The Latoria Group Response to the Coronavirus

The Latoria Group would like to make you aware again of our commitment to promote the health and well-being of our clinicians, clients and families during this time of concern. The impact of COVID-19 continues to be felt by individuals and communities around the world. Given the rapidly changing environment, we must all do our part in slowing its spread while our government and experts continue to take measures to protect and guide us.

As many schools and businesses are moving to an online platform, The Latoria Group has always had this capability to offer TeleMental Health, virtual (online) counseling services to our clients.  We have Board Certified Telemental Health Professionals on staff and we are HIPAA compliant.  Ask your clinician about this option.

We are taking the next step to protect the safety of our families and our community.  Beginning tomorrow, March 18, 2020 until at least Monday, March 30, 2020, the offices of The Latoria Group will be closed.  During this time we will be visiting you,  our clients virtually (online) or via phone.

Due to the health of our state and country constantly evolving, our plans may change and if they do, we will let you know. These are extraordinary times, but we have come through challenges as a country together before.  We don’t want to be driven by fear, but rather be both prayerful and wise as we slow the spread of this virus.

Philippians 4:6-7 states, “Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God.  And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.”

The Latoria Group is here to help you and your family during these trying times. Thank you for allowing us to guide you and your family through these times of adversity!

Supporting the Family

Family systems therapy is a form of psychotherapy that helps individuals resolve their problems in the context of their family units, where many issues are likely to begin. Each family member works together with the others to better understand their group dynamic and how their individual actions affect each other and the family unit as a whole. One of the most important premises of family systems therapy is that what happens to one member of a family happens to everyone in the family.

When It’s Used

Many psychological issues begin early in life and stem from relationships within the family of origin, or the family one grows up in, even though these issues often surface later on in life. Families in conflict, as well as couples and individuals with issues and concerns related to their families of origin, can benefit from family systems therapy. This treatment approach can be helpful for such mental health conditions as depressionbipolar disorderanxietypersonality disordersaddiction, and food-related disorders. Family systems therapy has also been shown to help individuals and family members better control and cope with physical disabilities and disorders.

What to Expect

During family systems therapy, the family works individually and together to resolve a problem that directly affects one or more family members. Each family member has the opportunity to express their thoughts and feelings about how they are affected. Together, the family works to help the individual in distress and to help relieve the strain on the family. Family members explore their individual roles within the family, learn how to switch roles, if necessary, and learn ways to support and help each other with the goal of restoring family relationships and rebuilding a healthy family system.

How It Works

American psychiatrist Murray Bowen began to develop his family systems theory in the mid-1950s while working as a psychiatrist at the National Institute of Mental Health. Based on his knowledge of family patterns and systems theory, which looks at the parts of a system (such as individual family members) in relationship to the whole (the family), Bowen believed that the personalities, emotions, and behaviors of grown individuals are a result of their birth order, their role within their family of origin and the coping mechanisms they have developed for dealing with emotional family issues. To understand the family system, the family must be viewed as a whole, and that what defines a family is more than the people who make it up but also how they interact with each other to create a unique family dynamic.

What to Look for in a Family Systems Therapist

Look for a licensed, experienced mental health professional with a background and understanding of family systems and dysfunctional family patterns, such as power struggles and communication problems. In addition to finding someone with the appropriate educational background and relevant experience, look for a therapist with whom you and your family feel comfortable working on personal and family issues.

For family systems therapy, click here.

References

  • Harris MA and Mertlich D. Piloting home-based behavioral family systems therapy for adolescents with poorly controlled diabetes.Children’s Health Care. 2003;32(1):65-79.    
  • Courtois CA and Ford JD, ed. Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide. Chapter 19: Family Systems Therapy. Ford JD and Saltzman W. 2009, Guilford Press.
  • Brown J. Bowen. Family Systems Theory and Practice: Illustration and Critique. The Family Systems Institute.  
  • Brief Interventions and Brief Therapies for Substance Abuse. Chapter 8—Brief Family Therapy. Center for Substance Abuse Treatment. Rockville, MD. Substance Abuse and Mental Health Services Administration(US); 1999.

Article originated from https://www.psychologytoday.com/us/therapy-types/family-systems-therapy

Research Finds Virtual Reality Can Help Treat Anxiety

A new study published in the Journal of Medical Signals and Sensors has added to research showing that virtual reality (VR) can be helpful to help treat claustrophobia. The software in this study simulated an elevator moving to the tenth floor and also a magnetic resonance imaging (MRI) device). Researchers found that it was helpful to reduce anxiety and was accessible and easy for people to use it. The study also examined different dimensions of how playable the game was, including how motivation, satisfaction, effectiveness, usability, and learnability. 

This study adds to the emerging, promising research using VR technology as a way to address various types of anxiety disorders. Another recent study has examined whether virtual reality could be used social anxiety as well. VR technology is not just limited to the therapist office either. One large study found that immersive virtual reality could be used as a distraction tool to reduce pain, anxiety, and help with anger management in the emergency room. Another study found that VR can help successfully reduce anxiety in children undergoing dental procedures. VR can also teach mindfulness skills to help people with generalized anxiety disorder

Virtual reality technology creates simulated real-world environments so that people can work on their fears of certain situations. Studies have used VR games with advancing levels to simulate elevators, houses, tunnels, corridors, caves, and basements. These VR simulations can be used in therapies like exposure therapy for phobias. Exposure therapy is a type of behavior therapy to treat anxiety disorders and gradually puts the person in real-world situations that triggers anxiety. Over time, one is able to face the threatening condition with less anxiety over time.

Furthermore, the gamification of VR treatment can also be a useful way to engage and incentivize participation in exposure therapy by providing levels and positive rewards.  One game simulated four VR rooms that gradually became darker and smaller over time and found that anxiety decreased each time people played.

Several studies have found that VR therapy can help shorten the length of treatment for anxiety and save on time and cost. It can also help therapists be able to provide more exposure therapy in an accessible way in therapy sessions either in person or remotely and in settings like hospitals and emergency rooms.

Some of the challenges of this technology is how expensive the computer system and VR glasses.  Nevertheless, the research in VR in the treatment of anxiety disorder is fast becoming a promising tool.

Article written by:

Marlynn Wei, M.D., J.D., is a board-certified Harvard and Yale-trained psychiatrist and therapist in New York City. https://www.psychologytoday.com/us/blog/urban-survival/201903/research-finds-virtual-reality-can-help-treat-anxiety

Parents, You Have Summer School Assignments

Article from ADDitudemag.com

News flash: The back-to-school season doesn’t start in August. It begins now, when lessons learned and challenges faced are fresh. To begin on the best foot, take on these five organizational projects now — not when school starts in the fall.

Clean out backpacks and go through school supplies

This seems like an obvious suggestion, but I have put off doing this task until a week before the new school year began. I was unpleasantly surprised. I found a summer-long assignment in my son’s backpack in the first week in August. Empty your kids’ backpacks, sort through the stuff, and run the backpack through the wash.

Sort through and organize your kids’ clothes

Summer is a great time to mend uniforms and clean out kids’ closets. Listen when your kids tell you why they don’t like certain types of clothing. Are they too tight, too hot, too stiff, too scratchy? Younger kids choose clothing for comfort, not for style. Determine the “feel” your children want their clothes to have, and buy items that they will wear.

[Self-Test: Could Your Child Have Sensory Processing Disorder?]

Organize school awards, papers, and artwork from last year

Managing school papers and artworkfrom last year is a challenging task. Here’s a plan for tackling it:

Step 1. Sort each child’s papers into neat piles.

Step 2. Look through the papers with your kids. Listen to their stories, and find their favorite pieces of art. The purpose of looking over these things is to enjoy the memories.

Simplify your kids’ toy collections

Organizing your child’s toys is a task that is usually on a parent’s summer to-do list. Keep these tips in mind when you do:

1. Let your kids play with the items you want to get rid of one more time. The toys will get more wear out of them and entertain your kids on a long rainy day.

[Free Guide: How to Tidy Up Your Home Like a Pro]

2. Get rid of toys that are below your child’s ability level first. If your child is over age five and is attending all-day school, he or she will likely have only two or three “go to” categories for toys: Legos, video games, board games, baby dolls, stuffed animals, cars, trains, balls, art materials, magic items. Have each child choose his or her top three categories, and sort all of the toys into piles on the floor. The toys that do not fit in those categories can be donated.

If there are no organizers available, create a toy zone. Each type of toy needs its home. Here are some examples:

  • Baby dolls, clothes, feeding supplies, and baby furniture belong in the child’s bedroom.
  • Trains go in the family room or under the train table.
  • Matchbox cars go in the child’s bedroom in boxes, on the racetrack, or displayed on a shelf.
  • Art supplies go in a kitchen cabinet and should be shared by everyone.
  • Stuffed animals go in the basement to be shared by all.

If you are looking for a physical storage solution, I think the most versatile option is a shelving system divided into 14-inch cubes. These are sold at Target, IKEA, and Walmart. They come in a variety of configurations and color choices. I recommend one for each child’s bedroom and one for each communal play area.

Article written by:

Lisa K. Woodruff is the founder and CEO of Organize 365, a company that helps busy women get their home and paper organized in one year. Her book, How ADHD Affects Home Organization, explains the qualities of the executive functions of the brain, and how to organize your home despite struggling with one (or more) of those functions. Find more about Lisa at organize365.com.

OPRAH WINFREY COVERS ABOUT CHILDHOOD TRAUMA THIS SUNDAY NIGHT

 

Here are the 5 things Oprah understands about childhood trauma that excite us most

1. Dr. Bruce Perry knows what he’s talking about. Frankly, there’s a lot of clinicians that think they understand the effects of trauma. But they don’t. Bruce Perry, Daniel Siegel, and Bessel van der Kolk do. We’ve been following their work for years and molding our treatment model accordingly. We wish others would too.

2. It’s a brain thing. When trauma occurs within the critical early stages of life, it affects the brain. It’s not just a “phase that people get over” or “outgrow” as many people believe.Rather, childhood trauma requires early and effective professional help.

3. “It” should be called developmental trauma. This makes far more sense than the term reactive attachment disorder (RAD), which is in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. The current definition of RAD in the DSM-5 is failing clinicians, and therefore, kids and families. Trauma during the critical early developmental years hinders development. Therefore, children remain cognitively “stuck” in those toddler years. Let’s call it what it is and define the disorder accordingly so clinicians can start to recognize and treat it effectively.

3. Childhood trauma is an important topic for our culture. Absolutely. Childhood trauma doesn’t just affect children. It follows them through adulthood. It fills our prisons. It enters our schools, alongside mental illness. With guns. Time to wake up.

4. A lot of people working in philanthropic organizations to help “disadvantaged, challenged people…are working on the wrong thing,” said Oprah. Yes, struggling people need education, healthy living, housing, and jobs. But if we don’t help them with their “hole in the soul”, as Oprah so perfectly puts it, nothing will help them. We need to work on their trauma so they can lead healthier lives.

Furthermore, to put children with childhood trauma in residential treatment centers, rely upon behavior modification techniques, or treat them for substance abuse issues won’t touch the trauma either. They need a relationship-focused milieu combined with attachment specialists to make a difference (ahem…we’d love to grow our program but need support and resources).

5. What happened to the Parkland, Florida shooter? As Oprah said, we need to look beyond what’s wrong with these violent children. We need to look at what happened to them. Trauma begets trauma in our families, communities, and in the world. To put resources toward gun control and mental health is good but we need to look at the “hole in the soul” too. And we need to support those raising them.

Awareness is vital. As Oprah said, if we “could get on the tabletops right now to get people to pay attention to [treating childhood trauma],” we would. We’d like to be a dancing emoji too, Oprah. But we also need people to act.

Here’s what’s we’ll be listening for Sunday night—

This Sunday, March 11 will be a big night for the trauma community. The people who “get it” will gather around to hear Oprah’s interview with Dr. Bruce Perry about childhood trauma on 60 Minutes on CBS at 7:00 p.m. ET. While we’re ecstatic that Oprah understands childhood trauma, here’s what we hope she covers as well—

1. There’s an army of loving, amazing adults all over the world caring for children with developmental trauma. Yet, they get blamed and shamed when they ask for help. People who raise children suffering the effects of childhood trauma, including adoptive and foster families, “get it” because they live it every day. Sadly, most people don’t understand this basic concept. Instead, their friends and family, as well as clinicians, educators, case managers, and policy makers ignore them. Or worse, they often blame them for their children’s problems. Parents can’t do it alone.

2. There’s a severe shortage of professionals and resources to address this huge worldwide problem. Even if professionals have heard about childhood trauma, they often don’t know what to do about it. We’re happy that people are starting to talk about “trauma-informed” practices. But, actually, people have been “informed” for quite a while. We need to train clinicians to effectively diagnose and treat it.

3. Many children with developmental trauma also have co-morbid mental illnesses.We believe that people who abuse and neglect children do so as a result of their own trauma combined with mental illness. So their children are at high-risk for childhood trauma and genetic mental illness too. Yet, most clinicians have a difficult time deciphering, and therefore diagnosing and treating, these many issues. Children can’t begin to work on their trauma if the effects of mental illness get in their way.

4. Children with developmental trauma don’t want to attach. Due to early abuse and neglect, children with developmental trauma live in “survival mode”. This means they’ll do everything they possibly can to protect themselves from attachment—even though that’s the very thing they need most. Children with developmental trauma use manipulation and disturbing behaviors to push away those who try to get close to them in devastating ways. To simply put caring adults in their lives isn’t enough. They need training and professional help.

5. Our foster care system fails kids battling childhood trauma. Foster and adoptive parents don’t get what they need to effectively care for children with developmental trauma. To deny them resources and training lends to the cycle of children in and out of the foster care system, perpetuating the effects of trauma.

6. Love alone won’t fix childhood trauma. Adoption and foster families can’t save these children on their own. Although a stable and loving environment is vital, it’s only the beginning.

Awareness is a giant first step toward effectively treating childhood trauma. “I’ve done a lot of stories in my lifetime,” said Oprah. “But I think this is the key…I think this could be a game changer. I just want people to listen.” Oprah, we whole-heartedly agree. But parents in the trenches and organizations like ours need resources and a giant megaphone to save more of these children. We’re glad Oprah is listening. And we’ll be listening too this Sunday night.

 

By Nichole Noonan, Institute for Attachment and Child Development Communications Director

6 more things we hope Oprah Winfrey covers about childhood trauma this Sunday night

 

What To Do If You Suspect Depression in your Kid

We see a lot of parents struggling with raising kids with Depression. Sometimes it’s situational, which happens often in our community when other problems are not identified or yet well-managed, like Learning Disabilities, ADHD or Anxiety. And sometimes it’s chronic — a co-existing diagnosis of Clinical Depression. Regardless of whether it’s a primary or secondary diagnosis, it is profoundly dangerous and scary for everyone involved –kids and parents, alike.

How do you know if a teen is “moody” or depressed?

You don’t. So you’ve got to take responsibility for your child’s health care and find out for sure.

Some signs to look for include:

  • Change of energy;
  • Change of friends or retreat from friends;
  • Change in music or entertainment interests;
  • Tendency to “seclude” or hide;
  • Single-word responses;
  • Deterioration of schoolwork;
  • Retreat in the house;
  • Stopping participation in family or household events or chores;
  • Tendency to say no to things that they usually like;
  • Stopping familiar activities like exercise, sports, etc.

Depression can also come out a lot like Anger:

  • Screaming,
  • Fighting,
  • Picking fights,
  • Picking at everything,
  • Being rude (especially when you know that’s not what a kid’s generally like)

How DO you broach the conversation?</h2

Trust your instincts here, Mom and Dad. This is one of those times that I think parenting should be a Democratic Dictatorship: be transparent with your child, get her input — and then make a decision and take action.

You might say something like: “I love you, I’m worried about you, and I don’t know how to help you. It’s my job to take care of you and keep you healthy, and I need some help to do that. If it turns out you’re just a moody teen, then that will be great to know, and we’ll figure out how to handle it together!” (Depending on your relationship, as a humorous aside, you can make a joke here about what happens if YOU turn out to be over-reacting. Personally, my kid would love pizza for a week!) “But if you need some additional support that I can’t provide, I need to know that. I want to be the best parent I can be for you – and that means making sure I take care of all aspects of your health.”

THEN you can give your child some options – different therapists, perhaps, or methods for evaluation — so that she can be part of the decision-making and feel some control for her own life. But ultimately, it’s a parent’s decision.

It’s Not Rational

Be clear: Depression is not rational. You can’t plan for it. And it requires a quick response, because it is incredibly dangerous, sometimes with VERY little warning.

From a parent’s perspective, managing Depression requires strength, direction, and commitment. It means not worrying about being fair, or how you look as a parent. It means doing everything you can to keep a child safe.

And, to some extent, that means accepting that there is only so much you can do by yourself. This is NOT something you SHOULD know how to navigate. You need help – and you don’t want to wait too long to get it.

That’s a hard shift for a parent to make – we fool ourselves into believing that we should know what to do with our kids because we’re the parent – even when we’re exposed to circumstances that are completely foreign to us! But it’s better to be overly protective and proactive, than to spend the rest of your life mourning the loss of your child and burying yourself with regret and guilt.

Bottom line: Whether your child is Moody or Depressed – if you’re concerned, don’t ignore it. Get some help – and get to the root of what’s going on for your child.

WRITTEN BY ELAINE TAYLOR-KLAUS ON

Raising Grandkids: What to Do When the Honeymoon Ends

Jan is a sixty-five-year-old grandmother who was given custody of her two grandsons, aged 8 and 15, after her daughter was jailed for drug abuse. “At first, it was a joy to have them in our house,” said Jan, whose grandchildren came to live with her one year ago. “They seemed so happy to be here. But then the real problems started. Now, my older grandson either just plain ignores me or he talks back—I don’t know which is worse. And the younger one is starting to follow suit. I’m starting to wonder where we went wrong.”

Raising Grandkids: When the Honeymoon is Over

Like Jan, often when you first take your grandchild in, there’s a honeymoon period where the change of environment and absence of stress from the old living situation gives your grandchild the chance to show his or her best side, which is great. Sadly, all too often the honeymoon ends. And the problematic behaviors emerge—sometimes slowly, sometimes with great rapidity. Either way, it knocks the family off balance. The honeymoon should be expected, but grandparents should not be deceived into thinking that a magic solution to the family’s problems has occurred by having the grandchildren come live with them. If the honeymoon never ends and your grandchild always does great, that’s beautiful.  But sometimes these kids are initially being manipulative, and are using their skills to try to “con” their grandparents. It’s my experience that this is a very common thing for kids to do. So if the period of calm ends and the disruptive behavior emerges, I tell grandparents “Don’t blame yourself. This is just the end of the honeymoon. And you’re starting to see the child in the light of his true problems.”

If You’re Helping to Raise Your Grandchildren While Their Parents are Working

Many grandparents are watching their grandkids in the daytime while a single parent or even both parents are working. So in effect, those kids have two sets of parents and two parenting styles to cope with, and those styles may not always be in sync.

If the picture is that there’s a working single parent and that you are raising the child during the work hours, it’s very important that you and the child’s parents sit down and come to a common understanding of how you’re going to manage behavior, what the limits are, and the range of consequences that are appropriate. New situations will present themselves every day, and you may get frustrated from time to time and feel like you’re going back to the drawing board, but stick with it—it’s very important that all the adults in the child’s life are on the same page.

The difficulty here is that grandparents don’t like to be told how to raise their grandkids, thinking that they’ve raised their own children and know how to do it just fine. And parents don’t want their kids to be raised outside of their own philosophy. This can become a point of conflict between grandparents and their children. Communication and a willingness to look and learn by both parties will prevent this problem from becoming a crisis.

When You Have Custody of Your Grandchildren Because of Parental Addiction, Abandonment or Neglect

Children who are living with their grandparents because of parental addiction, neglect or abandonment bring a whole set of other problems to deal with. These kids are already programmed to deal with the negative environment they came from, and may not be ready to move into a family situation where there are boundaries and rules. What grandparents have to remember is, when your grandchildren move in with you, you are their new family.

In my private practice, I knew many grandparents who raised their grandchildren because of parental neglect, abandonment, incarceration or substance abuse. Frankly, these grandparents had their hands full. Often their grandkids came to them with a constellation of inappropriate behaviors already firmly in place. It was very hard for these grandparents to try to change that behavior or intervene in the child’s life.  And there are generational difficulties, as well as physical problems with caring for children when you’re older. Your energy levels and mental flexibility may not be what they were when you were parenting young children yourself.

If the picture is that the grandparents are raising the child because of parental neglect, abuse or abandonment, above all, the parents should not be allowed to undermine the authority or rules the grandparents have put in place. You should limit or forbid visits until the parent is willing to comply with that. That’s because the grandparents have now become the primary parents, and the birth parents have to take a secondary role. It’s all too easy for the secondary parents to judge grandparents and be critical of their efforts, because it helps the birth parent not look at his or her own irresponsibility and neglect. But this should not be tolerated, especially in front of the children. The grandparents and the birth parent have to communicate, share thoughts and ideas, and then come to some method of operating together.

I want to be clear: such meetings should not become a forum for birth parents to be abusive, oppositional or defiant to the grandparent. This is all too often the case. Grandparents should not accept blame from birth parents who have lost their ability to meet their own parenting responsibilities.

“You’re not my mom! I don’t have to listen to you!”

When your grandchild says, “You’re not my parent!” I think the best strategy here is to agree with the child.  You can say, “You’re right, I’m not your mom. But you live in my house now, and these are the rules in my house.” Do not condemn the mom or dad or get into a discussion about it. All you have to say is, “There are the rules here, and there will be consequences if you don’t follow them.”

When kids say “You’re not my mom or dad,” what they’re really trying to do is take the power away from you. Focus on what your role is: Caretaker. That means you should inform the child what the rules are in your house. The whole idea here is to avoid a power struggle. What your grandchild is doing is inviting you to a fight. And remember, you don’t have to attend every fight you’re invited to. Avoid the power struggle, and calmly state what your role is and what the rules are. It’s very important to verbalize no judgments about the mother or father. Judgments will only lead to more anger and resentment, which will lead to more power struggles.

I want to add that I really admire and respect grandparents—or anyone who adopts or takes in a child who has behavioral problems. In my opinion, they’re amazing. But that doesn’t mean that you can do it alone. And just as parents need help, so do grandparents, and I urge you to get the help you need to successfully live with and raise these children.

For Grandparents whose Grandchildren are Being Physically Abusive

First of all, if your grandchild is being physically abusive to you, you should call the police. There’s no excuse for physical abuse. You did not work all your life to be abused physically in your later years. If you want to be a martyr and allow that, that’s your choice. But understand this: choosing to be a martyr doesn’t help the child. If you think you are doing it to help that child, what you need to understand is that the most important thing for that child is to have powerful limits set for them. And if they won’t accept the limits imposed by you, then you need to look outside the home for entities with more power, such as the police and the social service system. Often you’ll hear grandparents state that they don’t want to call the authorities because they’re afraid their grandchild will end up in group home or institution. My response is clear: if he’s physically hurting you, robbing you, or abusing you, maybe he needs to be in a group home or institution where the resources are available to teach him how to manage himself.

I don’t say this to be harsh. I say it with complete empathy for your situation. The fact remains that kids who are physically abusive, steal, set fires, or destroy property often need more resources than the ordinary family has to offer. These behaviors should be taken very seriously indeed, because they can be precursors of much larger problems.

If You’re Considering Taking in a Grandchild, Ask Yourself: Are You Able to Manage a Child with Behavioral Problems?

In my experience, many of the grandparents I worked with were very committed to their grandchildren, but were in fact just plain tired. They had lived their lives, they had worked like dogs, they had raised their kids, and now when they were dealing with their own failing health and financial problems, they felt obligated to take on the burden of raising their grandchildren. While I respect the generosity of grandparents tremendously, I wouldn’t always advise people to try to manage a behaviorally disordered grandchild. Each case is different. Remember, if the kid is well-behaved and knows how to manage himself, accept authority and recognize limits, the grandparents can do fine. But behaviorally disordered children are not only draining, they require people who have acquired special techniques in order to manage them.

Parenting Today Ain’t What it Used to Be: Get Help if You Need It

Many of the behaviors grandparents have to address today were not part of the youth culture 30 or 50 years ago: The blatant disrespect, the demand for autonomy, the open defiance to rules. These things were present, but not at the level of intensity they are today. Grandparents I met in my practice often reported to me how shocked and discouraged they where when their grandkids did not accept their authority or the limits they set.

My advice to grandparents in cases where inappropriate behaviors start to emerge is to get help. That help can be outside the home in a counselor’s office, or that help can be inside the home through a training program like The Total Transformation. If these children have behavior disorders, you’re going to see all that goes along with that: manipulative behavior, risk taking, rigidity, senseless defiance. Remember not to blame yourself if these behaviors emerge: grandparents need as much help as anybody else in dealing with these issues.

Article (Found on the webpage of Empowering Parents.com) By James Lehman, MSW

Report: There are 40 million slaves worldwide; most are women and children

A United Nations agency warns 40.3 million people across the globe were subject to some form of modern slavery in 2016. Among them, about 28.7 million — or 71% — were women or girls forced into sex, marriage or labor.

The 2017 Global Estimates of Modern Slavery report released Tuesday found modern slavery in every region of the world. The report didn’t specify how many of those victims were in the United States during 2016, but a Walk Free Foundation index estimated that number to be about 57,700.
The report was compiled by the UN’s International Labour Organization (ILO), the Walk Free Foundation and the International Organization for Migration. Modern slavery has no legal definition but includes human trafficking, forced labor, debt bondage and forced marriage. Put simply, the report said modern slavery is “exploitation that a person cannot refuse or leave because of threats, violence, coercion, deception, and/or abuse of power.”

The majority of the world’s modern slavery in 2016 took the form of forced labor, which accounts for about 24.9 million of modern slavery victims. These are people being forced to work in factories, farms and elsewhere under threat or coercion. It also includes the sex industry. The rest, about 15.4 million people, were living in an unconsented forced marriage, which often included labor.
Andrew Forrest, chairman of the Walk Free Foundation, said the number “shames us all.”
“This speaks to the deep-seated discrimination and inequities in our world today, coupled with a shocking tolerance of exploitation,” he said.

The regions most prone to modern slavery were Africa, Asia and the Pacific. And Europe and Central Asia.

About a quarter of modern slavery victims were children, including those forced to marry as children and those in sexual exploitation. About 1 million children were victims of commercial sexual exploitation in 2016 and 3.8 million adults were in forced sexual exploitation. Women and girls accounted for 99% of sexual exploitation victims and 88% of forced marriage victims.
The ILO also released its Global Estimates of Child Labour report, which estimates about 152 million children worldwide subject to labor.

The modern slavery report said ridding the world of slavery will require interventions on the economic, cultural, legal and social forces assisting slavery.
“This has to stop,” Forrest said. “We all have a role to play in changing this reality — business, government, civil society, every one of us.”

 

Follow Sean Rossman on Twitter: @SeanRossman

Is your daughter ok? Check again.

A precious teacher in my school sent me this letter.

This letter was written by one of her neighbors who just lost their daughter. My prayers go out to the Blackwell family. Thank you Richard for having the courage to share your daughter’s struggle with us.  May the many beautiful memories of your daughter comfort you and your family during this time.

 

“Dad I’m ok”. That’s what Alex said to me Tuesday afternoon. Alex has been suffering from Social Anxiety and general depression since receiving a concussion last fall playing soccer, but we felt things were moving in the right direction. Recently she had fallen in love with a longtime friend and there was more of the old Alex happy face around. Suicide had been something that Alex said she considered in the past and we took that very seriously, but she was telling her therapist and us she was past that now and we were believing her.

There was a pounding on the front door and it took me a moment to wake up. When I got down to the door there was a police officer there and he asked if I had a 16-year-old daughter and that I needed to check on her. In her last waking moments Alex called her boyfriend then fell asleep while talking and he knew something was wrong. Alex wasn’t breathing and had no pulse when we found her, and my wife and I immediately started CPR. The paramedics arrived only a few minutes later and started doing their thing to save her. They quickly got her out the door and we were off to the Emory Emergency room – Thank God, because we knew this was the best place to be for and emergency.

For almost two hours they had tried to get her back, but her heart would beat for a while then stop again. They tried tirelessly with heart compressions and as soon as one person was tired another stepped up to continue. Over and Over they tried. We knew it wasn’t working, but they continued. They were all at a point of exhaustion when they gave it one more go.

They let us sit with Alex for a long while afterward and we held her hand and kissed her checks until it was time to go. We went home and were surrounded by all our friends and family with more arriving every hour. Everyone tries to say some words to help but really just their presence is all we need because there is nothing to say. The last entry into her diary said “I’m just tired.”

If love could not save her what could? In my heart I think Alex made one bad decision on one bad day. One impulsive decision that couldn’t be taken back.
Sports concussions on children are worse than we believe. We need to stop Headers in Soccer and add more head protection in all sports.
Girls can be very mean to each other. We can’t just talk about bullies; we parents must ensure that Our kid shares warmth not hate to those they don’t like.
“13 Reasons why” (a movie) is great if you are not contemplating ending your life. For those in danger it glorifies suicide and makes it seem not so hard to do. If you are the editor of this movie reach out to me.
Don’t believe it when your daughter says I’m ok. Check on her often if she is a risk. Share how important it is to just hang in there and get past the teens. Get her in therapy.
Watch nutrition and get her exercise.
Share this with parents, coaches and therapist you may know.
Alex’s last words to her boyfriend were “it’s going to be Ok.”

Written by Richard Blackwell

September 14, 2017

Consider donating to http://www.soccerstreets.org/ for Alex.

’13 Reasons Why’: Strengths, challenges and recommendations

The Netflix series 13 Reasons Why has launched a national discussion regarding teen suicide, motivating a webinar response from professional organizations about how to shape the dialogue, dozens of editorials and millions of cautionary letters home from schools to parents across the country.

The series, based on a novel, is narrated by high school student Hannah Baker, who made a series of cassette tapes to be passed to 13 individuals she argues contributed to her reasons for dying. Her story is seen through the eyes of a peer, Clay, who listens to the tapes. He comes to understand Hannah’s perspectives about those people and events she claims motivated her suicide, which include Clay’s own (in)actions.

The series has been critically acclaimed for the acting and commended for addressing challenging topics, such as bullying/cyberbullying, sexual assault and teen suicide. However, school administrations, school counseling associations, suicide prevention organizations and counseling/psychology associations such as the American Foundation for Suicide Prevention (AFSP), the Suicide Prevention Resource Center (SPRC), the American School Counselor Association (ASCA) and the National Association of School Psychologists (NASP) have advised caution because of the graphic nature, revenge fantasies and potential contagion effect. This article highlights strengths and major challenges of the series. It also provides recommendations that have been underrepresented, though not absent, in the discussion.

 

Strengths

1) Raising awareness that suicide is a real problem.

According to the Centers for Disease Control and Prevention (CDC), suicide is a major public health issue. The most recent  statistics available note that among high school students, 17 percent have seriously considered suicide, while 8 percent have attempted suicide within the past 12 months. We know that for every suicide, there are many survivors, including the family and friends of the person and those who have experienced psychological, physical and social distress after exposure to a suicide.” The most commonly cited statistic is that each suicide directly affects six people; however, more recent research argues there are between 45 and 80 survivors per suicide.

In 2015, there were more than 44,000 reported suicide deaths, including 5,191 deaths by suicide among those ages 15 to 24. However, this statistic includes only those that were reported. Although there is no consensus on the rate of under-reporting due to stigma or ambiguous cause of death, the best analysis suggests that for each completed youth suicide, there are 100-200 times as many nonfatal suicide actions.

Combining CDC data with our current understanding of rates of suicidal ideation in youth, in this moment there are close to 15 million people in the U.S. who think of suicide in any given year. Suicide is a very real public health issue; when it is ignored, stigmatized or minimized, we as a community are missing the chance to prevent it.

2) Even professional counselors may not be ready to respond to a suicidal situation.

Because counselors often receive referrals of clients who are suicidal, counselors’ competency in identifying and intervening with those at risk is crucially important. However, the overtaxed counselor in 13 Reasons Why, Mr. Porter, is underprepared to face a suicidal student coping with complex trauma. Although he did not act in the scope of best practice, his failings are unfortunately not unusual among counselors, despite decades of advocacy for increased suicide assessment trainings in counselor education.

Mr. Porter missed several suicidal statements (e.g., “I need everything to stop”), made assumptions about contributing events and was uncomfortable talking about suicide (and other issues). We may easily judge Mr. Porter’s mistakes, but as counselors, we should take this opportunity to reflect and ask ourselves if we are ready to respond to a student at risk of suicide. The research is equivocal.

3) Suicide is complex and individual.

Although 13 Reasons Why portrays some known “red flags” that can indicate suicidal intent, the factors that contribute to individual suicides vary. Stressors that may influence one person’s decision to die by suicide may not have the same effect on others. For instance, we know that not all people who are depressed die by suicide (research shows the rate is from 2-15 percent) and that not all people who complete suicide are depressed. There is a variety of prevention programming regarding common warning signs. However, there is no perfect amalgam of warning signs or demographics (e.g., risk for transgender persons) that helps us differentiate who will decide to die by suicide. We need to go beyond just learning warning signs in order to help.

Livingworks, a suicide intervention training organization, focuses on three elements when assessing warning signs and risk factors. First, we must look for the meaning behind stressful events. For instance, in 13 Reasons Why, being listed “Best Ass” was highly distressing to Hannah because she felt objectified and was concerned people would misperceive her to be easy. However, another student, Angela “Best Lips” Romero, was flattered by such attention. The meaning behind the stressful event is more important than the stressful event itself.

Second, we need to know that warning signs can be, and often are, expressions of pain. When Hannah pushed Clay away, he recognized that something was wrong but did not see that her rejection was an indication of emotional pain. Third, we must trust our intuition. One peer recognizes Hannah’s poem as a cry for help but does not offer assistance. We need to pay attention to our gut feelings and act on them to take care of each other.

13 Reasons Why provides an opportunity to see Hannah’s experience of several traumatic events (cyberbullying, being stalked, public objectification, losing money, feeling responsible for a person’s death, witnessing rape and being raped) and does a good job of depicting the pain, shame and isolation she experiences as a result. The viewer has an opportunity to consider Hannah’s subjective experience and understand how the cumulative effect of these “reasons why” motivates her to suicide.

One model to help contextualize suicidality is the interpersonal-psychological theory of suicidal behavior developed by psychologist Thomas Joiner. Joiner states that the highest risk occurs when one feels like a burden to others, feels alienated or lacks belongingness and, crucially, has overcome the natural human inclination toward self-preservation. This model posits that suicide is a process — one gradually builds tolerance to the idea through self-injurious thoughts or behaviors (although each person’s path is unique). There are multiple points on that path at which others can intervene. The 13 Reasons Why series emphasizes those missed opportunities. As in Hannah’s case, every day there are suicides that happen as a result of those missed opportunities.

4) The central message is a positive one.

In the last episode, Clay says to Mr. Porter, “It has to get better, the way we treat each other and look out for each other.” Instead of feeling guilty or turning away, we can task ourselves with being more supportive community members.

All too often, we operate from a place of fear, which is understandable considering that schools have a legal duty to protect students from self-harm, and lawsuits are a potential reality (as shown in 13 Reasons Why). However, when systems or individual responders act out of fear, it focuses the interaction away from the needs of the person at risk. Even well-intentioned modern practices of “suicide gatekeeping” have substituted swift (and protocol-driven) identification and referral for the direct supportive intervention by community members proposed by John Snyder in 1971. Clay’s words echo those from Snyder half a century ago, when he said that most “who attempt suicide are victims of breakdowns in community channels for help.”

Although Mr. Porter clearly failed to proper identify Hannah’s suicidal ideation, perhaps even more troubling was his failure to hear her story and understand the factors behind her decision to die by suicide. Listening and demonstrating empathy to someone who is struggling was demonstrated to reduce suicidal ideation on calls to the National Suicide Prevention Hotline. Talking about suicide can help the person at risk to no longer focus on the past or feel alone and, instead, shift to the present moment, where the person can feel understood and cared for. If those in Hannah’s community who were witness to her emotional pain had actively engaged her and listened, it may have reduced her isolation and lessened her self-perception as a burden. This may even have prevented Hannah’s death.

Research indicates that our personal beliefs about suicide influence our responder behaviors. Therefore, gaining awareness of our beliefs and how our ability to intervene is affected by them is vital. Regardless of whether we can stop a suicide, we can control how prepared we are to try. We can make sure that our systems (in schools and elsewhere) are places where it is easy for someone to receive help.

After working through Hannah’s tapes, Clay now believes that we are, in a way, our brother’s keepers. Community-level response by direct intervention is a central theme in my (Laura Shannonhouse) research. It involves equipping “natural helpers” (e.g., teachers, bus drivers, resources officers, school counselors/psychologists) with the skills needed to perform a life-assisting suicide intervention at the moment it is needed most.

The producers and cast of 13 Reasons Why have underscored their desire for this series to start a conversation. Although that has certainly been accomplished, we hope the dialogue focuses more on how we can “look out for one another” and foster communities less at risk for suicide.

 

Challenges

1) Graphic nature and contagion

Viewers of 13 Reasons Why watch two rape scenes and Hannah’s suicide, which is shown in detail. Nic Sheff, one of the writers of the series, stated that the scene of Hannah’s suicide was intended “to dispel the myth of the quiet drifting off.” Some crisis texts suggest that we “deromanticize” suicide by helping our clients understand the unintended effects of trying to die by suicide, such as surviving but becoming disabled or alienating friends and family. Therefore, an argument could be made that a graphic, painful portrayal of suicide is warranted.

However, research does suggest that suicide portrayals can contribute to contagion by triggering suicidal behaviors in people — particularly youth — who are experiencing high levels of emotional distress. In fact, SPRC and AFSP have made recommendations for best practices in prevention of suicide contagion. A discussion of post-suicide intervention to prevent contagion is beyond the scope of this article, but as an example, the locker memorial portrayed throughout the series is against standard guidance (it should not last for weeks, as shown). Furthermore, when considering how media reaction to the series has often included sensational headlines, it is helpful to review these recommendations for reporting on suicide.

2) Survivor’s guilt and revenge fantasies

By assigning “reasons why,” the series sends a message that Hannah’s death is caused by other people’s actions. When Clay openly questions, “Did I kill Hannah Baker?” his friend Tony answers dramatically, “Yes, we all killed Hannah Baker.”

Although we suggested earlier that we all have a responsibility to create communities that help prevent suicide, Tony’s level of direct attribution can be counterproductive. Hannah experienced multiple losses, traumas and stressors caused by others, both intentionally and unintentionally. Placing responsibility for her death on those individuals instead of on Hannah’s action can exacerbate survivors’ guilt. Those viewers who have lost a friend, loved one or acquaintance to suicide may feel even more strongly after viewing the series that “It is my fault.”

These feelings are associated with lower functioning in comparison with survivors of accidents. Although undeserved, survivor’s guilt is a real phenomenon, and considerable research shows that even counselors who experience the death of a client by suicide can experience shame/embarrassment and emotional distress.

Whereas Clay may feel guilt for his part in Hannah’s story, the tapes could implicate others in criminal or negligent behavior, perhaps giving Hannah posthumous revenge. Some viewers who may have struggled with suicidal ideation themselves could get the message that if they take their lives, they can get revenge on those who have hurt them. This is an additional reason that schools across the nation and professional helping organizations have felt the need to do damage control for 13 Reasons Why.

 

Recommendations

1) Parents need to not just talk but watch, listen and connect.

Some school counselors argue that it’s harmful for children and teens to watch the series on their own without the support of a parent or trusted adult because the series depicts a graphic and romanticized portrayal of a teenager in crisis and does not identify competent resources capable of helping her. Accordingly, many experts encourage parents to talk to their children about the series. In addition to using talking points, we recommend that parents listen deeply and without judgment to what their children say. When people feel genuinely heard, they are more likely to talk about their true thoughts and feelings.

To accomplish this goal, parents can use active listening skills, such as open-ended questions, reflections of feeling, paraphrasing and encouragement. Also, we recommend that parents watch the series and risk being human — risk being impacted by the series and empathizing with their child. The construct of empathy is powerful, particularly if it is sincere. For a three-minute visual summary, consider watching Brene Brown on empathy. In our counseling skills courses, we often talk about “getting in the well of despair” and genuinely connecting with others. We know that talking about suicide paradoxically provides a significant buffer to suicidal action.

2) We need more than prevention programming in schools.

We know from a well-regarded U.S. Air Force study that we need suicide programing at all three levels: prevention, intervention and post-intervention. Many suicide prevention programs have been implemented in the school context, but there is mixed evidence of their effectiveness. From our clinical experience in crisis response, our scholarship and our history with training a specific model of suicide intervention, we need to acknowledge that we are biased about what types of programming should be implemented and when is the right time to implement. We feel that an appropriate first step for a school system is to implement basic screeners and gatekeeper trainings such as Signs of Suicide or Sources of Strength.

However, suicide prevention should not end with identification for referral. Optimally, the process continues by assessing level of risk, identifying reasons for dying and reasons for living, discussing alternatives to dying, enlisting the support of trusted loved ones and limiting access to lethal means or securing the person’s environment. Because youth who struggle with thoughts of suicide often seek out the support of those they trust rather than professional mental health providers, those teachers, coaches and others with open hearts and doors are the most effective gatekeepers for a system. Their nondirection and empathy are useful pedagogical qualities and vital to effective suicide intervention.

We endorse models that empower those “natural helpers” to provide a potentially life-saving intervention for students who are in suicidal distress. Although this may be augmented with the support and follow-up of a trained mental health provider, gatekeepers can implement the steps listed above.

3) Be intentional about identifying caregivers and shifting school culture.

My (Shannonhouse) research involves partnering with school districts and superintendents (in Maine and Georgia) to identify “natural helpers” and equip them with the skills to perform a life-assisting intervention in the moment (i.e., Applied Suicide Intervention Skills Training, or ASIST). These natural helpers are often teachers, resource officers, coaches, administrative staff, bus drivers and other people who are likely to be confidants to students who experience distress. Measuring suicide intervention skills and responder attitudes is easy for an academic. Identifying those school personnel in the trenches who would be first responders is more difficult — it requires the total involvement of administrators. Furthermore, such an approach requires schools to commit to a student-centered response model.

ASIST is relationship-driven and aligned with the values of the helping professions. It meets the needs of students who are at risk by focusing on responding to those immediate needs rather than referring the student (which can lead to further isolation and an increased sense of burdensomeness). Although the student is often referred for more long-term counseling, ASIST provides the student with a six-step intervention at the moment it is most needed and can be performed by anyone over age 18. Having natural helpers trained in ASIST or a similar protocol can dramatically increase a school’s responsiveness and effectiveness to help students in distress.

4) Use an intervention model backed by research.

ASIST is a 14-hour, two-day, internationally recognized and evidence-based model that has been adopted by multiple states and the U.S. Army. It has also been recognized by the CDC and used in crisis centers nationwide. Caregivers trained in ASIST consistently report feeling more ready, willing and able to intervene with a person at risk of suicide.

The program has been evaluated in a variety of settings (click to download), with pretest to post-test improvement noted in trainees’ comfort level at intervention and in their demonstrated intervention skills in response to simulated scenarios. Although outcome research is rare, research compared ASIST-trained counselors with those trained in other models through a double-blind, randomly controlled study of more than 1,500 calls to the National Suicide Prevention Lifeline. Those trained in ASIST more often demonstrated particular behaviors such as exploring invitations, exploring reasons for living, recognizing ambivalence about dying and identifying informal support contacts. Those trained in ASIST also elicited longer calls.

We found that ASIST can be applied to both university and K-12 settings. Our work measured increased suicide intervention skills and beneficial responder attitudes, which have been maintained over time. We have trained more than 500 people in ASIST and have received multiple reports of teachers disarming fully formed suicide plans with their new skills. More recently, we have conducted behavioral observations of ASIST responder behavior and have begun evaluating outcomes of students who have received ASIST intervention. Initial results have been promising, including better coping and commitment to follow-up and decreased lethality.

 

Summary

Although 13 Reasons Why gives us pause for its poor portrayal of effective suicide intervention, we feel that the series raises awareness and, at its core, advocates a community-level response to suicide prevention. This message to “look out for each other” is aligned with more intervention-oriented gatekeeping. We have explored the impact of one such model, ASIST, in several educational settings and found that it improves responder behavior. Furthermore, this approach comes with a mindset that systems can harness their strengths (i.e., natural helpers) to focus on responding to and intervening with the student rather than simply identifying and referring the student to the system.

 

*****

 

Please contact me (Laura Shannonhouse) should you have any questions about our research.

 

 

Laura Shannonhouse is an assistant professor in the Counseling and Psychological Services Department at Georgia State University. Her research interests focus on crisis intervention and disaster response, particularly involving social justice issues in this context. Currently, she is conducting community-based research in K-12 schools (suicide first aid) to prevent youth suicide and with disaster-impacted populations in fostering meaning-making through one’s faith tradition (spiritual first aid).

 

Julia L. Whisenhunt is an associate professor of counselor education and college student affairs at the University of West Georgia. She specializes in the areas of self-injury, suicide prevention and creative counseling. She is particularly interested in the relationship between self-injury and suicide and ways that mental health professionals can apply this knowledge to clinical intervention.

 

Dennis Lin is an assistant professor at New Jersey City University, with areas of expertise in play therapy, child/adolescent counseling and assessment, suicide prevention/intervention, quantitative research and meta-analysis. He is also a certified master trainer of Applied Suicide Intervention Skills Training (ASIST).