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Wellness for Care Providers: Identifying and Managing Burnout

Anyone who works in a stressful, emotionally taxing line of work may be familiar with burnout.

Merriam-Webster dictionary defines burnout as “fatigue, frustration, or apathy resulting from prolonged stress, overwork, or intense activity.” However, this description doesn’t quite do justice to the experience. Burnout is a state of debilitating emotional exhaustion that can lead to a lack of motivation, a reduced sense of accomplishment, and even a diminished sense of personal identity.

The health care industry and other “helping professions” are notorious for high rates of burnout, which can be seriously damaging to the health and wellness of workers. In the worst cases, burnout can lead to employees missing extended periods of work or even quitting their jobs to pursue careers in different fields.

At Cummins Behavioral Health, we care about the wellness of our team members and of all mental health care providers. If care providers struggle to maintain their own health and wellness, then the quality of care they can offer their clients will also suffer. That’s why we’re committed to helping mental health professionals avoid work-related wellness issues like burnout.

Although burnout is a danger for care providers, it can be managed if we know the warning signs and what to do about them. In this blog post, we’ll identify some common signs that you may be approaching burnout and explain how you can correct course before it’s too late. We’ll also include examples and insights from Ciera Jackson, Professional Development Specialist at Cummins, who leads our internal wellness trainings and initiatives.

We hope you find these tips useful in your own work!

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

Warning Signs of Burnout

Sometimes it can seem as though burnout happens all at once, like a tornado or hurricane that strikes unexpectedly and upends our lives. In reality, just as with a storm, there are almost always warning signs that precede it.

Below is a list of common signs a person may be approaching burnout. The more of these signs that are present for an individual, the greater are the chances that they may be headed for burnout.

Exhaustion

Physical, mental, and/or emotional exhaustion is a common precursor to burnout. As Ciera points out, exhaustion is a more oppressive version of the tiredness or lethargy you may sometimes feel on bad days. “This is more of that perpetual, chronic, ‘I am tired. I’m done. I’m kind of just over it,’ “ she says.

Lack of motivation

Waning motivation is also a significant sign that burnout could be near. “Your job doesn’t excite you like it used to,” Ciera explains. “You feel like you can’t muster up the energy to do it another day. You feel like it’s something that the weekend or a vacation won’t necessarily solve.”

Lack of resilience

“Normally, when people are resilient, they have an ability to bounce back fairly quickly,” Ciera says. When someone is approaching burnout, this ability becomes diminished. Frustrations and setbacks in their work may trigger feelings of resignation and hopelessness.

Bad interactions with others

Negative feelings about work may manifest as rude or inconsiderate behavior toward co-workers and clients. Ciera says, “We all have bad days, but sometimes when you’re burned out, it’s more than a bad day. It becomes a part of your character. People have a bad taste in their mouths about who you are as a person, because they may not have had favorable interactions with you.”

Inability to make decisions

“Sometimes, if burnout becomes chronic, it can feel paralyzing,” Ciera says. Work-related decisions you once made without difficulty may seem strangely unsolvable now. “Maybe there’s some counter-transference with consumers going on, maybe there’s some blending of boundaries going on, and things are becoming a little more personal or a little more close to home,” Ciera adds.

Increased work stress

Work stress often comes in the form of additional tasks that must be completed. “You just keep getting more piled on, and so it becomes a struggle to manage what you have,” Ciera explains. However, increased stress can also come from longer hours or greater responsibilities.

Being cynical

An individual who is approaching burnout may develop a negative attitude about nearly everything related to their work. This could manifest as snide or sarcastic comments to colleagues or even clients. The person may develop a reputation for negativity among their peers.

Reduced performance

As stress and exhaustion develop into burnout, an individual may find themselves unable to perform their work to their normal standards. “Maybe you used to be a high performer, and now you’re not performing so well or producing as much,” Ciera suggests.

Lack of satisfaction from achievements

Even when someone performs well in their work, they may cease feeling any sense of personal accomplishment. “People could praise you and reward you for what you do at work, and you could feel apathetic. And so you could start to feel numb and disconnected from what’s going on,” Ciera explains.

Using vices to cope (food, alcohol, cigarettes, etc.)

When everyday life becomes too stressful, some people may start to rely on something to numb that stress. These vices can come in many forms, but they always serve to cover up negative emotions. “People use vices to try to just get by and focus, just because they’re trying to feel something, or just because they feel like it helps them function,” Ciera says.

A change in sleep habits

Altered or unusual sleeping habits can be an early sign that stress is becoming unmanageable. “Some people wake up in the middle of the night because they are dreading going to work the next day,” Ciera says. Alternatively, they might also find themselves chronically oversleeping due to a lack of energy.

Lack of creativity

When a person is overburdened by long work hours or extraordinary stress, their ability to be creative is one of the first skills they lose access to. “For some people, they may have been artists in various forms, and that creative piece has dwindled,” Ciera says. “When your brain has experienced some trauma, creativity is hindered.”

Physiological issues (headaches, upset stomach, gastrointestinal issues)

Stress can commonly manifest as physical symptoms, which can be a clue that it’s becoming a chronic problem. Ciera explains, “Some people carry stress in different ways, and you have to figure out, ‘What is producing this?’ “ It’s possible that physical symptoms may be indicative of burnout.

A feeling of dread when you think about work

This is one of the most clear and obvious signs that a person’s work situation is leading them to burnout. “For some people, Sunday night is the worst time of the week,” Ciera says. “They may cry, they may have a pit in their stomach, because they think, ‘Monday is tomorrow, and that is the work week, and that’s when it starts.’ “

Burnout Creation vs. Burnout Prevention

We’ve discussed many common signs for detecting burnout, but what can we do to prevent it or recover from it once it has occurred?

The conditions and situations that lead to burnout are not always easy to change, and there is no one-size-fits-all solution for preventing burnout. However, burnout is often caused by several common sources. Therefore, it can be helpful to understand the sources of burnout creation vs. burnout prevention.

Your best option for counteracting burnout is to do whatever you can to tip the scales toward burnout prevention in your specific circumstances.

Work overload vs. sustainable workload

A workload that is chronically too heavy is almost guaranteed to create burnout over a long enough time frame. While short periods of heavier workload can be managed, unending overwork usually leads to exhaustion.

“In social services, I think we know when we’re going into it that there’s not always going to be sunny days, rainbows and gumdrops,” Ciera says. “And I think we also know that there are going to be seasons that are heavier than others. With that being said, I think it’s fair to say that you’re going to have sometimes where your caseload may be a little heavier than others. However, if that is the norm, that is a problem, and that is where there needs to be balance. Because if there is always work overload, or that is normally the case, that’s what starts to create burnout.”

The best way to achieve a sustainable workload is to let your superiors know when you have too much work to handle. This may feel uncomfortable sometimes, but if your management is truly supportive, then they’ll do what they can to help you get your workload to a sustainable level.

“It’s OK to say no. You should normalize saying no. There’s nothing wrong with that. There’s nothing wrong with work-life balance at all,” Ciera adds.

Lack of control vs. feelings of choice and control

If the current state of your work is unsatisfactory and you also believe that you have no control over it, feelings of burnout are likely to increase.

“In reality, there are things we don’t have control over,” Ciera explains. “There are certain policies we don’t have control over, there are certain things regarding billing we don’t have control over. But there are other things that are within our control, and that we can speak up and say something about.”

Again, the best way to regain feelings of control is to make sure your team and superiors know what you need from your work. “I want to encourage people to use their voice,” Ciera says. “It’s OK to speak up and say something. It’s OK to assert yourself. The things you do have control over, assert yourself, use your voice, and make sure your needs are known.”

However, it’s important to remember that asserting yourself doesn’t mean acting rude or being selfish. Ciera explains, “That doesn’t mean you don’t act like a team player. There’s give and take. Sometimes you cover things for people because there may be a time where somebody has to cover something for you. It’s not like you can always say no.”

Insufficient rewards vs. recognition and reward

A little bit of recognition and reward can sometimes go a long way toward making difficult work more tolerable.

As Ciera explains, this reward can look different from person to person. “It could be making sure your pay matches your duties. It could be simple verbal recognition. Like, ‘Hey, you did a really great job on that case. I know that you were on the phone for hours with that one client, and you did a good job getting them in the hospital.’ It could be a team reward. People have different reward systems, and people are motivated by different things,” she says.

It can be helpful to let your superiors know what kind of rewards and recognition you find most personally meaningful. You might also need to discuss whether the rewards you are receiving match the level of effort you put into your work.

Breakdown of community vs. a sense of community

For some people, a sense of teamwork and camaraderie among their co-workers is an important part of fulfilling work. This sort of community can often act as a protective factor against burnout.

Ciera gives an example of what this might look like: “Let’s say I’m out for a day, and one of my consumers comes in. They weren’t scheduled, but you’ve seen me with them before, and maybe they’re a little bit agitated. Are you going to de-escalate this person and take care of them the way I would take care of them?”

A sense of community can be enriched by superiors who lead by example and not by giving orders. “If you’re asking me to do something, are you going to be willing to do what you’re asking me to do? For some people, it is hard to be in a place where they’re moreso with bosses than with leaders. They want servant leadership instead of dictatorship,” Ciera says.

Unfairness vs. fairness, respect, and justice

Fairness and unfairness are subjective measures, but they are nonetheless very important for job satisfaction.

If we feel that our job is unfair, this might go back to the issues of work overload or insufficient reward that we discussed above. Ciera explains, “Some people may feel like, ‘I’m working, working, working, working, and I’m not being recognized. I feel like I’m spinning my wheels in mud. I’m giving all I can to this company, and it’s not fair because I’m not being recognized.’ “

Feelings of unfairness could also stem from the perception that other employees are being treated more favorably than you are. Whatever the case, unfairness can easily contribute to burnout if it is not addressed. “For some people, that leads to burnout, because it’s like, ‘Why am I doing this? Yes, I have or had a love for the population or the field, but now I’m at a point where I’m wondering if this place a match for me,’ “ Ciera says.

Significant value conflicts vs. meaningful, valued work

Every organization has a set of values that guides it. In the best cases, these values are compatible with the personal values of each employee at the organization. But sometimes there can be significant mismatch.

Ciera says, “The best example I can give is that I once had to leave a place I worked at because there was a high focus on money and a low focus on patients. And my belief was that we couldn’t be after their money and not treat the person with dignity and respect. There was a mismatch there, so I had to exit.”

If the values of your organization are at odds with your personal values, you will run the risk of becoming disillusioned and burned out. Therefore, you may need to assess whether the organization is a good fit for you.

“Sometimes you have to ask yourself: do my values match the company values, and do their values match my values? Ciera adds.

Lack of fit between the person and job vs. high job-person fit

We all have the ability to improve at a task or get better at our jobs, but it can sometimes be the case that a particular job is just not right for a particular person. This job-person mismatch can lead to burnout if it is not addressed.

“Sometimes people are not the best at something, but can they be coached to be better? And if not, maybe they just need a different position within the company,” Ciera explains. “Maybe they need to be moved to something else, because maybe they really are good in terms of certain value sets, or certain sets of job skills, but maybe just not at the position they applied for.”

Good managers may be able to recognize when their employees would do better in different positions. However, if you suspect you may be a poor match for your job, you shouldn’t wait for a superior to say something about it. “Maybe we ourselves say, ‘I applied for this job, but maybe I should move to this position. What do you think?’ “ Ciera says. We can’t always wait for someone else to tell us that. We have to be in tune with ourselves to tell ourselves that, or be honest enough to say that.”

The Bottom Line on Burnout

We’ve covered many ways of understanding, detecting, and measuring burnout. In fact, it might seem a bit overwhelming just to keep all of this information in mind at once. We’d like to close by briefly summarizing how you can assess whether or not you’re becoming burned out in your work.

When you think about your work, ask yourself if you are:

  • Energetic or exhausted. Does your work excite and inspire you, or does it drain your energy and enthusiasm?
  • Involved or cynical. Do you feel engaged and invested in your work, or do you feel detached and defeated?
  • Effective or ineffective. Do you believe you can make positive changes within your organization, or do you believe that any effort you make amounts to nothing?

“This is what you need to ask yourself when you’re weighing if you’re burned out,” Ciera says. “Where am I on this burnout scale? If you feel like, ‘I’m still engaged, I’m still OK,’ then you also have to start to ask yourself, ‘What am I going to do to remain engaged?’ Because you’re going to need to be intentional on taking breaks, giving that self-care, and doing things that are intentional to pour into yourself. You cannot pour from an empty cup.

In future posts in our “Wellness for Care Providers” series, we’ll go into greater detail about self-care strategies for preventing burnout. For now, we’ll end with these important words from Ciera Jackson:

“You cannot give and give and give and give to your work, because then what’s left for you? And if you have a family at home, whether it’s a significant other, whether it’s kids, whether it’s pets, what do you have left for them? You’re going to stop working one day. You’re going to retire one day. And the people that you’re left with are your family, or your friends, or your pets. Your job doesn’t last forever, so you have to maintain those relationships, because that’s what lasts. Not your work. Granted, it can be fulfilling. But be sure you’re intentional about the relationships in your life, and preserving yourself. That’s what’s important. Because you can’t give out what you don’t have, period.”

If you found this article on burnout useful, we encourage you to share it with someone else who might appreciate it! Our goal at Cummins is to be an advocate for all providers of physical and mental health care. The work you do every day changes people’s lives for the better!

Haven Homes Opens Its Doors to Survivors of Domestic Violence in Plainfield

Approximately 40% of women and 27% of men in Indiana will experience intimate partner violence sometime in their lives. That’s a total of 2.2 million individuals whose lives are altered by intimate partner violence.

The harmful effects of intimate partner violence or domestic violence continue long after an incident occurs. In addition to physical and psychological injuries, survivors may find themselves lacking the basic resources they need to rebuild their lives after an abusive relationship. In the worst cases, this can lead to sporadic or chronic homelessness.

In order to provide housing assistance to survivors of domestic violence, RealAmerica LLC has built Haven Homes, an affordable housing apartment complex in Plainfield, IN. Haven Homes is catered specifically toward individuals and families who are escaping domestic violence, offering amenities such as built-in kitchen appliances, in-unit clothes washers and dryers, and free in-unit internet service.

Cummins Behavioral Health and domestic abuse shelter Sheltering Wings have partnered with RealAmerica to provide support services to Haven Homes’ residents, as well. At the on-site clubhouse and community resource center, residents can speak with social workers and mental health professionals, receive counseling, and attend life skills classes either in-person or via teleconferencing. These services can further help residents recover from domestic violence and return to independent living after escaping abuse.

Haven Homes held its Grand Opening last Friday, December 17th, and we were thrilled to be in attendance! Below are some photos showing off the complex and the people who made Haven Homes possible.

The Haven Homes Grounds

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The two-story apartment building

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The three-story apartment building

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The clubhouse and community resource center

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Children’s playground behind the community resource center (lawn under construction!)

The Clubhouse / Community Resource Center

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Clubhouse room

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Clubhouse room—second angle

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Gym/fitness room

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Children’s playroom/activity room

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Classroom/meeting room

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Computer room

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Telehealth room (equipment not set up yet)

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Entrances to children’s activity room and private consultation offices

Grand Opening Ceremony

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Melanie Reusze, COO of RealAmerica LLC, opened the ceremony and introduced the speakers.

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Jacob Sipe, Executive Director of the Indiana Housing & Community Development Authority (IHCDA), which provided Rental Housing Tax Credits for the Haven Homes project

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“When we have a project like this, we’re really, really excited, because it truly does help fill our housing needs in Plainfield.” — Bill Kirchoff, Vice President of Plainfield Town Council

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“I couldn’t be happier to see this project completed, and I’m optimistic that it will help with the housing vacuum that’s been created.” — Brad DuBois, President/CEO of Plainfield Chamber of Commerce

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Brian Shelbourne, Vice President of Originations at Merchants Capital, which provided financing for Haven Homes

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“We’ve been talking for years about how we need to have better and more affordable safe housing in our communities, and Haven Homes is an answer to that need.” — Cassie Mecklenburg, Executive Director of Sheltering Wings

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“We look forward to serving the residents of Haven Homes in building safe and independent lives.” — Amy Mace, CEO of Cummins Behavioral Health Systems

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Ronda Shrewsbury, President and Owner of RealAmerica LLC, expressed her gratitude to everyone who helped make Haven Homes a reality.

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The ceremony closed with a ribbon cutting led by Melanie Reusze (click to view video)

We would like to thank all the organizations and dedicated individuals who had a hand in bringing Haven Homes to fruition. This is an important project for a vulnerable population in our community, and we are very excited to assist in their recovery and growth.

In the future, we hope to share more information about the services we are providing to residents at Haven Homes. Keep an eye on our blog in 2022 for that story and many more!

Cummins Values: How We Practice Continuous Learning Every Day

It would be hard to deny that learning is a big part of being a human.

When we are born, we come into this world without any knowledge or understanding of it. Everything that we know now, we had to learn.

This learning happened in many ways and came from a variety of sources. When we are very young, our parents bare most of the responsibility for teaching us about life. Later, schools and educators take the lead in filling our minds with knowledge, which can last more than a decade or two depending on the amount of formal education a person receives. And all throughout this time, we also learn lessons from personal experiences and the experiences of other people who are close to us.

After all this learning is done—not to mention the learning we must do when we start a new job or advance further in our career—we might feel that we’ve learned enough. After all, learning is often challenging, and it’s comforting to believe that we know enough. However, we believe in lifelong learning at Cummins Behavioral Health, not least because it helps us provide the best possible care for our consumers.

Continuous learning is one of our core organizational values, and it influences everything from our team’s professional development to how they work with consumers. To learn more about continuous learning at Cummins, we spoke with two of our staff members who embody this value in their work: Joel Sanders, a School-Based Therapist in Hendricks County, and Jennifer Knight, one of our Onboarding Specialists.

In this post, they explain why continuous learning matters and how they embrace it in their work.

Joel Sanders: Learning More to Improve Consumer Care

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Joel Sanders, LMHCA, School-Based Therapist

One reason we believe in continuous learning at Cummins is because it improves the quality of care we can provide to our consumers. When our care providers have up-to-date knowledge about mental health disorders and the best methods for treating them, they can help their clients achieve better outcomes.

For example, Joel views continuous learning as a way of getting better at his craft. “I always want to learn more about mental health because it means I’m providing the best care and support for the kids I see,” he says.

In fact, Joel believes that improving in his work is more than a just nice bonus for his consumers. He views it as an obligation. The kids I see deserve it. They deserve my very best,” he says. “I’m also super passionate about it, so I’m constantly wanting to learn everything I can. It helps me to better serve my kids.”

The main way Joel practices continuous learning is by attending optional trainings and workshops that teach new therapeutic skills. “I am always interested in going to trainings and workshops,” he says. “The information you get there is invaluable, and the resources and networking are incredibly helpful.”

Joel mentions that one of his favorite topics to learn about is trauma and trauma-informed care. “I swear that I could be a full-time trauma workshop attendee,” he jokes.

On top of his desire to serve his clients, Joel also says that his colleagues help to inspire his passion for continuous learning. He explains,

“I think my co-workers inspire me to learn more and always try to improve myself. One of them in particular shares my drive and passion for continuous learning. It’s almost like we push one another. I am constantly sharing workshops and training opportunities with this co-worker. We are always talking about trauma and how we can learn more about it so we can best serve our kids. I love talking about trauma, so it’s pretty easy and natural to engage in continuous learning about it.”

Jennifer Knight: Empowering Staff to be Continuous Learners

Jennifer Knight, Onboarding Specialist

Another reason we believe so strongly in continuous learning is because it tends to go hand-in-hand with growth mindsets.

To put it briefly, a growth mindset is the belief that we can improve and develop our talents with practice and hard work. The alternative to a growth mindset is a fixed mindset, which is the belief that our abilities are determined at birth and cannot be improved or developed.

A growth mindset is just as important for our staff as it is for the individuals we serve. As one of our onboarding specialists, Jennifer works hard to encourage a growth mindset among each new person who joins our team.

“For me, continuous learning is having a growth mindset and accepting that growth is not always linear,” she says. “Sometimes, we grow and learn more through the setbacks and failures we experience rather than via successes.”

As Jennifer points out, some amount of failure is inevitable whenever we are trying to do something that’s difficult. She believes that a continuous learning mindset can help us stay motivated in spite of setbacks. “Continuous learning is important because it not only conditions us to be able to handle challenges and struggles, but also to feel gratitude in areas where we may not have previously,” she says.

Like Joel, Jennifer views continuous learning as a team effort. For example, she believes that she learns from her co-workers just the same as she helps them learn new concepts. She explains,

“I live out my passion for learning and growth at Cummins by valuing the relationships that I have with my colleagues and teammates when sharing our experiences in the field and learning from one another. I think I inspire my co-workers to continue learning and growing by trying to always stay positive and encouraging, as well as by highlighting the many positive qualities and strengths they have but may not always see in themselves.”

At Cummins, we believe that we are never finished learning. When we work with our consumers, we ask that they learn about their mental health and wellness, learn new life skills and coping strategies, and sometimes even learn new habits and routines. Our providers also commit themselves to continuous growth in order to serve our consumers the very best way we know how.

We would like to thank Joel Sanders and Jennifer Knight for sharing their thoughts and for acting as models of continuous learning among our staff. Your commitment to our consumers is what makes our organization remarkable!

If you enjoyed this blog post about continuous learning at Cummins, then you might enjoy reading about our other organizational values below!

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Why Respect Is at the Core of Our Work
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How Our Providers Inspire the Hope of Recovery

HOPE for Youth Who Engage in Harmful Sexual Behavior: Explaining the Treatment

The onset of sexual development is a major milestone in the life of any child. Not only does the child’s body begin to change, but they also develop an interest in the bodies of others, and they begin discovering ways to express their newfound sexuality.

Unfortunately, not all of the ways they may choose to express this sexuality are healthy or constructive. In a previous blog post, we explained how children and teens can sometimes learn sexual behaviors that are harmful to themselves or others. Once an individual has learned these behaviors, they may repeat them without much conscious thought and without realizing they are unhealthy.

However, youth can learn to identify and change these harmful behaviors with help from caring adults. This is exactly what our new service program, called “Healing for Optimal living through Protective factors and Education” (or HOPE), is designed to do. Through a combination of individual therapy, family therapy, skills training, sexual education, and other services, our HOPE program can help youth express their needs and desires in constructive, age-appropriate ways.

These interventions not only protect a young person from potential legal problems and relationship issues, but they can also help set them on a path toward healthy, safe living.

For Part Two of our series on our new HOPE program, we once again spoke with Ashlee Prewitt, our Director of Specialty Programs. In this post, Ashlee explains what the treatment entails and what you could expect if you were to enter your child into services.

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Ashlee Prewitt, LMHC, CSAYC, Director of Specialty Programs at Cummins Behavioral Health

Getting Started in Services

All services at Cummins Behavioral Health begin with a simple assessment called an “intake assessment.” This occurs during an initial appointment with an Intake Specialist, and it is designed to determine what kinds of services your child may require.

Ashlee explains, “We’ll do an initial intake where we are assessing for mental health and behavioral health, including sexual maladaptive behaviors and trauma, and from that we’re going to get service recommendations. We’ll communicate with the family whether we are aware of any sexual maladaptive needs based on that initial appointment.”

For some consumers, an additional psychosexual assessment may also be conducted at this time. “We’ll get a complete psychosexual history and dive into more detailed questions regarding sexual behavior, sexual attitudes, values and beliefs around sex, and those kind of topics,” Ashlee says. “The benefit of this psychosexual assessment is really getting that deep history.”

If these assessments indicate that treatment for harmful sexual behaviors might be appropriate, then the family will be referred to a specialist in their county for further consultation. This specially-trained provider will work with the family to determine if treatment is truly needed.

If it is, then the youth and their family can begin attending therapy and counseling sessions. These sessions will seek to address any and all emotional, behavioral and developmental issues that are contributing to the youth’s harmful sexual behavior. Ashlee explains,

“We will usually start with weekly or biweekly therapy sessions, depending on their risk level, protective factors, and past treatment. We’ll provide case management and skill development to wrap around the family, so not only is the youth learning new skills and treatments to help with building relationships, healthy impulse control and urge management, but we’ll also incorporate that with the whole family. How can the family help? How can the family demonstrate impulse control, set healthy boundaries, promote safe sex practices, and things like that?”

How Treatment Changes Harmful Behaviors

Maladaptive, reactive, or otherwise harmful sexual behaviors are often only symptoms of underlying struggles a youth may be facing. As we have said, the goal of treatment is to discover these route problems and address them.

“We’re going to identify different decisions or skill deficits that have led to this behavior, whether it is a trauma response, poor impulse control, communication difficulties, or anger management issues,” Ashlee says. She continues,

“For example, if impulse control is a problem, then we’re going to help the child be mindful of what they’re feeling, be mindful of what they’re desiring, do some sort of pro/con list or stop-think-go techniques to help them be able to think through decisions and take in all of the different factors that are at play when they’re making this decision. On the other hand, sometimes these behaviors are manifested because the child doesn’t have words to communicate what they’re feeling. We’re going to teach them: how can you communicate that you’re sexually aroused? How can you communicate that you’re feeling unsafe? How can you communicate you have a need that needs met, and how can you meet that need in a healthy way?”

Consider the specific problem behavior of sending sexually explicit photos to peers over the phone or social media. Because this behavior has become somewhat normalized among adults, a child or teen might believe this is an acceptable way to express their sexuality. How might treatment go about correcting this behavior?

In this particular example, one of the first things the treatment team would do is educate the consumer about the legality of this behavior. Child pornography laws often prohibit the sending or receiving of sexually explicit images of a minor, even if they are sent and received consensually. “It’s something that kids and parents can get in legal trouble for, and not many people actually realize that,” Ashlee says.

Next, the providers will work with the youth to determine why they are engaging in this behavior. “What needs are they trying to meet, or what is the goal there? And what are the healthy ways that they can now meet those needs or have that desired outcome?” Ashlee explains. “If it’s because they want to be in a relationship with someone, then we’ll talk about how we can build a healthy relationship. If their motivation for doing this is to be funny, or for shock value, then we’ll discuss how we can do this in a way that’s not going to run the risk of getting them into legal trouble.”

Once the providers understand what need the behavior is meant to fulfill, they will work with the youth to help them meet that need in a more constructive manner. Ashlee explains,

“If we’re working on, for example, building healthier relationships, that’s going to take time. We’re going to dive into: what examples of relationships have they seen that are good, or positive and healthy? What have they seen that’s not positive and healthy? What did they like about each? Then we’ll move forward and start to apply. We’re going to practice how we build those relationships. We’re going to roleplay communication. We’re going to roleplay interacting in ways that are appropriate and healthy. And we’re going to help them achieve that desired outcome in a healthy, prosocial manner.”

Working with the Whole Family

Although our HOPE services are focused on youth-facing interventions, that doesn’t mean the rest of the family is left out of the process. On the contrary, as a child or teen progresses through treatment, their parents or caregivers will be involved at every step along the way.

Ashlee explains, “We have family therapy sessions with the whole family together, and parents or caregivers also have their own sessions with the therapist who’s providing services. That way the parents have a place that is safe where they can walk through and process what’s going on, and they can work with the therapist so that the treatment team truly is aligned with everyone.”

It can be difficult for parents to watch their child struggle with a behavioral health issue, so we also try to provide emotional support for parents as needed. “It is very tough, and there are not a lot of resources and support for parents who go through this with their children. That is one of the big reasons why we set up our treatment pathway the way we have,” Ashlee says.

Additionally, different families may hold different beliefs regarding what constitutes “appropriate” expression of sexuality. The treatment team will work with parents or guardians to ensure that everything they communicate with the youth is in alignment with family beliefs about sex. Ashlee explains,

“We are absolutely going to be culturally sensitive and take into account the family’s beliefs, whether they are religious or personal. We are always going to partner with parents and make sure they are on the same page with us so that we are never in contradiction of their beliefs. That is how we’re going to meet them where they are and communicate those beliefs that are healthy and appropriate.”

Meet Our Treatment Team!

Our HOPE services are now available in Marion, Hendricks, Putnam and Montgomery counties. We hope to extend services to Boone County in the future, but for now, consumers in Boone county may be connected with a provider in Marion County or Montgomery County.

Depending on the county you receive services in, one of the providers below will act as your primary clinician.

Stacey Bostian-Miller, MS, LMHC, NCC, CSA (Hendricks County)

Stacey has had the enjoyment of being in the helping field for almost 25 years. While most of her work in the helping field thus far has been in the dental field working with people of all ages, she switched careers in 2017 and went into the mental health field. She earned a Bachelor of Arts degree in Psychology with a concentration in childhood and adolescent development and a Master of Science degree in Mental Health Counseling and has been employed with Cummins Behavioral Health Systems Inc. since October of 2017, where her role is a school-based therapist for kindergarten through 4th grade. She has also had the opportunity of working with adolescents, teens, families, couples, adults, and domestic violence survivors. Prior to her time as a mental health counselor, she volunteered as a CASA in Boone County and volunteered with Mental Health America of Hendricks County, where she went to elementary schools and presented puppet shows focusing on mental health and social topics. She is always excited to engage in trainings to further her knowledge, improve her skills, and keep up with the latest evidence-based interventions. She truly enjoys trauma work and play therapy techniques and is working toward a Certificate in Trauma Studies as well as focusing on becoming a Registered Play Therapist. Her most recent venture is beginning to work with adolescents who have engaged in sexually harmful and/or reactive behaviors.

Jeremy Haire, LMHC (Montgomery County)

Jeremy started his career working with youth and families in 2005 after volunteering in an after-school program. He has served in several roles as a volunteer, case manager, community-based therapist, home-based therapist, school-based therapist, group therapist and a supervisor. He loves having the opportunity to make an impact in the lives of children and their families. It is important to him that youth feel respected and they learn there is hope in recovery. During his career, he has been given the opportunity to receive training to strengthen and improve his clinical skills. Some examples are: Motivational Interviewing, Cognitive Behavioral Therapy, Family therapy techniques, Play Therapy techniques, Theraplay techniques, and Trauma Focused-CBT. He has used these skills to provide a variety of services that include intake evaluations, risk assessments, individual and family therapy, group therapy, skills training, and case management.

Christina Kerns, Outpatient Therapist and MHIOT Group Facilitator at Cummins Behavioral Health
Christina Kerns, MSW, LSW (Montgomery County)

Social work has always been the right profession for Christina because of the overwhelming passion she has for helping individuals meet their mental, physical, social, and spiritual needs. She strives to understand all difficulties by encouraging individuals to challenge themselves to make a change in their own lives. Over the past nine years, she has developed a strong clinical skill set through the combination of education and practical experience. She provides therapeutic services for children, families, and individuals by utilizing an integrated approach tailored to their unique needs. She has also worked with a variety of diverse populations within the community. She understands the benefits of both professional and personal development throughout a lifespan and would consider herself a lifelong learner. She cultivates new opportunities by learning additional skills and techniques to assist all individuals. In addition, she has gained extensive experience in policy and public health research under the guidance of a research team and a fellowship. She encompasses advocacy and prevention surrounding the mental health of Putnam County’s residents, as seen through her work as Co-President for Mental Health America of Putnam County (MHAoPC). She works hard to establish financial stability and sustain community partnerships.

Erica Bostic (Putnam County)

Erica has been a provider supporting children and families since 2020. Her aspiration to help this underserved community has been her passion since she can remember. She started this career path in 2015 at Indiana State University by choosing to study social work. She served as an intern at a nursing home and the Salvation Army, but instantly learned that her passion was working with youth. In 2019, she started her master’s program at IUPUI and chose the school track in hopes of becoming a School Social Worker. She interned at Northwood Elementary school and was amazed at all the opportunities to help children within the community. When COVID-19 hit that school year, it opened her eyes to how desperately the field and community needed the extra supports and services that she could potentially provide. Through her education, she has been given the opportunity to improve her clinical framework by utilizing Cognitive Behavioral Therapy, play therapy, Trauma Focused-CBT, Mindfulness, and Dialectical Behavioral Therapy. Through these techniques and her current position as a School Based Therapist with Cummins Behavioral Health Systems, she can offer a wide range of services and supports to children and families in the community by providing skills training, individual therapy, and family therapy.

Kendra Solana, LSW (Putnam County)

Kendra is from a small rural town that suffers from mental health stigma, and it has been her goal to continue challenging that mental health stigma on the micro, mezzo, and macro levels. She graduated from Indiana State University with her Bachelor's in Social Work in 2020, and with her Master's in Social Work in 2021. She has interned with community mental health centers for the last 2.5 years, two being with Cummins, with a focus on working with the addiction population, i.e. IOT, life skills training, and case management. She was then offered a permanent position with Cummins prior to graduating with her masters. She was privileged enough to continue her professional development with those who supported her academic success, as well as found the inspiration through the Cummins team to take on the position she now fulfills. The position includes completion of intake assessments, collaboration with juvenile probation/DCS and their youth/families, focus on the high-risk youth population, and she facilitates the adolescent relapse prevention group. Thank you to our youth, families, affiliates, and team for allowing me to be a part of their processes! Recovery is possible.

Allen Graham, MMFT (Marion County)

Allen is enthusiastic about helping others to heal and to grow. He started working in mental health in 2014 as a life skills specialist at an inpatient setting. He worked primarily with adolescents and children, helping them to build Dialectical Behavior therapy skills. Since completing his Master’s in Marriage, Couples, and Family Therapy, he has worked with a diverse population with a variety of challenges. This has allowed him to further develop his clinical framework, building his understanding in Dialectical Behavior Therapy, Cognitive Behavioral Therapy (CBT), Trauma Focused CBT, Feedback-Informed Treatment, Structural Family Therapy, and Internal Family Systems.

Laura Braun, LMHCA (Marion County)

Laura has enjoyed being a mental health therapist since 2018. Professionally, she has served this field as a community-based therapist and an individual therapist for children, adolescents, and adults. She has been given the opportunity to strengthen her clinical framework by providing Cognitive Behavior Therapy, Play Therapy techniques, Trauma Focused-CBT, Certified Individual Trauma Informed Therapy, and best practice treatment for adolescents that have engaged in sexually harmful and/or reactive behaviors. She has utilized her framework to provide services and support to children and their families including but not limited to individual therapy and family therapy.

Our services for youth who engage in harmful sexual behaviors are available now! If you believe your child or teen might need treatment and you would like to speak with someone, please call us at (888) 714-1927. With the proper help and support, your child and your family can recover from these challenges!

All About OCD: What It Is, Who It Affects, and How It Can Be Treated

Have you ever felt that something in your environment was not quite right?

Maybe you’ve been lying in bed at night and started to wonder if you locked the front door after coming home or turned off the oven after cooking dinner. Perhaps you’ve felt a bit dirty after engaging in a physical activity and decided to wash your hands or take a shower. Or maybe you’ve noticed that your home has become disordered and spent a few hours tidying up.

If you’ve ever experienced a situation like one of these, then you know that they generally produce a mild amount of anxiety. This anxiety usually isn’t too troubling. It draws our attention to some situation that might be unsafe for us, and it motivates us to fix the unsafe situation. Then, having served its purpose, the anxiety subsides.

However, sometimes a person can have a very strong, exaggerated anxiety response to everyday situations like the ones we’ve described. This is precisely what people who have obsessive-compulsive disorder, also known as OCD, experience on a daily basis.

OCD is an anxiety disorder characterized by intrusive thoughts that cause anxiety and repetitive behaviors that a person performs to reduce this anxiety. It’s estimated that 1 in 100 adults and 1 in 200 children live with OCD in the United States. However, the ongoing COVID-19 pandemic has worsened the symptoms of many people living with OCD, which makes this disorder especially important to discuss right now.

In this blog post, we’ll explain the basics of obsessive-compulsive disorder, including how it works, who is susceptible to it, and how it can be treated. We’ll also include some thoughts and insights about OCD from our Chief Clinical Officer, Robb Enlow. We hope this information will help you know what you can do if you or someone you know is suffering from obsessive-compulsive disorder.

What Is OCD?

As we explained above, OCD is a disorder characterized by intrusive anxiety and behaviors that help to manage that anxiety. However, we can deepen our understanding of OCD by breaking down its name.

Robb explains, “Obsessive-compulsive disorder is a condition that involves a pattern of unwanted, unhelpful thinking that is driven by anxiety, called an obsession. For many, that obsession also involves a burdensome behavior that attempts to reduce the anxiety in repeated and time-consuming ways, called a compulsion.”

Most people have troubling thoughts and feelings of anxiety from time to time. However, people who have OCD tend to feel anxious much more frequently and for reasons that seem unnecessary or excessive to others. Both obsessions and obsessive-compulsive patterns become very difficult to stop and interfere with the person’s ability to function and feel internally safe,” Robb adds.

Many people who have OCD first experience symptoms in childhood, with most being diagnosed by age 19. The disorder tends to be equally prevalent among women and men and across different races and ethnicities. Although the causes of OCD are still unknown, it does appear to have a genetic component, as individuals with a parent or sibling who has OCD are more likely of developing OCD themselves.

What Does OCD Look Like?

OCD can be easier to understand if we also look at some of the ways it commonly presents itself. Specific obsessions and compulsions vary from person to person, but they do tend to fall into some commonly identifiable categories.

For example, some common obsessions among people with OCD include:

  • Fear of germs, dirt, illness, or contamination
  • A desire for items to be arranged in a specific way, such as symmetrically or at right angles
  • A desire for actions to be performed in a certain predetermined order
  • Fear of lacking a certain item when it is needed
  • Aggressive thoughts or urges to harm oneself or others
  • Unwanted and unpleasant sexual thoughts and urges

Some common compulsive behaviors in response to these obsessions include:

  • Excessive cleaning, bathing, or handwashing
  • Arranging and ordering items in a very precise way
  • Repeatedly “checking” things, such as checking to see that the door is locked or the oven is turned off
  • Counting and re-counting objects or actions
  • Hoarding items
  • “Mental checking” for intrusive, unwanted thoughts

As we mentioned above, the COVID-19 pandemic has only worsened obsessions and compulsions for some people with OCD, especially those whose anxiety revolves around sickness and contamination. Robb explains,

“At its core, OCD is about anxiety and one’s sense of safety, wellbeing, and balance, as problematic thought and behavior patterns organize safety for the individual in a world that is perceived as having dangers. COVID presents the world with legitimate dangers that make it imperative for us all to stay safe and healthy. For example, an individual with OCD who is concerned about germs and contamination repeatedly washes their hands; to them, COVID now gives something ‘legitimate’ to obsess about, and they increase handwashing behavior to attempt to relieve the distress. We all have been told to hand wash more frequently, but the individual with OCD perceives the impact with amplified distress, as there is no doubt to the dangers of COVID contamination. And for many, increased safety behaviors and rituals actually maintain that distressing anxiety instead of quenching it.”

How Can OCD Be Treated?

Obsessive-compulsive disorder can greatly impact an individual’s quality of life, and there is currently no cure for the condition. However, there are several forms of treatment that can help a person manage their troubling thoughts and behaviors.

“OCD can be treated with behavioral, cognitive, and sometimes medication-based treatments,” Robb explains. “Successful treatments allow individuals the ability to examine their thoughts and behaviors in a safe environment.”

For example, cognitive behavior therapy (or CBT) is one of the most common forms of treatment for OCD. This type of therapy helps a person learn to recognize their obsessive thoughts and resolve their anxiety without engaging in a compulsive behavior. A specialized type of CBT called Exposure and Response Prevention may also be used, which involves controlled exposure to situations that trigger compulsions in order to help a person become desensitized to these triggers.

“Learning cognitive-behavioral strategies, such as thought-stopping techniques and grounding techniques, helps many people gain control of patterns that seem to run against their will,” Robb adds. “Other treatments, such as Internal Family Systems, involve exploring how the mind and body seek safety by developing patterns of functioning intended to safeguard their self from underlying exiled feelings.”

If cognitive and behavioral therapies are not effective at reducing symptoms, a person might also be prescribed medication. Certain medications known as serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) can help reduce the intensity of obsessive thoughts and compulsive urges. In very specific cases, antipsychotic medications have also been shown to help certain people.

Finally, in cases where traditional therapies and medications do not achieve the desired results, several “add-on” treatments may be considered. One of these is transcranial magnetic stimulation (or TMS), which uses magnetic fields to stimulate specific nerve cells in the brain.

Although it is less common than other mental health disorders like depression and generalized anxiety, obsessive-compulsive disorder still affects the lives of 3–4 million people in the United States alone. Although this disorder is long-lasting and can greatly impact a person’s quality of life, it is also treatable through therapy and medication. With the appropriate treatment, and individual with OCD can learn to live a full and rewarding life despite their challenges with obsessive thoughts and compulsive behaviors.

If you would like to speak to a mental health professional about receiving treatment for OCD, we invite you to call us at (888) 714-1927. With the right help, you or your loved one can recover from OCD and take back control of your life.

HOPE for Youth Who Engage in Harmful Sexual Behavior: Understanding the Problem

Children tend to hold a special place in our hearts and minds.

In an objective sense, children are simply young human beings, but they are also so much more than that. Often, children represent the best parts of humanity. They are curious and creative. They are honest and welcoming toward others. And in the eyes of many, they seem innocent and pure. They remind us how good people can be before they are corrupted by harmful emotions, desires, and outside influences.

It is perhaps for these reasons that sexuality and sexual development are carefully scrutinized among children and teens. Society tends to have strong opinions regarding which expressions of sexuality are acceptable at which ages, and youth who engage in sexual behavior “too soon” are often heavily stigmatized.

These social pressures can be useful for guiding youth through their developing sexuality, which comes with risks they may be too young to understand. However, severe stigma can be detrimental if it prevents youth from receiving help for sexual development issues.

In particular, some children and teens suffer from a tendency to engage in harmful sexual behaviors. These behaviors may be subconsciously learned from a variety of sources, and they can be highly damaging to the youth, their peers, and their loved ones. However, these behaviors can be corrected, and youth can learn to express their sexuality in healthy, age-appropriate ways if they receive help from behavioral health care professionals.

Cummins Behavioral Health will soon begin offering a program designed specifically for youth who engage in harmful sexual behavior. The program, called “Healing for Optimal living through Protective factors and Education” (or HOPE), will help youth understand what constitutes healthy sexual behavior and change their actions accordingly. This sort of intervention can drastically change the course of an individual’s life, leading them away from destructive behaviors and toward healthier, safer ways of living.

Ashlee Prewitt, our Director of Specialty Programs, is the driving force behind our new HOPE program. In this blog post, she explains more about harmful sexual behaviors among youth, including what drives them, how they get started, and why stigma is dangerous to a youth’s treatment and recovery.

Ashlee Prewitt
Ashlee Prewitt, LMHC, CSAYC, Director of Specialty Programs at Cummins Behavioral Health

Defining Harmful Sexual Behavior and “Reactive” Sexual Behavior

The first step in understanding and correcting harmful sexual behavior is knowing what this behavior looks like.

First, we should clarify what makes this behavior harmful. In the simplest sense, harmful behavior is behavior that has negative ramifications for the person performing the behavior, another person or persons who become involved in the behavior, or both. The negative ramifications could include physical harm, emotional or psychological harm, or even legal consequences. Even if the negative effects are relatively mild, a behavior can still be harmful if it impedes a person’s daily functioning in some way.

“These behaviors are sexual in nature, and what it comes down to is: there is an inadequate adjustment or inappropriate response to the environment or stimuli that manifests sexually,” Ashlee explains. “This could be sending naked pictures of themselves to peers. This could be excessive pornography viewing. And it can go all the way up to hands-on offenses like sexual molestation and assault.”

It’s important to note that some of these harmful behaviors may be what are called “reactive behaviors.” This means that the behavior occurs in response to an event or stimulus without much conscious thought. For example, think about the decision you make to take a drink of water when you feel thirsty, or your decision to say “excuse me” after sneezing.

Reactive behaviors are behaviors that are learned, one way or another, as the normal response to certain environmental triggers. Many harmful sexual behaviors can be reactive in nature, meaning that the youth may not even realize they’re doing something wrong. Ashlee explains,

“If something is an immediate trigger, it is going to change a person’s thought patterns. Both intrigue and emotionality are going to be escalated, and so now, because of that escalation, something is going to happen. It’s kind of a cause and effect situation. In this case, triggers could be being sexually aroused, either because of puberty or through an external stimuli, such as seeing other people engaged in public displays of affection. That can absolutely trigger an increased sexual urge, which makes the youth want to do something to satisfy that sexual urge. That may be sending nude pictures. That may be excessive porn watching. That may be touching a peer or a younger sibling in a sexual way.”

How Harmful Sexual Behaviors Get Started

As we’ve said, most youth who engage in these harmful behaviors don’t realize they are harmful at all. On the contrary, their experience has led them to believe that these behaviors are normal. How is it that this happens?

In some cases, a history of trauma or abuse may be to blame. “Sexual abuse, neglect, and physical abuse are risk factors to starting the pathway to engage in some of these behaviors,” Ashlee says. “Youth may see these maladaptive patterns within their abuser, and if they’re not taught how to handle emotions, or sexual urges, or the trauma that they’ve experienced, they may be one decision away from engaging in these unhealthy behaviors.”

If a child has been the victim of sexual abuse in particular, they might develop a skewed perception of love, intimacy and sexuality. “That is the groundwork, that is the example, whether it’s, ‘I have been sexually abused, and now, in my brain, this is how I show love,’ or, ‘In my brain, this is how I have power and control,’ “ Ashlee explains.

However, past trauma is not the only factor that can lead youth to engage in harmful sexual behavior. For example, Ashlee notes that there can also be a variety of societal influences. “I would love to say that society doesn’t play a part in it, but it does,” she says. “Sex and sexual behaviors are often reinforced, so youth get the idea that this is normal, everybody else is doing it. So until there is that moment of, ‘Oh, no, I can’t actually do this, this is not OK,’ there are times where they operate under that impression.”

Ashlee also points out that these behaviors, although inappropriate and ultimately harmful, are usually undertaken in an attempt to fulfill the youth’s basic needs. Although we condemn the behavior, we must also recognize that the youth is simply misguided, not malicious. Ashlee explains,

“We do a lot of education around the five basic needs and how behavior is a response to try to meet the five basic needs that every human has. The five basic needs come from a psychiatrist named William Glasser, and they are love and belonging, power and control, fun, freedom, and survival. And the idea is that all behavior comes from a desire to meet those needs. So with these individuals, they’re seeking to meet those needs through that sexual component. Let’s take love and belonging for example. They want to feel that connection to other people, so they engage in behaviors that society, or porn viewing, or whatever it may be has shown them, ‘This is how we connect with people.’ So they seek it out in a way that is not beneficial or healthy.”

How Stigma Prevents Youth from Getting Help

Earlier, we mentioned that stigma can be a problem for youth who engage in harmful sexual behaviors.

On the one hand, this stigma is somewhat understandable. After all, behavior that is harmful toward other people is never acceptable, and it’s difficult to reconcile the innocence of youth with harmful sexual behavior. “People don’t want to go there, because I’m looking at a child, and how can I handle this child hurting another child and still see them the same way?” Ashlee says.

Parents or guardians of youth may also seek to minimize these behaviors so as not to feel guilty or at fault for bad parenting. “There’s the stigma of, ‘My kid engaged in sexually harmful reactive behaviors. I’m a horrible parent. Let me just ignore it so that I don’t have to deal with it.’ Or, you know, the ‘boys will be boys’ mentality, or, ‘Oh, they’re just kids, they don’t know what they’re doing,’ “ Ashlee explains.

However, seeking to ignore these problem behaviors always causes more harm than good, because youth are unlikely to change their behavior by themselves. Therefore, they will likely continue to cause harm to themselves and others for far longer than is necessary. “When we minimize it, we hurt the population, and we hurt the people who need help,” Ashlee says.

The good news is that these behaviors can be corrected with treatment from mental health professionals. “When treatment is followed, these kids have about a 4% recidivism rate, meaning they don’t re-engage in these behaviors after they go through treatment,” Ashlee says.

It can be difficult to admit when a child or teen under our care has a behavioral problem, especially when it’s in an area as stigmatized as harmful sexual behavior. However, ignoring the issue only causes more harm. Youth deserve help overcoming these behavioral challenges, and with the proper treatment, they can learn to express their sexuality in ways that are healthy for both themselves and their peers.

In part two of our blog series on our new “HOPE” program, we dive deeper into the treatment itself, explaining what it entails and how it works. Click here to read more!

Shame-Informed Therapy: Debunking the Lies That Shame Tells Us

“If you put shame in a petri dish, it needs three ingredients to grow exponentially: secrecy, silence, and judgment. If you put the same amount of shame in the petri dish and douse it with empathy, it can’t survive.” — Brené Brown

At some point in our lives, most of us have had an experience where we felt we were not good enough in some way. As a result, just about all of us know what it’s like to feel shame.

Shame is a complicated emotion. We are first able to experience shame around the age of three, and it can feel somewhat different from person to person. However, shame is always about hiding some part of ourselves from other people. When we feel ashamed about something, we are desperate to keep it hidden from others, because we fear that they will judge us negatively for it. In fact, the word “shame” is believed to come from an old Indo-European word meaning “to cover.”

Not only is shame upsetting to experience, but deep-seated shame can create a variety of challenges in a person’s life. Shame can make relationships with other people difficult, and it can also complicate mental health conditions like depression, anxiety and PTSD. Shame is also deceptive by nature: shame tells us lies about ourselves, and if we believe these lies, they can cloud our judgment, interactions with others, and belief in ourselves.

Shame-informed therapy is a model of care that we are currently integrating into our services here at Cummins. This model is informed by modern neuroscience, which shows how activity in our brains and nervous systems can directly affect our thoughts and emotions. Most importantly, shame-informed therapy offers a pathway for overcoming shame and accepting ourselves for who we are.

Robb Enlow, our Chief Clinical Officer, is currently leading trainings to teach shame-informed therapy to our service providers. In this blog post, he explains how this approach to treatment can provide hope for those who struggle with shame and other related challenges.

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

Explaining Polyvagal Theory, the Foundation of Shame-Informed Therapy

Before we can talk specifically about shame and shame-informed therapy, we need to explain a concept known as polyvagal theory.

You’ve probably heard of a phenomenon called the “fight or flight” response. When a human being encounters a threatening person, creature or object, it’s crucial that they determine how to stay safe from this aggressor. In some situations, fighting the aggressor may seem like the best option for maintaining safety, while in others cases, fleeing from the aggressor might seem more practical. This decision often happens quickly, without much conscious thought, and is controlled by the sympathetic nervous system.

However, there is a third response to danger that a person might also choose, which is to stay very still, or “freeze.” Freezing behavior is sometimes an attempt to avoid being seen by an aggressor, which could be the best option if fighting or fleeing doesn’t seem possible, or it may result from an extreme stress response that temporarily “overloads” the nervous system. Freezing behavior can often be observed in children (as well as in animals), and according to polyvagal theory, this reaction is controlled by the dorsal vagus nerve and related dorsal vagal complex.

Fight, flight and freeze are all responses to danger that can increase our chances of survival. However, these responses also limit our ability to perform higher-level thinking and reasoning. When we are fighting, fleeing or freezing in response to a threat, we aren’t wondering if we can appease the threat or considering whether or not it truly is a threat to us. We are simply thinking about survival. In essence, we are physiologically “locked out” of higher-level cognitive processes.

According to polyvagal theory, these higher-level processes are only possible when the ventral vagus nerve and ventral vagal complex are activated. Importantly, this nerve is also associated with social engagement and emotions like joy, compassion, curiosity and mindfulness.

Shame in the Context of Polyvagal Theory

What does polyvagal theory have to do with shame? As it turns out, polyvagal theory does a good job of explaining what happens when someone experiences shame.

“From a neurological standpoint, shame functions like trauma in a lot of ways,” Robb explains. “Trauma and extreme periods of shame, particularly between the ages of three and eight, kind of captivate or capture people into this frozen state.”

As we mentioned above, freezing behavior is common among children who are experiencing emotional distress. Due to their youth and limited life experience, young children are easily overwhelmed by negative feelings and emotions. As Robb explains, frequent activation of the dorsal vagal complex—which triggers the freezing behavior—can lead to trauma and shame that gets carries into adulthood:

“Research shows that between the ages of three and eight, the nervous system is developing at a very quick rate within the child. The nervous system is beginning to make connections in the brain about, ‘This is how I feel when this thing happens.’ It could be as simple as, I look at something disgusting, and I think, ‘Ew, that’s gross!’ while I feel unwell in my body. That feeling relays through my nervous system back to the brain, which I then make meaning of when I say, ‘Oh, that’s gross. Don’t touch that.’ That process continues as people begin to make meaning of the world.

Now, I’m going to make up a story. A three-year-old girl starts to play with older brother’s boys’ toys. Mom says to the three-year-old girl, ‘Little girls don’t play with that. That’s not yours. You play with dolls.’ Or maybe the three-year-old girl says, ‘I don’t want to wear a dress, I want to wear pants.’ And mom says, ‘No, bad! Girls wear dresses, not pants.’ These are just single instances, but think of all the times when people get told ‘no, bad.’ What happens is, when they’re told that, they go into that frozen state. They go into that place where there’s that painful feeling, and it forces people to do one of two things. They either become engulfed by it, or they hide from it, they avoid it.”

The Self-Lies of Shame

When young children are subjected to this kind of criticism, they can easily internalize it. Over time, they might come to believe that they are “bad” or “not good enough.” In many cases, these negative self-beliefs are carried into adulthood, resulting in shame.

Because shame is such an unpleasant emotion, most people develop strategies for avoiding it. Robb explains, “This is how we develop what’s called the ‘masks of shame.’ These essentially become parts of ourselves that get easily triggered by other things that remind us of that past pain. Deep down, we know we don’t want to feel that pain, so we exile that part of ourselves. We try not to go into that frozen state, and instead, we develop cover-ups.”

These masks and cover-ups are related to a fourth kind of response to danger known as “fawning,” or hiding our true self in order to feel safe. Some common masks of shame include self-beliefs like “I’m a bad person,” “I’m not good enough,” “I’m a failure,” “I’m a fraud,” and “I’m unlovable.” These masks may be covered up by behavior like shyness, secret-keeping, lying, co-dependence on others, substance use and addiction, and controlling behavior. But over time, these covering behaviors can actually reinforce the negative self-beliefs they were meant to hide.

All of these masks and corresponding behaviors can be highly destructive to the self and others. However, shame is almost always based on false beliefs. Put more accurately, shame results from false self-beliefs and misunderstandings about the origins of our behavior—behavior that was intended to help us feel safe and avoid our shame.

Robb explains in greater detail:

“I always like to tell people that shame is a lie, because it’s a cover. It’s always about not feeling what, for whatever reason, the body is trying to feel. And so shame will always have the ability to lie to people. It’ll always have the ability to tell people they’re not good enough, and they will even argue it as though it were the truth. It’s not until they recognize the origin of that shame, and how that origin played into their ability to maintain safety, that they realize, ‘OK, that had a reason. That had a purpose. And I can maintain my purpose and my safety without maintaining that behavior, that pattern.”

How Shame-Informed Therapy Helps Us Reprocess Shame

If we understand the root of shame, then we can understand how to eliminate shame. This is precisely what shame-informed therapy is designed to do.

“If I had to summarize it, you help people connect six things,” Robb says: “Feelings, body sensations, early memories of those feelings and body sensations, what core beliefs have developed in response to those memories, how are you really authentic today, and how can you create a new story to align all those pieces? That’s the process. You help people connect the dots with those things by gently talking about it in a safe environment.”

As we’ve discussed, revisiting or re-living feelings of shame is often an upsetting experience. This can emotionally and physiologically “trigger” someone, sending them into a defensive posture of freezing, fighting, or fleeing. In shame-informed therapy, every effort is taken to keep the ventral vagal complex activated so the individual can cognitively reprocess their shame. Robb 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.

According to Robb, the ultimate goal of shame-informed therapy is to help people re-frame the beliefs and behaviors they feel shameful about. This process can help someone see that the behaviors they are ashamed of were always intended to help them feel safe:

“The good part about treatment is you can actually rewrite the way that the brain interprets information. The person who’s always believed, ‘I’m a bad person, I can do nothing right,’ maybe now has a new belief that, ‘OK, maybe I was never bad, maybe that’s what I had to do to get through the horrible trauma that I endured.’ In shame-informed therapy, this is what we call respecting and honoring the survival nature of what people have had to do to feel safe. That’s the key element there. If someone says, ‘Oh, I did that because that must be something I did that’s wrong,’ I’ll challenge that with, ‘No, you did that because that, at the time, is what you had to do to feel safe. And if you didn’t do that, I don’t know if you would be here today.’ And that’s hard for people to come to terms with, that, ‘OK, this very thing that causes me agony is also what’s helped me to establish who I am and feel safe.’ “

Shame is among the most difficult emotions that we can experience in our lives. Shame makes us believe that we are inferior or flawed, and to avoid feeling this way, we may develop behavioral patterns that harm ourselves or others. If we hope to overcome shame, it’s essential that we examine its origin, understand how it has influenced our behavior, and recognize the lies it has made us believe about ourselves.

If you are struggling with shame and would like to talk to a professional therapist or counselor, we have care providers who can help you. We invite you to give us a call at (888) 714-1927 if you would like to learn more or discuss treatment options. You are capable of living a life free from shame!

National Recovery Month 2021: Supporting Recovery from Substance Use Disorder in our Community

Substance use disorder continues to be a massive problem in our society. According to statistics from the National Survey of Drug Use and Health, approximately 20.4 million people lived with a substance use disorder in 2019. In addition, it’s estimated that around 25 million people are in stable recovery from substance use disorder, meaning they have been successful in sobriety for one year or longer.

Even though we know more about the science of addiction than ever before, there is still a significant amount of stigma surrounding this subject. Individuals who struggle with substance use may be considered undesirable by some segments of society, and this prejudice may persist even after someone has been successful in their recovery for many years. For this reason, some people like to keep their recovery private, only discussing it in certain circles—which was one major appeal of Alcoholics Anonymous when that program first started.

However, times have changed since then, and a growing number of recovering individuals no longer want to be anonymous. Instead of feeling ashamed of their past substance use, they prefer to feel proud of their new lives in recovery, and they want to share their stories with others. This is the purpose of National Recovery Month, which this year focuses on the theme, “Recovery is for everyone: every person, every family, every community.”

Indeed, we can all play a part in supporting recovery in our communities, and there are many ways to help or receive help. We spoke with Erin Flick, our Substance Use Disorder Team Lead for Putnam County, to learn more.

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

Why National Recovery Month Matters

First observed in 1990, National Recovery Month is an annual celebration of the gains made by individuals in recovery, as well as of the treatments, recovery practices and community supports that have helped them along the way. “It’s an opportunity to bring awareness to recovery, as well as an opportunity for community stakeholders to come together and celebrate one another, and celebrate sobriety,” Erin says.

In recent years, there has been a growing movement in the recovery community to reject the stigma of substance use disorder and instead focus on the accomplishments of those in recovery. Erin explains, “Sometimes we’re tucked away in meeting rooms or in church basements, not always living out loud. We experience stigma every day in regards to substance use disorder. But about a decade ago, there was a surge in the recovering community, and we no longer want to be anonymous.”

Over time, public opinions about substance use disorder have started to change. Although stigma still remains, many people now know that addiction is a disease rather than a discipline issue, and our language for talking about addiction has become less discriminatory. Every year, the focus of National Recovery Month is on continuing these advances, as well as on supporting everyone whose life has been impacted by substance use disorder. As Erin says,

“It’s always nice to come together and celebrate, because with the disease of addiction, there’s so much trauma, tragedy, and premature death. But the great thing about the culture of recovery is that it’s more about the celebration of life and healing. And the most important piece is welcoming newcomers, showing them that they’re not alone, and showing them that if we can do it, they can do it.”

How You Can Support Others on Their Journey of Recovery

Although the stigma surrounding substance use disorder is lessening, and more individuals want to be “in the open” about their recovery, the fact remains that those in recovery need support from friends, family members, and their communities. Addiction is a chronic disease, and recovery from addiction is a lifelong process. Care and support from other people can often make the difference between continued sobriety and painful setbacks.

For both recovering individuals and those who know someone in recovery, Erin emphasizes the importance of open and honest communication. “For family or friends, my overall advice is just to talk out loud, to whomever, and eventually you’re going to get linked to something that might be beneficial for supporting that individual,” she says. “And for someone who is in recovery, the same thing: tell your story out loud, because you may say something that impacts someone who is struggling or a family member who doesn’t know what to do.”

However, if you do not personally have experience with substance use disorder, the first step is to seek to understand those who do. Erin explains, “As human beings, it can be easy to judge and take other people’s inventory. A lot of times, drugs and alcohol are a symptom of deeper issues—usually of trauma. If we listen to understand, then we can gain insight into an individual and their circumstances and have empathy, and by doing that, we can build knowledge about the disease of addiction.”

Finally, Erin stresses the importance of connecting with recovery-oriented organizations and participating in the recovery community:

“Do your research, get connected to community resources, and see what you can do, because we can’t do it alone. It takes a village. And a recovering community is a lot healthier than a community that says, ‘Not in my backyard.’ We can help individuals who are struggling become active participants of the community, whether it be through offering jobs, treatment, or an in-kind donation to a community resource. By the time someone gets to a point where they’re ready to make a change in their life, they might have nothing. So it’s about reaching out to the community to see how you can help. I just did this with a community member this week. In order to get them into sober living, where they really needed to be, it was going to cost $130 for their first week. I reached out to a church, and because they are recovery-informed, they committed to sponsoring the first week so this individual could get into sober living and be safe.”

Helpful Resources for Recovery

Fortunately, getting involved in your local recovery community isn’t difficult. There are many existing support groups for both individuals in recovery and those who know someone in recovery. Below, we’ve made a list of some of our favorite support organizations, as well as websites you can visit for useful facts and statistics about substance use and addiction.

Recovery & Support Groups
Learning Tools

Cummins Behavioral Health is proud to be an advocate for every person whose life is affected by substance use disorder, including all those who are successfully living their lives in recovery. This National Recovery Month, we encourage you to get involved in your local recovery community, seek support for your recovery if you need it, and “live out loud” regarding your personal experience with addiction and recovery!

If you know someone who could benefit from the information and resources in this article, please share it with them! Your care and support can make a lasting impact on someone else’s life.

Cummins Values: How Our Providers Inspire the Hope of Recovery

Take a moment to think about the importance that hope plays in your day-to-day life.

When you find that your current life circumstances don’t live up to your expectations, does hope for a better future help to improve your outlook? When you are faced with adversity, does hope help you push through the obstacles in front of you?

Or even worse, have you ever felt hopeless about some situation? If you have, then you surely know how demoralizing it can be. When we feel hopeless, we have no motivation to strive for something better, and we may also be vulnerable to experiencing mental health problems like distress, depression and anxiety.

Just as hope is important in life, it is also essential in recovery from a mental health challenge. Recovery from mental illness and addiction is not only possible—it is a journey of healing and transformation that enables individuals to live meaningful lives and to achieve their full potential. At Cummins, we believe in everyone’s potential for growth, change, and recovery, and we recognize that one of our primary roles is to help instill the hope of recovery in the people we serve.

In fact, hope of recovery is one of the core values that guides our organization and the work we do each day. To better understand how we inspire hope for our consumers, we spoke with four members of our staff who embody this value: Molly Pennell, Wraparound Facilitator and Master-level intern; Jenna Batta, Wraparound Facilitator; Christine Watson, Intake Specialist; and MeLinda Frazee, Licensed Mental Health Counselor.

In this post, they explain what hope of recovery means, why it matters, and how they strive to inspire hope for the individuals they serve.

What Does Hope of Recovery Mean?

Molly Pennell (left); Christine Watson, LCSW (middle); and MeLinda Frazee, LMHC (right). Not pictured: Jenna Batta, BS.

When discussing the hope of recovery, it’s important to first explain what this concept means. We all know what it’s like to feel hopeful about something, but what exactly does it mean to have hope of recovery?

In its simplest sense, hope of recovery is the belief that we can get better from whatever challenges we face and live happy, healthy lives. However, our providers offered some additional definitions that expand and enrich this meaning.

For example, Jenna believes that hope is about focusing on progress toward our goal rather than any setbacks that arise. “Hope of recovery means keeping your eye on the big picture so that you can remind families when the difficult days are becoming less and less and that their overall mental health is getting closer to their goals,” she says.

Molly points out that hope of recovery is also about how care providers interact with the individuals they serve. “For me, hope of recovery means showing encouragement, a positive attitude, and kindness to every person who enters our doors regardless of their situation or their current stage of change,” she says.

Christine agrees, noting her important role as one of the first individuals a consumer will interact with when entering services: “For me, the hope of recovery means that when people get started in services, they know that they will have someone who is going to be there with them as they walk through their journey—someone who will encourage and support them.”

Finally, MeLinda likes to focus on the transformative effects that hope can have for someone in recovery. She explains, “For me, hope is about supporting a client’s desire to live an authentic life.”

Why Hope Matters for the Recovery Process

Above, we illustrated the difference that hope can make when we are faced with a difficult or discouraging situation. The truth is that entering mental health services can be quite difficult for many people. Suddenly, we have a problem we need to address and much work to do before we might feel well again. So how exactly can hope helps us throughout our recovery process?

For starters, hope is one of those forces that helps us keep going when the going gets tough. Jenna explains, “Hope is like an urge or an internal motivator. If we are having a hard day, we need something within us to remind us to move forward every moment, and recover from the bad days, whether that means owning up to our mistakes or simply trying again.”

As we mentioned, the recovery process can often be a difficult one, so hope is necessary to help us keep pushing forward. “I believe that hope is important in the recovery process because going through it can be scary, unfamiliar and uncomfortable,” Christine says. “It takes a lot for people to come in and start in services. It is important to instill hope in them throughout.”

Importantly, Molly points out that hope works because it focuses our attention away from negative present circumstances and toward positive circumstances we hope to achieve in the future. “Hope is essential to the recovery process because people need to know that things can get better, people can make positive change, circumstances do change, and there is hope for a more positive future. Hope can set a person up for success,” she says.

And again, MeLinda connects hope to authenticity, suggesting that hope helps us achieve the life we truly want for ourselves. “Much of the time, individuals start to work with me and don’t believe that the life they desire is possible,” she says. “I help them see that there is hope that they can have a successful job, positive relationships, increased self-worth, maintain their sobriety, etc. So many times people have been told they are not worthy, and I, like many other treatment providers, am here to tell them that they are worthy.”

How Our Providers Inspire Hope

Given the importance of hope during recovery, part of our job as care providers is to inspire this hope when our consumers may be struggling to find it on their own. The process of inspiring hope may look different from provider to provider and consumer to consumer, but generally speaking, it involves a combination of validation and encouragement.

“My work helps consumers believe they can get better because throughout the intake process, I validate the person and their experiences while also providing encouragement to them that things can get better and that they deserve good things in life,” Christine explains. She also offers an example of one time she did this for a consumer:

“One time when I helped a consumer find hope of recovery was when I was doing an intake with someone who was struggling with depression, anxiety, severe trauma, and substance use. She cried so much, as telling her story was very hard. She told me that she had put off the intake for a while. I was able to remind her of her incredible strengths as well as how excited I was for her to be getting into services. She told me how much she appreciated being heard and was now eager to start in services.”

Molly also focuses on praising consumers for their personal strengths. “I help them see the strengths they already possess to help them continue to fight for recovery,” she says. “I like to highlight that they are the experts in their own life and they have the ability to fight for an improved quality of life.” Molly also shares a story about how she has accomplished this:

“Before becoming a wraparound facilitator and intern, I worked as a DCS life skills specialist and provided skills training and supervised visitation for families. I always tried to help my families feel empowered and capable of making the positive changes needed to reunite with their children. I always felt like they needed someone to believe in them as a person and a parent to help them overcome their obstacles in life.”

When providers are able to help their consumers find hope, the results can be remarkable, as MeLinda shares through another story: “I remember a client who came to work with me and was so used to others not believing in them that they attended our first few sessions without speaking more than a few words, their head dropped, and very little eye contact. Their world had become so small and their hope had become invisible,” she says. “During our time together, this person was able to have stronger relationships with their children, increased desire to pursue their passions, and would come to my office open and excited to set goals. Hope is hard to define, but you know it when you see it and when you feel it.”

Jenna shares the following perspective in summary: “Every day and every conversation I’m having with the consumers and families I work with is planting seeds, and watering and caring for those seeds after they’ve been planted. That’s all I think any of us in the helping field are doing. I’ve had lots of consumers find hope for recovery, but often when they are telling me about it, I can think of many other people that have been lifting that person up at the same time.”

Hope is a powerful force. It gives us motivation when we are feeling defeated. It presents us with an image of what our lives could look like in the future. And it pushes us to become our best and most authentic selves. Hope is absolutely essential for any person in recovery from a behavioral health challenge, which is why we strive to nurture it in every individual we work with.

Thank you to Jenna Batta, Molly Pennell, Christine Watson and MeLinda Frazee for sharing their beliefs and insights about the hope of recovery. It’s because of your passion and commitment that we can bring new hope to the people we serve!

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If you enjoyed this blog post about the hope of recovery at Cummins, then you might enjoy reading about our other organizational values below!

cummins-values-respect
Why Respect Is at the Core of Our Work
cummins-values-continuous-learning
How We Practice Continuous Learning Every Day

How Cummins Behavioral Health and Hendricks County Work Release Are Giving Incarcerated Individuals a Chance at Rehabilitation

Individuals who serve time in prison, jail, or another correctional facility sometimes have difficulty re-entering society after completing their sentence. In some cases, they may lack certain skills that are needed to live responsibly and lawfully in society. Other times, they might have difficulty finding gainful employment because of their past conviction or convictions. In situations like these, a person might be tempted to turn to further criminal behaviors, which could then lead to subsequent arrests and convictions—a phenomenon known as recidivism.

Certain programs and interventions are effective at reducing recidivism and assisting these individuals to make a smooth transition back into their communities. One such program is Hendricks County Work Release (or simply “Work Release”) in Danville. Work release is a County-owned facility working in conjunction with the Indiana Department of Correction that provides the opportunity to remain connected to the community through employment opportunities as well as educational and vocational programs. The individuals in Work Release have been convicted of felonies and/or misdemeanors and are serving a sentence as ordered by the courts. This and other similar programs can serve as a bridge to community reintegration for individuals who are nearing the end of their sentences.

However, programs like these don’t always address any behavioral health challenges their participants may be experiencing. According to a 2014 report by the National Research Council, 64% of jail inmates, 54% of state prisoners and 45% of federal prisoners report some type of mental illness. Issues related to substance use are especially common among those who are incarcerated, as the Federal Bureau of Prisons reports that 46% of all current federal inmates were convicted for drug offenses. If these issues are not addressed, then the individual may be at a greater risk of subsequent offenses and convictions upon release from incarceration.

In an effort to prevent this, Hendricks County Work Release partners with Cummins Behavioral Health to provide incarcerated individuals with high quality, person-centered mental health care. In some cases, services are delivered within the Work Release Facility, reducing the need for transportation to our outpatient offices. According to Taylor Lewis, a Case Manager at Hendricks County Work Release, “The partnership gets offenders access to care within 72 hours, especially when time is of the essence, and it reduces idle time by providing structured treatment and education.”

To learn more about this partnership, we spoke with David Bonney, our Addictions Team Lead overseeing Marion and Hendricks Counties, who has provided services many times for the Work Release consumers. In this blog post, David explains what the partnership entails, how it works, and why it matters for the individuals served.

David Bonney, MA, LCAC, MAC, CADAC IV, ICOGS
David Bonney, MA, LCAC, MAC, CADAC IV, Addictions Team Lead at Cummins Behavioral Health

Partnering for the Health of Offenders

The collaboration between Cummins and Hendricks County Work Release began when the two organizations saw an opportunity to better meet their mutual goals. “We discussed the opportunity to work with them and provide care for the Work Release consumers,” David explains. “In the correctional environment, the culture over time continues to change toward focusing on rehabilitation and providing treatment. I think it was part of that change in how we view people who are incarcerated and what their needs are, and recognition of mental health and substance use treatment.”

This partnership first began prior to the onset of the COVID-19 pandemic. At that time, Cummins was providing all services for Work Release at our outpatient office in Avon. “We actually went to Work Release to pick up the consumers and brought them back to the Cummins office for treatment,” David says.

This procedure, like many in the health care field, changed in the wake of the pandemic. “There was a hiatus on Intensive Outpatient Treatment for substance use (IOT) being offered at the Avon Office,” David says. Eventually, all IOT groups were switched to a virtual format, but this wasn’t possible with the Work Release consumers. “There were security concerns, so they were not able to participate in a virtual Group from the facility,” David continues.

It was finally decided that the IOT groups, which are the most commonly used service among the Work Release consumers, could be offered in person at the Work Release Facility, while individuals could still be transported to the Cummins office for individual services. David explains,

“We started on February 1st, and that was the only in-person IOT group that Cummins was offering. We followed all the standard safety guidelines—social distancing and masks. And in my view, it actually turned out really successful, and we were able to work through all those unique circumstances and accommodations. And that has continued. We’ve surpassed six months of doing that Group now.”

How Services Work for Work Release Consumers

Whenever an individual is transferred to the Work Release Facility, the staff conducts an assessment to determine their behavioral health needs. “We look at current charges, substance abuse history, assessment scores regarding substance abuse, length of sentence and emotional/mental ability. If they come from probation or home detention due to violating a drug screen, they are automatically assessed for a substance abuse program,” explains HCWR’s Taylor Lewis.

Based on the results of this assessment, the case manager will refer the individual for the appropriate services. “They’ll send an intake referral over, and then we’ll go through our standard intake process just like we would with any consumer,” David says. After completing intake, the consumer is then referred to the appropriate services and service providers.

As mentioned above, many Work Release consumers are referred for IOT for substance use disorder, and they are able to attend group sessions within the Work Release Facility. David explains what this service typically looks like for Work Release consumers:

“Right now we are doing IOT three times a week, three hours a day, Monday, Tuesday and Thursday. We’ll go to the Work Release Facility in Danville, and the consumers who are in the group will be released to come to that group. They’ll walk down the hall to a classroom that looks very much like what you would imagine a classroom to look like—tables, chairs, a whiteboard—and then we provide a regular Group session right there at the facility. Being in that space doesn’t feel much different than being at the Cummins office; the room has the feeling of a treatment center setting, which is great.”

If a Work Release consumer needs other services, such as individual therapy, life skills training, or medical services, they can receive these in person at the Cummins office. “They would come in to the outpatient office in Avon for the service they’re scheduled for, just like any other consumer would,” David says. “Work Release is also working with us to offer telehealth opportunities at the facility, but that is still on a case-by-case basis. Historically, that may not have been an option at all, so it’s an example of our growing partnership,” he adds.

Why It Matters for Consumers

How does the partnership between Cummins Behavioral Health and Hendricks County Work Release benefit the individuals who receive treatment? In David’s opinion, there are both immediate and long-term benefits.

First and most obvious is the fact that incarcerated individuals receive access to care for any mental health challenges they may face. As mentioned earlier, about half of all incarcerated people suffer from some type of mental illness, and receiving treatment is an essential step to improving their symptoms. In some cases, addressing any underlying mental illness may also address root causes for criminal behavior and recidivism.

Second, the partnership allows us to reduce the barriers to accessing treatment that these individuals typically face. “Many consumers do not have stable transportation or any transportation, and they ultimately would not be able to participate consistently at our office if we were doing it that way,” David explains.

Finally, the entire team strives to provide the highest possible quality of care for the consumers regardless of the fact that they are currently incarcerated. “It’s common for consumers to have had adverse experiences with treatment in the correctional setting,” David says. “We strive to provide the same quality of treatment as we do outside of the facility. We’re not providing a limited quality of treatment; we’re really trying to provide the best quality.”

For David, part of this high-quality treatment consists of addressing deeper behavioral problems in addition to the surface-level symptoms of illness:

“We try to look at the correlation between their underlying issues and the legal outcomes that they’re facing. We really work on understanding the subtle underlying reasons, such as, how did substance use contribute to your offenses that lead you to this facility? And what needs to be different for you to have different outcomes in your present and future legal issues?”

Ultimately, we hope that the services we provide for our Work Release consumers will help them address underlying mental health issues, complete their stay at Work Release satisfactorily, and stay out of the correctional system in the future. As David Bonney says, “Oftentimes we hear discontent about the facility or about the legal system itself. We try to affirm what we’re hearing from them and lead them to reframe their thoughts around the bigger picture—that the goal is not simply to be comfortable in Work Release, but to get out of Work Release and not come back. So they can be comfortable living their life the way they want to, not in a correctional facility.”

We’d like to recognize the hard work and dedication of everyone involved with the Work Release Partnership, including David Bonney, Michelle Freeman, our SUD treatment team, our Outpatient treatment team, our Medical team, and our Intake Specialists. We’d also like to thank Taylor Lewis and everyone at Hendricks County Work Release for giving us the chance to serve the individuals in their care. Together, we can continue to make a difference for every member of our community.