All posts by Mark Wilhelm

Trauma Specialist Linda Curran Provides EMDR Training for Cummins Staff

At Cummins Behavioral Health, we know our organization is only as good as our care providers. They are the ones who work directly with the individuals we serve, and their ability affects the success of our services. This is why we work hard to provide our staff with continuing education and professional development opportunities.

In past blogs, we have discussed EMDR therapy (short for Eye Movement Desensitization and Reprocessing), which is an increasingly popular tool for treating symptoms of trauma and post-traumatic stress. Cummins has been working to train team members who are interested in EMDR so we can offer this treatment to clients who would benefit from it.

To this end, we recently invited Linda Curran, BCPC, LPC, CAADC, CCDPD, to train 20 of our staff therapists in EMDR! Curran is a mental health clinician, trauma specialist, and best-selling author who has worked alongside influential practitioners and researchers like Bessel van der Kolk, Stephen Porges, Robin Shapiro, Janina Fisher, and Laurel Parnell. As an established expert in the field, she brings a wealth of real-world knowledge and applications to her instruction.

We were very excited to have Curran visit and train our staff, and we would like to share some of the experience with you! In this blog post, we’ll share some photos from the training and several of Curran’s insights into why EMDR is an important tool for behavioral health practitioners. Keep reading to learn more!

Getting to Know Linda Curran

Linda Curran, BCPC, LPC, CAADC, CCDPD

Linda Curran has dedicated her professional life to understanding and treating psychological trauma. She began her career working one-on-one with patients in clinical settings, but now primarily focuses on training and education for fellow clinicians. “I have a few clients,” she says. “I always say I try to get rid of them through attrition, but they don’t ‘attrish’—people keep coming back. So I have a few clients.”

Through the continuing education organization PESI, Inc., Curran has written and published the clinical workbooks Trauma Competency: A Clinician’s Guide and 101 Trauma-Informed Interventions: Activities, Exercises and Assignments to Move the Client and Therapy Forward. She has also produced several professional training videos and two online courses on the subject of trauma treatment. In addition, Curran is the President of Integrative Trauma Treatment, LLC and manages the website trauma101.com, which provides thorough information and resources about trauma treatment for practitioners and individuals seeking treatment.

“I teach because I love teaching,” Curran says. “I used to do it as an individual therapist, and then I thought, you know, wider and wider circles. I could affect change at a larger level if I did group therapy. And then the same thing: I could do more if I taught therapists, because these therapists touch lives. They’re touching whole families. So I think those wider and wider circles are one of the reasons why I love teaching.”

Funny enough, Curran agreed to visit Cummins to personally train our staff after a meeting with Robb Enlow, our Chief Clinical Operations Officer. Curran explains, “I met [him] at one of the trainings he came to this February past, and he asked me to come. I don’t do this for a lot of people, right? I mean, I’ve done it for other people, but only for bosses who really are going to follow up. And he does consultation, he does supervision groups with all the staff. He cares about their training.”

Linda Curran presenting to the class
Linda Curran demonstrating a resourcing exercise with a class volunteer

What Makes EMDR Therapy Different

Curran has been teaching about the neuroscience of trauma for the last 15 years. When asked why EMDR is important for the treatment of trauma, she answers, “It is an effective, kinder, gentler method than anything else we have. I don’t want to act like it is the have-all and be-all of trauma therapy, but most people in the field would say that if you’re working with trauma, you need to be equipped with it.”

However, Curran was skeptical of EMDR when she first heard about the therapy. She says, “From the beginning, some people—and I’m one of them—thought it was nonsense, that the only people getting good results were [EMDR creator] Francine Shapiro’s people, and stuff like that. But then I had a director in my Gestalt therapy training who said, ‘Linda, you work with all trauma, all the time. You have to have this skill.’ And then I’m in the training, and I don’t usually cry in front of people, but tears are running down my cheeks when I’m the role of client in this training. So I thought, there is something different about this.”

EMDR uses a process called alternating bilateral stimulation to help clients recall and reprocess traumatic memories, which makes these memories less distressing in the future and helps clients reframe negative beliefs about themselves. For individuals who suffer from “simple” trauma or single-incident trauma, EMDR can bring relief from symptoms much faster than other therapeutic methods.

“Some people are going to come in, they already have the skills to stay stable, you know, they had a one-time event that overwhelmed them, and that literally can be treated with a good assessment, a session, and a follow-up phone call,” Curran says. “I don’t know any other treatment that can do that. With prolonged exposure, that takes 10 weeks, and you have to keep going over your trauma, you have to keep going into the stress response. With EMDR, it’s a session and a follow-up phone call. It is miraculous for single-incident trauma.”

However, Curran is quick to caution that many—if not most—people who seek treatment for trauma do not suffer from single-incident trauma. Instead, complex trauma is the norm. “When I first brought EMDR to community mental health, what I did was re-traumatize people, because they didn’t have the skills to stay stable,” she explains. “All the people in this room don’t see single-incident trauma. Anybody that works in a prison, a rehab facility, or anybody that works in community mental health—you’re never going to see it.”

When working with clients who have complex trauma, the clinician must first help them emotionally prepare to recall their trauma so they do not become overwhelmed by it. Unfortunately, this can be a long process. “EMDR is a nice tool to have, but you have to get somebody to a point where they would actually benefit from it. For some people, it’s going to be months. For some people, it’s going to be years,” Curran says.

Linda Curran’s Advice for Clinicians

Curran likes to reference a quote from psychoanalyst Carl Jung when discussing EMDR and other therapeutic frameworks: Know all the theories, master all the techniques, but as you touch a human soul, be just another human soul.”

“There’s no question you have to know all these things,” Curran says. “There’s no question you have to have those skills. But mostly, you have to be able to sit and recognize this is another human being who has entrused you at their most vulnerable.”

When it comes to EMDR, Curran stresses that it is a very helpful tool, but ultimately only one piece of an effective treatment plan. Instead of expecting EMDR to solve all trauma-related issues for their clients, clinicians should view it as a supplement to their existing skills.

As Curran says, “Don’t forget you’re already a clinician. This is just a tool that you’re going to use. You bring your clinical prowess to this modality, not the other way around.

To learn more about Linda Curran and her work in the treatment of trauma, we encourage you to visit the website of Integrative Trauma Treatment, LLC at trauma101.com.

Cummins Behavioral Health Awarded CCBHC-IA Grant from SAMHSA, Extends CCBHC Services in Hendricks County Four Years

$4M Award Will Fund Continued Delivery and Improvement of CCBHC Services in Hendricks County

AVON, IN — The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced that it has awarded Cummins Behavioral Health Systems, Inc. with a four-year, $4M grant to continue providing CCBHC services in Hendricks County. This funding comes from SAMHSA’s Fiscal Year 2022 Certified Community Behavioral Health Clinic (CCBHC) Improvement and Advancement Grants, which were also awarded to six other care centers in Indiana.

Cummins previously received a Community Behavioral Health Clinic Expansion Grant from SAMHSA in 2021, which enabled it to become a federally-designated CCBHC in Hendricks County. Funding from the CCBHC-IA grant will allow Cummins to continue providing CCBHC-specific services through 2026.

“Cummins is proud to announce it has been awarded a new SAMHSA grant to advance and improve its CCBHC operations for an additional four years,” said Amy Mace, CEO. “This grant will allow Cummins to expand and enhance the CCBHC services being provided to the Hendricks County community. These services include, but are not limited to, behavioral health care, substance use treatment, primary care, and 24/7 crisis services. We look forward to continuing our partnerships with schools, healthcare providers, criminal justice organizations, and others within our community.”

The purpose of the CCBHC-IA grant program is to improve access to community-based mental health and substance use disorder treatment to anyone in the service area who needs it, regardless of their place of residence or ability to pay for services. This includes any individual with a serious mental illness (SMI), substance use disorder (SUD), children and adolescents with serious emotional disturbance (SED), individuals with co-occurring mental health and substance use disorders (COD), and individuals experiencing a mental health or substance use-related crisis.

“The CCBHC takes whole-person health care to a new level by ensuring that people with the most complex needs receive behavioral health, physical health and substance use disorder treatment, with professional supports to manage the complexity of their care,” said Robb Enlow, Chief Clinical Operations Officer (CCOO) at Cummins.

Although Cummins is currently providing the comprehensive range of services required for a CCBHC certification, it aims to further improve these services in the coming years. Goals include increasing equity of care for individuals belonging to underrepresented populations (racial, ethnic, gender identity, sexual orientation, etc.), improving accessibility of services for non-English speaking and disabled individuals, increasing the diversity of our Consumer Advisory Board, and increasing the number of individuals enrolled in CCBHC services at Cummins.

“Once the project is completed, a resident from the community should be able to walk into our Avon location, and not only could they get a psych evaluation and psychiatric medication, but they could see a therapist, they could have a substance use session, they could do a group service, they could see our primary care physician, and if they’re in a crisis, they could interact with our crisis team,” said Megan McNeal, Cummins’ CCBHC Project Director. “The goal of the Certified Community Behavioral Health Clinic is to create a place in Hendricks County where you can go and get all of your needs met, and not have to worry about keeping track of a lot of extra things.”

Cummins Behavioral Health Systems, Inc. is a community behavioral health center serving Marion, Hendricks, Boone, Montgomery and Putnam counties in Indiana. Our mission is to inspire the hope of recovery, to achieve excellence in all aspects of care, and to make the goals and aspirations of those we serve our highest priority. For more information about our services, please call (888) 714-1927 or feel free to browse our website.

Click here to view this article as a PDF.

Introducing CCBHC Services at Cummins: Primary Medical Care, Mobile Crisis Services, Assertive Community Treatment, and More

At Cummins, we understand that health is the foundation of a full and happy life.

When a person’s health needs have been met, they are free to attend to other important parts of life: work and career, personal relationships, hobbies and interests, and spiritual practices, to name a few. However, when they are unable to meet their health needs, they may have difficulty focusing on the activities and goals that make life feel full. Their health challenges might keep them fixated on the upsetting parts of life: their pains, their disabilities, and their fears for the future.

Since we first opened our doors in 1972, Cummins has been committed to addressing the mental health and substance use needs of our community. We are proud of the work we’ve done and the services we provide for behavioral health, but we have long known that we could do more. Our clients’ well-being is determined by their whole-person health. Therefore, we feel a duty to help them improve their health across all domains of personal wellness.

We’re very excited to announce that we’ve recently made progress toward this goal! In 2021, Cummins received federal grant funding to become a Certified Community Behavioral Health Clinic (CCBHC) and significantly expand the range of services we can provide in Hendricks County. These new services are now available, and our Avon office has undergone significant construction to accommodate them.

We believe our expansion into a CCBHC will allow us to more fully serve our community and fulfill our mission of improving our clients’ health and quality of life. In this post, we’d like to introduce our expanded service offerings and show how our Avon building has changed with the help of Megan McNeil, our CCBHC Project Director.

Introducing our CCBHC Service Line

Cummins’ CCBHC expansion has involved a substantial amount of work from our entire team in Hendricks County. In some cases, existing services were enhanced to meet new standards of care; in others cases, entirely new service lines were created. “Everyone has been involved in making this work. This is the product of 18 months of planning, working, and gathering money,” Megan McNeil says.

As Megan reiterates, the prevailing objective of our expanded service line is to offer a higher quality of care than was previously possible. “We want to be able to provide the best quality service to residents of the county, at a price point they can afford,” she explains. “We’re the community mental health center; we’re here for them.”

Primary Medical Care

Perhaps the most significant change to our service line is the addition of primary care services for our patients. Community members can now receive both mental health care and primary medical care at our Avon office, eliminating the need to visit separate providers from different networks. WindRose Health Network is our partner in primary care services, so they employ the staff to provide those services here on site,” Megan explains.

A component of these services includes better integration with our on-site Genoa Healthcare Pharmacy and more blood testing options at our on-site laboratory. For example, if you are prescribed medication by your mental health provider or primary care physician, you can get the prescription filled without ever leaving our office.

As for our laboratory testing, Megan explains, “We were doing lab services before, but our prior process was to draw the blood and then send it out for testing. And we’ll still do that with very complex tests, but now we can do a lot of testing on site for things like obesity, diabetes, and hypertension. For our diabetic patients, we can test them right here and make sure everything’s fine with their sugar levels.”

Our main atrium prior to CCBHC updates.
The updated main atrium. Medical services patients may check in at left.
Pharmacy area and Medical services check-in prior to CCBHC updates
Updated pharmacy and waiting area
New Medical Services waiting area
Patient exam room
Updated blood testing lab

Mobile Crisis Services

The second major change to our service line is the addition of mobile crisis services. These services are an expansion of our pre-existing, telephone-based crisis intervention services. Megan explains, “We now have a team of folks who can go out into the community and interface with law enforcement, first responders, community members, and schools to provide intervention for substance use and behavioral health crises.”

Mobile crisis services are designed to stabilize individuals in the most clinically appropriate, least restrictive, least traumatizing, and most cost-effective manner possible. One of their greatest impacts is the reduction of unnecessary hospital visits and law enforcement involvement. “The thing that tends to happen with folks who don’t have access to the care they need is they go to the emergency room for a behavioral health crisis,” Megan says. “Our crisis team can provide interventions in the community to alleviate strain on the hospital system and keep folks out of jail who are not going to get any help from being in jail.”

Assertive Community Treatment (ACT)

Another service we’ve been excited to introduce is Assertive Community Treatment, or “ACT”. ACT is a high-intensity service intended to assist adults who have not achieved desired treatment outcomes from other behavioral health services. “It’s a model that helps those struggling with serious mental illness, substance use, and chronic primary medical conditions like diabetes, obesity, or hypertension,” Megan explains.

ACT services are provided by a multidisciplinary team that can include psychiatrists, nurses, therapists, skills trainers, employment specialists, and substance use specialists. These team members work together to provide care when it’s needed and where it’s needed—at any time of day, at an individual’s home, place of work, in the community, or in our offices.

So far, we’ve seen excellent results among individuals in our ACT program. “They’re going from having multiple hospitalizations every six months to having multiple months with no hospitalizations. So that’s really good. And that lessens the strain on our medical ER services in our county,” Megan says.

Care Coordination

Navigating health care options and deciding which services you need isn’t always easy, especially when there are many choices available. Our last major service addition, called Care Coordination, is designed to assist with this challenge.

Megan explains, “We have staff now called Care Coordinators who can help people navigate not only the Cummins system, but any medical system, and they are both in-office and in-community, meaning they can go meet one of our patients at a specialist appointment and help them.” This can be especially helpful for individuals who must manage several behavioral health or chronic medical conditions.

“We also now have a registered nurse on site who can provide education to our CCBHC patients on any of their chronic illnesses or their medications, which is something we’ve never had before,” Megan adds.

Plans for Continued Enhancement

We’re proud of the work we’ve done transforming our Hendricks County office into a CCBHC, but we aren’t finished just yet. In fact, we’ve recently received an additional federal grant from SAMHSA to continue these services over the next four years.

“It’s called the CCBHC-IA grant, and it stands for Certified Community Behavioral Health Clinic Improvement and Advancement,” Megan explains. “It’s $1 million a year for four years to continue the work that we started with our CCBHC and improve and advance those services in Hendricks County.”

In addition to continuing the CCBHC services detailed above, the grant will be used to:

  • Increase equity of care for individuals belonging to underrepresented populations (racial, ethnic, gender identity, sexual orientation, etc.)
  • Improve accessibility of services for non-English speaking and disabled individuals
  • Increase the diversity of our Consumer Advisory Board
  • Increase the number of individuals enrolled in CCBHC services

In short, the CCBHC-IA grant will help us continue to realize our full vision for Cummins. Megan says, “Once the project is completed, and we’ve got all the bells and whistles done, a resident from the community should be able to walk into our Avon location, and not only could they get a psych evaluation and psychiatric medication, but they could see a therapist, they could have a substance use session, they could do a group service, they could see our primary care physician, and if they’re in a crisis, they could interact with our crisis team. The goal of the Certified Community Behavioral Health Clinic is to create a place in Hendricks County where you can go and get all of your needs met, and not have to worry about keeping track of a lot of extra things.”

If you’d like to learn more about the CCBHC-IA grant and our plans for continued service expansion, you can read our full press release here.

At Cummins Behavioral Health, we care deeply about the whole-person health of every individual who walks through our doors. We are excited to have this opportunity to provide more comprehensive care to members of our community, and we hope to replicate these improvements at our other service locations in the coming years. It is our greatest wish and honor to be your trusted partner on the road to recovery!

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Raising a Child with ADHD: Symptoms, Treatment, and Hope for the Future

If you are a parent or caregiver, then you don’t need us to tell you that raising a child is hard work. This already daunting task can become even more challenging if your child suffers from a disorder like attention deficit hyperactivity disorder, or ADHD.

Speaking broadly, ADHD is a disorder characterized by inattentiveness, hyperactivity, and impulsivity. Individuals who have ADHD might struggle to concentrate on tasks for extended periods of time or inhibit their own thoughts and actions. They might have trouble adhering to strict rules and schedules, and they could have a tendency to say or do things at socially inappropriate times.

Because ADHD usually develops during childhood, parents and caregivers often find themselves in charge of managing their child’s disorder. They might have special difficulty helping their child navigate the highly structured environment of the school classroom. On their worst days, they might find themselves frustrated, exhausted, and struggling to know how best to help their child with this challenging disorder.

Raising a child with ADHD isn’t easy, but fortunately, help is out there. Thanks to modern psychiatry, ADHD is very treatable, and many individuals with ADHD go on to live full, normal lives. They just might need a little help learning to manage and cope with their disorder.

To learn more about ADHD, we spoke with Dr. Tammie Dones, who is one of our three staff psychologists at Cummins. In today’s blog post, Dr. Dones explains the basics of ADHD and how individuals can overcome its challenges to lead happy lives.

Dr. Tammie Dones
Tammie Dones, PhD, HSPP, Psychologist at Cummins Behavioral Health

What Is ADHD and Who Does It Affect?

ADHD is what’s known as a neurodevelopmental disorder. In less scientific terms, this means that ADHD is the result of abnormal development of the nervous system.

“When ADHD is studied in a lab setting, there are brain differences in the frontal lobe, which relates to what we call ‘executive function,’ “ Dr. Dones explains. “Executive function is kind of like our mental secretary or our mental organizer. Executive functions in the frontal lobe also help us inhibit responses. For example, if I thought right now, ‘I’m thirsty, I’d like to get a soda,’ my brain can tell me, ‘Don’t do that, you’re in the middle of an interview.’  But some people with ADHD don’t inhibit that well.”

ADHD can be broken into three distinct types with slightly different symptoms:

  1. Hyperactive Type: individuals have difficulty paying attention and controlling their behavior, and they tend to be highly active
  2. Inattentive Type: individuals have difficulty paying attention and frequently experience procrastination, hesitation, and forgetfulness
  3. Combined Type: individuals experience hyperactivity/impulsivity as well as inattentiveness

Dr. Dones provides some examples of what these symptoms might look like in action:

“The combined and hyperactive types are characterized by over-activity. This could be restlessness or fidgeting. One of the criteria is being ‘on the go’, or feeling as if driven by a motor. With the inattentive type, there’s difficulty sustaining attention and focus, difficulty harnessing attention and focus, and difficulty often with emotional regulation. And then the other cluster is impulsivity, which of course affects your attention span as well, because if you’re trying to do, say, a math worksheet, but another thought crosses your mind, your mind drifts away from the math worksheet.

Impulsivity has other social and life management aspects, too. There tends to be about a 25% to 30% delay in general maturity in somebody accurately diagnosed with combined type ADHD. This means reaching life milestones later. For example, an 18- or 19-year-old with ADHD is going to have a harder time managing their debit card, driving without impulsivity, and things like that.”

Approximately 5% of children are diagnosed with ADHD, making it a fairly common mental disorder. Males are about twice as likely to be diagnosed with ADHD as females. The typical age of onset is 4 years old, although the inattentive type is often harder to detect and might not be diagnosed until closer to age 9 or 10.

How Can ADHD be Treated or Managed?

If your child has been diagnosed with ADHD by a psychiatric professional, there are several different treatments they can receive to help manage their symptoms.

To begin, prescription medications tend to be highly effective at reducing symptoms of ADHD. The specific medications used to treat ADHD, known as stimulants, help to regulate impulsive behavior and improve attention span by increasing the levels of certain naturally-occurring chemicals in the brain. According to the Cleveland Clinic, these medications improve ADHD symptoms in 70% of adults and 70–80% of children.

Dr. Dones adds, “At Cummins, we have a strong psychiatry staff. They’re very experienced, and they stay on top of the research in terms of side effects and things like that. So medication treatment is fairly common.”

Whether or not medication is used in treatment, it’s also important for individuals to learn strategies for managing their ADHD symptoms. For example, Dr. Dones emphasizes the importance of using visual cues and “thinking out loud.” She says, “You want to do things that draw that mental organizer or mental secretary out into the open. This could involve visual prompts and cues or the adult thinking out loud to help the child.”

Dr. Dones gives an example of what this might look like from her own life experience: “When I was teaching my daughter to look both ways before she crossed the street, I’d say, ‘Now, we’re going to look both ways before we cross the street.’ I wonder how many times I said that? Probably 9,000 or 10,000 times. Because we want that deeply trained in their brain, right? So for someone with ADHD, that type of thinking aloud, with their parents verbally mediating things using prompts and cues, is really important.”

At Cummins, most people who enter treatment for ADHD can also benefit from our life skills services. These services are specially designed to help individuals learn and implement skills for managing their disorder in the real world—not just in therapy settings. “ADHD is kind of a point-in-time disorder,” Dr. Dones explains. “Oftentimes, the problem isn’t a lack of knowledge; it’s that we don’t perform the right behavior at the right point in time. It’s like, ‘Oh, I knew that, but I didn’t do it right now.’ The skills training matches well to what people need when their symptoms happen in the real moment. So that’s one thing that I’m proud that Cummins has.”

Many individuals who have ADHD continue using the self-mediating skills they learn in treatment throughout the rest of their lives. Adults diagnosed with ADHD continue to use a lot of prompts, cues, and calendar reminders,” Dr. Dones says. “Post-it notes are a typical thing I’ve heard about from clients. They would say, ‘I knew I didn’t want to forget this appointment; look, here’s my post-it!’ People with ADHD, whether it’s inattentive or hyperactive, also tend to have a rough time with sense of time. So time either feels like it takes forever, or it passes without them noticing. So they might use timers like how some people do with social media now. They have those timers on their phones that say, ‘After 45 minutes, I have to get off this social media device.’ Those are the kinds of things that a person with ADHD might have to do just for normal tasks.”

The Role of Family Support in Recovery

As we mentioned in the previous section, parents, caregivers, and other family members play an important role for children diagnosed with ADHD. The younger the child, the more likely it is that they’ll need help learning how to manage the symptoms of their disorder. Family members can be instrumental in modeling and guiding new coping behaviors.

However, the experience can be challenging for everyone involved. “I think it’s important to meet the situation with as much grace, compassion and nurturance as you can, because ADHD is a chronic problem,” Dr. Dones says. “It can wear parents down. It can frustrate parents. Some of the things that are inherent to the disorder make it hard for children or teenagers to profit from experience. So you’re like, ‘I told you that yesterday.’ But it’s kind of lost on them. So you need to be patient, consider each day its own day, and reteach the best you can.”

Children who have ADHD may face frequent punishments and sanctions for their behavior outside of the home environment. It’s important that caregivers deliver praise for good qualities and productive behaviors whenever possible. “These kids are going to hear, ‘You messed up. Did you forget? What are you doing? Stop it!’ They’re going to get yelled at. So somebody has to counteract that self-esteem damage,” Dr. Dones says.

Having a young child with ADHD can be emotionally challenging for parents and caregivers. On top of the difficulties in managing their behavior, parents might also worry about their child’s future. They might wonder if their symptoms will ever improve or if they will ever be able to fit harmoniously into society. The good news is that many people live full and successful lives despite an ADHD diagnosis. For example, actress Emma Watson, gymnast Simone Biles, and musician Justin Timberlake are just a few people who have had great success in their lives despite living with ADHD.

Dr. Dones says, “When we say ADHD is chronic or lifelong, that can be discouraging. But people do improve. There are developmental lags, but a developmental lag eventually catches up. It’s an additional challenge for that person to meet each day, and a responsibility to manage things that come naturally to the next person, but many people do manage successfully.”

Although ADHD, like any mental health problem, can be a challenge for the individual diagnosed and those who are close to them, it is a disorder that many people can nevertheless rise above. With proper treatment and support from caring individuals, many children can grow up to be healthy, happy adults despite their ADHD.

If you’re concerned about your child’s behavior and wonder if they might have ADHD, we encourage you to speak with their primary care provider to voice your concerns. Your child’s doctor can look into the situation and determine next steps with you as appropriate.

Alternatively, you can call Cummins Behavioral Health at (888) 714-1927 to discuss the possibility of receiving a mental health assessment for your child. Our staff will treat you and your child with the respect you deserve and help you see the hope of recovery from ADHD.

Introducing Cummins’ Transportation Services for Justice-Involved Individuals

If you stop a moment to think about it, you’ll probably agree that life can be difficult.

Most of us want to live our lives the best we know how. The problem is that our best efforts don’t always turn out how we’d hope. As a result, we all make mistakes in life. We might disappoint someone we care about, fail to meet one of our obligations, or take an unwise action with possible legal consequences. Some mistakes are small and easily fixed; others can get us into serious trouble.

Everyone deserves a second chance, but not all second chances are created equal. When a mistake ends with involvement in the criminal justice system, for example, there are debts that must be paid and obligations that must be met before the mistake can be forgiven. A person who violates the law, even unintentionally, is responsible for dealing with the consequences. However, this doesn’t mean they don’t deserve a little help.

With this in mind, Cummins Behavioral Health will soon begin offering free transportation services for our clients who are involved in, or have been involved in, the criminal justice system. These individuals may have a variety of appointments they must attend as they work to rebuild their lives, and lack of reliable transportation can be a significant obstacle. By providing free transportation to important medical and legal appointments, we hope to remove some of the barriers these individuals face on their journeys toward recovery.

In this blog post, we’ll explain how these transportation services will work and why we believe they’ll make a difference for our clients and our community. We’ll also include explanations and insights from Tracy Waible and Jessica Hynson, who have been instrumental in bringing these services to Cummins.

Tracy Waible, LCSW, LCAC, Cummins' Director of Recovery (left) and Jessica Hynson, LMHC, CSAYC, Cummins' Director of County Operations for Marion County (right)

How the Services Originated

Our transportation services for justice-involved individuals are a collaboration between Cummins Behavioral Health and Indiana’s Family and Social Services Administration. More specifically, they are funded by a year-long grant from the Division of Mental Health and Addiction (DMHA).

The process started when the DMHA indicated its desire to fund programs of this type. Tracy explains, “We receive emails periodically for various grant opportunities, and when this one came through, we knew that we had to apply. We have an obligation to look at whether our consumers have the ability and resources to do what we are asking. If not, we need to help them problem solve those barriers—one of them being transportation.”

As part of the grant application process, Tracy and Jessica coordinated outreach to community partners who would also benefit from having these services in place. “The Director of County Operations in each county reached out to partners, like local court systems and the Department of Child Services, and asked for letters of support,” Jessica says. “I know Putnam County even got one from the 911 dispatch center because they have a good partnership.”

“We received letters from almost every county, and multiple letters from some of our counties. So I think those stakeholders were all really excited about this opportunity, and definitely willing to send us referrals and to help this to be successful,” Tracy adds.

Ultimately, Cummins was awarded a grant to pay for five vehicles—one for each of our counties of operation—and reimbursement for time spent transporting consumers. Since public transportation options are sparse in Indiana, and services like Lyft and Uber are not consistently available in rural areas or have extremely long wait times, we anticipate our transportation services to be a significant benefit for our consumers.

How the Services Will Work for Consumers

Once our transportation services are up and running, any Cummins consumer who is involved in the justice system will be eligible to use them. “They’re for anybody justice-involved,” Tracy says. “That could be DCS, probation, drug court, veterans court—any kind of legal involvement.”

Individuals will be able to submit an online form to request a ride to an appointment. This could be an appointment for Cummins services, a physical health appointment, a court-related meeting, or other legal appointments, to name a few possibilities. Once a request is submitted, the appropriate staff in that county will review their availability and make arrangements to provide transportation if at all possible.

Due to the specific details of the grant, the services will only be available to existing Cummins consumers or those who are beginning services with Cummins. Tracy explains by way of an example: “There’s a large correlation between justice-involved and substance use disorder. We worry about that gap between leaving incarceration and entering treatment, because maybe a person has 30 days of sobriety now, and they’re at risk of overdose if they leave and start using again. If we could transport them straight from jail to an intake or to some kind of support, we’re hoping to reduce drug overdose and recidivism.”

Piggybacking off of Tracy’s example, Jessica gets to the core of why we’re so excited to provide these transportation services. “This justice-involved population is one of the populations that struggle to get back on their feet, because there are just so many barriers constantly in their way,” she says. “I think some people sit in jail and think, ‘OK, I’m going to turn my life around.’ They’re motivated, but then they come out to the same environment, the same challenges, maybe more challenges, because now they have a record. So I’m very excited to have the opportunity to break through some of those barriers, just by saying, ‘Well, we can do that. We can take them there.’ “

“If I think about our mission, vision and values,” Tracy adds, “and if we know that there’s always hope, and recovery as possible, I don’t want transportation to be the barrier to making that a reality for the people we serve. Because if I don’t have a way to access the care, then I’m more than likely going to become more hopeless, and not be able to do the things that I’m hoping to do with my recovery journey. So I think that’s why I’m excited about this. It’s going to give people an opportunity to tap into that hope and to see what recovery is about.”

At Cummins, our mission is to inspire the hope of recovery, to achieve excellence in all aspects of care, and to make the goals and aspirations of those we serve our highest priority. We are thrilled to improve our services for justice-involved individuals by adding these transportation services!

We will update this page with information about requesting transportation once the service is live.

If you enjoyed this article and would like to help spread our message of hope and recovery, we encourage you to share it with others!

What You Should Know and What You Can Do About Indiana’s Youth Mental Health Crisis

If you are a parent or legal guardian to a child or teenager, then you might be aware that youth have been facing increasing mental health challenges in recent years.

Several statistics from the office of the U.S. Surgeon General showcase the severity of the situation. Even prior to the COVID-19 pandemic, mental health challenges were the leading cause of disability and poor life outcomes among American youth, with as many as 1 in 5 children ages 3 to 17 suffering from a mental, emotional, developmental, or behavioral disorder. In addition, more than 1 in 3 high school students reported persistent feelings of sadness or hopelessness in 2019—a 40% increase over the previous decade. And most sadly, suicide rates among youth ages 10–24 increased by 57% from 2007 to 2018.

Fortunately, there is much work being done to address this growing crisis. Among other initiatives, the Indiana Family and Social Services Administration (FSSA) announced earlier this month that it’s entering an $8 million partnership with Riley Children’s Health to provide mental health services at pediatric primary care offices across the state. This partnership will integrate mental health services into Riley Children’s Health’s primary pediatric care settings throughout Indiana, which will make it faster and easier for Hoosier parents and physicians to help youth with their mental health needs.

In light of these recent developments, we wanted to do our part to inform our community about the state of the current youth mental health crisis. We know that frightening situations like these can be improved if we understand why they are happening and what we can do about them.

In this week’s blog post, we’ll provide a brief overview of youth mental illness in our country, including why it’s on the rise and what you can do to help a child or teen who is struggling with mental health challenges.

What Is Causing the Youth Mental Health Crisis?

When discussing the mental health of young people, it’s important to explain that many mental illnesses first manifest during childhood or adolescence. The age at which a person first displays symptoms of a mental illness is referred to as the disorder’s “age of onset“.

Across the world, about 1 in 4 people will experience a mental illness sometime in their life. This means that as many as 25% of youth may experience the onset of a mental illness that negatively impacts their overall mental health. According to surveys by the World Health Organization, the average age of onset for various types of mental illness are as follows:

  • ADHD: ages 7–9
  • Phobia-related anxiety disorders: ages 7–14
  • Schizophrenia: ages 15–35
  • Substance use disorders: ages 18–29
  • Generalized anxiety disorder and PTSD: ages 25–53
  • Mood disorders: ages 25–45

As you can see, the development of a mental illness is one factor that may affect a child’s well-being. However, a number of environmental factors are also contributing to the youth mental health crisis our country is currently experiencing.

According to the U.S. Surgeon General’s Advisory on Youth Mental Health, research suggests that factors like the growing use of digital media, increasing academic pressure, limited access to mental health care, financial insecurity, highly-publicized societal violence, and anxieties about climate change may be worsening young people’s mental health and wellness. More research is required to determine precisely these subjects are affecting youth.

The COVID-19 pandemic has further added to the mental health challenges of many individuals; children and teens whose daily routines have been disrupted by the pandemic, who have experienced greater financial instability as a result of the pandemic, or who have lost a family member to COVID-19 are most likely to have suffered mental health challenges as a direct result of the pandemic.

What Can You Do About the Crisis?

Clearly, the challenges facing youth today are not ones that are easily solved. But there is plenty that we can do to help.

We have already seen signs that our government and health care professionals are attempting to respond to the crisis. In October of 2021, the American Academy of Pediatrics declared a national emergency in child and adolescent mental health, urging the country to take steps to address the problem. The following December, the U.S. Surgeon General’s office issued its advisory, signifying the federal government’s commitment to addressing the crisis. And in Indiana, the state government is allocating tens of millions of dollars to make mental health care more accessible and more effective for all Hoosiers. These are all encouraging signs.

There are also several things you can personally do to look after your child’s mental health. First and foremost is to have your child screened for mental illness and mental health challenges. Screenings are an important part of prevention and early intervention for mental illness, and they can often be obtained through your child’s pediatric primary care physician. In addition, Mental Health America offers free online screening assessments for a variety of mental illnesses, including an assessment that parents and guardians can take for their children.

In addition to screenings, the importance of talking to your child about their fears, worries and challenges cannot be overstated. Young people need trusted adults whom they can confide in without fear of judgment or punishment. As a parent or legal guardian, one of the best things you can do is normalize mental health challenges and encourage your child to share their struggles with you. The more they believe that you understand and support them, the better off they will be.

Dr. Ashleigh Woods, Cummins’ Senior Psychologist, adds,

“One of the biggest challenges I see facing children, teens, and families is lack of connection. Human beings are social creatures, and connection to others is what helps us regulate our thoughts, feelings, and bodies. When a parent or caregiver engages face-to-face with their child, that child’s mirror neurons and vagus nerve react to the caregiver’s facial expressions, tone of voice, etc. Not only is the child taking in what their parent is saying, but those nonverbal cues are also having a neurological impact on the child’s developing brain.

If we can help families improve both the quantity and quality of their face-to-face interactions, we can improve their connections and create more emotional safety and stability, which goes a long way toward building resiliency.”

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Ashleigh Woods, Psy.D., HSPP, PMH-C

There is no question that many young people in our country are struggling with their mental health and well-being. Of the challenges they face, some have been around for generations, while others are more unique to today’s world. None are easily solved, but they can all be helped by unconditional love and support from caring adults.

If you are the parent or guardian of a child or teen, we strongly encourage you to speak to them about their mental health. Listen to their concerns, and show them that you’ll always be there to help. Share your own concerns about their mental health with their pediatric physicians.

You have the opportunity to be a powerful advocate for your child’s mental health. We encourage you to make the most of it!

Wellness for Care Providers: Putting Wellness Into Action

For caring professionals, looking after the health and wellness of other people is what we do. It’s in our job titles and our lists of daily duties. But it is difficult, personally taxing work that requires us to also keep close tabs on our own physical, mental, and emotional health. It’s impossible for us to help others if we don’t first do what we must to help ourselves.

Our “Wellness for Care Providers” blog series has been all about self-care strategies for people who serve others. In previous entries, we’ve covered:

If you’ve been following along with us through each topic, then the only thing left to do is take what we’ve learned and develop an action plan for your self-care. By assessing your current level of wellness and your strongest and weakest areas of self-care, you can create a specific plan for improving your wellness according to your needs and desires.

In this blog post, we’ll walk you through the completion of your very own Self-Care Action Plan, beginning with a quick review of popular self-care strategies as well as wellness-depleting situations you should strive to avoid in your life.

Top Self-Care Behaviors for Practitioners

When discussing wellness and self-care behaviors, sometimes it can be helpful to know what works best for other people like us. Information and suggestions from other people can help us adopt new behaviors with the confidence that they’ve already been “tried on for size”.

Throughout our wellness series, we’ve often referenced the book The Resilient Practitioner: Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers, and Health Professionals by Thomas Skovholt and Michelle Trotter-Mathison. As part of their research into self-care, the authors reviewed several studies surveying professional psychologists and practitioners. Some of the most effective self-care strategies among those surveyed included:

  1. Maintaining social supports. Humans are social animals, and a little support from family, friends, colleagues and partners can go a long way toward keeping us happy and healthy.
  2. Using humor. Laughter can’t cure every malady, but it can be surprisingly helpful for managing our mental state and putting the little difficulties of life in perspective.
  3. Maintaining self-awareness. Like humor, practicing self-awareness and mindfulness can help take the sting out of negative thoughts and emotions. Remembering that negative situations are not permanent gives us a better chance of seeing the light at the end of the tunnel.
  4. Taking vacations. We all need a break from work sometimes. If you have the ability to take vacations, do so. If not, try to find other ways to unplug from your work from time to time.
  5. Consulting with others when you need guidance or second opinions. The work of a care provider is stressful, so it’s OK to ask for guidance or advice when you’re unsure what to do in a certain situation. Handing off even a little of the responsibility can do wonders for overwhelm and overwork.
  6. Setting realistic goals. You won’t be able to change everyone’s life. You won’t be able to do everything you want to. Expecting that you will is a recipe for disappointment and shame. Instead, do the best that you can and expect for it to not be enough sometimes.
  7. Maintaining strong personal and professional identities. When you know who you are as a person and as a professional, you’ll better understand what is important to you and what isn’t. This knowledge can help you prioritize demands and feel confident that you acted on the situations that were most critical.
  8. Balancing personal and professional demands. Maintaining good work-life balance can be easier said than done, but it’s important to make the effort. Pay attention to how much energy you’re investing in your personal life versus your professional life. When the balance tips too far in one direction, be unapologetic about re-centering it.
  9. Exercising. We all know exercise is beneficial for both body and mind. Even if you don’t enjoy exercising, any amount can do you good. Try to find activities and times that fit your lifestyle and schedule, and stick with them. The outcomes might surprise you.
  10. Engaging in hobbies and leisure activities. It’s not healthy if we have little in our lives besides work and personal demands. Hobbies and leisure activities are great ways to find enjoyment in life and refresh ourselves when things becomes too stressful or chaotic.
  11. Creating comfortable work environments. For better or worse, we spend a large portion of our lives at work. One way to improve our enjoyment of work is to make our work environments as comfortable as possible. Sometimes this can be as simple as creating a clean, calming, organized workspace for ourselves.

Wellness-Depleting Situations to Avoid

Wellness priorities and practices often vary between individuals, so it’s normal for self-care to look a bit different from person to person. However, according to The Resilient Practitioner, there are some situations that are almost universally harmful to a practitioner’s self-care and well-being. You should be on the lookout for these situations in your personal and professional life and take action to rectify them if at all possible.

Common wellness-depleting situations for practitioners include:

  1. Toxic supervisor and/or colleagues. Poor relationships with our work peers can be extremely draining on our motivation and emotional state. Sometimes, we can compensate for this by increasing self-care in other areas and seeking emotional support from friends and loved ones. In other cases, it may be necessary to change our working situation.
  2. Little fun in life or work. Taking life too seriously all the time can often make it seem joyless and dull. If we find ourselves in this situation, we can work at “manufacturing” fun by actively exercising the humorous and playful parts of ourselves.
  3. Poor understanding of one’s own needs. It’s normal to not always know exactly what we want in life, but it’s important for us to understand what we need in order to feel well. When you feel discontent or imbalanced, pay attention to which parts of yourself are being neglected or pushed too far. Introspection of this kind can help you determine your optimal range of wellness and know what you must do to stay within that range.
  4. Lack of a professional development process. We may lose all joy in our work over time if we’re unable to see a clear path of professional progression. It can be helpful to map out the “big picture” of where we’d like our career to go and then strategize each step we can make toward that goal. This might also be a topic to discuss with a supportive supervisor.
  5. No energy-giving personal life. Even the most fulfilling work in the world can leave us feeling empty if we don’t have a rich personal life to balance it. This is why it’s so important to develop and nurture all the dimensions of the personal self.
  6. An inability to say no to unreasonable requests. As helping professionals, helping others is what we do, sometimes at our own expense. But we must have boundaries in place that prevent us from giving so much that we can no longer care for ourselves. This is where our priority-setting self comes into play.
  7. Vicarious traumatization from work situations. The nature of our work sometimes puts us in traumatizing situations or in close emotional proximity to the trauma of others. Good support from supervisors and colleagues can help prevent this vicarious traumatization from taking a toll, as can following disciplined wellness behaviors.
  8. Giving too much in personal relationships. Again, it can be easy for helping professionals to slip into the habit of giving too much, even in our personal lives. We must work to build relationships where we both give and receive support in order to keep our emotional and loving selves well cared for.
  9. Constant perfectionism in work tasks. Being consistently too demanding of ourselves is a guaranteed recipe for frustration and burnout. We must give ourselves permission to make the occasional mistake, just as we do for the individuals we serve.
  10. Continual unresolved or ambiguous professional losses. When our work with a client doesn’t end as well as we’d hoped, it’s important that we receive proper closure on the situation. A supportive supervisor can make all the difference in the world in this regard. They can help to put the loss in perspective and provide reassurance that we as the practitioner did nothing wrong.
  11. A strong need to be needed. Many who choose to enter the caring professions enjoy the feeling of being needed by others. We must be careful to balance this desire with practices that nurture our self-sufficiency. Remember that you have value as an individual outside of your ability to help others.
  12. Professional success defined solely by client success or appreciation. When our job is to help other people get better, it can be difficult to separate our success from their success—or even from their appreciation of our efforts. To counteract this tendency, it can be helpful to develop the parts of our personal self that are more inwardly focused, such as our solitary and spiritual selves.

Completing Your Self-Care Action Plan

Now let’s complete your personal Self-Care Action Plan so you can put everything you’ve learned into practice.

In previous articles, we’ve explained how to assess your work stress level and self-care/other-care balance, your professional self-care, and your personal self-care. You’ll finish your plan by assessing your overall level of self-care and creating steps for working on areas of weakness.

Step #5: Assess Your Self-Care Strengths and Weaknesses

Using the information you gathered in Steps 1–4, take some time to write an informal assessment of how successfully you are nurturing your own wellness. Focus specifically on which areas of self-care you are excelling at and which can be improved upon.

Honesty is crucial at this step, because you can only develop an effective plan of action if you are honest about where your wellness practices are lacking.

Step #6: Develop Your Plan

Your action plan should focus on no more than two domains of self-care that you would like to improve upon. For each self-care domain you chose, you should write out:

  • A specific goal you would like to achieve, including measurable outcomes and time frames
  • The method by which you will achieve the goal
  • How you will reinforce and maintain your new self-care behaviors

For example, let’s imagine you have lax professional boundaries that are causing you to feel overwhelmed by requests from co-workers and clients. You decide that you would like to develop stricter work boundaries. Your action plan might look like this:

  • Specific Goal: Reduce work-related interactions during non-working hours by 50% over the course of 4 months.
  • Method for Achieving the Goal: Inform all colleagues and clients that you will not answer communications outside of work hours, with exceptions for emergencies. During months 1 and 2, monitor how often you still receive communications outside of work hours, and only respond to those that seem highly important. Monitor colleague and client response to your decreased responsiveness. During months 3 and 4, begin to respond only to communications that appear to be true emergencies. Monitor colleague and client response to determine if you are being too lax with boundaries, too strict, or just right.
  • Reinforcement for New Behavior: To offset any stress associated with disappointing colleagues and clients, set aside 30 minutes each week to journal, specifically ruminating on how your stricter professional boundaries have increased your overall health and wellness.

When choosing your goals, remember to keep realistic expectations. Don’t try to change too much too fast, and remain open to the possibility that you might need to reassess your plan if it doesn’t play out as you had hoped.

This brings us to the end of our series on Wellness for Care Providers!

We could all use a little help sometimes to improve our self-care practices and routines. But for those of us who care for others as a profession, maintaining our own wellness is especially important.

We hope this series gave you some useful ideas to implement into your wellness regimen. If you enjoyed it, we encourage you to share it with a friend who might also find it helpful!

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Wellness for Care Providers: The Many Facets of Physical Self-Care

For those of us who work in the caring professions—such as health care, education, emergency services, criminal justice, and social work—our job is to care for the well-being of other people. However, this is difficult to do if we aren’t also managing our own health and wellness. As Cummins’ Professional Development Specialist, Ciera Jackson, likes to say, “You can’t pour from an empty cup.”

In the previous post of our series on Wellness for Care Providers, we discussed the many dimensions of the personal self and how you can practice personal self-care. However, we left out one dimension of the self that is significant enough to warrant a separate discussion: the physical self.

Physical self-care is essential for overall health and wellness. Not only do we enjoy life more when we are physically healthy, but the health of our physical body also has a direct influence on our mental and emotional health. One of the simplest and most effective ways to improve mental and emotional well-being is to focus on improving our physical well-being.

In this post, we’ll divide the physical self into its core components and share some simple advice for maintaining each one. We’ll be guided once again by Ciera Jackson, who shares her thoughts and suggestions on this topic.

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Ciera Jackson, MSW, LCSW, Professional Development Specialist at Cummins Behavioral Health

Nutrition: Providing the Right Fuel for the Body

Physical self-care is all about keeping our bodies as healthy as we can, and a large part of keeping our bodies healthy involves being mindful of what we are putting into them.

It can be helpful to think of food and drink as fuel for the body. Giving our bodies high-quality fuel helps them run more efficiently and can make us feel better all around. By contrast, low-quality fuel creates strain on our bodily systems and can make us feel worse.

“What you put into your body will fuel you,” Ciera says. “If you’re eating McDonald’s Big Macs all the time, you’re probably going to feel like a Big Mac. Versus if you’re putting vegetables, water, and various nuts and berries into your body, you’re probably going to feel like that.”

Maintaining good nutrition is a crucial component of physical self-care. Here are a few pieces of advice to keep in mind when it comes to nutrition:

  • Try to avoid processed foods. These foods typically contain fewer nutrients and more unhealthy additives like salt, sugar and fat than “whole” or unprocessed foods.
  • Don’t skip meals; eat small meals. Eating smaller portions more frequently is better for your body than consuming large amounts of food all at once. Ciera acknowledges that this can be a challenge when we are short on time. “Sometimes as practitioners, especially if you’re in the office and you have patients back to back, it can be hard to get those meals. But if you keep little snacks in your desk, or if you carry a little cooler or something, then maybe you can kind of eat quickly.”
  • Try new foods. Eating the same things every day can cause you to miss out on essential vitamins and nutrients. Experimenting with new foods is an easy way to increase your nutrient variety.
  • Feed your body veggies. Vegetables are perhaps the best type of food you can eat, so you should make an effort to eat as many as you can. “Even if it’s just one vegetable that you like, find one and stick with it,” Ciera encourages.
  • Your body needs water! Beverages like coffee, tea, fruit juice and soda pop are not good substitutes because they may contain added sugars or dehydrating ingredients. Make an effort to drink pure water every day.

Exercise: Keeping the Body Active

The benefits of regular physical activity have been well documented for many years now. Here are just a few of them:

  • Exercise controls weight
  • Exercise combats health conditions and diseases
  • Exercise improves mood
  • Exercise boosts energy
  • Exercise helps with sleep
  • Exercise can help with brain functioning

We all know that exercise is good for our health, so why do many of us have such a hard time doing it?

“Many of us live a fast-paced life,” Ciera says. “We want things quickly. Research has shown that if exercise could come in a pill form, many people would take the pill, hence why there are so many diet pills and ‘lose weight quick’ programs out there. People want to be healthy or lose weight, but it is very difficult for them to do it.”

Of course, a shortage of time can be a legitimate barrier to getting enough exercise, especially when we have responsibilities to family and loved ones on top of our work duties. “We have to be honest with ourselves about when is the most optimal time of day to actually get a workout in,” Ciera advises. “And maybe you have to start small. Maybe you don’t have time during the week, but you can exercise just during the weekend. Maybe you can start with one day of the week and then work your way up. Something is better than nothing.”

Finally, Ciera suggests finding and sticking to a few exercises you enjoy rather than pushing yourself to do exercises you don’t like. “You know what I like when I go to the gym? The battle ropes. Those are fun for me. So you have to find what you like. Maybe it’s strength training, maybe it’s lifting weights, maybe it’s the stationary bike. Whatever it is, find your thing and stick with it,” she says.

Sleep: The Body’s Recovery Period

Our bodies are highly sophisticated biological machines, but they can only run for so long before they need to recuperate. Sleep is our natural recovery period, during which many of our bodily systems are “recharged” for continued use.

Adults need between 7 and 9 hours of sleep each night in order to function properly. “When you’re not getting enough sleep, you can be cranky. When you don’t have enough sleep, you’re just not yourself. So, getting a good routine down is important. Just like we do for children, as adults, we should have a sleep routine,” Ciera says.

Keeping a sleep routine helps our bodies prepare to go to sleep each night, which can be beneficial if you struggle to get enough rest during the week. Some activities you can try for your before-bed routine include:

  • Turn off all electronics 30–60 minutes before bed. “For some people, electronics tend to stimulate them,” Ciera says. “So if they’re looking at their phone, then they’re just wired to it. However, for some other people, it’s their way to wind down. It just kind of depends on who you are.”
  • Take a bath or shower. Bathing, especially in warm or hot water, can be soothing and sleep-inducing for some people.
  • Dim the lights. A reduction in light levels is one of the body’s natural cues to prepare for sleep.
  • Use aromatherapy. Some popular examples include candles, oil diffusers, and lotions.
  • Drink hot tea, hot chocolate, or warm milk. Just remember to avoid anything with caffeine or large amounts of sugar.
  • Listen to relaxing music or an audio book.
  • Meditate.
  • Write in a journal.

In addition, it can also be helpful to go to bed at the same time each night and to use your bed only for sleeping and intimacy. These habits can help provide behavioral cues for the body when you are ready to go to sleep.

Hygiene and Medical Checkups: Maintaining Bodily Health

The last major component of physical health involves the normal bodily maintenance and preventative actions we should be taking on a regular basis.

Personal hygiene standards may vary from person to person, and some amount of variance is acceptable. However, the primary utility of hygiene is to prevent illness and injury, so there are certain behaviors that everyone should try to follow.

For example, it is generally advisable to wash your hands before eating, before putting your hands in your mouth or eyes, and after using the restroom. These guidelines are especially true when you are in a public place. “It makes people feel uncomfortable if you’re in a public bathroom and you walk out without washing your hands. It makes people feel uncomfortable when you cough or sneeze, especially in your hand, and you don’t at least hand sanitize. It just does,” Ciera advises.

Beyond other items like regular bathing and dental hygiene, it’s important to schedule the preventative medical, dental and vision checkups recommended by your health care providers. “As people who are in this field, we can be so bad about this,” Ciera says. “We can be upset with our consumers when they miss their appointments, but we can be so poor at doing this ourselves. We will reschedule and reschedule and reschedule our own appointments, or just not schedule our appointments, because it doesn’t fit in our day. It’s not convenient. We might have to take time off. Don’t reschedule them. Don’t put them off to the last minute. It’s OK to take your kids to their appointments, it’s OK to take yourself to your appointments. See about your family, see about yourself. Period.”

Finally, Ciera encourages you not to feel embarrassed or ashamed if you are struggling with your regular hygiene and need help to meet your needs. “I can’t tell you the number of people who have come to me and told me, ‘Hey Ciera, I haven’t showered in a week. I haven’t showered in weeks. And I am struggling,’ “ she says. “These have been social workers. These have been therapists. These are people who have degrees. Sometimes people struggle with depression and other mental health disorders, and it’s nothing to be ashamed or embarrassed about. But you also have to take care of yourself and understand what is going on. And I do say that with sensitivity, because sometimes we don’t know how to say, ‘I am struggling, and I need help.’ “

Now that we’ve discussed the physical self in detail, you can add your assessment of your physical self-care to your Self-Care Action Plan.

Take a moment to brainstorm and write down some specific ways you are practicing physical self-care on a daily basis. Then, give yourself a rating from 0–6 for how well you are currently nurturing your physical self, with 0 being not at all and 6 being very well.

You’ll use this information to assess your overall wellness and create your action plan, which we’ll cover in our next and final blog in our series on Wellness for Care Providers!

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Sexual Assault Awareness: Finding Hope and Healing After Sexual Violence

Sexual assault is a horrible and deeply traumatizing experience, and it affects nearly half a million people in the U.S. each year.

Among women, who are disproportionately affected by sexual assault, 1 in 6 individuals will be the victim of an attempted or completed rape sometime in their life. For men, the number is 1 in 33.

Unfortunately, sexual assault is a problem even in our own community. For Sexual Assault Awareness Month back in April, our staff created an interactive display at our Marion County outpatient office. The display provided a number of teal awareness ribbons and invited visitors to pin one to a wreath if they or someone they knew was a victim of sexual assault. By the end of the month, every ribbon had been pinned to the wreath.

Survivors of sexual assault often continue to suffer long after the assault itself. They may feel ashamed and alone, psychologically isolated from the rest of the world. They may feel as though recovery is impossible and their pain will continue forever. If you are a survivor of assault, we want you to know that you are not alone, there is hope of recovery, and behavioral health organizations like Cummins can help you—if you’d like to be helped.

In this blog post, we’ll explain how you can begin your journey of healing and regain control of your life after a sexual assault. We’ll be aided by advice and insights from Tara Wilkins, our Marion County Outpatient Team Lead, who is passionate about helping survivors of assault and abuse.

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Tara Wilkins, MSW, LSW, CCTSI, Marion County Outpatient Team Lead (left), and the interactive sexual assault awareness display in our Marion County office (right)

Isolation: The First Barrier to Recovery

Many survivors of sexual assault struggle with feelings of isolation. This may seem ironic when we consider just how many individuals suffer from assault each year. But the truth is that despite its prevalence, sexual assault still carries a large sense of stigma for its victims.

“Some people think that if this happened to you, then you must have done something wrong, you must have done something to warrant this,” Tara explains. “And because of that, there’s so much shame involved. When you’re going through this, you’re thinking, ‘What did I do wrong?’ Or, ‘I wish I would have done this differently.’ Or you don’t want to talk about it for fear of being judged.”

This fear of judgment often leads survivors to keep the assault to themselves, which can have the unfortunate effect of making them feel alone, isolated, and misunderstood by their friends and loved ones.

But as statistics show, survivors of assault are not alone. Many others have gone through the same experience and can relate to the situation. Although it’s often difficult to speak out about an assault, doing so can help you find support and break down this sense of isolation.

Tara says, “There’s so much power in a ‘me too’, because it happens to more people than we realize. And by sharing that, and how you’re overcoming the adversity, and all those things, it helps move you from ‘I’m a victim and this happened to me’ to ‘I’m surviving and thriving now.’ “

Finding Hope After an Assault

Even with understanding and support from loved ones, it can be hard for many survivors of assault to find hope for a better future.

Any form of sexual assault is a horrific violation of a person’s body and mind. This sort of violation often leaves scars. It might trigger long-lasting feelings of depression, anxiety, or post-traumatic stress. It’s only natural for someone to lose hope under these circumstances. The good news is that, once again, statistics show that people do recover, and hope can be regained.

“You know, I love a model in one of the books we use for our women’s therapy group,” Tara says. “It’s called the Spiral of Trauma and Healing. Essentially, it just depicts what everyone encounters, which is at the beginning, a trauma happens. And then you have this downward spiral where you feel very confined by, in this case, a sexual assault. It just really grips hold of you and impacts your life, and so the spiral gets tighter on its way down, because a lot of intrusion and avoidance and all these other things are happening. And then once you enter treatment, and you begin to work on your recovery journey, then you’re on this upward spiral of expansion and recovery. And I think that’s a really great depiction of what happens.”

The Spiral of Trauma and Healing (pictured below) provides validation that recovery is possible, though it does take time. As Tara mentions, seeking behavioral health care can be very helpful for your recovery journey. Another option is to join support groups that provide education and tools to help you heal.

Tara adds, “We have a Women’s Trauma Group at our office. You don’t have to be a victim of sexual assault to participate, but many people there are survivors. We use Trauma-Informed Yoga in there, and we do a lot of psychoeducation to give them tools to help them self-regulate and feel safe. So at Cummins, that’s one way we do that. And I often refer out to other agencies, to a specific support group, a therapy group, or things like that.”

The Spiral of Trauma and Healing, by Stephanie S. Covington, PhD, LCSW

How Behavioral Health Services Can Help

As we’ve said, sexual assault can often create difficult mental health challenges for survivors. There is no shame in seeking out help to overcome these challenges. Therapy is a safe place to discuss painful memories and to learn coping skills for dealing with trauma.

One of the best parts about therapy is that most organizations now offer many different modalities of care, so you can work with a therapist to find the types that work best for you. Tara elaborates: “When I first started at Cummins, if you wanted to treat someone with trauma or sexual trauma, you had Cognitive Processing Therapy, which is an evidence-based practice approved by places like the VA, or if you were working with kids, you had Trauma-Focused Cognitive Behavioral Therapy. We now have so many different things. We have therapists in every location trained in EMDR, which is a phenomenal tool. We also have opportunities to do Shame-Informed Therapy, which is one of the things that I use frequently with my survivors, and Internal Family Systems Therapy.”

At Cummins, one of the most important aspects of therapy involves giving survivors control over the services they receive. “One of the things we do is when we get an intake, you know, we’ll assign providers, but I think the most fundamental thing that happens is putting this person in the driver’s seat,” Tara explains. “I’m not going to say as a therapist, ‘Oh, you’re here for this, so we’re going to use this method.’ I really like to lay out all the options that someone has available to them, let them know the pros and cons, and let them choose.”

Having permission to control their own care can be comforting for anyone, but we believe it’s especially therapeutic for people who have experienced an assault. “At some point, their control has been taken away,” Tara says. “They didn’t have control over their body. They didn’t have a choice. And so this is one small, tangible thing I can do, to say, ‘This is your choice. You’re in the driver’s seat.’ We as therapists are saying, ‘I understand what happened to you. I understand how this can make you feel. And we’re going to give you as much control as possible with this.’ “

Here at Cummins, we understand how devastating sexual assault can be. For survivors of assault, a single event can create severe and long-lasting challenges to their health and wellness. But we would like all survivors to know that they are not alone, and despite all odds, they can recover.

If you or a loved one has experienced a sexual assault and would like to learn more about mental health treatment options, you can call us at (888) 714-1927 to learn how Cummins can help. There is no obligation to your call.

With the right help and support, you can recover from sexual assault and find peace and happiness in life again. Your assault does not have to define you. Healing is possible.

Polyvagal Theory for Mental Health Care: Applying the Work of Deb Dana in Therapy

“Safety is not the absence of threat, it is the presence of connection.” — Gabor Maté

For providers of behavioral health care, it’s very important that the people we serve feel safe around us.

The process of therapy requires vulnerability from those in care, and vulnerability is difficult or impossible unless a client feels safe opening up to their therapist. Without this sense of safety and trust, the therapist won’t be able to make the emotional connection needed to help the consumer succeed in therapy.

Therefore, one of the provider’s chief duties is to make the individual feel safe and comfortable to engage in treatment. But how can we do this? There are many strategies that may work, but at Cummins, we prefer a trauma-informed approach to care that incorporates the developing science of polyvagal theory.

In fact, we have recently begun training our providers on the work of Deb Dana, LCSW, who has pioneered work in applying Dr. Stephen W. Porges’ ground-breaking polyvagal theory to therapy practice with clients. Deb Dana has written several books describing clinical strategies and techniques that further apply this foundational understanding, including The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation.

We’re very excited to be incorporating Deb Dana’s techniques using polyvagal theory into our own clinical practices! In this blog post, we’ll provide a brief synopsis of polyvagal theory and preview how it can serve as a framework for mental health care.

deb-dana-polyvagal-blog
Deb Dana, LCSW, author of The Polyvagal Theory in Practice

The Bodily Response to Danger

At some point in your life, you’ve probably had the experience of feeling unsafe.

If you think back to one of those instances, you’ll remember some interesting physiological symptoms. First, at the moment you detected danger in your environment, there’s a chance you might have frozen in place. Perhaps it was only for a second or two, or perhaps it was for longer than that. During those few moments, you made a rapid and instinctual assessment of the threat at hand without moving or speaking.

Then came the rush of adrenaline. Your body entered a state of high alert as your senses sharpened on the source of danger. Depending on the situation, you made a gut decision to either move away from the danger as quickly as possible, or, if you were threatened by a person or animal, to confront the aggressor in order to end the threat of danger. And then you did so, almost without conscious thought about it.

When you reflect back on the event today, you can probably understand it in its greater context. Using the logical part of your brain, you can surmise whether or not the perceived threat was a legitimate threat to your well-being, and you can judge whether you acted reasonably or unreasonably in the heat of the moment. You might even have some idea of how you wish you had reacted instead. But at the time of the incident, it would have been nearly impossible to have these kinds of thoughts.

Why is this so? Polyvagal theory offers an answer.

Polyvagal Theory: Linking Physiology and Cognition

As human beings, our cognition is closely linked to our physiology, and our physiology is closely linked to our perceptions of danger and safety. Polyvagal theory states that the presence or absence of a perceived threat activates different parts of our brain and autonomic nervous system (ANS), which produces different physiological states.

When we feel calm and safe, we are operating in what polyvagal theory calls the Engagement State. This state is associated with higher-level cognitive processes, social interaction, and emotions like joy, compassion, curiosity and mindfulness. When we’re in the Engagement State, the ventral vagus nerve and associated ventral vagal complex of the ANS are activated.

If we perceive a threat in our environment, our ANS may shift into the Mobilization State. In this state, our sympathetic nervous system is activated, which prepares the body to move in response to the threat. The Mobilization State may trigger “fight or flight” behaviors, and it is associated with emotions like anger, fear, anxiety and panic. Importantly, higher-level reasoning and social engagement are extremely difficult when in this state.

Finally, if the perceived threat is so great that we feel unable to counteract it, our dorsal vagus nerve and dorsal vagal complex may become activated, triggering the Collapse State. In this state, we might feel ashamed, hopeless, disassociated, depressed or even suicidal. At lower levels of dorsal vagal activation, we may also exhibit freezing behavior, which can occur when a sense of danger comes on very strongly and abruptly. While temporary, “defensive” freezing behavior can be useful for surviving dangerous situations, prolonged dorsal vagal activation is especially dangerous to our mental and emotional well-being.

The 3 Organizing Principles of Polyvagal Theory

In addition to the three physiological states described above, polyvagal theory proposes three key principles that explain how our bodies shift between them. They are:

1. Hierarchy

The three states of polyvagal theory are always activated in a specific order, without skipping any state. As our level of arousal and perceived danger increases, we move from the Engagement State (ventral vagal activation) to the Mobilization State (sympathetic nervous system activation), and then, if arousal continues, to the Collapse State (dorsal vagal activation). As arousal and perceived danger decrease, we move from the Collapse State to the Mobilization State, and if we are sufficiently calmed, then to the Engagement State.

It should be noted that arousal can happen very quickly, such as when someone who is calm jumps to freezing behavior in response to an abrupt threat. However, this is the one notable exception. In most cases, an individual does not move from a state of calmness and connection (Engagement State) to a state of numbness and hopelessness (Collapse State), or vice versa, without first passing through the state of frustration or anxiety (Mobilization State).

2. Neuroception

Neuroception is the premise that our nervous system can and does take in outside information and respond to that information. Importantly, this process happens without our conscious awareness.

Neuroception stands in contrast to perception, which is our capacity for consciously interpreting the world around us. While perception is moderated by conscious thought, neuroception is not. Neuroception explains how a person, object or environment that subconsciously reminds us of danger can create changes in our autonomic nervous system, even if we consciously know the person, place or thing does not pose a threat to us.

3. Co-Regulation

As our bodies and bodily systems mature throughout our lives, our autonomic nervous system develops the ability to self-regulate. For example, once it is sufficiently developed, our ANS can “learn” to transition out of heightened states of arousal on its own. However, this development process begins with co-regulation, which involves mirroring or mimicking the behaviors and arousal states of others.

Co-regulation can be seen commonly among young children, such as when an upset child is soothed by a parent or caregiver. Through neuroception, the child’s ANS responds to the calming cues given off by the parent and successfully de-escalates its own arousal level. Although co-regulation becomes less critical as self-regulation skills develop, it remains a useful principle to leverage in situations such as therapy and counseling.

Applying Polyvagal Theory to Clinical Practice

So, what exactly does all of this have to do with providing mental health care?

For individuals receiving care, seeking and receiving mental health services can be a challenging experience. For starters, a person who is seeking services may feel a variety of difficult emotions, such as uncertainty, anxiety, fear, or shame. What’s more, the therapeutic process may elicit upsetting thoughts and feelings as the consumer works through whatever issues they are seeking help for.

In some circumstances, these difficult emotions—perhaps coupled with traumatic memories or certain features of the treatment environment—may cause a person to feel unsafe, triggering an ANS response. If this happens, they will be temporarily “locked out” of the cognitive processes associated with the Engagement State, which are necessary for productive participation in treatment.

As care providers, we can use our understanding of polyvagal theory to help prevent this from happening. Although this is a nuanced process, Deb Dana’s framework poses three essential elements of practice:

1. Context

Some people seeking services may feel unsafe if they do not fully understand what is happening in treatment and why it is happening. For this reason, providers should demystify the process by consistently explaining what will be done, why it will be done, and how it will be done in the context of our brain and our nervous system. This will reduce the chance that the individual’s ANS will detect a perceived threat via neuroception.

2. Choice

Individuals may also be prone to feeling unsafe if they believe they don’t have any control over their treatment. This can create the feeling of being trapped within treatment, which may trigger ANS arousal. To prevent this, providers should ask their clients what they would prefer to do or offer multiple choices whenever possible. This will help the individual feel safe in the knowledge that they are in control.

3. Connection

As we mentioned above, the emotional tolls of treatment may cause some distress for the person receiving services. To prevent or counteract this, providers must constantly monitor their own emotional state and strive to remain in the Engagement State of the ANS. Doing so will assist the consumer in staying or becoming calm via the principle of co-regulation.

Robb Enlow, LCSW, Cummins’ Chief Clinical Officer, explains:

“Part of what any therapist, nurse, teacher, or communicator has to do with other people is co-regulate. If you’re in an ugly frozen state, and the person you’re communicating with is in an ugly frozen state, that’s not a pretty conversation. In fact, sometimes we see that clinically. The parents are frustrated and triggered, the child is screaming and triggered, and neither one of them are communicating effectively with each other. They’re both frozen or very ‘fight or flight,’ and it’s just not working for them. The idea is we get them regulated to the ventral vagal state, or the social engagement state. When people are truly in the social engagement state, that’s when your brain is able to do miraculous things. When you calm down those cover ups, those protective, defensive parts, the rest of your brain is able to access creative, curious things that you’re just not able to access when you’re not in that state.“

At Cummins, we are always working to provide the most effective care possible for the people we serve. Part of this means training our providers in new and promising clinical practices. (In fact, continuous learning is one of our core organizational values!)

To this end, we’re thrilled to be incorporating polyvagal theory and the work of clinician Deb Dana into our standards of care. We believe it will further improve the knowledge base and therapeutic effectiveness of our care providers, which will in turn result in better outcomes for our consumers. And this, after all, is our most important goal.

If you are interested in advancing your career with a position at Cummins Behavioral Health, we encourage you to visit our employment page. We are always looking for talented and passionate people to join our team!