Alternative ways of Thinking and Doing: Mobilizing to Help Children. Chris Morano, Ph.D.

Transcription

1 Alternative ways of Thinking and Doing: Mobilizing to Help Children Chris Morano, Ph.D.

2 Hello from Wisconsin

3 Main objectives.. 1) Why we should do this?..tiny, significant things 2) What it takes Do you have it? 3) To hospitalize or not THAT is THE question. But what IS the question? 4) The future

4 Big Ideas You Need to Know Before Starting 1) Everyone in the room has needs: 2) Stop Saying Crisis, in a crisis 3) Crisis Response is NOT All About Content, Words, Planning And it s not even close.. 4) It s risky doing things differentlyare you ready for that?

5 Hi, I m Chuck Norris and I don t sleep I just wait..

6 What is crisis intervention? A lifeline Emotional CPR Psychological First Aid (PFA) A strategy and service on the continuum of help

7 Crisis intervention is not a math equation..you can t learn it in a book- it s heart math. So was Jerome Frank (1973) Malcolm Gladwell is right- this stuff takes a lot of practice, work. soft non-clinical skills- empathy, presence, encouragement, respect, hope, most important.

8 AND your own MENTAL HEALTH, balance, stability is as important as anything, if you re going to do this well.

9 WHY

10 .. Because we have to see and do things differently Traditional strategies don t work for many youth Especially high risk kids and children with complex needs. Eg,. Hospitalization is costly, and not the best strategy for enduring change- it has a place on the continuum- use it effectively! From Developmental Psychopathology to Positive Psychology (Davidson) and the search for strengths

11 And because Anxiety rules the day.. NAMI (2016)- almost 3x any other problem WHO (2014) anxiety disorders twice that of depression, and more than any other mental health issue.

12 Trauma, stress all around..aces run wild ACEs (Adverse Childhood Experiences) studies s Common - Scores 4+ = high risk for poor health; leading determinant of public health costs (CDC)

13 Sticks and stones and words hurt..the same part of the brain.. Emotional pain triggers the same part of brain that does physical pain. For kids, this can mean bullying, being ostracized, marginalized, excluded, embarrassed

14 Focus on strengths and build a connective bridge through empathy, listening....because beneath all the hurt, people want to survive and thrive..

15 for Angie

16 And for fierce Jacory..

17 What it takes well, at least some of it..

18 Beginning a Program- First steps Understand your community- who are your stakeholders? Families! Mission Statement Your Intent for your community Staff- Train them..but more importantly.. Someone s gotta be in charge. Establish Expectations, expected program outcomes- Key

19 Once you re set up, then it s onto.. The Ground-Beyond CBT/TIC - The X-factor in Crisis intervention.the FBI s secret weapon and the X-factors: Empathy Banter Under react to everything Act as if.. Be in the No contempt Zone This will lead to crucial = Engagement!

20 Empathy swagger- Do you have it? Crush the 15 feet and be an Emotional Badass.. Just like in the story of Albert..

21 So, you want to do crisis intervention... Got what it takes? What HR says: Works with diverse populations Available flexible hours Explains ideas clearly Knowledge of community resources Knows Emergency laws Effective interpersonal relationships Knows steps of de-escalation Who you want: Calm in a crisis Non-judgmental Persistent-no give-up Hopeful Strengths and solutions Big Picture Outside of self Tolerant Exudes hope Low-reactive (Kagan, 1998)

22 Because Crisis work is especially hard on staff

23 Therapy, mobile or not, is 2 people in a relationship, one of whom is more anxious and emotional than the other If you re the therapist, try to ensure that the you re the less emotional one. This just works better. (Side note- everyone thinks they re a good listener, but few are.are you???)

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25 But guess what. Despite the rigorous, bracing challenges, the adverse impact on staff and other demands, the customer is STILL always right

26 And now a few words about one of the central reasons we do mobile response: Hospitalization? All Statutes and Medical Necessity Protocols have been written poorly so far. They all ask the wrong questions and focus on the wrong things. Almost invariably simply set standards for admission/detention. The key question is not about dangerousness, it s :Knowing the risks, what would it take to keep this child safe in the community tonite/tomorrow?

27 Because: It s about needs and safety planning, NOT about meeting criteria. Don t make it about whether someone does or doesn t meet criteria : Puts focus, and the question on how spectacular, serious, significant the recent or past behavior was. Encourages escalation to convince that youth has done enough to justify hospital Do make it about safety and needs: This discussion acknowledges risk behavior, but centers on reducing risk through strategies and a plan. Can we keep this person, and others, safe, with this plan? Critical question is what would it take to safely get this person through the next hours, day?

28 What are the next evolutionary steps? Yale Child Studies IT Post Traumatic Growth (PTG)

29 Families First Yale Child Studies Center Model- Law enforcement and mental health collaborate in response to community trauma involving kids. Emphasis is on training parents, caregivers as first responders in trauma, to lower risk of PTSD ==== Law enforcement + mental health + families = lower rates of PTSD

30 The rise of tech Old School v. New School: The impact of technology and social media. Respect the past

31 But embrace the future Teens more likely to turn to social media, texting for support than to call a help or hotline. Phones, texts set off powerfully addictive responses in the brain. Texting is private, and many kids find it easier to disclose They look like they re just doing something normalimportant to teens Eg., National Dating Abuse Hotline; National Human Sex Trafficking Center- often accessed by text (We ll cover this in more detail in Breakouts! WITH VIDEO)

32 The New Science of Post Traumatic Growth Mild to Moderate Stress: Stanford U U of Buffalo Just like exercise, everyday stress, when manageable, is good for growth- But even severe stress can lead to growth: Harvard, Hurricane Katrina and variants in the RGS2 gene. Sandra Lowe, Montclair St- importance of optimism and future orientation. Upside- Jim Rendon Only a small % get PTSD- The 6 Essentials: Your narrative makes/breaks Community/support vital Express yourself- communication of all types Transformative power of Optimism Faith can enhance growth Creativity spurs change- Open up to new experiences

33 Because all is not lost, even in trauma..

34 So, a couple of key things to keep in mind.. Growth from trauma.. Families are key

35 Let me leave you with this Katiana, the South Bronx and tiny, significant things.. Helen Keller... do a small thing nobly