Pomegranate Supports Student Scholar Athletes

Persistence 

This Wednesday, Pomegranate joins several other sponsors to support the 2016 Dispatch Student Scholar Athlete Awards at Greater Columbus Convention Center.  With our commitment to teens, it was a natural to be a part of this inspiring event which awards scholarships to both boy and girl athletes across several sports categories.  The keynote speaker this year is Tim Tebow, of NFL and Heisman fame. Pomegranate employs several athletes, coaches and former athletes who are influential in encouraging and mentoring our residential clients and acute patients.

Many kids play sports.  There are a lot of sports movies- like ‘Rudy’. If anything, Rudy was persistent.   Here’s one such tale from 3^rd grade baseball, California. This stuff can be larger than life for kids. (And parents.) Bottom of the seventh, two-on-base.  The score was 3-1. The freckle-faced kid in nerdy clothes came up to bat. Everyone on the bench groaned. Outfielders came in, nodding knowingly.  Swing and a miss. It was over quickly. The bell rang; recess done.  [Did not even get to the 9^th].   Bobby, the Team Captain-a tan kid with wavy blond hair, jeered at the opposition, ‘Losers!’  Opposing Team Captain Tommy, fired back, ‘Don’t bet on it, sucker!’  And following recess was a math quiz.  Double insult.

At supper that night, freckle faced kid (‘FFK’) was uncommonly quiet, shoulders slumped. Under watchful parental eyes, and gentle questioning, the story came out. Mom teased out a little more over the tuna casserole and Jell-O salad, before dessert. That weekend, Dad bought a glove, ball and a bat. He evidently knew his stuff, and this was a side to him ‘FFK’ had never seen before. Nightly practice began with the little brother ‘TLB’, and mom in the cheering section, occasionally stepping in to hit. From feeble ground balls they practiced until FFK could easily hit sluggers over the neighbor’s fence into his swimming pool.  As Dad drove the blue family Ford wagon past school grounds,  FFK rehearsed coming up to bat in his mind; how he would stand, holding the bat until the right pitch connected.

It was a hot day, dusty from Santa Ana winds on the playground, and the teacher had a headache. The team captains picked kids, until only ‘terrible Torrance’, FFK and Thelma with the thick glasses were left.  FFK didn’t see much action there in the outfield, but finally came up in rotation. Ironically, bases were loaded in the bottom of the ninth, 3-1.  FFK came up to bat and Tommy said glumly, ‘Just try to hit it, ok?’ Bobby waved the outfield in with a sneer, and prepared to pitch. ‘Ball!’ shouted the umpire. FFK stepped back, and then connected with the second pitch. With a loud crack, the ball flew far into the outfield and rolled down near the monkey bars were the younger grades were playing. The dugout went wild. ‘We did it!’ Tommy whooped, running to high five the bench. Bobby had a funny look on his face, resigned. He turned to FFK, punching his glove. ‘I might have to pick you higher up now. See if you can do that again,’ he mumbled.  FFK smiled, ‘Thanks. I’ve been working on it.’   

‘Persistence’ will not work if there isn’t desire and intent behind it.  ‘Persistence’ is also known as ‘stick-to-it-iveness’. Persistence’ won’t work if there isn’t learning involved. ‘Persistence’ doesn’t usually accomplish the goal if you weren’t meant to, or simply not ready to achieve something (yet), or, if it is the wrong goal. ‘Persistence’ is that quality of resilience that sees you through adversity, tough times and not shining’.  Persistence sees you through to something called serendipity, which is the moment (timing) it all comes together, at times, unanticipated. Magic occurs, and persistence pays off. You can’t predict when the moment will be, but it makes it all worthwhile.  Persistence teaches us the ‘yes you can’, ‘you will’, ‘it’s gonna happen’ and ‘you DID IT!’ Congratulations to ALL the winners of the student scholar athlete awards and their supporters!

Read more about The Dispatch Student Scholar Athlete Program at: http://www.dispatch.com/content/stories/sports/2016/04/17/dispatch-scholar-athlete-program–banquet-back-with-tim-tebow-as-speaker.html

[Photo credit: cShock/Dreamstime 9785607  Basket ball game Player@ sport hall] 

Helping teens transition

At the NASW continuing education,  Science of Social Work: Focus on Transitional Youth conference held Friday in Cleveland, Gabriela Celeste, JD and Policy Director at Schubert Center for Child Studies, Case Western Reserve made a keynote address on emerging adulthood.  In a study spanning over 75 years on the ‘Secret to a Fulfilling Life’ there were two key findings which move people from child-hood to adulthood, the ability to form loving relationships and a sense of intimacy with another/others, and finding ways to cope with life’s ups and downs and not push love away.  Celeste asked the audience what biggest drawbacks/threats exist for a young person making it successfully to adulthood.  The answers were well-informed:  lack of engaged parents, lack of adequate education, poverty.   ‘One of the biggest threats to young well-being is a sense of isolation,’ she said.  ‘This focus on independence is a false notion, it should be interdependence.  We need each other,’ she explained. There is a lot of science behind the importance of connectivity.

For disadvantaged youth, it’s not simply emerging adulthood or being on the frontier of adulthood, but ‘expedited adulthood’.  ‘Disadvantaged youth live in neighborhoods with shorter life expectancy-(up to 20 years shorter) and simply have less opportunity to take time to figure things out.   There is an urgency to get away from violence and drama; there is less time for discerning what one’s choices are or should be.  Then there is the compounded impact of biased treatment and navigating police as a developmental milestone for black and brown youth,’ she said.

Celeste continued, there are key developmental tasks in adolescence and ‘emerging adulthood’ as this phase is known, for navigating life.  ‘These tasks involve:  1) self-determination and decision making; 2) skillful navigation of life’s milestones and transitions; 3) identity formation & experimentation; and 4) building social capital/building supportive relationships.  Through each of these phases and tasks are three underlying social conditions for healthy youth development. These include: 1) having a caring adult invested in the kid’s success; 2) positive peer groups;  3) the opportunity for adventure, decision-making and to learn from risks (like driving).’

‘School can be a key protective factor, but one-in-five drop out (graduation rate is 80%).’  Celeste asked the audience to consider whether it is ‘drop out’ or ‘push out’ because of policies. ‘Students with one disciplinary contact are 5x more likely to drop out; one-in-9 are suspended at least once.  The vast majority of those suspended are for minor infractions- like tardiness, dress, disobedience. Defiance is a #1 reason; a #2 reason is fighting. But where do they go? Typically these kids go into exile and these are the kids who are likely to need our care the most.  Look at school design,’ she said.  ‘We treat kids more like a suspect than a scholar.’ The audience was quiet. ‘Our focus is safety first with metal detectors, video cameras, police tracking ID’s, and less money for arts, athletics, counseling, or music. One arrest raises the odds of dropping out of high school by 22% regardless of income.’  She shared an example.  ‘Advocates cite fewer arrests with a robust police presence, but that’s only true of violent incidents; smaller incidents are more apt to be criminalized.’  

The audience heard several more examples and saw a time lapse of brain development between age 5 and 19.  There was a chart of decision-making ability by age, contrasting intellectual ability and psycho-social maturity and the gap between the two.  Another chart (Dobbs 2011) on estimating risk and pleasure and the teen brain shows the difficulty in managing emotional response and controlling impulsiveness. This sense of control does not develop more fully until age 26-30.  The key task of this transitional time frame in navigating transitions- including daily lifestyle choices- is to invite a youth to: ‘1) pursue his/her passion, the ‘identity’ project;  2) encourage self-compassion- it’s worth being free of pain; and 3) encouraging relationship and connecting activities. Connecting activities are as important as school/career considerations in developing internal and external support people and systems.’ Perhaps this is just as true of adults.

A family affair

The National Center for Children in Poverty, Mailman School of Public Health, Columbia University cites ongoing developmental changes in the adolescent brain which make ‘adolescents particularly receptive to positive influences of youth development strategies social and emotional learning, and behavioral modeling.’  In other words, parents, educators, coaches and adults in the community working together to help shape a teen’s life can make a significant difference for good.  The article, Adolescent Mental Health in the United States, points out that, ‘At the same time, ‘adolescent’s developing brains, coupled with hormonal changes, make them more prone to depression and more likely to engage in risky and thrill-seeking behaviors than either younger children or adults.’  So, expect ups, downs, interruptions, experimentation, moodiness and mistakes, and prepare accordingly.  

The article refers to research from Archives of General Psychiatry, that ‘approximately 20% of adolescents have a diagnosable mental health disorder, and between 20% and 30% -a major depressive episode before adulthood.’ According to National Center for Injury Prevention and Control, CDC, ‘Suicide is the third leading cause of death in adolescents and young adults.’  Moving from what we know, to what we can infer, to what the research shows, there is plenty of opportunity to intervene and make a measurable difference in teen mental and emotional health- whether that’s in the school, a medical setting, or in the community –or earlier in the child’s life, developmentally.

‘Between 25% and 33% of adolescents forgo needed care or lack access’  according to The National Longitudinal Study on Adolescent Health, Journal of the American Medical Association.  Unstable home lives and homelessness may contribute to a teen’s distress. A recent article on ‘How to Prevent Mental Health Problems? Begin at the Beginning With Infants and Toddlers’ by Matthew Melmed, published in The Huffington Post suggests to, ‘Screen parents for depression. Parents who are experiencing depression may be unable to provide their children with the responsive care they need to feel safe, secure, and love. Supporting parents’ mental health is another way of supporting young children’s mental health.’  The author suggested screening for and intervention with mental health problems from infancy on, through-out the early years of life to prevent problems later.

Higher rates of substance use disorder, joblessness, incarceration, broken home, domestic violence are all contributing factors to that general term, ‘context’.  The stress of a family system impacts a developing child. When a child or adolescent does exhibit the need for assessment and intervention, stress is subsequently felt in the entire extended family system.  All members of a family need a haven where they find support, guidance, comfort, safety, security, and love- a place of peace and nurture.  Toxic stress, economic insecurity, fear, and violence in the home do not generate that supportive cocoon. New models of child protective service  tend to focus more on in-home intervention, assertive community treatment, or MST-multi-systemic therapy  with a focus on removing the causes of dysfunction to help a family learn to again thrive, and stay together for the good of all.  It takes work, consistency and commitment.  Change doesn’t happen overnight, but identifying and recognizing how to move forward to a new paradigm is the first step in a longer  (life-long) journey.

Child and Family – The Importance of Our Early Life Experiences

http://www.apa.org/monitor/2016/04/living-wage.aspx

http://www.healthyplace.com/blogs/mentalillnessinthefamily/2016/03/marriage-and-mental-illness-take-care-of-the-caregiver/

http://www.healthyplace.com/bipolar-disorder/bipolar-support/effects-of-bipolar-disorder-on-family-and-friends/

A Chat with The Chef

Behind every successful operation is an entire team of people, and the kitchen and cafeteria at Pomegranate is no exception. Facilities Director John Hedrick explained, ‘Our food is not institutional here. Don’t think prisons or cafeteria. It’s restaurant quality. We are balancing healthcare considerations with food that appeals to teens. Those might seem like conflicting demands.’  Pomegranate surveys its teen residents on an ongoing basis on a number of quality measures, food among them. Everyone has an opinion; and ‘food’ is not a neutral topic. We went to Registered Dietician, Shelby, of Dietary Solutions,  and Pomegranate’s Chef Bart for answers.

How does Pomegranate decide what to serve residents?

“There are many factors we consider when writing the menus. It has to look good, taste good, be healthy and nutritious, be cost effective and on top of all that, something the kids will actually eat,” explained Chef Bart.  “Some teens have specific needs or allergies which must be taken into account,” added RD, Shelby.

 Are there options?

“Any kid that does not like/want whatever we are having for a particular meal has the option of ordering a substitute,” said Bart.

What are some of the considerations a registered dietician must take into account?

“I look at overall calories, activity, age, gender, vitamins & minerals, sodium, carbs, sugar, fat, basic food groups, fresh, healthy foods, and balance,” said Shelby. Shelby then gives Chef Bart written recommendations for kids as needed.  He writes those recommendations on a dry erase board in the kitchen to communicate to all dietary staff so they know what to do.

Residents have input into what is chosen. How does that work?

“Every month the Resident Senate meets. I get together with one representative from each unit and we discuss what they like about the menu and what things they would like to change,” explained Chef Bart. 

What are some of the favorite meals?

“The kids really enjoy the things all kids like.  Things like pizza, chicken, and mac & cheese.  One of the favorites is what we call Hot Cheeto Chicken, which are chicken tenders that we bread in-house with crushed Flamin’ Hot Cheetos in the mix.  It’s definitely the thing I get asked, ‘When are we having that again?”  the most,” he added.

Does popularity of particular foods change?

“Yes, if we have a particular item too much the kids get tired of it. Also tastes change with the seasons.  Now that we are in the spring season, it’s time for lighter, more fresh options as the produce becomes readily available,” he said.

What has changed since Pomegranate started in 2008?

‘Well I haven’t been here since the beginning, but I have been with Pomegranate for over five years.  I’d say the biggest change is the number of kids.  With the expansion last year and all the beds they added, it sure keeps us busy. Teens go to the cafeteria in small extended family size groups by campus. It is a symphony of scheduling by walkie-talkie. There isn’t any overlap or a huge school cafeteria feel,’ he said.

What have been some learning experiences?

“I have really learned the difference between the tastes of kids and adults.  I am a classically trained chef with a fine dining background but that doesn’t matter if the kids won’t eat what I’m cooking.  I have learned little techniques to invite the kids to try new things, like our wording on the menus or by pairing something they are reluctant to try with something they really like. The biggest thing is getting them to try it,” Chef Bart suggested.  “They usually say, “Hey this is actually good!”’, added Shelby

What have been some high points for you along the way (makes your job rewarding)?

“Although I’m not around the kids as much as the direct care staff, I still enjoy getting to know them.  Telling them, “Good job!” as they reach a goal.  (Discharge, Graduation)  Making something that they really like and then having a kid come tell you it was the best thing they ever ate;  that’s why I do it, he said with a smile.

Anything else our readers might want to know; a ‘did you know . . . ?

“I am very proud to be leading dietary staff here at Pomegranate.  We have five full time cooks, two dishwashers and a couple of utility workers, and between us we put out three meals and three snacks 365 days a year, for residents and staff members. And that’s not including special events, meetings and parties that we cater.” 

Rejection

Sunday, some age 9-12 neighbor kids ganged together and rejected a bigger, awkward tween boy.  While walking Miss Wendy, we witnessed his agony and rage at their behavior as they screamed and ran away, hurling insults at the kid, locking themselves in family SUV, sticking their tongues out, shouting, ‘Nah, nah, nah, nah, big goofball’ –and other, shocking language, their parents would have surely censored. The dog was visibly upset. It prompted a lot of memories from childhood, and thinking about a big topic: rejection.

‘LuAnn’ has a history of getting angry at people and cutting them off.  Out-right rejection.  This might be considered an immature way of dealing with interpersonal conflict, which resulted in escalating anger directed back towards her and her family.  The ‘rejected’ count included an older sibling, a sister-in-law, an uncle, various friends, additional kin, and even a child for a year or two.  Rejection is a form of emotional blackmail or emotional abuse.  One always wonders what led to this response; what made this the ‘go to’ way of dealing with disagreement.  The behavior is often exhibited in families, when it has become systemic.  LuAnn’s daughter behaves in exactly the same way, but fails to see it in herself, and won’t discuss it.  There are times when it is in a person’s best interest to step back from a relationship, a self-protective, last choice, when abuse or emotional trauma are too much to bear. After ‘Wayne’, an addict had stolen from nearly everyone he knew, no one wanted to see him again. He died alone, of an overdose, far from home, rejected by everyone, who had tried everything.

‘Todd’ was in a relationship with male partner for several years, completely estranged from the family who condemned his orientation and choice.  The rejection hurt especially bad coming from those who had professed to love him (but only on their terms), that he required extensive therapy. The media has featured many stories of teens feeling suicidal from the sting of rejection for expressing an alternative gender orientation.

Rejection can take many forms. Sometimes it manifests as angry outbursts from deep-seated emotional pain against the person or persons who caused it, or anyone who represents/reminds one of that person.  A person might harbor simmering hostility towards the abusive partner of a parent, and subsequently anyone who triggered that rage, unwittingly or not. Untreated, it can become toxic. Trauma can be involved on both sides of a seriously disrupted relationship. But it’s not hopeless. In the Home Alone Christmas movie, the elderly man’s relationship is restored with his children, and healing takes place.  The Prodigal Son is a well-known theme from ancient times, where the son returns to his father, apologizes and begs acceptance. That’s probably the exception rather than the rule; a standard for all time.

For ‘Lynette’, rejection moved to a symbolic form of revenge, cutting her ex-husband’s photos out of family pictures. Her transition age son shrugged and shook his head. ‘He’s still my dad,’ the teen said, with an odd look on his face. It was no accident he’d downloaded and listened to an old school (’89) rock song recently by Don Henley, ‘The Heart of the Matter’ [https://www.youtube.com/watch?v=Xezg3z5IE8I]   Knowing there would be holidays, graduation, wedding, and probably grand-children in the future made him sad, just thinking about what used to be and was to come.  Rejection is a complex topic.  There are ideas how to deal with differing aspects of rejection.

Read more here:

http://ideas.ted.com/why-rejection-hurts-so-much-and-what-to-do-about-it/

http://www.patheos.com/blogs/freedhearts/2015/11/10/to-reject-ones-child-is-the-worst-transgression/

https://www.psychologytoday.com/blog/the-squeaky-wheel/201307/10-surprising-facts-about-rejection

http://www.wikihow.com/Handle-Rejection

http://www.apa.org/monitor/2012/04/rejection.aspx

http://kidshealth.org/en/teens/rejection.html

Check out the Lyrics:   http://www.azlyrics.com/lyrics/donhenley/theheartofthematter.html

Treating Substance Use Disorders

Clients in Pomegranate Health System’s residential treatment program have access to individual and group counseling for substance use disorders through  Maryhaven’s on-site program initiated early last year. This includes tobacco, alcohol or drugs, and even gambling addiction.  This allows Pomegranate to treat addiction and mental health issues holistically, as root causes of addiction are often the underlying diagnosis which fuels substance use.  For example, depression, anxiety, ADHD, bi-polar disorder or PTSD (post-traumatic stress disorder) are all examples of the type of diagnosis which might lead to intense highs and lows, feelings of being unable to cope, self-esteem issues, negativity or a sense of victim-hood.  Just as a mental health disorder is not a ‘moral failing’ or example of insufficient willpower, neither is a substance use disorder.  There are many reasons behind addiction. Many county children service agencies report children and teens being raised in an environment of addition. There is also a genetic component.  According to research, a high percentage of those with addictive disorders have a family member or relative with the same or similar issue. Addiction can go back generations.

SAMHSA’s Comprehensive Community Mental Health Services for Children and Their Families Program, (the Children’s Mental Health Initiative -CMHI), reported on the challenges facing older adolescents and young adults:  “More than one quarter (27%) had experienced four or more types of potentially traumatic events, such as physical abuse, sexual abuse, or witnessing domestic violence.  Almost one half (48%) said that they did not have an adult with whom they could talk about important things.  Nearly 1 in 10 (9%) participants 18 and older had experienced a period of homelessness.  Some 16% were neither enrolled in school nor employed.  About 10% reported having made a suicide attempt, and 28% had suicidal thoughts.  One quarter (25%) had been arrested, and 12% were identified as having a serious substance use concern.”

It is likely that a teen isn’t drinking or using merely ‘for the fun of it’, on special occasions, or because of social pressure, but  to cope with their emotional pain.  By changing one’s state of mind for a time, they attempt to escape the feelings or situations that they have difficulty enduring- also known as ‘self-medicating’.  Because you can’t suppress or hide from them, intrusive feelings emerge later.  This is especially true with teens that have experienced the trauma of physical, emotional or sexual abuse.  (Buried feelings emerge kind of like a game at the arcade with prairie dogs popping up from different holes. You can attempt to get them, but they pop up somewhere else.)  Then, there might be aftermath from risky behaviors engaged in under the influence that one did not recall fully later, but very much regretted.

By embedding the Maryhaven program within Pomegranate’s multi-disciplinary treatment approach, it functions alongside Pomegranate’s clinical and medical therapies to offer a more comprehensive treatment for those requiring AOD counseling, or identified with substance use disorder issues.  Its important to identify and treat or teach the tools to recover.

Teens are not powerless in the face of addiction, but can learn to make choices which help them to break the cycle of addiction for a productive adulthood and eventual independence.  It’s not easy, but recovery is possible in a holistic sense- body/mind (emotion) and spirit.

Resources:

http://discovermagazine.com/2014/dec/19-this-is-your-brain-on-drugs

http://pomegranatecares.com/2015/04/22/pomegranate-to-offer-alcohol-and-drug-counseling-by-maryhaven/

[photo credit: Monkey Business images/Dreamstime 7232176, and Pomegranate archive-poster contest+Superstock image]

Parenting Then; Parenting Now

As a few of the team gathered over early coffee after the holidays, there was the typical discussion. ‘Carla’ wondered about adolescents of distant family members who ate little but candy for 2 days straight- chocolate, gummy bears, sour treats, stayed up most of the night, and opened gifts nearly non- stop, pausing only to do Face-Time, text, or SnapChat with friends between opening an excessive amount of presents from mostly absent parents. A neighbor child’s parents popped in, drank heavily, and made crude comments about a questionable television show showing cartoon character behavior, that no one seemed to care to change.

She said, ‘Things are really different now. My parents would’ve flipped. It wasn’t like this growing up.’  Another staffer, ‘Lauren’ agreed. She said,  ‘There was the big family meal and no electronic devices. You had to enjoy quality food first before goodies, and those were measured amounts. Gifts were discussed or demonstrated a day or days later on the playground or in the neighborhood, not during family time.  Each person received a fixed # of presents and everyone shared in the opening of said gifts during a specific window of time.  The family attended church together and you minded your ‘p’s’ and ‘ques’. If the TV was on, it was a shared family show or sporting event. Kids didn’t even have their own TVs or computers in their bedroom. You never had a kid say to his/her mom, ‘Ah, Ruth, text me when dinner is ready.  That kid was helping get the table ready.’

So what’s changed?  The American Psychological Association reports, “Texting has become teenagers’ preferred method of communication, with adolescents sending and receiving an average of 167 texts per day, according to a Pew Internet and American Life Project study by Lenhart in 2012. Lenhart demonstrated that 63 percent of teens report texting on a daily basis, while only 39 percent use their mobile phones for voice calls.” http://www.apa.org/news/press/releases/2015/10/compulsive-texting-girls.aspx

Truly conversing, meaningfully, making eye contact, interacting respectfully with a range of ages, having shared family interaction sans electronics is one major difference.  Another significant difference is boundaries. Boundary setting is important between adults, between adults and children, within families and where a range of things are included such as diet, meal times, sleep times, consumption of alcohol, age appropriate television, and use of electronic devices. Boundaries include guidelines for apparel, treatment of loved ones, and ‘kind’, emotionally intelligent behavior.  Is it pre-modern to ‘put a lid on it’ and ‘grow up’, or have a higher number of parents forgotten parenting in favor of friending their kids? Where does the decision-making lie?  In many TV sitcoms, the parents are fools and the kids, manipulative, shrewd and downright disrespectful.

Last week, The Wall Street Journal featured an article on parenting, titled ‘Parenting in the Age of Awfulness’. [12/17/2015]  “America’s children are immersed in a culture of disrespect: for parents, teachers, and one another. They learn it from television, even on the Disney Channel, where parents are portrayed as clueless, out-of-touch or absent. They learn it from celebrities or the Internet. They learn it from social media. They teach it to one another. They wear T-shirts emblazoned with slogans like “I’m not shy. I just don’t like you.”  

Author Leonard Sax continues, “The challenge of raising children in America today is different from 30 or 50 years ago. Back then popular culture supported the authority of parents, whether it was the “Andy Griffith Show” in the 1960s or “Family Ties” in the 1980s. Kids are not born knowing how to be respectful. They have to be taught.”    There are personal, mental/behavioral health and societal implications to children and teens without filters, emotional regulation or ability to cope successfully with daily life.

A doctor of 29 years, Sax adds, ‘Multiple lines of evidence, including cohort studies such as the National Longitudinal Study of Youth, now demonstrate that disrespectful children are more likely to grow up to be anxious and depressed, three times more likely to be overweight, more likely to be fragile, less healthy and less creative, compared with respectful children.”  Parents are not the ‘enemy’ but the ally in raising better kids.  Children can be taught, helped and healed and family life can improve dramatically.  There is no better time to start than now.

Resources:

The Wall Street Journal, Dec. 17, 2015 7:04 p.m. ET

http://www.wsj.com/articles/parenting-in-the-age-of-awfulness-1450397051

….“Kyle was absorbed in a videogame on his cellphone, so I asked his mom, “How long has Kyle had a stomach ache?” Mom said, “I’m thinking it’s been about two days.” Then Kyle replied, “Shut up, mom. You don’t know what you’re talking about.” And he gave a snorty laugh, without looking up from his videogame. Kyle is 10 years old.”

From Healthyplace Blogs:

• What is Your Parenting Style: Parent Cop or Parent Coach?

http://www.healthyplace.com/parenting/the-parent-coach/what-is-your-parenting-style-parent-cop-or-parent-coach/

• Some Parents Drink to Cope with ADHD Child

http://www.healthyplace.com/adhd/children-behavioral-issues/some-parents-drink-to-cope-with-adhd-child/

• The Impact of Parental Child Abduction

http://www.healthyplace.com/abuse/articles/impact-of-parental-child-abduction/

• How to Behave So Your Children Will, Too!

http://www.healthyplace.com/parenting/child-development-institute/how-to-behave-so-your-children-will-too/

• Parenting Community Sitemap

http://www.healthyplace.com/parenting/main/parenting-community-sitemap/

• Behaviors that Hurt and the Loads to be Carried

http://www.healthyplace.com/addictions/articles/behaviors-that-hurt-and-the-loads-to-be-carried/

• Smart Love

http://www.healthyplace.com/parenting/child-development-institute/smart-love/

Parenting Resource on PsychCentral :

…”When children do become flooded with outside influences, Payne writes, two major problems arise: kids can suffer from overexposure (too much grown-up stuff), and they are highly vulnerable and easily impressionable.  A few sad effects of all this marketing, Payne tells us, is the eighty percent of kids who value being rich (over any other life aims, such as helping others), and the fourteen percent of eighth graders who have had at least one drink at a party in the last thirty days. The role of the gardener then is not just to “root out invasive species,” but to fertilize good ideas. This includes things like asking your tween, “Who are you being true to?” “…

From  http://psychcentral.com/lib/the-soul-of-discipline-the-simplicity-parenting-approach/

[photo credit: texting teen boy by Andrea Demarco/Dreamstime]

Family therapy meets crisis intervention

At the NASW National Association of Social Work Conference-Ohio Chapter last week, dozens of workshops were offered. Often, in an emergency situation such as occurs at a busy hospital ED, you’re dealing with more than the patient and must consider the entire family.  Therapists Marilyn Gale LISW-S and Julie Sheehan LSW, MSW developed their workshop presentation ‘Family Therapy Meets Crisis Intervention’ based upon years of experience through Cincinnati Children’s psych ED and PIRC-psychiatric intake response center.  This includes intake calls, the physical ED environment and ED physicians, telemedicine-interview through an I-pad if off site, and having a crisis presence.  It involves family therapy from a systems theory perspective.

“In a crisis, people are seeking homeostasis (balance).   With an extended family, you’re dealing with the field beyond the nuclear family.  This can help to explain the intergenerational transmission of attitudes, problems, behaviors and other issues,” Gale explained.  Maybe there is a specific family pecking order in place with grandpa or grandma at the head. Other times, the oldest sibling takes the lead.  Many holiday movies are about family dynamics. It’s something we share.

At this NASW-Ohio workshop, clinicians had the opportunity to explore best practice in working with families in crisis.  It’s important to understand differentiation, the ability of each member of the family to maintain his/her own sense of self while remaining emotionally connected to the family. Healthy families allow for differentiation.  In a transgender situation, some members (grandparents) may not accept disclosure, as the speakers continued with relevant examples.

A clinician often sees triangular relationships where 2 members triangle a 3^rd member as a way of stabilizing their own relationship- as a child with two parents might play one off the other, or in the case of divorced parents.  Example: Clark’s (middle) sister Mattie felt like the odd child out between two siblings, the oldest son (named after long line) and the youngest (golden boy).   Her communications style was to become enmeshed with one, triangulating the other (out) and controlling information, access, and favors.  By adulthood, she was mama’s favorite and the sons alternatively isolated.  Place them all in an ED, in crisis with decisions needing to be made on behalf of a patient.

There are several types of family therapy interventions. Among ten, the  presenters discussed:

1. Listening and empathy- are skills which build rapport with patient and family.  (We can use this skill in our own family dynamic.)
2. Joining can accommodate to their style, such as mimicking terms, understanding and adapting to educational level. (We have different terms for things. Talking with a child may require accomodation.)
3. Identifying a family rules and boundaries is helpful in understanding what a family finds acceptable. (Movie example: Meet the Parents)
4. Understanding a family’s established hierarchies can extend to body language, seating position and who manages a conversation. For instance, does mom rescue him or speak for him? Perhaps it’s a matter of supporting the parents, or creating a circle. (At Thanksgiving, who sits at the head of the table? Who hosts?)
5. Reframing is using the same fact in re-statement. In motivational interviewing, one asks, ‘what’s worked?’

In  6. Strength-based approaches, the task is to reinforce what works. The intervention of 7. ‘Checking,’ summarizes the situation to make sure folks are on the same page.   With 8. ‘Exceptions,’ one identifies times when a situation is less likely to occur. This might involve using scaling questions- ‘on a scale of 1 to 10’ . . . or coping questions, ‘what were you doing when?’,  ‘were there times when x is less likely to occur/less severe?’  In 9. ‘Externalization’ one might utilize a narrative to separate the problem from the person.  Finally in 10. It’s important to develop a safety plan, a crisis plan for every patient, and educate the family.  

In a crisis intervention situation you use the method which provides immediate short term help and prioritize what you need to do first.  This goes for both clinicians and family members- who may not be thinking clearly. The purpose for any intervention is to reduce the intensity of the emotional, mental and physical behaviors to return to a level of functioning.  Consider that in the Chinese language there is a character for the word ‘crisis’ in which one symbol offers a way, and another the opportunity for change.   Gale and Sheehan explained that in the first part of the year 2015, 6500 families coming through the ED had a psych crisis where a decision needed to be made what level of care they’d require.

The speakers presented the audience with three representative scenarios, and the teams were tasked with deciding which intervention/s to use and how to assess the situation.  In case 1, a 17 year old male was transitioning to female, depressed, cutting and expressing suicidal ideation in spite of anti-depressant medications.  In case 2, a 12 year old adoptee with a disability was exceptionally sad about the adoption and missed the orphanage.  The adoptive mother was distraught.  In case 3, a 13 year old boy was anxious, avoided eye contact, expressed some suicidal ideation to a girlfriend at school and completely ignored his mother.  Father was concerned about bullying over a potential sexual orientation issue.  What would you do in each case? Thinking about your own ED visits, what might have been handled differently or better? At Pomegranate, as we evaluate every survey and each comment, it’s with an eye to continuous quality improvement, because even with some pretty great ratings, every situation presents differently, and every patient & family matters. There is always room to listen & learn. 

[Photo credit: author, Katarzyna Bialasiewicz No. 57183032 Dreamstime]

Spiritually Informed Care

As part of the bio-psycho-social inventory, The Joint Commission and CARF require that spiritual care and the spirituality component be addressed.  At the NASW National Association of Social Work Ohio 2015 Conference, presenters Mari Alschuler,  Phd, LISW-S and Thelma Silver, PhD, LISW-S  addressed the role of spirituality in social work practice.  ‘It’s a matter of determining where the client is at,’ (in terms of their beliefs and the role of religion and spirituality in their lives).  Spirituality is an important component of the 12-step in substance abuse counseling.

The speakers discussed a number of religions and the core beliefs within each.  They asked how many of the audience were familiar with Hinduism.  (About 20%)  This is typical of the U.S. and yet by the number of adherents, this faith tradition is one of the top 5 in the world.  In Islam, also among the top 5, mental illness might be seen (culturally) as a weakness and shameful.  According to research, many Moslems consider the cause of mental health disorders to be an unbalanced lifestyle.  In Judaism, there is the legacy of The Holocaust.  The speakers covered the many different strands of Christianity.  For instance, among an Appalachian population, fundamentalism is often the predominant Christian belief system and a strong reliance on more patriarchal approaches. There might be an emphasis on daily scripture reading and prayer.  Hard work is valued and self-sufficiency, so adherents might not be as apt to seek help for mental and behavioral health conditions.

About 1/3 of Native Americans live on reservations (Sands 2012) and there are roughly 500 recognized tribal groups. Mental health therapy might be seen as intrusive.  Neo-paganism and nature religions should not be confused with Satanism, but instead, like Wiccan traditions, are a nature based religion, reviving pre-Christian practices.  Often the nature based religions embrace a duo-theistic philosophy with both male and female Deity/God figures.  About 20% of Americans do not profess a belief, affiliation or practice any religion and consider themselves to be atheist (acknowledging no Divine presence) or agnostic (‘show me the proof’).  And then, there is the SBNR group, ‘spiritual but not religious’ – which is neither atheistic or agnostic. This group believes in a higher spiritual reality, but outside organized religion, and may have been raised in a faith tradition they no longer actively practice or believe in.

Questions which might be asked in an assessment include:  ‘do you have a religious affiliation?’  ‘Do you practice any type of belief system?’  ‘Do you have a religious or spiritual preference?” ‘Do you have a religious or spiritual support system?’  ‘What gives you a sense of purpose or meaning? ‘What gives you strength?’  ‘Is spirituality an important part of your life?  ‘Does spirituality play a role in your life?’  ‘Is religion an important part of your life?’  ‘Who or what do you have faith in?’ ‘Was faith a part of the family you grew up in?’  ‘What spiritual or religious tradition did you grow up in and do you practice it now?’  (Why or why not?)  ‘Are there any conflicts with/within your family of origin?’

The speakers explained that the diagnostic manual DSM 5 outlines culturally-specific syndromes.  Religion and spirituality may be protective OR a risk factor.  (Some beliefs that pass for religion or religious practice demonstrate pathology.) Beliefs can mimic psychiatric disorders, trigger disorders, promote a positive worldview, or provide a role model for dealing with life which can be tremendously supportive. There were three examples with a spiritual dimension to the diagnosis for audience members to discuss.

[photo credit: author- mobi/Dreamstime ID#6827645824]

For more information on Americans and Religious Practice  see the PEWResearch Center

http://www.pewforum.org/religious-landscape-study/

http://www.pewresearch.org/fact-tank/2015/

‘Kids must learn social and emotional skills’

US Congressman Tim Ryan was the closing keynote speaker at the AOCC All Ohio Counselors Conference held November 4^th-6^th.   He began with some success stories and outlined  the mental health school act, providing funding  for on-site school-based mental health,  and the move toward mental health parity.  Ryan said, ‘We can’t change neighborhoods if we don’t change schools.”  Ryan stressed that ‘We need to compete and function at a very high level.’ He asked the rhetorical question, ‘Why are we disoriented as a country?’  Some 313 million Americans are competing with 1.4 billion Chinese and 1.4 billion in India.  Technology advances and changes every 18 months. The amount of time kids spend with technology access affects them as people (human beings).   The amount of stress people are under is enormous. Doctors and nurses are burnt out from high stress levels.  Teachers haven’t had a raise in 9 years. There is an economic squeeze on families to make it.  Some 44 million Americans experience mental health issues; 60% receive no mental health services.  Every 13 minutes a person dies by suicide. Of suicides, 7% are in  metro areas and 20% in rural areas.  Additionally, 1.7 million Ohioans are affected by substance abuse at a cost of $600 billion. Every county in Ohio has a heroin addiction issue. In Summit County (Ryan hails from Youngstown) 56 died of a heroin overdose in 2014.

“So,” he asked, “why do you do it?”  As Coach Valvano said, “Every day ordinary people do extraordinary things. That’s what this is all about.”   Ryan continued, “You do it because you believe you can help them (kids) become the best they can possibly be. “  He stressed that what we do must be grounded in the latest science, but our policies are often grounded in tradition.  “You can’t fix the problem with the same level of thinking that raised the problem!” (Attributed to Einstein).  Then Ryan took the audience on a trip through a range of approaches for the future.  “It is time we transition into a healthier culture.  We have to think differently,”  He explained. (This includes complementary and alternative approaches that are pre-emptive and often less expensive.)

Ryan said, ‘Some of the alternative approaches include epigenetics. We’ve learned in recent years that the genes we inherit  can be turned on or off based on our behavior.   Some 100 genes cause Alzheimer’s, but only 5 genes predict  who will get it; the other 95 are influenced by behavior.  Diet and stress contribute.  The budget for Alzheimer’s will sink the Medicare program; the same with breast cancer, if we do not approach this differently.  Further, we’ve learned each of us has a microbiome in our gut, some 100 trillion microbial cells which outnumber our DNA by 100x; 500 live in our guts and are linked to cancer.  We’ve learned that an imbalance in our gut bacteria can lead to ADHD, depression, and so forth when we’re out of whack through stress, poor diet and so forth.  The trends are not looking good. We need to re-orient how we look at problems in the U.S.’

He cited the work of Dr Hyman who has found that depression, and auto-immune diseases are linked to B12 deficiencies, lack of vitamin D in our diets, and decreased Omega 3 caused by increases in mercury.  “The U.S. agricultural system is subsidized to produce agricultural products which go into processed foods (such as corn syrup, corn, soy, wheat)  to make it cheap. [Cheap food is fast food is processed food.]  The species is 69,000 years old; we’ve only been eating this way 50 years -with negative outcomes. Agriculture is the #1 industry in our state, yet we have the highest rate of food insecurity in Ohio. The system is broken.  We need to support healthy products and teach kids how to eat right.  Healthy food is a common core.”

Ryan said another successful alternative approach utilizes mindfulness.  ‘Mindfulness can do much for the human brain.  This technique calms the amygdala and allows kids to overcome the fight, flight or freeze response and learn.  Mindfulness promotes social and emotional learning.  Results show there is an 11% increase in performance; 10% in good behavior when mindfulness is instituted in the curriculum. We need to teach kids how to pay attention. Mindfulness based stress reduction as researched at University of Wisconsin, The Ohio State University, and University of Michigan has been implemented with the Seattle Seahawks, Chicago Bulls, and with U.S. Marine Special Forces.  MBSR has even been tried with Google and Target employees because it works.  We have to re-orient ourselves re.: stress  so ordinary kids can do extraordinary things.  We need to treat our kids like high functioning future Olympians.  This approach can reduce school based suspensions 60%.’  He suggested having a peace corner in the room where a child can color, meditate, journal.  There is a case where a youth self-referred to the school resource center.  Besides food, kids need focus, building  connection, adequate sleep,  and arts -which provide outlets for creativity.  It’s a matter of the KISS principle; keeping it simple, and creating schools of the future that will transform communities.’

He wrapped up the keynote, ‘This is about empowerment.  We can do a heck of a lot better. If we don’t talk about the broader vision then we’ll never move the dime across the finish line at all. It’s time to teach kids to thrive in society. We are not doing them any favors with our approach in 2015.’

Read more about Congressman Tim Ryan   https://timryan.house.gov/about-me/full-biography

[photo credit:  AOCC conference program]