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Comprehensive Suicide Prevention: Understanding Adverse Childhood Experiences (ACEs)

Be sure to watch the vignette above from Teen Health Connection’s The Big Picture titled “The ACEs Test” for a look at the types of experiences considered to be Adverse Childhood Experiences. Knowing your score can help you, and your healthcare provider, make informed decisions about your care.

What are Adverse Childhood Experiences (ACEs)?
Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur in childhood but cause pervasive effects on health throughout the lifetime. ACEs may occur inside or outside the home, and include events such as child abuse, neglect, food insecurity, violence, deportation, and bullying. These experiences can have profound and lasting effects on an individual’s health and well-being and can be influenced by individual, family, and community factors. ACEs impact not only mental health, but also significantly increase the risk of physical health conditions.

Are ACEs Common?

• About 64% of adults in the United States reported they had experienced at least one type of ACE before age 18.
• Nearly one in six (17.3%) adults reported they had experienced four or more types of ACEs.

What’s the link between ACEs and suicide?
Suicide and ACEs are both complex topics, influenced by a variety of compounding factors. However, the link between increased ACEs and increased suicidality is clear.
Research has consistently shown a strong correlation between ACEs and an increased risk of suicide. Individuals who have experienced six or more ACEs are over 24 times more likely to attempt suicide compared to those with no ACEs (Merrick, 2017). This heightened risk is due to the toxic stress caused by ACEs, which can negatively affect brain development, immune systems, and stress-response systems (CDC).
ACEs have a “dose-response relationship,” meaning the more ACEs an individual has experienced, the greater likelihood of suicidal ideation and other negative health outcomes (Merrick, 2017). You can’t lower your ACE score, but you can mitigate the risk.

Do ACEs increase risk for other conditions?
ACEs are associated with at least 5 out of the 10 leading causes of death, including heart disease and cancer. Preventing ACEs could potentially reduce many health conditions, including depression and suicidality. Estimates show up to 1.9 million heart disease cases and 21 million depression cases potentially could have been avoided by preventing ACEs (CDC).

What can family and community members do?
Preventing ACEs and mitigating their effects is crucial for reducing suicide rates. Communities can create supportive environments for children, providing mental health resources, and addressing social determinants of health such as poverty and discrimination. By understanding the profound impact of ACEs on mental health, we can take steps to support those affected and work towards a future where fewer individuals are at risk of suicide.
Creating safe, stable, nurturing relationships and environments for all children can prevent ACEs and help all children reach their full potential. We each have a role to play in empowering every adolescent to be healthy, safe, and successful.

How can Teen Health Connection help?
Teen Health Connection is proud to practice Trauma-Informed Care. Our behavioral health clinicians are trained to assist adolescents in navigating and understanding trauma. If you’d like to learn more about behavioral health services, call triage at (704) 381-8379.

If you or someone you know is struggling with suicidal thoughts, please seek help immediately. Contact the National Suicide Prevention Lifeline by calling or texting 9-8-8 or by visiting 988LifeLine.org.

Resources

About Adverse Childhood Experiences | Adverse Childhood Experiences (ACEs) | CDC

Merrick, M. T., Ports, K. A., Ford, D. C., Afifi, T. O., Gershoff, E. T., & Grogan-Kaylor, A. (2017). Unpacking the impact of adverse childhood experiences on adult mental health. Child abuse & neglect, 69, 10–19. https://doi.org/10.1016/j.chiabu.2017.03.016

Back to School: Essentials for a Healthy and Successful Start

As summer winds down and the back-to-school season approaches, it is important for parents and students to prepare for a smooth transition. Ensuring that children and teens are ready for the academic year goes beyond shopping for school supplies – It involves fostering habits that promote health and well-being. Four key areas that can help are eating breakfast every morning, getting enough sleep, getting a sports physical, and being up to date on all immunizations.

The Power of Breakfast

“Breakfast is the most important meal of the day,” tends to sound like a cliche saying, but this saying holds true, especially for children and teens. A nutritious breakfast provides the energy and nutrients needed to start the day right. Research shows that children and teens who eat breakfast regularly perform better academically, have improved concentration, and are less likely to be tardy or absent (The Journal of School Health).
A balanced breakfast should include a mix of protein, whole grains, and fruits or vegetables. For example:

• A whole-grain cereal with milk and a banana.
• Scrambled eggs with whole-wheat toast and a side of berries.

The Importance of Sleep

Adequate sleep is crucial for everyone of all ages, but it is especially important for children and teens. In fact, they need more sleep than adults due to their growing bodies and developing brains. The American Academy of Pediatrics recommends 9-12 hours of sleep per night for children aged 6-12, and 8-10 hours for teenagers aged 13-18.
To help establish a healthy sleep routine for your child or teen:

• Set a consistent bedtime and wake-up time, even on the weekends.
• Create a calming bedtime environment by limiting screen time and encourage a relaxing activity like reading. Try getting an old-school alarm clock and leave phones out of the bedroom to limit bedtime distractions.

Ensuring your child gets enough sleep can improve their mood, behavior, and academic performance.

The Necessity of a Sports Physical

For any child or teen that is planning to participate in sports, a sports physical is necessary. A sports physical, usually conducted by a healthcare professional, assesses a child’s fitness level and ability to safely engage in athletic activities. The physical typically includes a review of medical history, a physical examination, and sometimes additional tests.
A sports physical can identify any potential health issues that could interfere with participation in sports and provide an opportunity to discuss injury prevention, nutrition, and other health concerns. It is a proactive step to ensure your child or teen is ready for the physical demands of their chosen sport.
If your teen needs a sports physical for the upcoming school year, call Teen Health Connection at (704) 381-TEEN (8336) to set up an appointment.

The Importance of Immunizations

Updating immunizations is a critical part of back-to-school preparation. Vaccines protect children and teens from serious diseases and prevent outbreaks in schools and communities. Common vaccines required for school entry include those for measles, mumps, rubella (MMR), diphtheria, tetanus, and pertussis (DTaP), and polio (IPV).
Additionally, the Centers for Disease Control and Prevention (CDC) recommends the HPV vaccine for preteens, the meningococcal vaccine for teenagers, and the annual flu shot for all school-aged individuals. Make sure to check with your child or teen’s school and healthcare provider to ensure all immunizations are up to date.
If your teen needs immunizations for the upcoming school year, call Teen Health Connection at (704) 381-TEEN (8336) to set up an appointment.

Tips for Parents

As the new school year approaches, it is a pivotal time for parents of teens to help them transition smoothly and set the stage for a successful academic year. Here are some essential tips to help support your teen:

• Establish a Routine

Teenagers thrive on routine, even if they might not admit it. Help your teen adjust to the school schedule by establishing a consistent daily routine before school begins. This includes setting regular times for waking up, eating meals, doing homework, and going to bed. A predictable routine helps reduce stress and ensures they are well-rested and prepared for school.

• Encourage Open Communication

Maintain open lines of communication with your teen. Encourage them to talk about their feelings, concerns, and goals for the upcoming school year. Listen actively and offer support without judgement. Being approachable and understanding can make a significant difference in their ability to navigate the challenges of adolescence and school life.

• Create a Study-Friendly Environment

Set up a dedicated study area that is quiet, well-lit, and free from distractions. Ensure your teen has all the necessary supplies, such as a comfortable chair, a desk, and any required school materials. Establishing a conducive environment for studying can help improve focus and productivity.

• Promote Healthy Habits

Healthy habits are crucial for your teen’s well-being and academic performance. Encourage them to eat balanced meals, including a nutritious breakfast, and stay hydrated throughout the day. Stress the importance of regular exercise and sufficient sleep. Teens need 8-10 hours of sleep per night, so help them establish a bedtime routine that allows for adequate rest.

• Stay Involved

While teens often seek independence, parental involvement is still important. Stay informed about your teen’s academic progress, school events, and extracurricular activities. Attend parent-teacher conferences and school meetings whenever possible. Your involvement shows your teen that you care about their education and supports their overall success.

• Set Realistic Expectations

Encourage your teen to set realistic academic and personal goals. Help them break down larger goals into manageable steps and celebrate their achievements along the way. Avoid placing undue pressure on them to achieve perfection. Instead, focus on effort and improvement, fostering a growth mindset.

• Monitor Technology Use

Teens are often glued to their devices, which can interfere with their sleep, focus, and overall well-being. Set boundaries for screen time, especially during homework and study hours. Encourage them to take breaks from screens and engage in other activities such as reading, hobbies, or spending time outdoors.

• Support Extracurricular Involvement

Extracurricular activities provide valuable opportunities for personal growth, social interaction, and skill development. Encourage your teen to participate in sports, clubs, or other interests. Balance is key, so help them manage their time to ensure these activities do not overwhelm their academic responsibilities.

• Address Behavioral Health

Behavioral health is a critical aspect of overall well-being. Be attentive to signs of stress, anxiety, or depression in your teen. Encourage them to talk about their feelings and seek professional help if needed. Promote relaxation techniques such as mindfulness, meditation, or yoga to help them manage stress.

If your teen needs help tackling back-to-school anxiety or other behavioral health challenges, contact our Behavioral Health Triage Clinicians at (704) 381-8379 to get started.

• Plan Ahead

Help your teen develop organizational skills by teaching them to use planners or digital calendars to keep track of their assignments, deadlines, and activities. Planning ahead can reduce last-minute stress and help them manage their time effectively.
Supporting your teen through the back-to-school transition involves a combination of establishing routines, promoting healthy habits, staying involved, and fostering open communication. By providing guidance and encouragement, you can help your teen navigate the challenges of adolescence and set them up for a successful and fulfilling school year.

Teen Health Connection is Here to Help!

Preparing for the new school year involves more than just purchasing supplies and new clothes. By emphasizing the importance of a healthy breakfast, adequate sleep, regular sports physicals, and up-to-date immunizations, parents can help set their children or teenagers up for a successful and healthy school year. These practices not only contribute to better academic performance but also promote overall well-being, ensuring that students are ready to thrive both in and out of the classroom.
Regardless of your family’s needs this time of year, Teen Health Connection is here to help! Reach out to 704-381-TEEN (8336) to learn more about how we can serve you and your teen during this transitional period.

Resources

Hearst, Mary O, et al. “Barriers, Benefits, and Behaviors Related to Breakfast Consumption Among Rural Adolescents.” The Journal of School Health, U.S. National Library of Medicine, Mar. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4825869/. 17 July 2024.

Summer Smarts: How to Stay Safe and Have Fun in the Sun

Resources

Centers for Disease Control and Prevention. “Summer Swim Safety.” CDC, 9 May 2024, https://www.cdc.gov/drowning/prevention/summer-swim-safety.html.

Centers for Disease Control and Prevention. “Sun Safety Facts.” CDC, 1 July 2024, https://www.cdc.gov/skin-cancer/sun-safety/index.html.

Centers for Disease Control and Prevention. “ Symptoms of Heat-Related Illness.” CDC, 15 February 2024, https://www.cdc.gov/extreme-heat/signs-symptoms/index.html.

National Highway Traffic Safety Administration. “Traffic Safety Facts: A Compilation of Motor Vehicle Crash Data.” NHTSA, July 2023, www.nhtsa.gov/research-data/traffic-records.

United States Department of Agriculture. “Summer Food Safety.” USDA, 15 June 2023, https://www.fsis.usda.gov/food-safety/safe-food-handling-and-preparation/food-safety-basics/how-temperatures-affectfood.

Navigating the Struggles: Disparities Faced by LGBTQ+ Youth

During the exciting time of adolescence, LGBTQ+ youths navigate a landscape colored by both progress and persistent challenges. While strides have been made in societal acceptance and legal recognition, disparities persist, casting a large shadow over the experiences of many LGBTQ+ adolescents.

• Mental Health Challenges
  • A study by the Centers for Disease Control and Prevention (CDC) found that LGBTQ+ students are more likely to experience feelings of sadness and hopelessness.
    • LGBTQ+ youth are twice as likely to experience symptoms of depression compared to their heterosexual peers (CDC).
  • According to the Trevor Project, LGBTQ+ youths are almost five times more likely to have attempted suicide compared to their heterosexual peers.
  • Over 40% of transgender individuals have reported attempting suicide at some point in their lives (American Foundation for Suicide Prevention).
• Bullying and Harassment
  • Statistics from the GLSEN (Gay, Lesbian, and Straight Education Network) show that more than 85% of LGBTQ+ students report experiencing verbal harassment, while over half face physical harassment at school.
    • 91% of LGBTQ+ students reported hearing “gay” used in a negative way frequently or often at school (GLSEN).
    • LGBTQ+ students are twice as likely to report being physically assaulted, kicked, or shoved at school compared to their heterosexual peers (CDC).
• Homelessness and Displacement
  • According to the Trevor Project, 28% of LGBTQ+ youth reported experiencing homelessness or housing instability at some point in their lives.
    • Homelessness and housing instability were reported at higher rates among both transgender and nonbinary youth, including 38% of transgender girls/women, 39% of transgender boys/men, and 35% of nonbinary youth, compared to 23% of cisgender youth (The Trevor Project).
    • 16% of LGBTQ+ youth reported that they slept away from parents or caregivers because they ran away from home, with more than half (55%) reporting that they ran away from home because of mistreatment or fear of mistreatment due to their LGBTQ+ identity (The Trevor Project).
    • 14% of LGBTQ+ youth reported that they had slept away from parents or caregivers because they were kicked out or abandoned, with 40% reporting that they were kicked out or abandoned due to their LGBTQ+ identity (The Trevor Project).
• Healthcare Disparities
  • LGBTQ+ adolescents often encounter barriers to accessing culturally competent healthcare services. A study published in Pediatrics found that transgender and gender-nonconforming youths are less likely to have health insurance coverage and more likely to postpone necessary medical care due to discrimination and fear of mistreatment.
    • 29% of transgender adults report being denied healthcare due to their gender identity (National Center for Transgender Equality).
    • LGBTQ+ individuals are more likely to delay or forgo medical care due to cost concerns, with transgender individuals being particularly affected (Kaiser Family Foundation).
• Academic Achievement and Dropout Rates
  • Despite progress in LGBTQ+ rights, disparities in educational outcomes persist. The National Center for Transgender Equality reports alarmingly high dropout rates among transgender students, with nearly one-third of respondents saying they had been unable to complete high school due to harassment, violence, or lack of support.
    • LGBTQ+ students are twice as likely as their heterosexual peers to say they have been threatened or injured with a weapon on school property (CDC).
    • 85% of LGBTQ+ students reported being verbally harassed at school, with over half experiencing cyberbullying (GLSEN).

The statistics can be shocking and overwhelming, but there are ways that we can all begin to change these statistics, whether big or small. When we breakdown each disparity mentioned above, we can begin to do the following:

• Mental Health Challenges
  • Inclusive Mental Health Services: Ensure that mental health services are inclusive and affirming for LGBTQ+ youth. Train mental health professionals the unique needs and challenges faced by LGBTQ+ adolescents.
  • Peer Support Programs: Establish peer support groups where LGBTQ+ youth share experiences and receive support from others who understand their challenges.
  • Access to Resources: Increase access to mental health resources, such as hotlines, online counseling, and community centers that specialize in LGBTQ+ issues.
• Bullying and Harassment
  • Anti-Bullying Policies: Implement and enforce comprehensive anti-bullying policies in schools that specifically address LGBTQ+ harassment.
  • Education and Training: Provide training for teacher, staff, and students on LGBTQ+ issues, fostering a culture of inclusion and respect.
  • Support Systems: Create safe spaces and support systems within schools, such as Gay-Straight Alliances (GSAs), where LGBTQ+ students can feel safe and supported.
• Homelessness and Displacement
  • Housing Programs: Develop and fund housing programs specifically for LGBTQ+ youth who are at risk of homelessness. This includes emergency shelters and long-term housing solutions.
  • Family Support Services: Offer counseling and support services to families to prevent displacement due to rejection based on sexual orientation or gender identity.
  • Community Outreach: Partner with community organizations to provide resources and support for homeless LGBTQ+ youth, including job training and education opportunities.
• Healthcare
  • Inclusive Healthcare Policies: Ensure that healthcare policies are inclusive and provide coverage for LGBTQ+ specific needs, such as hormone therapy for transgender youth.
  • Training for Healthcare Providers: Train healthcare providers on the unique health needs of LGBTQ+ adolescents and the importance of creating a welcoming environment.
  • Access to Care: Improve access to healthcare by providing services in schools and community centers and offering telehealth options.
• Academic Achievement and Dropout
  • Inclusive Curriculum: Incorporate LGBTQ+ topics into the school curriculum to foster understanding and reduce stigma.
  • Supportive Educators: Train educators to be allies and provide support to LGBTQ+ students, helping them navigate academic and social challenges.
  • Mentorship Programs: Develop mentorship programs that connect LGBTQ+ youth with role models and mentors who can offer guidance and support in their academic and personal lives.

There are also a few additional strategies:

• Legislation and Advocacy
  • Advocate for policies and legislation that protect the rights of LGBTQ+ youth in all areas of life.
• Community Involvement
  • Engage community organizations, parents, and allies in creating a supportive network for LGBTQ+ adolescents.
• Research and Data Collection
  • Conduct research to better understand the specific needs and challenges of LGBTQ+ youth and use this data to inform policies and programs.

Teen Health Connection also offers many services for LGBTQ+ adolescents. Those services include:

• Center for Gender Health
  • In association with Atrium Health Levine Children’s Center for Gender Health, we have a team of physicians and behavioral health clinicians who support the care of an adolescent’s gender identity and in a setting that helps them feel welcome and accepted.
  • The Center for Gender Health is for adolescents who do not identify with their assigned sex at birth, such as transgender and nonbinary youth. Gender-affirming care has been shown to enhance overall health and feelings of self-worth.
• Behavioral Health Services
  • We have 11 behavioral health clinicians, each one bringing a unique skill set to meet the needs of adolescents, including struggles uniquely faced by LGBTQ+ youth. Our areas of expertise are:
    • Anxiety
    • Depression
    • Grief and loss
    • Trauma
    • Family conflict
    • Anger management
    • Attention-deficit hyperactivity disorder
    • Gender Health
    • Eating disorders
    • Adjustment disorders
    • Stress with chronic medical conditions

If you would like to learn more about our services, visit our website at https://teenhealthconnection.org/.
Tips for Parents on Normalizing Conversations About LGBTQ+
As we celebrate Pride Month, it’s essential to remind our teens that equality, acceptance, and celebration of everyone are fundamental values. Encouraging our children to embrace diversity, respect differences, and stand up for the rights of all individuals fosters a more inclusive and compassionate society. Every person matters, and there are no exceptions to that. By advocating for and modeling these principles, we empower our teens to build a world where everyone can live authentically and with pride.
Some resources for parents of LGBTQ+ youth are:

• Gender Spectrum: this is a great resource to help parents/guardians with understanding of their child’s gender identity and contains many informative documents across many areas such as families, education, and medical and mental health (https://www.genderspectrum.org/resources).
• PFLAG: is the nation’s largest organization dedicated to supporting, educating, and advocating for LGBTQ+ people and those who love them (https://pflag.org/).
• Strong Family Alliance: this is an organization who can help parents become more informed about the LGBTQ+ community and how they can best support their child (https://www.strongfamilyalliance.org/).

Resources

American Foundation for Suicide Prevention: American Foundation for Suicide Prevention. “Facts and Figures.” AFSP, afsp.org/about-suicide/suicide-statistics.

Centers for Disease Control and Prevention (CDC): Centers for Disease Control and Prevention. “Lesbian, Gay, Bisexual, and Transgender Health.” CDC,   www.cdc.gov/lgbthealth/youth.htm.

Gay, Lesbian, and Straight Education Network (GLSEN): Gay, Lesbian, and Straight Education Network. “2019 National School Climate Survey.” GLSEN, www.glsen.org/research/2019-national-school-climate-survey.

Kaiser Family Foundation: Kaiser Family Foundation. “Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S.” KFF, https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-and-access-to-care-and-coverage-for-lesbian-gay-bisexual-and-transgender-individuals-in-the-u-s/.

National Center for Transgender Equality: National Center for Transgender Equality.  “National Transgender Discrimination Survey Report on Health and Healthcare.” NCTE, https://cancer-network.org/wpcontent/uploads/2017/02/National_Transgender_Discrimination_Survey_Report_on_health_and_health_care.pdf.

The Trevor Project. “Homelessness and Housing Instability Among LGBTQ Youth-Feb 2022.” The Trevor Project, https://www.thetrevorproject.org/resources/article/friends-family-support-systems-for-lgbtq-youth/

True Colors United: True Colors United. “Homelessness Among LGBTQ Youth.” True Colors United, truecolorsunited.org/homelessness.

Closing the Divide in Mental Health Disparities

There has been a growing recognition of the critical need for accessible and effective mental health services, particularly among adolescents.  Adolescence marks a pivotal period of development characterized by rapid physical, emotional, social, and cognitive changes. As our awareness of mental health issues during this stage has grown, so has the recognition of the significant disparities in access to and utilization of critical services.  Many of the disparities we see fall along race, ethnicity, socioeconomic status, and geographic location.  From stigma and lack of awareness to systemic inequalities in healthcare, understanding and addressing these disparities is essential for ensuring that all adolescents have access to the support and resources necessary for their mental well-being.

Racial and Ethnic Disparities

• Unaddressed behavioral health disorders
• 5% of Black adults and 6.8% of Hispanic adults are less likely to receive mental health treatment compared to white adults at 18.6% (SAMHSA).
• Adolescents aged 12-17 with any mental illness was higher among Hispanic adolescents (39.1%) compared to Black (32.7%) and white (30.2%) adolescents (NIMH).

Socioeconomic Disparities

• Individuals from lower socioeconomic backgrounds face significant barriers to accessing mental health care. In 2020, 35.5% of adolescents aged 12-17 from families with annual incomes below the federal poverty level received mental health services, compared to 51.2% of those from families with incomes at or above the poverty level (SAMHSA).
• Lack of insurance coverage contributes to disparities in mental health care access. Uninsured individuals are less likely to receive mental health treatment compared to those with insurance coverage (The Kaiser Family Foundation).

Geographic Disparities

• Rural communities often face shortages of mental health professionals, which limits the access to care for residents. Individuals living in rural areas are less likely to receive mental health treatment than those in urban areas (NIMH).
• Telehealth has been used to help bridge some of the mental health care gaps, especially in rural communities, though challenges remain due to access to technology and limited internet connectivity in rural areas.
• Though percentages vary, it is estimated that on average, a rural resident will need to travel 50 miles to reach the nearest mental health care provider.

Addressing these disparities requires a multi-point approach that includes increasing access to care, reducing the stigma of getting help for one’s mental health, promoting culturally competent services, and addressing social determinants of health.

Acknowledging these disparities isn’t enough. it is important to begin thinking about how to find solutions to fixing them, both at the local level and national level. 

Enhanced Access to Care

• It is vital to extend mental health services in underserved areas through strategies like telehealth, mobile clinics, and community-based programs. This can help reach populations who currently have limited access due to both geographic and economic barriers.

Culturally Competent/Responsive Care

• It is important for trained mental health professionals to understand the many distinct cultures in their practice and address how cultural differences might influence care delivery. This can help improve trust and have positive outcomes among diverse populations.

Integrated Care Models

• Integrating mental health services into primary care settings can help improve access and reduce the stigma around mental health services. Through an integrated care model, mental health needs can be identified much earlier and treated more effectively.

Education and Awareness

• Increasing public awareness about mental health challenges and available resources can help reduce stigma and encourage more people to seek help.

Policy and Advocacy

• Paying attention to and advocating for policies surrounding mental health, especially those that encourage mental health services to be covered by health insurance and support safe community policing and protection.

Community Support Programs

• Investing in community-based programs can help provide support, education, and resources for individuals with mental health challenges. This can help lower feelings of isolation and improve overall well-being.

Tips for Parents

Parents, talking to teens about mental health can be delicate but crucial. Here are some tips to help you navigate this conversation effectively:

1. Normalize the Conversation: Just like we discuss physical health, let your teen know that it’s not just okay, but important, to talk about mental health and any concerns that they have.
2. Create a Safe Space: Your teen won’t talk if they fear judgement or punishment. Open up about ways that you can support them and be respectful of these conversations in the media or in the community.
3. Lead by Example: Model healthy behaviors by taking care of your own mental health and talk to your teens about the strategies you use, including what works and what doesn’t.
4. Use Everyday Opportunities: Incorporate mental health conversations into everyday activities, like during car rides or while cooking together. Casual settings can make discussions feel less intimidating.
5. Listen Actively: When your teen does share thoughts and feelings, avoid interrupting or dismissing their experience. Validate their emotions and let them know you hear them.
6. Educate Without Pressure: Provide information about mental health but avoid pressuring them to share more than they’re comfortable with.
7. Highlight the Importance of Self-Care: Encourage your teen to prioritize activities that bring them joy and relaxation.
8. Monitor Changes in Behavior: Pay attention to changes in your teen’s behavior, such as sudden mood swings, social withdrawal, or academic struggles. These could be signs of underlying mental health issues that need addressing.
9. Offer Supportive Resources: Share information about mental health resources available to them, such as school counselors, hotlines, or online support groups. Let them know it’s okay to seek professional help when needed.
10. Check-in Regularly: Schedule regular check-ins with your teen to discuss how they’re feeling and coping. These conversations don’t have to be formal; even a simple “How are you doing?” can open the door for meaningful dialogue.

Remember, building trust and maintaining open communication are key. Encourage your teen to express themselves authentically and show them that their mental health matters to you.

Resources

American Psychiatric Association. “APA.” https://www.psychiatry.org/
Kaiser Family Foundation. https://www.kff.org/.
National Institute of Mental Health. “NIMH.” U.S. Department of Health and Human Services, https://www.nimh.nih.gov/.
Substance Abuse and Mental Health Services Administration. “SAMHSA.” U.S. Department of Health and Human Services, https://www.samhsa.gov/

Pass the…Trauma?

It’s well known that we get our eye color and height from our parents. But did you know that trauma can also be passed down? Emotional or psychological trauma is defined as a deeply distressing or disturbing experience – like abuse, violence, grief, or loss. Author Resmaa Menakem explained that “trauma is a wordless story our body tells itself about what is safe and what is a threat.”

According to the World Health Organization, 70% of people will experience trauma in their lifetime. Trauma involving interpersonal violence has the highest risk for diagnosis of Post Traumatic Stress Disorder (PTSD). Sexual violations and assault account for over 42% of PTSD diagnoses. Adverse childhood experiences (ACEs) such as violence in the home, substance abuse, parental mental illness, chronic instability, homelessness, and food insecurity are all considered forms of childhood trauma.

So, how does trauma get passed down?

There are different pathways that trauma can creep from one generation to the next. One obvious way is through behavior and modeling. A child who witnesses a parent being physically violent may become physically aggressive in their future relationships.

Trauma, even hidden trauma like molestation, can become normalized within the family unit; it seeps in and becomes part of the family norms. Family members learn to “deal with it,” keep it quiet, or ignore it. Family secrets fester in avoidant silence. Once it leaches into the family’s tapestry, unprocessed trauma gets passed down to future generations.

Another pathway is through genes. There is a growing body of research that has discovered a genetic component to trauma. You may hear the term “epigenetics,” which, simplified, is whether the expression of a gene is turned on or off. Epigenetics helps to explain how information can be carried or transferred through the genes from a parent to their offspring.

A research team at Mt. Sinai School of Medicine in Manhattan, NY found that pregnant women who had been exposed to the World Trade Center attacks (“9-11” terrorist attacks) transmitted trauma to their unborn fetuses. The researchers measured stress hormones and found abnormal levels in both the mothers and their babies. Experiencing trauma in the third trimester seemed to have the most prominent effects (Yehuda, 2022).

Trauma that makes its way into our “gene expression” can cause us to be more susceptible to its effects. This genetic predisposition can impact how someone responds to and/or recovers from trauma or adverse experiences. From the book, My Grandmother’s Hands, our bodies store trauma and “intense survival energy” which is then passed down to our children and grandchildren.

So how do we interrupt these patterns? One place to start is to trace the family history of trauma, as well as the ways in which your family members and cultural group/s have shown resilience. Determine how anger, stress, or emotional numbing may be tied to your family’s history. Learn how to manage “activators” or things that cause trauma/stress reactions in your family. Seek help from a mental health professional (therapist) who can help you identify adaptive ways of coping and can offer tools for working through trauma.

There are things you can do, starting now, to interrupt cycles and move toward healing.

1. Unaddressed behavioral health disorders
2. Practice anchoring and grounding through deep breathing, listening to soothing sounds, resting, meditating, or praying
3. Use multi-sensory calming techniques: visual imagery + body scanning + soothing sounds + warmth or cooling on your skin.

My personal favorite is journaling. Here are some journal prompts that can guide your narratives:

• What do I know about my family’s trauma history?
• How does hurt from my past show up in my current life?
• Dear younger self…
• Love letter to myself…
• What is a healing practice in my family or culture that I can implement in my life?

Dr. Cochran works with Teen Health Connection’s Independent Psychological Assessment program, providing in depth clinical assessments, history review, and extensive recommendations for youth entering the custody of the Department of Social Services-Youth and Family services due to abuse, neglect, or dependency. In her daily work, Dr. Cochran sees the impact of intergenerational trauma unfold in the youth and families she serves. The trauma-informed assessment practice of the IPA program helps to link youth and families with care and supports to address the multiple layers of intergenerational trauma.

References

https://dictionary.apa.org/intergenerational-trauma
https://iuhealth.org/thrive/generational-trauma-breaking-the-cycle-of-adverse-childhood-experiences
https://www.scientificamerican.com/article/how-parents-rsquo-trauma-leaves-biological-traces-in-children/
https://www.washingtonpost.com/wellness/2023/06/12/generational-trauma-passed-healing/
https://www.webmd.com/mental-health/what-is-intergenerational-trauma
https://www.who.int/news/item/06-08-2013

From Bullying to Violence

Youth violence is the “intentional use of physical force or power to threaten or harm others by young people ages 10-24″₁.

Youth violence is the third leading cause of death among teens and young adults aged 10-24, and it is the leading cause of death for Black and African American youth ₁.

Each day, over 800 young people are treated at emergency departments for physical assault-related injuries ₁.

Some youths are at a greater risk than others to experience violence. Sexual minority teens are more likely to experience multiple forms of violence compared to their heterosexual peers, while Black or African American youth and young adults are at a higher risk for the most physically harmful forms of violence (e.g., homicides, fights, aggravated assaults) compared with white youth and young adults₁.

Youth homicides and nonfatal physical assault-related injuries in 2020 resulted in an estimated $122 billion, which includes medical care, lost work, and quality of life ₁.

Prevention is Complicated

Prevention efforts must go beyond awareness and address the root causes of violence among youth, such as socioeconomic disparities, access to education and healthcare, home and community environments, and cultural influences. By fostering supportive environments, providing education and resources, and promoting positive role models, youth violence prevention seeks to create safer communities and brighter futures for young people.

Roots of Youth Violence

There is not just one singular cause of an experience of violence. Violence extends beyond the individual and involves their closest relationships, their community, and society itself. According to the World Health Organization, violence can be traced to the following factors:

Individual Level

• Unaddressed behavioral health disorders
• Early involvement with alcohol, drugs, and tobacco
• Low commitment to school and school failure
• Previous involvement in crime
• Unemployment
• Exposure to violence in the family

Close Relationships (Family, Friends, Intimate Partners, and Peers)

• Poor parental monitoring and supervision
• Harsh, lax, or inconsistent parental disciplinary practices
• A low level of attachment between parents and children
• Low parental involvement in children’s activities
• Parental substance abuse or criminality
• Parental depression
• Low family income
• Unemployment in the family
• Association with delinquent peers and/or gang membership

Community and Wider Society

• Access and exposure to alcohol
• Access to and misuse of firearms
• Gang presence
• High-income inequality
• Poverty

Long-Term Effects of Youth Violence
Unique instances of youth violence can have immediate and devastating consequences on an individual and their community. However, ongoing exposure to violence in neighborhoods, schools, and cities can have long-term effects that are often overlooked. The long-term effects of violence extend across physical, mental, and social health, and disproportionately impact communities of color.

The prolonged effects of violence can increase the likelihood of:

• Violence perpetration and victimization
• Smoking
• Substance Use
• Obesity
• High-Risk Sexual Behaviors
• Depression
• Academic Difficulties
• School Dropout
• Suicide

How Can We Prevent Violence

Preventing violence among youth is a priority to all communities, however, the systematic health and social inequalities that put individuals at risk for violence are disproportionately experienced by Black or African American youth and young adults. Concentrated poverty. Residential segregation and racism limit access to healthy, supportive, resource-rich environments₁. According to the CDC₁ and WHO₂, preventing youth violence involves:

Promoting family environments that support healthy development

• Early childhood home visitation
• Parenting skill and family relationship programs

Providing quality education early in life

• Preschool enrichment with family engagement

Strengthening youth skills

• Universal school-based programs

Connecting youth to caring adults and activities

• Mentoring programs
• After-school and pro-social programs

Creating protective community environments

• Reduce access to alcohol and drugs
• Promoting firearm safety
• Community outreach and norm change

Providing access to healthcare

• Mental health clinics and programs
• Treatment programs for substance abuse issues

Tips for Parents

Parents can be critical partners in the prevention of youth violence by actively engaging in discussions, educating their teens, promoting a culture of peace and respect, and accessing support early when necessary.
Below are 5 opportunities to support social-emotional development and healthy relationships in your family:

Open Communication: Encourage open and honest communication with your teen about their feelings, experiences, and concerns. Create a safe space where they feel comfortable discussing any challenges they may be facing, including peer pressure or conflicts.

Healthy Conflict Resolution: Teach your teen healthy ways to resolve conflicts without resorting to violence or aggression. Model positive conflict resolution strategies in your own interactions and encourage empathy, active listening, and compromise.
Set Boundaries: Establish clear boundaries and expectations regarding behavior, including zero tolerance for violence or abusive behavior. Consistently enforce consequences for any violations of these boundaries while also providing support and guidance.

Monitor Online Activity: Stay informed about your teen’s online activity and social media interactions. Discuss the importance of responsible digital citizenship, including the impact of cyberbullying and the potential consequences of online aggression.

Seek Support: Encourage your teen to seek support from trusted adults, such as teachers, counselors, or family members if they experience or witness violence or bullying. Provide information about local resources and support services available for teens needing assistance.

References

1. “Preventing Youth Violence.” Centers for Disease Control and Prevention. 25 Oct. 2023, https://www.cdc.gov/violenceprevention/youthviolence/fastfact.html
2. “Youth Violence.” World Health Organization. 11 Oct. 2023, https://www.who.int/news-room/fact-sheets/detail/youth-violence

Safe Love Could Be Misinterpreted

The start of teenage dating is a stressful moment for any parent as they see their child growing up.  Conversations around dating and romance are usually never easy!  But it is important to have conversations about relationships, respect, and safety, and to establish yourself as someone your teen can always turn to for relationship advice or protection.
According to the Centers for Disease Control and Prevention (CDC), 1 in 12 adolescents in the United States have experienced physical or sexual dating violence.

• 7.2% of heterosexual students have reported physical violence, while 13.1% of gay, lesbian, and bisexual students and 16.9% of questioning students have experienced physical dating violence.1
• 9.3% of adolescent females and 7% of males reported that they have experienced physical dating violence.1
• 12.6% of females and 3.8% of males reported having experienced sexual dating violence.1
• 6.7% of heterosexual students, 16.4% of gay, lesbian, and bisexual students, and 15% of questioning students reported that they had experienced sexual dating violence.1
• 65.5% of adolescents report being victims of psychological dating violence, making it the most common form of dating violence among adolescents.2
• Around 48% of adolescents were victims of stalking or harassment by a former or current partner.3

Look Out for Signs of Teen Dating Violence

It can be challenging to recognize the signs of an unhealthy relationship, whether it be a teen’s own relationship or that of one of their friends.
Someone might be in a potentially unsafe relationship if their partner:

• Makes frequent calls or texts to find out where they are, who they are with, or what they are doing\
• Is jealous, possessive, or controlling
• Makes false accusations
• Has unexpected moments of anger or rage or an explosive temper
• Ignores their opinion
• Keeps them away from friends or family
• Does not let them do what they like
• Follows them or shows up uninvited
• Invades their privacy
• Gets angry very quickly or fights a lot
• Threatens suicide or self-harm
• Threatens to hurt them or someone in the family
• Refuses to accept when a relationship is ended
• Uses alcohol or drugs and expects them to do so as well
• Touches or kisses them when they do not want to be touched
• Forces intimacy
• Taunts or bullies them
• Destroys their property
• Threatens physical violence
• Shoves, punches, slaps, pinches, kicks, hits, or hurts them in any physical way

Consequences of Teen Dating Violence

Ending an unsafe relationship is hard. The majority of girls who experience violence in an intimate relationship continue to date that individual. The consequences of staying in these relationships are far worse than the difficulty to leave. According to the CDC, adolescents who have or are experiencing dating violence are more likely to:

• Experience higher rates of depression and anxiety.
• Exhibit antisocial behaviors, such as lying, bullying, theft, or physical violence.
• Engage in unhealthy behaviors, like using alcohol, tobacco, or drugs.
• Contemplate suicide.

Tips for Adults

Parents, caregivers, and other trusted adults need to have conversations with teens about their relationships. Below are some of the ways parents can help empower and foster healthy relationships with their teens:

• Recognize Red Flags: Be vigilant for warning signs in your teen’s relationships.
• Encourage Open Dialogue: Foster a safe space for open communication, ensuring your teen feels comfortable discussing relationships, consent, and any concerns they may have.
• Educate on Boundaries: Teach the importance of setting and respecting healthy boundaries, emphasizing the significance of mutual consent in all interactions.
• Build Self-Esteem: Support your teen in cultivating a high sense of self-worth. Individuals with high self-esteem are less likely to tolerate abusive behavior.
• Teach Digital Safety Awareness: Educate teens about online safety, addressing the risks of cyberbullying and promoting responsible social media use.
• Promote Support Networks: Stress the value of a strong support system by encouraging your teen to build connections with friends, family, and mentors.
• Attend Community Events: Engage in community workshops or events, especially during Violence Prevention Month, to gather insights and resources for preventing teen dating violence.
• Know Available Resources: Familiarize yourself with educational programs and resources aimed at helping teens understand healthy relationships.
• Be Proactive: Actively participate in efforts to prevent teen dating violence, both at home and within the community.
• Practice Conflict: Disagreement is unavoidable in any relationship. Teach your teen to “fight fair” and negotiate disagreements respectfully, and to expect this in return.

Want more information on teen dating violence?

•  Talk to Teen Health Connection’s parent educator about more ways to discuss teen dating violence with your teen (Kris.Hawkins@TeenHealthConnection.org/704-381-8333)
• Talk to Teen Health Connection’s triage therapists if you’re worried about your teen being in or recovering from a violent relationship (704-381-8379)

Resources to Help End Teen Dating Violence

Know the resources to help those who have or are currently experiencing teen dating violence both in Charlotte and throughout the country.

• Teen Health Connection: 704-381-8379
  • Our behavioral health triage team can help connect teens to one of our behavioral health therapists to help in addressing the effects of being in a violent relationship and the many ways to begin healing from this trauma.

• The National Domestic Violence Hotline: 1-800-799-SAFE (7233) or 1-800-787-3224
  • This line helps to provide crisis intervention, information, and referral to victims of domestic violence, perpetrators, friends, and families. The number is toll-free, confidential, and anonymous.

• The National Centers for Victims of Crime -1-800-FYI-CALL
  • This line can help find local victim services counselors for young people in need of help.

• The National Dating Abuse Hotline: 1-866-331-9474
  • This is a national 24-hour resource line specifically for teens and young adults. It is accessible by phone or online chat and offers real-time, on-on-one support.

• Mecklenburg County Prevention and Intervention Services: 704-336-3210
  • Specializes in domestic violence and substance use services for those in Mecklenburg County.

References

¹ “Fast Facts: Preventing Teen Dating Violence | Violence Prevention | Injury Center | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 27 Jan. 2023, www.cdc.gov/violenceprevention/intimatepartnerviolence/teendatingviolence/fastfact.html.

² “Literature Review: Teen Dating Violence.” Office of Juvenile Justice and Delinquency Prevention, https://ojjdp.ojp.gov/model-programs-guide/literature-reviews/Teen- Dating-Violence#2-0

³ Rothman, E.F., Bahrami, E., Okeke, N., and Mumford, E. 2021. Prevalence of and risk markers for dating abuse–related stalking and harassment victimization and perpetration in a nationally representative sample of U.S. adolescents. Youth & Society 53(6):955–978.

Wait! It’s not About Weight!

Setting and Keeping Boundaries with Your New Year Resolutions

Every year, teens and adults make New Year resolutions related to their health. “Eat healthier,” “exercise,” “lose weight.”

Being mindful of how we set our intentions, and how we communicate them to others, can have a big impact. The messages we send to our teens about their health when talking about resolutions can have a lifelong impact.

-Worldwide, over 70 million people have an eating disorder, including 5.5 million people in the United Sates (Deloitte, 2020).

-One in seven men and one in five women experience an eating disorder by age 40. In 95% of cases, these disorders began by age 25 (Ward et al., 2019).

-During the COVID-19 pandemic, the proportion of emergency department visits related to eating disorders increased dramatically, doubling for adolescent girls (CDC 2022).

Define your goals so your goals don’t define you:

If you or someone in your life made resolutions about their health, take a moment to better define and set boundaries for these goals. Don’t set goals in terms of pounds lost or hours in the gym. Focus on how these goals benefit your health and wellbeing overall.

Focus on the fun:

• Get active: Pick an activity you enjoy and get moving. Switch it up and have a dance party. Teens should be active for 60 minutes every day, but only 33% of Charlotte Mecklenburg High School students follow this advice 5 days/week (YRBS, 2021).
• Use the buddy system: Exercise with friends. Make meals with family members. Turn your goals into opportunities to interact and get support.

• Be specific about eating habits you want to change or adopt:
  • Snack intentionally: Choose whole foods (veggies, fruits, hard-boiled eggs) and brands that use natural, plant-based ingredients. Don’t keep problem foods around!
  • Eat more…

-Berries: Not only are they delicious but they have a variety of disease-fighting properties and even help to reduce cholesterol and regulates blood sugar.

-Fiber: Fiber helps lower cholesterol, regulates blood sugar, and helps you feel full for longer.

-Family meals: Learn about the nutritional properties and cultural importance of the foods you eat to help you be more mindful of what you eat.

• Think about the bigger implications of your goals:
  • • Teens who regularly eat breakfast score higher on standardized tests, have higher attendance rates, and have fewer behavioral and educational problems

Tips for Parents from our Parent Educator:

• Communication is Key: Just as a balanced diet and regular exercise are essential for physical health, a robust parent-teen relationship forms the foundation for emotional and mental well-being. Trust and open communication create an environment where teens feel secure and supported. When teens feel understood and accepted by their parents, they are more likely to make healthy choices in terms of diet, exercise, and lifestyle.
• Lead by Example: When parents model positive habits and engage in open conversations about nutrition and exercise, teens are more likely to adopt a similar approach. Shared family meals create an environment where healthy eating becomes a natural part of everyday life.
• Quality Time: Engaging in activities together, whether it’s a family hike, game night, or a shared cooking experience, fosters emotional bonds as well as a healthy lifestyle, improved cortisol levels and better overall physical health.
• Respect Autonomy: While it’s essential to be involved, respect your teen’s need for independence. Involve your teen in the decisions related to food choices and physical activities.

It’s not uncommon for teens to struggle with their health, body image, and self-esteem, especially with the power of today’s social media and the stressors of today’s schools and peer groups. These struggles, when not addressed, can lead to devasting consequences and lifelong challenges. It is estimated that 75% of people with an eating disorder don’t seek professional care (Hart et al., 2011).

Teen Health Connection has programs and services to prevent and intervene with these challenges. If your family is struggling with disordered eating or other health habits, or if you want more information on prevention and supporting your teens’ well-being, connect with our multidisciplinary team.