Nutrition

I have to pat myself on the back a little bit. Since I've been working at my facility, I've been talking to the director about the correlation of nutrition and behavior. They're finally re-evaluating some of the nutrition and wellness issues. They're re-evaluating the contents of the vending machine and are pricing out more healthy options. The cafeteria is going to start sending veggies to the units for clients to snack on. We already get fresh fruit. It's a small start, but it's being talked about, and I'm thrilled!

I'm old!

Ugh... I took a 15 year old client to the hospital the other night for vomiting blood, and all the nurses (and even the doc) kept assuming that I was her mother. I would have been 12 when she was born....

Do I really look that old?!

Gang Activity

I learned about a new (new to me) gang tonight at work. After searching the client's school folders, I was showing a co-worker

this sexually inappropriate, slightly creepy drawing I confiscated from one of the folders. She immediately expressed concern that it was gang related... The Juggalos (or Juggalette feminine). Huh... never heard of it.

The Jugglos were initially started at an ICP concert when one of the musicians referred to the crowd as Juggalos... and it stuck. There have been violent acts ranging from homicide to arson

associated with the Juggalos, and due to this activity they have been classified as a gang in Utah, Pennsylvania, Arizona, and California. Though "studies have shown" that the violence has no relation to ICP's music, this is why ICP paraphernalia is not allowed in schools... I always wondered that.

Additionally my co-worker filled me in that Juggalo's "worship" the hatchet man, and carry hatchets as their preferred weapons (rather than guns). They consider themselves to be societal outcasts, and to be a family. Several of them will paint their faces like ICP.

Therapy Dog

I had a meeting today with my potential new boss, who is the therapist that runs the Canine Healers at Excelsior. In addition to Interviewing for the open position for Group Living Counselor in Edge Point, I expressed my interest in animal assisted therapy, and my desire to 1. Train Amos to be a therapy dog, and 2. to specialize in animal assisted therapy. She told me to look at TDI (Therapy Dogs International), or Delta, which are the two most recognized certifications for therapy dogs.

I was looking at the behavior requirements for TDI, and I'm feeling a little bit discouraged that Amos will be able to become a therapy dog. There are several things he can do, but several he just can't.

1. Greeting people and sitting politely for petting. Amos is just too exuberant, and happy to see everybody. I've worked with him with this...
2. The dog will welcome being groomed and examined and will permit a stranger such as a vet, groomer or friend of the owner to do so. Yeah right... ain't gonna happen. Amos is TERRIFIED of being groomed, and totally flips his shit every time he sees the brush, unless I have him in a small enclosed room (such as the bathroom), and am giving him treats every 30 seconds and am speaking sweetly to him... and even then its a bit of a struggle.
3. Coming when called.... needs some work. He's just inconsistent, which I know is my fault, as I'm inconsistent as well.

These are the one's that I'm worried about. I keep telling myself manners can be learned.... It just might be a bit of a process.... Le sigh.

Group Ideas

Part of my quarterly goal is to start to plan and facilitate groups for my clients. (This will become easier if I get the position I just expressed interest in in ONE unit). I already have several ideas.

Nutrition Group

This idea is still in rudimentary form...

I want to make a handout with nutrition information

Carbohydrates - The difference between good and bad carbs. Whole grain foods are rich in vitamins, minerals, fiber, and phytochemicals. When grains are refined the bran and germ portions are remove, and the endosperm is all that remains. 25-90% of the nutrients are removed!

What are whole grain foods? Brown and wild rice, popcorn, corn, whole wheat, oatmeal etc.

Aim for 3 grains and starches a day!

Proteins - Build, repair, and maintain all of your body tissues. If you don't eat enough carbs, proteins are broken down to use for energy. When this happens, protein is unavailable to maintain muscle, and you lose musce mass. Protein makes a meal feel more satisfying and sits in your stomach longer. It gives us an energy boost, and slightly elevates the metabolic rate.

Sources of proteins include: meat, chicken, fish, eggs, nuts and beans.

Fats - Not all fats are bad! Monounsataurated fats, Polyunsaturated fats, Omega-3's, and Trans fats. Talk about what cholesterol is, and which fats you should chose to maintain cholesterol.

Fruits and Veggies - Still working on this one

Aim for 3 veggies and 3 fruits a day!

Dairy (or dairy substitute)

Calcium and Vitamin D - Vital for bone growth and maintenance .

2-3 Servings a day

The Nutrition/Mood connection - Multiple studies have shown that a balanced died has a direct effect on mood and psychological function. A diet rich in fruits and vegetables, nuts, whole grains, and lean proteins will provide your body the nutrients it needs to function properly, and ultimately make you a happier person!

I then want to have some sort of activity. Right now my idea is to bring in paper plates (that you can draw on), and markers, and have each of the clients draw out a balanced meal that they would enjoy eating.

Some fun facts about suicide

Yesterday, I had to attend a Depression and Suicide prevention inservice for work... some parts of my job can be so incredibly uplifting. There were several interesting facts I learned that I had previously not known.

• More Americans die by suicide than by homicide.
• 93% of all suicides are completed by persons with an Axis I diagnosis
• Suicide is the leading cause of death for persons with Bipolar Disorder
• 15% of persons with Major Depressive Disorder will take their own lives, at a cost of $8 billion dollars to the U.S. economy per year.
• 15% of persons with Schizophrenia die by suicide
• 5-7% of persons with Borderline Personality Disorder die by suicide
• 50% of completed suicides met with a mental health provider at some time in their life
• 17% will be in treatment with a mental health provider at the time of their suicide
• Limitations on inpatient services, shortened lengths-of-stay and premature discharge have shifted the risk of suicide malpractice to outpatient providers
• Graduate schools preparing practitioners for the mental health field provide little in the way of formal course work in suicide risk assessment and risk management
• Mental health care providers are not immune to the myths, misperceptions, stigma and taboos associated with suicide. They may be reluctant to deal with the subject in an honest and helpful fashion.
• The well intended, but uninformed acts of caring professional communities are no substitute for specific knowledge about suicidal behavior, ignorance can not be an excuse for poor practice.
• Studies have repeatedly shown 85% of suicides are premeditated and approximately 90% of persons who take their own lives communicate their intentions to someone they know, frequently a health care provider.
• Suicide malpractice claims are the leading cause of suits against all mental health practitioners, including psychiatrists, psychologists, social workers, and nurses.

It really made me think of the ignorant attitude of EMS providers towards psychiatric patients. It is upsetting that many EMS providers are not even well intended - they willingly buy into the stigma and taboo of psychiatric disorders and suicide, dismissing them as medical concerns. I have even heard providers call these patients "a waste of oxygen". 911 is often the first line of help for patients with suicidal ideation. They are asking for help - a task that can be exceedingly difficult to do when in that state of mind. I wish they would receive the degree of respect that they deserve.

Reminiscing on my days in EMS makes me incredibly thankful that I shifted my career.

To the Suggestion Box

The facility at which I am employed has a wide range of psychological pathologies. Among these are numerous girls with eating disorders - ranging from disordered eating to full blown Anorexia Nervosa. In my opinion, the facility is not equipped to adequately handle or treat clients with eating disorders. I've heard SO many staff express frustration, "why won't they just eat?! It's not that hard!".

I understand with the economy they are accepting clients from anywhere in order to stay afloat. It's frustrating as a staff member however (especially having been through treatment for my own eating disorder) to see the inadequacy of the treatment for these clients.

I was speaking to a co-worker about this frustration, and we came up with the idea of an eating disorder unit within the facility. There is an open unit (that is traditionally used for transitional housing, but has not been used in quite some time). There are plenty of girls on campus who would qualify to live in this unit, and then the facility could advertise and accept more clients with these diagnoses.

They would have to hire special staff - therapists for treatment, and staff qualified to administer food through nasogastric tubes. Paramedics are qualified to do this, and I would love to work in an eating disorders unit (I think...). It would have financial impact upfront, but I think long term it would be a financially smart move.