Social Engagement and Children’s Mental Health: A Universal Response.
Creative Strategies, Applied Theory, and Global Implications for Social Work with Groups in Youth Development
Kenneth S. Turck, MSW, LICSW
January 3, 2020 (All Rights Reserved, 2020)
In October of last year, the CDC published a study revealing a 50% increase in suicides for young people ages 10-24 from 2007-2017 in the United States (Curtain & Heron, 2019). In 2016, the National Survey of Children’s Health revealed only half of children with mental health conditions received services from a mental health professional (Whitney & Peterson, 2019). Stigma continues to be an issue and “many times families and youth don’t feel comfortable accessing services” while throughout the country there is a significant shortage of mental health providers (Whitney & Peterson, 2019). As children’s mental health continues to be a growing concern, there have been numerous studies questioning if the increase in various forms of screen time consumption may play a role in depression, anxiety, and emotional and behavioral dysregulation (Holmgren & Coyne, 2017)
In 2004, Dr. David Walsh determined children ages 8-18 in the United States were, on average, consuming 40 hours of screen time per week (Walsh, 2004). In January 2010, the Kaiser Family Foundation published a follow up to Walsh’s study which revealed children ages 8-18 in the United States were then, on average, consuming over 55 hours of screen time per week (Rideout, Foehr, & Roberts, 2010). In 2015, that number had risen to 63 hours per week on average (Rideout, Pai, Saphir, Pritchett, & Rudd, 2015). Now, four years later it would not be a leap to suggest that number may, on average, be approaching 70 hours per week.
In his book, Identity, Youth, and Crisis, Erik Erikson (Erikson, 1968) suggested identity formation happens in adolescence, but not outside one’s social context. As our social context continues to be dominated by electronic formats, recent neuroscience suggests face to face social engagement may be the key to well-being (Dana, 2018; Porges, 2011, 2017; Rosenberg, 2017). Many of the young people my agency serves don’t have a single friend they spend time with outside of school and lack opportunities for face to face social engagement. As we have continued to increase our use of technology, natural opportunities for face to face social engagement (lived experience) have decreased, inhibiting our ability to understand and empathize with others (Porges, 2011, 2017; Rosenberg, 2017).
Bessel van der Kolk (2014) indicates “social support is a biological necessity, not an option and this reality should be the backbone of all prevention and treatment”. Relationships are the foundation for healing trauma and a lack of social engagement can result in people feeling more isolated, disconnected, anxious, depressed, and/or dysregulated (Siegel, 2011, Van der Kolk, 2014). Social work with groups can provide a social context which fosters successful youth development through social engagement by providing an experiential social context for participants to learn, practice, and master important skills which prepare them for life (Turck, 2011).
Lived experience, increased social engagement, and social context are important considerations in modulating/treating emotional and behavioral reactivity, mental health impairments, trauma, and suicidality in youth in the United States (Van der Kolk, 2014). This paper will explore the importance of social work with groups in youth development, discuss the functions of the autonomic nervous system, it’s relevance to trauma and social and emotional intelligence, recent findings in neuroscience, and current relevance and implications for social work practice.
Recent Findings in Neuroscience: Autonomic Nervous System Structure and Function
The ANS is made up of the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System and twelve cranial nerves (CN) (Dana, 2018; Porges, 2011, 2017; Rosenberg, 2017). The SNS is commonly understood as responsible for our “fight/flight” response. The Parasympathetic Nervous System (PNS) controls our automatic bodily functions and has two branches. The Dorsal Vagal Branch is commonly understood as responsible for our “freeze” response (shutdown, collapse, immobilization) and controls our sub-diaphragmatic visceral organs and functions (digestion, wound healing, liver function, pancreas function, stomach, etc.). The Ventral Vagal Branch is understood as being responsible for a physiological state known as “social engagement” and our sense of safety and well-being. The Ventral Vagal Branch controls our heart, lungs, respiratory functions, those visceral organs above our diaphragm (Porges, 2011, 2017; Rosenberg, 2017).
According to Dr. Stephen Porges (Porges 2011, 2017, 2018) our ANS operates subcortically (subconsciously) and is constantly scanning for danger and safety. This process is known as “neuroception”. Everyone’s experience of neuroception is different based on individual lived experiences. Neuroception for individuals who have experienced trauma will be different from those who have not. Someone who has been in combat may have different “triggers” (neuroception) from someone who has experienced childhood sexual abuse or domestic violence. For a child who grew up in a violent, abusive household or has experienced overwhelming chronic stress, their SNS may become hyper-aroused (constantly on edge) which manifests in an increased state of “fight/flight” and increased production of adrenaline and cortisol to support their body in harnessing the necessary energy to fight or flee. When someone lives in this sort of chronically stressed environment, their ANS can become overwhelmed to the point of hypervigilance. When this occurs, their neuroception is incessantly signaling for danger and can overwhelm the ANS. When this condition exists, a Dorsal Vagal activation can take place, manifesting in a state of freeze, immobilization, collapse, or shutdown and significantly increases impairments in overall functioning and well-being (Dana, 2018; Porges, 2011, 2017; Rosenberg, 2017). When the Sympathetic (fight/flight) or Dorsal Vagal (freeze/shutdown/immobilize/collapse) state are active the Ventral Vagal Branch is inhibited (Porges, 2011, 2017; Rosenberg, 2017) and “all of our energy goes into instinctive, defensive responses (Rosenberg, 2017)”. However, when a Ventral Vagal state is achieved, the sympathetic activation and dorsal vagal activation are also inhibited. According to Rosenberg (2017) social engagement activities can take us out of dorsal vagal states.
A healthy ANS demonstrates flexibility in its function, being able to shift appropriately between the fight/flight-freeze-and social engagement states (Sympathetic Activation-Dorsal Vagal Activation, and Ventral Vagal Activation) (Dana 2018). According to Porges (2011, 2017, 2018) and Rosenberg (2017), we are designed to exist in a Ventral Vagal state and only shift to Sympathetic activation or Dorsal Vagal activation in extreme situations necessary to preserve our lives.
Trauma and the ANS
Trauma or chronic stress can be understood as an overwhelming experience that is significantly distressful to the individual experiencing the event(s) resulting in Sympathetic or Dorsal Vagal activation (Dana 2018; Levine 1997; Porges 2011, 2017, 2018; Rosenberg 2017; Van der Kolk, 2014). When an individual has experienced a traumatic event, the endocrine system produces adrenaline and cortisol to harness energy quickly to engage in survival behaviors (Porges, 2011, 2017, 2018; Rosenberg, 2017). When the danger has passed, a healthy ANS will demonstrate the appropriate flexibility and return to homeostasis and a state of social engagement (Ventral Vagal Activation/State).
When the ANS becomes hyper aroused due to chronic overwhelming stress (as in traumatic experiences), sympathetic activation can remain heightened even when the danger has passed. This is known as “faulty neuroception” (Dana, 2018; Porges, 2011, 2017, 2018; Rosenberg, 2017). Due to this chronic stress, the level of adrenaline and cortisol remains elevated and an individual may be triggered by misinterpreting actions/events (dissociation/flashbacks), communications, or experiences. At times this can cause dorsal vagal activitation. Existing in a dorsal vagal state can make it feel impossible to accomplish even simple tasks and is often reported by people experiencing depression and anxiety (Porges, 2011, 2017, 2018; Rosenberg, 2017). This state is where despair lives and where suicide can happen (Dana, 2018; Porges 2011, 2017, 2018; Rosenberg, 2017).
Social and Emotional Intelligence and the ANS
Social and emotional intelligence was defined by Goldman (1995) as our ability to be aware of and to monitor one’s own and other’s feelings. How we learn to do that has to do with the five cranial nerves of the ANS that are responsible for social engagement (Dana 2018; Porges 2011, 2017, 2018; Rosenberg 2017). Social engagement can be understood as the physiological and physical act of engaging with others in face to face communication (Dana 2018; Porges 2011, 2017, 2018; Rosenberg 2017). Siegel (2011) suggests lived experience shapes our neural circuitry and is necessary for them to develop properly. Alternatively, adverse experiences or environments can also shape our neural circuitry which can lead to people feeling more isolated, disconnected, anxious, depressed, and/or dysregulated (Levine, 1997, Siegel, 2011, 2012, Van der Kolk, 2014).
Cranial Nerves and Social Engagement
Cranial nerves V, VII, IX, X, XI are responsible for social engagement and manifest in non-verbal communication through facial expressions and voice prosody and are key to understanding and learning to monitor our own and other’s feelings and manage our own interactions (emotions and behaviors) in various social contexts (Goldman 1995; Porges 2011, 2017, 2018; Rosenberg 2017)
The brain is a social organ and these lived experiences or lack thereof, shape neural circuitry; how we focus our attention, changes the structures of our brain (Siegel, 2011). As evidenced by the increased consumption of screen time, the occurrence of face to face social engagement has diminished (Porges, 2011; Rosenberg, 2017) and may be contributing to the increase in mental health concerns in young people (Banjanin, Benjanin, Dimitrijevic, & Pantic, 2015; George, Russell, Piontak, & Odgers, 2018; Holmgren & Coyne, 2017; Whitney & Peterson, 2019).
Just like a dirt road or trail forms from repeated traffic, much in the same way neural pathways form from engaging in intentionally focused, redundant activity. We form habits by engaging in the same behaviors or thought processes repeatedly and over time this repeated traffic creates a habit. According to Siegel (2011, 2012), experience activates neurons (action is required for neurons to fire), neurons that fire together, wire together and strengthen synaptic connections. “Repetition, emotional arousal, novelty, and careful focus of attention” are required for neuroplasticity to occur (Siegel 2011, 2012). I consider engaging in intentionally focused, experiential, redundant, novel, visceral, meaningful, consistent, activities which require action to be a good synthetization of Siegel (2011, 2012), Porges (2011, 2017, 2018), and Rosenberg (2017) discussion of applied neuroplasticity in practice.
The Polyvagal Theory
Discovered by Dr. Stephen Porges in 1994, the Polyvagal theory focuses on activating the “social Vagus” (Porges, 2018) or the ventral vagal branch of the autonomic nervous system as a means of healing from trauma or to experience a sense of safety and connection. There are 12 cranial nerves that are part of the ANS and we know CN V, VII, IX, X, and XI are responsible for this sense of safety. This physiological state of social engagement is shaped by neuroception (ANS scanning for danger/safety) dictated by our individual lived experiences. Someone who has experienced trauma will likely have a different experience of neuroception than someone who has not. Kids who have experienced a lot of social engagement (lived experiences) will likely have a different experience of neuroception than someone who has not in unfamiliar social contexts.
The ventral vagal branch has been considered “a framework for understanding and treating developmental trauma” (Porges, 2018). Our individual lived experiences dictate how the three branches of our autonomic nervous system respond to cues of danger and safety. The sympathetic, ventral vagal, and the dorsal vagal branches. The sympathetic is often understood as our “fight/flight” response, the dorsal vagal branch is often understood as responsible for our “freeze” response, and the ventral vagal is understood to be responsible for our sense of safety, social engagement, and well-being. Polyvagal theory indicates interpretation of neuroception between these three branches result in emotions and social behavior which manifest in non-verbal communication in the form of facial expressions and voice prosody (Porges 2011, 2017, 2018) This would seem to be crucial in our ability to be aware of and to monitor one’s own and other’s feelings (Dana, 2018; Goldman, 1995; Porges, 2011, 2017, 2018; Rosenberg, 2017).
The Relevance of Social Work with Groups
Recent findings in neuroscience and mental health (Porges, 2011, 2017, 2018; Rosenberg 2017; Siegel 2011, 2012; Van der Kolk 2014) suggest lived experience, social engagement, and social context are very important ingredients in understanding mental health, treatment, and general well-being. As our reliance on technology continues to increase (Walsh 2004, Rideout, et al., 2010, 2015), we need to be intentionally focused on the importance of human relationships and how our lifestyles of “connecting” may vicariously promote disconnection and dis-ease.
Social work with groups can provide a social context for social engagement not just for youth experiencing impairments related to a mental health condition, but a context which exists in a systemic, meaningful way for both upstream (“at-risk”) and mainstream youth. In her book, Resilience: What we have learned, seminal resilience researcher, Bonnie Benard (2004), asks why many of our interventions or initiatives around youth development and mental health “still reflect the deficit model they were founded on”. In our classification system mental health conditions are referred to as “disorders”. It is time to consider a more holistic and systemic approach and how current may impact children’s mental health and youth development in general trends (Walsh, 2014; Rideout et al., 2010, 2015; Banjanin, Benjanin, Dimitrijevic, & Pantic, 2015; George, Russell, Piontak, & Odgers, 2018; Holmgren & Coyne, 2017; Whitney & Peterson, 2019). Social work with groups can foster successful youth development, mental health, and well-being around preventative and interventive measures both, focused in inclusion and social engagement (physiologically and physically). Systemic structures which exist currently as social contexts for children and adolescents can incorporate a core curriculum model to promote structured, intentional opportunities for social engagement which fosters social competence, problem solving, a sense of meaning/purpose, and autonomy (Benard, 2004).
As stated in the article, by Brendtro & Strother (Brendtro & Strother, 2007):
A century ago, John Dewey proposed educating children through a curriculum rich in real-life problem-solving experiences. While many traditional schools have been slow to adopt such methods, experiential learning is making a significant impact in alternative education, youth development, and treatment settings. Challenge and adventure activities create powerful learning environments which fully engage youth and foster the development of courage, resilience, and responsibility.
DIRT GROUP is an award-winning nature-based, resiliency and trauma informed children’s mental health application based in social and emotional learning in the context of a gardening, farming, foods, and creative arts project. Originally an after-school, weekend, and summer program, DIRT GROUP now serves the St. Cloud and Brooklyn Center School districts in Minnesota as well as youth in the after-school program in the Twin Cities, St. Cloud, and Litchfield. DIRT GROUP is informed by recent findings in neuroscience and experiential learning, social learning, strength-based, symbolic interactionism, ecological systems, and polyvagal theories.
DIRT GROUP participants are involved in experiential gardening, culinary, and creative arts projects which engage participants in intentionally focused activities around social and emotional learning in a skills training group. Participants typically work on skills related to socialization, self-regulation, and compliance that have been identified through diagnostic assessment and treatment planning. Students also learn meaningful skills relevant to our social context including soil building, greenhouse work, gardening, harvesting, and preparation, marketing, food preservation, food security, restaurant, and social justice youth work. DIRT GROUP participants engage in every aspect of this food system utilizing creativity and innovation to engage in individual, community, and economic development through increased connections, participation, and inclusion. Participants work together cooperatively to learn, practice, and master important interpersonal skills to support them in navigating life. Learning how to plant, grow, nurture, harvest, prepare, and preserve food together provides shared meaning and opportunities for mutual aid and connection with other participants. Sharing food with family members, making food shelf donations, and learning how to make dill pickles, Sauer Kraut, homemade pizza sauce, cookies or homemade ice cream with our own lemon verbena, Cinnamon basil, or chocolate mint herbs provides opportunities for rich social engagement. DIRT GROUP provides participants with tangible results in the forms of fruits and vegetables and increased social competencies, pride and ownership, skills which prepare them for life, an opportunity to participate in “the big ripple effect” making a difference in the community through contributions of fresh fruits and vegetables, and social inclusion (Turck, 2011).
Home, school, and community are consistently identified in assessment, treatment planning, and interventions as the three domains that make up a young person’s social context. Mental health diagnosis considers the level of impairment a young person is experiencing in each of these domains as a direct result of a mental health condition (emotional and/or behavioral) to determine developmental trajectory and medically necessary care. The young people my agency serves demonstrate significant impairment in overall functioning in all three domains and are not on a normal developmental trajectory as a direct result of their mental health condition. The goal of treatment is to return them to a normal development trajectory through the course of treatment. Many of these kids don’t have a single friend they spend time with outside of school or participate in any traditional extra-curricular activities, significantly limiting their opportunities for social engagement. This lack of experience shapes neural circuitry (Siegel, 2011) and does not provide opportunities to learn, practice, and master important skills which prepare them for life (Turck, 2011). As Walsh (2004) and Rideout et al., (2010, 2015) studies reveal, young people’s screen time consumption in general inhibits opportunities for lived experiences in social engagement and may promote mental health concerns (Banjanin, Benjanin, Dimitrijevic, & Pantic, 2015; George, Russell, Piontak, & Odgers, 2018; Holmgren & Coyne, 2017). Social work with groups can provide intentionally focused, meaningful opportunities for social engagement and experiential opportunities to learn, practice, and master skills which prepare them for life (Turck, 2011).
As literal and figurative barriers continue to promote polarization and dis-ease, applied theory in social work with groups can provide a systemic and equitable solution which increases our social contexts and connections, and opportunities to learn, practice, and master important social and emotional skills through lived experiences of social engagement in growing food together. As more schools recognize the growing need for school-based mental health services, systemic innovations and partnerships which build and promote universal well-being through social engagement can hold space for inclusive core mental health curriculum and programming.
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