Friday, August 31, 2012

Urban Youth Need Adult Eyeballs On Them


"Parental monitoring is associated with improved behavior – A growing literature has documented the relationship between parental monitoring and adolescent risk behavior.   
Steinberg et al. argued that high parental monitoring can insulate youth from a host of misbehaviors and that monitoring is a skill that can be strengthened through parent training programs and interventions.
Furthermore, efforts by parents to actively monitor their youth may serve multiple preventive functions: increase the likelihood of parental knowledge of youth activities and peer relationships, encourage parent-youth negotiations as to rules for social behavior (i.e., agreement as to curfews and safe places), and enable early detection of youth psychosocial distress."

In urban communities, youth need more eyeballin' by parents - that is, adequate supervision.  Parents need to know where they are, what they are doing and with whom.

We all had secret lives as teens.  But a super secret life for an urban teen is very risky.  If you are a middle class kid then you may be able to get away with highly rebellious behavior and then go straight when you tire and are done with la vida loca.  But if you are an urban teen, then you may or may not have the luxury of a second chance.

Urban parents may need to walk their kids to and from school until they graduate from high school. Immigrant families sometimes double and triple up in a single family home.  What this means economically and socially is that there is usually a parent per family that can watch the kids at all hours of the day.  This is protective.  This is an economic sacrifice for a good purpose.  Time available to supervise children - priceless.

The Parent-Child Open Communication Dilemma

"Overall, parents of African-American youth residing in urban public housing developments tended to underestimate the extent to which their children were exposed to acts of violence and suffered from distress symptomatology.  This was seen for acts of direct victimization (i.e., attacked with a knife), as well as events youth witnessed.  Most striking was the tendency for parents to underestimate youth distress.  Rather than being a new finding, this proclivity for parents to underreport symptoms their children experience is a replication of findings derived from studies of childhood psychiatric disorders.  Multiple explanatory models have been posited to account for this effect, including parental denial or minimalization of symptoms, or particularly with older youth, children's increasing concealment of distress."
O'Donnell, D.A., Schwab-Stone, M.E., & Muyeed, A.Z. (2002).  Multidimensional Resilience in Urban Children Exposed to Community Violence, Child Development, 73(4), 1265-1282.

Parents don't know.

Kids don't tell them.

Parents have a hard time hearing it - it is painful to know your child is suffering and you don't know what to say or do.

It is hard to see your parent suffer when you tell them what you've seen or experienced.  It doesn't help when parents get mad and lecture you about what happened (because they are scared).  Next time, you just skip telling them.

It's sad and painful for everyone to talk about it.  Even if talking about it and listening (really listening with your head and heart) is exactly what will help.

Wednesday, August 29, 2012

Psycho-education for the People

Are social workers just as scared about change as clients?

Are social workers professional co-dependents? That is, are we driven to fix, rescue, and help?  Or do we endeavor to truly empower - help the client figure it out?

It would be so much easier if we did it for them.  It would be way more efficient.  We would feel pride of accomplishment.  But then where would the client be?  Where is their pride of accomplishment?  And what happens the next time they gotta do it and we're not around?

When the literature is teeming with evidence about what works, what helps, what makes a difference for whom - what makes social workers hesitant to adopt these practices?

There is a lot of money being spent to determine the best way to implement and disseminate evidence based practices. That is, to sell what works to practitioners.

I am not as passionate about this as I used to be.  Now I just wanna take the evidence straight to the people who need it most.

I envision developing social marketing campaigns as a form of mental health treatment.  If social marketing can be used to change health behavior - that is, behavior that promotes health and well-being or prevents disease - then it can probably be used to promote mental health behaviors that are protective (for example, family communication about traumatic events).

That's my hypothesis anyway.  I am banking my research agenda on it.

Avoidant Coping

"Two important moderating effects of coping were found. Our findings indicated that there was a strong positive relationship between violence and PTSD re-experiencing symptoms in children who use cognitive distraction coping strategies more often, but that there was no relationship for children who use cognitive distraction less often."
The following statement is an example of cognitive distraction:  
When I feel (mad, sad, anxious), I try to see the good side of things in general.

Too much cognitive distraction as a way to cope with violence exposure leads to PTSD re-experiencing symptoms (flashbacks, intrusive thoughts, etc.).

A little cognitive distraction isn't so bad.

DEMPSEY, M., OVERSTREET, S., & MOELY, B. (2000). "Approach" and "Avoidance" Coping and PTSD Symptoms in Inner-City Youth, Current Psychology: Developmental  Learning Personality Social, 19(1), 28-45. 

Detachment & Dancing

I met a male prostitute recently. 

He said he worked very hard in a very rich part of Los Angeles to support himself and his child. 

I asked him when he started and he said, "13." 

I asked him how he protected himself emotionally, mentally, physically. 

He said, "I don't care.  The less I care the more I get what I want.  The more I care the less I get what I want."

I asked him what he wanted.  "Happiness," he replied.

I said this sounded a lot like the concept of detachment from the Buddhist tradition - that is, not striving and detached from the outcomes of things. 

It also sounds like hardball negotiation - willing to walk away from the negotiation table in order to secure the best terms. 

It sounds like action and reaction, push and pull - the more you pull, the more they push. 

It's like the dance of intimacy - from suffocation to distancing - the closer you get the farther they run - the further you run the closer they get.

What if we stood still?  What if we laid ourselves bare?  What if we were strong and confident enough to be vulnerable, honest and loving?  If we were rejected, what if we tolerated the pain until it passed.  Nothing lasts forever.  What if we let them go in peace?  What if it gave us joy to see them happy, even if it meant they were happy without us?

Imagine.

Tuesday, August 28, 2012

My Mentor & Friend

It makes me happy just thinking about Paris :)
 "Chicano artist Roberto Gutierrez is one of the most important artists to come out of the East Los Angeles artistic boom of the early 1970s.  However, he has been largely ignored." --Jose Orozco

Attention must be paid!

Come see for yourself.

Monday, August 27, 2012

My Venn Diagram


At a dissertation proposal boot camp last summer, the instructor suggested I divide the topics I am trying to cover in my literature review into 3 or 4 broad categories.  

The areas that are shaded by the overlapping circles are relevant literature.  The intersection of all three circles is very relevant literature.  This helps in deciding what to put in, what to leave out and what to emphasize in the literature review section of my proposal.

Next, I will place each source in my annotated bibliography into the appropriate circle.  If the article/book covers more than one of my broad topics, then I will place it in the space that represents the intersection of the relevant circles.

I have not completed my annotated bibliography (unless I consider that is what this blog is for me) so I pile sorted all the articles I have read or accumulated for my proposal.  They are sitting on my dining room table.  I'd include a picture but I'm having problems with the cloud email on my phone.  I'm going back to the AT&T store for trouble shooting - that is, it's on my list of things to do.

The Venn diagram is supposed to help me spot imbalances.  Have I done a lot of research on one aspect of the literature, but neglected another?  This may tell me what to focus my research time on.

"An effective literature review focuses on the details of and relationships between the most relevant sources."  (Social Sciences Dissertation Proposal Handbook, UCLA, 2009)

Conceptualizing the Statement of Problem

What is the problem?
  • Overwhelming incidence of untreated PTSD among low-income urban youth and families resulting in lots of negative consequences - emotional, social, behavioral, cognitive, academic, physical, economic, safety and generational.

Why is it a problem?
  • Multiple and chronic trauma exposure common in urban communities
  • Limited access and underutilization of intensive and selected interventions, particularly evidence based interventions and mind-body-spirit approaches

Why is it important to study?  Gaps in the research?
  • Variability in PTSD development has been largely explained in terms of individual risk and protective factors and less so in terms of family and cultural risk and protective factors
  • Explaining PTSD development primarily in terms of individual-level risk and protective factors limits treatment to individual-level approaches - which are more expensive and may not be culturally acceptable to urban families

Working Titles

"And the first step is to imagine your dissertation...Imagining your dissertation allows you to develop passion, curiosity, and questions about your topic, as well as to think of yourself as someone who can make a commitment to scholarship." --Joan Bolker
Taking the first step can start with a title.  Here goes my brainstorming...
Families Can Talk About It:  The relationship between posttraumatic resilience and family communication

Telling Our Stories:  Posttraumatic resilience and parent-child communication among low-income urban families
Love, Stories and Resilience:  The relationship between posttraumatic resilience and family communication

Talking About It

"Sometimes, I don't want to think about it (her miscarriage) but talking about my pain helps me to get through it." 
"Separation was a good thing for both of us because it helped us realize we still have feelings for each other.  We are more open with each other about our feelings.  In the past, we both felt we did not communicate about things that were bothering us.  This time around, we decided to talk more.  Things are working out better.  I feel better about the relationship."

Thursday, August 23, 2012

Carrot vs. Stick, contd.

First, you need to know the difference between negative and positive reinforcement.

It's possible to train ourselves to do things by punishing ourselves each time we do something wrong, but this method is both inefficient and inhumane.

Positive reinforcement, rewarding ourselves each step of the way as we accomplish a series of small goals on the way to achieving the large one (called "shaping"), is both more pleasant and much more effective.

If you've tried, God forbid, to train a puppy by beating it, you'll know that you can end up with a docile dog, but not one with any spirit or joy  Puppies who are trained with praise and treats grow into lively, obedient dogs.

Joan Bolker

The Politics of Relationships

One of the hardest lessons to learn is that no one can "make you" feel bad about yourself:  you have a choice about whether to take other people's disparagement to heart.

Having said this, I also acknowledge that it is terribly demoralizing to have an advisor who runs you down.

If you feel up to it (and this is a very delicate judgment call) you might decide to take your advisor on.

Joan Bolker

Transformation by Research

...think of research as active inquiry into a subject in order to work on it using the singular quality of your own intelligence...

...research is not merely a matter of accumulating data that you then swallow; that is a relatively passive occupation.

Research requires that your mind engage with the material, ask it questions, and act upon it in such a way as to change the material - and, incidentally, yourself.

Joan Bolker

My Main Squeeze

Writing a dissertation is very much like being in a long-term relationship:  there are likely to be some very good times and some perfectly dreadful ones, and it's a big help if you like what you've chosen.

This particular relationship asks you to give up a lot of other pieces of your life, to work like a dog, and to postpone gratification.

Joan Bolker

Bliss

If you enjoy research and writing, some of the greatest gifts life can offer you are time, space, and a good rationalization for devoting yourself to a project that truly interests you.

Joan Bolker

Carrot vs. Stick

Negative reinforcement is not very useful for encouraging behavior; positive reinforcement works much better.

One of the most common mistakes struggling writers make is self-flagellation; it impedes their progress - substitute the carrot for the stick.

Joan Bolker

Write On!

"...use writing to think, to explore, to blunder, to question yourself, to express frustration, to question further, to get to what feels like the truth of your subject.  And to celebrate."
Joan Bolker

Wednesday, August 22, 2012

Reevah on Parent-Child Dynamics


Kids see the world the way their parents do.

If children are suicidal, parents may be depressed.

If parents don’t change, children are not likely to change.

Parents treat their own children as they wish they would have been treated as children thereby recreating abusive relationships - making children abusive to parents.  In order to avoid being the victimizer, parents are willing to be the victim (of their own children) - from one extreme to another.  

Parents were good kids and wanted to please their parents.  Now, as parents, they want to please their kids and their kids become abusive towards them as parents.

What is the goal of a parent -- to have their child love them or to raise their child to be a productive adult in the world?

Parents sometimes avoid making children do what they don't wanna do or not let them do what they wanna do for fear that the children won't love them.  Sadly, this is mixed up logic.  I have heard way too many teens say that their parents let them get away with too much.  Feeling like your parents are in charge and making appropriate rules for your safety and well-being feels loving, even if it makes you mad temporarily.

More Reevah-isms


When a mother doesn’t own her own aggression, it is because she is afraid of her anger – she is afraid of becoming out of control as a result of her anger.  This out-of-control expression of anger was probably modeled in her family of origin.  She decided to go the other way - way over to the opposite side.

Parents are afraid of their own anger or their child’s anger or their spouse’s anger because anger means being or becoming out of control.

Anger is a healthy and important expression when communicated properly.  Think about how you feel when someone you care about is angry at you.  It is unpleasant enough to motivate us to change.  If someone you care about hurts you, it is okay to be angry - the feeling is not the behavior.  How you choose to express the feeling in words is your choice.  It does not have to be out of control and scary or hurtful. 

Debt is a Feminist Issue

When I was in college, fat became a feminist issue.  Women were targeted, judged and stigmatized in all areas of life based on size.

Debt is a feminist issue, too.

When I tell people that I am a feminist, some want to know more.  Simply put, I believe we have the right to make choices in our lives and deal with the consequences.  I have the right to be single or married.  I have the right to loooove hot pink and be a bada$$.  I have the right to be as smart as I can be and being smart is sexy.  I have the right to go back to work after having my baby, stay home or work part-time.  I can choose to work while my husband stays home to care for our baby.  I chose to try all of the above.  I was able to choose because of my economic independence.

It used to be that women's primary vocational options were marriage or nunnery.  I would have chosen the latter, probably.  When I teach a Women's Issues in Social Work course, I often talk about the importance of educational attainment for women.  We can no longer (if we ever really could) depend on a significant other to care for us financially.  Our partner may lose their job, leave us or die.  Then what will we do? 

Women no longer need to marry for financial security.  That is not to say that you cannot or should not choose to do so.  No judgments.  Just make sure you have a Plan B (marketable skills, hefty life insurance, etc.)

That is not to say that women shouldn't marry.  Women can do whatever they please and deal with the consequences of their choices.

Debt locks us in like indentured servitude - and limits our ability to make choicesI can't leave because I have no where to go.  I can't leave because I can't pay the rent/mortgage on my own.  I can't leave because I can't afford the car payment. 

Sticking to jobs or partners that make us profoundly unhappy (despite our best efforts to work it out)because we can't afford to leave means that somewhere along the way we bought something that we could not afford and now we are paying for it with our lives.

Marketing in our capitalist society is ruthless and sophisticated.  The priority is the bottom line, not your life.  Buy the designer X, Y, Z, go on the X, Y, Z vacation, buy the most expensive house or car you can afford if you choose, but ask yourself - why am I choosing to do this?

What do you value more dearly - stuff or your life?

Writing to Learn

"To do research is to inquire, to dig one's way into a problem, and writing is one of the best tools available for such work."

Joan Bolker
Writing Your Dissertation in Fifteen Minutes a Day

Tuesday, August 21, 2012

Integrating

The construction of a coherent story
together with the expression of negative emotions
work together in therapeutic writing.

"It made me realize who I was."

"It felt good to purge my emotions."

The body expresses itself linguistically and biologically at the same time.

Pennebaker, 1993

Tell the Story

In the short run,
confronting upsetting experiences may be psychologically painful and physiologically arousing.
In the long run, however,
the act of psychologically confronting emotionally upsetting events is associated with improved physical and psychological health.
Pennebaker, 1993

Write to Heal


Tell It Like It Really Is


Ima Dork & I like It

Socially, I'm awkward.

This means I don't understand people's behaviors sometimes - they are profoundly mysterious to me. It's probably the reason I have spent so much of my adult life reading and studying human behavior with my left brain.

I understand the world of ideas and concepts much better.

Emotions are irrational, by definition - although they make their own sense.

I can take relationships very seriously - this makes me a bit of a dork.  I don't like blowing people off (anymore).  I used to be the biggest flake! - avoiding social interactions if I was depressed.

Now I pay attention to the process and content of conversations.  Now I want closure in quotidian interactions.  It's not a rule-based system - so it's not about being rigid.  It's about being loving to self and others:  What is the most loving way to turn down a first, second or third date? What is the most respectful way to address an employee regarding complaints received about their work?

Now that I'm balancing Love, Work & Play (the definition of good mental health), I am focusing energy (previously spent entirely on work) on my relationships.  Only, because I'm kinda new at it, it comes off as a bit formal - like the courtesies usually only extended in professional networking.  That's okay.  Niceties in any relationship aren't so bad.

Everyone describes dating as a game - for both men and women.  But our reality is socially constructed.  It is a game only if we all agree that it is.  What if we disagree?  What if we are committed to honesty, transparency and full disclosure in all our communications - even if it doesn't appear - initially and superficially - to be to our advantage?  In the long run, the deep trust and mutual understanding engendered from all this open communication may in fact prove to be more satisfying than any short-term gains of saying less to come off as cool:

"I really wanna see you this Saturday but ....(insert details that make you seem less cool/attractive)" vs. "I'm busy."

See, I told you Ima dork.  I have to admit, I like it.

Light and Shadow

Love is a gift from God.  It is God's joy to love us.  I accept all the love joyfully and gratefully.

(Shame is a lie of the devil.)

Some men are inclined to perform a sexual act referred to as bukaki.  A quick and dirty google search spells out the historical origins of this word:
In feudal Japan, many moons ago. If a japanese wife was unfaithful to her husband and this was discovered, she would be tied to a post in the centre of the village and all the local men would masturbate over the woman. This was the accepted punishment for infidelity.
I suspect this practice is seeping into the mainstream due to its popularity in porn.  Even disconnected to the origins of this behavior, the intention to shame and humiliate cums through.

What does this tell us about men and women?  
What is the origin of all this shame?  
How do we free ourselves from this self-imposed prison of shame?
Do women who have sex with men other than their husbands deserve to be shamed?  
What is the rationale behind this ancient idea?  

When a wife has sex with a man other than her husband, she incurs his wrath.  This may not be because he loves her and is hurt, but because he is humiliated among the other men.  Therefore, his response is to humiliate her - due to his selfish arrogance with deep underlying insecurities (for very good reasons, I'm sure).  He conscripts the other men to aid in the humiliation.  Vengeance.  An eye for an eye until we are all blind.

When you love someone - you want the best for them, you want them to be happy.

When you love yourself - you are hurt but forgiving of self and others.

I had a professor in undergrad who did his dissertation on family life in the Old Testament.  Apparently, it was only illegal for a woman to have sex with a man other than her husband but not for a man to have sex with a woman other than his wife.  The "practical" reason for this was that a man's wife was considered chattel (property).  Stealing a man's property - cattle, wife, etc. - was punishable by death.

Values and beliefs die hard.  So are women still viewed and therefore treated as property?

It is commonly known that many of the women in porn have abuse histories and therefore vulnerable to repeat exploitation.  Being subject to abuse makes us think there is something wrong with us (shame) and therefore deserving of being treated shamefully (vulnerable).

We all matter.  We all deserve to be seen, understood, loved and cherished.  This is our birthright, whether or not it was acknowledged by the adults in charge around us at the time.

Commuter Thoughts

When someone tries to hurt you,

it's not about you.

You don't deserve it.

It's about them.

It's about what they think about themselves, others and the world - it's skewed - and there must be a good reason why it's skewed.

When you are full - of love, joy and peace - then you are grateful for grace, understand others and forgive.

I used to wonder and question - What did I do wrong?  What's wrong with me?

Peace is knowing I'm all kinds of wrong and all kinds of right.  My intimates - and I - love and accept me anyway.

If we did not come to this world to love, then what exactly are we doing here?  No matter what happens, I choose to love.

Wednesday, August 15, 2012

Reevah-isms

I had a fabulous clinical supervisor, Reevah Simon.  She taught me so much - it saved my personal and professional behind.  Her words ring in my mind like mantras.  I will share some (paraphrased)...
We feel ambivalent about everything (including our parents). There are always two sides. If we don’t own both sides, then one side is underground.  Acknowledge all thoughts and feelings and strive for integration.

Ongoing conflict implies underlying agreement.  The only reason we put up with disrespectful treatment from another is that there is a part of us that believes we deserve it.  Otherwise, we'd kick 'em to the curb.  There is no fight if one of us refuses to participate. Word.

Positive Expectations

I have a friend I'll call Holly.  She sees the best in people and consequently the best in people shows up.  I've seen her bring out the best in people for whom the best is rarely seen.  It's like magic.

If you are rolling your eyes before you even talk to that person, then you are dead in the water.

Dr. Walter Brackelmanns says that we are supposed to see and treat others as if they are competent and mentally well, even if they are not.  Our beliefs, expectations and assumptions matter and muddy the interaction.  Consciously or unconsciously, the other person "knows" what you are thinking and feeling.  Even if you smile, your assumptions will seep or shine through in the conversation.

Whatever we focus on grows.  Whatever we believe, happens.  Thoughts become things.

Feel free to experiment with this concept if you are feeling cynical (no wonder the worst in others comes through).  ;D

Endeavor to find the best in someone (it's there, guaranteed) even if you have to become a super sleuth detective to find it.  Watch what happens - it's like magic.

Albatross

The word 'albatross' is sometimes used metaphorically to mean a psychological burden that feels like a curse.  
It is an allusion to Samuel Taylor Coleridge's poem The Rime of the Ancient Mariner (1798).  In the poem, an albatross starts to follow a ship — being followed by an albatross was generally considered an omen of good luck. However, the titular mariner shoots the albatross with a crossbow, which is regarded as an act that will curse the ship (which indeed suffers terrible mishaps). To punish him, his companions induce him to wear the dead albatross around his neck indefinitely (until they all die from the curse, as it happens). 
Thus the albatross can be both an omen of good or bad luck, as well as a metaphor for a burden to be carried (as penance).
--From Wikipedia 
I am letting go of my albatross.  We carry baggage as self-punishment when self-forgiveness can set us free.  Because of the law of cause and effect, there are consequences to our behavior.  But an albatross is a burden that we choose to carry long after the cause-effect cycle.  We carry the burden because we feel ashamed and feel an urge to do penance.  Love is the antidote to shame. Making amends and forgiveness of self/others is the antidote to guilt.

Sometimes we hold onto a job or a friendship/relationship or personal rule as penance for something we feel guilty about.  Tina Turner said she wouldn't leave Ike because she knew what it felt like to be abandoned and she didn't want to put him through that again.  Some women don't leave their husbands because of the children. 

Doing penance for others is not noble.  Loving self is noble not narcissism.  Ultimately, truly loving yourself is good for others.  I love being around people who are whole, happy, and filled with self-love and self-acceptance.  I expand and relax into myself in their presence. 

In recovery, an albatross is replaced with an affirmation.

I am loved.  I matter.  I make mistakes.  I get to be myself.  I can be happy.  I have a right to make my own choices and deal with the consequences of those choices.  I can take the opinions of those I care about and respect under advisement, however no one but me has a vote in my life choices.  I deserve to be loved, respected, understood, cherished, happy and free.

Monday, August 13, 2012

August 12

Nine years ago, on August 12, my mother, Irene Acuña, was diagnosed with lymphoma.  She died four months later.  This has been the singular most painful loss of my life.

Four years ago, on August 12, I met with the Director of the Doctoral Program at UCLA, Stuart Kirk.  This auspicious meeting set in motion a complete transformation of my life.  He helped me take the next baby step in my application to the doctoral program and now, even in his retirement, he is my adviser and will be my dissertation defense committee chair.

Anniversaries can be bittersweet.  They are reminders of the good and the bad of our past.  They trigger positive and painful memories.  It helps to be gentle and kind to self and others always, but especially around anniversary dates when our thoughts, feelings and memories can go back to a time when we felt more vulnerable.  Remembering and talking about the good and the not-so-good is important in digesting and integrating all memories.  The good and the bad live side by side.  Focusing on the good is healing.  Ignoring the bad is not.  Optimism is helpful unless we dismiss the obvious red fluorescent flags.  Being whole and mature means we can stand to see it all, just as it is - isn't that the most horrible, wonderful and beautiful thing?

What are your significant anniversary dates?  How do you celebrate?  How do you grieve?

Thursday, August 2, 2012

Population Health


"It may be useful to take a step back and consider the factors contributing to illness. It’s important to realize that things like education, the environment, and wealth (and how it’s distributed) play an enormous role in health outcomes, too.

In this lesson, we’ll learn that to make progress combating many of the most important threats to human health, it’s not enough to improve clinical care for one patient at a time. We also have to focus on improving the health of entire populations."

From Institute for Healthcare Improvement, PH 101: Introduction to Population Health (online course)
Join the IHI.org community now! Registration with the site is free and open to all.


I love that social work pioneers, like Jane Adams, have been saying this for a very long time.

With the proliferation of positive psychology and a focus on strengths (another social work hallmark) in the historically male-dominated field of psychology and now a focus on population health in medicine - specifically taking into account person-in-environment factors - well it looks like the social work perspective is finally being integrated by powerful men.

My question is, will the profession receive/take credit?

It's time that we take pride in our models, approaches, theories and assumptions, test them rigorously and then broadcast them to the world.  It serves no one to sit quietly in the shadows waiting for more confident and powerful others to discover the missing pieces we have seen all along.

Wednesday, August 1, 2012

Clinician Attitudes Toward EBPs Matter

Provider Attitudes Towards Evidence-Based Practices:  Are the concerns with evidence or with the manuals?
Borntrager, CF, Chorpita, BF, Higa-McMillan, CK, Weisz, JR
Mental Health Services Research, 60, 677-681

Researchers found...
...If therapists like it better, they will be more engaged.

...If therapists like it better, they will use it when the study is over.

Evidence-Based Practice

How do we know what to try?  Review the literature about the presenting problem and population.

How do we know how to do it?  Participate in training, clinical supervision and practice.

How do we know if it is working?  Monitor progress, track and log changes and evaluate outcomes.

How do we know what to say when?  "Wisdom is knowing when to apply our knowledge and when not to (Speigler, 2000)."

Treating Anxiety in Children & Adolescents

What are the Top 5 Practice Elements in treating Anxiety?

1.  Exposure
2.  Relaxation
3.  Cognitive
4.  Modeling
5.  Psycho-education

from Bruce Chorpita, Grand Rounds, UCLA

Practice Elements

What do the best treatments in Parent Training have in common?

Incredible Years:
  • Commands
  • Time out
  • Rewards
PCIT (Parent-Child Interaction Therapy):
  • Commands
Defiant Children:
  • Commands
  • Time out

From Bruce Chorpita, Grand Rounds, UCLA

Clearly, most intervention researchers agree that "Commands" is an essential practice element when training parents.

This may seem obvious but asserting demands or making commands is not always easy for parents to do.

We don't want our kids to hate us for telling them what to do or what not to do.  But if we don't, then who will?  My clinical supervisor, Reevah Simon, used to say, "the police will do it but they won't do it with love."

Either you, as a parent, give in or your child gives in - how does it happen that you give in first?  You must feel you have a very good reason for giving in?

Is there a part of you that wants to be firm and is there a part of you that is scared to be the parent in charge?  Do you think your kids will not love you if you make them angry by telling them what to do/not to do?  What would the firm, fair and caring parent do?

Children's Mental Health

There are 333 evidence-based protocols (treatment manuals)

There are 254 randomized trials (the gold standard in intervention research)

The most common approach (22%) used is CBT (Cognitive Behavioral Therapy).

The most common procedures are:
(1) Cognitive (39%)
(2) Problem Solving (35%)
(3) Modeling (34%)

Notes from Bruce Chorpita, Grand Rounds, UCLA

Transitions & Growth

Why is change so scary and hard for us?

There must be a built-in instinct to avoid change because the new and unknown is a crap shoot.  We feel vulnerable, freshman-like and uncertain.  It's hard to be a beginner unless we let go of our illusory control and instead, trust that everything tends to work out and that we will figure it out, with enough resources and social support.

My girl has always cried at the beginning of a new school year, on the first day of summer camp, on the first day of art class...well, you get the idea.

Now she is transitioning to middle school and even I'm a little scared!  The dreaded middle years of childhood.  I won't even work at a middle school as a social worker.  I remember saying that these were the years that I would consider home schooling her.

We found a wonderful arts and technology magnet school in our public school district.  They have student poetry slams and student film festivals. During a tour last Spring, my girl remarked, "this is my school."

She is not crying but she has the jitters and lots of important questions:

  • will there be school dances?  what do the girls wear - dresses or jeans?
  • what if the older kids bully me?
  • will I make friends?
  • will the other kids like me?
  • if I break a uniform policy rule, will the Principal announce it on the PA system?
  • what if I can't remember my locker combination?  what if I don't turn it the right way?
  • what does the school do for Christmas? for Halloween?

Sometimes mama's words ring hollow because she expects me to say loving and supportive things.  That is something she now takes for granted.  So I enlisted family and friends to share their own advice, support and stories about middle school.  These are some of the texts she has received so far:

Paoli!! Ur gonna love middle school!! Yes it will be a little nerve racking at first, but that feeling will pass just as it has every time you've done something new. And believe me, the other kids will be nervous too, so u will not be alone. You are smart, have a great personality, and a great sense of style!...The kids are gonna love you! Hugs Paoli!  
Hi ale, would you tell paoli that since I worked at a middle school up here, I realized middle school is pretty much the same everywhere. The scared feelings are very normal and all the students have them. Some kids just hide it better. Just remember that you are loved very much by your family n friends. Watch Michael Phelps win his next swim medal too!  
Paolina, jitters? That sounds so familiar! The night before my first day of middle school I was super nervous about everything. What would I wear? Where would I sit? Who would I know in my classes? When I got there, the school felt huge! I felt like a tiny kite in a big, big sky! When the bell rang for lunch on that first day I was too shy and too scared to ask where I was supposed to go. Can you believe it? So my soggy sandwich and I found a spot to eat away from everything. I reached in my brown paper bag and found a note scribbled from my momma. All it said was "I love you." and then I knew that even though I felt sooo lonely in that moment, I would never be alone because my mama loved me. I hope this story of my soggy, lonely sandwich helped! (and the lesson would be to ask where the lunch area is - haha) I really wish you the best first day and first middle school lunch! P.S. Your mama loves you!
Hey, Paoli, it's Sarah :) So I hear you are worried about middle school?  Why?! Middle school is where I met my best friends and we are still friends today! and I'm about to be 21 :o) haha
There's always sunlight when we walk in God's hands and path.  Despite the clouds coming in, the light guides us even in the darkness.  U will be ok and so will your doll.  I love you both, hermana. 
I am soo grateful for friends, family and their stories, love and support. I don't know where I'd be without them.  I shudder to think.  May your circle of support grow stronger too.