In our conversation with Dr. Sarah Kate Bearman, the assistant professor and child clinical psychologist in the Department of Educational Psychology talks with Dr. Rui Zeng about child psychopathology and how study of this topic can be used to further people’s understanding of emotional and behavioral problems in children. Specifically, she discusses how she uses her course Emotional and Behavioral Disorders in Children and Adolescents to help people understand the typical development of children’s mental health problems and ways to protect children from developing such problems. Through student-led cases, first account interviews, pop-culture moments, and interactive games, etc. her students leave her course with not only better knowledge about these disorders but different approaches to treatment that beyond medication.
Rui Zeng: Welcome to the podcast series, "Learning from the Texas Education Innovators". This is Dr. Rui Zeng from the Office of Instruction Innovation. Today with me is Dr. Sarah Kate Bearman from the educational psychology department in the College of Education at UT Austin.
Sarah Kate, welcome.
Sarah Kate Bearman: Hi, thanks for having me.
Rui: So do you want to start by, introducing yourself, tell us a little bit about you, your research, and your teaching?
Sarah Kate: Sure, happy to. So I'm a child clinical psychologist, and I actually did my training here at The University of Texas, in the Department of Psychology a long time ago. And then I left Austin for a while to get some more advanced training to do my internship, and post-Doctoral Fellowship, and eventually was lucky enough to come back here to the Department of Educational Psychology. My research focuses on children and families and the psychosocial mental health interventions that have been tested and shown to be effective with children and families with common mental health problems, so I really focus on disruptive conduct behavior problems, anxiety disorders, depression, and post- traumatic stress disorder. And because I'm really focused on how treatments that have been tested and scientifically shown to work can be adopted or implemented in the real world, I tend to think a lot about the places where children, families naturally are, which doesn't tend to be mental health clinics, right. Children and families are more often in schools, they are in daycare settings, they are at home with their families, their parents; and so I work a lot to think about how we can implement these treatments for children, using natural settings and natural providers like teachers, like parents, like childcare providers, to bring these interventions out into the places where kids and families already are. So that's the main focus of my research.
In my teaching, since I'm very interested in these empirically supported treatments, these treatments that have been supported by scientific research, I focus on those in my teaching as well. So I teach a graduate course on the fundamentals of behavior therapy; and then for undergraduates, I have a course Emotional, and Behavioral Disorders for Youth and Adolescents that really focuses on child psychopathology. How emotional and behavioral disorders in youth -- how they develop -- and a little bit about treatment and intervention too because I find that people are really interested in understanding how problems can be addressed.
Rui: Yeah, so actually as a mom of two young kids, I'm really interested in the topics that you teach and the things that you are researching and write. But I feel like when I talk with other people, a lot of people don't know a lot about these, these things. So why do you think it's important for the general public to know about this, and what's the way that you use to make this public, make this information like, how do I say, make this information available to more people.
Sarah Kate: Sure, well it's interesting, you know, when we say mental health problems people tend to think about diagnoses, and they tend to think about things that are pretty removed from themselves; but actually, you know, a lot of child and adolescent disorders are pretty common. So particularly anxiety disorders, up to about 20% of children will experience an anxiety disorder; depression is not far behind that; and then disruptive behaviors, whether they meet criteria for a diagnoses or not. Disruptive behaviors are really prevalent because probably the most problems for parents and teachers, and they are the number one reason for mental health referral.
So one of the reasons why I think it's really important for people to know about these emotional and behavioral problems in children is because they are so common they are so prevalent, and being able to identify them, and even just knowing that it's normal, can be really comforting for people, but also being able to identify them and know when you can get help from a pediatrician, or from a teacher, or from a mental health provider is really important. So knowing about their prevalence I think is critical. Understanding also, the kind of slope from typical behavior to atypical behavior is really helpful. You know I know as a first time parent myself, you're very worried I think all of the time about new behaviors that arise and is this normal, is it not. So I find that it's really helpful and empowering to teach people about kind of what does typical development look like, and then when to know when things have started to veer into more atypical status so that they can seek intervention, and then lastly that intervention piece I really like to share with people because there is so much hope for kids who do display, early signs of mental illness, or emotional and behavioral problems. One of the things that's pretty true across all different problems whether we're talking about anxiety or depression, or conduct problems, or autism spectrum disorders is that early intervention, is critical, and the earlier you intervene, typically the better the outcomes are for kids and for their parents. So just letting people know what treatments are available, what they look like, what good treatments look like, what to ask for. I think that's really important as well.
Rui: So what did you and your team do to make this information more available and helpful to the broad audience?
Sarah Kate: Well some of the things that I actually have tried to incorporate into my class. It's really important to me that people get almost like as close to a first person account as you can get, which, you know it's not always possible to really walk in the shoes of somebody who's experiencing these challenges but whenever possible, we like to invite people in to speak about their own experiences, so sort of time intensive pursuit, so we're doing it slowly, but one thing that we are working on is creating a library of firsthand accounts, so inviting a former client of one of my graduate students to talk about her experience as a depressed high school student and what that was like and when it actually started, which was in middle school, and what has been helpful. And then more recently, we invited parents of a child that we worked with who had, has attention deficit hyperactivity disorder, as well as some acting out, disruptive behaviors, to come talk about what it's been like to parent him, what some of the challenges have been. Again, what's been helpful, what they would want someone else to know.
So that's one way that we work to make the information really, not only available, but very relevant, and also to, to help kind of provoke compassion from others, because it's very easy to think about people with emotional and behavioral disorders, kind of to marginalize them or think about them as other, and instead to show them how much these people look like you, talk like you, experience some of the same struggles.
And then another thing that we've done is, I have students in my class, make case presentations, about sort of hypothetical people who are struggling with these disorders, and also in the past I've had them seek out resources that could help somebody who's experiencing these kinds of problems and I think that's a great way to connect them to what's available, what kinds of resources are out there.
Rui: Yeah, so you talked about your course and how you actually use your course as a way to spread this information to a broad audience, right, and I think it works great. Actually, I want to read a quote from your student who took your course and-- I don't know whether it's a he or it's a she, but this is what he said, "It was eye-opening to learn about how youth and adolescents are not excluded from mental illness. This course also made me aware of how social economic status plays a role in the lives of young children." I think this reflects the purpose of this course, I hope, and so my next question is, you teach-- you have taught this course twice, right?
Sarah Kate: Mhm.
Rui: And so what do you want your student to take away from this course when they finish?
Sarah Kate: Yeah, it's a great question. So I spend a lot of time talking with students in my course about the interactions that take place between a lot of different facets and different factors to lead to mental illness outcomes. So, obviously, we know a lot about temperament and in-born characteristics and, sort of, biological vulnerabilities that people just come into the world with, but we also know that those things interact with environment tremendously. Not only can they exacerbate, you know-- can environmental factors exacerbate vulnerabilities, they can also protect people from vulnerabilities. So we spend a lot of time in this class talking about risk and protection and how, you know, something like having a family history of mental illness is not-- it may increase your probability, but it doesn't mean that you'll necessarily end up with, you know, a mental illness.
Sarah Kate: I like them, I would like to think that students, when they leave my course, have a really strong understanding of all the many malleable factors, the things that can be manipulated, that can actually protect children from developing mental health problems, or can help children who have mental health problems lead fulfilling, exciting, enriching, happy, productive lives and that they will go forth into the world and try to enact some of that. And that doesn't have to mean that they're directly working with kids with mental health problems and we talk a lot in my course about social determinants of health and mental health. So it was actually, since this was an election year, in my course, you know, we talked a lot about things like how quality education can really influence mental health outcomes for kids, how quality daycare can, how reducing parenting stress, which has a lot to do with income or health insurance, things like that, how those have an impact on child mental health. So I hope that students leave my class with an understanding of how all of the different factors in our society contribute to the health and well-being of our children and how we all can play a role in increasing the likelihood that children have, again, happy, healthy, productive lives. So that's one goal.
Rui: (laughs) I think that's a great goal. I want to switch the topic a little bit to talk about the preparation of your course.
Sarah Kate: Sure.
Rui: Because I think your course was very successful and very interesting. I know each time you offer this course, that it always fills up so fast, like you know, you always have students just waiting on the waiting list, trying to enroll in this course, right? So what did you do to make this course to interesting and how did you engage your students in your course?
Sarah Kate: Well I think, first of all, I'm lucky that I think people in general find the topic of child psychopathology really interesting. I think people are often very interested in children and their lives. We all were children, so there's a little bit of like, I want to understand my own life. (laughs) So I think I'm helped out by the topic and the content area. But then, I mean, I worked obviously very closely with the Office of Instructional Innovation to be very thoughtful about what I wanted people to get out of this class and how the activities could really lend themselves. And it might be the first time that I've actually given that much thought to my own-- what the learning objectives were for the students and how I could pair those with the things that we did in class. So for example, I wanted students to be aware of the way that mental health issues are portrayed in the media and how that can be sometimes very helpful, but it can also sometimes be problematic. So we wove in these pop-culture moments together, which were little snippets from popular media, movies, television shows, that portrayed different emotional and behavioral disorders. And then the class, we would talk about, you know, do you think that's an accurate portrayal? Do you think that a portrayal like this is helpful? What are some ways it could maybe be problematic? And so that really helped me, I think, open students' eyes to the ways in which our stereotypes about mental health are formed.
The first account interviews, I think, were really-- like I already alluded to, helpful in giving people an understanding of what the real personal toll of mental health problems can be for somebody, but also inspiring. I think in terms of how, because the people we interviewed were people who had navigated, having either themselves a mental health problem, or having a child with a mental health problem, and had a lot of ideas of what had helped them and what could be helpful to other people.
I think the student-led cases where they developed a case demonstration were really great, it gave them, each of the individual students, it gave them insight into the problem. And then one of the things we had the other students who observed these case presentations do was vote on which diagnosis best fit the kids.
Rui: Did they always get it correct?
Sarah Kate: No, not always and that was great, too, because that led us to be able to talk about how much overlap there is in some of these diagnostic categories and do these diagnostic categories really serve us in terms of how they parse apart mental health problems into these different discrete categories when really things are probably much more closely related to that. So all of those activities led to really useful conversations, I think, that were illustrative of some of the concepts in the course.
One of the things that we did that, thank goodness, the Office of Instructional Innovation helped me with, is this game that we play about cumulative risk and protection where students actually are given a profile and then they choose cards about things that happened to them in their life that either increase the likelihood of a positive outcome, or a more negative outcome and the goal of the game is to show how risk and protection interact. And how if you enter with certain risk factors, it makes you more likely to accumulate more, but if you actually have one or two protective factors, how it can actually offset risk.
I get so much feedback from my students that this was a really helpful way for them to understand risk and protection because risk and protection are sort of like a seesaw. You have risk on the one side and protection on the other and they sort of balance each other out, but sometimes risk is heavier than the protective factor and vice versa. And also, some people are already kind of, their life course is already sort of set up with one or the other weighing more. So I think that game was super-- it's fun for them actually, they enjoy the game, but then it's also really thought-provoking for them about how not everybody is dealt an equal hand and some people are more positioned to have negative outcomes and other people are better positioned to have positive.
Rui: Yeah. I actually got a chance to look at some of your students, the cases they created. I think they did a really great job. As undergraduate students, I didn't expect the quality of those cases to be that good.
Sarah Kate: Yeah.
Rui: I was really impressed and I feel that all those cases can, you know maybe in the future, creating a case library and having all those cases as the resources that you can always use for your future courses or in other ways.
Sarah Kate: Absolutely, some of them really-- I mean, there's always going to be a variety, but I remember last year someone did one where they had a whole, sort of bird's eye view, they filmed it from the perspective of the person, so you never really saw the person, it was all that person's internal thoughts and their perception of their reality, it was so great. And I've been so impressed by how sensitively they handle the content because it would be easy, I think, to sort of be silly with it, but they are very respectful of the content so I've been glad to see that.
Rui: Yeah, I've also seen that your students reflected in their course review that they really like this hands-on experience, which I think is great. You know, as undergraduate students, they don't just listen to lectures, you give them the opportunity to actually try it out, you know, using the case as a great way to do that.
Sarah Kate: Yeah, I'm glad you said the word, "reflect" because I wanted to mention that one thing I also have incorporated the last two semesters is a reflective journal. So at the end of every two courses-- or every two classes, they fill out this reflective journal, which is really for their own benefit, kind of what they think they learned the most this week and what they're curious to learn. And we actually added that because that kind of reflective practice has been shown to improve how much you learn in a course. So that's from, kind of, research on adult learning, so it's really meant to be useful, but I actually, I do look at them and they're really great, I mean, not every student completes them, I would say about a third do it regularly and about half do it at some point, but the things that they reflect upon are really great. They're, many of them are interested in a career in the Allied Mental Health Services in some way and I think the reflective journal gives them an opportunity to pause and think about, you know, what was I most excited to learn about this week or how can that inform choices that I make about my own future career or learning experience? So I really like that activity as well.
Rui: I also want to mention the way that the reflective journal was created on Canvas. I actually used your course, that piece, as an example to show a lot of faculty members because they wanted to create something similar that students can always go back to continue working on an assignment and the way how that reflective journal is set-up in your course actually show them as a great example that they can adopt in their courses.
Sarah Kate: Oh great, well I really, I've loved it. I like looking through it to see who's completing it and the kinds of things that they're putting in it. So I think it's been a great exercise.
Rui: Yeah, and my next question is still about the course preparation. (laughs)
Sarah Kate: Sure.
Rui: I know that you have taught this course twice by now, right? So when we started to work on this course two years ago, it was a brand new face-to-face course, right?
Sarah Kate: Yes, yeah.
Rui: So can you share your experience on what you did to prepare for a new course?
Sarah Kate: Yeah, I mean this was a really, this was the first time I've ever planned a course in this way, but now I think it's the only way to really plan a course. So I had no slides created at that point, I had no lectures prepared. We really started with learning objectives, what did I want students to walk away from the class with? And that was an exercise for me that was really instructive because I think a lot of times you build the class and then you think about what you want students to learn instead of the other way around. So that was the first piece, then we talked about the different kinds of activities I wanted to include and started working on the experiential part. I knew I wanted it to be a highly experiential class because I think that's really how people learn best. I knew it was going to be a big class, but I wanted to find some space for more discussion and interactive aspects, so that was something that I know we worked on very early on.
And all of those things really provided the framework for the course, so actually the framework of the course was built before any of the content was sort of put into it, that actually worked so well for me, that I think that is a great way to think about a brand-new course rather than trying to make the framework fit the content. And then it was actually pretty easy for me to go back in and put the content in and when I've tweaked things, because I now taught it twice, what I've tweaked most is the content. I think because there was so much thought put into what the structure of the class would be that, that actually worked really well and I've never had a class that worked so well structurally, from the first time. And I think that's where we put a lot of our emphasis, in many of our early meetings we spent most of our time thinking about that.
Rui: And how long did we spend to work on this? I think it was...
Sarah Kate: It was a lot!
Rui: I know, it was like the whole summer, right?
Sarah Kate: It was so luxurious. Yeah, but we even started I think in the spring...
Rui: Early, yeah.
Sarah Kate: before the summer and we had met -- I don't, I'd have to look back, I feel we met at least eight times probably.
Rui: I think, yeah.
Sarah Kate: And I had homework assignments in between-- some of which I completed on time, not always, I wasn't the most compliant student. But, for example, I knew that I wanted to have some way to check that they were doing their reading, but I didn't want to have, you know, papers or something really burdensome, so we put into place these weekly, brief, kind of reading checks. Those have worked really well. We have improved upon it from year one to year two by putting a cap on how many times they could take the quiz. And some of the resource finding assignments that I've given them where they have to find, for example, a popular culture article that talks about ADHD, or an example of OCD from a movie. And those have then, I've let them find those things as their assignment and then discuss them in small groups in class. Those have just been terrific and you could insert any content around those types of exercises so the structure came first and then the content, which is different than how I normally design a class, but it's what I would recommend going forward.
Rui: Yeah, I think it worked out really well and I'm glad that your course is so successful and I also want to congratulate you on winning the teaching award from your department!
Sarah Kate: Thank you, well, I really think that this course was a big reason why. And actually, the preparation that I did working with the Office of Instructional Innovation, because even though we only formally worked on one class, a lot of what I learned in our work, I then applied to other classes that I taught last year. So I think-- I definitely saw improvements in all of my CIS evaluations.
Rui: (laughs) That's great.
Sarah Kate: But to teach a course the first time and get such high evaluations, that would never-- I feel like usually when you teach a course, the first time is really you're working through all the kinks. I think because I, you know, I'm an expert in child psychology and clinical psychology and interventions, but I'm not an expert in instruction. So having this resource of someone who could help me to really think about, I'm sure using all kinds of instructional theory that I know nothing about-- how to engage students, make them curious, it's not easy to do. This is a large-- this semester I taught 60 students.
Rui: Yeah, that's a lot.
Sarah Kate: I had some students who are from this discipline and were naturally interested, but others who are probably just fulfilling a social science requirement, or you know whatever, and so to be able to engage them all-- I mean that's not easy to do and I really feel like I learned so much about how to engage learners from our work together.
Rui: That's great. I'm glad this course is so successful.
Sarah Kate: Yes, me too. (laughs)
Rui: Any other advice that you'd like to share with faculty members here?
Sarah Kate: I think that it's really, it can be a little daunting to-- you know, I think when we first met I said to you, "You know I sort of am a traditional, the way I teach is sort of traditional. I lecture a lot, I do a lot of didactics," and it can be a little anxiety provoking to veer away from that sort of traditional approach, but I think that the risks are worth the rewards because you know I think people learn in lots of different ways. And so having more opportunities for different learners to engage in the material is really valuable, especially if you have a super diverse population of students who, you know, may be coming in with different levels of expertise. Trying lots of different strategies, some experiential, some flipped classes where, you know, they-- I did some little mini lectures where they watched the lecture online, that made me a little nervous, but actually it had turned out to be great, I think. And, you know, students will still come back with questions if they...
Rui: I understand.
Sarah Kate: So taking more chances and trying to spice up the way that we teach is only going to increase the reach and so just to go back to what my research is about, you know, my research is about increasing access and adoption of evidence-based treatments for kids and I think that this teaching style that I worked on with OII is about increasing the reach of our teaching and our knowledge and reaching new audiences. So I feel like, for me, it's just been another way to kind of try to achieve my academic mission.
Rui: Well, Dr. Sarah Kate Bearman from the Educational Psychology Department, thanks again for coming and sharing your work with us.
Sarah Kate: Oh, thank you so much for having me and thank you for all the work that you do to help us teach more effectively.