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]

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]

‘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]

Meet the New Nursing Management Team

         Pomegranate announced an updated nursing management infrastructure recently. Under Pomegranate’s new Director of Nursing, Melveena D. Edwards, PhD, RN, BSN, MA (with significant psychiatric nursing experience),  three nursing supervisors were named: All have demonstrated psychiatric nursing proficiency and supervisory experience.  The new structure includes a supervising nurse manager, Thomas Engram, RN, whose focus is management and support for nursing and care staff in both the acute hospital and residential treatment setting across all five wings. Pomegranate employs over 200.  

          Edwards explained the new nursing model, ‘Nursing C.A.R.E.S’, which stands for: compassion, accountability, respect, excellence and service. The inspiration behind the model is Watson’s ‘Ten Carative Factors’.  “The DON will assume a more educational focus to promote excellence, innovation and change management encompassing evidence-based practice.  There are now rounding nurse huddles, a greater reliance on strategy, data collection and statistics as well as documentation. When a resident/patient is admitted, he/she is assigned a therapist and a CPST (psychiatric case manager) and now, his/her own nurse.  In addition, nursing is assuming a more prominent leadership role as part of the enhanced corporate-wide emphasis on trauma-informed care,” said Angela Nickell, MS, CEO.

           At the October 2015 All Staff meetings, nursing supervisors presented an updated and more thorough trauma-informed care module which will be expanded upon in small group sessions with participation of Pomegranate’s compliance/quality improvement manager, Kia Brown, LPN.  Nurse Engram, the presenter, shared statistics that ‘90% of public mental health clients were exposed to trauma and most to multiple experiences of trauma.’  He explained that the effects of trauma predispose a client to maladaptive coping mechanisms such as the body’s natural alarm system not functioning as it should -which can result in a diminished capacity to trust others and affect an individual’s sense of safety.  A maladaptive response might include the survival mode of fight, flight or freeze with rational thought less possible. A client might experience hyperarousal or shutdown mode.

             According to Nickell, “along with the nursing infrastructure update, an intake social worker is joining the acute admissions team due to Pomegranate’s growth and quality enhancement initiative.  The exam room is being renovated and updated with an enhanced focus on patient and family care upon admission, with a streamlined entry process in the works.  Nurse Tiffany Folmar RN was named residential UR/admissions manager as Valerie Nutter transitions to the business development & marketing team as customer relations manager.  This will continue to contribute to our positive, safe and therapeutic environment in building professionalism, enhanced therapeutic communication, rapport, and patient advocacy as Pomegranate continues to look toward the future.”

What is a psychiatric assessment about? What to consider.

What is a psychiatric assessment about? When does a child need one and what are the implications for diagnosis and treatment?  At the Cincinnati Children’s Pediatric Mental Health Conference held in early October, Sergio V. Delgado, MD, Professor of Psychiatry, Child Psychiatry Medical Director and Outpatient Services at CCHMC presented a highly accessible general session covering psychiatric symptoms, parental concerns, learning issues and diagnostic dilemmas. An integrated assessment is important because it includes developmental milestones in addition to what are considered psychiatric and learning issues. A pediatrician is often the first to be consulted and will know when to refer to a psychiatrist.

When a problem presents, there might be psychiatric symptoms which include ”irritability, disruptive behavior in school, (suspensions), trouble paying attention in class, mood swings, depression, suicide attempts, self-harm, cutting and/or substance abuse.”  Delgado named several DSM (diagnostic manual) psychiatric diagnoses.  Then there is the ‘mom report’. This report can include  ‘outbursts’, ‘rapid mood swings’, ‘anger towards others’, ‘history of ‘getting depressed’’ coupled with a history, and/or record of prior treatments.  Parents may become frustrated with therapy, medication, school, and even their own parenting approaches. Signs and symptoms as described by patient, parents- including frequency, variations or intensity, may be 40-60% inaccurate, so a multi-faceted approach is important.

Delgado discussed early years, and  subjectivity of others. Is the child secure, anxious, dismissive or disorganized? What is development of cognition, and different learning styles like?  He stated that 10-40% of the population  have learning weaknesses; 6-7% of population has a formal learning disability; schools often help about 2-3% (based on funding), and 15-20% of the population may have some symptoms of dyslexia.  In addition, early life experiences of trauma, environment, intellectual disability, learning disability or brain injury may affect outcomes.

An appropriate visual called ‘Our Expectations’ shows a professorial man behind a desk addressing a bird, monkey, penguin, elephant, fish, otter, and a dog. He says, ‘for a fair selection everybody has to take the same exam: please climb that tree.’  If 80% have a language-based learning disability, and 20% a non-verbal learning disability, this could explain some of the contributing factors to difficulty with learning and behavior.  An integrated assessment includes verbal, visual, fluid reasoning, working memory and processing speed. There are contributing effects of cognitive weakness which can include everything from sensory responsiveness to social skills, understanding moral rules, reciprocity, fine motor skills, and impaired insight.  As a result, a child or teen might be oppositional, manipulative, truant, disrespectful, and awkward, isolates him or herself, or engages in impulsivity. It is not an equal playing field for differently abled kids.

Delgado presented representative examples as approached from different professionals-occupational, and speech-language. He cautioned that, ‘our expectations need to match with the child’s abilities.’  This might require an IEP (individual educational plan) for the home- and not just the school.  He suggested a visual token system to accumulate successes and not lose what is gained.  There are also hardwired personality traits. Some children will be more dependent (clingy); others demanding, or self-destructive. Some will reject help altogether. His recommendation is to be humble in the face of a comprehensive assessment and be prepared to offer a large amount of external support.  His final slide: ‘it’s okay to be different’ summed up a message of acceptance and hope.

(Photo credit: Image shows Air Force Capt. Kristine Andrews, a pediatrician from Montgomery, Ala. during a Continuing Promise 2011 community service medical project at the Polideportivo medical site in the Caribbean.  U.S. Air Force photo is by Staff Sgt. Courtney Richardson.  This Image was released by the United States Navy with the ID 110715-F-NJ219-161. Source Wikimedia Commons.)

Teen moms and perinatal depression

Pomegranate was a sponsor/exhibitor at the Mental Health America Franklin County Fall Conference on Maternal Mental Health and Perinatal Depression. Speaker Birdie Gunyon Meyer, RN, MA, CLC  was the primary presenter.  PSI, Postpartum Support International focuses on perinatal mood disorders.  The organization was founded in 1987 by Jane Honikman, MS and is a global network ‘dedicated to increase awareness of mental health related to childbearing. This is the only worldwide organization representing support groups that play a significant role in prevention and treatment of maternal mental illness.’  It is essentially about ‘mothering the mother’ according to the speaker/s.  View an educational DVD called ‘Healthy Mom, Happy Family’ at  http://postpartum.net/Resources.aspx or call 1-800-944-4773 for more information.

Depression is the number one medical complication related to child-bearing and up to 23% of pregnant women experience moderate to severe symptoms of depression and/or anxiety. PMAD stands for Perinatal Mood (depression and bipolar), Anxiety (GAD, panic, OCD, PTSD), Disorders.  There are many myths and facts associated with pregnancy along with unrealistic expectations, and both psychological and physiological changes. In recent years we’ve heard from public figures like Brooke Shields and through her book, ‘Down Came the Rain.’  Pregnant teens may experience barriers to utilizing support, Gunyon-Meyer explained.  Research by Clemmens, Paskewicz and Matern shows teens may be in denial, or not get adequate pre-natal care; feel isolated, abandoned and rejected by partners and peers and of course feel scared.  Postpartum, a woman often experiences feelings of loss.  This might be from loss of: freedom, old identity, sense of control, body image, career/potential, or self-esteem; all magnified in a teen mom.

According to Gunyon-Meyer, ‘Some 750,000 Teenage women age 15-19 become pregnant in the US each year; 11% of all births are to teens and almost half experience depressive symptoms in early postpartum period. Prevalence of depressive symptoms at 3 months was 36.7%.’  Significantly, ‘Almost 90% of those who reported depressive symptoms at 4 years postpartum had experienced these symptoms at 12 months postpartum.’   There are many effects of PMADs on a teen mother which include stressed relationships and disruption of school and work plans. For as much as some shows/the media glamorize motherhood and ‘her baby bump’, this is a side to motherhood which is un-appreciated, and not understood.

There is a role conflict between responsibilities to one’s child and one’s self as well as fear of an unknown future. Additionally, ‘there is stigma. Studies of inner city teens include crying, feeling of being punished, sadness, guilt, self-criticism, feeling like a failure, anxiousness, panic, tired . . . ‘ according to a study by Shanok and Miller, cited by Gunyon-Meyer.   Support from parents and learning new skill sets through multi-disciplinary treatment is helpful.  The thorough presentation covered treatment approaches to help process feelings of loss, alienation and rejection as well as medical and pharmacological interventions.  The pharmacological section stressed there are the risks of NOT treating and the benefit of treatment- to both mother and fetus.  Evidence-based therapeutic approaches include cognitive behavioral therapy, dialectical behavioral therapy, interpersonal psychotherapy, peer support, psycho-educational group therapy and mother-infant therapy and education.  It’s important to bond with baby; and good to know that help is available.

Resources:

Hope . . . Joy (and a Few Little Thoughts) for Pregnant Teens by Rachel Brinoni, 2008

Teen Pregnancy: Teenage Pregnancy Support: Advice for Parents and Teens 2014 by Phebe Pearson

Pregnancy: The Essential Teen Pregnancy Guide: All-In-One Advice for Anxious Teens 2015 by Susan Hart

[article by P.A. Rodemann; photo credit by GEOGOZZ posted April 2015 to Wikimedia Commons under Creative Commons Attribution]

What does employee orientation cover?

“Pomegranate Health Systems reviews all its policies on an ongoing basis. One of the policies relates to training and is evaluated against Ohio Mental Health and Addiction Services standards. The policy covers not only orientation but in-service, and mandatory training and certification-specific training,” explained Pat Griffey, HR Director. Working with an under age 18 population and in mental health in a hospital setting does have additional requirements than other types of employment environments.

“For instance, after their mandatory orientation, employees attend All-Staff meetings every month which cover a range of related topics. Recent examples have included suicide intervention, boundaries, trauma informed care, anger management, and managing stress. The August workshops (all 3 shifts) covered LGBTQQIA terminology and understanding. There are also additional departmental in-service trainings for nursing, the therapy team-which can now offer CE coursework, dietary, youth leaders and direct care staff,”   she explained.

The September All Staff meeting was more of a ‘town hall’ format. Angela Nickell, CEO and Pat Griffey HR addressed all three shifts and provided updated employee handbooks. January 2016, the company is mandating a uniform dress code for youth leaders, senior youth leaders and shift supervisors with polo shirts. The company has an order form with a range of shirts, vests and jackets available –with logo.

Here are the training modules required for direct care employees at new employee orientation. This is by no means the complete list of training which also includes mission, goals, core values, leadership, benefits, tour, facilities, housekeeping, dietary, maintenance, boundaries, communication, marketing, psychotropic meds, infection control and nursing, trauma informed care, behavior management, crisis intervention, CPR, first aid and training in medical software.

Here’s the summary:

• CPR/First Aid
• Standard/Universal Precautions and OSHA
• Fire Safety and Other Disaster Procedures
• Infection Control
• Communicable Disease Prevention
• Cultural Diversity
• HIPAA
• Abuse and Neglect
• Client Rights
• Client and Staff Confidentiality
• Crisis Communication
• Location of First Aid Kits
• Non-Physical Intervention/De-Escalation Techniques
• Obtaining Medical and Psychiatric Assistance
• Minor Aversive Behavioral Interventions
• Major Aversive Behavioral Interventions
• Behavior Management Plan Intervention
• Assistance with Self-Administration of Medication
• Incident Report Documentation
• Major Unusual Incidents (MUI)
• Confidentiality and Boundaries
• Obtaining Medical/Psychiatric Assistance
• Identification and Assessment of Contraindications

In addition to the above, there are employment requirements prior to a new hire coming on board to provide patient care, treatment or services. These include a BCI background report, negative drug screen test, negative PPD test or current CRX. Licensure verification is required and no findings on the Ohio Department of Developmental Disabilities, Nurse Aid Registry, Office of Inspector General and Sex Offender Registry databases.

A confidentiality information statement must also be signed. ‘We take our obligations seriously and work hard to ensure the team is equipped to care for the adolescents in our facility,’ added Griffey. “The symphony of scheduling both activities and facility for 90 teens and staff is incredible and it’s accomplished one wing or unit at a time in a continuous overlapping pattern throughout the building. You can really appreciate the dedication of the entire team 24-7 in serving the mental and behavioral healthcare needs of Ohio’s teens.”

Link to HR Video:

http://youtu.be/C7fg5-Mt-og

Positive Parenting

Everything that happens in life is within a context.  No one grows up in a bubble.  Interactions shape how we’re socialized, how we develop given the genetics, family unit and socio-economic/demographic environment we’re delivered into.  The Positive Parenting workshop at OCPOA Ohio Chief Probation Officer Association Conference covered the importance of building relationships and collaboration to affect change in an adolescent’s life- especially with regard to substance abuse, behavioral issues, and making the right changes.  Presented by Home Remedy, LLC, Emily Coen, MT-BC, LPCC-S, Burton Griess, PC and Mary Kay Bulmer, LSW, LCDCIII  made the point that, “Every individual has a story, every family has a history. We cannot expect to help or support families if we do not know what makes that family unique.”  Often, the negative behavior which is causing a problem is the target for change; not pointing a finger at the child-or parent.  The therapist asks, ‘why?’

Because any change has to occur within the context or family system, each person will have a different understanding of what the biggest concern is and a different view of family strengths, struggles, values and what works or doesn’t work.  The therapist role is establishing respect and listening.  Griess presented four parenting styles from Diana Baumrind research: authoritative, authoritarian, permissive and uninvolved.   This has proved helpful in understanding  a family system. Here are some examples:    For Tony, Pop set the rules. He was old world, old school and rigid. You knew where you stood; no negotiation.  Tony became deceitful to get around it.  This ‘my way or the highway’ style is authoritarian.  By contrast, Jackie’s dad held a high profile sales job and was gone much of the time.  Her mom was busy with her own career and Jackie often nuked her own dinner which was left in the fridge-or not.  Mom would flatly say, ‘that’s interesting’ while checking text messages when Jackie tried to tell her about the day at school or added, ‘whatever’ when asked permission to go out with an older guy. This is ‘uninvolved parenting’.

Authoritative parenting might be represented by Bob whose son Jamal knew what was expected of him and strived to live up to Dad’s standards.  His parents often came to his games, or school events, and even hosted cook-outs that his friends found inviting.  They were engaged in his life and he looked up to them.  Rachelle’s folks crossed the line in allowing her to hold overnight get-togethers, giving her more responsibility than she could safely handle (including beer), and friended her pals on Facebook, Snapchat and Instagram. This is known as permissive parenting.  In understanding a teen’s context, one looks at not only the home, but school, community, peers and the maturity/personal characteristics of a child.  A behavior plan which holds folks to accountability includes identifying the behaviors, expectation and consequences- both positive and negative.

In decreasing risk factors and enhancing a pro-social environment, it’s important to model  high nurturing, enlightenment and positive influence in the home environment. Coen and Griess stressed that socializing should be encouraged in the home, and parents should have names and contact information of peers and families.  Because the peer environment is so important; identify ‘red light’, ‘yellow light’ and ‘green light’ friends, they advise. Positive parenting should include meaningful interventions- which can include short consequences-such as removing a cell phone, and setting measurable goals.  Clear expectations and matter of fact explanations are more effective than responding in an emotionally charged way.  Negative behaviors are often used to manipulate parents if a child develops maladaptive personality traits over time.  In hitting the ‘reset button’ through counseling and new insight, self-control, peace,  respect , and hope return.

Teens take art to new level

Art therapist Darci, ATR works with Pomegranate’s teens in the acute hospital to explore memories, moods and dreams as part of the therapeutic process.  CPST Ruthie brings her art background to encourage teens on Pomegranate’s five residential campuses to express themselves through art-which can include painting, drawing, knitting and assorted arts & crafts.  A guest on tour recently was exceptionally impressed at the emerging art in residential day rooms, corridors and meeting rooms. Afternoon light streamed in and the murals glowed- while teens alternately finished up their day in the classroom, went to the gym, watched a movie for group discussion, or were scheduled for a short quiet period. The entire facility continues to evolve and improve aesthetically with unique and interesting murals and art creations.  In addition to the Madison County 4H contribution to the cafeteria, Pomegranate’s own teens designed their day rooms, mixing their own colors and diligently painting their hearts out across all 5 wings.

“The residential art program gives teens the opportunity to learn to make decisions and control the process, to learn from their mistakes. They can still have a success even with a ‘mistake’-and teens learn to focus on the process, not merely on the outcome.  Art touches all the intelligences; you can teach almost anything through art.  As creators, each child has a different goal; and it is cool for them to discover and share their perspective.  I have them acknowledge what skill they learned, and how to practice it.  It is more than just making art, however. I ask, ‘What do  I need to do to move them along the healing process?’  They’re craving this SO MUCH,” explained Ruthie.  A client said to her, ‘I wouldn’t ever be painting. I wouldn’t ever be knitting if it wasn’t for you.  Its helped me realize  I can create something meaningful. Thank-you! Thank-you!’

Currently, in process:

• The Celso unit mural is an ornate elephant, blowing colorful bubbles through his trunk.
• The Kennedy unit mural has a woman lying in the grass with emerging flowers.
• The Sathappan unit mural features super-heroes.
• The Meena unit mural features random designs.
• The Kaufman unit mural has well-known icons-like Mario or Popeye.

Teens have now painted inspirational sayings in the gym, and plans are in the works for additional corridor enhancement. You can see all the individual paint cups representing the inspiration which contributed to a beautiful outcome. Beauty is more than skin or surface deep! It changes attitudes and inspires hope.

See previous posts:

http://pomegranatecares.com/2011/06/30/unlocking-feelings-through-art-as-a-therapeutic-tool