DAY SEVEN
On day seven I shadaowed Colleen and was able to learn some new teqniques to help cope with performance anxeity. Colleen discussed the calming method called coping cat, which is a technique used with younger patients suffering from anxiety. The coping cat has four steps that the patient goes through to help reduce his or her anxiety. First, the patient is to try and recognize and understand their emotional and physical reactions to the source of the anxiety. For a theoretical example, a patient begins to have a panic attack and they recognize that it is because a new school year will be starting. The second step is to clarify thoughts and feelings in anxious situations, so the patient has recognized they are anxious over the new school year so why? They clarify their thoughts and realize that they are nervous because they will have class with people they don't know and will start the school year sitting by themselves. The third step is to make a plan to deal with their anxiety in an effective manner. This step means helping the patient recognize that they aren't in a new area so they will see their friends from last year at lunch or recess. To help deal with panic attacks that may pop up through the day, the patient was to go through a calming breathing sequence and calming thoughts to help slow their heart down. The breathing sequence for beginners is 3-3-6, the patient breathes in for three seconds, holds for three seconds and then breathes out for six seconds. The goals of this breathing method is to slow the patient's heart beat down helping calm down their bodily reaction to their anxiety and helping tell the patient's brain that they are safe. When the patient becomes older and or gets better at the breathing sequence, they can change the pattern to 4-4-8. The other part of the breathing sequence is as they go through the three parts they are to think of something that distracts them from their anxiety and makes them happy and calm. They can think of memories specific to the patient like a family pet or something universal like the Penguins winning the Stanley cup. The final step in the coping cat was evaluating the patients performance and giving them self reinforcement.
Another interesting case I had the opportunity to sit in on with Colleen was a session with a family going through PCIT training, parent child interaction therapy. During this training a family would work to Master the CDI skills which means that during a parent's special play time they have ten behavior descriptions, ten labeled praises, and ten reflections, while using less than three questions, commands and negative talk. The hardest part of the training for parents is when they have to ignore bad behavior. When the parent ignores the child banging the toy forcefully or climbing on the table, the child sees that the responses they were expecting didn't come with the bad behavior and they will try other tactics. By not giving the child a response, it decreases the bad behavior.
DAY EIGHT
Today in the office was a little different because there was a fourth year medical student visiting the offices who was considering a duel focus in family medicine and child psychiatry. She spent the day following the events in the office with me and talking to Dr. Schlesinger about her duel focus and the other locations in the area that focus on family practice and child psychiatry. Dr. Schlesinger took this student and myself on a tour of the other offices of Children's in the Pine Center, these other rooms are used by the behavioral health doctors for group therapy and some other area which were more focused on family medicine. After the tour, we came back to the TiPs offices and got to sit in on the team meeting. At the meeting they discussed updated information on policies, the upcoming newsletter and the replacement of one of the big doctors from the TiPS program. The first TiPs news letter, which was sent out to all family practices that are signed up through the TiPs program had been sent out in May 2017. The newsletter contained a psychiatry and trauma treatment article by one of the TiPs' doctors, upcoming visits to family practices that Dr. Schlesinger would be making, the new offices that had been enrolled, how care coordination works, yearly visits, trauma therapy, TiPS data and the TiPS team. The news letter is a great summary of all that TiPs can do and the newsletter shows how easy it is for family practices to get involved in the program.
While the meeting was finishing up, a consult was sent over for Dr. Schlesinger, so after the meeting was finished I had the chance to walk through another consult with her. This consult was emailed to her but because it was part of a TiPs program,from the minute the TiPs offices was contacted with the patient's information Dr. Schlesinger had thirty minutes to review the information by herself before calling patient's doctor and talking them through her recommendations and any further questioning. It can not be stressed enough that these quick phone calls are a very important part of the TiPs program. These phones calls show how quick and easy helping a patient with a disorder when the family doctor does not feel comfortable diagnosing the disorder. The family doctors are not shamed or all their free time taken by waiting on the line to be called back or connected with a child psychiatrist. The simplicity of the phone call consult is one of the important aspects that the whole team at Children's TiPs wants put across, because it makes delivering quality behavioral health services easier.
Comments
Post a Comment