New Tools for Difficult Conversations with Youth

It’s never easy to know what to say when a child is in an emotional crisis, but the counselors at three YMCA summer camps may have added some tools to their belts after a training by Samantha Thomas and Lance Metayer of Northwestern Counseling & Support Services. There were about 100 counselors in attendance from Camp Abnaki in Grand Isle; Camp Koda with locations in Burlington, Georgia, Waterbury, and Essex; and Camp Greylock in Ferrisburgh. The training focused on mental health in youth and traumatic stress in childhood, topics that are all too often unexplored and misunderstood.

One of the most powerful messages behind the training was in the way we think about mental

Samantha Thomas presents to the group

illness and mental health crises. Samantha Thomas, Team Leader for the Children’s Initial Response Team at NCSS, phrases it as a paradigm shift.  When we alter our questioning from “What’s wrong with you?” to “What happened to you?”  and “Why are you acting that way?” to “Why are you reacting that way?”, we respect each individual’s experiences.  A child’s behaviors may suggest intent, yet often the behaviors of traumatized children are not intentional; they are reactions, or stated differently, these behaviors are coping mechanisms learned over time.

These coping mechanisms can be misperceived as manipulation, intentional defiance, and aggression for example, says Thomas. A child with complex trauma—multiple traumatic events overtime, often within the childcare-giving system—may act out due to a trigger in their immediate environment.  These behaviors often stem from a child’s trauma history.  Behaviors that are rooted in traumatic experience, such as name calling, can appear to be plain old aggression. It is certainly challenging not to take it personally when someone is yelling and calling names, but these behaviors are what the child has learned to do in the moment to navigate their experience and feel safe.
Other questions and approaches become more natural when one makes that paradigm shift.

Lance Metayer presents to the group

Thomas and Metayer would like counselors to use language that expresses clearly what they want the child to do in the midst of an outburst or crisis, not what they want the child to stop doing. In moments of crisis, a child may not know what an adult expects of them. “We’d like adults to ask questions like ’What is it going to take to help this child regulate and get in a better space? What are some strategies I can use to help calm them so they can process?’” explains Thomas.

Some common triggers for traumatized children may seem banal: transition from one setting to another; noises such as slamming doors or ringing bells; redirections from teachers and peers. While many young people have developed coping skills to manage these everyday situations, children who have experienced complex trauma are acting in whatever manner they have determined will keep them safe within an environment they assume will cause them harm.  Some possible Adverse Childhood Experiences, known as ACES, are exposure to domestic violence; parental substance abuse; sexual or physical abuse; neglect; poverty; caregiver incarceration.  The prevalence of Vermont children who have experienced one ACE is 50.6%, compared to the U.S. prevalence of 47.9%. The prevalence of Vermont children who have experienced more than one ACE is 23.3%, compared to the U.S. prevalence of 22.6%, according to www.childhealthdata.org.  

ACEs often last a lifetime, but they don’t have to. Healing can occur. The cycle can be broken. Safe, stable, nurturing relationships can heal the caregiver and child. “One misperception about mental illness is that there is no recovery,” says Lance Metayer, who works for NCSS as the project manager for Aware Vermont, a statewide initiative that brings no-cost Youth Mental Health First Aid training to educators and communities throughout Vermont. Many of us might think of traditional talk therapy as the only treatment, “but the truth is, everyone can help,” Metayer says. While that may be true—that we can help—talking about mental illness is not always easy. Trainings like the one recently offered at Camp Abnaki may make those conversations feel a bit less intimidating.  
Other more physical health issues are comfortable topics for everyday conversation in ways that mental illness is not, and the difference is not always explicable. Going to the doctor for a

swollen knee, chronic migraines, or high blood pressure is often something people are more than willing to share with their family, friends or co-workers. But mental illness is not viewed through the same lens. It’s rather shocking to consider the level of stigma related to mental illness, given that 1 in 5 people will experience a mental health condition in their lifetime. There are two kinds of stigma: public stigma and self-stigma. Public stigma is the reaction the general population has to those with mental illness. Self-stigma, which can be very damaging, is the prejudice one turns against oneself. And what is more powerful than the things we believe about ourselves. Stigma often prevents people from accessing care and talking about what is going on. Yet, talking about mental illness is just the way to normalize it.

Trainings like this can be particularly helpful in helping people feel more comfortable talking about suicide. “There’s a big misperception that if you ask someone about suicide, you will drive them to it,” Metayer says, “and that’s not true.” Another myth is that if someone speaks about suicide, they are not serious about their thoughts; in fact, talking about suicide may reveal the true depth of someone’s feelings. There are some common warning signs of suicide: withdrawing from family or friends, having a dramatic change in mood—sometimes an individual with a plan will appear extremely happy. Other warnings signs may be sleeping all the time, being unable to sleep, and giving away prized possessions. In the training, the counselors were reminded of the importance of asking the question directly, learning the warning signs, and reaching out to the crisis system if a situation seems dire. One should not avoid the direct questions. Asking, “Are you having thoughts of suicide?” with confidence can actually be reassuring for an individual with suicidal thoughts.

The reality is that camp is inherently a healing structure, Thomas points out. “The routine is established; the expectations are clear.” At camp, the counselors build strong, personal relationships with the campers. And with that, “counselors are sometimes the best people to provide an intervention,” notes Metayer.



Thomas and Metayer with Sara Robertson Ryan, Director of School Aged Programs
and Jon Kuypers, Director of Camp Abnaki

The training also touched on ways that leadership can approach policy from a trauma-informed care lens. There are guidelines or policies that businesses, schools, or camps might have held for a long time, and so they feel customary and comfortable. Metayer explains that looking at those policies through a trauma lens pushes leadership to ask questions about current processes: Does this process feel comfortable for everyone? Does it cause any harm? Does it call anyone out? Does it make anyone feel unsafe?

Thomas and Metayer were impressed by the counselors who took this training. They were a very thoughtful group who genuinely cared about the kids they worked with at camp. Several counselors asked pointed questions about kids they had worked with before and what a meaningful intervention would have looked like.

It is never easy to have difficult conversations with loved ones, friends, strangers, or those we meet at camp. Talking about mental illness makes it feel just a little more normal, which is powerful, since it is all around us.

 Written by Meredith Vaughn

 

AWARE VERMONT is a statewide collaboration between state designated mental health agencies (DA’s), identified youth serving community partners, the Vermont Cooperative for Practice Improvement and Innovation and Vermont Care Partners.  

The development and implementation of AWARE VERMONT is made possible by a grant from Substance Abuse and Mental Health Services Administration (SAMHSA).  For more information about AWARE VERMONT or to sign up for a training near you, contact Lance Metayer at lance.metayer@ncssinc.org or 802-582-8039.

 

 

A Most Natural Approach



Amy Anderson smiles as she repeats the phrase. “Dignity of risk and the right to fail.” She lets the phrase sit quietly for a moment before she continues. “Being a human means you can choose to do something or not do something. It doesn’t matter what I think you should do; it belongs to you,” Amy says. Amy feels the importance of breaking assumptions about people with intellectual and developmental disabilities. There is a sense sometimes that everyone with a disability is the same, she states, but we should really be asking ourselves, “How are we all alike? What about our dreams, passions, and fears?” Amy works directly with clients a few days a week as well as in the Learning for Living program, which aims to provide independent living skills to individuals with intellectual

Amy Anderson and Randy Lizotte

and developmental disabilities. She also acts as a coordinator for the peer training team and as an ally for the Next Step Peer Support Group, which gives her multiple contacts with clients and allows for relationship building.

Many people are told what to do their whole lives, Amy notes, and part of being a peer advocate is demonstrating what it looks like to make choices and speak up for yourself in a way that works for you. It’s giving people the confidence to speak up without fear of retribution. It’s believing in them,” Amy says simply. Heather, a peer advocate, sits next to Amy with her hands folded tidily across her lap. “Amy believed in me when I was studying for my learner’s permit and I actually got it.” Her face lights up as she recalls her triumph.
We all know how hard it can be to speak up for ourselves, especially if we feel like it’s not our place or we don’t have the right to express our opinions. Maybe we don’t know what to say. Or we just don’t want to do it alone.

Green Mountain Self Advocates (GMSA) is a statewide organization with a purpose of supporting people with intellectual and developmental disabilities to take control of their lives, solve problems, make decisions, and advocate for themselves. GMSA offers assistance with voting registration and helps to unify voices at the state level to affect legislation by offering information and education about the legislative process, as well as accommodations to allow groups face-to-face opportunities with politicians. About 15 years ago Randy Lizotte became a member of GMSA and he has served as president of the Board since 2010. Self-advocacy has always been Randy’s passion. He actually met his wife at a GMSA meeting, and two and a half years later, he moved to St. Albans where his wife resided. Shortly after Randy began volunteering at NCSS, there was a job posting in the Developmental Services division, which Randy landed right away.

GMSA started out as a small self-advocacy group in Burlington and has now expanded to a network of 23 local groups located in towns across the state, including the St. Albans’ group. Next Step, the St. Albans GMSA group, meets every Friday at the Academy of Learning, one of NCSS programs within the Developmental Services division. Though the group is not affiliated with NCSS, Kathy Brown, Developmental Services director, wanted to show her support for the group by offering up NCSS space as a meeting zone. “It is an honor to be given

Academy of Learning

access to the Next Step peer advocates voices,” Kathy says. “They are insightful, honest, and dedicated to pushing all of us at NCSS to deliver person-centered services. The Next Step peer group has allowed our Local Standing Committee to join them monthly; this unified collaborative gives a significant consumer voice to all our new initiatives and divisional decision making.”

Amy feels grateful that there is such support and that their group is valued. “It’s really cool,” she says brightly. “It’s a real luxury at NCSS to work with open-minded, flexible people,” she adds.

Individuals in the Next Step group share in a confidential setting and participate in activities like the monthly movie showing, the occasional bowling trip, or the rare excursion to the water park. Heather has been a part of Next Step since 2008. Her first meeting was made a little easier, she remembers, because she knew someone in the group, and it quieted some of her discomfort about showing up to a room full of strangers. Now, she couldn’t feel more comfortable. “The meetings are mostly run by us, peers, not by Randy and Amy,” she notes proudly. “I have confidence in everyone that’s there.”

Even though the group is accommodating and accepting by nature, it doesn’t mean showing up the first time is free of anxieties. Randy, nodding agreeably, eyes Heather as she recalls her first group. He, too, felt nervous when he attended his first group. “You don’t quite know your role right away,” he explains. “I had to learn what I was good at, discover it on my own. Had my good points and things I had to work on. Work on this, accomplish that.” Self-advocacy is something you learn as you go along. Heather and others in the group help with these anxieties by providing welcome baskets with information and goodies.

Amanda, short-haired and bespectacled, chimes in. “The group helps me connect with people. I’ve made a lot of friends. I met some people I otherwise wouldn’t have, and it got me out of my shell.” Finding this kind of genuine support feels incredible for anyone; it offers an even deeper layer of support for individuals with disabilities, who can be at higher risk for social isolation. The peer 

Amy Anderson and Randy Lizotte

support group offers a non-judgmental setting to discuss personal issues and concerns. Sometimes the concerns shared are about services received, and that’s okay. Amy points out that receiving services can something feel controlling, especially if an individual does not feel as if they have a voice to contribute to the conversation about how their services are delivered. These feelings are by no means a slight to providers—who always aim for the highest quality of care—but we all need a little support sometimes in asking for what we need and articulating our fears, desires, and hopes.

As an alternative to asking someone to speak up solely for themselves, Randy and Amy can help to facilitate peer support within an Individual Support Agreement (ISA) meeting. This aspect of peer support really inspires Heather who loves to “help people speak up and help them talk with their case managers about their dreams and goals.” Heather can sit there with her friend and guide them through the difficult conversation. If her peer so chooses, Heather may speak for them based on what they discussed ahead of time.
Someone may feel they need help making their feelings clear, but it doesn’t mean they need to speak alone. Self-advocacy is a choice.

 

 “There’s a real community for people with disabilities now where there wasn’t before,” says Amy. When it comes to advocacy, most of Amy’s background was in crisis management and recovery services. Her work at NCSS within peer advocacy felt new. “I was used to speaking for those who couldn’t, but stepping aside is new and encouraging. Helping people speak up for themselves has really worked for me,” she says.

Randy and Amy both believe that peer services will be the future of care, and that makes sense when considering the ripple effect the groups have had on individuals. There have been fewer calls to crisis because, now, people are calling their friends instead.  “Peer to peer support is the most natural approach in all of our lives,” says Kathy Brown. “NCSS is very fortunate to have such a strong cohesive group of men and women helping to guide our future.”

 

Written by Meredith Vaughn

A Spectrum of Services

There are many types of autism and understanding of its causes and diagnoses have changed over time. In 2013, four diagnoses that were once separated in the Diagnostic and Statistical Manual of Mental Disorders (DSM) were combined into the umbrella diagnoses of Autism Spectrum Disorder (ASD) in the DSM-5. These four diagnoses were autistic disorder, childhood disintegrative disorder, pervasive development disorder-not otherwise specified (PDD-NOS), and Asperger syndrome. ASD in more prevalent in boys; the Centers for Disease Control and Prevention estimates the prevalence of ASD as 1 in 68 children in the United States.

Autism is a complex brain-based disorder that affects a person’s behavior, social and communication skills. Symptoms can range from mild to severe and no two children with autism are exactly alike. Each person with autism, like all of us, has unique strengths and differences. Common problems exhibited by those with ASD are difficulty in social situations; some never learn to speak, while others speak, but use language in unusual ways. Others are sensitive to loud noises or bright lights. There is no single treatment for autism, though many benefit from highly structured educational programs and other services. You can visit our website for more information about these services.

If a child is diagnosed with autism, early intervention is critical to gain the maximum benefit from existing therapies. In addition, after children have been diagnosed by psychologists, developmental pediatricians, psychiatrists and neurologists, the need for treatment and services are abundant.

At NCSS, there are several programs designed to serve individuals with autism. The School-Based Autism Program assists local schools in providing effective, strengths-based interventions and programming for students with ASD, intellectual and developmental disabilities and/or Down Syndrome. The program is based on the principals of Applied Behavior Analysis (ABA); students typically need a behavior support plan to help decrease maladaptive behaviors while increasing prosocial and coping skills. 

We, at NCSS, believe that students, regardless of their abilities, belong in their local community schools. The school-based services include behavioral interventionists, available on a one-on-one basis; individualized services like this provide opportunities for students to maintain positive relationships with peers and access their education on a level that works for them. Behavior specialists, autisms specialists, service coordination and case management are also available.  The programming is flexible and the child drives the program, making service delivery unique and individually tailored.

The Program for Adaptive &Expressive Arts (PAEA) offers therapeutic and recreational music, art and sensory exploration experiences to children and adults with autism and developmental disabilities as well as communication supports and socialization opportunities. Like the services within the School-Based Autism Program, PAEA sessions—private and group—are consumer-driven, allowing individuals to explore personal goals set by them and their support teams. Music, art and sensory exploration offer emotional, social, and physical benefits by facilitating creative expression, fine and gross motor skill practice, and stress reduction.

The PAEA music and art room at The Family Center is brightly lit and filled with instruments and art supplies; the space invites creativity! The newly upgraded sensory room provides a relaxed space with a variety of sensory stimulators that can enervate or calm depending on the participant’s needs.  At NCSS’ various events, such as the Buddy Walk and the Autism Walk, you can find the PAEA Team at their station, a large table full of instruments and sensory items. PAEA also offers workshops in cooperative play, family life and sexual health, American Sign Language (ASL) and Alternative and Augmentative Communications (AAC). There are seasonal concerts and recitals and art shows where everyone can show to the community-at-large what they’ve accomplished!

Camp Rainbow, a creative summer camp for children with autism or other developmental disabilities, provides stimulating activities such as swimming, singing, crafts, outdoor play and more. Camp Rainbow incorporates sensory exploration, fine/gross motor skills, communication skills, academic skills and social skills into the activities each day. This year, Camp Rainbow will run from August 7-August 11, 2017 and be held at the Soar Learning Center. And who knows…there might be some surprises in store! You can find registration information here by visiting our website.

The Applied Behavior Services team of Northwestern Counseling & Support Services provides treatment in the home, community setting, and in our new building, the Applied Behavior Center. Services are provided to children of all ages diagnosed with Autism Spectrum Disorder and other developmental disabilities using Applied Behavior Analysis (ABA). This team adheres to best practices and ethical guidelines of ABA.

Each program is tailored to meet the needs of the individual child and their family, with a strong emphasis on specific skill acquisition, behavior, and communication. These skills are taught through ABA and B.F. Skinner’s model of Verbal Behavior. Individual acquisition and behavior management programs are created from individual assessments.

Skills are reassessed frequently and progress is monitored and measurable via weekly data tracking. Teaching strategies and content are modified as needed to fit each child’s needs and all teaching techniques are based on what research studies have proven to be the most effective.

Program Components:

• Functional language skills: vocals, sign language, picture exchange communication system

• Consultative model consisting of parent training in ABA procedures

• Self-care: toilet training, tooth brushing, dressing, shoe tying

• Reductive procedures for non-desired behaviors

• Video modeling

• Skill acquisition

• Social stories

• Social skills

 

NCSS believes daily programs for people with autism or intellectual and developmental disabilities should also be unique and individualized to each person’s specific needs.

we’re here for you

Winter's Effect

Vermont is a wonderful place to live for many reasons—clean air, open space, small town charm—but it also offers its challenges, especially in the winter.  Anyone who has spent considerable time in Vermont and lived through a winter can recognize the trouble! It’s frigid, windy, dark, wet, and long.

While many of us might feel a bit starved for sunlight or warmth during the winter months, for some people, the seasons can have a dramatic effect: seasonal affective disorder, or SAD, is a condition that can have a tremendous impact on a person’s well-being. SAD is a form of depression that comes and goes depending on the time of year. Spring-onset SAD—a type of SAD that starts in the spring and goes away in the fall and winter—can truly impact someone’s life, though it is much less common than the most common form, fall-onset SAD, a type of SAD that starts in late fall and goes away in the spring and summer.

Individuals with fall-onset SAD might notice increased appetite, especially for starchy and sweet foods; low energy; increased sleep; weight gain; hypersensitivity to rejection; feeling of heavy arms and legs; and irritability. Dr. Steve Sobel of NCSS says that individuals experiencing these symptoms often have to distinguish their feelings from other possible triggers in the season, such as the holidays, which can be a real stressor for many. There are plenty of things in everyday life that can make us feel blue from time to time, or make us want to indulge in carb-heavy meals and sweet treats; but if an individual experiences these symptoms for days at a time, they should not be tempted to brush them off. Like with other forms of depression, SAD can worsen if not treated.

A primary care provider can be a great resource; depending on the severity of the symptoms, varying treatments are available. For mild symptoms, phototherapy (light therapy), talk therapy, and lifestyle changes can be effective. Talk therapy can be helpful in managing symptoms, and individuals might be less likely to experience SAD in the future. Being diagnosed with depression with a seasonal pattern might indicate that an individual is more likely to experience SAD year after year; it doesn’t guarantee it. For those whose symptoms are having a pronounced and significant impact on daily life, medication, along with other treatments, might be considered.

There are several lifestyle changes—some of them small—that can improve symptoms associated with SAD.

1.       Try to go for a walk during the day. Even if it is cloudy and cold outside, outdoor light can help.

2.       Expose yourself to as much sunlight as possible. If you have a window in your office, open up the curtains or blinds. If you work on a desk at home, try to move your desk closer to the window to soak up as much light as possible.

3.       Incorporate exercise into your daily routine. Exercise is beneficial on so many levels; it can increase self-esteem, relieve stress, and help you sleep, all of which can reduce SAD symptoms.

It’s not always easy to work up the energy to go for a walk or get outside when it’s blustery and cold. Good news is, spring is right around the corner!

 

Check out these links for more information about SAD:

http://www.nami.org/About-NAMI/NAMI-News/Less-Sunlight-Means-More-Blues-for-Some

http://www.apa.org/helpcenter/seasonal-affective-disorder.aspx

Written by Meredith Vaughn