Thank you very much for coming. It is an honor to be invited to speak with you today. I hope we may have a conversation together that will be interesting to everybody. I may have some knowledge to share with you, but you also have much knowledge to share with me. So I look forward to learning together. First, let me tell you a little about myself. My name is Sarah Rosenbaum. I am a clinical psychologist in the city of Philadelphia in the United States. I received my Bachelor of Arts in psychology from Bryn Mawr, and completed my doctoral training at Columbia University in New York. I have been a therapist working with adults and adolescents for almost twenty years. In that time, I have worked in almost every type of setting available in our country, including hospitals, clinics, group homes and private practice. Emiko-san invited me to speak to you today about the problems we see today in the US with youth who are struggling in school. I will describe some of the most common problems facing our youth, and some of the approaches taken to try to help these young people. I hope this may be helpful to you and to everyone who is involved in the development of ikiru ikiruﾕs exciting new program. I. There are several reasons why a teenager may struggle or drop out of school in the US. Here are some of the main causes: 1) The student has trouble doing the work required; that is, the youth has some kind of learning difficulty that may never have been diagnosed but makes the work too hard. Children are often ashamed to qdmit they cannot do something. Many will behave badly or pretend they don't care to hide this. My cousin has a son who has always had some learning difficulties, especially with math and science. She worked very hard all during his childhood to ensure he went to schools with special programming designed for children with learning disabilities, or as she says ﾒlearning differences.ﾓ Two months ago he graduated from college with a degree in film, and hopes to become a successful screenwriter. My cousin is a therapist herself, and her mother was a school psychologist. My cousin also had learning difficulties herself and understood his situation very well. But if her son had not had parents who knew the signs of learning problems, and who were prepared to fight for him to get the special attention and programming he needed, he probably would have dropped out before finishing high school. Poverty is a significant contributing factor here. Without the money to send their children to better schools where there is a lot of individual attention, their childrenﾕs problems may be missed and even intensified by poor teaching, overcrowding and lack of good supplies and materials. In addition, children whose parents lack much education themselves often have more trouble recognizing when their children are struggling, or do not know how to help them effectively. 2) Young people with stress at home often have problems with staying in school. Such things as fighting between their parents, neglect or abuse, or any kind of traumatic experience can result in school problems. In one of my first jobs (before I went to graduate school) I worked in a group foster home for disturbed children and teens. These were kids who had been taken away from their families because of abuse or neglect, but who were not doing well in any foster family they were placed with. This home was their last chance before being taken into state facilities (usually not good places to grow up). I remember one boy, I will call him Andrew; he was 17 and very angry. His mother was dead; he had grown up in a home with a father who beat him all the time. There was never enough food, and no interest in whether he did his schoolwork, or even whether he went. Andrew was a smart boy. But he was athletic also, and because of his background, he thought only of becoming a sports star as a way to escape his past and get ahead. For Andrew, providing education in academic subjects like math and history was not enough. His emotional life was very twisted, and he needed to feel at home, loved and safe in order to achieve his real potential and learn to make good decisions for himself. Much more recently, I worked with a teenage girl a few years ago; Iﾕll call her Angel. When I met her she was 15 and hated coming to therapy. She only came because she was required to do so by our fostercare system. Angel was taken from her mother at age three after being sexually abused by her motherﾕs boyfriend. However, she was moved from one home to another, and was abused several more times in the places she was put. (The American foster-care system is very overloaded. So many people who are not really fit parents are allowed to take children when their real interest is just in the money the state will give them.) She too was a very smart girl, but in 10th grade she still could not spell the name of her home state correctly. Shortly after I met her, she became pregnant, and dropped out of therapy when her baby was born. I did not hear about her for some time but a few years ago she came back to see me on her own. She was living in a state-run apartment for foster children who are almost grown, with her own young son. Amazingly, she had completed highschool and was enrolled in college. But she was seeking therapy because she still struggled to develop healthy and trusting relationships, and to make good decisions for herself and her son. 3) Some children simply do not fit in well with the model of education offered by our culture. They may have difficulty with the regimentation or discipline of a traditional school, or with traditional mechanisms for teaching. But they may still have many gifts, and even be more creative than average. These children in particular might benefit from a program such as ikiru ikiru, that gives them individual attention, assesses their strengths and weaknesses, and gives them a positive experience of learning something that really interests them. For example, a friend of mine has a son, Eddie, who has shown unusual artistic ability from an early age. He is very bright and imaginative. However, he is also a bit ﾔspacey or otherworldly, and there is a history of some mental illness in the family. He rebelled often against too much routine or structure by tuning out or just not going to class. Some subjects hold no interest for him and he has trouble disciplining himself to learn these. My friend was able to get him into a special school for high school called a charter school; this is a type of school that teaches a basic required curriculum but then focuses on some particular interest or talent of the kids it admits. In Eddieﾕs case, he got into the top charter school for art in our town. This has undoubtedly helped him both to stay in school, and also to build up his self-confidence about both his artistic and academic abilities. 4) It is estimated that 10 - 20% of the general population in the U.S. have a diagnosable form of some type of mental illness. I do not know if these percentages are comparable in other countries because many countries do not yet have the capacity to effectively diagnose mental illness or to keep track of such statistics well. Many mental illnesses can start to develop in teenage years or earlier. This includes things like depression, anxiety, bipolar disorder, schizophrenia, obsessive-compulsive disorder and others. These diagnoses are often missed until the children grow older. It is very hard to study well if, for example, you are hearing voices in your head, are afraid of going outside os speaking to anyone, or cannot leave the house without lining up all your clothing in your drawers so the edges are perfect. Yet, there is still so much stigma and shame about mental disorders, that children will often go to great lengths to hide their symptoms. For the same reason, parents may be very slow and reluctant to notice the signs that their child is not the same as others, or they may try to excuse or explain the symptoms away. 5) In the U.S., drug abuse among teens is also a major cause of school failure and other behavioral problems. The drug culture reaches to ever-younger kids. It is still worst in poor, urban environments, but it has spread to the suburbs and the middle and upper classes as well. More children than ever before are developing serious substance abuse problems. Often, untreated mental health issues are an underlying cause here. Children who are depressed, traumatized or unable to focus due to something like attention deficit disorder may turn to illicit drugs in order to escape or to try to ﾒself-medicateﾓ their problems. The wish to fit in also leads many teenagers into behaviors they know are wrong and that they donﾕt even enjoy much, just to feel accepted or gain the respect of another youth they look up to. Once begun, a drug habit can be very hard to break, both physically and psychologically. II. Each of these types of problems may respond favorably to some degree to enhanced attention, a safe environment and encouragement of creativity and self-expression. In the U.S., there are four major approaches generally taken to identify and address the needs of what we call ﾒat-riskﾓ youth. 1) The schools are supposed to watch for children who are struggling with the material, not attending classes or not fitting in socially. Then the parents are consulted, and the school counselors involved. The child may be sent for specialized assessment or testing to determine what the cause of the problem may be. Depending on what problem is identified, the child may be sent for special tutoring, may be assigned to specialized classrooms for children with the same kind of problems, or may be sent for mental health evaluation and treatment at a clinic. Sometimes all three methods may be tried. However, this is the ideal situation. In many cases, the schools do not do this job well, either because they are under-trained to recognize and deal with these issues, or because they do not have the funds they need for this specialized testing and programming. Again, this is especially true in poorer school districts in inner-city or rural areas of the country. 2) Some families work to help their children at home. This can be vital to childrenﾕs development at any time. But it is especially important when the child is struggling. Things that families can try include more attention, more family-based activities, and more supervision of what their children are doing. Some families try taking their children out of school and teaching them at home; there is a growing movement toward this in the US, and many technological advances have made it easier for parents wishing to home-school their children to stay connected to their school district and state expectations for curriculum. The issue of effective supervision is very important. Many youth in the US end up in trouble because either their parents do not show enough interest in what they are doing and also what they are thinking and feeling about it, OR their parents show too much interest and become too intrusive and controlling of their childrenﾕs lives. Children do not exist in a vacuum; they are part of a family system. So it is critical whenever possible to have the support and buy-in of parents in helping their children change direction. Sometimes this means the parents must be willing to change too, and this can be a major block to making changes that really last with kids. It is often easier for parents to come to a program or doctor and say ﾒhere, please fix my child.ﾓ It is much harder for parents to hear that they may be contributing to their childﾕs problems and must alter what they are doing. 3) In the U.S. there is a growing industry devoted to camps and programs for youth with special needs or behavioral problems. These camps can be after-school programs, day-time programs instead of school or during the summer, or residential programs that go for different lengths of time. The camps vary widely in focus, program, and quality. Some are very well-designed and employ well-trained and devoted staff. Others suffer from poor planning, under-trained staff or lack of real interest in the kids. At the worst end there are programs that are just interested in making money from worried families, or from government funding. Programs like ikiru-ikiru can play a very important role for many children by providing them with a form of artistic self-expression and a way to build their self-esteem and sense of purpose that may not be achieved in their regular schooling. 4) Finally, there is mental health treatment. This comes in two main forms, talk therapy and medication. Talk therapy may be individual or in groups with other teenagers. It is supposed to be provided by mental health professionals such as psychologists, with in-depth training in the mental health needs of adolescents, which are different from those of young children or adults. Therapy is not the same as counseling, which often confuses parents and teachers, who do not understand the difference. Medication should come from a psychiatrist (a medical doctor who specializes in mental health), who similarly has expertise in the uses and effects of medications with the changing bodies and brains of this age group. Recent research indicates that for many mental illnesses, especially depression, the most effective treatment is the combination of talk therapy and medication, which works better and faster than either treatment provided alone. Suicide is currently the third leading cause of death for adolescents (behind car accidents and homicide). Undiagnosed or untreated mental illness, especially depression, is behind many of these deaths. This is even more tragic because depression is now very treatable. However, if it is not dealt with early, depression and other forms of mental illness can become entrenched and are much harder to cure in adulthood. The effective delivery of good mental health treatment at the right time can make a crucial difference in the lives of at-risk youth. In the U.S., there are many types of mental health professionals; some work in clinics or hospitals, some in schools or community agencies, and some work independently in private, individual or group practices. As you may know, the entire healthcare system in the U.S. has been seriously damaged by allowing it to become a for-profit industry with little regulation from the government, and no requirement that everyone receive care. The mental-health field has been even more severely damaged by our system, because insurance companies constantly seek to reduce or eliminate treatment for mental health problems, and each insurance company is allowed to make its own rules about what treatments and medications it will cover. The result is chaos, in terms of what treatments are available in different regions, what types of training and experience are required of the professionals, and what the standards are for good treatment. The biggest barrier to accessing mental health care however, is the social stigma that still prevents many youth--or their families--from using the services that are available. Yet those who are too frightened or too ashamed to allow another person into their inner world tend to suffer longer and to have worse outcomes. I often tell people that asking for help when needed is a sign of strength, not of weakness. This is because it takes strength to allow oneself to be vulnerable and to share ones' inner world with another person. Assessment is the key to effective intervention for children with all of the types of problems we have discussed. The problem must be identified correctly in order for effective measures to be taken quickly to counteract the problem. Interventions that are not based on a knowledge of the childﾕs individual issues and the underlying causes will probably fail. IV. There are also major societal forces that contribute to the problems youth are having in the US. Poverty and the resulting lack of access to resources is one major factor. Families with less education and less money are less likely to recognize or find appropriate help for their childrenﾕs problems early. Many immigrants to the US are also struggling with acculteration and language barriers that make the journey for their children even more difficult. As I mentioned already, our societyﾕs broken healthcare system also guarantees vast inequalities and lack of consistency in what is available. Also, our industrialized and increasingly technology-driven culture has come at a great cost to the integrity of families and communities. The breakdown of the American family has been the subject of many books. Again partly due to economic pressure, children are left more and more to their own devices or enrolled in multiple activities while both parents work outside the home. Meals are eaten on the fly and not enjoyed together, and leisure-time and vacations when families can bond together are vanishing. Many studies have shown that a lack of family togetherness and closeness is associated with more problems in school, and in life for the children. In conclusion, programs like ikiru ikiru can provide a vital oasis for young people who have lost their way in lifeﾕs journey as a place that celebrates the positive in each child, and emphasizes their potential and ability to express themselves through the beauty of the arts. It can also be an important link between families who need help and the services they need. Trust and understanding are the most effective ways to overcome the barriers of fear and stigma that often prevent children and their families from reaching out. Through the relationships these youth form with their teachers at ikiru ikiru they can be guided toward additional services and help they may need to succeed in school and in life. Thank you very much for your time and attention today. I am honored to have been able to speak to you, and I thank Emiko-san for the invitation to do so. Speech by Sarah Rosenbaum