Mandated Reporter Training

After an incident at the hospital where two doctors were fired, as they each assumed the other had made a CPS report for a physical abuse situation, and the perpetrator eventually killed the child; mandated reporter training has become an important part of our business.  This training really makes you think as a mandated reporter.  Our training was presented by Jane Smithson J.D.

I really like her the definition of why you report.  It is not only for the safety of children, which is important enough; it can also be the catalyst for a family in trouble to get they help they need.
Much of the training revolved around when a child abuse report is needed in a sexual situation, which are sometimes mutual.  The light didn't turn on for me until I realized that statuary rape is not necessarily child abuse, although it could be reported to the police.  In this situation that would be a parent who would need to report.  A child abuse report is warranted based on the age difference of those involved.

Second Hand Smoke

Second Hand Smoke and Apartments, Condos and townhouses: What You Can Do About It, California Department of Health Services.
Second hand smoke can be deadly.  This pamphlet estimates 53,000 American deaths annually and 4,700 in California.  The chemicals from cigarettes can kill, and they can linger for a long time.  It is much worse if there is a smoker in the home, with the gases locked inside.  However in close living quarters the smoke can come from outside the home.  This pamphlet suggests talking to smokers, having  non smoking apartments, No Smoking in common areas such as laundries and recreation areas, and effecting repairs to keep smoke out.

Immunizations for Adults and Seniors.

Center for Disease Control, California suggests three immunizations for adults.  After age 50 it suggests an annual influenza shot.  Even if you have no previous issues with the flu, as our immune system grays we need additional protection.
Immunization for pneumonia is suggested after 65 years of age.  This is generally a once a life time immunization.  It is also recommended for those with chronic health conditions.
Lastly tetanus is important for those over 50.  This immunization should not be administered more than every ten years, unless you have sustained an injury.
It is important to keep a record of all you immunizations.  The timing for some is dependent on when you last received a shot.

Magazine Article: Self-regulation and Stress Coping at the Foundation of Resilient Recovery

Self-regulation and Stress Coping at the Foundation of Resilient Recovery by Stephen Sideroff, Phd, Counselor: the Magazine for Addiction and Behavioral Health Professionals, October 2016.
I found this article very fascinating.  It is presented in two parts really.  The first is how childhood effects someone's vulnerability to addiction and relapse.  "High levels of early childhood stress alter and impair neural mechanisms of self-regulation and functioning."  He is mostly talking about attachment issues, and how impairment in attachment "impairs endorphin brain circuitry" which in turn makes it more difficult to self-soothe.  It is also partially why stress can lead to relapse in adults.  Substances become a substitute for self soothing.
The second part of the article deals with the model for self regulation as a way to teach individuals how to self-regulate rather than turning to drugs.  This is a nine-step process.  It focuses on three areas, relationships, balance and mastery and engagement with the world.  This concepts are presented as things to learn:
1. Relationship with Self.  Being able to have positive and loving self-talk is essential.  Much of the author's work involves relearning this internal script.
2. Relationship with Others.  Healthy relationships should have a ratio of at least twenty positives to one negative.  He suggests relationship with less than a five to one ratio may need to be discarded.
3. Relationship with Something Greater.  This of course is the core of 12-step programs.
4. Physical Balance and mastery.  Relaxation techniques should be a part of any recovery program.  Being able to be at peace with yourself is essential.
5. Mental or Cognitive Balance and Mastery.  The perspective of an addict is frequently flawed.  Maintaining a positive attitude is essential to recovery.
6. Emotional Balance and recovery. Emotional reactivity negatively impacts resilience.  A brain is easily high jacked by reactivity.  A four step guide: 1) Become aware of emotions and accept them. 2.)Sit with emotions and recognize what they are about and whom they involve. 3) Expressing emotions in the contest of acceptance.  It is ok to be sad or angry about past events.  however it is not always possible to change the past.  Sometime accepting reality is needed.  4) Let go.  Once a feeling has been expressed, it is important to let go, and not continue to expect the impossible.
7. Presence.  This is about our ability to be in the moment.  This also deals with how you project into the world, which is charisma.  This can involve a change of posture.
8. Flexibility.  Flexibility is the ability to adapt.  Awareness of patterns is essential to being able to confront them, and adapt other ways of coping.
9. Power: The Ability to Get Things Done.  This is having realistic expectations, and setting goals, but understanding new learning is a growth process.  Having more power leads to more freedom, and less dependence, and then increased confidence in one's self.

Article: Eat to Reduce Belly Fat

This article is form the email stream "Living with Diabetes from Everyday Health.  I was looking for the easy fix for my belly fat, however this article basically says there is no easy fix.  However it does say that to lose one to two pounds a week then you should eat 500 to 1000 less calories per day.  Now that is a big goal.  Here is the exact quote, "To reduce weight in this area [the midsection], it's important to go on a diet that includes plenty of fruits and vegetables, lean protein, low-fat dairy, and whole grains, and to reduce portion sizes and therefore caloric intake.  It points out how belly fat can lead to problems such as heart disease and type II diabetes.  In terms of exercise, it suggest cardiovascular mixed with resistance training to build muscle.  
  

New refugee Services: AACI

408-975-2366  Leave a message in your language and someone will contact you

RSV

RSV Respiratory Syncytial Virus is related to the common cold.  Most children or adults do not have serious symptoms from the virus other than those of a cold.  However there are some who are particularly vulnerable.  this includes small babies up to ten weeks, babies born prematurely, infants with lung conditions and infants whose immune system is compromised due to a medical condition.  The virus results in trouble breathing, rapids breathing, cough, refuses to breast feed, and dehydration.  If your child is very tired, breathes rapidly, or has a blue tint to lips or fingernails medical attention should be sought.  Although there is no medicine for this virus, symptoms are treated and monitored.  This may include oxygen, medicines to open the air passages, and fluids.  RSV is also highly contagious so washing hands frequently is necessary.

Picture from Kids Health

Suicide Prevention: LivingWorks

This is a pamphlet from Living Works entitles Imagine a suicide-safer community.  It then describes several training programs provided by this program:  these include: esuicideTALK, suicideTALK, safeTALK.  This program has as its objectives training people to move beyond brushing over suicide, being able to recognize those who are suicidal, and applying steps to connect people with help when they are suicidal.  The other programs are ASIST and suicideCARE

Reconozca Los Senales: Suicide is Preventable

What would you do if you knew I wanted to suicide?

Suffering is not always noticed

Recognize the signs

listen and discuss

seek help

Intensive Case Management Services for the Severely Mentally Ill

This is the summary of a comparative research conducted in Santa Clara County. I don't see any dates on this but the results were released in 1993.

A Comparative Evaluation of Three Intensive Case Management Services for the Severely Mentally Ill:

Jeanette M. Jerrell, Ph.D., Director of Research

Rex S. Green, Ph.D. Evaluation Research Specialist

Santa Clara County Mental Health Services Research Center

Santa Clara County Mental Health Bureau

Bob Martinez, Director

Summary: It is certain that severely mentally ill adults with high levels of need for services can be managed and treated most effectively using intensive case management programs.  These programs clearly reduce the total direct care costs for clients over time and improve client functioning in the community as well.  These findings indicate that expansion of these case management services will result in substantial savings to the County mental health system while improving client outcome.

The Mental Health Bureau has been evaluating the relative cost-effectiveness of three of its intensive case management programs which specifically target their services to adults who are severely and persistently mentally ill and are high users of the acute and subacute treatment services.  These clients have two or more inpatient or skilled nursing facility episodes during the year prior to their entry into one of these three case management programs, as well as being noncompliant with previous outpatient services, being conserved and receiving SSI payments.  the three case management programs are: Virginia Street Project, Community Companions, and Downtown Mental Health Center.  Each program offers clients a different mix of outpatient, medication, case management, housing, and supportive day services, depending on their service philosophy and their caseload size.

Overall, the three intensive case management programs currently serving severely and persistently mentally ill adults are substantially reducing the direct service costs for these clients and improving their psychosocial functioning in the majority of clients served.  Our data also indicate that these reductions in direct mental health service costs do not increase the burden on families or other social/criminal justice services.  However, there are differences among the three programs in the degree to which they are lowering direct service costs and increasing client functioning.  The relative cost-effectiveness of the three programs depends on which outcome (treatment cost reductions versus client improvement) is considered.

The most cost-effective service from both of these perspectives is the Virginia Street Project which is reducing the total cost of mental health services to its clients by about $14,000 per year, compared to the level of care they required prior to receiving this service.  the greatest reduction is in the inpatient days and skilled nursing facility days of service used (see Figure 1).

They are also providing significantly more supportive outpatient and case management services to these clients (see Figure 2), but these services are offered at only a fraction of the cost of acute and subacute treatment facility costs.  Client functioning is improving to the greatest extent among VSP clients as well (see Figure 3).

Clients served by Community Companions demonstrate the next greatest improvement (see Figure 3) in functioning, and their total treatment costs are reduced $5,000 per client per year, the first year they are provided intensive case management services.  This outcome seems consonant with Companion's program philosophy which emphasizes client empowerment and rehabilitation as well as compliance with taking medications and explicit avoidance of hospitalization.

Downtown Mental Health Center clients showed reduced annual direct treatment costs of about $7,800, per client per year.  Client functioning improved less in the first year than for the other two programs, although Downtown MHC clients demonstrated the same pattern of overall change as the clients in VSP or Companions (Figure 3).  These outcomes seem consistent with the program's emphasis on maintaining clients in the community by providing supportive outpatient counseling and medications and with staff caseloads being twice the size of those at VSP or Community Companions during this study.

MY3 Wallet Size: Suicide Prevention App

This is a wallet size card for the MY3 suicide prevention app.

Diabetes Focus

These are some ideas I gleaned form the Diabetes Focus magazine, Spring 2016:
Sleep Balance:  By sleep balance they mean having the same sleep schedule every day, not waking later on weekends for example.  Those who have the same schedule tend to be healthier.  Those with a greater discrepancy in their sleep schedule have higher cholesterol levels, and greater insulin intolerance.
Stress: Diabetes distress is a real thing.  Managing diabetes can be stressful as you worry about diet, exercise, medical care etc.  Also there is at times a lack of support from those around you.  This can lead to diabetes distress.  It is good to talk to your doctor about stress and diabetes.
Testosterone: There is a correlation between testosterone level and insulin intolerance.  In may be a good idea to ask for blood test.
Singing:  Singing has been shown to improve mood and decrease tension.  Singing also can help with memory and social skills.  People who participate in choirs feel more confident and supported in social settings.
Feet (Socks and Shoes)  Who knew there are socks better for diabetics than other socks.  Fitted socks are best, synthetic materials will keep your feet dryer, padded styles can keep feet protected.  For more recommendations check out American Podiatric Medical Association.  Shoes should be replaced more often than you think, 300 to 500 miles, and more often if you are overweight.  Best to buy shoes later in the day as feet are larger later in the day (who knew?), and best to try them out.  If they don't feel comfortable in the store, they won't at home.  They should feel good without being "worn in."  They should have plenty of room for the toes, but not be so big they slip.  Finally, with your feet protected, we all should walk just a bit more.  For diabetics a pre and post walk check of feet is important to check for any blisters or damage.

Cockroaches

NAMI: Peer to Peer

NAMI is a national organization to support those with mental illness and their families.  Peer-to-Peer is a program of mental health consumers helping other mental health consumers.

E-training: Electrical Safety

The biggest issue with electrical problems seems to be damaged or old parts.  This includes rods, plugs and outlets.  Also a problem is misuse of electricity, such as multiple appliances to one cord etc.   The damage cased by electricity is dependent on the amount of voltage, type of voltage and duration of the contact.   Electrocution can cause shock, burns and falls.  It is important to never ignore an electrical issue.  tingling caused by an appliance should always be dealt with.  Symptoms of shock include tingling, painful shock, painful muscle contraction, respiratory failure, cardiac problems, deep burns and falls.  Coming upon a scene where electricity is important to remember not to rush in.  The source of power needs to be removed with plastic or wood pole as they don't conduct electricity.  You don't want to become a victim yourself.

E-training: Lifting and Protecting the Back

Over a third of work-place injuries involve the back and lifting.  The back was not designed for lifting.  Instead it was designed to support the trunk, support the weight of the body and help people walk upright.  It contains 24 bones, seven cervical, 12 thoracic and 5 lumbar.  Injuries to the back happen from poor posture, improper lifting, constant lifting and poor physical condition.  Lifting mistakes can be lifting with a bent bak, hold objects too far away from the body, twisting as you lift, not communicating with a partner when lifting, lifting several objects at a time or a big load, and losing your balance.

E-training: Radiation Safety

Sometimes we have mandated trainings at work which don't effect me, but which are interesting all the same  On of those is radiation safety.  There are three places where radiation is used in a hospital setting: x-ray, nuclear medicine and radiation oncology.  Alona is the concept of exposure to radiation "As low as reasonably achievable."  A way of measuring radiation exposure is with a Posimeter.  Staff who may be in radiation areas wear these.  A pregnant woman would wear two, one over her belly and one outside her gown.  Limiting exposure of pregnant women is important but does not require a pregnant woman to not perform her job if precautions are taken.   Risk from radiation goes down over time.  Risks include inhalation, puncture, ingestion (don't eat when radiation is present) and absorption (don't apply make up in radiation areas.