All posts by Mark Wilhelm

National Child Abuse Prevention Month 2020: Keeping Children Safe in the Age of “Social Distancing”

“The true character of a society is revealed in how it treats its children.” — Nelson Mandela

We have long known the harmful effects that childhood abuse or neglect (also known as “child maltreatment”) can have on a person’s life. Child maltreatment can lead to long-lasting negative consequences for an individual’s physical and psychological health and create behavioral issues that persist into adulthood. However, it is still shockingly common. In 2018 alone, an average of 9.2 out of every 1,000 children—a total of 678,000 children—were the victims of child maltreatment in the U.S., according to the 2018 Child Maltreatment Report from the Children’s Bureau of the U.S. Department of Health & Human Services. In Indiana, the rate was 16.4 out of every 1,000 children, making our state the 9th highest in the country for reported instances of child abuse.

The Federal Child Abuse Prevention and Treatment Act, passed in 1988, defines child abuse and neglect as “any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.” Since abuse is often perpetrated by a member of the immediate family, the burden of detecting and reporting abuse typically falls on the shoulders of adults outside the family, such as teachers, counselors, relatives, neighbors, medical professionals, religious leaders and members of law enforcement.

However, the ongoing COVID-19 crisis has made it much more difficult for victims of child abuse to receive help. School closures and social distancing guidelines have given children fewer opportunities to interact with individuals who could provide assistance, which means that we must all be more vigilant about detecting abuse. This sentiment is shared by Kevin Carr of Sheltering Wings, a domestic violence shelter based in Danville, IN:

“When families are isolated, the reporting structures for abuse are interrupted. Victims are in closer proximity to their abusers and at the same time are isolated from anyone who could offer help. The primary message we’re trying to convey right now is that neighbors, ministers, therapists—anybody who has the chance of interacting with the family—need to be watching and observing when possible. That takes some skills that we’re not all used to using, or maybe we haven’t developed, but we have to become better at watching and listening closely and being able to interject in ways that are not only helpful, but safe. We’re responsible for each other, and everyone has a part to play.”

Kevin Carr, Development and Communications Officer at Sheltering Wings
Kevin Carr, Development and Communications Officer at Sheltering Wings

In light of the heightened risk of abuse that children are currently facing, and in honor of National Child Abuse Prevention Month, we spoke with Raychel Hamby, one of our care providers who works in coordination with the Indiana Department of Child Services (or DCS). In this post, Raychel explains how we can all spot warning signs of abuse in the children we interact with, including the proper way to respond when abuse is suspected.

Raychel Hamby on the Warning Signs of Child Abuse

Raychel Hamby, LMHC, Montgomery County DCS and Outpatient Team Lead at Cummins Behavioral Health
“I’m the point-person and liaison in our county for all of our services that we provide to those in DCS,” says Raychel Hamby, LMHC, Montgomery County DCS and Outpatient Team Lead at Cummins Behavioral Health.

For many of us, the best thing we can do to help prevent child abuse is know how to detect it. Although some children will speak up about abuse before it becomes severe, many others unfortunately will not. “Through my experience working with DCS for so many years, it really depends on the child’s personality and the family values,” Raychel explains. “In families that teach ‘what happens here stays here,’ those children typically won’t explicitly tell you what’s going on unless it becomes so severe that they finally say something.”

However, there are many telltale signs that professionals who work with children use to spot potential abuse. While these signs do not guarantee that abuse is occurring in the home, they do warrant additional scrutiny and investigation. The presence of multiple signs typically indicates a greater likelihood of abuse.

According to Raychel, here are some of the most common signs of abuse that behavioral health professionals look for when working with children:

  • Suspicious bruises: Bruises that seem unlikely to have resulted from regular play, such as bruises on the face or bruises in the shape of handprints, are some of the most common signs of physical abuse. “The child may say, ‘I fell down the stairs,’ but if you know there are no stairs in the house, then you know that story is not true. And if it’s the middle of summer and the child’s wearing long-sleeve clothes, then the parents may be trying to cover up the bruising,” Raychel adds.
  • Cowering behavior: Physical abuse can also cause a child to develop an instinctive fear response to adults. “When you approach them, they become scared and cower,” Raychel explains. “They’re so traumatized that they feel threatened and respond fearfully to any type of authority figure.”
  • Violent behavior or excessive anger: Alternatively, a child may internalize the violence of physical abuse or perpetuate it as a way of coping. “They could be acting out and hitting other kids, or they could become angry in situations where that level of anger is not appropriate,” Raychel says.
  • Isolating behavior: A child who is being emotionally abused may exhibit signs of developmental regression, which frequently manifests as isolating behavior. “If you know the child is typically outgoing, and all of a sudden they’re isolating and don’t seem like their normal selves, that could be a sign of emotional abuse,” Raychel says.
  • Low weight or frequent requests for food: If a child is underweight or emaciated in appearance, then they might not be receiving enough food at home, which could be a sign of neglect. The likelihood of neglect is even higher if the child frequently comments that they are hungry or asks others for food.
  • Lack of parental supervision: Children who spend a lot of time outside the home without supervision might also be suffering from neglect. This particular sign often indicates that the parents may be using substances. “A major concern for DCS right now is families that are using substances,” Raychel explains. “The children run the street and usually get in delinquent behavior, or they may be using substances themselves.”
  • Many people going in and out of the home: High volumes of traffic in and out of the child’s home can also indicate that their parents are using substances, especially if you don’t recognize the individuals as family members or friends of the family. If the child also exhibits behavioral issues, then neglect as a result of substance use is likely.
  • Rarely spending time outside the home: If a child is rarely seen outside the home, there’s a chance that they are suffering abuse and their parents are attempting to isolate them from others who could help. “Does the child not get to go outside, or if they do, do they have to come back in after a few seconds? Sometimes these are signs of abuse because the parents don’t want others to see the child,” Raychel explains.
  • Cries for help on social media: Finally, children who are suffering from abuse may use social media to alert others to their situation. However, they will typically only hint at their emotional distress rather than disclosing the full nature of the abuse that’s occurring. “In one case I’m working on, the daughter was posting on social media about suicide,” Raychel says. “Her parent’s mental health had gotten so bad that she just wanted out of the situation, and that was a sign of neglect that got DCS involved.”

What to Do If You Suspect Child Abuse

The second component of effective child abuse prevention is knowing how to respond when abuse is suspected. If you believe that a child is suffering from abuse, it is highly inadvisable to confront the suspected abuser directly. While you may feel that it’s your duty to personally put a stop to the situation, it is often wiser to bring in child welfare professionals.

“If your gut is telling you that something is going on in a home—abuse, neglect, substance use, anything of that nature—it’s best to make a DCS Hotline report,” Raychel says. The Indiana Child Abuse and Neglect Hotline is answered 24 hours a day, seven days a week (including all holidays), and the identity of callers is never disclosed outside the agency. Once a report is made, DCS will determine the likelihood that abuse is occurring, send out an assessor if appropriate, and begin the necessary procedures to address the situation.

In addition to securing a safe living environment for the child, DCS may refer them or their parents for services with a behavioral health provider like Cummins BHS. As Raychel explains, the type of support provided can vary widely based on the circumstances:

“We do an intake assessment, make the appropriate recommendations, and then follow up with the family. In general, our heaviest involvement is due to substance use. In extreme cases, the child may be removed from their parents, and the parents would complete substance use treatment. We also have cases where a child isn’t attending school due to their parents’ substance use, so we would help the parents develop structure and address whatever is keeping the child from getting to school. We also work with kids who’ve been through trauma—sexual abuse, emotional abuse and physical abuse—that are in foster care. DCS will usually get us involved to help the foster placement provide support and nurturing to the child they have in their home, because the child will probably have behavioral issues from the trauma.”

The safety and well-being of children is always the top priority when abuse has occurred, but it should be noted that protective services never wish to break up families. Whenever possible, the intention is to rehabilitate abusers and mend fractures in family harmony. As Raychel Hamby says, “Our goal when we get involved is always to assist the family in reunifying. Our goal is never to keep the children away from their family, but to help the family establish healthy boundaries, structures and routines.”

During these challenging times, we are all responsible for the well-being of our most vulnerable community members. If you suspect that a child you know is suffering from abuse, please call the Indiana Child Abuse and Neglect Hotline at 1-800-800-5556 to make a report. Your call may be the critical first step in protecting a child!

Looking for more information about domestic violence and children’s behavioral health? Here are a few more articles we recommend!

Giving Domestic Violence Survivors a Chance at Independence: Cummins BHS, Sheltering Wings and RealAmerica Announce Haven Homes
How Avon Community School Corporation and Cummins BHS Are Supporting Students’ Mental Health

Addiction Treatment for Teens: Introducing Adolescent IOT with Madelin Biddle and Katherine Richards

Despite the efforts of dedicated health care professionals and organizations, substance use continues to be a major behavioral health issue for millions of people across the U.S. According to the National Survey on Drug Use and Health, approximately 20.3 million Americans suffered from a substance use disorder (or SUD) in 2018. In Indiana, the estimated number of afflicted Hoosiers totaled 389,000.

Although not everyone who needs treatment for SUD ultimately receives it, there are today a wide variety of providers and services that can help adults who have substance use problems. However, one population that is sometimes overlooked is teenagers and adolescents. Although 916,000 American adolescents aged 12–17 suffered from a SUD in 2018 (18,000 in Indiana), only 159,000 received any treatment for substance use. In addition, statistics show that the percentage of adolescents with a SUD who receive treatment is consistently lower than among individuals above age 26.

Cummins Behavioral Health has long provided substance use services for individuals who need them, which includes our popular Intensive Outpatient Treatment (IOT) program, but they’ve sometimes been difficult to cater toward adolescent populations. However, we’ve recently launched a virtual IOT program specifically for youth and adolescents to meet the needs of this age group.

To learn more about the specifics of this new program, we spoke with two of its facilitators: Madelin Biddle, one of our school-based therapists, and Katherine Richards, a graduating intern in substance use counseling. They explained the origins of the adolescent IOT program, how it has been received by consumers, and what plans are in place for its future.

Addressing a Difficult-to-Meet Need for Teenage Youth

Madelin Biddle, MSW, LSW, and Katherine Richards, MSW
Madelin Biddle, MSW, LSW, school-based therapist (left) and Katherine Richards, MSW, graduating intern in substance use counseling (right)

Although Cummins’ adolescent IOT program is brand new—it started in Putnam county on April 27th—the need for this type of program is not. “I’ve spoken about it extensively with [Director of Operations for Montgomery and Putnam counties] Rebecca Roy, and she’s been talking about doing this since I first started as an intern a little less than a year ago,” Katherine says.

Traditionally, adolescent consumers who need Intensive Outpatient Treatment for substance use have been integrated into our adult IOT groups. While this policy has allowed younger consumers to receive the treatment they need, they’ve often been unable to undergo treatment with other individuals of similar age. “We had a lot of people who were 17 or 18 in adult IOT, and it very much felt like they could’ve benefited better from a group consisting more of their peers. It was very evident that they would benefit from adolescent IOT, but we just didn’t have one,” Katherine says.

Ironically, the COVID-19 pandemic played a role in finally making adolescent IOT a reality. As most schools remained closed and telehealth services quickly became normalized, some of the obstacles that had previously prevented the program’s implementation were cleared away. “As a school-based therapist, I think the barrier was getting around school schedules. It’s not really our job to pull kids out of school for three hours at a time,” Madelin explains.

“There were also barriers like transportation needs for a lot of adolescents,” Katherine adds. “Being able to do IOT through telehealth has opened doors that were previously closed.”

The Future of Adolescent IOT at Cummins BHS

Although the virtual adolescent IOT program has only been running for a few weeks, early feedback from consumers has been encouraging. “Some of our feedback has been that consumers feel they’re not the only ones who made mistakes and that they feel they can find trust in the group,” Madelin explains.

For some teens, nine hours of group sessions every week seems like a big commitment at first, but Madelin and Katherine have found that many participants end up expressing gratitude for the opportunity to connect with their peers. “When I was first introducing the idea of Group to individuals, I found that the time component was really intimidating for them,” Madelin says. “But I think they’ve been really surprised by how well Group is going. And especially during COVID-19, I think it’s been really beneficial to have that time to meet as a group and that space to talk about substance use with peers where there isn’t such a stigma surrounding it.”

While the program is completely virtual for the time being, there’s a possibility that it will be expanded to include in-person sessions in the future. As with many of Cummins’ services, this depends on how the COVID-19 pandemic changes in the coming months. “We’re waiting to see what happens,” Katherine explains. “If it’s more convenient to continue it online even if restrictions are loosened, then we may do that. But I was hired into my role to do this kind of work, so I believe the intention is to continue the program whether it’s in-person or online.”

In case the program does begin offering in-person sessions, preparations are already being made to remove some of the associated barriers. For example, Area 30 Career Center in Greencastle has indicated that it could assist with providing transportation to and from sessions for students who need it. “I think the intention is to eventually work with Area 30 to reduce that barrier,” Katherine says.

Cummins’ virtual adolescent IOT program is primarily operating in Putnam County at this time, although it is open to individuals living in all counties that Cummins serves. If you or your teenage friend, child or relative is struggling with substance use, we encourage you to call us at (888) 714–1927 and inquire about substance use treatment. Our adolescent IOT program could be a good fit for you or your loved one!

Looking for more information about substance use disorder and Cummins’ SUD services? Here are some more posts we recommend!

Managing Dual Diagnosis: Cummins’ Tracy Waible on How to Identify and Treat Substance Use with Co-Occurring Disorders
Observing Alcohol Awareness Month with Cummins’ Erin Flick and Virtual IOT

Teletherapy for Kids: How to Work with Young Children during Virtual Behavioral Health Sessions

Working with children in a behavioral health setting can be challenging. Care providers may have difficulty keeping young children focused, communicative and engaged in the session even when they are in the same room together. Telehealth sessions with children make this task even harder, reducing the provider’s control over the situation as well as the immediacy of their presence.

We’ve previously shared some tips and best practices for engaging behavioral health consumers via telecommunication, and many of these suggestions can also apply to children. To recap, consumers should be coached through any aversions they may have to virtual care, encouraged to participate with motivational interviewing and rapport-building, and engaged with visuals and activities whenever possible. However, high-quality engagement throughout the session is especially critical with children, as they could easily lose interest when the provider is just a face on a screen or a voice on the phone.

Fortunately, it’s possible to conduct successful virtual sessions even with young children, and a growing body of research shows that telehealth therapies and behavioral interventions for children can be just as effective as in-person treatment. Care providers need only alter their engagement strategy slightly to keep young children interested and interacting in the session.

Dr. Ashleigh Woods, one of our psychologists here at Cummins Behavioral Health, recently held a training seminar to educate our staff on the best ways to work with children over phone or video chat. Her advice can be broken down into two categories: interventions for overcoming technical issues and limitations, and strategies for keeping children engaged during virtual sessions.

Making the Best of Technical Limitations

Ashleigh Woods, Psy.D., HSPP, Staff Psychologist at Cummins Behavioral Health
Ashleigh Woods, Psy.D., HSPP, Staff Psychologist at Cummins Behavioral Health

Depending on the age and disposition of the child, behavioral health sessions with children can be much more “lively” than those with teens or adults. Young children often like to move around, explore their environment and play with objects in the room, especially if elements of play therapy are being utilized in the session. Although these behaviors aren’t usually problematic during in-person sessions, they can cause some disruption when the provider can only see the child through the camera on their device.

Providers can take the following steps to compensate for these technical limitations:

1. Find the best camera position

If you are communicating via video chat (which is recommended over voice-only calls), you should work with the child at the start of the session to determine the best location for your camera. Ideally, you should be able to see as much of the area where the child may be interacting or playing as possible.

“I’ve found in my own work with kids that having the device on the floor tends to work out well for me, because that way I can see more of the space and what’s happening in it,” Dr. Woods says. However, you should also be prepared for this position to change as the child moves to different parts of the room or moves the device, which leads to our next point.

2. Anticipate and be patient about technical difficulties

Providers can save themselves some angst by accepting that no virtual session with a child will go completely smoothly. “As the clinician, we might feel that every minute of the video chat needs to be productive and goal-oriented, but I think that we need to have patience and know that the child is going to wander out of the frame. That’s just a normal part of working in this kind of virtual space with kids,” Dr. Woods says.

Instead of becoming flustered when this happens, respond with patience. If the child leaves the frame, simply let them know that you can’t see them and ask them to come back. Continue speaking to let the child know you’re still present, and calmly encourage them to move your camera or return to view. If you are direct yet reasonable about what must be done, most children will accommodate your needs so that the session can continue.

3. Ask the child to show and explain what they’re doing

Even when you’ve taken the above precautions, there will likely be times during the session when you cannot fully see what the child is doing. Instead of nitpicking the placement of the camera, it is sometimes easier to have the child bring items to you or verbally explain what they are doing off-frame.

“Any opportunity you have to ask the child to ‘tell me about,’ ‘show me,’ any of those kinds of things, you may have to take,” Dr. Woods explains. “You might need the child to be a little bit more aware of the position of the camera and that they might have to hold something up to show you, and they also might have to be more verbally engaged in describing what they’re doing or describing the item they’re holding.”

Improving Engagement in Virtual Sessions

In addition to overcoming technological limitations, providers must also do their best to keep children engaged throughout virtual sessions. Because the provider and child are no longer in the same room, it may be more difficult to build rapport and hold the child’s attention. Providers will need to change some of the ways they interact with children over video or phone in order to keep them interested and participating during the session.

Providers can use the following strategies to improve telehealth engagement when working with children:

1. For first sessions, try a “scavenger hunt” activity to build rapport

It’s important to establish a sense of trust and rapport in your first session with a consumer (especially with children), but this can be slightly harder to do when meeting virtually. If your first meeting with a child is conducted virtually, consider starting with a “scavenger hunt” activity in which you ask the child to find their favorite toys and tell you something about them.

“This intervention can apply for therapy, and it can also be modified for skills training,” Dr. Woods explains. “It’s a nice rapport-building, ‘getting-to-know-you’ activity. Most kids are going to be pretty excited to show off their space and the things they have at home.”

2. Use more verbal communication and instruction than normal

During in-person sessions with children, a significant amount of interaction may be nonverbal. For example, the provider might engage in an activity with the child or read their body language to assess what they’re thinking and feeling. Since this is often not possible during virtual sessions, you may need to rely on verbal communication more often than you normally would. Ask the child how they’re feeling when you can’t determine their mood, and instruct them to show you how they perform certain activities when you can’t do the activities with them.

“In the virtual space, we don’t have the luxury of being in the room with the child to see how the play is going to unfold, so there has to be a little bit more verbal conversation about it,” Dr. Woods says. “This can really encourage the child to get into the play and show the therapist how to play with the item. And as they show the therapist how they play with the item, the therapist can do all of the things they would normally do in play therapy, such as providing empathic reflections, wondering about thoughts and feelings, and seeing what conceptual themes emerge.”

3. Exaggerate your nonverbal communication and cues

Of course, nonverbal communication still has its place during virtual sessions. Facial expressions can be excellent tools for encouraging children or conveying your emotions to them, and inflection can be utilized to draw their attention to certain words. However, you should exaggerate your nonverbal cues when communicating virtually so they are easier for children to pick up on.

“It’s harder to convey emotions via video, so I encourage anyone to practice with that. Use exaggerated facial expressions like bigger smiles, and exaggerate the affect behind emotion words. I think that’s really helpful for getting kids engaged,” Dr. Woods says.

Although telemental health sessions with young children can be uniquely challenging for care providers, a little preparation can smooth over difficulties and make these sessions just as productive and rewarding as any other. We encourage all behavioral health professionals to use these tips to improve the quality of their virtual care sessions with children!

Looking for more information about mental health issues faced by children and teens? Here are a few more blog posts you might enjoy!

How Avon Community School Corporation and Cummins BHS Are Supporting Students’ Mental Health
How One Indianapolis Police Officer Is Fighting Teenage Substance Abuse

Teletherapy Tips: Best Practices for Engaging Behavioral Health Consumers over Phone and Video

The COVID-19 crisis has led to a paradigm shift in the way behavioral health care is provided. With in-office visits now inadvisable, care providers have begun to adopt telehealth technologies on a scale that’s never before been seen. While this rapid change has allowed mental health professionals to continue serving the needs of their clients, it has also created many questions about the most effective way to provide care from a distance.

Perhaps the biggest challenge of telemental health care is how it alters the dynamic of the consumer-provider relationship. In a virtual session, nonverbal communication is more difficult to utilize and detect, which places a greater emphasis on the words spoken in the session. The environment is also less controlled than in an office setting, which makes it harder for participants to focus and allows more opportunities for distraction. Finally, the balance of power is different in a virtual session, as consumers have more agency to ignore provider recommendations, end the session prematurely or skip it altogether.

These issues can be compounded if care providers are simultaneously struggling to adapt to remote work. Working remotely comes with unique advantages and challenges, and many behavioral health professionals may be unprepared for the realities of working outside the office. In addition to effectively engaging consumers over phone or video chat, providers must also take care to manage their environment and behaviors in order to be successful under these new circumstances.

The good news is that telemental health sessions can be just as effective and achieve the same outcomes and as in-person care when conducted correctly. Kristen Yost, a therapist for Cummins’ Marion County school-based program, has developed her own methods for working around many common telehealth difficulties. We spoke with Kristen to learn what obstacles you should expect during a telehealth session, how to engage consumers under the altered dynamics of virtual care, and what remote work practices will help you excel under the new telehealth paradigm.

Best Practices for Engaging Consumers via Telehealth

Kristen Yost, LMHC, School-based Therapist at Cummins Behavioral Health
Kristen Yost, LMHC, school-based therapist at Cummins Behavioral Health

As mentioned above, bringing the consumer-provider relationship into the virtual realm changes the nature of this relationship. Consumer engagement is a continual concern even in face-to-face treatment, but a lapse in engagement during virtual treatment can be more damaging and more difficult to recover from. Therefore, providers must take special measures to keep consumers engaged with treatment when sessions are being conducted virtually.

There are several points in the virtual treatment process where consumer engagement can dwindle. First, consumers may be reluctant to engage with virtual services at all, which could be due to anxiety about the telehealth process or the belief that virtual services are not necessary. “If they were engaged in services before, it would first be helpful to identify the underlying reason for this change,” Kristen says. “It may be anxiety about transitioning to teletherapy, a dislike for talking on the phone, or concern that others may overhear conversations. If these are the barriers, then identifying and working through them would be therapeutic. Otherwise, it may be helpful to work with the consumer to revise or identify new goals, as changes in the environment and daily living may have resulted in a change in needs.”

Second, some consumers might engage with treatment during their sessions but become difficult to contact between sessions. If a consumer doesn’t join the session or answer their phone at the scheduled appointment time, simple forgetfulness could be to blame. “I will work with my consumers to set a reminder alarm on their cell phones for our session. It’s helpful to have them set a reminder to go off before the actual time of the session so they are ready at the scheduled time,” Kristen suggests. “I also ask my consumers to answer the phone even if they aren’t able to meet at that time; that way we don’t have a lapse in communication.”

Finally, other consumers may be difficult to engage during their session or express a desire to end the session early. Kristen explains what she does to work with these kinds of consumers during virtual sessions:

“For my consumers who tend to process information internally (as opposed to those who process by talking out loud), there can be a discomfort when too much emphasis is placed on dialogue. For these consumers, I love doing timelines and/or visuals to guide discussion and understand past history. The option for consumers to share photographs or special objects offers additional ways to engage. For my consumers who communicate via resistance, I use motivational interviewing and rapport-building techniques while also setting firm boundaries. Humor and sarcasm, if appropriate, can be helpful to change the mood and tone of the session. If there is insistence on ending the session, I provide the option of taking a five-minute break. Regardless of how much time they give to the session, I make note of the small successes, and I strive to end on a positive note. And for my consumers who struggle to focus, I make these sessions as active and engaging as I can over the phone. For those with video access and their own deck of cards, I may supplement dialogue or skill-building with a card game. It can also be helpful to add some type of physical activity, such as every time the consumer engages in an undesired behavior, they will then implement a physical activity of their choice. This serves the purpose of bringing attention to the thoughts, feelings or behaviors we are trying to change while also enhancing focus and engagement.”

Best Practices for Adapting to Remote Work

Of course, keeping consumers engaged with treatment is harder if you as the provider are also struggling to stay engaged. Remote work is a new arrangement for many behavioral health professionals, and some might be surprised to find that working from home requires a different type of discipline than working in an office environment. Fortunately, providers can take a few simple precautions to improve their focus and productivity when treating consumers virtually.

It can be tempting when working from home to relax your regular morning routine. Waking up late and working in pajamas sounds nice, but departures from your normal work preparations can instead prime you to be unproductive. “Every day feels like the weekend if I don’t create my own structured work routine at home. I’m trying to make it feel as much like a typical workday as I can so that I keep that mindset,” Kristen says. “This helps me maintain consistency with my own behaviors, which also creates a feeling of familiarity for my consumers.

If possible, it’s also best to work in a different area of the home than where you spend your leisure time. Just as maintaining your normal work routine can help you stay in a working mindset, having separate environments for work and leisure can improve your focus and productivity during working hours. “Setting up an area of my home that I use specifically for work helps me create a conscious separation between work and home. This helps with productivity during the workday and also makes it easier to transition out of ‘work mode’ when my workday is done,” Kristen says.

One more thing to consider is the privacy of your workspace. Anyone else who lives in your home should know when you are working and when it is and isn’t acceptable to disturb you. Setting and adhering to these boundaries is important for the confidentiality of your sessions as well as your productivity, as Kristen explains:

“My family understands the nature of my work, and they are respectful of my need for a confidential space. I make my consumers aware that although I am working from home, their privacy and confidentiality is important to me. I let them know about the measures I have taken in order to provide a secure and safe place to open up, and I ask my consumers to follow suit by finding a space in their homes away from distractions and other people. My hope is for our teletherapy sessions to have the same safe and comfortable atmosphere as when we meet in the office.”

Although teletherapy requires some adjustment on the part of care providers, it is an extremely valuable asset when seeing consumers in person isn’t possible. We encourage behavioral health providers to utilize these tips in their day-to-day work to overcome some of the most common obstacles of telemental health care!

Looking for more tips to help improve your professional skills and behaviors? Take a look at our posts on multitasking and the Imposter Syndrome below!

Stress Can Be Good For You (as in this picture of a woman doing her homework)
Why Multitasking Doesn't Work at Work
Perfectionism and 'Hurry Worry'
Embracing Your Inner Expert: Perfectionism and the Impostor Syndrome in Mental Health

Observing Alcohol Awareness Month with Cummins’ Erin Flick and Virtual IOT

Have you ever wondered how long it takes to form a new habit? While the process varies from person to person, one influential study found that it takes 66 days on average. However, some participants in the experiment were able to learn a new habit in just 18 days. This research suggests that under the right circumstances, people are capable of making long-lasting changes to their behavior in a relatively short amount of time—for better or worse.

Since 1987, the National Council on Alcoholism and Drug Dependence has designated April as Alcohol Awareness Month. This public health program aims to educate Americans about the dangers of alcohol use and alcohol dependence, and it comes at a crucial time this year. With many people stuck at home on account of the COVID-19 crisis, some are turning to alcohol use to pass the time. A quick search of Google Trends shows that online searches for “drinking games” have been on the rise since March, with “quarantine drinking games” and “virtual drinking games” exploding in popularity.

Although moderate alcohol consumption may be safe for some people, periods of increased use can lead to the development of dependence and other issues. And since people are capable of ingraining new behaviors over the span of just a few weeks, the ongoing lockdown provides ample time for someone’s drinking habits to change. For these reasons, it’s important that we keep track of our alcohol consumption, recognize the signs of problem use, and know where to get help if we need it.

For more information about identifying and treating alcohol use disorder, we spoke with Erin Flick, a Substance Use Disorder Specialist and Team Lead based out of our Greencastle office. In this post, Erin shares some of the most common symptoms of alcohol dependence, and she also explains how Cummins Behavioral Health has begun providing virtual outpatient services to help people with substance use disorder during the current pandemic.

Erin Flick on Identifying Problematic Substance Use

Erin Flick, MSW, LCSW, LCAC, Substance Use Disorder Specialist and Team Lead at Cummins Behavioral Health
Erin Flick, MSW, LCSW, LCAC, Substance Use Disorder Specialist and Team Lead at Cummins Behavioral Health

Substance use disorder (or SUD) can cause immeasurable harm to a person’s life, but one big challenge of prevention is that SUD can sometimes be difficult to detect. Although there are many signs that someone may be chemically dependent on a substance, they can be subtle and tough to spot in ourselves or others, especially early in the progression of the disorder. Knowing the signs of problematic use can help us identify and seek help for substance use disorder sooner rather than later.

“Problematic substance use may look different for everybody, but if you’re questioning whether someone is developing a problem, one thing to reflect on is what their ‘normal’ has been and if there have been changes to their normal,” Erin says. She also encourages you to ask yourself the following questions; if the answer to one or more is “yes,” then it’s possible that the person is suffering from substance use disorder:

“Does the person have a change in friends, or if they’re normally very social, are you not seeing or hearing from them as much? Has their sleep hygiene changed? For example, are they staying up all night, or do they have their days and nights mixed up? How is their energy level? Have they usually been laid-back, easy-going and task-oriented, and now they appear more energetic and focused on things that they weren’t focused on before? If the person would come home and have one beer at dinner, for instance, are they drinking a little bit more? Are they continuing throughout the evening? If they have responsibilities such as work or school, have they been neglecting those responsibilities?”

In addition to these signs, the Mayo Clinic lists the following behaviors as possible symptoms of substance use disorder:

  • Having intense cravings for the substance that block out other thoughts
  • Needing more of the substance to get the same effect as before
  • Experiencing withdrawal symptoms when you stop using the substance
  • Spending money on the substance even when you can’t afford it
  • Continuing to use the substance even though you know it’s causing negative consequences in your life
  • Doing things to obtain the substance that you normally wouldn’t do, such as stealing

 Introducing Virtual IOT for Treatment of Substance Use Disorder

If you or someone you know develops a problem with alcohol or other substances, the ongoing State lockdown isn’t a good reason to put off seeking treatment. Early intervention has been proven effective at addressing risky substance use behaviors before a disorder can develop, so it’s crucial to get help as soon as you notice a problem. Fortunately, the option of virtual treatment makes this possible even during the COVID-19 pandemic.

We’ve spoken previously about how Cummins BHS has adopted telehealth technologies to care for our consumers, and this extends to our services for substance use disorder. Intensive Outpatient Treatment, or IOT, is one of our most popular services for treatment of substance use disorder, and it’s now being provided virtually in Montgomery and Putnam counties. “We utilize a platform called RingCentral Meetings,” Erin says. “Group members can log in through their phone or their computer, and we engage the group with the same rituals and format as we would if we were sitting in a circle together.”

Just like with any telehealth service, it can take some time for providers and group members to adjust to the dynamics of virtual IOT meetings. However, virtual sessions allow participants to continue receiving care from the safety and comfort of their own homes, and they can even provide some unanticipated benefits to the therapeutic process. Erin explains,

“There’s been a lot of positive feedback in regards to consumer engagement. Those clients that previously had barriers to get to the facility for Group seem to be the ones that are ready to go every morning virtual Group is facilitated, so it’s been encouraging to see that commitment level. And for the providers, it’s nice to get to see some of their consumers’ home environments. We hear about them and can only imagine when we’re sitting in Group, but with video chat, we have an inside look into whatever their environment is. For example, their family members or children might pop in as they’re walking through the house, so it’s a nice way to get a visual of those things.”

As Indiana’s coronavirus lockdown continues, we encourage our consumers to make use of all our virtual care services for their behavioral health needs. You can read more about how our telehealth sessions work in this blog post.

If you believe you may need treatment for a substance use problem during this time, virtual services may be an option for you. Speak with your provider if you’re already a Cummins consumer, or call (888) 714-1927 Ext. 1501 to schedule a new consumer appointment.

Explaining Telehealth: How It Works and What to Expect During a Virtual Behavioral Health Session

Telehealth, the practice of conducting health care via telephone, video or other means of communication technology, has been slowly growing in popularity and practicality over the past several decades. However, the ongoing COVID-19 pandemic has led to a rapid adoption of telehealth services across the mental health industry. Organizations like Cummins Behavioral Health have a responsibility to continue providing life-saving mental health care for our consumers, and this is where telehealth can help.

Although telehealth for behavioral health care is a relatively new frontier, research has shown that virtual sessions with a behavioral health professional can be just as effective as face-to-face meetings. For example, one 2013 research review found that telemental health care is effective for diagnosis and treatment across many populations and appears to be comparable to in-person care. Some care recipients might even prefer telehealth sessions to in-office visits, as a 2012 survey found that 42% of teens and 33% of adults feel more comfortable sharing personal information online than in person.

Nevertheless, most people have very little experience using telehealth services, so the process might seem somewhat confusing or intimidating. Those who aren’t well versed in the latest communication technologies might feel especially uncertain about navigating a phone or video conference with their care provider. Fortunately, most of these technologies are very easy to operate using some basic instructions.

To make the transition to telehealth services as seamless as possible for our consumers, we spoke with IT Director Kevin Dykes about the technologies Cummins is using to provide virtual care during the current health crisis. In this blog post, we explain exactly how to use each of our videoconferencing tools and what you should do to prepare for a virtual session with your care provider.

How to Connect to a Virtual Session with Cummins BHS

Kevin Dykes, IT Director and Information Security Officer at Cummins BHS
Kevin Dykes, IT Director and Information Security Officer at Cummins Behavioral Health

Until the Centers for Disease Control (CDC) and Indiana state government relax their guidelines on social distancing, the vast majority of appointments at Cummins BHS will be conducted virtually, which includes individual therapy and counseling, group therapy and counseling, skills training, employment skills training, peer recovery sessions and medical appointments. This means that most consumers will be asked to call into a phone or video appointment instead of meeting at their local Cummins office.

Before you attend your first virtual session, your care provider will contact you to determine which electronic devices you have access to. “You’ll have the option to use your smartphone, a tablet or a computer, and your care provider will have a discussion with you about the audio/video requirements,” Kevin explains. “In the event that you don’t have video capabilities, then your provider can resort to a basic phone call.”

Your provider will choose the best option for conducting the virtual session based on the resources available to you. Video calls require that you have a device with a camera and microphone, access to the Internet, and a personal email address. However, you might still be able to join a video call if you lack one or more of these items. “There are several meeting options available and more than one way to connect to your meeting. For instance, if you don’t know your email address or you don’t have access to the email address, there are ways to work around that,” Kevin says.

In most cases, your provider will ask to connect with you using one of three possible videoconferencing technologies. Once you know which technology you’ll be using, simply follow the steps below to connect to your virtual session.

If you are meeting via RingCentral:

  1. Your provider will send you an email containing a link to the video meeting. On the appropriate date and time, you can join the meeting by clicking the link on any device that is connected to the Internet. Alternatively, your provider could send the link via text message, which you can follow to the meeting in the same way. If you do not have Internet access, you can instead call into the meeting via phone by dialing the phone number included in the email or text message.
  2. If you would like, you can also download the RingCentral Meetings app on your smartphone, tablet or computer. If you do this, clicking the link your provider sent will open the meeting in the RingCentral Meetings app.
  3. If you don’t have an email address or don’t have access to your account, your provider will call you and give you a ten-digit meeting ID. On the appropriate date and time, you can join the meeting by visiting ringcentral.com, clicking on “Join a meeting” at the top right of the screen, and entering the meeting ID when prompted.
  4. You may be asked to enter your name before you can join the meeting. Once you’ve done so, you’ll be connected to the meeting session.
  5. If you see a pop-up window on your device asking for permission to access your camera and/or microphone, select “yes.”

If you are meeting via Zoom:

  1. Your provider will send you an email containing a link to the video meeting. On the appropriate date and time, you can join the meeting by clicking the link on any device that is connected to the Internet. Alternatively, your provider could send the link via text message, which you can follow to the meeting in the same way.
  2. If you don’t have an email address or don’t have access to your account, your provider will call you and give you a nine-digit meeting ID. On the appropriate date and time, you can join the meeting by visiting zoom.us, clicking on “Join a meeting” at the top right of the screen, and entering the meeting ID when prompted.
  3. You may be asked to enter your name before you can join the meeting. Once you’ve done so, you’ll be connected to the meeting session.
  4. If you see a pop-up window on your device asking for permission to access your camera and/or microphone, select “yes.”

If you are meeting via Doxy.me:

  1. Your provider will send you an email containing a link to the video meeting. On the appropriate date and time, you can join the meeting by clicking the link on any device that is connected to the Internet. Alternatively, your provider could send the link via text message, which you can follow to the meeting in the same way.
  2. The link will take you to your provider’s “virtual waiting room,” where you will be asked to enter your name. Once you’ve done so, you’ll need to wait until your provider initiates the meeting.
  3. If you see a pop-up window on your device asking for permission to access your camera and/or microphone, select “yes.”

Preparing for a Successful Telehealth Session

Knowing how to join a telehealth session isn’t the only thing that determines the success of virtual care, however. Since you won’t be meeting in the controlled environment of your care provider’s office, there are more opportunities for distractions and problems that could reduce the quality of your session. To prevent this from happening, you should take the following steps to prepare for your meeting:

  • Find a private space. It’s important that you have privacy to speak openly with your care provider. If other people are in the home during your meeting, inform them that you are attending a telehealth session and ask not to be interrupted during it.
  • Keep extraneous noise to a minimum. Noise from other people and activities in the home can be very distracting during your session. Ask others to stay as quiet as possible while you are meeting, or consider wearing headphones to help drown out other sounds.
  • Try to ensure a stable connection if possible. Poor connection to the telehealth session could make it difficult for you and your provider to see or hear each other, or it could result in the call dropping. Use the fastest and most reliable Internet connection available to you, whether that’s a wired connection, WiFi or your mobile phone data network.
  • Minimize distractions. Do everything possible to eliminate any potential distractions prior to your session. For example, you should refrain from multitasking during the session, which includes eating or drinking any food items. Keep pets contained in another room if possible, and provide children with an activity to do during the session if they will not be involved in the session. Take care of personal needs such as eating and using the restroom prior to the start of the session. Finally, silence all electronic devices and alerts for the duration of the meeting.
  • Gather supplies before the session if possible. Again, your meeting will go most smoothly if all interruptions can be avoided. Check with your provider to see if you’ll need any supplies for activities during your session, and gather them together before your session begins.
  • Use a computer or tablet with video capabilities if possible. In order for you and your provider to see each other’s facial expressions, share files, and share screens (to review handouts/resources, complete activities, etc.), we recommend that you use a webcam and a computer or tablet so that you have the largest possible screen. It’s also best to place the device on a hard surface rather than hold it, as this reduces movement and noise during the session.
  • Maintain a professional relationship and boundaries. Even though you won’t be meeting at your care provider’s office, you should still adhere to all the normal guidelines of the provider-consumer relationship. Dress and behave just as you would if you were coming into the office for your session.

Although telehealth services might take some time to get used to, they allow organizations like Cummins Behavioral Health to continue providing crucial behavioral health care while keeping our employees and consumers safe during this health crisis. We encourage you to refer back to this post if you forget what happens next in the virtual care process, or consult your care provider if you need further clarification regarding specific details.

For more information about safeguarding your physical and mental health during the COVID-19 crisis, we recommend reading the articles below!

Cummins Behavioral Health’s Response to COVID-19
COVID-19 and the Diathesis-Stress Model: How to Relieve Stress under Extraordinary Circumstances

COVID-19 and the Diathesis-Stress Model: How to Relieve Stress under Extraordinary Circumstances

Everyone experiences periods of increased stress in their life. These may be mild and recurrent, such as the stress involved in working or raising children, or they may be more severe and unique, like the stress of losing a job or getting a divorce. When we encounter a stressful situation, we can usually get through it without any lasting repercussions. However, extreme or prolonged periods of distress can sometimes have negative effects on our mental well-being.

The diathesis-stress model, which is sometimes also called the stress-diathesis model, is a psychological framework for understanding how stress affects our mental health. According to this model, every person has a certain amount of vulnerability toward depression, anxiety, and other mental health problems and conditions. Although some people do not struggle with these issues under normal circumstances, extreme distress can sometimes cause symptoms to develop where none existed before. And for people who do struggle with a mental health condition under normal circumstances, additional distress can worsen their symptoms and make management of their condition more difficult.

As the public health crisis created by the COVID-19 disease continues, it’s important that everyone be prepared for the ways this additional stress might affect their health. Even individuals with no preexisting behavioral health conditions may find themselves feeling more worried, anxious or depressed over the coming weeks. Fortunately, we can all lessen the negative effects of this particular stressor by taking precautions to boost our emotional resilience.

To learn more about what to expect and how to manage behavioral health issues during this difficult time, we spoke with Margot Everitt, one of our Team Leads for school-based services in Marion County. Below, Margot explains how a person’s health might be impacted and what they can do to relieve stress during this or any other extraordinary situation.

Explaining the Mental Health Risks Posed by COVID-19

Margot Everitt, LMFT, School-Based Team Lead at Cummins Behavioral Health Systems
As a Team Lead for school-based services, Margot Everitt, LMFT, supervises therapists and life skills specialists who work with children and teens in the Indianapolis school system.

As stated above, most people should expect to experience some amount of increased distress due to the ongoing situation with coronavirus disease. Individuals who have an existing mood or anxiety disorder are the most likely to experience worsened symptoms as a result of this added stress. While symptoms of increased distress will vary from person to person, Margot anticipates that they will follow two main trends.

First, a person might experience reduced well-being right now, as we are living through the crisis day-to-day. “When there is a stressful situation like what we’re going through right now, if you already have anxiety, for instance, you’ll likely feel increased symptoms,” Margot says. “When people are worried about getting their basic needs met, that’s when we see things like depression and anxiety come into play.”

These effects could be more pronounced if a person’s employment status has changed, if their normal daily routines have been greatly interrupted, or if they spend a lot of time following the situation’s development. “You could see increased symptoms if you’ve lost a job, if you’re watching the news, or if you’re not able to do things that help you relieve that stress,” Margot says.

Second, a person might also experience increased distress when they must transition back to normal life at the end of this crisis. For some people, this stress could be the result of employment changes and financial difficulties. For others, it could occur due to the strain of returning to old habits and routines, as Margot explains:

“For example, some kids have a lot of anxiety and struggle with going to school because of that anxiety. My concern is that this whole situation will make the transition back to school much more difficult. Right now, they’re getting used to being in their homes and in their ‘cocoon,’ so I think they’re going to have a harder time transitioning back to school. In the same way, getting back into the workforce may be difficult for adults who aren’t working or have been laid off.”

What You Can Do to Guard Against Distress

Once we understand how additional distress could impact our mental health, it’s important that we take measures to counteract these negative effects. One of the best ways to manage distress is to continue normal wellness behaviors like exercising frequently, eating nutritious food and maintaining a regular sleep schedule. These behaviors have been proven to boost resilience and improve mental health, so continuing them during times of crisis is critical.

Since many of us are currently spending a great deal of time at home, we might find it difficult to continue our regular wellness routines. However, we can work within existing constraints to continue our wellness behaviors to the best of our abilities, as Margot explains:

“For sleep, you should keep a consistent sleep schedule and have a good bedtime routine. Do something that relaxes you before going to bed, and get up at the same time you always get up. If you’re staying up all night and sleeping late into the day, that’s going to change your body chemistry, and then how are you going to function when you have to go back to your regular hours? For exercise, any kind of movement is beneficial, and there are things you can do to modify your normal exercise routine. Take a walk, or if you live in a neighborhood where you don’t feel safe walking outside, then walk around your house. Get a milk jug and lift it as a weight, or do jumping jacks. For nutrition, practice healthy eating and try not to snack all day. Have dedicated times for eating breakfast, lunch and dinner. You should do all the same things you were doing before and figure out how to modify those behaviors for the present circumstances.”

In addition to these wellness behaviors, Margot emphasizes the importance of building structure into our day even if we aren’t leaving the house for school or work. “It’s very important for kids and even adults to create structure, although it’s going to look different than normal. They need to get up, take a shower, eat breakfast—whatever their routine is—even if they don’t leave the house. I think people will feel a lot better if they keep a structured day,” she says.

Finally, it’s a good idea to limit your exposure to anxiety-inducing information and news about the crisis. While it’s important to stay informed of new developments, spending excessive amounts of time tracking the situation will likely increase your level of distress. “I think people have to be really careful,” Margot explains. “There’s so much information out there that’s just going to increase anxiety and paranoia. Right now, I don’t watch the news unless it’s something like Good Morning America, and when I get on social media, if I start seeing too many things about the coronavirus, I get off. Some people might need to limit or eliminate these things if they’re causing too much stress.”

In times of heightened anxiety and distress, we must also be sure to continue regular appointments with behavioral health professionals. Although Cummins BHS is limiting face-to-face sessions during the COVID-19 crisis, our providers are still conducting sessions via telephone and video conference. Call us at (888) 714-1927 Ext. 1500 if you’d like to schedule an appointment, or dial extension 1501 if you are experiencing a mental health crisis and need to speak with someone immediately.

Looking for more advice about coping with stress and anxiety? Here are some other posts we recommend!

Stress Can Be Good For You (as in this picture of a woman doing her homework)
Remember This Next Time You’re Feeling Stressed
Yoga, meditation
Calm Down Quick With this Simple Trick: Extended Exhale

Cummins Behavioral Health’s Response to COVID-19

The rapid worldwide spread of the COVID-19 disease, also known as the coronavirus disease, has created a public health crisis the likes of which have not been seen for many years. Cummins Behavioral Health is closely monitoring developments in this unfolding situation, and the safety and well-being of our consumers and employees continues to be of utmost importance to us. First and foremost, if you are experiencing a mental health crisis during this challenging time, we encourage you to call our 24-hour emergency phone line at (888) 714-1927 Ext 1501.

We understand this crisis is impacting everyone’s daily life in various ways. We are dedicated to ensuring your safety while limiting the impact this health event has on the services we provide. We will continue to follow guidelines from the Centers for Disease Control (CDC) as well as federal, state and local governments to help prevent the spread of the COVID-19 disease in our community. We are keenly focused on maintaining a safe environment for our employees and consumers while continuing to provide services.

We have robust integrated behavioral health processes in place, and they are managed by a dedicated team of professionals committed to ensuring your well-being and keeping our operations running as smoothly as possible during these trying times. As such, we have put the following response plan into action, effective immediately:

New Policies to Prevent the Spread of COVID-19:

  1. Anyone exhibiting symptoms of COVID-19 and/or acute respiratory illness should not come in for therapy or counseling sessions. This policy applies to both consumers and members of our staff. Click here to reference the CDC’s official list of COVID-19 symptoms. Individuals who are ill and in need of hospitalization may be permitted entrance into our facilities in some circumstances.
  2. Until further notice, therapy sessions and other services will be conducted via telephone or video conference whenever possible. Individuals who are not ill and who have an imperative need for face-to-face care will be permitted into our facilities on a case-by-case basis. Your care provider will inform you how your sessions will be handled moving forward.
  3. Additionally, we have temporarily suspended our Open Access for initial assessments. Please call our offices at (888) 714-1927 Ext 1500 to schedule an initial appointment. 
  4. All consumers and staff should follow the hygiene protocols laid out by the CDC both inside and outside Cummins’ facilities. These include frequently washing your hands with soap and water for at least 20 seconds, using hand sanitizer with at least 60% alcohol when soap and water isn’t available, coughing and sneezing into a tissue or the inside of your elbow instead of your hand, and refraining from touching your face with unclean hands. We invite you to visit the CDC’s webpages on handwashing and coughing and sneezing etiquette for more information.
  5. All individuals should practice social distancing to prevent the spread of illness. This means staying home when possible and only leaving the home when absolutely necessary, staying six or more feet away from other people, and reducing or eliminating large group gatherings.

We will continue to monitor this fluid situation and modify our response as necessary to ensure essential services to our consumers and our community. Check back with this page for further updates and changes to our policies as more information becomes available. We also recommend reviewing this COVID-19 Quick Facts Sheet prepared by the CDC.

For decades, Cummins has demonstrated unwavering support to our consumers. In dealing with the present circumstances, we will continue to use every effort to deliver essential services to all our clients to the utmost of our ability. On behalf of everyone here at Cummins, we appreciate your cooperation and support as we forge a path ahead during this uncertain time.

Observing Self-Harm Awareness Month: Cummins CCO Robb Enlow on 13 Myths and Misconceptions of Suicide

“Suicide is a solitary event, and yet it often has far-reaching repercussions for many others. It is rather like throwing a stone into a pond; the ripples spread and spread.” — Alison Wertheimer

Although most of us would prefer otherwise, everyone feels negative emotions in life. Feelings like sorrow, grief, guilt, shame, hopelessness and worthlessness can be extremely difficult to deal with and taxing on our mental well-being. Often we find the strength to hold on until the feeling passes, but sometimes, for one reason or another, we might feel the urge to phyically harm ourselves in order to escape intense emotional pain. In the most extreme cases, we might consider ending our own life to make the pain go away.

Suicide is a major public health concern throughout much of the world. It affects all races and genders, and in the United States, it is the 10th leading cause of death. In addition to deaths by suicide, the American Foundation for Suicide Prevention estimates that there were 1.4 million suicide attempts in 2018. However, suicide remains highly stigmatized in America and elsewhere, and it is often misunderstood as a result.

March is internationally recognized as Self-Harm Awareness Month (or Self-Injury Awareness Month), and in observance, Cummins Behavioral Health hopes to improve understanding and erode the taboo surrounding suicide, the most drastic of all forms of self-injury. Persistent myths and fallacies about suicide not only isolate those who have contemplated or attempted it, but they can also prevent people from receiving help during a time of emotional crisis.

To get to the bottom of what is and isn’t true about suicide and suicidal behavior, we spoke with Robb Enlow, Chief Clinical Officer at Cummins BHS. Robb provided us with an evidence-based curriculum he assembled that explains and debunks 13 of the most common fallacies about suicide and those who struggle with the urge to take their own lives.

13 Common Fallacies about Suicide, Explained

robb_enlow
Robb Enlow, LCSW, Chief Clinical Officer at Cummins BHS

Fallacy #1: Most suicides are caused by a single traumatic event.

Too often, people assume that the decision to take one’s life is made following a single highly upsetting event. As a result, they might believe that suicide happens so quickly that it cannot be prevented. In reality, a sudden traumatic event is unlikely to be the only cause of suicidal ideation. “More typically, these events are one of other contributing events and feelings which have occurred over time. The stressful event and the person’s reaction to that event should be viewed as invitations to help,” Robb’s curriculum states.

Fallacy #2: Most suicides occur with little or no warning.

A similar misconception is that people decide to end their lives in secret, without giving any indication that they’re thinking about doing so. As with the previous fallacy, this belief can lead to a sense of futility toward suicide prevention efforts. However, most people who have suicidal thoughts communicate their feelings and struggles with others before actually attempting suicide. According to Robb’s curriculum, “These invitations for others to offer help come in the form of direct statements, physical signs, emotional reactions, or behavioral cues indicating the person may be considering suicide as a solution to their problems.”

Fallacy #3: Youth suicides occur with little or no warning.

Teenagers and adolescents are often thought to be flighty and emotionally volatile, which can make caretakers feel even more hopeless about the possibility of preventing suicidal behavior. But just as with adults, young people usually communicate their distress in one form or another prior to attempting suicide. “Although youth may appear to be constantly changing, change is seldom made without purpose or thought,” the curriculum points out. “Not all youth act with haste. Additionally, young persons who do act in haste (impulse) often have a history of other risky behaviors such as substance abuse, reckless driving or unprotected sex.”

Fallacy #4: You shouldn’t talk about suicide with someone who you think might be at risk.

Some people still believe the myth that talking about suicide can “plant” the idea in a person’s head. As a result, they might think it best to avoid the topic altogether when they believe someone is at risk. On the contrary, serious talk about suicide reduces risk rather than creating or increasing it. As the curriculum explains, “Open talk and genuine concern about someone’s thoughts of suicide are a source of relief for them and are often the key elements in preventing the immediate danger of suicide. Avoidance leaves the person at risk, feeling more alone and perhaps too anxious to risk asking someone else to help.”

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Fallacy #5: People who talk about suicide won’t do it.

On the other hand, some people may believe that anyone who talks about suicide is not seriously considering it. They might think the person is only seeking attention or pity and therefore choose not to offer any help. As we mentioned above, people who attempt suicide usually talk about their intentions before they act, so any talk of suicide should be taken seriously. “Most people who die by suicide talk about it in some way before they act. Not taking this talk seriously may be a contributing cause in many deaths by suicide,” the curriculum states.

Fallacy #6: A nonfatal outcome means it was only an attention-getting behavior.

In the same way people may dismiss talk about suicide as nothing serious, they might also believe that a nonfatal attempt proves the person doesn’t really intend to go through with it. With this in mind, they might ignore the person’s behavior so as not to reward or encourage it. This belief is false, as nonfatal suicide behaviors are often a desperate invitation for help. “If help is not offered, the person may conclude that help will never come and others not taking them seriously could be another reason for dying,” the curriculum states.

Fallacy #7: Suicidal people want to die.

Perhaps one of the biggest misconceptions about suicidal behavior is that the person who is engaging in it wants to die. In actuality, most people who are suicidal are deeply conflicted and unsure about dying, often up to the very moment of acting. It’s very important that others understand this so they won’t be discouraged from attempting to help. “Most people are looking for help to avoid suicide even if they aren’t immediately aware that they want help. The vast majority of people who are suicidal at some time in their life find a way to continue living,” the curriculum explains.

Fallacy #8: All people who take their own lives are mentally ill.

It’s true that there is a correlation between suicidal behavior and mental illness. However, this doesn’t mean that all suicidal people are mentally ill or that treating mental illness eliminates the risk of suicidal behavior. Rather, mental illness and suicide risk must be managed concurrently in order to give the person the best chance of recovery. In the curriculum’s words, “Not all people who die by suicide are mentally ill, nor are all who are mentally ill likely to die by suicide. Risk behaviors are treated parallel to mental illness.”

sarah crying

Fallacy #9: Once a person attempts suicide, they won’t do it again.

Yet another false belief about suicide is that if a person attempts to take their life and fails, then they won’t try again. Rather than alerting friends and family to the need for intervention, this belief may convince them that the risk of suicide has ended with the unsuccessful attempt. The truth is that many people who attempt suicide will do so again in the future. According to the curriculum, “The rate of suicide for those who have attempted before is 40 times higher than that of the general population. Prior suicide behavior is a major risk factor.”

Fallacy #10: When a person feels better, the danger is over.

When someone who has been struggling with suicidal thoughts and behaviors appears to suddenly improve, many people assume this means the danger of suicide has passed. While this may be true in some cases, in others it may signify that the person has made up their mind to take their life. Therefore, efforts to mitigate risk should continue. “Feeling better can have different meanings: a decision for life, or the person has made the decision to die and is no longer in emotional conflict. Continued discussion is needed,” the curriculum cautions.

Fallacy #11: Most people who kill themselves just couldn’t make it in society.

One extremely harmful myth about suicide is that it’s inevitable for some people. Some may believe that suicidal individuals are so dysfunctional that they can never succeed in the world, so it’s better to just let them end their lives. This line of thinking is incorrect, as most people who think about suicide never act on the idea, and most only seriously consider suicide once in their lives. “Suicide is a choice anyone can make, although almost no one wants to be suicidal. Your efforts to help may be enough to support a person through a difficult and dangerous period of their life,” the curriculum explains.

Fallacy #12: People who kill themselves are taking the easy way out.

In a similar vein as the previous fallacy, some people believe that those who contemplate, attempt or complete suicide are morally weak. They may think that suicidal individuals do not deserve help, or worse yet, that society would be better off without them. This view ignores the tremendous emotional burden of suicidal thoughts, and it also reduces the chance that a suicidal person will recover. “Most people at risk are desperately looking for another way out of their situation. Labeling people at risk in such a negative way serves only to make it harder for them and for other persons at risk to reach out for support,” the curriculum states.

Fallacy #13: Suicide is an individual choice.

Finally, even those who have the best intentions and who would like to help a suicidal person may believe it isn’t their place to do so. They might think that if a person says they want to die, it isn’t right to intervene. However, it’s important to remember that suicide is rarely a person’s preferred choice, and it is therefore not disrespectful to exercise prevention measures. “The decision for suicide may be made in the midst of many turbulent feelings and is seldom the result of informed decision-making about all the possibilities,” the curriculum states.

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In order to reduce stigma surrounding suicide and lower rates of suicidal behavior, it’s crucial that everyone understands what is and isn’t true about suicide and individuals who consider or attempt it. In honor of Self-Harm Awareness Month, we encourage you to spread awareness of these suicide myths and misconceptions and open a dialogue with anyone you know who might be struggling with self-injury or suicidal thoughts.

Here at Cummins Behavioral Health, our therapists and counselors use a model known as “Assessing and Managing Suicide Risk” (AMSR) to detect and intervene on suicidal tendencies. If you or someone you know struggles with self-injury or suicidal ideation, feel free to call us at (888) 714-1927 to discuss treatment options.

For more information about difficult behavioral health situations you may face and how you can work to overcome them, here are a few more posts we recommend.

Managing Dual Diagnosis: Cummins’ Tracy Waible on How to Identify and Treat Substance Use with Co-Occurring Disorders
Identifying Toxic Relationships: Dr. Armen Sarkissian Explains How to Escape the “Drama Triangle” Trap

Trauma-Informed Care: What It Means and How It Can Be Implemented in Behavioral Health

“Trauma leaves ‘fingerprints’ on the victim. These don’t fade when the bruises do.” — Dr. Ellen Taliaferro, physician and author specializing in domestic violence and abuse

Violent events—whether they occur on purpose or by accident, and whether they are physically or emotionally violent—leave a mark on a person’s psyche. Long after an event has passed, its memory can cause psychological suffering for those who experienced it. In some cases, this prolonged suffering may be diagnosed as post-traumatic stress disorder, but the event and its emotional consequences are also referred to more generally as trauma.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma “results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” Statistics from SAMHSA show that 61% of men and 51% of women are exposed to a traumatic event sometime in their lives, and 90% of clients in public behavioral health care settings have experienced trauma.

We’ve previously explained how interventions like yoga can help to reduce symptoms of post-traumatic stress, but most of the time, trauma is so deep-seated that it must be addressed by professional therapy or counseling. However, it’s crucial that behavioral health care is delivered in a way that’s attentive to the needs of trauma victims. The last thing that’s wanted is for treatment to trigger residual feelings of stress and anxiety, which is why all care must be trauma-informed.

Trauma-informed care is a framework for treatment that helps clients feel safe, respected and in control while minimizing any risk of re-traumatization. Here at Cummins Behavioral Health, we strive to integrate the principles of trauma-informed care into every interaction between care providers and consumers. We spoke with Rebecca Bradford, Team Lead at our Marion County outpatient office, to learn more about trauma-informed care and how it can be effectively implemented in behavioral health care.

The Six Principles of Trauma-Informed Care, Explained

Rebecca Bradford, LCSW, Marion County Team Lead at Cummins BHS
As Team Lead at Cummins' Marion County outpatient office, Rebecca Bradford, LCSW, supervises therapists and clinicians as well as peer service providers.

As mentioned above, trauma affects more than half of all adults in the U.S., and the percentages are even higher among people who seek out behavioral health services. Interestingly enough, a higher than average number of behavioral health workers may have also experienced some form of trauma in the past. As a result, a trauma-informed approach to care is important for the well-being of consumers as well as employees within an organization.

“Trauma-informed care is important because there are so many people who have experienced trauma,” Rebecca says. “Whether they have a diagnosable condition like PTSD or not, it is likely that at some point in their life, a large majority of the population we serve has experienced some sort of trauma in their life. It even affects a lot of our providers, because we know that people sometimes go into the helping fields because they’ve experienced things in their own life that make them want to help others.”

But what does a trauma-informed approach to care mean, exactly? According to SAMHSA, trauma-informed care is treatment that adheres to six guiding principles:

  1. Safety: throughout the organization, both staff and the people they serve feel physically and psychologically safe. As Rebecca explains, this is one of the first things that a person who has experienced trauma considers when entering a treatment environment. “If I’m talking to someone who has trauma, their safety has likely been threatened or taken away from them at some point in their life, so that’s going to keep them guarded. We need to make sure the physical space is presented as safe as well as the emotional space, which is often done through rapport-building with consumers,” she says.
  2. Trustworthiness and transparency: organizational operations are conducted with transparency in order to build trust among staff, consumers, and consumers’ family members. This can be achieved with consumers through open communication about everything that happens during treatment. “We use collaborative documentation so consumers know what’s being written about them and what the provider is documenting,” Rebecca says. “Being transparent about the parameters of the therapeutic relationship is very important, as well, and those boundaries get established up-front.”
  3. Peer support: consumers have access to peer recovery specialists who have experienced trauma in their own lives and can provide additional emotional support. Due to their unique position in the organization, peer specialists can often engage with consumers in ways that might be inappropriate for a therapist or counselor. “With trauma, people often feel isolated, so sometimes they feel more comfortable opening up to somebody that has had that experience versus a therapist who may not disclose, even if they have had that experience, just to keep those therapeutic boundaries,” Rebecca explains.
  4. Collaboration and mutuality: consumers act as partners with staff in their own treatment, and the balance of power remains equal between consumer and provider as well as among staff. According to Rebecca, one part of collaboration means that consumers take equal responsibility for their recovery. “A huge part of treatment is that we’re always giving it back to the consumer and not just doing things for them. We teach them how to do things themselves, or we do it with them if they can’t do it themselves just yet,” she says.
  5. Empowerment, voice and choice: consumers are encouraged to take control of their treatment and freely express their concerns and desires. Care providers are facilitators of recovery rather than controllers of recovery, and they strive to support consumers in shared goal-setting and decision-making. “We let the consumer know that they can control the pace of treatment. That’s a big part of Empowerment as well as Safety and Collaboration,” Rebecca says.
  6. Cultural, historical and gender issues: the organization ignores cultural and gender stereotypes and is responsive to the racial, ethnic, cultural and gender-specific needs of consumers. At Cummins, this is partially achieved through the Cultural Competency Committee, which researches and disseminates best practices for treating people from diverse populations. “It’s a matter of continuing to educate our providers on diversity and gender issues and making sure that we’re not imposing our own belief systems on any other person,” Rebecca explains.

Putting Trauma-Informed Care into Practice

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Once the core principles of trauma-informed care are understood, the real challenge lies in implementing these principles throughout the organization. In its guidelines for trauma-informed care, SAMHSA lists ten domains for implementation: governance and leadership; policy; physical environment; engagement and involvement; cross-sector collaboration; screening, assessment and treatment services; training and workforce development; progress monitoring and quality assurance; financing; and evaluation.

In Rebecca’s experience, workforce training is among the most crucial of these domains. In order for trauma-informed care to truly make a difference, its principles must be upheld at every point of consumer contact within the organization. “From that first person a consumer meets when scheduling an appointment all the way up to the CEO, everyone should know about these things,” Rebecca says.

Trauma-informed care is typically implemented from the “top” of an organization by means of policy choices, but employees at all levels of the organization should be encouraged to offer input. This helps to ensure that policies remain as current and effective as possible, as Rebecca illustrates:

“At Cummins, leadership is always open to hearing what providers have to say about treatment environments and treatment modalities. For example, my providers were recently discussing needs with the Chief Clinical Officer and identified a book that had some protocols to address poverty, which often goes hand-in-hand with trauma. The Chief Clinical Officer took that input and came back to us two months later, presented his interpretation of the basic ideas, and changed the way we do our onboarding system as a result of reading this book that was suggested by my providers.”

Finally, behavioral health care providers must be careful to avoid common stumbling blocks like burnout and compassion fatigue, which can undermine their ability to administer effective trauma-informed care. For this reason, regular self-care is important for everyone in the organization. “Something we talk about a lot is good supervision and open communication with the provider, with me being able to say, ‘I think you need to take a step back,’ and them also being able to come and say that to me,” Rebecca explains.

Due to the high prevalence of trauma among behavioral health care consumers, it’s imperative that treatment recognizes the challenges faced by trauma survivors and empowers them to improve their own lives. We continually strive for this goal at Cummins Behavioral Health as we work toward our mission of inspiring the hope of recovery in every person we serve.

Looking for more information about recovery from trauma? Here are some other posts we recommend!

Giving Domestic Violence Survivors a Chance at Independence: Cummins BHS, Sheltering Wings and RealAmerica Announce Haven Homes
Some say Yoga is simple physical exercises. They’re wrong.