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Help Starts HereThu, 01 May 2014 17:46:05 +0000en-UShourly1http://wordpress.org/?v=4.0.6Health Reform Tips for Consumershttp://www.helpstartshere.org/health-and-wellness/healthy-lifestyles/health-reform-tips-for-consumers.html
http://www.helpstartshere.org/health-and-wellness/healthy-lifestyles/health-reform-tips-for-consumers.html#commentsThu, 14 Feb 2013 17:13:45 +0000http://www.helpstartshere.org/?p=9252A Consumer’s Guide to the2014 Affordable Care Act Changes The Affordable Care Act, signed into law in 2010, has already made meaningful improvements to the U.S. health care system and has established a number of consumer benefits. The ACA’s most significant feature begins on January 1, 2014, when many uninsured Americans will have access to...

The Affordable Care Act, signed into law in 2010, has already made meaningful improvements to the U.S. health care system and has established a number of consumer benefits. The ACA’s most significant feature begins on January 1, 2014, when many uninsured Americans will have access to health insurance, some for the first time. Here’s a primer on how the law might affect you.

WHAT PARTS OF THE LAW ARE NOW IN PLACE?

Individuals and families can apply for and purchase coverage on the health insurance exchanges (also called “marketplaces.”)

Insurers cannot deny you coverage based on a pre-existing medical condition.

In most cases, preventive services such as annual check-ups, mammograms, and cholesterol
screenings will be available with no out-of-pocket costs.

Health plans can’t cancel your coverage once you get sick – a practice known as “rescission” – unless you committed fraud when you applied for coverage.

Insurers have to provide rebates to consumers if the companies spend less than 80 to 85 percent of premium dollars on medical care.

I DON’T HAVE HEALTH INSURANCE BUT WANT TO SIGN UP.WHAT DO I NEED TO DO?

Visit healthcare.gov, the federal health care enrollment website. The website will provide you with information about health plans available in your state, as well federal subsidies you may qualify for. For best results, try to use healthcare.gov during morning, evening, and weekend hours. The middle of the day is the busiest time for the site, which can sometimes mean slowdowns or waiting times. You have until March 31, 2014 to enroll in a health insurance plan, after which, you may incur a penalty for not having health coverage. The next open enrollment period is November 15, 2014 – January 15, 2015.

HOW CAN I COMPARE HEALTH PLANS ON THE EXCHANGE?

The health insurance plans sold on the exchange are grouped together in four categories so you can compare them easily: Platinum, Gold, Silver, and Bronze. The different plans have different levels of monthly costs and out-of-pocket costs. The most expensive are the Platinum plans, which offer the most benefits and less out-of-pocket costs when you get care; while the Bronze plans have the lowest monthly costs but higher out-of-pocket expenses when you get your health care services.

I WANT HEALTH INSURANCE BUT I CAN’T AFFORD IT.WHAT CAN I DO?

Depending on your income, you might be eligible for Medicaid, the federal-state health insurance program for low-income people. Before the health law was passed, most states offered Medicaid coverage only to children under 18, pregnant women, the elderly and disabled individuals. But now, states have the option to offer Medicaid coverage to anyone with an income at or lower than 138 percent of the federal poverty level (about $16,000 for an individual or $32,500 for a family of four based on current guidelines). Currently, 25 states and the District of Columbia have chosen to expand Medicaid eligibility. The remaining states have the option to expand their Medicaid programs at any time.

WHAT IF I MAKE TOO MUCH MONEY FOR MEDICAID BUT STILL CAN’T AFFORD INSURANCE?

You might be eligible for government subsidies to help you pay for private insurance plans sold in the exchanges. These subsidies will be available for individuals and families with incomes between 100 percent and 400 percent of the poverty level, or about $11,490 to $45,960 for individuals and $23,550 to $94,200 for a family of four (based on current guidelines).

If you earn less than 100 percent of the poverty level and live in a state that does not expand its Medicaid program, you generally cannot qualify for a subsidy to purchase coverage.

I GET MY HEALTH COVERAGE AT WORK AND WANT TO KEEP MY CURRENT PLAN. WILL I BE ABLE TO DO THAT? HOW WILL MY PLAN BE AFFECTED BY THE HEALTH LAW?

If you get insurance through your job, it is likely to stay that way. But your employer is not obligated to keep your current plan and may change premiums, deductibles, co-pays and network coverage. The law has already made several changes to employer-sponsored insurance, including a guarantee that an adult child up to age 26 can stay on her parents’ health plan.

Some existing plans, if they haven’t changed significantly since passage of the law, do not have to abide by certain parts of the law. These are known as “grandfathered plans.” If you’re currently in one of these plans and your employer makes significant changes, such as raising your out-of-pocket costs, the plan would then lose its grandfathered status and have to abide by all aspects of the health law.

CAN I PURCHASE INSURANCE ON THE EXCHANGE IF I HAVE EMPLOYER-BASED INSURANCE?

You can purchase insurance on the exchange, but in most cases, you will not qualify for federal subsidies.

I’M OVER 65. HOW DOES THE LEGISLATION AFFECT SENIORS?

Medicare is not included in the new health insurance exchange system, so there is no need for you to enroll in an exchange health plan. But the law does make other changes to Medicare. It is narrowing a gap in the Medicare Part D prescription drug plan known as the “doughnut Hole.” The law also expands Medicare’s coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit.

WILL I HAVE TO PAY MORE FOR MY HEALTH CARE BECAUSE OF THE LAW?

It depends. Younger people who often paid less for health insurance before the health law may pay more for coverage. Older people may pay less because there are tighter rules governing how much more insurers can charge based on age. People who could not afford insurance before may now be eligible for subsidies to cover the cost of premiums – and possibly out-of-pocket costs as well. Individuals who purchased insurance before may pay more because the law’s “essential health benefits” require that more services be covered.

]]>http://www.helpstartshere.org/health-and-wellness/healthy-lifestyles/health-reform-tips-for-consumers.html/feed0Parenting Techniques for Teaching Empathy to Childrenhttp://www.helpstartshere.org/kids-and-families/healthy-parenting/healthy-parenting-tip-sheet-parenting-techniques-for-teaching-empathy-to-children.html
http://www.helpstartshere.org/kids-and-families/healthy-parenting/healthy-parenting-tip-sheet-parenting-techniques-for-teaching-empathy-to-children.html#commentsTue, 18 Dec 2012 15:37:26 +0000http://www.helpstartshere.org/?p=9095Introduction Wouldn’t it be simple if you could just say to your kids, “Now look you guys, be empathetic!?” The blank looks you would get would be enough to let you know that a different starting point might be more effective. How you go about teaching empathy depends on the age of the child and...

Wouldn’t it be simple if you could just say to your kids, “Now look you guys, be empathetic!?” The blank looks you would get would be enough to let you know that a different starting point might be more effective. How you go about teaching empathy depends on the age of the child and your own personal parenting style.

The world of little ones revolves around them. Older kids may have some working knowledge of what it means to have empathy. However, if you tailor the following ideas to age and understanding, you will be able to give your children some basic skills for understanding and employing empathy.

One of the first concepts to teach is that everyone’s mind is their personal territory and we cannot read someone’s mind. What you are thinking might not be what the other person is thinking. But you can imagine what it might be like to be experiencing what someone else is experiencing. In addition it can be helpful to differentiate sympathy from empathy. Simply, empathy is feeling “with” and sympathy is feeling “for” someone. While the terms are often used interchangeably, empathy involves the idea of being able to mentally experience what the other person is actually experiencing.

Tools:

Read, play, and discuss real life situations.

Depending on age, experiencing situations indirectly or directly and debriefing are the best ways to teach a concept that has to do with an internal experience. With the little ones, you can use stories from books or ones you make up. After the story discuss along lines of “how do you think the little bunny might have been feeling when . . .?”

You can play out scenarios with younger and latency age kids. Discussion embedded into play, and afterward too, can be effective. When tweens and young teens “get into a fight” you can debrief more fully, using a no-shame/no-blame approach. “How did that situation make you feel? How do you think (the other person) might have felt? How might you feel in that situation?”

With older teens you can name the state of “empathy.” You can do that also with littler ones too, but sometimes they understand the idea more effectively as “The Golden Rule—Do unto others as you would like them to do unto you.” Children are almost always able to grasp how they would want to be treated in a given situation.

And of course, model, model, model with your own behavior.

Children are listening and paying attention. They will take in your words and mimic your behavior. Make a point of letting them overhear empathetic conversations. Even invite older ones in. Your behavior and your way of dealing with others is your best parenting tool for teaching what you want children to learn.

]]>http://www.helpstartshere.org/kids-and-families/healthy-parenting/healthy-parenting-tip-sheet-parenting-techniques-for-teaching-empathy-to-children.html/feed0Reparative Therapy Q&A With Dr. Michael Ian Rothenberg, LCSWhttp://www.helpstartshere.org/kids-and-families/healthy-parenting/reparative-therapy.html
http://www.helpstartshere.org/kids-and-families/healthy-parenting/reparative-therapy.html#commentsThu, 29 Nov 2012 18:51:45 +0000http://www.helpstartshere.org/?p=9063Introduction Dr. Michael Ian Rothenberg, LCSW holds a faculty appointment at the University of Central Florida School of Social Work where he teaches courses in Human Sexuality and Child Abuse Treatment and Prevention and is the Founder and Clinical Director of the Center for Counseling and Sexual Health of Winter Park (Orlando), Florida where he...

Dr. Michael Ian Rothenberg, LCSW holds a faculty appointment at the University of Central Florida School of Social Work where he teaches courses in Human Sexuality and Child Abuse Treatment and Prevention and is the Founder and Clinical Director of the Center for Counseling and Sexual Health of Winter Park (Orlando), Florida where he provides counseling and therapy for straight, LGBT, gay, lesbian, bisexual and transgender adults, children and adolescents and specialized treatment for sexual addiction, pornography addiction, hypersexual behaviors and male survivors of childhood sexual abuse. Dr. Rothenberg has served as a keynote speaker, conference presenter, guest lecturer and panel participant at venues including Yale University, Peking University (Beijing, China) and The German Society for Social-Scientific Sexuality Research (Munich, Germany).

Q. Dr. Rothenberg, three LGBT organizations have protested Dr. Oz’s recent program on Reparative Therapy. As a psychotherapist, you have counseled many LBGT clients but you will not offer reparative therapy? What are your principal objections to it?

As a social worker and a psychotherapist I have, first and foremost, a professional obligation to do no harm to my clients. Reparative, or conversion therapy, as it is also known, has been proven, through studies and through client self-report to be inherently detrimental to the psychological health and overall well-being of many gay and lesbian individuals. Including children, adolescents and adults.

In order to advocate for the many LGBT clients whom I serve as well as bring attention to the detrimental nature of this divisive issue, I have taken the additional step of adding the following statement to all of my professional websites “Dr. Rothenberg does not support the practice of reparative therapy and will not provide referrals to mental health practitioners and medical professionals who do support this harmful practice”.

Q. What would you say to people who have had reparative therapy and now says they are “cured?”

In order to cure an individual, one must first be considered ill and individuals who identify as gay or lesbian are neither ill nor are they suffering from a sickness that is in need of being cured. As a board certified clinical sexologist and specialist in human sexuality and sexual behavior who has worked with many hundreds of gay and lesbian individuals, I can definitely attest that a person’s sexual orientation is not, nor is it ever, a choice.

The individuals who make these claims might choose, for themselves, not to engage in certain sexual behaviors but it does not change one’s sexual orientation. To promote the claim that this is possible, or even an option, creates a precarious, dangerous and psychologically harmful situation for gay and lesbian children and adolescents who are exploring, understanding and coming to terms with their sexual identity.

Q. How would you counsel someone who is struggling with their sexual identity?

When working with clients who are struggling with their sexual identity or sexual orientation, I would always normalize their feelings and would strive to help them to find a safe place to explore the thoughts and feelings that can often be troubling and confusing.

Proponents of reparative therapy are, in effect, telling young people that what they’re feeling is not accurate and the very harmful, underlying, message that young people are receiving is that you are not good enough just as you are. As a social worker and a psychotherapist, the message that I would strive to convey is, entirely, quite the opposite.

John D. Weaver, LCSW, BCD, ACSW is a founding partner of EYE OF THE STORM, Inc. (Nazareth, PA), a company that provides private mental health consultation and training services. The firm specializes in disaster mental health, crisis intervention, and risk management related training and support. He also works as a part-time therapist for Concern (Bethlehem, PA). Mr. Weaver previously worked as a Casework Supervisor and the Disaster Crisis Outreach and Referral Team Coordinator for Northampton County Mental Health (Bethlehem, PA). He has served as a member of the Adjunct Faculty for DeSales University’s ACCESS program (Center Valley, PA), Marywood University’s Graduate School of Social Work (Lehigh Valley, PA), and the Psychology Department of Northampton Community College (Bethlehem, PA). Mr. Weaver received his undergraduate degree in Psychology from Moravian College, Bethlehem, PA and his Master’s Degree in Social Work from the University of Pennsylvania, Philadelphia, PA.

Q. Mr. Weaver, you are a social worker with many years of disaster relief experience. Earlier this week you were a shelter manager with 88 people in your facility. What was that like?

This was an exciting extension of my work as a volunteer with the Red Cross Disaster Mental Health (DMH) team. I’d been working the disaster from home as a virtual volunteer – a new role supporting disaster victims and relief workers who were sharing experiences via social media. My power went off, putting a stop to that. The next day, when power was still off, I drove over to our chapter to help out in any way I could. All of our management people were stressed and tired. Most needed some uninterrupted sleep and I’d already gotten mine. I told the shelter manager I’d cover for her and she took me up on the offer.

Q. Did anything surprise you about the people in your shelter?

No. I’ve worked shelters many times and people tend to react to disaster stress in similar ways. We see a mix of emotional reactions including numbness, anger, fear, sadness, and grief. Folks are always thankful to be safe and worried about what will happen next.

Q. What are the most common reactions? How do children and the elderly cope, for example?

Disaster stress reactions may include changes in appetite, poor sleep, anxiety, depression and possible crying spells, short temper, and questioning of faith. Children and teens have similar reactions and may regress a bit in their behavior (e.g., young ones may use baby talk, return to thumb sucking, or have some bed wetting). Older persons may show increased confusion and disorientation, a reaction to loss of familiar surroundings, routines and supports. All of this is normal in the short run following a major disaster.

Q. Have you found that men and women are equally resilient?

Yes, most people are very resilient. In the moment, the disaster takes control of their lives, knocking them down but not out. Most people discover inner strength and rely upon one another for peer support to get back on their feet, retake control of their lives, and rebuild.

Psychologically speaking, disaster victims are forever changed by the events – they’ll never forget the sights, sounds, and smells they experience – but they are not damaged by the events. In fact, years later most people think they are stronger, tougher, and wiser in the aftermath of disasters.

Q. Could families bring their pets to your shelter?

Yes, we were working with a partner animal response agency that operated a shelter for pets in a building next to us. People would bring in their pets (and pet food), register them, be photographed, and receive an arm band with the pet’s ID number. This assured safety — only they could visit and eventually retrieve the pets — while avoiding problems with allergies and accidents that might happen if the pets were commingled with the people. Years ago, before we had this partnership, people often opted to stay home or in their own cars, rather than shelter without their pets.

Q. How do you expect families who lost much of their property to deal with this event as they re-build?

Rebuilding after a disaster is like moving forward after you’ve lost a loved one who has died. It is a long, slow process that involves grieving the losses, rebuilding the home (or resettling to a different one), replacing lost things (photos, videos, furniture, books, art, holiday decorations, etc.), and reconnecting with life. I expect most people will be surprised that this process takes so long – typically takes two to seven years – and can involve new disasters (e.g., finding out their insurance coverage wasn’t what they thought it was and that outside help from charitable organizations and government will not make them whole). Nevertheless, I expect most will survive and, in time, come to thrive. For now, there will likely be more tears than laughter, but that will gradually change too. Most disaster survivors eventually can look back and brag about what they went through and overcame as they moved forward.

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The Red Cross has several ways volunteers can help the victims of Hurricane Sandy. Please click here to learn more.

]]>http://www.helpstartshere.org/kids-and-families/family-safety/resiliency-and-hurricane-sandy-victims-qa-with-disaster-mental-health-specialist-john-weaver-lcsw.html/feed0Weight Bullying: Body Image Q&A with Judith Matz, LCSWhttp://www.helpstartshere.org/kids-and-families/schools-and-communities/weight-bullying-body-image-qa-with-judith-matz-lcsw.html
http://www.helpstartshere.org/kids-and-families/schools-and-communities/weight-bullying-body-image-qa-with-judith-matz-lcsw.html#commentsTue, 09 Oct 2012 16:03:18 +0000http://www.helpstartshere.org/?p=9044Introduction Judith Matz, LCSW is an Illinois-based Licensed Clinical Social Worker (LCSW) with more than 25 years of experience as a therapist who helps people to end overeating. Ms. Matz specializes in the treatment of Binge Eating Disorder (BED), compulsive eating, and emotional overeating. She is the director of the Chicago Center for Overcoming Overeating, Inc., an organization dedicated to ending...

Judith Matz, LCSW is an Illinois-based Licensed Clinical Social Worker (LCSW) with more than 25 years of experience as a therapist who helps people to end overeating. Ms. Matz specializes in the treatment of Binge Eating Disorder (BED), compulsive eating, and emotional overeating. She is the director of the Chicago Center for Overcoming Overeating, Inc., an organization dedicated to ending the preoccupation with food and weight through educational programs and workshops. Ms. Matz is co-author of:

Q. Ms. Matz, you have been a social worker and psychotherapist specializing in body image for many years. Does the public reaction to the incident involving the overweight newscaster who received a negative e-mail from a viewer surprise you? Is there more acceptance of a variety of body types than there was 20 years ago, for example?

What’s surprising is to see someone speak out so publicly about weight bullying. Given our culture, people who are “overweight” and “obese” feel so much shame, and news anchorwoman Jennifer Livingston was very courageous to tell viewers about her experience. I’m pleased to see so much attention being brought to this issue; the message is now out there that criticizing and shaming people about their body size is unacceptable. Clearly she struck a chord given the national focus on her video as she spoke to how her personal experience is part of a greater societal problem. I hope that attention to this issue will continue.

Q. What has brought about this change in public opinion of overweight people? Is it a reaction against extreme skinniness and awareness of eating disorders? A greater public awareness of the effects of bullying?

I agree that there are several factors that contributed to the strong reaction we’re seeing. On the one hand there is greater awareness that the constant focus on thinness in our culture creates body image problems, disordered eating patterns, and eating disorders. These messages affect not only adults, but our nation’s children and teens as well. At the same time, “anti-obesity” messages have never been stronger, and the discrimination and shame that results also have a negative impact on physical and emotional health. While there is much attention paid to bullying in the media, campaigns have not gone far enough to include the issue of weight as a significant source of bullying for kids and adults.

Fortunately, an increasing number of professionals and lay people are identifying weight bullying and discrimination as problems that need to be addressed. Understanding that people naturally come in all shapes and sizes, that weight is not as malleable as we like to think, that diets are ineffective for the great majority of people, that weight does not equal health, and that healthful behaviors can be practiced at any size is part of a new paradigm, known as Health At Every Size, that is gaining national recognition.

Q. Given that there is an obesity epidemic in this country, what would you say to someone who chided an overweight person regarding their weight?

Judging a person based on their body size is nothing short of stereotyping. You cannot tell anything about the health status of a person simply by looking at them. There are people who are fat and healthy just as there are people who are fat and unhealthy. Likewise, there are people who are thin and healthy, just as there are people who are thin and unhealthy. As Jennifer Livingston suggested, people are much more than the number on the scale. In fact, it turns out she participates in marathons! I found it ironic that the man who bullied her stated she was a poor role model for young people; I imagine that there are thinner news anchors on TV who engage is unhealthy practices – perhaps skipping meals or purging – to stay thin; yet the assumption is that if they are thin, they must be healthy.

I’m thrilled to see Jennifer Livingston, a woman of size, become a role model for all of us. As a society, we no longer tolerate negative comments, discrimination and bullying based on race, ethnicity, religion or sexual preferences. The time has come for us to add weight stereotyping to the list – in fact, it is long overdue.

Q. How do therapists like you help clients dealing with body image issues?

On the one hand, it’s important for people to realize that their self-worth is much broader than the number on the scale. At the same time, we live in a culture where being thin is associated with being happy, healthy and successful, so it’s no wonder that very few people, and especially women, truly feel good about their bodies.

Helping people build a stronger body image takes place at many levels. It means challenging the cultural messages – as Jennifer Livingston did – and understanding factors such as how advertisers actually photoshop models to appear much thinner than they really are.

It also means learning to take good care of one’s body by practicing sustainable behaviors such as a healthy relationship with food, physical activity, good sleep patterns, managing stress, etc. (and these practices will vary from person to person.) We encourage people to make sure they have clothes they like at their current size, and to stop putting life on hold until they lose weight.

But the most powerful tool to help people transform their negative body image into a positive one is to raise their awareness of the critical and harsh statements they tell themselves about their body. If you ask someone struggling with body image to write down their negative body thoughts, it turns out they say things to themselves that they would never say to a friend. We teach that: “If yelling at yourself worked, you’d be thin by now!” Instead, people learn to replace their internal criticism with words of compassion. It takes time, but the payoff is well worth the effort.

]]>http://www.helpstartshere.org/kids-and-families/schools-and-communities/weight-bullying-body-image-qa-with-judith-matz-lcsw.html/feed0Attention Deficit Disorder Versus Attention Deficit Hyperactivity Disorder — Q&A With William Shryer, LCSW, BCDhttp://www.helpstartshere.org/mind-spirit/attention-deficit-and-hyperactivity/adhd-current-trends-attention-deficit-disorder-versus-attention-deficit-hyperactivity-disorder-qa-with-william-shryer-lcsw-bcd.html
http://www.helpstartshere.org/mind-spirit/attention-deficit-and-hyperactivity/adhd-current-trends-attention-deficit-disorder-versus-attention-deficit-hyperactivity-disorder-qa-with-william-shryer-lcsw-bcd.html#commentsTue, 24 Jul 2012 18:54:35 +0000http://www.helpstartshere.org/?p=9010Introduction William Shryer is the Clinical Director of Diablo Behavioral Health Care in Danville, CA. Mr. Shryer earned his BA degree in Sociology at California State University in Hayward. He received his MSW from the University of California at Berkeley specializing in Children and Families. Mr. Shryer has been in private practice since 1981 specializing...

William Shryer is the Clinical Director of Diablo Behavioral Health Care in Danville, CA. Mr. Shryer earned his BA degree in Sociology at California State University in Hayward. He received his MSW from the University of California at Berkeley specializing in Children and Families. Mr. Shryer has been in private practice since 1981 specializing in Autistic Spectrum Disorders, Mood Disorders, and the Anxiety Spectrum in children, adults and their families. Mr. Shryer has lectured frequently to college classes and professionals in the areas of ADD and Autistic Spectrum disorders and their implications in the educational setting. He has been active in a number of CHADD chapters. Mr. Shryer manages three behavioral clinics with a staff of MD’s, Counselors, Clinical Psychologists, and Special Education teachers. He has been the moderator on CCTV, (Contra Costa Television) for both “Mental Health Perspectives”, and “With the Family in Mind” which discussed topics such as Asperger’s Disorder, Autism, Bipolar disorder and Attention Deficit Disorder in children and adults.

Q. Mr. Shryer, you have many years of experience working with children who have been diagnosed with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). Would you please define and describe the difference between the two?

The difference between the two has to do with the behaviors a child may exhibit. For example, boys are more likely to show signs of being hyperactive (ADHD) while girls are more like to have trouble paying attention and staying focused (ADD). And because a girl’s ADD symptoms may be less noticeable and less disruptive in the classroom, they are more likely to get missed because in the schools it’s the squeaky wheel that gets the grease. While both boys and girls can exhibit the same behaviors it is just more common that hyperactivity is seen in boys. Now for the why, this may be a genetic neurotransmitter phenomenon that is still poorly understood.

The main factor that gets missed when children are diagnosed is that we are dealing with a disorder that is primarily one of inattention and short term memory. This seems to get lost and many seem to think that hyperactivity and attention deficit are the same thing and they are not. The medications used to treat inattention work very well. Stimulants are still the gold standard, while other medications such as atomoxitine are second tier approaches. Food, diet, therapy, supplements seem to do very little other than having some placebo effects. A highly structured learning environment can assist the student, but not directly impact the ADHD. Knowing what is ADHD and what is not is the exception and not the norm and this feeds right into the next question.

Q. In your practice have you had clients referred to you who have been mis-diagnosed? Why is there confusion even among well-trained clinicians?

I would have to say that the majority of patients referred to us have been mis-diagnosed. This can be summed up very easily as the main reason for all of this is a poor or inadequate history. So many therapists don’t spend the time delving into the family history. ADHD is highly genetic and it tends to be sex linked meaning it is more likely to go from mother to daughter and father to son than mother to son, etc. I always say that it is important to know the difference between deficits of attention and attention deficit disorder.

Children and teens with deficits of attention can exhibit the same behaviors as a person with ADD or ADHD when they actually have a type of Obsessive Compulsive Disorder. These children are too busy in their heads thinking or obsessing about irrelevant things that take the priority rather than school work, for example. Also, a depressed child will not be able to pay attention due to sadness and a child or teen with Asperger’s Disorder cannot pay attention due to having too much fun thinking about dinosaurs, vacuum cleaners or quantum physics.

Children with mood disorders such as bipolar disorder often have co-occurring attentional issues, often due to the speed at which thoughts are flying through their brain. The confusion that exists even between well trained clinicians is perhaps due to the fact that they have forgotten the importance of treating more than just the tip of the iceberg.

Q. How are the two conditions different in adults? What behaviors are typical for each?

In adults the difference between ADHD and ADD is often hard to spot due to the fact that the hyperactivity of childhood gives way to more of a sense in internal restlessness. For many women in the US with poorly treated or un treated ADHD there is a sense of depression. Often they may seem to be depressed and we have found that when properly treated for their ADHD their depression is resolved. Untreated or poorly treated ADHD in adults is a huge problem and there are still many clinicians that believe that this disorder goes away at puberty. Some of the symptoms of adult ADHD are memory problems, poor follow through, going off topic during a conversation, interrupting, social skills difficulties, etc.

Q. How is each treated?

Both conditions are treated the same with attention being paid to any co-occurring conditions. The gold standard is still psychostimulants such as mixed amphetamine salts also known as Adderall, methylphenidate preparations also known as Ritalin. There are many variations of these and the old fashioned and generic such as dexadrine tablets and longer acting dexadrine spansuls work just as well as the far more expensive preparations.

Q. Mr. Shryer, would you please recommend some resources for those interested in learning more about ADD and ADHD?

A excellent article by Gayle Zieman, PhD givez a good overview of ADHD from a variety of perspectives. It can be found at http://www.ziemang.com/pnm_articles/9903adhd.htm The website for Children and Adults with Attention Deficit Disorder at www.CHADD.org and the website of Diablo Behavioral at www.behaviorquest.com and click on “Concerns and Symptoms and then onto Attention Deficit Disorder. Also on the website by clicking on “Resources” then clicking on Attention Deficit Disorders will put you into many resources for ADHD.

]]>http://www.helpstartshere.org/mind-spirit/attention-deficit-and-hyperactivity/adhd-current-trends-attention-deficit-disorder-versus-attention-deficit-hyperactivity-disorder-qa-with-william-shryer-lcsw-bcd.html/feed0Teaching Kids Conflict Resolutionhttp://www.helpstartshere.org/kids-and-families/healthy-parenting/kids-and-conflict-resolution.html
http://www.helpstartshere.org/kids-and-families/healthy-parenting/kids-and-conflict-resolution.html#commentsTue, 17 Jul 2012 14:33:33 +0000http://www.helpstartshere.org/?p=9006Introduction Conflict is normal, and kids can be taught how to handle it effectively. Key ideas to teach kids are that conflict is normal and handling it does not mean always getting your way. Teach kids what compromise means, and use this three-pronged approach to teach them how to resolve conflict appropriately. Familiarize Yourself with...

Conflict is normal, and kids can be taught how to handle it effectively. Key ideas to teach kids are that conflict is normal and handling it does not mean always getting your way. Teach kids what compromise means, and use this three-pronged approach to teach them how to resolve conflict appropriately.

Familiarize Yourself with These Five Basic Strategies of Conflict Resolution

Stick with facts

Use “I” messages

Listen with empathy

Brainstorm choices

Separate problems versus people

Focus on the present

Teach and Train Children How to Use These Strategies at Their Age Level

Young kids are concrete. Older kids can understand more abstract concepts. Depending on the ages of the children you are teaching you can make these strategies nuanced or matter-of-fact. Encourage kids to stick with facts by teaching them to focus on the problem to be solved without bringing in past things that have happened, or referring to other friends by saying things like, “Bobby says I’m right!!” Or “You’re wrong! Even Susie says so!”

Focusing on facts and using “I” messages lead to a focus on the present.

Train kids to refrain from saying things like “But, Once, YOU did____________.” Or “You always act like a jerk!” Rather teach them to say things like, “I think________is a good idea. What do you think?”

Kids, especially older kids, can be taught the concept of empathy. Suggest they put themselves in the other person’s position and then imagine how things would seem from the other person’s point of view. To teach empathy parents can read and discuss, (or make up) stories, discuss movies or TV shows with the kids, and/or talk about life examples. Little kids can play out scenarios with their stuffed animals.

When empathetic listening is used, kids will be learning how to stay with the facts, and the focus will naturally be on problems not on people, which is a key concept in resolving conflict. To help them learn this, you can teach the kids to discuss choices without saying things like, “That’s lame!” or “That’s a stupid thing to do!” Or “You’re lame!”

It is recommended that adults write down the choices when resolving conflict.

While that can be useful with older kids, it may be less effective with little ones. However, if children are having a hard time keeping track of the choices, as littler ones might, an adult could scribe for them, and review the choices with them.

To teach and train children about conflict resolution, it is necessary to be involved in a good deal of their interpersonal doings. When as a parent you know what is going on with the your child, you can be proactive in directing and redirecting behavior based on the above strategies, and available to discuss the conflict resolution skill involved.

Model These Strategies by Using Them in Your Own Affairs.

Your kids will watch what you do. The more you use conflict resolution strategies yourself, particularly when it arises with the kids and you, the more likely your kids will be to be able to use them.

NOTE: Adults are advised to call for a mediator or agree to disagree if the conflict can’t be resolved. The equivalent for kids is for them to ask a safe adult for help, or when appropriate, agreeing to disagree under the supervision and direction of an adult.

]]>http://www.helpstartshere.org/kids-and-families/healthy-parenting/kids-and-conflict-resolution.html/feed0Strategies to Help Sarcastic Kidshttp://www.helpstartshere.org/kids-and-families/healthy-parenting/sarcastic-kids.html
http://www.helpstartshere.org/kids-and-families/healthy-parenting/sarcastic-kids.html#commentsMon, 09 Jul 2012 14:48:25 +0000http://www.helpstartshere.org/?p=9002Introduction As kids hit latency age and the ‘tween years, when peer pressure builds, they can become sarcastic with friends and/or family, thinking it is cool to respond with wisecracks or the most current equivalent to “Well, Duhhhh!” that they have heard on a TV show or on the web. Things get even more tricky...

As kids hit latency age and the ‘tween years, when peer pressure builds, they can become sarcastic with friends and/or family, thinking it is cool to respond with wisecracks or the most current equivalent to “Well, Duhhhh!” that they have heard on a TV show or on the web. Things get even more tricky when the sarcastic comments are witty, which they can be. If their friends laugh, the attention can reinforce the sarcastic behavior making it more difficult to combat; however, it is possible to combat sarcasm.

I recommend a three-pronged approach that parents can use to combat sarcasm.

Teach pro-social skills.

Develop positive self –esteem.

Structure your home life atmosphere in a way that models respect and fairness, and discourages sarcasm or even teasing that carries a stinger.

Pro-social Skill Development

Kids can be taught how to be a friend and how to keep a friendship. Watch TV shows with them, and notice/point out anything that depicts sarcasm. Then you might have a discussion that encourages “empathy,” the ability to see another’s perspective by imagining yourself in their place.

Questions such as, “How do you think (the character being the target of sarcasm) felt when (the character being sarcastic) said, “You’re (gay, queer, weird, etc.)? You can also teach social skill development with books that have object lessons. “the Self Esteem Shop” online carries many books of this nature.

Also, pay attention when your older child has a “play” date with a friend at your home. You can interrupt and re-direct if you hear words, tone or even see facial expressions that express sarcasm. Slightly older children, such as fourth, fifth graders, and middle schoolers are beginning to place great stock in peer relationships. Talk to your children about your values re how you believe friends should treat one another.

To develop social skills, ask them questions about how they want friends to treat them. Be aware of the emotional underpinnings of sarcasm. Often it can point to low self-esteem or an upset. Putting someone else down to build up the Self is not an uncommon strategy. You might comment like this: “I noticed you were sarcastic to (so and so). Sometimes people are sarcastic when something is bothering them, I wonder if something might be bothering you.”

Positive Self-esteem Development

How you interact with your child will go a long way to combating sarcasm. Use realistic and specific praise for the behaviors you wish to reinforce, such as respectful interacting.

Your child’s self-esteem is directly related not only to parents’ words, but also to the tone of voice. Encourage self-esteem by refraining from sarcasm about your child or about a child’s mistakes or awkward efforts at something new.

You can normalize missteps and mistakes by referring to them as “just the way we all learn.” Follow up with, “What can you do differently next time?”

Redirecting is particularly important when your child is sarcastic to you, to a sibling or to a friend. Being sarcastic back will reinforce the behavior even though it may seem like a natural object lesson. Redirect the behavior by asking, something like,“ Can you say that to (the individual) in a more respectful way, please.”

Home Life Atmosphere

This is a category in which parents really have some power to model the type of behavior they want to elicit from their children. Children will mimic what they see and hear. When parents commit to an atmosphere of non-sarcasm, fairness and respect in dealing with each other, with their children and with family friends and others, the pro-social, self-esteem lessons will be structured in.

In your home life, you have golden opportunities to use discipline (not punishment) to guide your children to non-sarcastic behavior. Use a no-shame, no-blame approach. For example, if your child begins a conversation with a sarcastic remark about you, you might say something like, “We can have a conversation when you speak to me respectfully.”

When a child is sarcastic, it is normal to want to reprimand, or be sarcastic back, but those responses can produce shame, which leads to low esteem and possibly more sarcasm.

Think in terms of correcting course and redirecting behavior. For example,

When your child says, “You’re a…………..” or just uses a “tone” you can employ comments like these:

What you just said hurt my feelings. Can you say that in a kinder way?

Put yourself in ( )’s position. How do you think you would feel if someone said to you what you just said to her?

You can also call out the sarcasm by naming it. Try saying something like:

“Speaking sarcastically is not going to get you what you want. Please say it again a different way.” (Remember if you say you will or won’t do something until the sarcasm ends, be sure to follow through.)

Bear in mind: children learn what they live. If you are sarcastic to them, they will learn to be sarcastic. Your own behavior is your best ally.

And remember to keep from laughing even if you think a sarcastic comment is funny.

]]>http://www.helpstartshere.org/kids-and-families/healthy-parenting/sarcastic-kids.html/feed0Veterans Affairs Current Trendshttp://www.helpstartshere.org/landing-page/veterans-affairs-current-trends.html
http://www.helpstartshere.org/landing-page/veterans-affairs-current-trends.html#commentsFri, 06 Jul 2012 19:40:24 +0000http://www.helpstartshere.org/?p=9001Training Social Workers to Help LGBT Military Service Members About Post Traumatic Stress Disorder (PTSD) and Brain Injury in Iraq’s War Veterans

]]>http://www.helpstartshere.org/landing-page/veterans-affairs-current-trends.html/feed0Training Social Workers to Help LGBT Military Service Members: Q&A with Michael Ian Rothenberg, PhD, LCSWhttp://www.helpstartshere.org/kids-and-families/veterans-affairs/veterans-affairs-current-trends-training-social-workers-to-help-lgbt-military-service-members-qa-with-michael-ian-rothenberg-phd-lcsw.html
http://www.helpstartshere.org/kids-and-families/veterans-affairs/veterans-affairs-current-trends-training-social-workers-to-help-lgbt-military-service-members-qa-with-michael-ian-rothenberg-phd-lcsw.html#commentsFri, 06 Jul 2012 18:26:17 +0000http://www.helpstartshere.org/?p=8999Introduction Dr. Michael Ian Rothenberg, LCSW holds a faculty appointment at the University of Central Florida School of Social Work where he teaches courses in Human Sexuality and Child Abuse Treatment and Prevention and is the Founder and Clinical Director of the Center for Counseling and Sexual Health of Winter Park (Orlando), Florida where he...

Dr. Michael Ian Rothenberg, LCSW holds a faculty appointment at the University of Central Florida School of Social Work where he teaches courses in Human Sexuality and Child Abuse Treatment and Prevention and is the Founder and Clinical Director of the Center for Counseling and Sexual Health of Winter Park (Orlando), Florida where he provides counseling and therapy for straight, LGBT, gay, lesbian, bisexual and transgender adults, children and adolescents and specialized treatment for sexual addiction, pornography addiction, hypersexual behaviors and male survivors of childhood sexual abuse. Dr. Rothenberg has served as a keynote speaker, conference presenter, guest lecturer and panel participant at venues including Yale University, Peking University (Beijing, China) and The German Society for Social-Scientific Sexuality Research (Munich, Germany).

Q. Dr. Rothenberg, you were recently invited to provide training for the U.S. National Guard on working with LGBT services members since the repeal of the military’s “Don’t Ask, Don’t Tell policy. Can you give us some background on this project and how it came about?

I was asked, as a specialist in human sexuality and sexual behavior, to present at the U.S. National Guard Psychological Health Services National Professional Development Conference, on “Lesbian, Gay, Bisexual and Transgender Service Members, Coming Out and Military Transitions since the Repeal of Don’t Ask, Don’t Tell” (DADT).

I was fortunate to have been afforded the opportunity to provide this specialized training to mental health practitioners who traveled from all across the United States, Puerto Rico and the U.S. Virgin Islands and who work, regularly, with LGBT service members and their families. Since the repeal of DADT, counseling and therapy for LGBT service members, related to challenges in the coming out process, has been, rightfully, recognized as an area of significance and importance.

As a clinical sexologist, I was heartened to participate in this training as, even as recently as one year ago, a presentation dedicated to the needs of LGBT service members would, likely, not have ever been offered. It is very encouraging to stand upon the precipice of change and, both, participate in and bear witness to important societal transformation.

Q. What points did you stress most in your training sessions?

We talked a great deal about the coming out process, itself, which I defined as understanding, accepting and valuing one’s sexuality and then, subsequently, sharing that knowledge and understanding of oneself with others. It was very important to help the attending mental health practitioners to observe that there is, actually, no right or wrong way to come out and the coming out process is, in fact, quite different for each LGBT individual.

When talking about the coming out process, I find it’s, sometimes, helpful to think about coming out in three different ways; firstly, coming out to oneself, then coming out to other LGBT people and establishing a support system and, then, coming out to straight people.

Q. What types of questions did the audience ask?

The audience was, mostly, concerned with helping LGBT service members and their families to find the appropriate assistance and support. As many practitioners do not have extensive experience in working with LGBT specific issues and the various challenges related to the coming out process, it’s important to help the practitioners understand basic needs and identify where to obtain assistance and support for, both, themselves and for their clients.

We also talked about the very harmful practice known as reparative therapy. I expressed that it was vitally important to let clients know, in no uncertain terms, that reparative therapy is never an option in working with LGBT clients. In fact, I have the following statement prominently featured on my own website “Dr. Rothenberg does not support the practice of reparative therapy and will not provide referrals to mental health practitioners and medical professionals who do support this harmful practice”. It is so very important that we, as social workers, and as mental health practitioners, create a safe environment and strive to do no harm to those clients who actively seek our help and support.

I was very glad to see that so many mental health practitioners had a real and genuine interest in attending this training and learning more about the needs of LGBT service members and the lesbian, gay, bisexual and transgender, family members whom they also serve.

Q. What would be your advice to an LGBT service person regarding being openly gay versus secretly gay?

“Don’t Ask, Don’t Tell” was in effect from 1993 until 2011 and was the official policy that prohibited the United States Military from harassing or discriminating against closeted gay, lesbian and bisexual service members but, at the same time, barred openly gay, lesbian and bisexual service members from serving at all. As such, it bred, in the U.S. Military, an environment of secrecy designed to keep individuals in the closet. Now that the policy has been repealed, there is an expectation, among some, that everyone is free to, and should, come out.

Although the policy has been repealed it is important to note that there is still no protection in the military against discrimination based on sexual orientation and there, still, exists unequal treatment of LGBT service members. I would suggest to LGBT Service members that it’s important to proceed in the manner that feels most right to them, taking careful time to explore and negotiate all options, as coming out is a very personal decision and there, truly, is no right or wrong way for an individual to come out.