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Mental Health

Absent Parent Returns, Active Parent in Turmoil

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After parental separation, a consistent relationship between child and both parents is best. A parent entering and leaving a child’s life can be disruptive for the child and for the life of the other parent. Some folks may feel that upon being absent for some period of time, the absent parent should not be allowed back into the child’s life.

In some situations, the active parent has remarried and the new partner has formed a meaningful and significant attachment to the child. The re-introduction of the absent parent, therefore, threatens to not only cause emotional turmoil to the child, but maybe a perceived threat to the relationship between child and new partner. Needless-to-say, there can be a tangled web of intense feelings on all sides.

Generally speaking, the social science literature supports the notion that children fare better in the long run with secure attachments to both parents. This is true even in the face of many parental difficulties, but assuming that neither parent is outright abusive. In the case of an absent parent wanting to re-enter a child’s life, it may be difficult to determine what is best for the child.

Hence the decision may rest upon the clinical judgment of an assessor. The challenge in assessing these cases is separating parental issues of anger, jealousy and the like, from the needs and interests of the child. At times it is parental issues that require more management than the child’s renewed relationship with the absent parent.

In the event it appears that the relationship between child and absent parent will be re-established, certain precautions and structures can be put in place to allay concerns, facilitate the process and provide safeguards. Pre-meeting conditions can include:

  1. Abstinence from alcohol or drugs where a parent is known to abuse such substances.
  2. Drug testing for a parent known to abuse drugs.
  3. Counseling for the above, if at issue.
  4. Anger management if anger issues are identified.
  5. Attendance at a parenting course.

Then, with regard to a process for facilitating the relationship between absent parent and child:

  1. Consider a counseling process where the counselor meets the absent parent alone. This meeting or series of meetings is to establish motive and also to provide an opportunity for education as to the needs of the child in question.
  2. Concurrently there should be a meeting or series of meetings with the same counselor and the active parent and partner to discuss and prepare them, followed by a meeting with the child to discuss concerns and issues. The purpose of counseling is not to curtail the process, but to continue to discuss and develop strategies to manage change in view of concerns.
  3. Finally, the child meets with the absent parent under the auspices of the counselor. Several future meetings can occur with the counselor or under supervision through a designated supervision center if considered necessary.
  4. Then assuming all goes well, visits can progress to unsupervised.

Hence the issue may not be withholding the relationship rather than facilitating it through a safe and structured process. If the absent parent abides by the process, benefits to the child can significantly outweigh the loss of this parent-child relationship. If the absent parent proves incapable of meeting the requirements and abiding by the safeguards, then there are supports in place to help the child and family adjust.

If the absent parent refuses to follow the processor gets into trouble along the way, the process can be modified or even ended. These situations are balancing acts with no easy solution. The challenge is to manage the process as delicately as possible. The above process may help.

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Gary Direnfeld, MSW, RSW is a Canadian Social Worker in private practice and a Social Work Helper Contributor. From his 65 episodes of the hit show Newlywed/Nearly Dead, to over 300 columns as the parenting expert of a major metropolitan newspaper, to more than 250 media appearances, to his book, Marriage Rescue: Overcoming ten deadly sins in failing relationships.Courts in Ontario, Canada, consider him an expert in social work, marital and family therapy, child development, parent-child relations and custody and access matters He speaks at conferences and workshops throughout North America.

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LGBTQ

Gay, Bisexual, Sexually Abused Male Inmates More Fearful of Prison Rape, More Open to Therapy

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There is nowhere to escape in what often is referred to as a “sexual jungle,” especially for the most vulnerable. However, “Zero tolerance” toward prison rape is now national policy thanks to the Prison Rape Elimination Act passed by the United States Congress in 2003. Although this law changed how Americans think about prison rape, few studies have examined how inmates perceive rape and if they feel safe in prison. Even less is known about how their perceptions influence whether or not they ask for mental health treatment while incarcerated.

The most recent National Inmate Survey of 2011-12 of 92,449 inmates age 18 or older shows that among non-heterosexual prison inmates, more than 12 percent reported sexual victimization by another inmate and almost 5.5 percent were victimized by a prison staff member within the past 12 months. In comparison, 1.2 percent of heterosexual prisoners were sexually victimized by an inmate and 2.1 percent were victimized by a prison staff member. These rates are even higher for those with mental illness. About one in 12 inmates with a mental disorder report at least one incident of sexual victimization by another inmate over a six-month period, compared to one in 33 male inmates without a mental disorder.

Using data from more than 400 male inmates housed in 23 maximum-security prisons across the U.S., researchers from Florida Atlantic University conducted a novel study to examine the factors related to fear of rape in prison and the likelihood of male inmates requesting mental health treatment while incarcerated. They focused specifically on prisoners at risk of being sexually victimized in prison: gay or bisexual inmates and those with a history of childhood sexual abuse.

A key finding from the study, published in the Journal of Interpersonal Violence, is that sexual orientation and a history of childhood sexual abuse are significant predictors of male inmates fearing rape as a big threat in prison and voluntarily requesting mental health treatment. Findings from the study reveal that nearly 38 percent of gay and bisexual inmates and 37 percent of inmates with childhood sexual abuse fear rape as a big threat.

Compared with straight inmates, gay and bisexual inmates are approximately two times more likely to perceive rape as a threat and three times more likely to voluntarily request mental health treatment in prison. Inmates with a history of childhood sexual abuse are more than twice as likely to perceive rape as a threat and almost four times more likely to request mental health treatment than inmates who did not report a history of childhood sexual abuse. Notably, this finding is inconsistent with previous research that has shown that there is no significant relationship between childhood sexual abuse and feelings of safety among male inmates.

“The consequences of perceiving rape to be a threat in prison are vast and could contribute to violence among inmates as well as negative mental health ramifications such as increased fear, psychological distress, chronic anxiety, depression and thoughts of suicide,” said Cassandra A. Atkin-Plunk, Ph.D., co-author and an assistant professor in the School of Criminology and Criminal Justice within FAU’s College for Design and Social Inquiry.

Inmates incarcerated for two to five years are nearly three times more likely to perceive that rape is a big threat compared with inmates incarcerated for less than two years. Inmates in prison longer than 18 years are nearly four times more likely to voluntarily request mental health treatment in prison. The researchers also found that Black inmates are twice as likely to seek mental health treatment in prison compared to White inmates.

“Knowing that gay and bisexual inmates and inmates with a history of childhood sexual abuse are more likely to fear rape and seek mental health treatment, prison staff can target outreach and treatment efforts for this vulnerable sub-population,” said Mina Ratkalkar, LCSW, MS, lead author and a licensed clinical social worker pursuing a Ph.D. who conducted the study while she was a graduate student at FAU. “Our study shows that these sub-groups of inmates are receptive to treatment, and our findings have implications for both practice and policy in the United States.”

The sample consisted of a nearly equal number of men in their 20s, 30s and 40s. Black inmates made up about half of the sample, with White inmates comprising about one-third of the sample. Nearly one-third of the sample had previously been in juvenile detention and about one-quarter were incarcerated for the first time in the adult criminal justice system at age 18 or younger.

About 16.4 percent of the sample identified as gay or bisexual. About one-fifth of the men (73) reported a history of childhood sexual abuse, and about one-third of the men reported having received mental health treatment outside of prison.

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Health

How to Recognize and Help an Addict

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It’s devastating to know a friend or a loved one suffers from an addiction. Before people get help, they often go down a long road of addiction prior to anyone, including themselves, noticing a problem. Consider the information and advice below if you know or suspect someone is an addict.

Your Gut

Addicts are excellent liars. It can seem disheartening to hear that you shouldn’t take them at face-value. However, listen to your gut. Your gut is telling you that something is wrong. Do not ignore this. They will tell you all the right things you’d like to hear. They will go into detail about where they were, why they did something and more. Everything will sound right to your mind. The very fact that you feel something isn’t right means more than likely something truly isn’t. Listen to what they say, and take notes because if they are addicts, they will slip up eventually. Don’t be the big-bad wolf that’s out to get them, but don’t be an enabler either. Enablers help them to stay stuck in their addiction by making excuses for them.

Denial

Addicts especially high-functioning addicts think that if they’re able to go to work, bring money home, do housework and other normal day-to-day life they do not have a problem with addiction. An addict is not just the junkie on the corner. Most addicts are high-functioning, which means they go under the radar for what passes as an addict to society. Because of this, and for reasons such as not wanting to face themselves, addicts will lie to themselves and the world. This is why most addicts are in denial. They might also reason that they don’t drink “enough” to be an addict. Make no mistake that alcoholism isn’t about the quantity of alcohol ingested. It’s about the mental obsession and physical craving of alcohol that makes someone an alcoholic. People who don’t drink for three of four months and suddenly “binge” can be alcoholics.

Things Don’t Add Up

It is often said that addicts lead double lives. This is true for anyone living in dysfunction. To the outside world, they have it together. Underneath that façade is a broken human being who uses alcohol, substances or anything else to get by. To make matters worse, this outward appearance can be further covered up, or justified, with a prescription medication. Abuse of a prescription medication is a serious concern. People often overdose on their pills or makeup excuses for why they need them even though they don’t have a legitimate need for them. This is why centers offer painkiller addiction treatment because it is a common phenomenon. It is also a growing phenomenon.

Real Help

To the addict, you’re “mean,” “unreasonable,” and a few choice words when you confront them. Expect this upfront. It’s not a reflection of who you are as a person despite their best attempts to assassinate your character. What they say about you has everything to do with their dysfunction. More often than not, they will choose their addiction over you. Real help and real love mean saying, “I’m going to tell you the truth,” “I need to love myself before I can love you,” or “I don’t accept your excuse. You’re responsible for your behavior, and I refuse to be a part of your life until you take responsibility for yourself.”

You can’t force someone to get help, but you can stop enabling them. Don’t make excuses for their behaviors or addiction. Addicts have to want to get help before they do. Once you know there is a problem, stand your ground. Speak truthfully to the addict. Above all, love yourself because this has been and will continue to be incredibly hard on you. Understand that they have to learn to love themselves too.

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Health

Veterans: Take This Survey!

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Learning about military-to-civilian reintegration requires asking the right questions of the right people. A novel, new study is seeking military veteran respondents to learn more about the way service impacts health, civic engagement, and socio-economic outcomes for military-connected men and women. The data collected through this survey are expected to help us answer questions such as:

• Do veterans feel welcome and interested in institutional service groups like the VA and informal groups like VSOs? Do those organizations serve their needs? How are prospective members welcomed and served?
• How does military service impact community involvement and political engagement?
• How does military service impact experiences on the job market (and is this effect conditioned by demographic factors?
• Does military service break the glass ceiling for service women?

The project was developed by an interdisciplinary research team with experience, training, and connections to the military community. Dr. Kyleanne Hunter is a Marine Corps Cobra pilot and political science researcher. Dr. Rebecca Best is an experienced security studies researcher with a focus on service women. Dr. Kate Hendricks Thomas is a public health researcher and Marine Corps veteran. Each has specific training in community-based, participatory research and is invested in filling current gaps in what we think we know about the transition from service member to civilian.

Access the survey online here: https://udenver.qualtrics.com/jfe/form/SV_572AiK5P3P75KQt

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Human Services

Is Counseling For You

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Have you been in counseling or therapy? If not, have you ever hesitated in seeing a counselor, or wondered why you felt so wary? Studies show about 20-35% of Americans having attended some form of counseling and psychotherapy compared to approximately 80% of mental health professionals.

Believing that counseling and psychotherapy could be helpful for anyone in alleviating problems, improving relationships, and developing a more positive outlook toward life, a Journal for Human Services research study explores why some people attend counseling or therapy while others do not.

Researchers, Ed Neukrug, Mike Kalkbrenner, and Sandy Griffith wondered why it was that some people seemed readily to attend counseling while others hesitate or who don’t attend often to their own detriment. Their research on attendance in counseling of helping professionals and their upcoming research on attendance in counseling of the public in general offers a thoughtful analysis which will hopefully shed some light on this important concern.

After an exhaustive review of the literature, researchers independently looked at over 60 potential barriers to attendance in counseling and eventually reduced this number down to 32 specific items. Their research found three broad areas or reasons likely to affect individuals who tend to avoid counseling and therapy. They identified these areas as “Fit,” “Stigma,” and “Value” to reflect the areas they represent.

Factor 1: Fit

Fit has to do with one’s sense of comfort with being in counseling and whether one has the ability to trust the process of counseling will be beneficial. Some typical fit questions were related to whether a potential client believed a counselor would feel comfortable with the potential client’s sexuality, disability, or other aspects of the client’s identity. Other questions in this area assessed whether a potential client believed a counselor could understand him or her, was competent enough to deal with the client’s problem and could keep the client’s concerns confidential. In addition, other “fit” questions queried whether potential clients had a bad experience with a counselor in the past and if they thought they could find a counselor near to where they lived

Factor 2: Stigma

Stigma is the feeling of shame or embarrassment some people experience when they consider entering a counseling relationship. Some of the stigma questions highlighted whether a potential client believed their friends, family, peers, colleagues, or supervisors might view them negatively if they knew the individual was in counseling. Other questions focused on how some potential clients might consider themselves weak, embarrassed, or unstable if they were in counseling. Often, those with high scores on stigma believed others would judge them, and thus, they would feel badly if they were to enter counseling.

Factor 3: Value

Value is the perceived benefit or worth one believes he or she is receiving from attendance in counseling. Potential clients who would score high in this area often believed the financial cost of counseling was not worth its benefits. Participants in this category simply could not afford counseling or they didn’t have time for it. Many participants in this category believed counseling wasn’t necessary because problems usually resolve on their own, or that counseling was simply not an effective use of their time. These individuals simply did not embrace the counseling process because the financial costs in their mind are hard to justify over meeting basic needs and/or having to take time off from work.

Although some individuals cannot find a counselor to their liking, participants worried whether counseling would be worthwhile, or they were ashamed or embarrassed about going to counseling. Most people believe that when faced with difficult life problems, counseling could be helpful.

It is hoped through research like this, people can better understand why they might be hesitant to seek a counselor and  maybe overcome some of their fears. Additionally, this research can help national organizations, in the helping fields, find ways to help clients overcome these barriers.

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Global

Turnkey: A Co-Housing Experience in an Italian Public Service for Addiction

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Turnkey is a term used in the economic field, but it also fits well in a social rehab project. The idea comes from the need to give some answers to the problem of those patients that experienced a long term therapy in an addiction rehab center for 3 or 4 years.

In the Italian welfare system, the outpatient service team -work (doctor, psychologist, educator, nurse and social worker), operating in the addiction recovery can schedule long term treatment in the residential rehab centers. In some cases, this long time permanence is something obliged, because of the serious addiction and also for the lack of different life perspectives after the recovery.

These kinds of patients need more therapeutic help in order to return to civil society in order to find  meaningful social membership. Usually, these clients have no meaningful familiar connections, no job, and no significant friendship.

In the last years, our social services system has become more careful about the use of public money. They noticed social workers more equipped to provide therapeutic interventions using a holistic approach in order to spare economic resources. Social workers are more capable to assist patients in reaching a better life condition by using their abilities toward social integration.

The Project

Five years ago, the program’s director asked for the professional team to think about a solution for the rehabilitation of the” long term patients”.

I started wondering about the meaning of poverty which is not only economics but it also the satisfaction of primary needs. It’s the lack of healthy relational bonds which weakness a lot the patients coming out of the drug addiction recovery programs.

I also noticed that this relational deficiency is a modern human condition; in the weakest social situations the loneliness is something that “destroys the mind “.

So I got an idea: I proposed to my director to start thinking about a possible apartment for a temporary co-housing for at least two patients.

He liked the project and submitted the plan to the municipalities which have the competence in the social side of rehabilitation. The municipalities agreed to the project and financed it.

For the patients in long term recovery, the rent was paid through the financing with the municipalities (an average of 6.000 Euro a year for 4 years, renewable), whereas the utilities and the others cost of the house has been in charge to the occupants.

The management of activities like the admission of the patients, the guaranteed respect of the therapeutic contract, the check of daily life and the help in the money administration, are some of my specific competences as a social worker.

In my job role, I had a significant part into find fitting persons for the project who were able to live together. I also contributed to choosing the people eligible to live in that specific therapeutic situation.

I helped the patients to organize their new life and to establish minimum rules of mutual life in the apartment. The project is strictly tied to the learning of the skills required to come back to live a regular life.

For example:

– living together is an opportunity for the patients to learn mutual respect

-cleaning the home and paying the utilities is a way to come back to daily responsibility and autonomy.

– having a good neighborhood relationship is a way to learn again to have good relationships without drug addiction to interfered an apartment, next to the main social and sanitary services of the town.

The results

Since 2011, we housed 11 clients in the apartment with an average of one year placement. We should consider that one year in a residential rehab center cost 30.000 euro each person.

Eight of them returned was able to manage a regular social life, their addiction, a job, maintain social relationships which helped them to achieve a dignified lifestyle.

Two persons are still in the co-housing situation, one of them has a regular job, and he is searching for an own house. Only one person abandoned the treatment.

This intervention is a daily challenge for our team; it gave us good results in the recovery outcomes like independence, citizenship, struggle against the stigma and improvement of personal resources.

We also have spared a significant amount of public money while offering to our clients a higher quality of life.

The creativity and the professional skills mixed together with the help of other colleagues in the multidisciplinary teamwork made this project an effective strategy to help patients overcome their circumstances.

So, I can call myself a responsible social worker, because I help to improve the personal resources in my client’s life. I was mostly inspired from the basic professional principle “start from where the client is”.

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Mental Health

Will Veteran Suicide and Mental Illness Rate Improve?

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Even in Afghanistan, I will seek pet therapy! – Rick Rogers (pictured above)

It was about 9 years ago.  I decided to put down the rifle and pick up the DSM. You see, I was an infantryman since I was age 17.  That means, since I was a child, I was literally trained to kill people.  Looking back at it, that sounds like a profound concept.

I am proud of my time in the military.  I am proud of my brothers and sisters who have ever answered the call.  But…  I am also worried.

As I said, 9 years ago, I decided to change my path.  I didn’t realize where that path would lead.  I seen multiple traumas and death happen to my fellow comrades.  I went through some trauma myself, but I still worried about others more than myself.  So, I decided to become a Mental Health Specialist in the military.

It’s been a long road going from Infantryman to Social Worker. There are a lot of learned attitudes and behaviors I had to change. Can you believe it? I literally had to learn empathy.  And that took a long time.

Just about anyone in the military knows that drinking alcohol is a part of the lifestyle. Everyone I looked up to drank and considered me a p**sy if I didn’t.  So… when I was sent to Germany back in the early 2000’s as a 19 year old kid, you better believe I drank. It was legal!

Looking back at my adventures between then and now, I don’t regret a thing. Yes, there were many embarrassing moments, and I have lost many friends along the way.  I also met some great people.  My alcohol use made my path rockier than anything else.

Many others have had this experience as well.  Between 1998 and 2008, binge drinking went from 35% to 47% of veterans, and 27% of that 47% experienced combat. 

Between 2002 and 2008, misuse of opiate prescriptions went from 2 percent to 11 percent in the military.  These prescriptions were mostly due to injuries sustained in combat, as well as the strain of carrying heavy equipment.

This concerns me. When I was young, I had a good time. Looking back, maybe it wasn’t.This might not be every veteran’s experience, but the culture encouraged substance use and discouraged getting help. There are others that would agree with me.

This could explain why 20 veterans a day on average commit suicide. This is actually down from 22 a day before the 2014 study from the VA.  However, it is a 32% increase since 2001. In 2014, veteran suicides accounted for 8.5% of U.S.’s adult suicides, and the rates were especially high among 19-29 year old compared to the older generation.

Let’s not forget about the infamy of PTSD. Up to twenty percent of veterans have suffered from this. Of course, those who suffer are more likely to admit their distress to a computer program than a battle buddy or their superior.  This, again, goes with the constant culture that causes our military to fear judgment.

These wars have been a constant the last two decades, and have cost all U.S. citizens a pretty penny. According to one report, the VA spends $59 billion a year on health care.  This number is 3 times as much as it was since before 2002.

And let’s not forget the cost this country has incurred for being in war for this long.  Well, we don’t really know an exact number.  The cost is estimated by many to be in the billions or even trillions.  This isn’t including the interest from borrowed money.

So, after looking at all these figures, I am overwhelmed.  How can I even make a dent in helping our nation’s veterans? The current administration is planning on increasing our presence in war zones.  I am expecting the rate of PTSD and suicide to increase once again.  Also, our country will continue to spend.  It seems to me that we are all participating in a death and mental illness factory.   The thing is, I didn’t even get to the physical injuries many of our combatants have suffered from.

I love our nation’s military.  I want every one of them to know that I am here to support them.  But most of all, we all need to be here to support each other.

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