Pomegranate Cares

How do you guys handle behavioral outbursts?

Communications — Tue, 21 May 2013 17:28:21 +0000

This week, Pomegranate holds another new team member orientation session. There is a lot of pre-employment training that takes place. One of the workshops is for CPI or Nonviolent Crisis Intervention training Program. Alongside CPR, it’s mandated of all direct care staff. This highly effective training is evidence based and practiced internationally.

Here’s an example: Jenna, 15, got in her foster mom’s face for ‘hassling her’ about being out way past curfew and hanging with the wrong crowd. After Jenna ‘went out of control’, mom locked herself in a safe place and called the cops. Jenna’s outbursts had escalated and her increasingly violent behavior was downright scary towards peers, even in a school setting. The cops took her to an ER. For her own safety and others, Jenna was referred to a residential treatment center for diagnostic evaluation and assessment. She was not happy going to a secure environment! Her very difficult early childhood in an abusive environment appeared to be contributing to the current outbursts. At the treatment center, Jenna might also exhibit a meltdown. How is the staff supposed to handle that? [The answer is, calmly, and in a well-trained manner.]

It is exactly for Jenna, and others like her that CPI was first developed in the 1970’s. Crisis Prevention Intervention is about the registered Nonviolent Crisis Intervention® training program designed to prevent physical or emotional harm and minimize risks. ‘Physical intervention is to be utilized only as a last resort when an individual’s behavior presents an imminent danger to self or others,’ according to the CPI course explanation.

The strategies ‘provide staff members with an effective framework for decision making and problem solving to prevent, de-escalate, and safely respond to disruptive or assaultive behavior,’ according to the program. The program is taught by experience professionals who undergo ‘rigorous training’ and ‘annual competency testing’ as part of their performance appraisal, as they teach the curriculum internationally.

From dementia patients in nursing homes to schools to detention centers to hospital environments, CPI is a highly effective, evidence based form of de-escalation and intervention education. The Joint Commission has a leadership standard for this type of training. According to the CPI website, “The Joint Commission named its July 9, 2008 Issue 40 Sentinel Event Alert “Behaviors that undermine a culture of safety.” It is clear that, through the undermining of employee safety, disruptive individuals threaten patient safety—the core mission of every accredited hospital or organization. In response to this safety threat, effective January 1, 2009, the Joint Commission promulgated a new Leadership Standard (LD.03.01.01) to address intimidating, disruptive, and inappropriate behaviors. The Joint Commission cited research ‘ . . . See:

http://www.crisisprevention.com/CPI/media/Media/Resources/alignments/Joint-Commission-Workplace-Bullying-Alignment-2013.pdf

Pomegranate does not use chemical or mechanical intervention or seclusion. “All Pomegranate staff is required to participate in pre-employment CPI training and ongoing refresher course modules. This is an investment in employee and patient safety and also a therapeutic response,” says April Turner, Pomegranate’s Compliance and QI Manager. “The program focuses on using less restrictive alternatives and verbal de-escalation techniques before the incident results in a physical hold, which gives the youth the responsibility of practicing self-control. As a result, the course has significantly decreased our restraints since implementation in 2010.”

April tells the staff to think about using CPI much like CPR. “You wouldn’t administer CPR to someone who is having trouble breathing. One only administers CPR if the person is not breathing at all.” This is much like the same concept she uses with CPI; the adolescent must be in immediate danger to themselves or someone else , and all less restrictive alternatives must have been utilized before applying a physical hold. “This is extremely important because we believe in safety first for our teens and our staff.” Following any incident is an opportunity for additional therapeutic intervention for teen, and staff to process and evaluate what happened to ensure better, more positive future outcomes. CPI is coupled with individual and group therapy as well as psychiatric care as necessary for symptom management.

‘No!’ does not mean ‘yes’

Communications — Tue, 14 May 2013 15:00:27 +0000

The last weekend in March featured a public art T-shirt project to raise awareness of rape, assault and sexual violence. The public art was exhibited on the campus of Ohio Wesleyan University. Survivors of abuse (male and female) each created a personal message on T-shirts which were hung like festive banners, clothes-line style all across the main walkways of the OWU campus. (This was during all the television media coverage of the Steubenville rape trial, with Ohio State Attorney General Mike DeWine still issuing statements.) The topic was certainly top of mind, and for survivors, it’s sometimes pushed out-of-mind, or comes back later because of the trauma of it all. The color of each shirt carries specific symbolism for survivors of childhood trauma including incest, to shirts in memory of victims of domestic violence.

Titled: ‘The Clothesline Project”, a large sheet held the message that “these shirts have been decorated by OWU students as a way to break the silence and raise awareness about the issues of sexual assault and rape.” The individual messages read: ‘Assault, think about it. Now STOP it!’; ‘I can be restored’; ‘If you have to push for a YES, it’s a No’; ‘Stay strong, you aren’t alone’; ‘I will Never forget. I am a Survivor’; ‘Each of US is someone’s daughter, sister, best friend, mother’; ‘Being too drunk to say no is not the same as saying yes’; ‘(this is why we still need feminism) 1 in 4 Women will be sexually assaulted in their lifetimes’; ‘males are also victims’ and countless other messages, blowing in the March wind.
Sexual abuse is one of many triggers of PTSD or post traumatic stress disorder. Pomegranate Clinical Director Demetra Taylor said, ‘This is an important topic and a contributor to mental and behavioral illness in both male and female adolescents because oftentimes victims of sexual abuse remain silent and do not seek help which can lead to depression, PTSD, substance abuse, etc.

Nursing Director Rosetta Cowan RN, BSN added, “It is necessary to express and release such emotional and physical turmoil in a positive, holistic, and healing manner such as this project. Self-advocacy and awareness are key elements to the healing process. “ Here’s a link to read more about The Clothesline Project website. View videos, photos, listen to concerts, and read about this powerful witness around the world. The website says, “At the moment we estimate there are 500 projects nationally and internationally with an estimated 50,000 to 60,000 shirts. We know of projects in 41 states and 5 countries.” See http://www.clotheslineproject.org/

Front line of teen life

Communications — Fri, 03 May 2013 14:39:00 +0000

Isolated girl from bullying group
At the 2013 Voices for Children Spring conference, Marilyn E. Crumpton, MD, MPH Medical Director Division of School & Adolescent Health City of Cincinnati Health Department and Kate King, RN, MS, President of the Ohio Association of School Nurses presented a session on Adolescent Health in Schools. The presentation was about what we really see-including problems with sexuality, adult responsibility, drugs and alcohol, mental illness, violence, teen needs of medically fragile and special needs students and chronic disease- such as asthma and diabetes.
The latter two -asthma and diabetes- have increased significantly in the past 10 years: asthma 40% in school aged children and diabetes 50%. School nurses must deal with more complex medical needs like catheterizations, tube feedings, tracheostomies, and ventilators. There are pregnant teens and teen moms. Prenatal care is important. According to the 2011 YRBS (Youth Behavior Survey) 42% of teens had sex during the past three months and 77% didn’t use birth control pills.

Educating about and dealing with the effects of alcohol and drug use is important. King presented statistics that 38% drank alcohol during the last month; 24% binge drank during the past month; 24% used marijuana during the past month; 7% ever used cocaine; 24% offered, sold or gave an illegal drug on school property and 19% used drugs or alcohol before having sex. Aside from illegal underage aspect of use, and criminality of purchase/sale of substances, binge drinking is a huge problem with ‘shot time’ a popular activity. Alcohol poisoning is a concern. Another reason binge drinking is an issue is because 21% of teens rode with a drinking driver, and 9% were forced to have sexual intercourse. Other substances King outlined include tobacco: 21% smoked cigarettes, and 52% tried smoking.

Other risky behaviors include violence: 16% carried a weapon and 31% were in a physical fight. The reasons behind some violence include 23% having been bullied at school and 15% electronically bullied. This is one cause for some teens to suffer suicidal ideation; 9% attempted suicide. Then, there are homeless teens; 40% of homeless youth are LGBT and the primary cause is family rejection.
‘We don’t have that type of teen here. These are good kids. Can’t remember that I’ve seen any kids here in crisis,’ a silver haired volunteer at the desk of an Ohio hospital said, shaking her head. The ER Department team had a quite different take. Far too often it takes a headline news story to shake a community up and realize how real these issues are and what teens face day in and day out. Adolescents have always experimented and pushed the boundaries. The difference now is that bullying is front and center with social media, substance abuse has escalated dramatically with opiates, and energy drinks coupled with mega-caffeine and alcohol have introduced bigger dangers. There will always be a frontier of exploration. “There’s a difference between a frontier with a horizon, and one with a cliff. Adolescent health is an important topic,” adds Pomegranate Nursing Director, Rosetta Cowan. [Nursing care is provided 24-7-365 at Pomegranate Health Systems, a secure facility.]

Its in your brain . . .

Communications — Mon, 22 Apr 2013 13:47:29 +0000

Its in your brain . . .
The National Institute of Mental Health published a great fact sheet with some of the latest information from neuro-science which confirms the neuro-biological basis of symptoms of mental illness. Its called: Brain Development During Childhood and Adolescent Fact Sheet. It contrasts what we learned ‘yesterday’ (meaning the ‘80’s and ‘90’s) with today (which is tomorrow’s yesterday)! Much of what was learned in the recent past was developmental and experiential in nature. Patterns of growth and development appear early in one’s life and early experiences shape the brain’s response system. Much of what has come from more recent research is informed by imaging technology and also gene mapping. For example genes are linked to one’s stress response and affect behavior as well as neural development. It’s not just what you inherit genetically, but your own bio-chemistry which helps determine behavior. Brain mapping is becoming another tool in the diagnostic arsenal. We also now know that how one responds to stress and trauma affects cognitive development. In other words, your environment affects your behavior as well as your personal biochemistry.
In a presentation on trauma by Dr. Maria Stamatakos at the recent 2013 Voices for Children conference, held March 27th & 28th, Stamatakos showed structural images of the ‘normal’ brain as contrasted with symptoms of PTSD (post traumatic stress disorder). She also discussed physiological response to trauma in the brain. There are several viable treatment options: therapeutic, psycho-pharmacologic and environmental. Some of the therapeutic treatments include trauma-focused cognitive behavioral therapy (CBT), and eye movement desensitization and reprocessing (EMDR). Both are used at Pomegranate Health Systems. Stamatakos discussed additional therapies: PCIT, CTG, ARC, TST, SPARCS and CBITS. She outlined the core components of effective treatment and importance of evidence-based treatment (TF-CBT) which was named a model program by SAMHSA, the Substance Abuse and Mental Health Services Administration.
Stamatakos addressed psychopharmacology- medications which are helpful in situations where there are specific symptoms such as “emotional hyper arousal, irritability, anger outburst, poor concentration and sleep disturbance. These are prescribed with severe symptoms impairing function, associated physiological hyper-arousal, poor response to therapeutic interventions alone and co-morbid disorders” (more than one). She covered each of three classes of medications-when to prescribe, brand names, side-effects and monitoring: selective serotonin reuptake inhibitors, adrenergic agents and atypical antipsychotics and what function they perform. There were visuals of coronal sections of the brain.
Perhaps you remember a public service ad campaign designed to prevent drug abuse which showed a fry pan with an egg cracked onto the hot surface, frying. The voice over/headline said: ‘this is your brain on drugs’. We know that brain-body-genetic-environment is integrated, and anything one is exposed to or ingests, has the potential to heal or harm. This should be respected. Mental health is a combination of intricate variables over time. As mental health advocates stress, mental illness is not a character flaw, and should be regarded as other biologically-based illnesses are. Healing is possible and with the right treatment, an amazing difference can be made. Brain research is becoming an important new frontier.
Recently President Obama pledged a “bold new research initiative designed to revolutionize our understanding of the human brain. Launched with approximately $100 million in the President’s Fiscal Year 2014 Budget, the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative ultimately aims to help researchers find new ways to treat, cure, and even prevent brain disorders, such as Alzheimer’s disease, epilepsy, and traumatic brain injury,” according to the release. Read more here:

http://www.whitehouse.gov/the-press-office/2013/04/02/fact-sheet-brain-initiative

Lungs, livers, brains, kidneys and eyeballs, “Oh my!”

Communications — Fri, 12 Apr 2013 20:28:18 +0000

Wellness nurse, Lori Harris, LPN is tasked with prevention, employee health and leading nursing groups for Pomegranate teens, alongside individual, group and family therapy sessions, school , and recreation in a jam packed schedule. Nursing groups are an ideal component of Pomegranate Health Systems broader educational, advocacy, and outreach mission. “Lori brought in a lung today,” mentioned the CEO, “isn’t that wonderful to make the dangers of smoking real?” With that, inquiring minds had to ask, ‘What else is going on!? Is it true?”

“Oh yes!” Lori exclaimed with excitement, “teens want to know the effect of different medications, drugs, substances, on their health and lives. The squishier and more real I can make it, the better! We dissect lungs, livers, brains, kidneys and even eyeballs. It’s very real and immediate education!’ Her dark eyes danced with delight. Lori thrives with workshops on infectious diseases, STD prevention, wellness, and the brain. The more she can learn and teach the better.

Right now, there’s a major movement underway to limit or avoid psychotropic medications altogether. As with so many trends, the mood of the moment is to not approve medications because of potential risks on developing bodies and brains. According to the NIMH (National Institute of Mental Health) report ‘Treatment of Children with Mental Illness’, U.S. Department of Health and Human Services National Institutes of Health, “Some children need medication to manage severe and difficult problems. Without treatment, these children would suffer serious or dangerous consequences. In addition, psychosocial treatments may not always be effective by themselves. In some instances, however, they can be quite effective when combined with medication.’ (p2) Pomegranate’s philosophy is to accomplish the most with the least. When teens arrive- some on multiple and lengthy lists of meds, it takes a while to wean and adjust dosages to arrive at the optimum solution for each individual case. Years of experience with adolescents by Pomegranate psychiatrists and nurses makes a difference.

This is why Pomegranate treats teens with a thorough and integrated program including physical health (exams & nursing group), psychosocial therapies (CBT, EMDR), and psychiatric care in a comprehensive care plan in a secure residential environment, with follow up care recommendations put in place. For Lori, who tracks even the common cold with a vengeance, wellness at its core is a body-mind-emotion-spirit holistic proposition. For teens with serious mental and behavioral health issues, that’s even more important in learning to manage their symptoms and being a partner in their healing process. She hopes to add many more exciting and interesting workshops to the routine sounding title: ‘nursing group’ in the very near future. Pomegranate is committed to permanency. With just under 20 nurses under the direction of nursing director Rosetta Cowan, RN, BSN, Pomegranate teens can count on intensive care 24/7.

Growing up: So very hard to do . . .

Communications — Thu, 04 Apr 2013 15:44:33 +0000

At the 2013 Spring Voices for Children Conference, it was evident a LOT of work needs to be done on behalf of not only Ohio’s children and adolescents, but children and adolescents around the world. For instance, starting with the youngest and most vulnerable, Anne Harnish, Assistant Director ODH, said “in 2010, 1,068 babies died before their 1st birthday. Ohio has the 11th highest infant mortality rate in the US. The cost for a pre-term infant is $38,500; full-term it’s $3,950”. And evidence shows, teen moms are more likely to deliver pre-term infants.

During the Thursday luncheon panel, Dr. Arthur James, Associate Professor Clinical, The Ohio State University, and Co-Director Ohio Better Birth Outcomes Nationwide Children’s Hospital, addressed socio-economic and socio-demographic determinants which have a significant impact on health. He said, ‘Where you are on the ladder predicts how long you live and how healthy you are during your life-time. Genes are only part of the picture.“ The pictures and futures he portrayed with statistics showed how much work has to be done to achieve better societal outcomes.

Jennifer Justice, Deputy Director of Child Welfare ODJFS cited national statistics from the ‘Connecting the Dots’ program which shows 48% of females (who aged out of foster care) become pregnant by age 19. Statistics show “every year in Ohio approximately 1,000 to 1,400 young people age out of foster care, and the futures they face are often grim.” Here are some national statistics from her presentation:
• 81% of males are arrested by age 24
• 54% report having at least one mental health problem
• 33% receive neither a high school diploma nor a GED, compared to 10% of their same-age peers
• 33% have household incomes below the poverty level, which is three times the national rate
• 25% have experienced post-traumatic stress disorder, compared to 15% of Vietnam War veterans and 12% of Iraqi War veterans
• 22% experience homelessness, and 40% of the adult homeless population spent some time in foster care.

Initiatives undertaken by ODJFS ‘Connecting the Dots’ are aimed at improving the transition to adulthood including education, employment and daily life-including reduction in the incidence of pregnancy, increasing success at living independently and receiving the assistance needed to ‘make it’.

Pomegranate CPSTs (psychiatric case workers) Bobby, Emanuel, Heather, Jennifer and Deidre teach units of curriculum and lead groups designed to help older teens with the critical thinking and skills needed to negotiate independent living and think about their future options, and to make concrete plans to attain education, jobs, housing and manage money, to think about the horizon of their impending young adult lives in a new way.

An RN Case Manager for a large hospital system Northeast of Columbus, said she has seen a surge in ‘failure to launch’ in the 18-24 year old population who couch surf from friend to friend, kin, anyone who will take them in for a time. They play video games, watch television, drink, dabble in drugs and generally can’t find themselves or launch their future. Often lacking a diploma, or the ability/initiative to negotiate the employment process, they become increasingly depressed and disconnected. Some huff inhalants, dabble in bath salts, chasing a ‘cheap buzz’ and wind up in the ER with a psychotic episode, or become suicidal. The seeds for this malaise were often sown at a much younger adolescent age or even through childhood experiences and bad choices. The time to reach adolescents with therapy, education and care is now and even earlier intervention/s.

Having an IEP (individual education plan) is an important part of staying on track. [At Pomegranate Health Systems there are tutors from Columbus Public Schools on-site to help students with homework and to stay on-task. Some teens are transported to their home schools each day.] For Luke Everhart, Site Director for Virtual Community Schools, the process of getting each teen enrolled is critically important. VCS is for those teens for whom a regular school environment may pose a challenge. To enroll these students may involve multiple phone calls to pull together birth certificates, and/or any other necessary paperwork to sign each teen up for school.
When a teen receives a certificate of achievement in a subject, or graduates, that’s a big deal and a moment to celebrate, because it’s the start of empowerment, which provides seeds of hope for a better future. Learn more about VCS, Virtual Community Schools at: http://www.vcslearn.org
VCS mission ‘is to make a difference in the life of a student.’ Pomegranate’s mission is to help adolescents and their families recover from mental illness, learn to care for themselves and each other, and achieve the highest possible quality of life in their homes and communities. We all care very much about outcomes.

Pomegranate to sponsor 2013 NAMI-FC Walk

Communications — Mon, 01 Apr 2013 14:31:40 +0000

Team Pom Kid at the 2012 NAMI Walk
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Last year nearly 40 Pomegranate team members, friends and family members walked to support NAMI- National Alliance on Mental Illness, Franklin County Chapter, and raise over $1000 to help provide pro-bono counseling, workshops and community education. Pomegranate associates wore Pomegranate flower-hued T-shirts emblazoned with ‘Pomegranate Health Systems Adolescent Psychiatry’ to show the team Pom Kid spirit as they walked a mile around Fred Beekman Park, which is on the west Ohio State University campus park area South of Lane Avenue. It was a beautiful day and a positive opportunity to make a difference and bond outside the hospital and treatment facility. This year’s walk is June 1st.

The NAMI fact sheet states that “One in four adults-approximately 57.7 million Americans- experience a mental health disorder in a given year. One in 17 lives with a serious mental illness such as schizophrenia, major depression or bipolar disorder and about one in 10 children live with a serious mental or emotional disorder.” (Source: US HHS Mental Health: A Report of the Surgeon General) The executive director of NAMI National explained in his ‘Grading the States’ 2006 talk that treatment works when you can get it, but many don’t get the treatment they need. The fact sheet goes on to explain that “Fewer than one-third of adults and one-half of children with a diagnosable mental disorder receive mental health services in a given year.’

It’s important to recognize signs and symptoms in children, as ‘half of all lifetime cases of mental illness begin by age 14, three-quarters by age 24.’ (Kessler, Berglund, Demler, Jin, Merikangas & Walters General Psychiatry, 62, June 2005). Significantly, ’70% of youth in juvenile justice systems have at least one mental disorder with at least 20% experiencing significant functional impairment from a serious mental illness.’ (Skowyra, Cocozza, 2007 Blueprint for change. National Center for MH and JJ; Policy Research Associates, Inc. ) The class of serious disorders include: schizophrenia, attention deficit disorder, bi-polar disorder, conduct disorder, oppositional defiant disorder, major depressive disorder, anxiety disorders, obsessive compulsive disorder, co-occuring mental health and addiction disorders.

NAMI offers a course called “Basics: Caring for you, your family, your child” which helps families understand the experience and emotional reactions. The course presents the latest research covering biology of mental illness, treatment strategies and problem solving. Mental illness affects the entire family. The course is free, and class schedules can be access through http://www.namifc.org or call 614-501-6264. There is also information on the national website at http://www.nami.org.
Pomegranate team captains this year include April, Quality & Compliance Manager, and Lori, Wellness nurse; ‘Cia’ will serve as communications liaison. Pomegranate CEO, Angela Nickell says, “Supporting NAMI is important to us, caring for over 1000 teens in the past few years, we realize the family and the community are an integral part of healing, offering hope, and promoting resilience.”

Opiate Addiction in Teens: Not a Pretty Story

Communications — Sun, 24 Mar 2013 19:44:10 +0000

At the 29th Intercourt Conference presentation on ‘Understanding Ohio’s Opiate Epidemic and Treating Adolescents with Addiction’ the presenters (Orman Hall, Director ODADAS, Dr. Steven Matson, MD Nationwide Children’s Hospital) explained in data adapted from the Ohio State Board of Pharmacy 2012 that ‘Ohio’s average per capita rate of Opiod doses from 1/1, 2010 to 12/31/2010 was 67.3 doses.’ What’s so dangerous about the addiction problem is the ability to destroy lives, families and communities and take over brain and body, enslaving them chemically.
Opiates are a class of analgesics (painkillers), which includes Hydrocodone (Vicodin), Oxycodone (Oxycontin, Percocet), Oxymorphone (Opana), Propoxyphene (Darvon), Hydromorphone (Dilaudid), and Meperidine (Demerol). The National Survey on Drug Use and Health for 2009 reported 5.3 million nonmedical users and 9.0 million medical users in the past month.

Heroin use is also on a dramatic rise in Ohio. Because of the lower cost and ready availability, some users are going directly to heroin, bypassing so-called ‘gateway’ drugs like Marijuana or Percocet. Obviously, unintentional fatal drug poisoning is a consequence. Admissions for Opiate abuse and dependence are high. (The percentage of ODADAS Clients with an Opiate Diagnosis chart showed 28.5% in 2012.)
In one example, the presenters showed Jail Days in Fairfield County by Age and Opiate Status in 2008; 53.6% had opiates present in the age 18-25 group. In the teen and young adult population, bodies and brains are still developing. The criminal connection is significant. Here are some statistics:
• A July 2011 white paper on Ohio’s Opiate Epidemic by ODADAS, reported, “Ohio’s opiate epidemic is a crisis of unparalleled proportions with devastating, often deadly, consequences. The most culpable substances are the opiate family, which includes heroin and prescription pain reliever medications. In fact, these substances accounted for nearly 40 percent of the state’s 1,373 overdose deaths in 2009.” http://www.odadas.state.oh.us/public/OpenFile.aspx?DocumentID…74cf…;

• “On average, four Ohioans die each day as a result of drug overdose.” (Source: Ohio Department of Health)

• “The Ohio Substance Abuse Monitoring (OSAM) Network reports a move from prescription painkillers to heroin among opiate abusers. Heroin is highly available in all regions of the state.”
(Source: ODADAS, OSAM Network, 2011)

• A study in the Journal of Managed Care Pharmacy estimates that the medical expenses of a person who is abusing opioids are eight times those of a non-addict.

In the 29th Intercourt Conference afternoon session, “Treating the Opiate Addicted Adolescent”, Lorain County representatives outlined the development of a Drug Court starting in 2000. Judge Debra Boros explained why a drug court is different, ‘The team approach is inclusive of judge, probation and treatment with juveniles and their parents. Both juveniles and their parents are held accountable.’ She explained that in addition to constant daily contact there is random drug testing and monitoring peers and parents of participants. A special challenge is when parents are unaware, don’t care, or abuse drugs themselves.

She explained the several levels of treatment from the outset, at level one where clients are seen weekly and start on house arrest. It typically lasts 4 weeks to level two. There is a clinician for the teens and a clinician appointed for parents, daily contact with the court staff, weekly consultation meetings and weekly team meetings.

Judge Boros said ‘Drug court forces them not to use and/or face things they’re in denial about.” The presentation concluded with some final thoughts: “You don’t recover from an addiction by stopping using. You recover by creating a new life where it is easier to not use. If you don’t create a new life, then all the factors that brought you to your addiction will eventually catch up with you again.” Measured 90 days after program completion, there is a 9% recidivism rate; since level 5 was implemented it’s 0%. Out of 165 drug court participants 38% graduated; 62% terminated.

For teens who are facing mental and behavioral health issues, dabbling in opiates is a losing proposition. Pomegranate therapist Dinni, LSW says, ‘Prolonged opiate use can manifest in psychotic break with episodes of hearing voices, seeing hallucinations, or perceiving things that are completely fictitious. One’s entire framework of reality becomes distorted and affects their ability to function in society. On top of say, a depressive disorder, or a conduct disorder, there can be some very negative outcomes the adolescent wasn’t anticipating, or never intended.’ Pomegranate doesn’t treat primary addiction as Talbot House does, but does conduct AOD group for teens with mental and behavioral health disorders with a dual diagnosis. ‘It’s best not to experiment in the first place,’ concludes Dinni.

What is Prep?

Communications — Tue, 12 Mar 2013 14:02:30 +0000

by Orangeline, Dreamstime.com 5480227
Pomegranate became a test site for implementation of the PREP (Personal Responsibility Education Program) for Foster Care and Adjudicated Youth through a grant provided by Nationwide Children’s Hospital recently. The PREP program is about reducing the risk of unplanned pregnancy, sexually transmitted diseases like HIV, and others. What’s unique about PREP is that it stresses the importance of healthy relationships and interactions, financial literacy, and developing skills for employment and self-sufficiency as teens face living on their own, and the need to become productive members of society. The program is oriented towards teens, who may not have had a stable family situation, or been in foster care, treatment centers, youth services, or multiple placements -which disrupted both education and access to positive adult role models. This program is effective because it is evidence-based and focuses on preparation for adulthood.

PREP is important because, as the Youth Behavior Risk Survey and the February 2012 PREP newsletter report, “Teen pregnancy rates in the US are alarmingly high. Thirty-four percent of young women become pregnant at least once before the age of 20, with most being unintended and occurring amongst unmarried teens. The pregnancy rate of young women in foster care is higher. All teen mothers experience higher rates of preterm birth, low birth weight and infant death compared to adults.” (from Newsletter 4)

You can read more about the program through the Ohio Department of Health Adolescent Education web site at: http://www.odh.ohio.gov/odhprograms/chss/ad_hlth/adhlth1.aspx. The Ohio Department of Health partnered with the Ohio Department of Job and Family Services and the Ohio Department of Youth to initiate a ‘train-the trainer’ program to launch PREP. The State of Ohio was divided into several regions (Central Ohio is region 9) and training partners selected in each. For teens in residential treatment centers like Pomegranate Health Systems, the PREP program is invaluable in learning the skill set to transition toward independent living. The program was initiated late summer and ran through Fall with 8 individual training modules. After a short hiatus to update materials and train additional staff, the program resumed this Winter.

At Pomegranate Health Systems, Residential Manager Tiffany says the program was well received. “The residents were afraid to talk about anything related to intimate behavior or health issues in the beginning because they felt embarrassed about the possibility of not knowing what was being discussed. After a few sessions, they opened up and were intrigued about many things they didn’t know about. The teens asked lots of questions. Things teens thought they’d learned correctly were addressed by trained staff. Residents learned how to prevent unplanned pregnancy and STD/HIV and to promote healthy relationships. Residents were empowered to say, ‘No’ when they are not ready to have sex; evaluate risks and lasting consequences of becoming an adolescent parent or becoming infected with HIV or any other STD. They also learned that a healthy relationship involves the cooperation of two positive people.” She added, “We’re very thankful for the partnership that made this program possible”.

Bullying Prevention

Communications — Mon, 11 Mar 2013 14:23:26 +0000

Image by Christy Thompson, Dreamstime 11699801
At the 29th Intercourt Conference held in Columbus, Ohio last week, James Bisenius, Child and Adolescent Therapist delivered a 2-part workshop on Bully Proofing Youth. He has taught the workshop to over 450 schools, nationally. The workshop was sponsored by The Village Network. Bisenius explained how to deal with verbal bullying and physical bullying, including body language, movements and walking, voice, behavior, and material things. He said that physical bullying is actually a small percentage of the bullying that happens- most is verbal and social. There were some key points, among them that ‘Parents are always the last to know what is going on’, and ‘Almost all kids who target others tell their parents they are being targeted by the victim.’
It’s not advisable for a victim’s parent to call the bully’s parents. He explained that ‘One in ten incidents are caught by adults when the bullying is blatant name-calling or physical. Only one-in-fifty incidents are caught by an adult with the sneaky sophisticated social/exclusion type of bullying.’

‘Patsy’ remembered a sneaky bully from kindergarten who bit her on the wrist before a special movie on trains. He was always creating drama, causing grief to others, emerging as the hero-victim, as the teacher did nothing. The other kindergartners were intimidated and kept silent. The bully’s prominent parents were ‘snowed’ by his sweet and bright demeanor. Patsy’s mother said, ‘I wouldn’t put up with that, bite him back! Don’t be a pushover.’ This was not good advice. When bitten back, the bully screamed and carried on, in puzzling excess, to enlist the teacher’s favor and vilify the 6 year old girl. There were negative consequences for ‘Patsy’.

Bisenius outlined how small group dynamics work in a bullying situation- from the leader kid, to the social, ‘under-the-radar’ sneaky bully (who snows everyone), to the followers, to the outsiders, to the blatant stereotypical bully. Each role was identified and unpacked in detail, with percentages given for each, based on his work over 17 years. He outlined how to disarm different situations with specific examples.
Bisenius spent considerable time in part two, explaining how sneaky social bullies operate (often, but not always girl bullies). The leader is usually ‘sucked in’ like a host/parasite situation with the sneaky social bully type. He expanded upon how control strategies are used similar to a diabolical game of chess, and how rumors are planted by the social bully with a ‘gossip’ so that a ‘weasel’ girl will repeat them. Often, the attempt to break up close or emerging friendships within the group is based upon jealousy. All the carefully calculated maneuvers by a social bully become a power trip. Social bullies fear solid/strong friendships and friends who stick together. Ignoring the commands of a bully dis-empowers them. As Bisenius expanded upon his presentation with examples, audience members appeared to be engaged in recognition of their own life examples.

A significant part of the presentation came at the end of part 2, when Bisenius explained that this behavior typically continues into early adulthood, marriage, and family. Many social bullies have marriage problems, many bring similar relationship dysfunction into a family, making their children compete for their love. The behavior can even continue into senior years in a nursing home setting. The presentation offered cyber-bullying facts and resources, what not to do and what to do. Some of the statistics Bisenius presented showed the prevalence of cyber-bullying among teens. For instance, 43% of teens have been victims of some form of cyber-bullying in the last year. See http://www.cyberbullying.org and prior posts on Pomegranate Cares. Read more about Bisenius’ Bully Proofing Youth workshops at: http://bullyproofingyouth.com/#/presenter/4525501146