Ohio Governor John Kasich addresses OACBHA Conference

oacbha-conf-keynoteThe Honorable John R. Kasich, Governor, State of Ohio addressed the Ohio Association of County Behavioral Health Authorities Wednesday, January 11th during the lunch keynote.  His presentation followed that of Nancy Lublin, Founder/CEO of the Crisis Text Line, a text-based crisis intervention system with a 95% open rate. The Crisis Text Line has processed some 30 million messages and has an impressive mental health database. There have been 33,466 coversations in Ohio over 4 years and 243 active rescues; 79% are under age 25; 10% are under age 13.  Sixty-one percent of text messagers shared new content they had never shared with anyone else- one-in-five referenced self harm.

Governor Kasich referred to the crisis presentation statistics and said he looks forward to the day when we actually understand more fully how the brain works. He has been a champion of taking care of those suffering mental health and addiction disorders, and thanked those assembled for caring for their fellow Ohioans.

Kasich shared a story from the campaign trail when a man asked him what he was going to do to help his small town in the Northwest, if elected President of The United States.  Kasich said it is “not what I’m going to do, but what you’re going to do in your town.  Only when the ‘bottom-up’ gets mobilized can the ‘top down’ do something.”  He referred to community meetings and community involvement and citizen mobilization to tackle the key issues facing us- like opiate addiction, or trafficking.

Kasich said he’d recently read The Tipping Point by Malcolm Gladwell, which suggests that the tipping point is just 5% engagement/involvement to begin to change things.  So when there is a community forum and perhaps only 5% show up, that’s still powerful. “It’s not just top down, but bottom up. This gives us hope in getting communities going again.  We have got to set our communities on fire.”

Following one address in Southeastern Ohio, he saw a teen girl with a defeated demeanor.  He said to her, “There is no one just like you. You are a made a unique creation,  born with a purpose, born for something special.” The girl began to cry. No one had ever said that to her.  “Often, kids who are on drugs grew up with every conceivable advantage, but they are bored and have no sense of meaning, and no sense of purpose. Something is missing. Each child needs to understand that they’re born for something special.  You inherit the earth, but can lose your soul. The spiritual aspect matters.”  He ventured further into his understanding of Christian hope, meaning, and promise and thanked the crowd of  500+ to applause.

 

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The mission

survey-decemberSequel Pomegranate’s mission is simply to help adolescents and their families recover from the effects of mental illness, learn to care for themselves and each other; and achieve the highest possible quality of life in their homes and communities- whatever that may look like: bio family, kinship care, foster care, group home family, or new family-as independent living with schooling and/or job.  But those are the words and pledges. This mission is something our team seeks to embody on a daily basis through the good and triumphant moments and through the dark and difficult feelings and behaviors that are expressed during the course of treatment and recovery. Each teen and family have a ‘context’, the rest of his or her story. 

Driving from one end of Ohio to the other, one sees the small towns, semi-rural and rural communities, suburbs, and cities-both small and large.  At the neighborhood level, impressive palatial homes and or old homes in river towns with perhaps rotting front porch supports and in need of a roof and/or windows, large city apartment complexes, or farm houses far from towns. At the regional level, there are distinctly different micro-populations –beyond supporters of Browns or Bengals, Buckeyes or Steelers.  At the geographic level, ‘Firelands’, Portsmouth or Marietta on the Ohio River, the Miami Valley or Western Reserve have a very different vibe than Hocking Hills. Even weather systems impact where you’re from in Ohio with ‘Lake Effect Snow’, Bellefontaine ridge, or ‘Little Switzerland’ a real thing. You see the differences in care environments and referring sources from community hospitals to mega-block, multi-site institutions, combined county agencies or large specialized court systems.

History lends names (Washington Court House) or genealogical origin-(Native American-Wyandot County, or Scioto) and fascinating markers from times when Shawnee Indians, or Lucas Sullivant walked the earth in Franklinton, where our facility is located.  Geological features such as rolling hills and winding roads, heavily forested, or home to mighty rivers-shape us and define our sense of place.  Socio-cultural background could indicate if one were raised in Amish country or inner city Cleveland, Toledo, or Gallipolis, St. Clairsville, or Appalachian Athens. There is the big influence of employment and economic health which directly impacts jobs- whether one works in farming, coal, automotive, energy/tech, manufacturing, medical, government, education, insurance, or retail. Family composition and stability are immensely important beyond just medical or psychological history. All factor in to state of mind, physical and mental health and sense of community- where one ‘comes from’ and into how one heals, whether one feels safe (crime rates?) or has a supportive environment to rely upon.   

Mental and behavioral health disorders do not distinguish origin or context- just as everyone can suffer a cold or a broken bone. Data does suggest higher rates of SED, serious emotional disturbance among those experiencing poverty- SAMHSA data 8% on average vs. 11-13% below poverty line.  Another common contributor to mental and behavioral health issues is the number of ACES, adverse (traumatic) childhood experiences-which can affect brain development.  Violence in the home impacts one’s experience, and everyone has different resilience mechanisms.

Sequel Pomegranate connects with ­­­­­­adolescents across the spectrum in need of help. Because each child brings a different history and story, our approach is multi-disciplinary. We realize it takes therapy, several types-coupled with nursing care and medication/med management to arrive at an optimum solution with longer term results. At the root of it all you’ll find empathy. Whether it’s the smile and greeting from Edna or Lakeisha in the kitchen, the wisdom of Dr. Vaka or nurse practitioner Kristin, D.O.N. Melissa, or the listening ear of therapists Cory, Eric, Tony, Clay or Erika, the inspiration and insight of Ruth on an art project, the care of mental health associates, or dedication of drivers Flu, Mike, Tom and Kenny, or steady oversight of Brian, Dan, or Joe across the building supervising fire inspections, making repairs or painting- the entire team 200+ ‘has it’.

Thanks All for a wonderful 2016! We look forward to the New Year! [Our next chapter . . . ­­­­­]

All the very best!

 

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Presenting Parenting-101

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At the NASW Ohio conference November 17th & 18th, a number of excellent continuing ed workshops were offered to social workers. Psycho-analyst Norm Shub of The Gestalt Institute, author of several books, and leader of some 150 parenting programs annually, delivered an intensive, (impressive) interactive session on dealing with difficult parents.  Here are a few highlights, paraphrased:

‘A UN Study found kids are in therapy 6-6.5 months while parents only go to 2 sessions.  To be successful, we have to help the parents understand fully for a child to learn, thrive and grow. They need to discover what they need to do differently to help their kid develop.  If their heads are buried in electronic devices with-out real engagement –eyeball to eyeball, that’s a problem.’

A key point Shub made, ‘You cannot reach success as child therapists without working with the parents.’  He continued,  ‘Lots of parents default to top psycho-education when they really have to look at behavior. Kids learn to be in the world 3 ways: 1) the way you relate to them, 2) how you are with your partner,  3) there’s power in what they say to you- 80% of learning comes from watching.  This is about ‘show’; not ‘tell’. But, you do not show them how to act; you’re constantly modeling behavior for them. Autistic children learn through modeling and repetition.’

He explained that instead of parents blaming; there is a 4 step need-meeting cycle1)Say how you feel; 2) ask for what I want with/in the family; 3) get it/acknowledge what you need; 4) feel better.  “Some 62% of the problem is fixed by changing parenting.”  He asked the audience what to do, and the first person said ‘ask the kid a question’. Shub screamed ‘Aaarrghh!’  and said,  “Tip #1- kids HATE probing questions. The first thing in engaging parents is not just about guidance but finding out what’s getting in the way of their ability to parent. For example, single parents: 1. Often compensate for the divorced parent. 2. Thinking you and divorced spouse must be on the same page. (Respect other but don’t have to agree.) 3. Deliberately make person who hates you an ally in parenting – there are parents who hate each other more than they love their kids.”   See his book: “Jumping over Quicksand”.

‘Look at parents; how they engage you. To the kid it’s not your fault. 1. To that kid at school, you draw the child out through gentle curiosity, not probing questions-or they’ll shut down. 2. More interested in hearing than telling,  3. Feel rewarded that you really care about them to let them share, 4. It’s more than the ring of sincerity; they can spot a phony a mile away.  Kids change in 3-stages in response to parenting behavior change: 1. Get worse because perceive no credibility, 2. Build trust over time; 3. Change behavior incrementally.’   

Shub suggested understanding how parents are doing.  Some 2/3 of couples are in unhappy relationships because they do not have the skills to sustain a relationship over time. Kids learn their relationship skills from parents. “Heart to heart, what would your partner say you need to do differently in your marriage commitment?”(He went around the circle for participants to answer.)  “A marriage commitment involves: 1. Being the best partner I can be, 2. He/she should make you feel like the most important person in his/her life;  3. Keep the lines of communication open and do not let anything come between us.”   (See his book, “Heart to Heart”).   

‘Feedback in parenting is a core skill of parenting.  There has to be open emotional engagement with the child to foster a connection.  Working with and through conflict builds self-esteem.  A feeling of safety in parenting comes from: 1. vulnerability/opening up.  2) if you feel what you’re saying is true, they’ll trust you;  3) they need to feel you care about them.”  Shub explained.

In a (representative, fictitious) client history, parent wasn’t involved, didn’t seem to care from infancy forward, had substance issues, other parent absent, sometimes neglect, sometimes abuse, sometimes hunger, frequent moves, poverty, and inconsistent schooling, bullying, and inadquate housing. Kin only periodically involved. Isolation. Ultimately, the outcome frequently is rage, conduct issue, ADHD and/or depression.  A child feels that ‘no one cares.’ 

Shub said there are “three skills needed to parent effectively:  1. Be emotionally present, 2. Know there is a difference between answering and responding.  They don’t want an answer but to know you care.  Responding takes what the kid says and draws them out; it’s not so much responding to what they said as to what’s in ‘my head’/what’s behind it.  3. You can’t expect a kid to share if you don’t share and care; show vulnerability.  4. A key parenting skill is melting; becoming radically immersed.”   This needs to be distinguished from helicopter parenting. 

What’s often missing where there are issues?  Shub explored the idea that, ‘Every child needs a container. A container is a core skill set of parenting: it is what’s important to you as a family. What are the rules you’re running the family by? There should be chores in every container- as an investment in my family. It’s not an allowance; not a payment for chores- you don’t have to pay to be in the family.’  He explained, ‘This is training for adulthood.  For instance with an allowance you get to keep 1/3; you give 1/3 back-to charity; and 1/3 is for college- because research has found a child is 2x as likely to go, and also to do a grade and a half better.’  

Rather than the familiar reward-punishment ethos, Shub said, ‘For a child not abiding by the rules, there are basic consequences. Consequences change behavior; it’s not discipline. The world doesn’t punish you; it consequences you.  Punishment implies bad or guilty; consequences are the price of screwing up- you don’t take away things for a mistake in social development. Anger has nothing to do with parenting; it’s about understanding the depth of your hurt.’

He summarized, ‘A container teaches: 1) respect, 2) impulse control 3) self-discipline, 4) safety and 5) let’s child know he/she is loved.’  The group gave him a round of applause.  It felt like he was just getting warmed up, as he departed for the airport and another talk. 

Resource Link:

https://www.psychologytoday.com/blog/nation-wimps/201612/the-failure-launch-epidemic?   Psychology Today interview by Hara Estroff Marano with David Lancy Professor Emeritus of Utah State University and author of Anthropology of Childhood- described as the best parenting book by the New York Times

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Sequel-Pomegranate, our next page

sequel-vp-chief-culture-officerPomegranate Health Systems is experiencing  ‘acculturation’ into the Sequel family with visits and enhancements by IT, payroll, billing-essentially department-by-department, incrementally.

This week’s All Staff meetings moved beyond the initial welcome reception 10/27 with windbreaker jackets for the entire staff. December featured an orientation to Sequel history and brand by Jack Rachko, VP and Chief Culture Officer.  He has trained and consulted for numerous social service agencies, schools and residential programs both nationally and internationally. Rachko joined Sequel in 2001 providing training and consulting when it was only a 2-program company. He began his career in behavioral healthcare working on the 4pm to midnight shift in direct care at a residential facility in Pennsylvania.

Rachko has conducted numerous developmental initiatives numerous at Sequel facilities and was promoted to Chief Culture Officer in 2014. He explained to all assembled that, ‘We now continue to write the next chapter of Sequel history from Pomegranate’s standpoint.’   In talking about the Sequel brand, he covered notable examples: ‘With Hershey you think of chocolate; Disney-Mickey; with Ford- cars and trucks.  With Sequel, our brand is our service.’  And he said, ‘We spend 90,000 hours in our work life, over 45 years. About half of your adult life is spent at work, working.’  He implied that it’s something you want to get right and make right.

Rachko presented the origins of the vision and mission of Founders Jay Ripley and Adam Shapiro back to the mid-1980s. He explained how Jay and Adam met in Pennsylvania and immediately connected with their similar vision of helping to make the lives of people better. After an initial attempt at realizing the vision, Jay and Adam went to Clarinda, Iowa for round 2 in 1999 where Sequel was founded with a commitment to do behavioral care right.   Rachko outlined the succession of partnering and the addition of new Sequel family members from 1999 to the present culminating with the challenge to Pomegranate Health Systems to write the next chapter in the history of Sequel.

“Sequel provides service to 42 states and has 42 programs (technically 44) in 19 states with over 2,500 beds, six distinct lines of service and over 4,000 staff,” Rachko said.  He covered the number of people served in each program type and near 80% successful discharge statistics.  A succession of inspiring stories and videos followed, featuring teens overcoming and succeeding. Woodward Academy has an alternative day school and was the first RTC in March of 2015 in Iowa high school sports to qualify for the state basketball tournament.  He cited the story of a client who became a champ in power-lifting, the youngest in his weight class to place 2nd in the world in the deadlift, bench combined and squat in Prague.   There were many other inspiring stories followed by an outline of Sequel norms.  Sequel doesn’t micro manage and there is not a big corporate office, but a solid cloud of support for outcomes-based programs.  The Philadelphia-based Rachko delivered his presentation with passion and conviction to share that Sequel respects the history of its partners and believes firmly in loyalty and commitment. Its programs are widely recognized nationally.  Thus begins the Sequel for Pomegranate.

[Photo credit: Sequel Pomegranate Team member, Devon Queener (L) shares a Philadelphia Sixers chat with  Jack Rachko, VP and Chief Culture Officer of Sequel following the 3rd shift All Staff peresentation.]

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Pomegranate Health Systems acquired by Sequel Youth and Family Services, Inc.

Pomegranate’s 70 bed secure residential inpatient center for psychiatry and 20- bed acute hospital for teens age 12-17 has been sold to Sequel Youth and Family Services, Inc. a national provider with some 43 programs catering to the needs of youth and families.

Columbus, Ohio  (PR Web) November 9th, 2016

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Angela Nickell, CEO announced that Pomegranate Health Systems of Central Ohio, Inc. was acquired October 27th by Sequel Youth and Family Services, Inc.  Sequel’s comprehensive spectrum of services include long term  residential treatment, short term impact programs, shelter care, therapeutic group homes, therapeutic foster care, community based services, in-home services, alternative education programs and psychiatric residential treatment facilities (PRTF).

“Populations Sequel serves include adjudicated and at- risk delinquents, children with autism, children, adolescents and adults with physical disabilities or sexual, substance abuse, emotional or conduct disorders.  Sequel facilities offer expertise in juvenile justice, trauma-informed care, ranch settings, eating disorders, special education, and a range of treatment environments oriented toward a youth’s specific needs,” said Nickell.

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Pomegranate was built in 2008 and completed a residential expansion to 70 beds late fall of 2014 and a previous expansion of its acute hospital to 20 beds in 2013. The 54,000 square foot inpatient psychiatric facility has been consistently at capacity before and since.  “Joining Sequel will be a good fit for us as they bring expertise and infrastructure to us as we continue to grow to meet the needs of Ohio’s youth and families-and beyond,’ said Nickell.

Tom Kenny, Regional Vice President explained, ‘Sequel is a privately-owned company founded in 1999 that develops and operates programs for people with behavioral, emotional or physical challenges.  The company expanded to 43 programs located in 17 different states with nearly 4000 employees, literally coast-to-coast.  They also don’t acquire just anybody. This is strategic.’  Kenny and VP HR Roy Day were on hand to meet and greet Pomegranate associates gathered in the cafeteria to receive Sequel windbreakers at receptions for all three shifts.  The company will keep the existing Pomegranate name and logo as it becomes, Sequel Pomegranate.

photo-3 Tom Kenny,  Roy Day

Day told the team that there wasn’t a big top heavy corporate facility, just a resource-support center in Huntsville Alabama, and that each site functions as an individual corporate office.  ‘You’re not just joining Sequel; we’re joining Pomegranate.  You do some very challenging and amazing work. You should be proud of yourselves,’ he said.

Sequel Pomegranate treats mental health disorders, behavioral health disorders, teens referred in crisis- with suicidal or homicidal ideation or psychosis, teens in need of shelter care, or facing juvenile court charges. Its treatment options include an integrative structured program featuring individual therapy, group therapy, family therapy, art therapy, and case management with medical/nursing care 24-7.  Pomegranate is licensed and certified by The Ohio Department of Mental Health and Addiction Services and Accredited by The Joint Commission on Hospital Accreditation.  It is a member of The Ohio Hospital Association, OACCA Ohio Association of Child Caring Agencies and BBB Central Ohio.

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Anger. A diagnosis?

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Consider anger:  both inwardly directed (self-harm), and outwardly directed (rage).   What are the potential outcomes with a failure to control oneself?  Here’s a fictitious (but representative) example.  Nina could no longer manage her daughter, Reanne. Reanne would ‘go off’ and get scary. She threatened and shoved her mom, got in her face, broke glasses and dishes, punched the wall, kicked the dog, threw chairs and grabbed a kitchen knife and slashed the furniture. Locked in her bedroom, Nina had to call the cops.  Reanne’s dad had been abusive towards both of them; she harbored hatred towards the man who had even harmed her grandparents and eventually abandoned them all, but hated her mom more for putting up with it.

“In the United States, more than 60% of adolescents have reported at least one angry outburst that resulted in violence, threat of violence, or destruction of property. Of  these young people around 8% meet the DSM-5 criteria for intermittent explosive disorder (McLaughlin, et al., 2012). Although the disorder can persist throughout the lifespan, symptoms are most likely to begin in individuals younger than 40.” http://www.theravive.com/therapedia/Intermittent-Explosive-Disorder-DSM–5-312.34-(F63.81 Theravive Heather Sheaffer, MA, LCSW

In another (fictitious, but representative) example, young Tim flew off the handle even as a pre-school child. Faced with excessive demands in the home, his law enforcement dad encouraged him to ‘be tough’ and berated him for being a cry baby, even with a concussion and possible fracture from extreme sports. Forced to fight to protect himself, Tim developed a deep-seated rage and expressed it by blowing things up and shooting stuff, and spending hours playing violent video games, a loner. Acquaintances at school described him as, ‘angry and kind of weird; unpredictable’.  His speech became increasingly threatening.

“Onset of intermittent explosive disorder usually begins around age 12 (McLaughlin, et al., 2012), but can be diagnosed in children as young as six (American Psychiatric Association, 2013). At least 80% of patients diagnosed with experience an explosive episode at least once per year throughout the lifespan (McLaughlin, et al., 2012). Although no direct cause of intermittent explosive disorder has been identified, several studies have linked the disorder to childhood trauma. In addition to being high among those in military service, high rates of intermittent explosive disorder is also found among individuals who has survived abuse, assault, and human rights violations.” Theravive-Sheaffer

The classic question of trauma-informed care, not, ‘what is wrong with you, but what has happened to you?’ might hone in on one cause of the disorder, though there are many reasons a person experiences toxic anger. A classic question in the mindfulness movement is to ask the emotion what it is telling you. For some, it can be experience of an exceptional injustice, grief, or outrage over being shamed.  ‘It can manifest in not being able to be in a regular school to more of a bipolar manifestation to outright homicidal ideation – perhaps at perceived bullying,’ explained Pomegranate therapist, Erika B. ‘Coupled with hormonal fluctuations and disruptive life events, an adolescent may experience difficulty coping.’

We’re most apt to hear about road rage incidents in the media, as anger gone wrong. The Public Children Service Association of Ohio Factbook 2015-2016 showed primary reason for removal: 20% neglect, 17% dependency, 8% physical abuse, 2% sexual abuse, 15% delinquency/unruly and 38% ‘other’. (There were 1,966 children in custody 1/1/14).

“The DSM-5 explains that because of the violent and intimidating nature of intermittent explosive disorder, the patient is likely to experience significant impairment in many areas (American Psychiatric Association, 2013). Common behavioral manifestations of intermittent explosive disorder include road rage, domestic violence, child abuse, and property damage. Violent and aggressive behavior creates a sense of distrust among family members and friends. (Morland, et al., 2013). Relationships are likely to suffer.” Theravive-Sheaffer

Pomegranate staff receives training in crisis intervention protocol, HBS-Haugland Behavioral System (previously in CPI Crisis Prevention Institute), for when teens become disruptive and have difficulty with impulse control or maintaining themselves safely.

In another real example, client ‘Monica’ hung back after lunch, and became agitated, then, alternatively tearful and shouting. A ‘big brother’ mental health associate stayed with her while another ‘big sister associate’ immediately came and began encouraging her to talk it out, walked with her through a calming sequence, and the issue was successfully resolved. It’s not easy working with anger, yet anger management & resolution is an essential skill in a civilized, healthy functioning society.

https://www.psychologytoday.com/blog/resolution-not-conflict/201305/got-anger-disorder-not-according-the-dsm

http://www.dsm5.org/Documents/Disruptive%20Mood%20Dysregulation%20Disorder%20Fact%20Sheet.pdf

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Pomegranate Acute Hospital Updates Visiting Policy and Programming

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Pomegranate’s  Acute Hospital recently updated the visitation policy to encourage more family involvement and support for the youth.   Visitations may take place Monday through Friday from 4pm until 7pm.  On Saturday and Sunday hours are from 2pm until 5pm.  Visitation is up to an hour.  Out of town visitors can make adjustments in advance.

The reason behind Pomegranate’s visiting policy is, and has always been, adequate programming time for a teen in crisis.  If a teen is visiting with family, he/she is not in therapeutic programming, individual or group session, or art therapy.  There is time scheduled for family session/s, but it’s not the same as visitation time.  Another change to both residential and acute is that families are being asked not to bring in food or drink.  We provide that here at Pomegranate. Snack and beverage selection is available.

New acute program director, Darci, is working on additional updates and adjustments to acute policies, programming, and family time. Many innovative approaches are in planning. Some new additions include Family Game Night where guardians are asked to join on the unit for an hour of games and prizes.

Additional programming includes Talent Showcase, Carnival Night, Trivia Night and Fitness Night. This serves to recognize that while the youth are here for treatment, they are still teens and need to feel supported by and connected with others. The therapeutic milieu is designed to ensure that the youth are engaged in structured programming throughout the entire day, working towards their treatment goals at every possible opportunity.

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