All posts by Mark Wilhelm

Compassion Fatigue: Overcoming a Common Challenge for People Who Help Others

Any type of work that puts people under large amounts of stress for extended periods of time can lead to burnout. Burnout is often identified by feelings of physical and emotional exhaustion, a reduced sense of accomplishment, and loss of personal identity. High-stress professions such as law enforcement, nursing and legal work are notorious for high rates of burnout, which can also lead to high employee turnover.

However, individuals who work in the “helping professions”—such as nurses, physicians, educators, social workers and counselors—may also experience a special type of burnout known as compassion fatigue. With this type of burnout, a helping professional may feel overwhelmed by the struggles and challenges of their clients, which can create emotional distress in their own lives.

Rachele Love, one of our life skills specialists, has personal experience with the challenges that can come with working in a helping profession. Consider Rachele’s story about her close brush with compassion fatigue when she first joined our team in Putnam County.

Rachele Love’s Story of Professional Stress and Adaptation

Rachele Love, Life Skills Specialist at Cummins Behavioral Health
Rachele Love, Life Skills Specialist at Cummins Behavioral Health

Before she joined Cummins, Rachele Love already had a wealth of experience working in the helping professions. She previously spent 17 years working as a paraeducator, assisting school-aged children and teens who had mild, moderate and severe disabilities. In addition, she also served five years active duty in the U.S. Army, which instilled her with a strong sense of duty and personal achievement. “When you’re a soldier, you’re given a directive, and you don’t just meet it—you exceed it. That’s just what’s been ingrained in my life,” Rachele says.

When Rachele joined our team at Cummins, she knew she wanted to continue her work with children, so she became a school-based life skills specialist (or LSS) at Cloverdale middle school and high school. Although the work was different than it had been in a special education environment, Rachele took to it quickly. Many of the youths she counseled had behavioral problems rather than mental illnesses or developmental disabilities, but Rachele had little difficulty connecting with them. “The rapport and relationship with all of my kids was great,” she says.

However, scheduling appointments with her consumers soon became an issue. Rachele was only permitted to pull students from non-core classes such as computers, physical education, art and music, but she also needed to rotate through these electives so her students didn’t miss any one class too many times. Despite her best efforts, these restrictions caused her to start falling short of her counseling expectations. “My position was productivity-based,” Rachele explains. “The expectation was 25 hours of direct clinical care each week, and I was struggling to meet that. It was a huge problem for me.”

Rachele’s supervisors, for their part, were very supportive. They encouraged her not to worry about her hours and just focus on providing high-quality care for her students. But even with this reassurance, Rachele had trouble accepting her own perceived shortcomings. “I was definitely stressed out about it, and I would say a little bit depressed as well, because it’s really a punch in the gut when I can’t meet an expectation,” she says. “I felt like I was letting myself and everyone else down.”

Rachele was struggling, and she knew that the situation would only get worse if it continued. Clearly, something needed to change.

Shelby Rusk on the What, Why and How of Compassion Fatigue

Shelby Rusk, MSW, LSW, Youth Therapist at Cummins Behavioral Health
"In this field, we're trained to have empathy and compassion toward others, but sometimes that compassion and empathy can become overwhelming. Then our consumer's stressors can become our stressors," says Shelby Rusk, MSW, LSW, Youth Therapist at Cummins Behavioral Health.

Rachele’s story is not a textbook example of compassion fatigue, but it does bear many similarities. As mentioned above, compassion fatigue is a sort of burnout caused by repeated exposure to people who are experiencing difficult life circumstances. The psychologist Charles Figley, the so-called “Father of Compassion Fatigue,” has described it as “vicarious traumatization”—a phenomenon that occurs when therapists and other helping professionals personally experience the trauma felt by the people they are helping.

“Compassion fatigue is very similar to burnout, but it can affect us faster,” says Shelby Rusk, a Youth Therapist at our Montgomery County office. “We take on the suffering of our consumers, and we start to feel what our consumers feel. Having intrusive thoughts, having trouble sleeping, maybe being irritable, withdrawing from our supports or not wanting to do things that previously brought us joy— these would definitely be some things to look for.”

According to the American Institute of Stress, some other common symptoms of compassion fatigue include:

  • More intense emotions
  • Diminished cognitive abilities
  • Feelings of isolation
  • Depression and post-traumatic stress
  • Loss of self-worth
  • Loss of hope and personal sense of meaning
  • Anger toward people or situations that have caused harm to others

Why does compassion fatigue happen in the first place? As human beings, it is natural for us to feel concern when we witness another person suffering. Those who work in the helping professions encounter suffering much more often than the average person—and perhaps more than our brains are equipped to handle. “Every hour is a new traumatic story, and hearing all these traumatic stories can really wear on a person,” Shelby says.

In addition, Shelby speculates that individuals who join the helping professions may be especially sensitive to other people’s suffering. “I think people who come into these fields just naturally want to help others. A lot of times, we want to fix problems, so we take on a lot of responsibilities for our consumers,” she says.

Returning from the Brink of Exhaustion

If compassion fatigue is caused by overexposure to other people’s suffering, then it can be prevented by limiting this exposure and focusing more energy on ourselves. But how is this possible for someone whose entire profession revolves around helping others?

It begins with basic self-care routines like getting plenty of sleep, exercising regularly, eating a healthy diet, and practicing mindfulness whenever possible. According to Shelby, it’s also important to focus on positive outcomes and situations when working in the helping professions, which is where gratitude exercises can come in handy. “You are going to see more challenges with people than not, so it’s important to focus on the positives and the successes you had,” she says.

However, it’s also crucial that helping professionals have access to good support systems both inside and outside of work. Shelby says, “Having a positive support system at work is huge. Ideally, we need co-workers who can help us have fun and not get stuck in negative ruts, and we also need leaders who can give us guidance. But that support system outside of work is very important, as well, to help you separate your two lives. You have to separate them, and it can be hard when you live and breathe work.”

Having said that, let’s return now to Rachele’s story. Was she able to find balance in her work and turn back from the brink of burnout and compassion fatigue? Fortunately, she was.

“I have to give credit to Anna Harmless,” Rachele says. “She was my team lead, and she was just so helpful, and just incredible. I met with Anna and I told her, ‘We have to talk, because this isn’t working for me. But I love this company and I don’t want to leave.’ “ For Rachele, the solution was not to change her line of work, but to change her assignment within the organization. She left the school-based environment and started working as an LSS at Green Willows, a supported group living home operated by Cummins. “Green Willows sounded perfect for me, because it was very close to what I had done for three years prior to joining Cummins,” she says.

Today, Rachele’s story shows that it is possible to recover from the stress and fatigue that sometimes afflicts those who work in the helping professions. “It’s been awesome. I’m just so happy here,” she says.

For more information about challenges that helping professionals may face in their line of work, we recommend our blog posts on multitasking and the Imposter Syndrome below!

Stress Can Be Good For You (as in this picture of a woman doing her homework)
Multitasking, Attention-Deficit Trait, and Boundaries
Perfectionism and 'Hurry Worry'
Embracing Your Inner Expert: Perfectionism and the Impostor Syndrome in Mental Health

How Motivational Interviewing Helps Create Positive Life Change During Counseling

“Everything changes and nothing stands still.” — Hereclitus of Ephesus, ancient Greek philosopher

Change is one of the few things about life that never changes. No matter who we are or how old we get, the circumstances of our lives never stay the same forever. Sometimes change is unplanned, unexpected, or outside of our control—we may lose our job or be offered a new job, meet a new friend or lose an old one, live through a natural disaster or be gifted a large sum of money. Other times, change occurs because of actions we take to create it.

As we’ve discussed in a previous post, any change that we make to our own lives follows a predictable pattern known as the Stages of Change. First comes precontemplation, the stage in which we haven’t even begun to consider the change we’d like to make. Next come contemplation and preparation, when we begin to consider and make plans for the upcoming change. Then we reach the action stage, where we take the necessary steps to implement our change, and finally maintenance, where we work to continue whatever behaviors brought about the change.

However, it’s impossible to make a conscious change to our life if we don’t know what we want to change. With all the daily duties and distractions that occupy our thoughts, we may sometimes find it difficult to envision how we’d like to improve our lives. We can become stuck in the precontemplative stage of behavior change, in need of a spark to ignite positive change like a rocket taking off from its launch pad.

Motivational interviewing is a counseling method that can help with this indecision. By focusing on the consumer’s values and life goals, a counselor using motivational interviewing (or MI) can help someone discover their internal source of inspiration, providing that much needed spark to jump start the process of change. In this blog post, Cummins’ Tracy Waible and Tim Grzeskiewicz explain what principles motivational interviewing is based upon, what it looks like in practice, and why it’s a highly effective tool for eliciting positive life change.

Principles of Motivational Interviewing: “A Dance, Not a Wrestling Match”

Tracy Waible, LCSW, LCAC
"For me, motivational interviewing is a way of connecting with another human being and ensuring they feel valued and heard," says Tracy Waible, LCSW, LCAC, Director of Recovery Services at Cummins BHS and a DMHA-certified trainer in motivational interviewing for the State of Indiana.

To understand motivational interviewing, it helps if we recognize how it is different from other forms of counseling.

In traditional counseling or therapy, the care provider’s job is to impart knowledge and guidance to the recipient. The assumption is that the person in counseling has a problem that only the counselor knows how to solve. We can see this even in the definition of the word “counsel,” which means to advise. By contrast, to “interview” someone means to question or talk with (them) to get information. In motivational interviewing, the counselor does not tell the consumer how they should change, but rather asks them if and how they would like to change.

“When you’re using MI, the provider is focused on the thoughts, values and goals of the person coming in for services,” says Tracy Waible. “It’s not about what I think is best for you or how I think you need to go about changing, but rather, what do you think? How do you think you can get there? What are your reasons for change?”

When working with a consumer using motivational interviewing, care providers utilize a set of person-centered skills known as “OARS+A”:

  • Open-ended questions: Instead of asking simple “yes or no” questions, the provider poses questions that prompt the consumer to elaborate. E.g. “How do you feel about that?” or “What do you want to do about it?”
  • Affirmations: The provider comments positively on the consumer’s intentions and efforts to change, which helps build confidence in their ability to change. E.g. “I think you’re making great progress toward your goal, well done.”
  • Reflections: The provider repeats back the consumer’s thoughts and feelings to let them know they’re being heard and understood. E.g. “It sounds like you feel frustrated about this aspect of your life.”
  • Summaries: The provider connects the dots between the consumer’s thoughts to help them better understand their own feelings and desires. E.g. “You’ve told me that you always feel stressed at work, you dread getting up in the morning, and you would quit your job if you could. It sounds to me like you aren’t very happy in your current line of work. Does that sound right to you?”
  • + Advice with permission: If the consumer is open to suggestions, the provider may offer advice about what they should do next. E.g. “Based on what I’ve heard, I think you should consider changing your sleep habits.”

According to Tracy, motivational interviewing is ultimately about collaborating with the consumer to help them make the changes they want to make in their life. “Motivational interviewing views people as very values-driven. For any behavior that’s happening, there’s a value or an emotion behind it,” she says. “Our job as providers is to tap into that. A lot of therapy techniques are very confrontational or directive, where the provider just asks people a bunch of questions and they don’t really feel a part of the process. MI is more like a partnership. It should feel like a dance versus a wrestling match.”

Motivational Interviewing in Practice: Continuously Increasing Insight

Tim Grzeskiewicz, LMHA, QBHP, Substance Use Disorder Therapist at Cummins Behavioral Health
"No matter how long someone's been in therapy or in recovery, and no matter how motivated they are for change, I think there's always room for increasing insight and awareness," says Tim Grzeskiewicz, LMHA, QBHP, Substance Use Disorder Therapist at Cummins Behavioral Health.

As we’ve explained, the goal of motivational interviewing is to help consumers discover why and how they want to change their lives. But how does this translate into a typical counseling session?

According to Tim Grzeskiewicz, who uses MI in his work treating individuals with substance use disorder, it all begins with the initial assessment for services. “Let’s say someone has gone through the intake assessment, they’ve been identified as needing IOT, and they’re ambivalent or arguably resistant,” he says. “They come to my office, and I just kind of lay it out there. I say, ‘You’re in my office because somewhere along the line, somebody said you have a substance use problem. What do you think?’ “

Depending on how the consumer responds, Tim begins to determine their willingness to change and how to proceed with counseling. “There’s a great tool that I like to use called ‘branching,’ “ he explains. “You ask that first open-ended question, and then you continually branch questions down from there. If the response is, ‘Yeah, obviously I’ve been using a little more than I should, that’s why I’m here,’ there’s a different question that follows that versus if the response was, ‘Yeah, my wife’s a little worried. It’s not a problem for me, but it is for her.’ “

No matter what a consumer believes or how open they are to change, the ultimate goal of motivational interviewing is to continuously build insight regarding potential problems in their life. As Tim explains, this is the best way to help a consumer identify opportunities for change:

“As people, we aren’t stupid, we just have blind spots. We don’t want to think that we’re making bad decisions, but when we hear them out loud, we might realize they aren’t healthy for us. That’s the whole thing with motivational interviewing: it leads people to their own insights. Because I could tell you, ‘You need to change. Look at the scores on this assessment. You have a problem.’ If I do that, you’re probably not going to make a change. But if I lead you to the discovery, now you’re thinking about it, so I just helped you move from precontemplation to contemplation. Then you might say, ‘Wow, do I need to change something?’ and I would say, ‘I don’t know, let’s talk about that.’ And then we would be moving toward preparation and planning.”

Even after a person has successfully made a change to their life, the usefulness of motivational interviewing doesn’t end. “Therapeutically, I’m always using MI,” says Tim Grzeskiewicz. “If I’m in session with someone I’ve been seeing for two years, and we’re exploring whatever’s happening in their personal life, I’m still asking open-ended questions so they can develop insight into areas of their life that they may want to change.”

At Cummins Behavioral Health, motivational interviewing is one of the primary tools our providers use to help consumers achieve their behavioral health goals. As Tracy Waible says, “Our view at Cummins is that MI is the lining in any hat you’re wearing. Even if we’re using other treatment modalities, we can always embody the spirit of MI.”

Looking for inspiration for your next positive life change? Our blogs posts on nutrition, exercise, sleep and mindfulness might provide you with a few interesting ideas!

Fruits and vegetables
How Nutrition Affects Mental Health with Cummins’ Jaime Selby and Hendricks Regional Health’s Kaitie Delgado
Exercise for mental health
Exercise and Mental Health: How Physical Activity Improves Mood, Cognition, and Overall Wellness
Dr. Ashleigh Woods Explains How—and Why—to Get a Good Night’s Sleep
Using Art to Practice Mindfulness with Holly Combs and MHA’s Karen Martoglio

Family Therapy: Restoring Cohesion through Validation and Compromise

“Family is not an important thing. It’s everything.” — Michael J. Fox

Since the beginnings of human history, the family has always been our most vital social unit. Across all times and civilizations, people have always developed rules and customs for how to act within a family, which indicates the universal importance of this closest form on human connection. As Cummins therapist Melanie Gibbs puts it, “Our culture is really based on family systems. I don’t know of any culture where families are not the basis of what holds that culture together and drives it.”

Because families are our most fundamental social groups, it’s extremely important for our mental and emotional health that our family unit is cohesive. Generally speaking, a cohesive family is one in which the members live together harmoniously and each person is free to grow and express themselves as individuals. However, some amount of conflict within a family is virtually unavoidable.

Conflict can occur between two people anytime their needs or desires interfere with each other’s. Within families, this may be especially likely during periods of change and transition, such as when children are born or begin schooling, when a parent loses a job or begins a new one, when the family moves to a new geographic location, or when the parents become separated or divorced. When conflict arises, it is in everyone’s best interest to find a resolution that maintains or restores family cohesion as fully as possible.

Sometimes families need help working through conflict and returning to cohesive functioning. This is both understandable and normal; in fact, more than half of the work we do at Cummins Behavioral Health involves children and families. Melanie Gibbs, LCSW, has been a provider of behavioral health therapy for over 20 years, and she has helped many families heal from conflict during that time. In this blog post, Melanie explains how therapy can help a family overcome internal conflicts using the key principles of validation and compromise.

Mistrust: The Result of Communication Breakdown

Melanie Gibbs, LCSW, Outpatient Therapist at Cummins Behavioral Health
"One thing that's so easy to forget is families are systems, and what impacts one member of the family impacts everyone," says Melanie Gibbs, LCSW, Outpatient Therapist at our Putnam County office.

As we said above, conflict usually arises between two people when the things one person wants interfere with the things the other person wants. It’s often possible for the two parties to resolve their conflict if they listen to each other’s perspectives and agree on a mutually acceptable compromise. When a conflict escalates, it’s typically due to a breakdown of respectful communication between the individuals in dispute.

This is usually the stage of conflict a family has reached when they choose to begin therapy. “Typically, feelings are very hurt, and people have been dealing with that hurt by either withdrawing or attacking back, typically with words,” Melanie explains. “Over time, that starts to erode feelings of trust and safety within the family. Trust diminishes, trust diminishes, trust diminishes, until there’s really no communication and no trust.”

If it is not addressed, this lack of trust will ultimately drive a family apart. The goal of therapy is to rebuild trust within the family, and the first step toward rebuilding trust is reestablishing constructive communication. “My job is to get people to hear each other—and to keep hearing each other until the message sent is the message received,” Melanie says.

In therapy, this is primarily achieved by validating the feelings and desires of each family member, as Melanie explains:

“I want each person in the room to tell me their perception of the story that brought them to therapy. What do they think is going on? How do they see it? I’ve been doing therapy for 20 years, and I’m not sure that I’ve ever had a conversation with anyone where I could not find some validity in what they were saying and how they were seeing it. A person’s backstory influences how they see things and what they need, so if you have four people in a room and everyone tells their story one by one, it’s easy to say, ‘Yes, I understand you because of this and this. This is the way this feels to you, and this is what’s going on in your mind.’ Everyone can feel heard and respected, and they can still come together to solve the problem.”

Dismantling the Fallacy of “Right and Wrong”

When two people are engaged in a conflict, it’s only natural for each person to believe that they are right and the other person is wrong. However, taking the time to listen to each person’s perspective helps us realize that this is not true. “People often anticipate that there’s going to be a ‘right’ and a ‘wrong,’ and they worry they’re going to be in the wrong and their feelings are going to be invalidated. But that’s not what family work is,” Melanie says. “It’s not my job to call out right and wrong. There is no right and wrong.”

To accept that neither person is right or wrong means two things: first, that each person has behaved reasonably given their point of view, and second, that each person may have unintentionally contributed to the problem. As Melanie explains, this is easier for people to do if they believe their own perspective is being taken into consideration:

“Until someone feels heard, they can’t be open to hearing anyone else. Their mind is full of everything they need to say. So before you can ask people to change, and before you can ask them how they think they’ve contributed to the problem, you have to hear their feelings, their perceptions, their experience, their hopes, and you have to say, ‘OK, I hear you. I see that these particular things are very important to you, and I understand why they’re important to you, and we’re going to remember that.’ It’s called ‘creating safety.’ You have to create emotional safety so people can begin to relax and be more open to hearing other people.

In the case of family therapy, everyone must ultimately must work together to find an acceptable compromise that will keep the family together. “One of the premises that I promote in couples or families work is: instead of solving a problem in terms of who’s right and who’s wrong, how do you solve a problem in a way that everyone can most live with?” Melanie says. “What’s the solution that everyone can genuinely be the most on-board with? That’s the solution you want to go with, because in the end, holding the family system together in a way that people can feel seen, honored, respected and safe is much more important than the particular decision you make.”

Some amount of conflict within a family is normal, but conflict that escalates and goes unresolved can seriously threaten family cohesion. Family therapy can help to restore harmony by validating the thoughts and feelings of each person and working to find a compromise that everyone in the family can live with.

At Cummins Behavioral Health, we are committed to promoting healthy families and family resiliency among our consumers. If you are experiencing dysfunction in your family and think that family therapy might be right for you, please give us a call at (888) 714-1927 to discuss your options and schedule an appointment!

Looking for more services and interventions that can help strengthen family functioning? You might like our blog posts on wraparound services and Conscious Discipline below!

Wraparound Services: 360-Degree Support for Youth with Greater Behavioral Health Needs
Conscious Discipline: A Constructive Approach to Behavior Modification for Children

Mental Health IOT: Meeting the Need for Intensive Outpatient Therapy in Indiana

Just as no two individuals are the same, so too are everyone’s behavioral health needs unique. Even when two people suffer from the same mental illness—such as depression, anxiety or schizophrenia—the severity of their condition can vary greatly. Depending on the individual, a mental health issue could be a minor inconvenience in their life or a debilitating condition that impairs their day-to-day functioning.

When a person seeks treatment to help manage a mental illness, the level of care they receive should match the severity of their needs. For consumers with lesser needs, standard outpatient therapy (which typically consists of 30-minute to one-hour sessions no more than once or twice a week) is often sufficient to help them with their challenges. On the other hand, consumers who are experiencing a period of extreme need may be admitted to a psychiatric hospital for inpatient care. But what if a person’s needs are somewhere in between—too great for outpatient care to fully address, but not severe enough to warrant hospitalization?

Consumers who struggle with substance use disorder have the option of Intensive Outpatient Treatment (or IOT) if they fall within this category. However, consumers with other mental health challenges have not traditionally had access to this level of care, which is a gap that Sarah Gunther of KEY Consumer Organization has been passionate about filling. Gunther explains,

“I am on the Cummins Consumer Advisory Board, where I’m able to give some direction on ways that Cummins can improve. Every time we’ve had a conversation about substance use IOT, I’ve advocated for general mental health IOT as well. I thought it could help a lot of people as a step between purely outpatient and inpatient treatment. Not everyone benefits from hospitalization, which can actually be harmful for some people, but they might benefit from more intensive help than they get with regular outpatient care.”

Sarah Gunther, Executive Director of KEY Consumer Organization
Sarah Gunther, Executive Director of KEY Consumer Organization

At the suggestions of Gunther and other advocates, Cummins Behavioral Health has begun providing Intensive Outpatient Treatment for consumers with challenges not related to substance use disorder. We believe this program will help more people get the right kind of help for their behavioral health challenges, right when they need it. In this blog post, IOT group facilitator Christina Kerns explains who the program benefits, how it works, and exactly what it does help individuals with greater mental health struggles.

MHIOT: How It Works and Who It Can Help

Christina Kerns, Outpatient Therapist and MHIOT Group Facilitator at Cummins Behavioral Health
Christina Kerns, Outpatient Therapist and MHIOT Group Facilitator at Cummins Behavioral Health

Mental health IOT (or MHIOT) is a relatively simple program in practice, though it does require a large time commitment from consumers. Therapy is administered in a group setting, with group members meeting three days a week for three hours each day. During sessions, group members discuss whatever mental health difficulties they’re experiencing, provide input and communal support for each other, and learn life skills that can help them through their struggles.

As the group facilitator, Christina’s primary job is to ensure that the session runs smoothly. “I help keep the discussion moving,” she says. “I’m there to give feedback on any issues, help group members reach their treatment goals, and assist them in identifying common themes with one another so they can work together and help each other heal and grow. It’s so important because group members learn how to problem solve and cope with their challenges together.”

As mentioned above, the program is ideal for people whose needs are too great for standard outpatient treatment but not severe enough for inpatient treatment. In practice, many consumers are referred to MHIOT as a means of preventing hospitalization or as follow-up care after a stay in the hospital. “Our hope is to provide consumers with additional services so that we can help prevent crisis situations and hospitalizations from occurring,” Christina explains. “And if anyone has been hospitalized within the last month, we like to check and see if our group would be appropriate as a step-down for them.”

Although it has only been running since the end of June, Christina reports that many consumers of MHIOT have responded favorably to the program. It’s her opinion that the group format has been especially beneficial for helping members achieve their mental health goals. “The mental health IOT group is extremely important to Cummins, because so many individuals within our communities who are trying to manage a mental illness do not have access to support groups,” Christina says. “Since we’ve started this group, many of our consumers have found it helpful for their recovery to share their experiences in a safe and confidential setting, which allows them to gain hope and develop supportive relationships with one another.”

What Happens During a Typical MHIOT Session

We’ve explained the underlying principles of mental health IOT, but what exactly do these principles look like in practice? How do group members work toward their mental health goals, and what does Christina do to guide each session? What should someone expect the first time they attend a group?

Like many group therapy sessions, every MHIOT meeting begins with introductions. “We have five basic questions that everyone answers,” Christina explains. “They tell us their name, how they’re feeling that day, any court issues they’re willing to discuss, what skills they’ve used since the last session, and whether they’re having any suicidal ideation, homicidal ideation, or thoughts of self-harm.” The group works through each member’s answers one by one, providing emotional support and guidance as needed.

After introductions, Christina leads the group in a discussion of their recovery values, including a daily reading to help members understand and apply each value. Once this is done, the group typically moves on to a lesson on mindfulness. “We teach the ‘wise mind,’ which is about not getting stuck in our emotional mind or our rational mind, but mixing the two together,” Christina says. “A lot of our members had no idea whether they tended to react with their emotional mind or their rational mind, nor did they know how to identify what feelings they’re feeling in the moment. It’s really a process that we have to teach ourselves.”

Finally, each session ends with training and discussion on a life skill that can help group members achieve their mental health goals. These skills are taken from dialectical behavior therapy (or DBT), a type of psychological therapy that emphasizes validation and acceptance. According to Christina,

“We chose dialectical behavior therapy because it’s the basis for skills training, and it’s been shown to help an array of diagnoses—especially serious mental illnesses like depression, anxiety, and personality disorders. There are three bases that I teach from: on Monday, we focus on distress tolerance skills; on Wednesday, we focus on interpersonal effectiveness skills; and on Friday, we focus on emotional regulation skills. So the group is learning how to recognize and identify their emotions, how to interact with other people, and how to use these skills to improve their mental health and wellness.”

We are excited to now be offering Mental Health Intensive Outpatient Treatment to consumers who need additional support with non-addiction-related behavioral health problems! If you are a Cummins consumer and you believe MHIOT could be a good fit for your needs, we encourage you to discuss it with your care provider.

We would like to extend a special thanks to Sarah Gunther and KEY Consumer Organization for helping us continue to provide the best behavioral health care possible for our consumers. If you would like to learn more about KEY, you can visit their website at KEYConsumer.org, or call their mental health “warmline” at 800-933-5397 if you need a sympathetic ear to discuss your mental health challenges with.

Conscious Discipline: A Constructive Approach to Behavior Modification for Children

“Discipline is not something you do to children; it is something you develop within them.” — Dr. Becky Bailey

As many parents would attest, few things about raising children are easy. On top of the substantial commitments of time and resources that children require, parents must also determine how best to guide their children as they learn, grow and develop as individuals. Providing discipline can be a significant part of this process, which leaves parents with the additional task of deciding how they ought to do it.

The old adage “spare the rod, spoil the child” suggests that punishment (and in this case, corporal punishment) is a necessary component of discipline for children. However, modern psychologists have discovered that punishment is not as effective at changing behavior as once thought. For example, studies presented by the American Psychological Association have found that punishments like “time-outs” can be effective at reducing defiant and violent behavior, but reasoning with children is most effective for milder forms of misbehavior. In addition, reasoning proved more effective at reducing violent and defiant behavior in the long-term than punishment.

It’s with this knowledge that Dr. Becky Bailey, at the time a professor of early childhood education at the University of Central Florida, created “Conscious Discipline” in 1996. Conscious Discipline is a social-emotional learning program for parents, educators and mental health professionals that emphasizes behavior modeling and problem solving rather than punishment for misbehavior. According to a report by the The Harvard Graduate School of Education, Conscious Discipline has been shown to reduce aggression, hyperactivity and conduct problems among children.

Anna Harmless and Melissa Lawson, two school-based providers at our Putnam County office, have begun utilizing components of Conscious Discipline in their work with youth, parents and educators. In this blog post, they explain the basic science underlying Conscious Discipline and why it can be an effective, constructive alternative to punishment-based discipline.

Brain States and Behavior: The Science Behind Conscious Discipline

Anna Harmless and Melissa Lawson of Cummins Behavioral Health
Anna Harmless, LCSW, Team Lead and school-based therapist (left) and Melissa Lawson, LSS, OBHP, school-based life skills specialist (right)

According to the Conscious Discipline model, anyone who wants to modify a child’s behavior must first understand a few things about the way the human brain functions.

The tenets of Conscious Discipline are based upon a simplified neuropsychological model of the brain. This model does not tell us everything about the way our brains work, but it can help us predict how a person will feel and behave in certain situations. “Dr. Becky Bailey did a lot of research on the human brain, and she found that we have three different ‘brain states,’ “ Melissa explains. These states are:

  1. The Survival State: This is the most basic or “primal” of our brain states, which is activated when we perceive a threat to our well-being. When our brain is in the Survival State, we look for ways to fight or flee from the perceived threat, and we are incapable of thinking clearly and rationally.
  2. The Emotional State: This state is typically triggered when something upsets us and causes us to feel anger, fear, sadness, or another negative emotion. In this state, we tend to revert to ingrained patterns of behavior and are not good at thinking critically or considering other people’s opinions.
  3. The Executive State: This state makes full use of our prefrontal cortex, allowing us to think through conflicts and find logical, constructive solutions. It is the optimal brain state for problem-solving and learning, but it is only accessible when we are in a state of emotional calm.

The main problem with “traditional” or punishment-based discipline is that it keeps children in the Emotional or Survival Brain States—neither of which are conducive to learning. “I’ve been doing therapy at Cummins for seven years now, and I have seen traditional discipline fail so many times,” Anna explains. “The child is already thinking, ‘I’m bad. I’m sad. I feel bad.’ So if we punish them by taking something away, that just reinforces the child’s inner voice. We want to help the child calm themselves and express themselves instead.”

Melissa adds, “Ideally, we want children to develop their executive functioning skills so they can problem-solve and learn to cope with their emotions in a healthy way.” Therefore, the primary goal of Conscious Discipline is to teach children how to work through problems using their Executive Brain State.

Behavior Modeling and Problem Solving: Conscious Discipline in Action

As we’ve said, Conscious Discipline teaches that children must be engaged in their Executive Brain State in order to truly learn from disciplinary action. This is all well and good if the child is calm and collected at the moment discipline is required—but what if they are misbehaving due to emotional turmoil? How can we help move the child out of the Emotional or Survival Brain States so they will be receptive to instruction?

This brings us to another important concept of Conscious Discipline: behavior modeling. Humans, and especially human children, intuitively imitate the behavior of other humans. It’s one of the primary ways we learn how to think, act and socialize with others. With this in mind, Conscious Discipline teaches that adults can help shift children into their Executive Brain State by modeling calm, thoughtful, non-aggressive responses to problems and conflicts. Melissa explains further,

“Dr. Bailey calls this ‘downloading your calm’ onto the child. If you’re approaching the child in a calm state, you can help them get to that calm state with you, whether it’s through affection or just recognizing how they’re feeling and reflecting it back to them. You can say, ‘You seem upset. Is this why? OK, we’re going to breathe, and I’m going to teach you how you can calm down and help yourself feel better.’ Once they’re calm, that’s when you can solve the problem together and teach them a skill they can use for the rest of their life.”

Of course, if the adult is upset by the child’s misbehavior, then it may be difficult for them to respond to it constructively. As a result, Conscious Discipline also requires adults to monitor their own brain states and regulate themselves appropriately. “There’s a lot of mindfulness work that the adult has to do,” Anna says. “Overall, it’s a self-regulation program to help adults first so the adults can help the children.”

For adults and children both, this means breaking free from any maladaptive disciplinary practices they may have learned in the past. “Family culture is huge in the way the world works and the way our children learn, but a lot of people don’t even think about the concept of family culture,” Anna continues. “We want people to understand how they learned what they learned about parenting and being a part of a family. We’ve been able to help some parents realize, ‘Wow, I didn’t like how it felt when I was punished as a kid. Maybe I don’t want to cause my own child to feel that same negativity.’ “

When exercised appropriately, Conscious Discipline inverts the focus of child discipline by teaching the child what to do instead of what not to do. According to Melissa, the most difficult part of the whole process is not getting carried away with our emotions: “The hardest part for kids and adults is noticing the reaction they’re having, calming down, and getting out of that Emotional or Survival State. then they’ll be able to process and work through the problem in their Executive State.”

If you’d like to learn more about Conscious Discipline, we encourage you to visit ConsciousDiscipline.com, where you can learn even more about how the program works and access free resources for working on discipline with children!

If you’d like to learn more about behavioral health challenges that children may face, we recommend watching our video on trauma and student mental health below, which we recorded last year with Cummins’ Michelle Freeman and Jessica Hynson!

How IAPRSS and Cummins BHS Are Advancing Peer Recovery Support Services in Indiana

When someone is working toward recovery from substance use disorder (or SUD), support from loved ones and treatment professionals is a must. In particular, behavioral health workers like therapists, counselors and life skills specialists can offer invaluable guidance and assistance for anyone who is working to overcome addiction. However, sometimes a recovering person can benefit most from the support of an individual who has their own lived experience with SUD.

This is where peer recovery support services can be helpful. Peer recovery support services (also called “peer recovery services” or “peer support services”) are behavioral health services that supplement clinical treatment for substance use disorder. These services are delivered by peer recovery coaches or peer recovery specialists, individuals who are themselves in long-term recovery from substance use. According to the Substance Abuse and Mental Health Services Administration, peer recovery services have been shown to improve relationships with treatment providers, increase satisfaction with treatment, decrease criminal justice involvement, reduce relapse rates, and improve access to social supports.

In a nutshell, peer recovery support adds to SUD treatment services by extending care beyond the doors of a clinical facility. Peer recovery coaches rely on shared understanding and respect to support their clients’ recovery on an informal, day-to-day basis. In many cases, a peer may serve as a bridge to other individuals and supports that can help a person stay invested in their recovery for the long term.

As a strong advocate of peer recovery services, Cummins Behavioral Health has been working with the Indiana Association of Peer Recovery Support Services (or IAPRSS) to promote their implementation throughout our state. In this blog post, we speak with IAPRSS Director Justin Beattey about what his organization does and how it’s working to improve peer recovery services throughout Indiana.

Justin Beattey and IAPRSS: Advocates for Peer Recovery Support in Indiana

Justin Beattey, Director of the Indiana Association of Peer Recovery Support Services
Justin Beatty, CAPRC II, CADAC II, CHW/CRS-GA, ICPR, MATS, Director of IAPRSS

Justin Beattey isn’t an advocate for peer recovery support just because it sounds good on paper; on the contrary, he has witnessed the good it can do firsthand.

“I am a person in long-term recovery from mental health concerns, substance use issues and the criminal justice system,” Beattey explains. “I’ve had several go-arounds with treatment since I was a teenager. All of my engagements with treatment were very provider-focused, by which I mean the provider pretty much told me, ‘This is what you need to do.’ My last go-around with treatment was when I connected with peer support, and that was the first time I ever had anyone ask me, ‘What do you want to do, and how do I help you do that?’ “

IAPRSS works to advance the profession of peer recovery support in two main ways: by supporting peer professionals as well as the organizations that employ them. For peer recovery coaches and specialists, this primarily means providing professional development assistance and community support. “For example, we have a once-a-month peer professional support group for peers to get together and talk about their profession and what’s going on in their work,” Beattey says. “And we also meet with peers individually to help them map out how they want to grow professionally—how to strengthen current skills and where to make improvements.”

For behavioral health organizations, IAPRSS provides varying levels of consultation related to peer recovery support services. “Sometimes it’s helping an organization figure out policy and procedure, plan out workflow, create job descriptions, advertise those jobs—everything related to building out that program,” Beattey says. “For other organizations, it’s just talking through what ideas they have and what other organizations are doing.”

According to Beattey, one of IAPRSS’ primary goals is to improve the quality of all peer recovery services provided across the state:

“We want to help ensure that consistency is provided throughout Indiana, because a lot of organizations have kind of had their own understanding of peer support. Some organizations really understand it, and others don’t so much just because they haven’t been educated on it. We’ve been able to use organizations like Cummins as examples of what good, robust peer recovery programs should look like, and also how to properly support peers through effective supervision.”

How IAPRSS and Cummins Are Raising the Bar for Peer Recovery

As Beattey hinted at above, one of the prevailing issues with the peer recovery profession is a lack of standardization across different organizations and programs. Because there are no external regulations on peer recovery services, organizations that provide peer services are left to determine their own guidelines and best practices. In response, IAPRSS has been working to develop universal standards to help all peer recovery support programs effectively serve their clients.

“We used a grant from Indiana’s Division of Mental Health and Addiction to create a peer infrastructure advisory board for the state,” Beattey explains. “We gathered a lot of industry leaders and created a ‘think tank,’ for lack of better wording, and one of the things we did is create some standardized documentation.” These include ready-to-use guidelines covering professional standards for peer recovery coaches, supervision of peer recovery professionals, and ethical standards for peer recovery support services.

Once these standards were agreed upon and documented, Beattey and IAPRSS made sure to get the word out in the peer recovery community. Beattey says, “We worked throughout the state doing town hall discussions about peer recovery support to get the community as a whole educated on what peers are—that they’re not sponsors, they’re not counselors or therapists, they’re just people who are going to provide person-centered recovery support based on the individual’s needs. And what was more important than just creating standards was making sure we educated the community on them.”

Throughout the whole process, IAPRSS has collaborated closely with Cummins and other behavioral health organizations that are operating successful peer recovery programs. This process has been invaluable for determining best practices of peer recovery support, as Beattey explains:

“It’s been incredibly important for us to maintain regular communication with behavioral health providers to have real-time updates on what’s happening in the peer support profession. Cummins has been a great partner, because they have had no qualms about reaching out to me and letting me know what’s working well for them. This provides us with real-life examples, so rather than saying, ‘We think this is how peer support should be done,’ we’ve been able to say, ‘Well, this is what’s working great at Cummins, or this is what’s not working great at Cummins—this is what needs clarification.’ And that has helped me advocate for peer support services with other organizations, because I can say that it’s not just IAPRSS thinking this, it’s Cummins thinking this, as well.”

At Cummins Behavioral Health, we believe strongly in the value of peer recovery support services for individuals who struggle with substance use disorder. We are thrilled to be working with IAPRSS and doing our part to help peer recovery support services grow and flourish throughout Indiana!

If you’d like to learn about some of the other addiction treatment services that Cummins BHS provides, we recommend reading our blog posts on virtual IOT and adolescent IOT below!

Observing Alcohol Awareness Month with Cummins’ Erin Flick and Virtual IOT
Addiction Treatment for Teens: Introducing Adolescent IOT with Madelin Biddle and Katherine Richards

How Behavioral Health Providers Can Serve Our Veterans’ Mental Health Needs

Service members of the U.S. Armed Forces fill an extremely important role in our society. They are the frontline defenders of our country and all its citizens, and for that, they deserve our deepest respect and appreciation. Unfortunately, the nature of their work puts them at a significantly elevated risk of sustaining injuries both physical and psychological.

One study conducted by the RAND Corporation in 2008 found that approximately 18.5% of veterans who served in Afghanistan and Iraq later suffered from PTSD or depression. The same study also found that only half of veterans who need treatment for these conditions seek help, and only half of those who receive treatment get minimally adequate care. This gap in treatment is especially concerning given the fact that suicide rates for veterans are 50% higher than for members of the general population.

In theory, all veteran health care needs are addressed by the Office of Veterans Affairs (or “the VA”), but in reality, this is not always the case. To begin with, not all veterans are eligible to receive care from the VA, with one common disqualifier being discharge from service under other than honorable conditions. In addition, not all veterans live near a VA hospital, which means they must travel long distances for medical or behavioral health appointments. For these reasons and more, community behavioral health providers have a duty to offer high-quality care to veterans and service members.

Like with any consumer population, it’s essential that veterans receive behavioral health care that is sensitive to their unique experiences and needs. To learn more about these needs and how providers can meet them, we spoke with Cummins’ Matt Baker, a Peer Recovery Specialist and Armed Forces veteran, and Melissa Bush, a Licensed Therapist who also comes from a military family. In this blog post, Matt and Melissa explain what kind of behavioral health issues veterans may face, what barriers to treatment stand in their way, and how care providers can give them the treatment they need and deserve.

Behavioral Health Challenges of the Military Lifestyle

Melissa Bush, LMHC, and Matt Baker, CRS, CHW
Melissa Bush, LMHC, Clinical Team Lead and Licensed Therapist (left) and Matthew Baker, CRS, CHW, Peer Recovery Specialist (right) at Cummins BHS

When we think about current and former members of the Armed Forces, it’s important to remember that not all service members are the same. On top of the personality differences that make every individual unique, a veteran’s experience in the military is also affected by their time and place of service, which branch of the military they served in, and what role(s) they filled. For these reasons, no two veterans will have identical mental health needs.

“Veterans are just like the rest of the population when it comes to mental health care needs,Matt says. “I’ve worked with vets who have major depressive disorder, schizophrenia, personality disorders, generalized anxiety disorders—you name it, veterans suffer with it.”

However, there’s no denying that military service members are exposed to a large amount of stress in the line of duty. “The military experience is very high-stress by nature,” Melissa says. “If you think about boot camp, for example, it’s a very stressful environment. Some of us who have not gone through that experience are not sure we could make it out the other side.” It’s not surprising, then, that post-traumatic stress disorder is a well-known concern among veterans.

A lesser-known problem that some veterans may struggle with is the concept of “moral injury.” As Melissa explains, “Moral injury is the idea that I have this moral code or this person that I believe myself to be, but I’ve been in a high-stakes situation, and in the context of that situation, I’ve acted in a way or saw others act in a way that doesn’t fit with my moral code.” This experience of behaving or witnessing behavior that is contrary to our personal ethics can be traumatizing in its own right.

Unfortunately, the stigma of mental illness is especially prominent in the Armed Forces, which have organizational cultures that value resilience and team cohesion. According to Matt, this can pose a large barrier to treatment for service members and veterans:

“I don’t want to come across sounding negative in any way toward our military or the way we’re trained. I loved my time in the service. I’m proud of my time in the service. But my personal view is that it’s almost an indoctrination that civilians go through when becoming a service member. Starting with basic training, you’re torn down and built back up into this idea of what a service member is and what they represent. You’re a member of a team first and foremost, and an individual second. Mission success is the objective above anything else. So if a service member becomes injured or suffers some kind of mental health issue, then they’re no longer effective as part of that team. It’s perceived as a weakness, and that can cause a lot of chaos in that individual’s life. There’s loss of identity, loss of purpose, loss of belonging. It’s hard to break through that wall that’s been built up, that culture, to get through to the individual and get them to buy-in to the fact that we want to help.”

The Basics of Culturally-Competent Care for Veterans

Given what we know about the veteran population and their mental health needs, there are several steps a behavioral health professional can take to provide them with the best possible care.

First and foremost, providers should be sure that they are asking about military service in their initial assessments with clients. “One of the big factors for providers to know is that this is a population that tends to be under-identified,” Melissa explains. “Have they ever served? Are they currently serving? Have they ever been deployed? Did they see combat? Do they have any close family members or loved ones who are in those same categories? Part of the assessment should be asking these questions to get an idea if there’s more there that needs to be explored.”

Since every service member’s experience in the Armed Forces is unique, providers should also be careful not to assume they know how a veteran feels about the military or the time that they served. “You can’t just assume that all veterans are proud of their service,” Melissa says. “The time they served, the experience they had while serving, the circumstances of their discharge—you need to ask those personal questions to assess how they identify.”

Once this has been done, therapists and counselors should focus on building a relationship of respect and trust just as they would with any consumer. “It all starts with the relationship between the client and the provider,” Matt says. “Sitting down and talking with this person, getting on their level, being empathetic, and digging through the wall that’s going to be put up automatically. Because most veterans are going to be respectful, but they’re not going to want to open up.”

According to Matt, providers may find it easier to build trust and engagement with veterans if they implement a few simple techniques during treatment:

“First of all, providers should understand some of the different language that veterans use. Time is the first one. When you schedule an appointment, try scheduling for ‘1300’ instead of 1:00 PM. Instead of going to lunch, veterans go to ‘chow.’ They may use some derogatory terms for the combatant they fought—understand those. Also, it may sound bad, but you shouldn’t give a vet too many choices. Just tell them what time they need to be somewhere and what to expect, and they’ll be there. That’s a part of the military culture that we come from. Finally, a good way to approach treatment is to lay out the treatment plan like a mission. Sit down with the vet, set the objective, and educate them on it. I think that’s a good approach to get them to buy-in.”

At Cummins Behavioral health, we believe that all people deserve access to exceptional mental health care. Our duty to serve our communities extends to the service members and veterans living within them, especially considering the sacrifices they have made to safeguard our own well-being. That’s why we’re committed to providing the best culturally-competent care possible for our veteran population!

Interested in learning about therapeutic best practices for other behavioral health consumer populations? You might enjoy our blog posts on African American mental health and women’s mental health below!

Black History Month 2020
How Stigma of Mental Illness Affects African American Communities
Women’s Mental Health Awareness: Dr. Corinne Young on How to Provide Effective Behavioral Health Care for Women

Complicated Grief: How to Cope with Loss in Complex Situations

“How lucky I am to have something that makes saying goodbye so hard.” — A. A. Milne, author of the “Winnie-the-Pooh” children’s books

For better or worse, loss is an unavoidable part of life. Loss can come in many forms, such as the death of a loved one, a life-altering injury or medical diagnosis, the breaking-up of a family, the termination of a friendship or romantic relationship, or even the untimely end of a job or career. A loss can be large, small or somewhere in between, and it can affect us in a wide variety of ways.

Grief is one common and very normal reaction to loss. In its simplest sense, grief is deep sorrow or distress that we feel because of a loss. Grief is our natural response to the loss of something that was familiar or comforting to us, and grieving is our way of coming to terms with that loss. The grieving process could take days, weeks, months or even longer, but it usually ends with acceptance and a return to relative peace.

However, grief can sometimes be so intense that it does not go away on its own. Rather than diminishing over time, feelings of grief may sometimes remain unchanged or even get worse as the loss fades into the past. This type of persistent, unresolved grief is known as “complicated grief,” and it can severely impact a person’s mental health and their ability to live a normal life after experiencing loss.

In order to heal from complicated grief if and when it occurs, it’s important that we understand what it is and how it affects us. In this blog post, Cummins school-based therapist April Allgood explains how complicated grief differs from regular grief, what types of loss may cause a person to experience complicated grief, and how someone who is suffering from complicated grief can begin to heal from their loss.

Layers of Loss, Layers of Grief

April Allgood, MSW, LSW, School-based Therapist at Cummins Behavioral Health
"Especially over the past few years, I've really had to become comfortable with grief, because about two-thirds of my caseload deals with complicated grief," says April Allgood, MSW, LSW, a school-based therapist at our Boone County office. April works with school-aged youth and their family members in her day-to-day work.

As mentioned above, the first major difference between regular grief and complicated grief is that regular grief goes away while complicated grief does not. “Typically, individuals are able to adapt to a new normal and learn how to move on,” April explains, “but with complicated grief, symptoms are persistent. They don’t go away, and they impair the person from moving on to what life was like before the loss.”

Just as everyone experiences grief in their own way, complicated grief doesn’t present itself the same way from person to person. In general, though, it is typically characterized by extreme, seemingly unbearable feelings of sadness, guilt or hopelessness. A person is also more likely to experience complicated grief if they’ve suffered multiple losses at the same time or if their grief has multiple layers.

April offers a few examples:

“Especially with COVID-19, there are individuals who are not able to be at their loved one’s bedside to have that final goodbye, or maybe they can’t have the typical funeral or celebration of life. That puts those individuals at a higher risk for complicated grief, because they’re not able to mourn the loss of their loved one in the way they normally would. Another example is when a child is removed from their home. For parents, having their child removed is very tragic and very hard, but sometimes they also have to come to the realization that their choices resulted in their child’s removal. Or maybe one parent is struggling with the loss of their child, so they may potentially resort to substance use, and then maybe they are incarcerated. For the remaining parent, not only was their child removed, but their spouse was then incarcerated for substance use, so they might experience complicated grief because they lost two big entities of their life and their support system.”

Another common difficulty of complicated grief is that each layer of grief can distract from the others, effectively prolonging the overall process of grieving and healing from loss. “Say it’s that parent—when they’re managing the emotion connected to their spouse going to jail, it takes their focus off of grieving their child’s removal from the home,” April says. “It creates a deeper layer because there’s two different things they have to grieve.”

Strategies for Coping with Complicated Grief

Although complicated grief can be an extremely difficult experience, there are many ways a person can cope with their feelings and begin to work toward some sense of resolution. First and foremost, it is always important to reach out to people who can provide emotional support. This support can be found through professional behavioral health services as well as among friends, family members, teachers, coaches, and other individuals who care about our personal well being.

When it comes to professional services, therapists and counselors can help a person make sense of the emotions they are experiencing and understand that their feelings are normal and valid. “It’s my job to help them understand what they’re going through and how it impacts their body, their emotions and their thoughts,” April says. “But I also try to help them comprehend the loss and address the grief. In my office, I try to create a safe, non-judgmental space where that individual can share what’s on their mind and understand that it’s OK to have the emotions they have.”

In addition to seeking support, April stresses the importance of increasing self-care and maintaining regular wellness behaviors like getting plenty of sleep, exercising regularly and eating a healthy diet. Another coping strategy that people sometimes overlook is emotionally preparing for upcoming holidays or anniversaries of their loss. “I help a lot of people of all ages prepare for those moments, because they can be a big shock for families and individuals to go through, especially if they’ve not had to process or deal with that before,” April says.

Professional therapy or counseling can also help the entire family deal with the ramifications of complicated grief, as it frequently affects others who are close to the grieving person. April explains,

“As professionals, we are trained to help not only children, teens and adults navigate this new way of life, but the family as a whole. Grief can be an uncomfortable topic to discuss, but we’re well trained in that area, and it’s not an uncommon topic for us to deal with. Therapists can help caregivers and guardians understand how to talk to their loved one about the loss, and we can also help them come alongside the grieving person to help them develop healthy coping skills and a new way of surviving life without that person who’s potentially gone forever or just gone temporarily.”

Ultimately, the goal for someone who is experiencing complicated grief is not only to move past their loss, but to emerge on the other side stronger than they were before. “I really try to help them understand their resiliency,” April says, “because anyone dealing with a loss is also creating very strong character traits. I try to help them understand that they’re sometimes stronger than they think they are.”

For more resources to help someone build resilience after a loss, we recommend reading our blog posts on gratitude and learned optimism below!

The Power of Being Thankful: Jessica Hynson, Jeremy Haire & Mindy Frazee Explain the Benefits of Gratitude
Training Ourselves to be Optimists: Positive Psychology

Wraparound Services: 360-Degree Support for Youth with Greater Behavioral Health Needs

Although childhood is typically perceived as a time of carefree happiness, children and adolescents can also face many challenges to their mental health.

For starters, many youth contend with difficult home issues like poverty, lack of food, poor family harmony, and even domestic violence. On top of these difficulties, about one in six children in the U.S. must also cope with a developmental disability such as ADHD, autism spectrum disorder, cerebral palsy, or other intellectual and learning disabilities. Finally, about half of all mental disorders start before or during the teenage years, further complicating life for youth who have them.

When a youth’s behavioral health needs are relatively mild or moderate, interventions such as individual therapy or counseling, family therapy, or skills training can be sufficient to help them address whatever challenges they may face. However, sometimes a child or teen needs a greater level of support to account for severe or very complicated behavioral health difficulties. In these cases, “wraparound” services may be the best option.

To learn more about wraparound services and how they fit into a behavioral health continuum of care, we spoke with Lakisha Wren, Wraparound Team Lead for our Hendricks County office. In this blog post, Lakisha explains what wraparound services entail, who might be a good fit to receive them, and how they can help create stability and healing for youth with greater behavioral health needs.

Comprehensive Support for Complex Challenges

Lakisha Wren, Wraparound Team Lead at Cummins Behavioral Health
"We've had a good success rate with our wraparound services here in Hendricks County. We've had a lot of people graduate the program, and we even have some families where the youths have gone on to college," says Lakisha Wren, a Wraparound Team Lead at Cummins Behavioral Health.

Wraparound services (also referred to as “wrap services” or “the wraparound process”) are intensive care programs specialized for the specific needs of each consumer. They comprise the highest level of care provided by community mental health agencies, and they are the last option before a youth is removed from their home for treatment purposes. “We work with youth who are at risk of being placed into residential facilities or acute hospitalization,” Lakisha explains.

In Indiana, wraparound services are funded by the Department of Child Services (DCS) and the FSSA’s Division of Mental Health and Addiction (DMHA), and children between the ages of 6 and 18 are eligible. Because the entire family tends to be involved in situations of this kind, wraparound services may be extended to everyone in the household. “We wrap services around everyone, not just the focus child. The mom, the dad, siblings—everyone can get services under the grant,” Lakisha says.

As the access site for wraparound services in Hendricks County, Lakisha is the first person a family will speak to if they are referred for wrap services. Lakisha’s job is to assess their eligibility and connect them with the appropriate care providers. “I’ll assign a therapist and a life skills specialist, and if they need more intensive services, that’s when I would assign a wrap facilitator,” Lakisha explains. “Then they might also receive habilitation services, respite services, and family support training as well.”

Regardless of the exact services provided, the wraparound process is always guided by four key principles of care:

  • Grounded in an inner strengths perspective: service providers assume that every individual possesses valuable inner strengths that can help them thrive in life if they are developed and applied
  • Family voice and choice: all family members have a say in their care and can choose how they would like services to proceed
  • Strengths-based: service providers aspire to identify each individual’s constructive life skills and nurture their development—not fixate on personal shortcomings
  • Outcomes-based: all services are designed to work toward a positive end result as defined by family members and care providers

How Wraparound Services Create Outcomes for Youth and Families

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The overall goal of wraparound services is to address whatever challenges a youth is facing without removing them from their normal home environment. With this in mind, efforts are also made to make services as unobtrusive as possible to a child or teen’s daily life. “A lot of our youth do not work well just with traditional services,” Lakisha explains. “They don’t do well just sitting, discussing their feelings and trying to stay focused for a 45-minute session. So, we try to be very creative and think outside the box with our plan of care.”

This is precisely where non-clinical service providers and interventions shine. “If skills training isn’t working, we might try some fun habitation services,” Lakisha says. “For example, a mentor could meet with the youth out in the community and try to do skills training at a basketball court, or just while walking around the community. I think that’s why a lot of our families benefit from wrap services—we try to be creative and make it fun for them.”

According to Lakisha, the highly individualized nature of wraparound services are another important key to their effectiveness for youth and families:

You may have Johnny who does not do well in a school setting, but we can have a support person at school who can sit next to him, help knock down some of those barriers and underlying needs, and pull the teacher aside and say, ‘Have you tried to do this with him, have you tried to do that?’ We can have a habitation provider help that teacher work with Johnny—explain Johnny’s needs, his care plan, and how the teacher can be creative with Johnny. Or we could have another individual who is struggling with just getting up, going to school and being motivated each day, or has suicidal ideation. We can give that person a mentor who’s there on the weekend to pick them up and take them to peer mentoring groups out in the community, or just sit down with the parents and talk about why it’s important to have crisis plans, help them understand suicidal ideation, and things like that. It’s just about having an individualized plan of care for every youth and family.”

By surrounding a youth with various types and levels of support, wraparound services can effectively treat complex behavioral health issues during childhood and adolescence. Most importantly, their focus on helping the whole family lowers the chances that problems will resurface in the future—and keeps youth in the home and community environments where they are loved and feel most comfortable.

Looking for more information about the types of services provided at Cummins Behavioral Health? You might enjoy our blog posts on employment services and substance use disorder services below!

Employment Services: Helping People with Mental Disabilities Find Rewarding Work
Managing Dual Diagnosis: Cummins’ Tracy Waible on How to Identify and Treat Substance Use with Co-Occurring Disorders

Pride Month 2020: What Does Good Mental Health Care for LGBTQ+ People Look Like?

The LGBTQ+ community (individuals who identify as lesbian, gay, bisexual, transgender, queer, or as another nontraditional gender identity or sexual orientation) has made many great strides in recent years. In 2015, the U.S. Supreme Court made same-sex marriage legal in all states, and earlier this month, it ruled to protect gay, lesbian and transgender people from employment discrimination. Despite these recent achievements, however, many people who identify as LGBTQ+ or are questioning their gender identity or sexual orientation still face serious challenges to their overall well-being.

For example, at least 1 in 4 LGBTQ+ people report experiencing some form of discrimination in their daily lives. Discrimination or fear of discrimination can be especially harmful for youth in this population. According to a 2019 survey conducted by The Trevor Project, 71% of LGBTQ+ youth reported feeling sad or hopeless for at least two weeks in the past year, and 39% of LGBTQ+ youth seriously considered attempting suicide, with more than half of transgender and non-binary youth having seriously considered suicide.

Proper behavioral health care can help LGBTQ+ individuals deal with the challenges of discovering and living out their gender identity and sexual orientation. Unfortunately, this care isn’t always readily available. This is partly because not all behavioral health professionals have access to the training and resources they need to treat this population. “In my experience providing therapy over the last four years, one barrier is a lack of LGBTQ-specific resources for mental health professionals,” says Julie Campbell-Miller, an Intake Specialist and Outpatient Therapist at Cummins Behavioral Health. “Even as a self-identified queer person, treating someone from the other side is much more difficult than I ever imagined.”

This begs the question: what does respectful, effective behavioral health care look like for LGBTQ+ individuals? How can mental health professionals help their clients discover and feel comfortable in identities that other people might not understand or agree with? In this post, Julie Campbell-Miller explains what behavioral health care should look like for people struggling with issues related to their gender identity or sexual orientation.

Placing Control in Clients’ Hands

Julie Campbell-Miller, LCSW, Intake Specialist and Outpatient Therapist at Cummins Behavioral Health
"I identify within the LGBTQ+ community, and I have some lived experience in regards to discrimination and knowing how difficult it is to come out to your loved ones. I think it's extremely important for community mental health centers to be vocal and show that they are a safe place to come and talk about these kinds of things," says Julie Campbell-Miller, LCSW, an Intake Specialist and Outpatient Therapist at our Putnam County office.

When a consumer of behavioral health care is seeking help for problems like depression, anxiety or substance use disorder, it is sometimes appropriate for their therapist or counselor to take close control of their treatment. Mental disorders and illnesses can be very complex, but there are typically clear guidelines for treating them as well as clear goals to work toward. However, this is not the case for someone who is questioning or struggling with their gender identity or sexual orientation.

In many cases, LGBTQ+ individuals may not have a specific behavioral disorder that they are seeking treatment for. Rather, they might simply be looking for someone to talk to. “Most people who are seeking services because of their sexual orientation or gender identity just want somebody who’s empathetic and willing to ask questions and learn more,” Julie says. Instead of assuming they know the solutions to their clients’ problems, providers should strive to learn more about their situation, ask what they would like to get out of therapy or counseling, and then work with them toward that goal.

If a person is seeking help to make sense of their gender identity or sexual orientation, it’s also important that professionals resist the urge to come to a conclusion for them. Questioning one’s gender identity or sexual orientation is a deeply personal and sometimes confusing experience, and the person going through this process must ultimately make their own decisions about who they are. Therapists and counselors should act only as guides and sounding boards for this process, as Julie explains:

“It’s different than your traditional talk therapy. You don’t want to tell them what they are because it’s very specific to an identity, as opposed to something like trauma where you can simply point out the cognitive distortion they might be having. For someone who’s trying to explore their own identity, you want to support them in a way that they can come to it on their own. For example, I might give them some resources to read through as homework, and then the next time they come in, we discuss what they thought about it. This helps them to self-identify as opposed to me saying, ‘Oh, I think you might be pansexual,’ or something like that.”

Building Up the Whole Person

As we’ve suggested, there are many educational resources that can be helpful for someone who is questioning their gender identity or sexual orientation. Part of a care provider’s job should be directing consumers toward these resources when appropriate. “One way providers can help is by exposing consumers to resources such as the Human Rights Campaign, The Trevor Project, and Indiana Youth Group,” Julie explains. “For example, I use HRC a lot because they have a glossary with definitions for various sexual orientations and gender identities.”

Beyond simple education about the many gender identities and sexual orientations a person might have, some tools can even help walk them through the process of questioning their identity. “There’s one workbook I like called The Gender Quest Workbook, and it utilizes cognitive-behavioral therapy techniques specific to LGBTQ+ youth who are on the journey of figuring out how they want to identify,” Julie says.

However, behavioral health professionals should also emphasize that their clients are more than their gender identity and sexual orientation. A person-centered, strengths-based approach to therapy should be used to remind clients that they are worthwhile and valuable regardless of what gender they identify as and who they are attracted to. “Counseling is the perfect opportunity for them to identify all of their great qualities as opposed to the one facet they’re trying to make sense of,” Julie says.

Finally, it’s possible that a person might not fully understand or come to terms with their gender identity and sexual orientation by the end of their treatment. This process often takes many years to complete, and it might not be the primary goal of someone’s therapy or counseling. Care providers should reassure their clients that there is nothing wrong with this, and that they can still live fulfilling lives as they continue to work toward this long-term goal.

“I think it’s important for providers to be upfront that they are not necessarily there to help someone identify who they are. They’re there to address what the person is struggling with,” Julie explains. “If you are questioning, and you happen to come to that conclusion by the time you’re done with therapy, that’s awesome. But my goal is for you to feel confident that even if you don’t have that specific identity, you can still live and be happy while you’re figuring it out, and that it will be OK.”

Cummins Behavioral Health is committed to providing exceptional mental health care to people of all genders, races, ethnicities, creeds and sexual orientations—including those individuals who belong to the LGBTQ+ community. If you would like to speak to a behavioral health professional about struggles related to your gender identity or sexual orientation, we encourage you to give us a call at (888) 714-1927.

Or, if you’d like to learn more about the basics of gender identity and sexual orientation, we recommend starting with our blog post about the five dimensions of gender and sexuality!

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