Mental Health U

Unlocking Courage: Megan Rinehart and Julia Manolukas on Confronting Childhood Anxiety and Building Resilience

• Bill Emahiser

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Ever wondered why anxiety seems to be an unwelcome shadow following so many children today? Megan Reinhart and Julia Manalukas from Unison Health join us to illuminate the dark corners of this growing epidemic, offering their expertise from within school walls. With an intimate exploration of the factors that fan the flames of childhood anxiety, our discussion exposes the harsh reality of how social media, bullying, and the disruptions of the pandemic have reshaped the mental landscape of our youth. We don't just highlight the problem; we dig into the potential long-term effects on a generation grappling with these mental health battles daily.

Anxiety can feel like a labyrinth with no exit, but Megan and Julia share keys to unlocking paths toward coping and resilience. This episode is a trove of strategies, from grounding exercises to the visually engaging 'rainbow breathing,' that promise more than temporary calm—they plant seeds of lifelong fortitude. We reveal how crucial it is for a nurturing figure to walk alongside children in this journey, arming them with tools to dismantle overwhelming negative perceptions and rebuild them into challenges they are equipped to overcome.

In the tapestry of support for children facing anxiety, schools play a pivotal role, and our conversation weaves through the ways they can provide solace and stability. Tune in and uncover the importance of open communication, the establishment of comforting routines, and the tell-tale signs that signal a need for professional intervention. For parents seeking solutions, we outline how Unison Health's school-based mental health programs stand as beacons of guidance, and where to find these resources to shelter the emotional well-being of their children. Join us on this heartfelt mission to foster an environment where the mental health of our children is prioritized and nurtured with the utmost care.

Julia:

But it's really, really hard to motivate yourself to climb Mount Everest in one go. You have to spend time acclimating as you increase in the elevations, and I think mental health can be like that too. You got to take time and acclimate.

Bill:

Hello and welcome. I'm your Bill ,Emahiser, and you're listening to Mental Health U, the podcast dedicated to demystifying and destigmatizing mental health issues. So if you or someone you know is struggling with depression, anxiety, trauma or some other mental health issue, then this podcast is for you. This episode is proudly sponsored by Unison Health, dedicated to making lives better through compassionate, quality mental health and addiction treatment services. Learn more at unisonhealthorg. In today's episode, we are privileged to host two remarkable professionals from Unison Health Megan Rinehart, director of Child and Family Programming, and Julia Manolukas, manager of the School-Based Program. With their extensive experience and expertise, megan and Julia are at the forefront of treating emotional and behavioral issues in children. Today, they'll be sharing invaluable insights into one of the most prevalent challenges affecting our youth childhood anxiety. I'm really excited. Thank you both for coming on. Megan, julia, how are you today Doing?

Julia:

well, Super fantastic Bill.

Megan:

Thanks for having us.

Bill:

Absolutely Well, can we get started? Megan, could you tell us a little bit about your credentials and about your experience in mental health?

Megan:

Sure, my name is Megan Reinhart. I think you already said that I'm the Director of Child and Family Programming here at Unison and I have been in the field. This is my 20th year actually in the field. Majority of my career has been spent working with children and families in office-based and school-based settings, so a lot of time spent doing work with kids and their families. I came back to Unison in 2020 and joined the school-based team and became the director just this past fall, so I'm very grateful at the opportunity to build and expand our kids' programming here at Unison.

Bill:

Excellent, and Julia, can you tell us a little bit about your credentials and your experience in mental health?

Julia:

Sure, so I'm Julia Manalukas. I'm currently licensed as an LPCCS. I have been licensed as a counselor since August of 2020, when I took a job with Unison in the school-based program. I've done that since and I recently became the program manager in the fall. So my experience professionally has been with kids in the school setting, specifically done a little bit of office on top of that, working with kids anywhere from five I want to say 17, has been the oldest.

Bill:

I'm kind of interested in what your take is. I recently looked up a study in the Journal of Medical I'm sorry, the Journal of American Medical Association, pediatrics, and they utilize some data from the National Survey of Children's Health spanning from 2016 to 2020, and it showed a significant increase in anxiety and depression among children. Even before the pandemic, there was a noticeable uptick in these mental health issues, and I mean not just, I mean it was huge, with anxiety and depression increasing 27% 24% for depression through 16 to 2019. And in 2020, approximately 5.6 million kids, or 9% of the kids that they surveyed, were diagnosed with an anxiety problem. In addition to that, about 5 million children also experienced behavior or conduct problems, and this was an increase of 21%. My question to you are you seeing the same thing in the schools and kind of a follow-up? What's going on? What's causing these problems?

Julia:

Well, we are for sure seeing that in the schools. A lot of times children will be referred to our staff because there's behavior problems or I should say challenges I don't want to say problems, but behavior challenges in the classroom. So we're definitely seeing that in the schools for sure. Those numbers break my heart, but they're not surprising to me to hear. As for the why, I mean like there's a whole host of reasons you could potentially point to. Social media is a very big thing. Kids are getting on it younger and younger. We've seen an uptick in bullying across all of ages that we work with. The pandemic cannot be discounted. It was a trauma for the country, but a trauma for children. I mean, their schooling was interrupted for almost two years. Some of the kids that are entering first grade now have never been in a group setting like that before because they couldn't do preschool or pre-K and things like that.

Megan:

So I think there's been a whole host of know. With all the changes in routine that went along with the pandemic and have lasted since then. You know how much the routine at home may have been interrupted, with guardians working out of the home, in the home, back and forth, school in session out of session. We're doing hybrid. We're not doing hybrid. All the just the constant changes and routine that kids have had to manage, and as adults sometimes it's hard for us to manage that many changes, let alone, you know, kids in kindergarten, first grade and then here they are actually in a classroom now. And how do I interact with people here? This isn't my guardian, this isn't my home. I'm learning in a new environment with new people and other kids, actually in person. So there's lots of things that could be anxiety inducing in that situation.

Bill:

The pandemic was huge and and I've seen some research that shows that actually the delays, not just academically but socially and emotionally in children. So this is probably something I guess we'll we'll be seeing until this cohort of kids move through the school system and graduate. I mean this might be something that's long, long lasting. Is there an age group that you see that seems to be more impacted right now by anxiety? I mean you said that you work with kids as young as, like kindergartners all the way through seniors in high school. Do you see a certain developmental age to be more impacted by anxiety right now at this time?

Megan:

For me, I think it's across the board. I mean, I can think of clients that I've worked with that are, you know, first and second graders that are dealing with some anxiety all the way up through the teens I'm working with that have been even into their, you know, senior year of high school and you know managing anxiety. So I think, while the triggers may be different for those different age groups, I think across the board at least from my experience I'm seeing some anxiety, not just in one certain age group.

Julia:

I had the same thought, megan, because I can think of teens I work with that have anxiety, and younger kids that do too. I think the big difference that I'm seeing is how that's expressed. So a teenager might say I'm up till three o'clock in the morning because I have to get this paper perfect, or I keep throwing up before I have to take a test or things like that. Maybe it's specific to academics, whereas for a younger child it might just be separation anxiety. They don't want to be away from their parent, or I'm used to being home with mom and dad. Now they're expecting me to like do math, and I feel shy and anxious about having to share that. So that could be some avoidance or even some tantrums.

Megan:

I was just going to say that I think sometimes it, you know, with the younger kids it might be externalizing the anxiety a little bit and you'll see it more in like maybe what you think of like acting out behavior, right, so like a temper tantrum or throwing something, ripping up their paper. Where the teens I've worked with it's like more internalizing, where you know they might be isolating themselves more, stop wanting to do things with their friends more, you know, maybe seeming more irritated or on edge, but it's a little bit more internalized. With the little kids it seems to be a little more externalized.

Julia:

I think I would agree with that for sure.

Bill:

You mentioned triggers. I heard some one of you mentioned triggers, so you kind of talked a little bit about how those different age groups it impacts them or it looks a little bit different based on their developmental, their developmental age. What are some of the triggers that you see in the different school ages for anxiety to come on?

Megan:

So I think that some of the triggers I've seen with my older, with my teens a lot of times it's having to give presentations, having to do, you know, some type of public speaking or presentation in front of their class Lunchtime seems to be a big trigger, I think, because of the social, increased social interaction during that time, as opposed to being in the classroom where it's a little more contained and you're, you know, focused on, supposed to be focused on what the teacher is doing.

Megan:

I think also bullying, as Julia mentioned, I think, a little bit ago, bullying we're seeing an increase in that and so that can be triggering for some anxiety and I think even just school work in general, you know whether it's the work is too hard or not understanding it. Or I know sometimes they're doing more work on computers and not having a knowledge of how to do that. How do I get logged in? How do I, you know, do the work? If I don't know how to do it on paper, how do I know how to do it on the computer? So I think all of those things can be triggering.

Julia:

Yes, my first thought was definitely schoolwork, and then maybe expectations, whether that's from an adult at home, whether those are expectations you have for yourself. I think about some teens who have very intense workloads. I mean, it makes me feel what was I doing in high school? Because some of the things that these kids are expected to do, I'm like that sounds like college work to me, you know. So that seems really intense. And then I think about the little kids. I feel as though a trigger can be when there's a change in the routine. So especially when you're young, school is very structured, so if something changes and you're not anticipating that change, that can be stressful and anxiety-inducing, especially if you don't understand why the change is occurring. All of a sudden you have a sub and it's not your teacher, and that can be scary, especially if you have a long-term sub.

Megan:

You know like you have a teacher to start the year and then, all of a sudden, that teacher's gone and there's a long-term sub. Now, and even as wonderful as some of those long-term subs may be, it's still that transition and that change. And you know, is it going to happen again? Are they going to go and another teacher is going to come in, and everybody has different teaching styles? So I think you're right on that Exactly.

Bill:

Mental Health? U is brought to you by Unison Health. Unison Health, making lives better. Unison Health, making lives better. What do you see as far as escape and avoidance, and what's the impact on the child's learning and their social interactions because of that avoidance and escape behavior?

Julia:

I think a really obvious example of avoidance would just be school refusal. I'm not going to go. You can't make me, I hate it there, I'm not going. So if kids are missing, you can't learn if you're not there.

Bill:

Right.

Julia:

Right. So that's going to affect you academically if you're not physically in school. It's also going to rob you of opportunities to practice your social skills. The only way to get more comfortable is to practice it. So I think school refusal can be something pretty obvious as an avoidant thing. It could be as subtle as we're having a discussion about cat in the hat and the teacher's calling on people and I do not want her to call on me. So I'm going to try to make myself as tiny as I can. I'm going to look away. I'm going to pretend I'm writing something very important about cat in the hat, so they don't call on me.

Julia:

I know sometimes with transitions between classes for the little kids it might be a tantrum. I'm not leaving the room. I want to avoid. I don't want to go to gym class where if you were like young Julia Manalukas, you were never picked first for dodgeball and I don't want to do that. I don't want to be picked last for dodgeball. That makes me anxious. So I'm going to stay in the classroom. I'm not going to transition. So I think those are some examples that I think a lot of those were for specific. But you can have school avoidance and that can turn into truancy for older kids as well they don't want to go or refusing to do something. Megan mentioned presentations. So if you have so much anxiety that you're like I'm not, I'll take the zero. That can affect your grade and your ability to get more comfortable in practice with something that you might have to do later on in your life.

Bill:

Right, and do you notice, um, as far as escape and avoidance, you ever see any kind of somatic symptoms where, uh, you know people are, you know the kids are like I got a stomachache or I got a headache or anything like that.

Megan:

Yes, they all have stomachaches. That's a big one. Headaches, um, just a general. I'm not feeling well. I need to go home. I need to call my guardian to come pick me up.

Julia:

Definitely see that the kids that the nurse knows Like oh here comes little Julia, it must be gym class.

Bill:

Right.

Julia:

Must be gym time.

Bill:

What are some things therapeutically that you do to help the kids get over that escape and avoidance?

Megan:

So I think if you know somebody that I would be working with, I would be looking at. You know what are some self-calming or some grounding techniques that we can use to help manage those symptoms of anxiety. So when it's time to go to gym, what are some things you can do? Nobody has to know you're doing it. Nobody has to know you know you're practicing a grounding exercise. You can do it on your own and see if that helps to decrease the level of anxiety you're experiencing or help you regulate enough that you're able to go to gym and maybe not participate but maybe go to gym. Maybe it's like a step in that direction. So I think we're really working on learning some practical things, self-calming strategies that they can use at school. That isn't going to be necessarily obvious to everyone around them.

Julia:

I think, to pinpointing the specific things that are triggering the anxiety. I think anxiety is very talented at making everything seem awful.

Bill:

Right.

Julia:

Anxiety can be very convincing, that everything is terrible and you should feel stressed 24-7. So if we can take that big giant cloud of everything and we can reduce it down to gym class is a trigger because of this. Or my Spanish teacher scares me, so that's a trigger, I don't want to go to Spanish, or whatever the case may be, or I get the Sunday scaries because of this reason. If we can make it specific, then, exactly like Megan said, we can identify and learn skills that are going to help us address those specific triggers. But it's really really hard to motivate yourself to climb Mount Everest in one go.

Julia:

You have to spend time acclimating as you increase in the elevations, and I think mental health can be like that too. You've got to take time and acclimate. Be specific.

Megan:

I think having a safe person to delve into that with of like, what is the root, what is the trigger, what is it about gym or what is it about Spanish? And having, thankfully, you know, we're embedded in some schools directly so that we're able to be that safe space for our clients to come to, to help them process through their anxiety, to help them figure out what might be triggering it, what's underneath it, and then learning those strategies to use at school.

Julia:

And then helping remind them too. So, if we can, we know that the transition to gym is going to be a challenge.

Megan:

Well, let me hang out and I'll remind you to use your grounding, or we can do it together in the moment until they're able to do that on their own, or sometimes even just seeing you, you know, as a visual reminder of like, okay, there's Miss Julia, and I remember that she taught me to do a grounding exercise or to do this rainbow breathing. So I'm going to do these because I see Miss Julia and now that's visually reminding me of the skills that I'm working on with her to help me in these situations.

Bill:

So it really is a combination. You're modeling the behavior that you're wanting to see from the kids, you're kind of giving them a heads up, you're practicing with them outside of that situation that causes the anxiety or that triggers the anxiety, and then you remind them to practice that prior to or during those events. You mentioned rainbow breathing. What's rainbow breathing?

Megan:

I'll let Julia explain this one.

Julia:

It's one of my favorite forms of breathing to do with the kids because it involves some body stretching, which is always helpful. So you stand up, you plant your feet firmly on the ground, you breathe in really deep and as you breathe in deep, you reach down towards your toes and you scoop up a color. So I'll sometimes let the kids pick. I'll have times where it's like we're going to make only shades of green. So this is dark green, this is light green. But you pick up your color and when you put your hands up above your head almost like you're making a pyramid with your hands above your head, and then you breathe out as you spread your hands open, like you're creating a rainbow, and so you can do that as many times as you need to calm down, and it's also fun to imagine what color am I adding now. But it gets your body moving, it gets you stretching and it is focusing your attention on your breathing, your body. What color is this again, as opposed to whatever is happening that was making you feel anxious.

Bill:

Right, right. So would you count that as a grounding or a mindfulness exercise?

Julia:

Yes, for sure I would, and I think those are the things that can be most helpful for anxiety, because it pulls you back into where you are right now, as opposed to wherever your anxiety is telling you you should be in your mind.

Bill:

Is there an intervention as a parent that I can help my child or help my student out with?

Megan:

So I think first thing is talking to your child.

Megan:

So you know, talking with them about how they're feeling, what their feelings are, listening and you know, being available to support and helping them to manage them, or just simply being there to listen so they can express how they're feeling, letting them know it's okay to feel their feelings.

Megan:

You know, sometimes it might be a tendency to say stop worrying or stop thinking about it, when really you know that may not be helpful to the child. So I think, just giving them a space to be able to express how they're feeling, know that it's okay to feel that way and that you're going to be there to help support them. I also think just reinforcing mindfulness techniques. You know there's a lot of techniques out there online that you can teach your child and maybe even would be beneficial for you as a guardian. Sometimes it's stressful being a parent and so having some things that you can do to then model it for your child as well Maybe I need to take a break and do some rainbow breathing, so helping practice those at home to model that for them again, but to also give them the tools that they can use as well.

Julia:

Something that I know I've talked about with Megan when I'm trying to get ideas for my own clients is that idea of routine. So we talked about how, when routine is disrupted or becomes unpredictable, it can be anxiety inducing. So I mentioned the Sunday scaries which, as a not child, I still experience, and so having a routine can help with that. So I know what I'm going to do on Sunday to prepare myself to go to sleep. I know what I'm going to do on Monday morning to prepare myself to get up and have the energy to go to unison and do the thing. So creating that with your child.

Julia:

So what are some things that we can do to get ready for bed before school? And you can make like a poster board and they can decorate it, and it's also an opportunity for you to do it with them. So if one of the things you're going to do is we're going to set out our outfit for the night before, I'll watch you pick out your outfit, jimmy, and then you're going to come in my room and watch me pick out my outfit. So you're modeling, you're helping them see how the routine is keeping you calm, it's keeping you focused, and so then they can see. Okay, wait if that really works for mom. I want to keep doing that for me, so establishing a routine can be helpful as well.

Bill:

How do I know when it's time to reach out and get professional help?

Julia:

Well, I think so. There's something we call impairment, which we look at oftentimes when we're talking about mental health. So the things that you're experiencing how is that making certain areas of your life difficult? So, if it gets to a point where we feel like they're not able to do certain things or there's been a big change so their mood really, really fluctuates, on Sunday night it's not just like, oh man, I don't want to go to school. It's like I'm huddled up in a ball in my room and I don't want to talk to anybody, or my grades were okay, but now they've dropped all of a sudden. So looking for areas where you're like, okay, this seems more than just I'm 12 and I hate gym class and I don't want to go. So looking for those areas where you feel like they're really having an impact. That might not be positive, but this is also a moment where I want to shout out school counselors.

Julia:

In the school-based program we work with school counselors a lot and they are fantastic people that really care about their kids at their schools and that can be a person as a parent to go to to say I've noticed that little Julia is saying this or doing this. Do you have any suggestions? Do you have any advice? Could you talk with her one-on-one, and the school counselor can be a great ally and advocate for getting your child support and then also probably has an idea of how to get you connected if you want to take the next step for professional help. So is there an embedded partner at your school? If there isn't, I guarantee your school counselor knows of places in the area that they could give you the information on so you could have your child evaluated and talk to a licensed mental health professional.

Bill:

Can you say how many schools you're actually in and maybe list a few of those off?

Megan:

So we are in four K-8 elementary schools within Toledo Public Schools, and those are Burndale Elementary, Reynolds Elementary, Raymer Elementary and Robinson Elementary. We are also in Toledo Technology Academy of Engineering and Toledo Pre-Med and Health Sciences Academy. Those are both Toledo Public School Academies serving high school students and junior high, junior high and high school students. And then we also are in providing individual therapy services at Independence Education Center, which is out in Defiance, Ohio, so we're able to help engage some of the kids out there that may be in need of some school-based supports.

Bill:

Well, if I have a child who's struggling with anxiety, they might be at one of these schools. Where can I learn more information about your school-based program?

Julia:

So you can go on to the World Wide Web, use the browser of your choice and look up wwwunisonhealthorg forward slash school-based program and you'll get some information on what we can offer. If you go on there and you see, my child doesn't go to these schools, but I'm still interested in Unison as a potential place to get support. We do offer office-based child and family programming, so our website will have a way for you to reach out and get connected to whatever program makes the most sense for you if Unison is the avenue that you want to pursue for your child.

Bill:

Well, thank you both so much for sharing today. I really appreciate all of the great information that you have relayed on our show today, so thank you so much.

Julia:

Thank you, Bill.

Megan:

Thank you, Bill, for having us again. We appreciate you.

Bill:

This podcast has been brought to you by Unison Health. Unison Health is a non-profit mental health agency dedicated to serving the Northwest Ohio community for the past 50 years. You.