Shop Talk

[Rogert]

Is this an OK place to just talk shop? I'm just looking for some people to talk to other than my coworkers about cases/tell funny stories/get advice/etc. Is there a better forum for this? It seems like every thread here is "How do I get into X program."

As a for instance, I've got a case where the kid states "Everyone thinks I'm a bad kid but I really just can't control it." It'd be easy to dismiss this as the kid looking for excuses, but the kid's mental health/trauma history makes me a lot more sympathetic. If that's the case, I've got bugger all idea what to do. How do you help a kid control something he may legitimately not have control over?

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[WisNeuro]

Shop talk is fine, as long as it's relatively respectful, happens more in the Phd/PsyD thread. Some people do some group private messages for some discussions. Plenty of us clinicians on here in addition to students/trainees.

 

[wesleysmith]

Is this an OK place to just talk shop? I'm just looking for some people to talk to other than my coworkers about cases/tell funny stories/get advice/etc. Is there a better forum for this? It seems like every thread here is "How do I get into X program."

As a for instance, I've got a case where the kid states "Everyone thinks I'm a bad kid but I really just can't control it." It'd be easy to dismiss this as the kid looking for excuses, but the kid's mental health/trauma history makes me a lot more sympathetic. If that's the case, I've got bugger all idea what to do. How do you help a kid control something he may legitimately not have control over?

Refer him to a trauma-informed therapist if that's an option. Otherwise, I'd say skill building would be a great place to start (e.g., relaxation, cognitive coping, emotional regulation, etc.) and, of course, some psychoeducation on :insert pertinent trauma: and how it can affect an individual, common reactions (i.e., normalize), all that standard jazz.

 

[Rogert]

Shop talk is fine, as long as it's relatively respectful, happens more in the Phd/PsyD thread. Some people do some group private messages for some discussions. Plenty of us clinicians on here in addition to students/trainees.

Great to hear. I'm a skill builder so I didn't feel real comfortable posting in the clinical forum since I'm not a clinician and because I would think asking a clinician and a lower level social worker (I don't think that's the right phrase but that what I got right now) would generate different answers. For instance:

Refer him to a trauma-informed therapist if that's an option. Otherwise, I'd say skill building would be a great place to start (e.g., relaxation, cognitive coping, emotional regulation, etc.) and, of course, some psychoeducation on :insert pertinent trauma: and how it can affect an individual, common reactions (i.e., normalize), all that standard jazz.

As the skill builder, telling me to skill build isn't helpful (the eg was helpful though, I just thought your answer was funny). These answers seem very reasonable from a clinician's standpoint but, and maybe this is just the population I work with (that you would have had no knowledge of), I can't imagine this strategy working in the field. You're never going to get the level of cooperation or insight necessary for it to work. I also don't know if psychoeducation is something I can or should do given that I have no training or experience in it.

 

[erg923]

Is this an OK place to just talk shop? I'm just looking for some people to talk to other than my coworkers about cases/tell funny stories/get advice/etc. Is there a better forum for this? It seems like every thread here is "How do I get into X program."

As a for instance, I've got a case where the kid states "Everyone thinks I'm a bad kid but I really just can't control it." It'd be easy to dismiss this as the kid looking for excuses, but the kid's mental health/trauma history makes me a lot more sympathetic. If that's the case, I've got bugger all idea what to do. How do you help a kid control something he may legitimately not have control over?

Case discussions about specific patients should not be held on public internet forum. But obviously, general treatment discussions are fine.

I would be curious about your belief that he "cant control it.' Does he have a frontal lobe? Does he have brain damage? Impulsivity is not the same as inability control behavior, and cannot be used as exculpation for ones behavior. Distress tolerance skills building seems like the obviously place to start.

If you think trauma creates the current clinical picture, you should treat the trauma reaction or refer to him someone who is competent in this treatment area.

 

[wesleysmith]

Great to hear. I'm a skill builder so I didn't feel real comfortable posting in the clinical forum since I'm not a clinician and because I would think asking a clinician and a lower level social worker (I don't think that's the right phrase but that what I got right now) would generate different answers. For instance:

As the skill builder, telling me to skill build isn't helpful (the eg was helpful though, I just thought your answer was funny). These answers seem very reasonable from a clinician's standpoint but, and maybe this is just the population I work with (that you would have had no knowledge of), I can't imagine this strategy working in the field. You're never going to get the level of cooperation or insight necessary for it to work. I also don't know if psychoeducation is something I can or should do given that I have no training or experience in it.

Did not realize your professional background (or population, for that matter), so I gave the most reasonable response based on the provided information for the sake of "talking shop." My response was generated based on my experiences training in and implementing an evidence-based trauma-informed intervention for children and adolescents. If you aren't looking for a clinician's perspective, this may be the wrong forum for this discussion.

 

[Rogert]

Case discussions about specific patients should not be held on public internet forum. But obviously, general treatment discussions are fine.

I would be curious about your belief that he "cant control it.' Does he have a frontal lobe? Does he have brain damage? Impulsivity is not the same as inability control behavior, and cannot be used as exculpation for ones behavior. Distress tolerance skills building seems like the obviously place to start.

If you think trauma creates the current clinical picture, you should treat the trauma reaction or refer to him someone who is competent in this treatment area.

In the sense of revealing identifying information? Of course not. There's a reason I'm referring to the kid as "the kid" rather than "s/he."

"Belief" is a way stronger word than what I'm thinking. Like I said, the kid might just be looking for an excuse, but I'm sympathetic to the idea and am willing to try skill building geared toward it. This kid's been in my program for nearly two years with limited success in this particular area so I'm exploring different ideas.

I also find it interesting that multiple people have suggested referral. In my area, we wait 3 months and drive an hour and a half to get any sort of diagnostic done let alone one that specializes in trauma. I didn't even know that was a thing. I knew my area was lacking but it's being spoken of like it's no big deal and that blows my mind. What would a trauma specialist actually be able to do differently?

Did not realize your professional background (or population, for that matter), so I gave the most reasonable response based on the provided information for the sake of "talking shop." My response was generated based on my experiences training in and implementing an evidence-based trauma-informed intervention for children and adolescents. If you aren't looking for a clinician's perspective, this may be the wrong forum for this discussion.

Like I said, I wasn't trying denigrate your response, just point out that it wasn't exactly what I was looking for. Your answer was perfectly reasonable given the amount of info I provided and your position in the treatment hierarchy. If this is not the correct place, does anyone know of a forum more geared towards non-clinicians?

 

[erg923]

What is your job and level of education in mental health?

If you have a license of any sort in this field, you are ethically obligated to refer your patient to the appropriate services, and the appropriate level of care for their current condition. If you feel the individual has PTSD and/or trauma reaction is the source of the current affective or behavioral disturbance, providing empirically supported treatments (CPT, TF-CBT, play therapy protocols, EMDR, etc) for this is clinically indicated. If you can't do this, and apparently you can't cause you just said you don't know what we are even talking about, then you should research and make appropriate referrals. Patients have a right to know their treatment option, even if said options are far away.

See below for more options. http://www.ptsd.va.gov/professional...nd_adolescents_overview_for_professionals.asp

 

[Rogert]

What is your job and level of education in mental health?

If you have a license of any sort in this field, you are ethically obligated to refer your patient to the appropriate services, and the appropriate level of care for their current condition. If you feel the individual has PTSD and/or trauma reaction is the source of the current affective or behavioral disturbance, providing empirically supported treatments (CPT, TF-CBT, play therapy protocols, EMDR, etc) for this is clinically indicated. If you can't do this, and apparently you can't cause you just said you don't know what we are even talking about, then you should research and make appropriate referrals. Patients have a right to know their treatment option, even if said options are far away.

See below for more options. http://www.ptsd.va.gov/professional...nd_adolescents_overview_for_professionals.asp

I'm a skill builder. I have a bachelors plus a little training I got from my organization. I do not have any sort of license. I can't make any sort of referrals. I don't make treatment plans. I'm told to make these kids suck less at life and I do my best to do so with the limited resources I have. I was hoping the power of the internet could help me learn to do my job better.

 

[erg923]

I'm a skill builder. I have a bachelors plus a little training I got from my organization. I do not have any sort of license. I can't make any sort of referrals. I don't make treatment plans. I'm told to make these kids suck less at life and I do my best to do so with the limited resources I have. I was hoping the power of the internet could help me learn to do my job better.

If you are in a tech role, which is what it sounds like, then what I said does not apply. However, hopefully, these individuals are getting (or being offered) some sort of actual treatment for their mental health difficulties by your organization. If they are not, then this is the organization's fault, not yours.

Personally, I would have issues with working for an organization that was undertreating its patients/clients, but that's just me.

 

[Rogert]

If you are in a tech role, which is what it sounds like, then what I said does not apply. However, hopefully, these individuals are getting (or being offered) some sort of actual treatment for their mental health difficulties by your organization. If they are not, then this is the organization's fault, not yours.

Personally, I would have issues with working for an organization that was undertreating its patients/clients, but that's just me.

I don't feel we're undertreating but that may just be because I don't know what regular treatment looks like. Even if we are, it's us or no one and we're doing our best. Can you elaborate on what you mean by "actual treatment"? And perhaps explain it like I'm 5?

 

[erg923]

Can you elaborate on what you mean by "actual treatment"?

As in psychotherapy, and psychotropic medications if needed.

You are not doing psychotherapy, and don't get the feeling these kids have access to a psychiatrist if you are saying they aren't even seeing therapists.

 

[Rogert]

As in psychotherapy, and psychotropic medications if needed.

You are not doing psychotherapy, and don't get the feeling these kids have access to a psychiatrist if you are saying they aren't even seeing therapists.

Gotcha. That may have just been poorly explained by me. All our kids have access to a psychiatrist, almost all see a therapist on semi-regular basis (assuming the kids cooperate), and almost all if not all are medicated. Now, the ease of access, suitability of therapist, and the properness of the medications may be up for debate, but that's all limited by the number of providers which is beyond our control.

 

[erg923]

Gotcha. That may have just been poorly explained by me. All our kids have access to a psychiatrist, almost all see a therapist on semi-regular basis (assuming the kids cooperate), and almost all if not all are medicated. Now, the ease of access, suitability of therapist, and the properness of the medications may be up for debate, but that's all limited by the number of providers which is beyond our control.

I would suggest talking with the therapists on a regular basis so that you can build upon what they are working on or doing in those sessions, rather than practicing your own version of counseling or life coaching.

Care should be collaborative, not isolative. Everyone needs to be on the same page ands agree (reasonably) on the approach and the goals that are being worked towards.

 

[Rogert]

I would suggest talking with the therapists on a regular basis so that you can build upon what they are working on or doing in those sessions, rather than practicing your own version of counseling or life coaching.

Care should be collaborative, not isolative. Everyone needs to be on the same page ands agree (reasonably) on the approach and the goals that are being worked towards.

I can absolutely agree that my organization and more specifically, I, should be trying to be more collaborative. We currently are "collaborative" in that we know how often the kids see therapists and the case managers occasionally talk with the therapist, but I have no idea what any of my kids' therapists talk about or are working on which seems pretty bad considering I have more face time with them than anyone. I also doubt the therapists have ever read any of my reports on the kids. This has been helpful, thank you.

I was hoping this thread would turn up more people in my role/level of care, but I'll take what I can get.

 

[erg923]

I can absolutely agree that my organization and more specifically, I, should be trying to be more collaborative. We currently are "collaborative" in that we know how often the kids see therapists and the case managers occasionally talk with the therapist, but I have no idea what any of my kids' therapists talk about or are working on which seems pretty bad considering I have more face time with them than anyone. I also doubt the therapists have ever read any of my reports on the kids. This has been helpful, thank you.

I was hoping this thread would turn up more people in my role/level of care, but I'll take what I can get.

I guess I am struggling to understand your role?

Too many cooks in the kitchen makes treatment confusing for those that are going through it. It is generally not indicated that a person have more than one therapist at the same time. Thus, your role (whatever it is or suppose to be) probably needs to be better defined and better understood by you and everyone involved. It seems to me that being a "skill builder" would require that you work closely with the person therapist so that skill building is consistent and not at odds with their treatment plan/goals.

 

[MAClinician]

I can absolutely agree that my organization and more specifically, I, should be trying to be more collaborative. We currently are "collaborative" in that we know how often the kids see therapists and the case managers occasionally talk with the therapist, but I have no idea what any of my kids' therapists talk about or are working on which seems pretty bad considering I have more face time with them than anyone. I also doubt the therapists have ever read any of my reports on the kids. This has been helpful, thank you.

I was hoping this thread would turn up more people in my role/level of care, but I'll take what I can get.

I guess I am struggling to understand your role?

Too many cooks in the kitchen makes treatment confusing for those that are going through it. It is generally not indicated that a person have more than one therapist at the same time. Thus, your role (whatever it is or suppose to be) probably needs to be better defined and better understood by you and everyone involved. It seems to me that being a "skill builder" would require that you work closely with the person therapist so that skill building is consistent and not at odds with their treatment plan/goals.

Curious if Rogert is providing home-based or community-based services to kids with Medicaid insurance involved in a state system? Child protection, juvenile justice, mental health systems in the state you are working in? Or funded by said agency? In MA there are these types of services for Medicaid insured kids. One service is called In Home Therapy with a masters level family clinician and bachelors level Therapeutic Training and Support who's job is to "skill build" based off of the clinicians treatment plan. The other service is Therapeutic Mentoring, which focuses on social skills and community living skills from someone else's treatment plan. Other states may have these services in some capacity but call it something else. Is this what you do? I also know of services where a child is connected with a residential program but receives community based services to facilitate reunification home. The "skill builder" works with a case manager to develop a treatment plan. Is any of this similar to your job/role?

 

[Rogert]

I guess I am struggling to understand your role?

Too many cooks in the kitchen makes treatment confusing for those that are going through it. It is generally not indicated that a person have more than one therapist at the same time. Thus, your role (whatever it is or suppose to be) probably needs to be better defined and better understood by you and everyone involved. It seems to me that being a "skill builder" would require that you work closely with the person therapist so that skill building is consistent and not at odds with their treatment plan/goals.

Curious if Rogert is providing home-based or community-based services to kids with Medicaid insurance involved in a state system? Child protection, juvenile justice, mental health systems in the state you are working in? Or funded by said agency? In MA there are these types of services for Medicaid insured kids. One service is called In Home Therapy with a masters level family clinician and bachelors level Therapeutic Training and Support who's job is to "skill build" based off of the clinicians treatment plan. The other service is Therapeutic Mentoring, which focuses on social skills and community living skills from someone else's treatment plan. Other states may have these services in some capacity but call it something else. Is this what you do? I also know of services where a child is connected with a residential program but receives community based services to facilitate reunification home. The "skill builder" works with a case manager to develop a treatment plan. Is any of this similar to your job/role?

This sounds very close to what I do. I work for an NPO and our work is reimbursed by Medicaid. My program works exclusively with kids in foster care whose diagnoses make permanency (either through adoption or return to parents) very difficult. The structure is very similar to what MAC has described. The big difference is that I wouldn't describe the masters position as a clinician. They act more as a coordinator between me, the foster care specialist, the bio families, the foster families, and all of the kids medical needs. I am still working off what the coordinator plans, but I'm very divorced from the therapists and psychs.

 

[MAClinician]

This sounds very close to what I do. I work for an NPO and our work is reimbursed by Medicaid. My program works exclusively with kids in foster care whose diagnoses make permanency (either through adoption or return to parents) very difficult. The structure is very similar to what MAC has described. The big difference is that I wouldn't describe the masters position as a clinician. They act more as a coordinator between me, the foster care specialist, the bio families, the foster families, and all of the kids medical needs. I am still working off what the coordinator plans, but I'm very divorced from the therapists and psychs.

Without going into identifying specifics, ARE there goals for you to work on from the coordinator? You stated earlier your job was "to make them suck less at life" but that is not a goal (as stated) that would get reimbursed by Medicaid are you supposed to be helping them with their behavior? Learn social skills or decrease conflicts with peers? Get better grades by improving class or homework? If you can give general examples of your goals that would help for identifying skills to build. If the coordinator hasn't told you or developed a plan for you to work off of, then THAT is the first problem to address. If the coordinator is talking to the therapist the coordinator should at minimum know the treatment plan goals for therapy. If not, a discussion with your and/or the coordinator's supervisor may be needed. This will help insure coordination of care. Sounds to me you work in a rural area with limited access to resources?

 

[Rogert]

Without going into identifying specifics, ARE there goals for you to work on from the coordinator? You stated earlier your job was "to make them suck less at life" but that is not a goal (as stated) that would get reimbursed by Medicaid are you supposed to be helping them with their behavior? Learn social skills or decrease conflicts with peers? Get better grades by improving class or homework? If you can give general examples of your goals that would help for identifying skills to build. If the coordinator hasn't told you or developed a plan for you to work off of, then THAT is the first problem to address. If the coordinator is talking to the therapist the coordinator should at minimum know the treatment plan goals for therapy. If not, a discussion with your and/or the coordinator's supervisor may be needed. This will help insure coordination of care. Sounds to me you work in a rural area with limited access to resources?

Haha. Yes, I work on goals as defined by the coordinator. They are usually better than "make this kid not suck." They cover a pretty wide range from "X will learn how to properly manage money" to "X will participate in 15 minutes of every hour of activities" but generally fall under the categories of independent living, social skills, anger management, and impulse control. And yes, rural area with limited resources.

 

[smalltownpsych]

You mentioned therapists not reading your notes on kids, that would be pretty bad. In settings like this, I always go through the documentation on the kids I see. I need that information to be effective. It is sad, but often the case, that therapists don't collaborate well with other staff. Sometimes it is a protective turf thing and a misunderstanding of what psychotherapy is and isn't that leads to this. This often takes the form of therapist telling staff to "stop doing therapy" without any guidance on what they are supposed to be doing with the kids.

I rarely tell staff not to talk to kids about whatever the kid wants to talk about and emphasize the importance of healthy relationships and conversations about any topic that is of interest to the kids. Much of the time I talk to kids about video games and music myself. They really need that from all adults. If a staff starts crossing boundaries such as giving medical, religious, or political advice, then that's a problem and I'll address that but other than that if a kid has a difficulty with a staff, then I help the kid work through it. I want the staff and teachers to just be regular, caring people with their own personalties and my job is to help the kids deal with them more often than the other way around. Healthy relationships are therapeutic. If the kids like you and you are being appropriate with them, then you are helping. Sometimes it's as simple as that. When there are problems in a relationship with a kid, then consult with the psychotherapist and hopefully they can guide you.

 

[MAClinician]

when I was the masters level clinician I would ask my "skill builders" to work on a variety of skills that need more practice than a 1 hour weekly therapy session can provide. Skills such as identifying and expressing feelings, communication skills (body language, tone of voice, what you say vs how you say it etc), relaxation skills (deep breathing, muscle relaxation, guided imagery), problem solving and recognizing consequences, identifying alternate solutions, coping skills practice, initiating conversations with others, learning to compromise and conflict resolution skills. Making friends and keeping friends. For older teens they focused on job skills (how to fill out applications, interviewing, attire for interviews, skills needed to keep a job), drivers Ed process, money management (opening bank account, understanding interest and bank fees, balancing and writing checks, budgeting), and college readiness. Hope that gives you an idea and you can collaborate w others.

 

[Lisbet85]

Is this an OK place to just talk shop? I'm just looking for some people to talk to other than my coworkers about cases/tell funny stories/get advice/etc. Is there a better forum for this? It seems like every thread here is "How do I get into X program."

As a for instance, I've got a case where the kid states "Everyone thinks I'm a bad kid but I really just can't control it." It'd be easy to dismiss this as the kid looking for excuses, but the kid's mental health/trauma history makes me a lot more sympathetic. If that's the case, I've got bugger all idea what to do. How do you help a kid control something he may legitimately not have control over?

I think it is OK to talk as long as it does not breach confidentiality agreement. If you are not sure, it may be best to get an explicit permission from your client.

 

[erg923]

I think it is OK to talk as long as it does not breach confidentiality agreement. If you are not sure, it may be best to get an explicit permission from your client.

No