07:45 That's really empowering a child to be able to ask for what they need.

07:51 That is self efficacy, he was so proud of himself.

07:57 We want to make sure that all of these children have access to resources.

08:02 And of course, if we are not seeing them, if we are not being able to see their behaviours without judgement, understand that some of the behaviours that we're seeing as being rude or difficult, are actually symptoms of a mental health disorder.

08:21 Well, once we see that, we can get them the resources they need.

08:26 And once they have those resources, we can help them to turn around.

08:30 That's why having access to resource, giving them a sense of self efficacy, giving them a trusting adult, being able to give them a feeling that their environment is safe, allowing them to practice their faith to give family supports and provide them with a community of supportive people around them.

08:53 These are considered essential protective factors.