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Simple activities developed to help teachers calm anxious kids in post-quake Canterbury are soon to be shared more widely to help nurses, parents and teachers boost child wellbeing around the country. Nursing Review talks to mental health nurse MICHELLE COLE to find out more.

Add to the mix children who have experienced their home and classroom being literally shaken on thousands of occasions – including some who may have lost their home, school and even loved ones – then settling them down can be even more challenging – particularly when their teachers and parents have been through the very same stresses.

It was dealing with such scenarios that spurred a project in Canterbury aiming to provide simple, evidence-based interventions that can be used by all adults to support children both “in and out of difficult times”.

The project being developed by Canterbury’s school-based mental health team  – with the support of Canterbury wellbeing agency ‘All Right?’ – started with a working title of ‘Tiny Interventions’ but the final name is yet to be decided.

The school-based mental health team was set up in 2013 to provide outreach services to post-quake Canterbury with mental health nurses making up four of the seven-strong team serving schools from Ashburton to Kaikoura.

The Canterbury District Health Board-based team is one of the Government’s youth mental health initiatives and the model may in time be rolled out to other regions. At present the team is working with more than 90 of Canterbury’s 200 or so primary and secondary schools.

Michelle Cole, a mental health nurse with a strong background in youth mental health, joined the team in late 2013 to start reaching out to rural Canterbury schools. The rural hinterlands had not only been shaken like their urban counterparts but also had quake-traumatised families move into their school communities. More recently North Canterbury has been suffering a long, morale-draining drought.

New therapies for quake-anxious kids

The seed for the project came about when a school approached the team in 2014 wanting support for about 17 children it had identified as having anxiety issues in its year 3–4 cohort.

The children were seven to eight years old at the time so had been aged around four and five when the quakes hit in 2010–11. Cole says while there is no simple formula for forecasting which ages or developmental stages were most affected by the quakes there were “definitely some groups of kids that have more vulnerabilities”. And the cohort of children that were preschoolers or early primary school age around the time of the quakes are one of the cohorts that the team often gets requests from schools to work with.

Though she adds there are pockets of kids and youth across all ages whose developmental trajectory has been thrown off track by the quakes. “I will still go and consult on a kid who may have an issue with attendance or something like that and when you start to talk to them you sometimes find they are still co-sleeping in their parents’ bed … and earthquakes are still something they think about quite frequently.”

When Cole and the team went to work with the rural school with its cohort of 17 anxious children she says it wanted to see what therapeutic tools or skills it had to share with the staff that could make a difference.

When the team suggested introducing ‘tummy’ (diaphragmatic) breathing in class circle time as a self-calming technique for children it found that while some of the teachers had heard of the technique none of them had actually done it.

Teaching the teachers how to share tummy breathing with their class seeded the idea with the team to look further for simple, do-able interventions that could help teachers help their students and along the way also help themselves.

“As our poor teachers had been through so much as well,” says Cole. “So doing something that is good for their own wellbeing is good for the kids’ wellbeing as well.”

“The idea then grew its own legs and took off,” laughs Cole. The project now has around 30 activities or interventions aimed at primary school age children. Early on the team approached Sue Turner, the campaign manager at All Right?, as it had loved the Tiny Adventures resource it had developed for families (see more next page) and wanted to develop something similar for schools.

With the support of Christchurch Earthquake Appeal Trust (CEAT) funding the project was widened to create a resource not only useful for teachers but also parents, nurses and other adults supporting children’s wellbeing.

A steering group was established to drive the project made up of representatives from the DHB’s school-based mental health team, health promoters from the DHB’s Community and Public Health division, Pegasus Health and the All Right? team. The project is being led by the school-based mental health team, in collaboration with the steering group.

Cole says as part of designing and developing the resource it has been offering professional development to other professionals working with children in schools including public health nurses.

The ‘pick ‘n’ mix’ simple activities or interventions the team are sharing with teachers and nurses aim to proactively lay the seeds of wellbeing as children grow up and into adolescence.

“I suppose from a nurse’s point of view – as a nurse who has worked offering brief interventions to adolescents – it is like my ‘dream wish list’ of what you wish that that 14-year-old in front of you could have been exposed to when they were at primary school,” says Cole.

So while the project was prompted by children suffering quake anxiety it has resonance beyond Canterbury and could be helpful for all children, as anecdotally Cole hears that some of the behaviours being reported by Canterbury schools – including increasing numbers of new entrants not seeming ready for school, with behaviours ranging from struggling to sit still at mat time to hurting other children – are not just a Canterbury experience.

“At first we thought it might be related to the earthquakes and upsets to the children’s developmental trajectories but we are being told that they are also being seen at a national level.”

The quakes may also only be a component in Canterbury schools’ reports of increased anxious behaviour being shown by children around ages 10 and 11 and reports of self-harming behaviour starting to emerge at primary and intermediate school level.

Cole says the aim of the project is to help children notice their emotions, balance their energy and become aware of their senses and are clustered into five themes including ‘Managing self’, ‘Showing kindness’ and ‘Creating a calm space’.

The project’s activities or interventions are still being refined but are built on exercises the team already use with schools including a popular breathing workshop developed by Cole’s colleague Carmen Murphy which she has offered in many classrooms in many schools around Canterbury. “It’s incredible – and we are all using it as well.”

“It’s amazing when you go back and ask the small children ‘how are you going with your tummy breathing?’ and they tell you they are using it to help them get to sleep at night or when they’ve had an argument with their big brother … they are adopting it and soaking it up in a way that is quite surprising to us.

“And the teachers are reporting that it is very beneficial and they are using it [tummy breathing] at times like when kids come back in from lunchtime or other busy times to help settle the children.”

Tummy breathing and other resources being shared by the project will follow a similar format. So each intervention or activity has the same subheadings: i.e. ‘The skills’ (under which they list the skills enhanced by the intervention), ‘Why we love it’ (which introduces some of the science behind the intervention) and finally ‘What to do’ (how to carry out the intervention).

One activity can involve colouring-in mandalas (usually circular symmetrical patterns) which is a ‘flow activity’ that allows kids to relax into and stop a busy mind by engaging in a calming activity.

Another is called ‘Energy rollercoaster’ and aims to help kids identify their energy levels at that moment on a scale from 1–5 and then flow on to use other ‘Managing self’ interventions to either help them burn-off some energy (like star jumps) or help boost their energy levels if feeling lethargic.

Cole says an advantage of the project is that it is offering simple and inexpensive activities and interventions that work and don’t soak up schools’ limited budgets and times for professional development. “We find schools pretty thirsty for easy, doable, achievable things.”

The mental health nurse is also keen for the team to be able to share these simple mental health interventions with nurses in other practice areas who work with children. And so maybe more kids will be able to take some deep tummy breaths next time they feel angry or want to relax.