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Aug. 23, 2019 - Work Worth Doing - Doug Burgum
33:15
Dr. Stuart Ablon: Challenging Kids Lack Skill Not Will

Dr. Stuart Ablon is the director of Think:Kids, a program in the Department of Psychiatry at the Massachusetts General Hospital. After he spoke to attendees at the Governor's Summit on Innovative Education, he sat down with Gov. Burgum to have a conversation about behavioral health in an educational setting. To learn more about Dr. Ablon's work, visit thinkkids.org.

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More than 500 educators, students, behavioral health professionals, and community leaders signed up for the 2019 Governor's Summit on Innovative Education to gather and discuss best practices for K-12 education.
As in previous years, the summit began with a focus on classroom instruction.
This year there was an added emphasis on student behavioral health, which was the topic of conversation on the entire second day of the conference.
Teachers, health providers, administrators, and local leaders provided an expansive look at the state of behavioral health in North Dakota schools.
All presentations from the summit will be available online soon, but today we're giving you a conversation that wasn't heard on the main stage.
Welcome to Work Worth Doing.
I'm Mark Staples.
Attendees at the Summit on Innovative Education heard a fascinating address from Dr. Stuart Ablon, director of Think Kids, a program in the Department of Psychiatry at the Massachusetts General Hospital.
He is also an associate professor and endowed chair in child and adolescent psychiatry at Harvard Medical School.
As a doctor of clinical psychology, Dr. Ablon's work is thought-provoking, evidence-based, and practical for students with behavioral health challenges.
After he delivered his presentation on the main stage, he sat down with Governor Burgum to discuss behavioral health.
Let's get started.
Here's Doug Burgum and Dr. Stuart Ablon.
Honored to be here today with Dr. Stuart Ablon.
So fantastic to have you back in North Dakota one more time.
Really groundbreaking work, inspirational message, and thanks for sharing it with all the state leaders that had an opportunity to hear you today.
But tell us, Doctor, what led you to get into this field in the first place?
Sure.
Well, first, a pleasure to be here.
So thank you for having me as part of your summit, and it's amazing the folks who've come together here.
It's really exciting.
I actually come from a family of mental health providers, and early on in my career, I was sort of studying, all right, what is it about how we try to help people that works and what doesn't?
And I was also working with really challenging kids.
And I ended up saying to myself, how do I put the two of these things together?
Because what we've learned is the best way to help people is build a helping relationship with them.
And I'm working with all these really tough kids that are really hard to build a helping relationship with because their behavior is so difficult to deal with.
And it's so frustrating to be around.
How are we going to help people empathize with those kids and understand them and build the kind of relationship that's going to work?
And that's sort of how I got into this field.
the word empathy in that answer.
And I would say from listening to your keynote, the empathy that you have developed personally and that you've applied to your work has been part of how you've come up with this creative collaborative problem solving approach, which is the key to the working.
But, and then you use the word aggressive empathy during your talk.
But it's so key, but tell us just more about empathy, because you also said empathy is not excusing.
It's not agreeing.
That's right.
But it is understanding.
And I think that there's a fundamental issue around behavioral health behaviors in school where we perhaps as adults just don't understand the root cause.
And how do we all up our empathy and why is that important to the process?
Empathy is hard.
I mean, as you were just saying, you know, empathy isn't agreeing or disagreeing.
It's really just understanding.
And the root of it is listening and gathering information from people.
And we humans, when we're talking to people, it's really hard for us to suspend our reaction to what they're saying and to actually really listen just with the intent to understand and not be thinking, you know, how do I think about this?
How am I going to respond?
It's really, really hard for us.
But I find that empathy is the greatest what I call human regulator.
In other words, it calms people.
And working with challenging kids, that's one of the biggest obstacles.
And it's not just the kids, because we adults, we get very, what we in professional jargon call, dysregulated around these kids.
We lose our cool.
And for good reason, because they're very disruptive.
And, you know, whether you're a teacher or a principal, they get in the way of you doing your work and they make your life much harder.
And it's hard to have empathy for them.
But yet, if we can have empathy for those folks, they can then have empathy for the kids.
And I think one of the exciting things is that in this day and age, we have scientific reasons to be empathic.
Because we have learned that people who behave poorly, kids in school included, they actually don't lack the will to behave well.
What they lack are the skills to behave well.
That ironically, kids who struggle with their behavior in school are trying harder than the other kids to behave well.
It doesn't come naturally to them.
They struggle with skills.
And if you can understand that, Whether you just sort of get it emotionally or whether you read the last 50 years of research in the neurosciences that shows us this, it helps build in that empathy that's at the basis of doing something different with these kids.
One of your key theses was that kids will do well if they can do well.
And I think that that creates a completely different understanding because the traditional approaches that we've taken to school discipline to solve behavioral issues have been based in a false assumption that That we need to add external motivation through rewards or punishment.
But maybe just spend a minute and talk a little bit about how the current approach that's traditionally used, the conventional wisdom, why it doesn't work.
Yeah, well, you know, it's sort of built into our systems in schools.
I mean, actually, our assessments that we do in schools look to find whether a kid is trying to get out of something or get something with their difficult behavior.
It sort of starts from the assumption that the behavior is goal-oriented.
It's sort of willful.
But what we've learned studying these kids, and I don't just mean what we, you know, in my work at Massachusetts General Hospital, but people all over the world have learned, and literally for 50 years now, is that kids who struggle with their behavior lack certain skills related to things like flexibility is that kids who struggle with their behavior lack certain skills related to things like So the notion that these kids just aren't trying hard enough to behave well or that they're behaving poorly on purpose is misguided.
It's actually inaccurate.
That all of this research shows.
I mean, in North Dakota here, if we had, from every school, we had everybody pick their 10 most challenging kids and then 10 kids randomly from their schools, and we gave them all what we call neuropsychological evaluations, you would see huge differences.
The kids who were challenging would have striking deficits in areas like language and communication skills and emotion and self-regulation skills, which is a fancy way of saying, like, Emotional control or self-control, flexible thinking skills, social thinking skills, attentional skills, memory skills.
So it's been proven beyond the shadow of a doubt these kids lack skill, not will.
So if our interventions are all motivational in nature, which is what they are usually in schools, timeouts, suspensions, detentions, demerits, those are motivational.
It's just barking up the wrong tree.
It's not that they're ineffective.
It's that they're ineffective when matched to a problem that they don't address.
I'm going to jump way ahead.
Okay.
The kid that is having these behavioral issues in school and like many states for school safety, we've added the school resource officers, law enforcement into the schools.
Yep.
When we took office, Lieutenant Governor and I and the First Lady touring our state penitentiary had an opportunity to understand how many of the people who are residents in our system are needing to take remedial reading.
You just talked about severely lacking.
I mean, we're talking about early childhood trauma and other stresses can affect brain development.
That brain development is like a learning disability that then emerges as As a behavioral.
And we've developed great empathy or better empathy about students with learning disabilities.
Why haven't we developed that empathy around the learning disabilities that's holding back behaviors?
And again, when we're We spend just over $10,000 per student in our K-12 system in North Dakota, which is a healthy state-supported number.
In terms of the dollars, it's been one of the fastest increases in the country, and really education is a priority in North Dakota.
We spend $41,000 a year on someone who's incarcerated.
Right.
Right.
Well, and when you look at those folks who were incarcerated, they were typically identified early on in their schools as exhibiting challenging behavior.
And the interventions that were applied were ineffective.
I mean, I think this sort of school-to-prison pipeline, as they call it, is fueled by people missing the mark early on when it comes to what the difficulty was for these folks.
Now, I want to be very clear, though, that it's not like anybody's trying to misunderstand these kids.
People are working from the best knowledge they have.
Now, it's time, though, for our practice to catch up with what we have learned.
And we have learned what really causes challenging behavior.
So now it's time to do something different.
And I think the big challenge with doing something different, I mean, you ask why haven't we come along there, is because, you know, if somebody's struggling to read, You don't take it personally.
It's frustrating teaching somebody who's not getting it, but you try your best to help them.
You don't take it personally.
When somebody's learning disability manifests itself in the form of challenging behavior, it disrupts your class.
It frustrates you.
It makes you feel disrespected, ineffective in some cases.
And this is what leads us to put law enforcement in schools.
It makes us feel unsafe.
And when we feel unsafe, disrespected, scared, ineffective, we get dysregulated.
Fancy word for we lose our ability to think straight.
And we start responding much lower down in our brain.
And then we reach for how do we get the power back?
And how do we sort of punish the person for causing all of this upset?
And I think much of that is unconscious.
I don't think teachers are walking around thinking that, but it's operating.
So, you know, you mentioned our philosophy, kids do well if they can.
We apply that to adults as well.
Teachers do well if they can.
I mean, we're all trying to do the best we can to handle these issues with the skills that we have, but we've got new knowledge now and we need to develop new skills to match to what we now know the problem is.
You talked about power.
And when we think about schools, and I grew up in North Dakota, a small town, went to a school that had a traditional, you used the word power differential.
You know, teachers have more power than students.
Coaches have more power than athletes.
If teachers' power isn't working, then it gets escalated to a principal or a superintendent who's going to apply more power.
But it's a...
It's interesting because even in the progressive way we're managing our institutions of incarceration, we're trying to shift that power differential.
We're trying to, in those institutions, have people that are building relationships with our residents because we know that in North Dakota, 99.5% of the people...
Are going to end up being our neighbors.
And so we need to make better neighbors, not better prisoners.
And in the same way, this whole power differential model that's applied to the school system, when applied to behavioral issues, appears to actually be, as you called it, we're just throwing fuel on an emotional fire.
If you react to somebody with power who's escalating, you actually get the reverse effect.
That's right.
Well, but, you know, I think the reason we go to sort of, you know, power and control is that we used to think that that worked.
We used to think it was effective.
I mean, you look at the court systems and things.
I mean, you know, it's as basic as why is a judge, you know, why is a judge's bench elevated?
And why are they, you know, it's to convey the power differential.
And we used to think that the power differential induced compliance, right?
That if you were in the face of somebody with more power, you would become compliant.
The thing we realize now is, first of all, compliance is a skill.
It's not a choice.
But also what power differentials induce.
Is actually dissociation, which is a form of dysregulation that people basically tune out.
And at best, if they don't escalate, they shut down and just go through the motions and sort of tell you what you want to hear.
But they're not even there.
They have sort of disconnected from the whole process.
And now that we can image the brain, we know that.
We know that that's what power differentials do, particularly to traumatized people.
And, you know, kids in our schools who have trauma histories are our most challenging kids.
And so they're the ones that invoke that power differential, which then causes them to dysregulate or dissociate, and nothing happens.
So if what we've been doing hasn't been working, what does your research, your experience tell you that can work and how can we move towards a more collaborative approach to solve this problem?
Well, I think, you know, at a larger level, we need to be focused on building skill, not will.
So we need to recognize that these kids have the will to behave well, but they need the skill.
So any approaches that have been shown to build skills like flexibility, frustration tolerance, problem solving are going to be effective.
Now, ideally, though, those approaches need to sort of honor what we were just talking about when it comes to dysregulation.
So they need to engage these kids in a way that...
Calms them.
Regulates them.
And that gets back to the beginning of our conversation together.
Empathy.
So I think approaches based on empathy and accurate understanding of what's going on that are then focused on building relationship and skill.
Two things that we know predict positive outcomes.
Skill development and relationship development.
That's what's going to work.
We teach one called collaborative problem solving.
There are others that are what I would call relational approaches that focus on building relationship and skill and not leveraging a power differential.
You mentioned in your talk, Dr. Bruce Perry, Some would remember him as a star track athlete from Bismarck, North Dakota, went on to Stanford.
Well, first he went to Amherst College, my alma mater, too, before.
But he's a national reputation related to trauma.
Maybe just share a few thoughts about how that interrelates with your work.
Sure.
So Dr. Perry and I work closely together.
We do a lot of teaching together.
He's a good friend and a great colleague, and he's helped advance our work a lot because, in essence, he teaches people how to understand the impact of trauma or chronic stress on brain development and what it causes.
He also teaches people the kinds of things that are restorative, that actually can facilitate progress, that can help the brain develop.
And, you know, he talks a lot about that those are things that need to be born of empathy, that need to be relational, that need to be provided by sort of a web of people in the kids' lives.
But what's really nice is sort of our work operationalizes it.
So he helps people understand what you need to do and why, and then we give people the sort of concrete tools to, okay, when a kid is disrupting your class in this way, how do I respond in a way that Dr. Perry would say isn't going to dysregulate the kid, is going to help facilitate brain development.
So it's been a great partnership in that way.
And when collaborative problem solving, building empathy, building relationships, building these brain development skills that are missing, when that's all working and clicking between an educator and a student, talk about how the change manifests itself and what that could mean for North Dakota and for our education system.
Well, it manifests itself in a lot of different ways.
I mean, one of the sort of just most concrete and visible is you reduce challenging behavior, which helps everybody learn.
You reduce, you know, punitive responses like detentions and suspensions and things like that that have kids, ironically, outside of the learning environment, so you capture more time.
But the other thing you do is you see relationships improve.
And again, you know, Dr. Perry will tell you, that's how you help relationships help people change.
But the other thing you do is you reduce stress.
One of my favorite findings of ours is we reduce teacher stress.
And actually, really interesting is sometimes you can reduce teacher stress even before behavior has improved, just by shifting the teacher's thinking so that they're now in a more empathic place when it comes to a very challenging kid in their class.
Because, you know, teacher stress is the number one cause of dropout.
You know, we lose talented teachers.
So, you know, you have more time teaching, you reduce teacher stress, you build relationships.
The other thing you do is you help students build skills.
And, you know, that's, again, a great predictor of how they're going to do in the future.
Now, I think when you talk about what's ahead for North Dakota, one of the things I'm most excited about is it seems like you have put together really a consortium of folks here who had the ability to initiate and follow through on a change process.
Because I think in schools, like many places, we're very guilty of exposing people to new ideas in what I call spray and pray training.
So you've got a professional development day and you fly somebody like me in and I spray training over people and fly back to Boston and pray it takes.
And the research shows it just doesn't, even if people love what they heard.
That if you really want to change people's practices, especially in challenging circumstances, you've got to be really intentional about it.
You've got to have a good, thorough plan with a lot of training and coaching.
You've got to monitor the data.
You've got to support people along the way.
And you've got to finish it where you've got the talent and the expertise right here in your schools to sustain it.
And you can do that, but it's got to be a team effort, and people have got to be in it for several years and expect some discomfort along the way.
And on that implementation process, you've also done actually a lot of research about not only how to solve the problem, but then if we're trying to implement a solution, what are the barriers that we run into?
And maybe just talk a little bit about all three layers, the teacher in the classroom, the leadership principal, superintendent in the building or in the district, and then the school boards themselves.
What do we need for leadership capacity, leadership development to support this kind of important change process?
Yeah, well, it's interesting.
I think the most important thing leaders need, whether that's at a building level, district level, or state level, is they need to practice what they're preaching.
And so that if we really want people to adopt a more empathic, collaborative intervention and process, it needs to be led that way as well.
So you can't impose...
Something like collaborative problem solving on someone.
And there are going to be challenges, whether, again, it's at the level of an individual classroom or a school or a district.
And what leaders need to do is when there's a problem with implementation, when people are upset, when people are dysregulated, they need to listen really, really hard and not impose their own view.
And then they'll get a chance to raise their concerns and invite people to collaborate with them.
So you, in essence, have some sort of shared governance and leadership that empowers people.
And so I have found that schools and other places that really take this on well, they have a leader that leads by example.
And implementation science tells you one of the biggest factors of successful implementation of anything is a leader demonstrating that this is how it's done in their interactions as people go about implementation.
One of the things that we're faced in North Dakota and faces our entire country is the disease of addiction.
And, of course, now there's a greater understanding that the disease of addiction is also a chronic brain disease.
And you talked about these behavioral challenges being where people have lacked.
You showed a slide of a toddler's brain development healthy versus those that experience trauma.
As we continue to learn more about this, and I know we have students in our school system that use the word regulated, that one of the ways that people that are challenged with development may choose to self-regulate where then they start using drugs or alcohol to feel better.
Tell us a little bit about how these two things intersect and Yeah, obviously it's a huge problem.
And, you know, the way we conceptualize it is that the substance use itself, you know, you could call that the form of challenging behavior.
You know, for somebody else it might be a different form of challenging behavior.
this is the sort of best solution they're able to come up with.
And why is it?
Well, generally speaking, we see there's still, again, a lack of development of certain skills that lead to challenging behavior.
So, for example, somebody who uses substance to regulate him or herself may be somebody who is delayed in the development of emotion and self-regulation skills.
And if you can help them build those skills, They can find more adaptive solutions.
So it's the same process, but you also have to overlay it that there's biologic factors at work with addiction, and that makes it one of the most challenging things for us to do.
But again, it all starts with empathy.
It all starts with a compassionate understanding of the problem in the first place.
This is your third trip to North Dakota in nine months.
It's so fabulous that you're here.
You've got an opportunity as a world-renowned speaker and researcher, author, best-selling author, to go anywhere.
What's about North Dakota?
What's going on here that brings you back here when you could be going anywhere?
And I mean, just say, grateful that you're here, but help us understand ourselves.
What's going on in North Dakota that's attractive to you?
Yeah, well, you know, first of all, I travel around.
I've traveled around for years and years teaching this stuff, and it doesn't get old and it doesn't get boring because I sort of feed off of the passion of people.
And one of the things I've found here is people are really passionate for trying to do better by kids, and people feel a real responsibility here.
And the other thing I would say is I think there's incredible opportunity because when I look at our work, getting it off the ground in New York City, places like that, really, really complicated, tough systems.
And you often need to sort of prove concept in a less complicated system.
The state of Oregon is a good example.
Where collaborative problem solving has taken off like wildfire because a few early successes and it started to spread and you could really easily get decision makers in the room and start making changes, which is harder in some places.
My sense is from this gathering today and what I've heard, y'all are good at putting together decision makers and trying to get things done.
And there's, again, a sense of responsibility for the well-being of people I'm thrilled at the notion of partnering with you all to see if we can get something exciting off the ground together.
Yeah, and we're also competitive and we like to win.
And if Oregon's ahead of us, then that's good motivation for us because we want to be number one in leading the way on these new effective approaches because it's great for the students, great for the teachers, and great for taxpayers because we know that what we've been doing has not been either effective or cost effective.
That's right.
That's right.
No, it's great for everybody in a variety of different ways.
And one of the things we really haven't talked about in our discussion is that the impact of some of these things we're talking about early on in childhood, what we now know is that predicts the best predictor of all kinds of physical problems later in life that cost states inordinate amounts of money.
If you want to save dollars in a state, what you really want to be doing is you want to be trying to reduce the exposure to chronic stress and trauma early in childhood and try to remediate and help kids build skills when they've been exposed to it.
It's the best thing a state can do.
And of course, I think dollars aside, it's the most important thing we can do for the well-being and the lives of the next generation of adults.
It's the right thing for people, but also over the long-term, save money in our healthcare system, our long-term care, our corrections.
No doubt.
And we're really talking about changing the course of individual human lives.
That's right.
And ultimately, there's no more important thing than that.
I love during your talk you shared a personal story about your daughter encouraging you to go see the movie The Greatest Showman.
I was smiling and touched by that because a daughter, three kids, middle daughter, she's spent her career in acting and musical theater.
She I wouldn't say drag because I love movies, but she encouraged me to go to The Greatest Showman.
When you were sharing that you were touched by that movie both emotionally and you were taking notes, I really was...
Because I had the same response.
I have to admit, I was getting a little teary-eyed in the dark watching that movie in terms of how empowering people that maybe were a standard deviation or two away from the norm, but are still people, still deserve respect, and have enormous talents.
And it was an inspiring movie.
It was.
I have to be honest, I was up for going, but my I think 16-year-old at the time.
Boy, he wasn't so into it.
But we agreed to go.
But yes, as I was saying earlier, I went with sort of one hand tied behind my back.
But when I got there, my daughter had to tell me to stop crying in the middle of it.
It was moving.
And as you saw, the quote I shared from P.T. Barnum from there was, comfort is the enemy of progress.
And I think work worth doing is always work that is going to make people uncomfortable.
So if you're really doing work worth doing, it's going to be tough.
It's going to be stressful, and you're going to have to ask others to be up for some discomfort.
It sort of echoes the old saying, no pain, no gain.
And interestingly, that applies to brain science as well.
You don't change anybody's brain without stressing it a little bit.
You don't change a system without stressing it.
And I'm excited because it seems like Your administration is up for the stress involved in making important change.
And as I said, that's a prerequisite to work worth doing in my mind.
And one of the four values that we talk about is humility.
And we talk about it at two levels.
And first level of humility is the understanding that we can learn from anyone.
And I think that ties directly here that we have an opportunity as part of the collaborative problem-solving to Through the aggressive, empathetic listening to learn directly from the people that might have the challenging behaviors.
But the second level of humility we talk about relates to your P.T. Barnum quote, which is we actually have to have the humility to understand that the things that we believe to be true may not be.
The things that we believed worked, we have to have the humility to say, wow, we've been doing that for 20, 30 years.
That doesn't work.
And it's very tough sometimes, I think, for elected leaders at all levels, you know, business leaders, community leaders, school districts, school board leaders, hard for leaders to have the humility to say, hey, we have to try something new.
There's a lot of discomfort in saying what we've been doing isn't working.
Absolutely.
But for us to achieve our full potential, we've got to bring both levels of humility to the work we're doing and I felt like today your words, your remarks maybe opened the door for some unlearning as well as some learning.
And so for that, I'm grateful.
Thank you.
Well, you're welcome.
And I do think some unlearning is necessary because the reality is conventional wisdom is almost always disproven.
And it's just how quickly we embrace the fact that it may have been wrong and it's time to do something else.
So I'm happy to be a part of that humbling process as we go forward.
Exactly.
We talk about empowering people, improving lives, and inspiring success.
That's the mission of Team ND, and this is right in that wheelhouse.
Well, I'm pleased to be a part of it.
And thank you, Dr. Elwin, for being here.
Thank you for sharing.
And for listeners that are listening in that want to learn more, tell us, you know, you've got multiple books, you've got websites, you've got Think Kids.
Just help steer people to where they can learn more.
Sure.
If people want to learn how this is applied with kids in schools and homes and treatment facilities and things like that, they can visit our program at Massachusetts General Hospital, which is called Think Kids.
And you can find us on the web at thinkkids.org.
And if you want to learn more about me and my books, you can go to my website.
Probably the easiest way to get there is just to go to changeable.info.
Changeable is the name of my latest book.
Great.
And I haven't had a chance to read Changeable, the new book, but I would say that I am getting a copy.
I will be reading it.
And because what I saw today, if that's part of the book, we're not just talking about schools.
This could be applied to families and virtually every other institution.
Same principles apply.
That's right.
And it can also be applied at the level of government and politics.
And it's really wherever we're trying to come together towards some goal and having a hard time doing so.
So I'd be happy to give you a copy.
Well, thank you, because our whole theme is to get the ideology out of the room and get the data in the room, and your approaches have all been data-driven with great results, and thanks for showing us a path.
The name of our podcast comes from the famous Theodore Roosevelt quote, which says, the great prize in life is the opportunity to work hard at work worth doing.
Certainly, it's evident from your passion and your efforts and Research and books that you are working very hard, but tell us for you personally what makes this work worth doing.
Great quote.
And it's probably the thing I'm most proud of, honestly, with my work is that when I sort of go to bed at night, I say to myself, I'm trying to leave the world a better place as a result of some of my efforts.
And when I see so many people sort of taking to these ideas and going out and inspiring change and making the world a better place, you know, it's incredibly fulfilling.
And I think there's a responsibility that each of us have, honestly, for the next generation, is to make the world a better place.
And that makes the work very well worth doing.
Great.
Super.
Thank you so much for being in North Dakota.
Thanks for inspiring new approaches.
Thanks for making a difference in the lives of so many.
You're very welcome.
My pleasure.
Thank you for having me.
And I really do look forward to next steps ahead together.
If you want to learn more about the resources that Dr. Ablon mentioned, start by visiting thinkkids.org.
All of the presentations from both days at the Governor's Summit on Innovative Education will soon be available online.
You can keep an eye on our Facebook page for the release date.
That can be found at facebook.com slash Gov.
Doug Burgum.
Thanks to Dr. Avalon for his commitment to helping people of all ages live healthier, happier lives.
We're thankful to the Department of Human Services and our audio producer, Alicia Jolliff, for their help in making today's episode possible.
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