Wednesday, October 27, 2010

What's going on, anyway?

I am teaching my favorite class fall quarter and we are at the point where my students really "get it"! The class is "Teaching Students with Emotional and Behavioral Disorders". My students are all graduate students in special education, school counseling and school psychology. The goal of the course is to develop skills in my students to support K-12 students who have difficulty in school due to behaviors caused by mental illnesses (depression, anxiety, bipolar disorder, schizophrenia, others), conduct or oppositional defiance disorder, attention deficit disorder, and perhaps a general lack of understanding and skills in behaviors that support positive school experiences. Assessment is the first step in this process. What, where, when and how much? The behaviors are not the fault of the child or adolescent. There is a function for the behavior. It is so fun, awesome and inspiring to see my students not only look at the environment and what they can do to support the young person but to learn the skills to advocate for the child/adolescent in their school! Very simply put and without all the research behind the process here is what they are learning:

1. What's the problem? (Child A (let's call her Shonna) puts her head down during the entire class and doesn't talk. Child B (let's call him Matt) disrupts class by talking out and bothering others, "I don't GET IT! I can't DO IT!!")

2. When, where and how often? (Shonna: First two hours of the day. Matt: During math class right before lunch. During social studies at the end of the day.)

3. What is the function of the behavior(s)? What does the student get or get out of with the behavior? (Shonna doesn't have to interact with other students or the teacher. Matt doesn't have to do math or social studies and gets attention from teacher and peers- negative attention but attention never-the-less. Questions to ask: Is the child hungry? Tired? On medications? Does she/he have the skills to do the assigned work? What's going on at home?)

4. How can the environment be changed and/or the consequences of the behavior? (Teacher meets with Shonna individually prior to the class. Make sure that Shonna has had breakfast. Explain the assignments (give specific work prior to group work); give snacks if necessary, put in small, supportive peer group. Check in often with a touch on her shoulder and thumbs up/ thumbs down. Give Shonna "token" to place on desk when she needs teacher assistance. Give positive reinforcement for looking at peers, speaking to group. Check to see if this should be private or public. Some kids don't see public praise as a reinforcer!
Assess Matt to determine his skills in math and social studies. How does Matt do during other periods? If okay then look at environmental factors. Tired? Hungry? Over-stimulated? Medications? Make sure that Matt has an assignment that allows him to be successful. Build assignments to optimal level so Matt is successful but still challenged. Develop a self-monitoring plan for Matt. Have Matt keep track of successful on task behavior and provide appropriate and natural rewards. Even 6 year olds can do this!!)

5. Review data and evaluate effectiveness of interventions. Change as necessary. Communicate with parents and all other teachers involved. Keep working!

Okay, so now you have 4 weeks of a graduate course in one short blog. I love, love LOVE working with "difficult kids" because they are beautiful, challenging and awesome children/adolescents who need someone to step up and support them in their desire to be successful. It is wonderfully rewarding to figure it out with the child and the parents and develop an intervention plan that leads to success! Thoughts?

Thursday, October 21, 2010

The Mom Thing: Dedicated to Roberta, Nanci, Lolli, and all the other MOMS

From my posting on the Child and Adolescent Bipolar Foundation Blog:

The thing about bipolar disorder is that it lifelong. It may finally submit to treatment and be tamed for years. It may stay docile or, more likely, it will come out of hiding and snap or bite at times. It may be dormant but it does not go away. This frightening fact hit me hard as my daughter, Linea, and I were working on our book. She had become extremely ill. She was suicidal. She was hospitalized. She had ECT. She was finally able to go back to school. End of story. Great, happy ending and one that I wanted to believe. I wanted to call it good and end it there. Yet that wasn’t the end and I wasn’t prepared to continue the fight.

We don’t get a guide to parenting when we are handed our newborns, let alone parenting a child with a serious mental illness. Even though I may have been prepared in my professional life, I wasn’t prepared for my own daughter’s plethora of symptoms beyond the initial “stability”. Continued depression, extreme anxiety, mania, cutting, eating disorders, alcohol and drugs. I thought it was over after the first hospitalization. Hadn’t my beautiful daughter been through enough? I struggled to understand how and why “it” couldn’t just be treated and why it wouldn’t lie down nicely for a long, long rest. But, like an autoimmune disease, there are flare-ups as well as times of raging symptoms.

Eventually, like any chronic illnesses we all began to make peace with it. Of course I wish with all my heart and soul that Linea did not have bipolar disorder, but she does. Linea slowly began to understand her illness and her body and began to not only accept it but began to work towards stability. Through hours of talking, listening and reading each other’s words I began to trust Linea. I began to understand how desperately she wanted to live, and not only live, but live well. She began to partner with her doctors and we all slowly accepted this new reality.

As she moved into young adulthood I began to realize and accept something else. I could not and cannot be with her every minute, keep her safe at all times, prevent her from harm or make decisions for her. What I could do was everything in my power to assure an honest and close relationship so that she can tell me what she needs and I can do the same. We can discuss and agree to interventions and treatment if it is needed and if she is unable to make decisions for herself. We can have a support network in place composed of family and friends to catch her if it is ever needed. There are no guarantees….actually, there are few guarantees with much of anything. But there is trust and faith, and we are doing everything possible to assure the best possible outcomes for her.

The older I get the more I realize that I have so much left to learn so I can only offer my thoughts from my own experiences and my work. It has become easier as Linea becomes more confident of her abilities to manage her symptoms. We have all been through a process that has strengthened our commitment to each other as well as to something bigger than ourselves. Yet we know it is not over. But we are in a place of relative peace with this illness. It’s the way it is. It’s “not fair” and I still beg that “it be given to me, not her” but that won’t happen. I can only travel with Linea on the “vast journey” (Linea) of hers, trust her, stay steady and try my hardest not to worry about the future. It doesn’t do much good anyway. Life in the moment is much sweeter.

Saturday, October 9, 2010


I am such a copycat. Linea's picture on her blog  made me want to post one of MY trip. She is way more creative and ingenius than I am and I readily admit it. But is a picture taken from the boat on the Canal du Midi somewhere around Carcassonne. I want to remember the joy of those carefree weeks less than a month ago! It was mostly sunny but the days of a little rain and clouds were so beautiful. Monet?

Tuesday, October 5, 2010

Mental Health Awareness Week: Can I Use the Word BREAST?

Mental Health Awareness week is October 3 - 9. Have you noticed that there are many, many people wearing pink in October for Breast Cancer Awareness month? Pink stays with us most of the year in one way or another because of the inspired breast cancer campaign. The breast cancer campaign has successfully led the way for many other campaigns including heart, diabetes, prostate cancer and others. Decreases in deaths from breast cancer are partially attributed to the result of treatment advances, earlier detection through screening, and increased awareness, certainly with great contributions from the campaign. There are campaigns designed to do the same for mental illnesses. What are the similarities between the two?

First, let's make it okay to talk about mental illness. It is not an illness to be whispered about nor hidden between the generations and family members. Just like the word "breast" was once taboo in most environments, mental illness still has the power to make many people look away, turn away or at least feel very uncomfortable.

Early screening and knowing what to look for is the second critical aspect of these two campaigns. Just as we teach women to be aware of their own bodies and health, we need to teach all people to be aware of mental health conditions. And, we need to start very early. Parents and teachers should be knowledgeable partners in screening for emerging mental health issues and know exactly what to do and who to talk with if something is amiss. Our children should be taught about mental health just as we teach them about nutrition, general health and sex education.

Thirdly, just as with the breast cancer campaign, we should be talking about and teaching prevention. As with cancer, mental illness is not the "fault" of the person but there are things that build resiliency and help to prevent worsening of symptoms. These are quite similar to any prevention program: eat healthy meals, get the right amount of rest, exercise, have meaningful work or avocation activities, develop and maintain good friends, have a positive social life, and find some purpose either from faith or spirituality or commitment to something beyond one's self.

Finally, find the best treatment possible. Unfortunately this may be the most difficult to achieve. With treatment and support, mental illness is not the "sentence" it has been in the past. Recovery and stability is possible. The days when someone faced certain death from a diagnosis of breast cancer is no longer the case. The same is true with mental illnesses. We face huge challenges across the nation to assure treatment is provided for everyone with a mental illness. In Washington State the growing deficit has negatively impacted the most vulnerable. DSHS is slashing away at services for the mentally ill. What would you do if your mother was turned away from treatment programs if she had breast cancer?

We have a long way to go in treatment for the mentally ill, particularly those without strong family or advocate support. This fourth step is paramount to recovery. Mental illness affects the entire family and I know how priviledged my family is with the care that my daughter receives. Let us all turn to our family, neighbors, fellow employees and community and assure that mental health awareness and treatment is as readily available as a mammogram. To learn more check out NAMI's site.