WEBVTT 00:00:00.000 --> 00:00:08.000 music 00:00:08.000 --> 00:00:09.000 my name is Geoff Thoma -- 00:00:09.000 --> 00:00:11.000 I actually graduated from this -- 00:00:11.000 --> 00:00:13.000 program in 2016 00:00:13.000 --> 00:00:15.000 I am the therapist and screener 00:00:15.000 --> 00:00:16.000 for Linn County Mental Health's 00:00:16.000 --> 00:00:17.000 EASA program as well as the 00:00:17.000 --> 00:00:20.000 therapist for our CATS program 00:00:20.000 --> 00:00:21.000 despite the name there are 00:00:21.000 --> 00:00:23.000 no actual cats in the program 00:00:26.000 --> 00:00:28.000 is that it is what we 00:00:28.000 --> 00:00:30.000 call our ED diversion program 00:00:30.000 --> 00:00:32.000 so whenever a person 00:00:32.000 --> 00:00:33.000 under the age of eighteen comes 00:00:33.000 --> 00:00:35.000 into the emergency room with 00:00:35.000 --> 00:00:36.000 some sort of mental health 00:00:36.000 --> 00:00:39.000 crisis our job is to get them 00:00:39.000 --> 00:00:40.000 connected to all the different 00:00:40.000 --> 00:00:42.000 services that they need -- the 00:00:42.000 --> 00:00:44.000 caveat being that we are 00:00:44.000 --> 00:00:45.000 only serving people that are 00:00:45.000 --> 00:00:47.000 indigent or have Oregon Health Plan 00:00:47.000 --> 00:00:49.000 or in our community health 00:00:49.000 --> 00:00:50.000 network -- with some plans 00:00:50.000 --> 00:00:52.000 to be able to actually expand into 00:00:52.000 --> 00:00:54.000 private insurance as well so 00:00:54.000 --> 00:00:56.000 we have myself we have a case 00:00:56.000 --> 00:00:58.000 manager care coordinator -- we 00:00:58.000 --> 00:00:59.000 also have a psychiatrist that's 00:00:59.000 --> 00:00:62.000 available so typical person 00:01:02.000 --> 00:01:03.000 shows up they're having some 00:01:03.000 --> 00:01:04.000 sort of mental health crisis 00:01:06.000 --> 00:01:07.000 and they're just really really 00:01:07.000 --> 00:01:09.000 struggling other times and 00:01:09.000 --> 00:01:10.000 honestly the most common thing 00:01:10.000 --> 00:01:11.000 that we see it's that they're 00:01:11.000 --> 00:01:14.000 having a need for mental health 00:01:14.000 --> 00:01:15.000 services they just don't know 00:01:15.000 --> 00:01:16.000 how to access them and they 00:01:16.000 --> 00:01:17.000 have no idea where to even 00:01:17.000 --> 00:01:19.000 start and I don't know if 00:01:19.000 --> 00:01:20.000 anybody here has ever tried 00:01:20.000 --> 00:01:22.000 to get access to mental health 00:01:22.000 --> 00:01:23.000 services you don't have to raise 00:01:23.000 --> 00:01:25.000 your hand or anything I work 00:01:25.000 --> 00:01:28.000 in mental health and when I've tried 00:01:28.000 --> 00:01:29.000 to access it for my daughter to 00:01:29.000 --> 00:01:31.000 find a counselor she's twelve 00:01:31.000 --> 00:01:33.000 it was a pain first you've got to 00:01:33.000 --> 00:01:35.000 find somebody that's even open 00:01:35.000 --> 00:01:36.000 let alone somebody that takes your 00:01:36.000 --> 00:01:37.000 insurance somebody that has 00:01:37.000 --> 00:01:39.000 availability and even knowing 00:01:39.000 --> 00:01:40.000 who to call and how to call 00:01:40.000 --> 00:01:43.000 them -- so a lot of times we 00:01:43.000 --> 00:01:44.000 primarily see kids that come 00:01:44.000 --> 00:01:46.000 into the emergency room and 00:01:46.000 --> 00:01:47.000 they just don't even know where 00:01:47.000 --> 00:01:50.000 to start and so we really -- 00:01:50.000 --> 00:01:51.000 roll out the red carpet so 00:01:51.000 --> 00:01:52.000 to speak for them we get them 00:01:52.000 --> 00:01:54.000 set up with a therapist if 00:01:54.000 --> 00:01:56.000 they need medication or feel 00:01:56.000 --> 00:01:57.000 medication would be appropriate 00:01:57.000 --> 00:01:58.000 for them we get them signed up 00:01:58.000 --> 00:01:61.000 for a psychiatric evaluation and we 00:02:01.000 --> 00:02:02.000 have a reserve time slot every 00:02:02.000 --> 00:02:04.000 Friday with one of our doctors 00:02:04.000 --> 00:02:05.000 to be able to be seen which 00:02:05.000 --> 00:02:06.000 is in and of itself a pretty 00:02:06.000 --> 00:02:08.000 big deal because a lot 00:02:08.000 --> 00:02:09.000 of the times wait times for a 00:02:09.000 --> 00:02:12.000 psychiatrist are weeks or months 00:02:12.000 --> 00:02:13.000 as opposed to with us we've 00:02:13.000 --> 00:02:16.000 had somebody in within hours 00:02:17.000 --> 00:02:19.000 regard we have family supports 00:02:19.000 --> 00:02:22.000 that are available it is -- 00:02:22.000 --> 00:02:24.000 provided through a volunteer 00:02:24.000 --> 00:02:26.000 organization -- that works 00:02:26.000 --> 00:02:27.000 within our county and they are 00:02:27.000 --> 00:02:29.000 able to reach out to the family 00:02:29.000 --> 00:02:30.000 they can provide one on one parenting 00:02:30.000 --> 00:02:32.000 assistance like some 00:02:32.000 --> 00:02:33.000 different interventions for 00:02:33.000 --> 00:02:35.000 the kids usually based off of 00:02:35.000 --> 00:02:36.000 something called collaborative 00:02:36.000 --> 00:02:38.000 problem solving we have myself 00:02:38.000 --> 00:02:41.000 doing -- crisis therapy 00:02:41.000 --> 00:02:42.000 which pretty much my whole 00:02:42.000 --> 00:02:45.000 gig is to help them stabilize 00:02:45.000 --> 00:02:46.000 before they get connected to 00:02:46.000 --> 00:02:48.000 their long term therapist and 00:02:48.000 --> 00:02:49.000 psychiatrist and care team 00:02:49.000 --> 00:02:51.000 and then we have our skills 00:02:51.000 --> 00:02:52.000 trainer who's able to do more 00:02:52.000 --> 00:02:54.000 hands on training specifically 00:02:54.000 --> 00:02:56.000 around skills because there's a difference 00:02:56.000 --> 00:02:57.000 between just learning coping 00:02:57.000 --> 00:02:58.000 skills and being able to process 00:02:58.000 --> 00:02:61.000 what's actually going on -- 00:03:01.000 --> 00:03:02.000 it's a really cool program 00:03:02.000 --> 00:03:04.000 it's a new state initiative 00:03:04.000 --> 00:03:05.000 it's been around for a little 00:03:05.000 --> 00:03:07.000 bit but it's kind of the new 00:03:07.000 --> 00:03:09.000 hotness right now as far as -- 00:03:09.000 --> 00:03:11.000 prevention and reducing overall 00:03:11.000 --> 00:03:13.000 costs and increasing access 00:03:13.000 --> 00:03:15.000 to care the states making -- 00:03:17.000 --> 00:03:19.000 everybody connected with this 00:03:19.000 --> 00:03:20.000 within the community of mental 00:03:20.000 --> 00:03:22.000 health -- primarily I was asked to 00:03:22.000 --> 00:03:24.000 talk about EASA though which 00:03:24.000 --> 00:03:25.000 is the thing that I'm super 00:03:25.000 --> 00:03:27.000 excited about EASA stands for 00:03:27.000 --> 00:03:28.000 Early Assessment Support Alliance 00:03:28.000 --> 00:03:31.000 and we are a program 00:03:31.000 --> 00:03:32.000 that is now currently in every 00:03:32.000 --> 00:03:34.000 single county within Oregon 00:03:34.000 --> 00:03:36.000 and what our program is focused on 00:03:36.000 --> 00:03:39.000 is two different things one is 00:03:39.000 --> 00:03:40.000 the identification of something 00:03:40.000 --> 00:03:41.000 that we'd call clinical high 00:03:41.000 --> 00:03:43.000 risk for psychosis and then 00:03:43.000 --> 00:03:45.000 the other is a first or early 00:03:45.000 --> 00:03:47.000 intervention for psychotic 00:03:47.000 --> 00:03:50.000 break or FEPs First Episode Pyschosis 00:03:50.000 --> 00:03:53.000 so our job is to 00:03:53.000 --> 00:03:54.000 have people they end up 00:03:54.000 --> 00:03:56.000 getting referred to us and we 00:03:56.000 --> 00:03:57.000 are going to figure out whether 00:03:57.000 --> 00:03:59.000 or not they have schizophrenia 00:03:59.000 --> 00:03:60.000 schizoaffective or one of 00:04:00.000 --> 00:04:02.000 the other primary psychotic 00:04:02.000 --> 00:04:03.000 diagnoses that are within the 00:04:03.000 --> 00:04:06.000 DSM -- you guys are first-year 00:04:06.000 --> 00:04:07.000 students right so you probably 00:04:07.000 --> 00:04:09.000 haven't taken any diagnosis class 00:04:09.000 --> 00:04:11.000 or anything okay as you dig 00:04:11.000 --> 00:04:14.000 into the DSM you'll find that 00:04:14.000 --> 00:04:15.000 you'd be hard pressed to actually 00:04:15.000 --> 00:04:17.000 identify any diagnosis 00:04:17.000 --> 00:04:19.000 that at some point doesn't have 00:04:19.000 --> 00:04:20.000 some sort of psychotic feature 00:04:20.000 --> 00:04:22.000 associated with it psychosis 00:04:22.000 --> 00:04:23.000 is actually really really common 00:04:23.000 --> 00:04:25.000 off the top of my head I'm 00:04:27.000 --> 00:04:28.000 population will experience 00:04:28.000 --> 00:04:30.000 some sort of psychotic like 00:04:30.000 --> 00:04:32.000 experience within their lifetime 00:04:34.000 --> 00:04:36.000 isn't schizophrenic -- they're 00:04:36.000 --> 00:04:38.000 actually really really common 00:04:38.000 --> 00:04:39.000 we most often see people 00:04:39.000 --> 00:04:40.000 referred to us that are 00:04:40.000 --> 00:04:41.000 actually experiencing some 00:04:41.000 --> 00:04:44.000 symptoms of trauma or autism 00:04:44.000 --> 00:04:47.000 mood disorders like depression 00:04:48.000 --> 00:04:49.000 see with people that are really 00:04:49.000 --> 00:04:50.000 struggling with depression 00:04:50.000 --> 00:04:52.000 is what we call delusion of 00:04:52.000 --> 00:04:54.000 reference and it's the belief 00:04:54.000 --> 00:04:56.000 that when you walk into a room 00:04:56.000 --> 00:04:57.000 everybody was just talking 00:04:57.000 --> 00:04:58.000 about you or when you're sitting 00:04:58.000 --> 00:04:59.000 at the front of the class you 00:04:59.000 --> 00:04:61.000 feel like everybody's talking 00:05:01.000 --> 00:05:03.000 about you behind you and maybe 00:05:03.000 --> 00:05:05.000 when you leave that everybody 00:05:05.000 --> 00:05:07.000 about you again or maybe walking 00:05:07.000 --> 00:05:08.000 down the street you overhear 00:05:08.000 --> 00:05:09.000 a conversation you're convinced 00:05:09.000 --> 00:05:11.000 that maybe was about you I 00:05:11.000 --> 00:05:13.000 mean that's a psychotic like 00:05:13.000 --> 00:05:15.000 experience and it sounds 00:05:15.000 --> 00:05:16.000 pretty normal when you're 00:05:16.000 --> 00:05:18.000 depressed and it is really common 00:05:18.000 --> 00:05:19.000 but what we're really looking 00:05:19.000 --> 00:05:22.000 for though are the pervasive 00:05:22.000 --> 00:05:24.000 long term mental illnesses 00:05:24.000 --> 00:05:26.000 namely like schizophrenic -- 00:05:26.000 --> 00:05:28.000 with clinical high risk -- 00:05:28.000 --> 00:05:30.000 that is a off shoot of the 00:05:30.000 --> 00:05:32.000 original work we were doing with 00:05:32.000 --> 00:05:33.000 schizophrenia and that we found 00:05:33.000 --> 00:05:34.000 that ninety percent of people 00:05:34.000 --> 00:05:35.000 that develop schizophrenia 00:05:35.000 --> 00:05:37.000 get what's called a prodromal symptom 00:05:37.000 --> 00:05:39.000 prodromes are pretty 00:05:39.000 --> 00:05:42.000 much the early warning signs 00:05:42.000 --> 00:05:43.000 that something bigger is going 00:05:43.000 --> 00:05:45.000 to be happening they may not 00:05:45.000 --> 00:05:48.000 be actively in the middle of a 00:05:48.000 --> 00:05:49.000 psychotic break they may have 00:05:49.000 --> 00:05:51.000 complete understanding of you 00:05:51.000 --> 00:05:52.000 know this isn't normal for me 00:05:52.000 --> 00:05:54.000 to be hearing voices it's not 00:05:54.000 --> 00:05:56.000 normal for me to be feeling 00:05:56.000 --> 00:05:57.000 paranoid about different 00:05:57.000 --> 00:05:60.000 stuff but it's the early early 00:06:00.000 --> 00:06:01.000 interventions before they 00:06:01.000 --> 00:06:03.000 fully get kind of sucked into 00:06:03.000 --> 00:06:05.000 that psychotic break and the 00:06:05.000 --> 00:06:06.000 more research that's been done on it 00:06:06.000 --> 00:06:08.000 we've been finding that there 00:06:08.000 --> 00:06:09.000 are certain predictors that 00:06:09.000 --> 00:06:10.000 somebody could be at risk of 00:06:10.000 --> 00:06:13.000 developing schizophrenia we 00:06:13.000 --> 00:06:14.000 know that some things like 00:06:16.000 --> 00:06:18.000 owning cats especially 00:06:18.000 --> 00:06:21.000 cats being owned by somebody who is 00:06:21.000 --> 00:06:23.000 pregnant and later on -- the kid 00:06:23.000 --> 00:06:24.000 can have some higher risk for 00:06:24.000 --> 00:06:26.000 that but we have specialized 00:06:26.000 --> 00:06:28.000 training to be able to identify 00:06:31.000 --> 00:06:33.000 indicators and we also have 00:06:33.000 --> 00:06:34.000 the ability to really suss 00:06:34.000 --> 00:06:35.000 out the difference between 00:06:35.000 --> 00:06:37.000 schizophrenia and other types 00:06:37.000 --> 00:06:40.000 of psychotic diagnoses did 00:06:40.000 --> 00:06:41.000 I say that owning a cat is 00:06:41.000 --> 00:06:44.000 correlated with schizophrenia 00:06:48.000 --> 00:06:50.000 factor there it doesn't 00:06:50.000 --> 00:06:51.000 necessarily mean that there -- 00:06:51.000 --> 00:06:52.000 owning the cat isn't gonna make 00:06:52.000 --> 00:06:55.000 you psychotic that's not at 00:06:55.000 --> 00:06:56.000 all -- I want to be really 00:06:56.000 --> 00:06:58.000 clear about that one but it is 00:06:58.000 --> 00:06:60.000 a risk factor just like early 00:07:00.000 --> 00:07:02.000 marijuana use it's Oregon -- 00:07:02.000 --> 00:07:03.000 we're gonna be realistic about 00:07:03.000 --> 00:07:06.000 pot most people have tried pot 00:07:06.000 --> 00:07:07.000 I mean that's just the reality 00:07:07.000 --> 00:07:08.000 especially in a place like 00:07:08.000 --> 00:07:09.000 Oregon where it's no longer 00:07:09.000 --> 00:07:11.000 illegal for recreational use 00:07:11.000 --> 00:07:14.000 what we do know is that early 00:07:14.000 --> 00:07:17.000 marijuana use also has a risk 00:07:17.000 --> 00:07:18.000 for developing a psychotic 00:07:18.000 --> 00:07:21.000 illness later in life -- and 00:07:21.000 --> 00:07:22.000 so that's just one of the 00:07:22.000 --> 00:07:23.000 risk factors there's a lot of 00:07:23.000 --> 00:07:24.000 other risk factors I'm trying 00:07:24.000 --> 00:07:26.000 to remember just how many 00:07:26.000 --> 00:07:27.000 but there's a huge number of 00:07:27.000 --> 00:07:29.000 them and it's not that having 00:07:29.000 --> 00:07:30.000 one means you're doomed to it 00:07:30.000 --> 00:07:31.000 it doesn't even necessarily 00:07:31.000 --> 00:07:33.000 mean that it significantly 00:07:33.000 --> 00:07:35.000 increases your risk it's just 00:07:35.000 --> 00:07:36.000 one of those things that we 00:07:36.000 --> 00:07:38.000 identify the reason why is 00:07:38.000 --> 00:07:40.000 exposure to their droppings 00:07:40.000 --> 00:07:42.000 and the different -- flora 00:07:42.000 --> 00:07:43.000 and fauna that live within 00:07:43.000 --> 00:07:46.000 cats -- every animal just like 00:07:46.000 --> 00:07:48.000 us we have different symbiotic 00:07:48.000 --> 00:07:50.000 bacteria that live within us 00:07:50.000 --> 00:07:51.000 we have different chemicals in 00:07:51.000 --> 00:07:52.000 our bodies and stuff like that 00:07:52.000 --> 00:07:54.000 cats are associated with certain 00:07:54.000 --> 00:07:56.000 ones that apparently have -- 00:07:56.000 --> 00:07:58.000 a connection to an increased 00:07:58.000 --> 00:07:60.000 risk I want to say specifically 00:08:00.000 --> 00:08:02.000 it has to do with their poop 00:08:04.000 --> 00:08:06.000 general for -- women during 00:08:06.000 --> 00:08:08.000 pregnancy is a risk factor for 00:08:08.000 --> 00:08:11.000 pregnancy in general -- kind of 00:08:11.000 --> 00:08:12.000 the same thing and specifically 00:08:12.000 --> 00:08:13.000 the risk factors are more 00:08:13.000 --> 00:08:15.000 associated with pregnant women 00:08:15.000 --> 00:08:16.000 not just owning a cat early 00:08:16.000 --> 00:08:17.000 in life it's specifically 00:08:17.000 --> 00:08:20.000 around -- that exposure to cats 00:08:20.000 --> 00:08:24.000 in utero so good question though so the 00:08:24.000 --> 00:08:26.000 EASA program is pretty 00:08:26.000 --> 00:08:28.000 cool -- I get really jazzed 00:08:28.000 --> 00:08:30.000 up about it -- I'm not really 00:08:30.000 --> 00:08:31.000 good at faking excitement over 00:08:31.000 --> 00:08:33.000 stuff so I promise it's genuine 00:08:35.000 --> 00:08:37.000 disciplinary program meaning 00:08:37.000 --> 00:08:39.000 multi disciplinary meaning 00:08:39.000 --> 00:08:40.000 we have a lot of different 00:08:40.000 --> 00:08:42.000 people on a team -- we have 00:08:42.000 --> 00:08:43.000 myself as the screener and 00:08:43.000 --> 00:08:47.000 therapist and I am able to do 00:08:47.000 --> 00:08:48.000 motivational interviewing 00:08:48.000 --> 00:08:50.000 CBT I'm also specially trained in 00:08:50.000 --> 00:08:52.000 something called CBTP 00:08:52.000 --> 00:08:53.000 which is Cognitive Behavioral 00:08:53.000 --> 00:08:54.000 Therapy with a focus on 00:08:54.000 --> 00:08:56.000 psychosis -- along with all the 00:08:56.000 --> 00:08:58.000 other evidence based treatment 00:08:58.000 --> 00:08:59.000 modalities that are really 00:08:59.000 --> 00:08:61.000 common out there we have an 00:09:01.000 --> 00:09:02.000 occupational therapist that 00:09:02.000 --> 00:09:04.000 is able to do a occupational 00:09:04.000 --> 00:09:05.000 therapy eval and turn that 00:09:05.000 --> 00:09:08.000 into a list of accommodations 00:09:08.000 --> 00:09:10.000 that can help this person 00:09:10.000 --> 00:09:11.000 that we're working with 00:09:11.000 --> 00:09:13.000 or their family set up their 00:09:13.000 --> 00:09:15.000 life to better accommodate how 00:09:15.000 --> 00:09:16.000 their brain processes the world 00:09:16.000 --> 00:09:19.000 around them and how they react 00:09:19.000 --> 00:09:22.000 to it most often we see this 00:09:22.000 --> 00:09:25.000 turning into a recommendation 00:09:25.000 --> 00:09:27.000 with the accommodations office 00:09:27.000 --> 00:09:28.000 at their college or if they 00:09:28.000 --> 00:09:30.000 need some help with work then 00:09:30.000 --> 00:09:31.000 that's another thing that we 00:09:31.000 --> 00:09:34.000 often interact with which kind 00:09:34.000 --> 00:09:35.000 of goes into the next person 00:09:35.000 --> 00:09:36.000 that we have on our team 00:09:36.000 --> 00:09:37.000 which is support employment and 00:09:37.000 --> 00:09:39.000 support education specialist 00:09:39.000 --> 00:09:41.000 these people are -- it's really 00:09:41.000 --> 00:09:42.000 in the name they support an 00:09:42.000 --> 00:09:44.000 education employment whether 00:09:44.000 --> 00:09:46.000 that is resume building 00:09:49.000 --> 00:09:50.000 and exploration on what it is 00:09:50.000 --> 00:09:52.000 that they want to do and why 00:09:52.000 --> 00:09:54.000 it can be a conversation with 00:09:54.000 --> 00:09:56.000 the boss they can be working 00:09:56.000 --> 00:09:57.000 with somebody at a practice 00:09:57.000 --> 00:09:58.000 a conversation with the boss over 00:09:58.000 --> 00:09:59.000 what their needs are and then 00:09:59.000 --> 00:09:60.000 the other part is of course 00:10:00.000 --> 00:10:02.000 getting into school and staying 00:10:02.000 --> 00:10:03.000 in school to be successful so 00:10:03.000 --> 00:10:06.000 there's a lot of skill building and 00:10:07.000 --> 00:10:08.000 to talk about what their needs 00:10:08.000 --> 00:10:10.000 are -- within the comfort of 00:10:10.000 --> 00:10:12.000 what it is that they're okay 00:10:12.000 --> 00:10:14.000 with disclosing to other people 00:10:14.000 --> 00:10:15.000 not everybody wants to walk up 00:10:15.000 --> 00:10:16.000 to the boss and be like hey I have 00:10:16.000 --> 00:10:18.000 a psychotic illness it's not 00:10:18.000 --> 00:10:20.000 like usually the way people 00:10:20.000 --> 00:10:21.000 work some people are very open 00:10:21.000 --> 00:10:23.000 but other people are very very 00:10:23.000 --> 00:10:24.000 private about what that is 00:10:24.000 --> 00:10:25.000 and they have a right to that 00:10:25.000 --> 00:10:28.000 privacy we also have a case 00:10:28.000 --> 00:10:29.000 manager who does everything 00:10:29.000 --> 00:10:31.000 that's not therapy and case 00:10:31.000 --> 00:10:33.000 manager is primarily connecting 00:10:33.000 --> 00:10:35.000 to resources our program is 00:10:35.000 --> 00:10:36.000 really lucky in that we have -- 00:10:36.000 --> 00:10:38.000 a what we call the RAS grant 00:10:38.000 --> 00:10:39.000 and it's a rental assistance 00:10:39.000 --> 00:10:41.000 program that we get people 00:10:41.000 --> 00:10:42.000 into while they're waiting for 00:10:42.000 --> 00:10:44.000 section eight to get started 00:10:44.000 --> 00:10:46.000 and we have five reserved slots 00:10:46.000 --> 00:10:47.000 just for our clients in the 00:10:47.000 --> 00:10:49.000 EASA program and so he'll 00:10:49.000 --> 00:10:50.000 go out and take them to find 00:10:50.000 --> 00:10:52.000 apartments find apartments that are 00:10:52.000 --> 00:10:53.000 affordable for them people that 00:10:53.000 --> 00:10:55.000 are willing to take a risk on 00:10:55.000 --> 00:10:56.000 young people because if you 00:10:56.000 --> 00:10:57.000 don't have any rental history 00:10:57.000 --> 00:10:58.000 it can actually be pretty hard 00:10:58.000 --> 00:10:60.000 to find a place on top of it's 00:11:00.000 --> 00:11:01.000 Oregon so it's already hard 00:11:01.000 --> 00:11:04.000 to find a place to rent -- we 00:11:04.000 --> 00:11:06.000 have a psychiatrist that is 00:11:06.000 --> 00:11:08.000 dedicated to our program and we 00:11:08.000 --> 00:11:10.000 are very firmly in the belief 00:11:10.000 --> 00:11:12.000 of low and slow -- medication 00:11:12.000 --> 00:11:16.000 is a important part of treating 00:11:16.000 --> 00:11:17.000 mental illness but it's not the 00:11:17.000 --> 00:11:19.000 only part of it -- one of the 00:11:19.000 --> 00:11:21.000 things about anti psychotics 00:11:21.000 --> 00:11:22.000 though is the placebo effect 00:11:22.000 --> 00:11:24.000 with anti psychotic medication 00:11:24.000 --> 00:11:26.000 is significantly lower 00:11:26.000 --> 00:11:28.000 than it is with any other type 00:11:28.000 --> 00:11:30.000 of medication that we use for 00:11:30.000 --> 00:11:32.000 mental health -- so we know 00:11:32.000 --> 00:11:33.000 that these things work but they 00:11:33.000 --> 00:11:35.000 are very very powerful drugs 00:11:35.000 --> 00:11:37.000 and they have side effects and 00:11:37.000 --> 00:11:40.000 so we are able to provide them 00:11:40.000 --> 00:11:42.000 more frequent interactions with 00:11:42.000 --> 00:11:43.000 our psychiatrist we're able to 00:11:43.000 --> 00:11:45.000 get them in sooner and really 00:11:45.000 --> 00:11:47.000 explore what medication means 00:11:47.000 --> 00:11:49.000 to this person and be able to talk 00:11:49.000 --> 00:11:50.000 a lot about what it is that 00:11:50.000 --> 00:11:51.000 their needs are and what it 00:11:51.000 --> 00:11:52.000 is that they're feeling about 00:11:52.000 --> 00:11:53.000 these medications because not 00:11:53.000 --> 00:11:54.000 everybody's going to want to 00:11:54.000 --> 00:11:56.000 be on them and a lot of people 00:11:56.000 --> 00:11:57.000 feel like taking a pill makes 00:11:57.000 --> 00:11:60.000 them weird or different or that 00:12:00.000 --> 00:12:01.000 they just don't feel like they 00:12:01.000 --> 00:12:03.000 should have to take a pill and 00:12:03.000 --> 00:12:06.000 we are completely okay with 00:12:06.000 --> 00:12:07.000 them having those feelings and 00:12:07.000 --> 00:12:08.000 we wanna explore those with 00:12:08.000 --> 00:12:10.000 them because if you hate taking 00:12:10.000 --> 00:12:12.000 a pill and you can't stand it 00:12:12.000 --> 00:12:13.000 how long are you gonna actually take 00:12:13.000 --> 00:12:14.000 it on your own without being in 00:12:14.000 --> 00:12:16.000 a treatment team they'll graduate 00:12:16.000 --> 00:12:17.000 from our program -- if they're 00:12:17.000 --> 00:12:19.000 not bought into medication 00:12:19.000 --> 00:12:21.000 then they're probably not 00:12:21.000 --> 00:12:22.000 gonna want to continue with 00:12:22.000 --> 00:12:23.000 it so we really encourage that 00:12:23.000 --> 00:12:25.000 conversation we have a nurse 00:12:25.000 --> 00:12:26.000 that's associated with the program 00:12:26.000 --> 00:12:28.000 she's also our supervisor 00:12:28.000 --> 00:12:30.000 within Linn County and she's 00:12:30.000 --> 00:12:32.000 able to do health and wellness 00:12:32.000 --> 00:12:34.000 she's able to do some -- health 00:12:34.000 --> 00:12:35.000 screenings and we talk a lot 00:12:35.000 --> 00:12:37.000 about nutrition and active living 00:12:37.000 --> 00:12:40.000 and stuff like that 00:12:42.000 --> 00:12:43.000 our fidelity model are supposed 00:12:43.000 --> 00:12:45.000 to have a peer support however 00:12:45.000 --> 00:12:46.000 our county does not have a peer 00:12:46.000 --> 00:12:47.000 support at this time and peers 00:12:47.000 --> 00:12:49.000 are people that have lived 00:12:49.000 --> 00:12:50.000 experience they go through 00:12:50.000 --> 00:12:52.000 training specifically on how to 00:12:52.000 --> 00:12:54.000 utilize that lived experience 00:12:54.000 --> 00:12:55.000 whether it's drug and alcohol 00:12:55.000 --> 00:12:57.000 or it's having mental illness 00:12:57.000 --> 00:12:60.000 and being able to help mentor 00:13:00.000 --> 00:13:01.000 other people that are going 00:13:01.000 --> 00:13:04.000 through similar situations 00:13:04.000 --> 00:13:05.000 our peers don't necessarily have to 00:13:05.000 --> 00:13:07.000 have a psychotic illness or 00:13:07.000 --> 00:13:08.000 experienced psychotic illness in 00:13:08.000 --> 00:13:09.000 order to be able to work with 00:13:09.000 --> 00:13:11.000 somebody that has psychosis 00:13:11.000 --> 00:13:13.000 so that's a multi disciplinary 00:13:13.000 --> 00:13:14.000 aspect of our program but the 00:13:14.000 --> 00:13:16.000 trans disciplinary aspect is 00:13:16.000 --> 00:13:18.000 I'm a therapist my role is as 00:13:18.000 --> 00:13:20.000 a therapist and screener but I 00:13:20.000 --> 00:13:22.000 also know how to do support and 00:13:22.000 --> 00:13:24.000 employment I also know how to 00:13:24.000 --> 00:13:26.000 navigate different resources 00:13:26.000 --> 00:13:28.000 in the community just like 00:13:28.000 --> 00:13:29.000 our case manager does or our support 00:13:29.000 --> 00:13:30.000 employment person does so we're 00:13:30.000 --> 00:13:32.000 able to help cover down on 00:13:32.000 --> 00:13:34.000 each other now as the therapist 00:13:34.000 --> 00:13:36.000 I'm the one that's actually 00:13:36.000 --> 00:13:37.000 certified to be able to provide 00:13:37.000 --> 00:13:38.000 therapy our case manager 00:13:38.000 --> 00:13:39.000 isn't going to be able to provide 00:13:39.000 --> 00:13:41.000 therapy but he's able to engage 00:13:41.000 --> 00:13:43.000 with our people and cover down 00:13:43.000 --> 00:13:44.000 on different aspects of what 00:13:44.000 --> 00:13:47.000 the team offers but having a 00:13:47.000 --> 00:13:49.000 team is able -- allows us 00:13:49.000 --> 00:13:51.000 to really talk through everyone 00:13:51.000 --> 00:13:52.000 of our clients and really 00:13:52.000 --> 00:13:54.000 figure out what it is that 00:13:54.000 --> 00:13:55.000 they need and why and where 00:13:55.000 --> 00:13:56.000 we're going with it because 00:13:56.000 --> 00:13:58.000 it turns out as charming as I 00:13:58.000 --> 00:13:60.000 like to tell myself I am and as 00:14:00.000 --> 00:14:01.000 charming as my mom tells me I am 00:14:01.000 --> 00:14:02.000 it doesn't mean everybody's 00:14:02.000 --> 00:14:04.000 going to connect with me even 00:14:04.000 --> 00:14:06.000 if I'm the therapist but we 00:14:06.000 --> 00:14:08.000 have a case manager that this 00:14:08.000 --> 00:14:09.000 dude somehow can connect 00:14:09.000 --> 00:14:11.000 with everybody and as long as 00:14:11.000 --> 00:14:12.000 somebody's connecting that's the 00:14:12.000 --> 00:14:13.000 most important piece because 00:14:13.000 --> 00:14:14.000 one of things that we do know 00:14:14.000 --> 00:14:17.000 more and more is that one of 00:14:17.000 --> 00:14:19.000 the most important aspects of 00:14:19.000 --> 00:14:21.000 therapy is the alliance that 00:14:21.000 --> 00:14:22.000 you create with the person 00:14:22.000 --> 00:14:24.000 there was a old study that came 00:14:24.000 --> 00:14:26.000 out and I'm gonna -- I'm off on 00:14:26.000 --> 00:14:28.000 the numbers roughly 30 percent 00:14:28.000 --> 00:14:29.000 or 40 percent of 00:14:29.000 --> 00:14:31.000 the outcome somebody comes 00:14:31.000 --> 00:14:32.000 into therapy and the entire 00:14:32.000 --> 00:14:33.000 change that's made at the 00:14:33.000 --> 00:14:34.000 conclusion of therapy 00:14:35.000 --> 00:14:37.000 person walks through the door with 00:14:37.000 --> 00:14:39.000 has nothing to do with you has 00:14:39.000 --> 00:14:40.000 nothing do with your treatment 00:14:40.000 --> 00:14:41.000 modality has nothing to do with 00:14:41.000 --> 00:14:42.000 anything that you say it's 00:14:42.000 --> 00:14:44.000 that person's supports it's 00:14:44.000 --> 00:14:45.000 their outlook on whether or not 00:14:45.000 --> 00:14:48.000 they can get better it's their 00:14:48.000 --> 00:14:50.000 internal resiliences so 00:14:51.000 --> 00:14:52.000 already determined before you 00:14:52.000 --> 00:14:54.000 even talk to the person the 00:14:54.000 --> 00:14:55.000 next 30 percent of that 00:14:55.000 --> 00:14:57.000 is just the relationship that 00:14:57.000 --> 00:14:58.000 they have with you not your 00:14:58.000 --> 00:14:60.000 modalities not the way you 00:15:00.000 --> 00:15:01.000 it's just their ability to 00:15:01.000 --> 00:15:03.000 connect 15 percent of it is 00:15:03.000 --> 00:15:05.000 the treatment modality and then I can't 00:15:05.000 --> 00:15:06.000 remember what the final fifteen 00:15:06.000 --> 00:15:09.000 percent is but seventy -- 00:15:09.000 --> 00:15:10.000 percent of this is relationship 00:15:10.000 --> 00:15:11.000 and what that person walks 00:15:11.000 --> 00:15:14.000 through the door with so we don't 00:15:14.000 --> 00:15:15.000 have to get hung up on that 00:15:15.000 --> 00:15:16.000 person coming and talking to 00:15:16.000 --> 00:15:17.000 therapists because sometimes 00:15:17.000 --> 00:15:18.000 the most therapeutic thing that 00:15:18.000 --> 00:15:20.000 person can do is just connect 00:15:20.000 --> 00:15:22.000 with somebody and that's what 00:15:22.000 --> 00:15:24.000 our program really allows 00:15:24.000 --> 00:15:25.000 us to do so they're not 00:15:25.000 --> 00:15:26.000 stuck seeing a therapist that 00:15:26.000 --> 00:15:27.000 well I'm the only therapist 00:15:27.000 --> 00:15:28.000 available so I guess you have 00:15:28.000 --> 00:15:30.000 to talk to me no we have a 00:15:30.000 --> 00:15:31.000 care coordinator that can go do that 00:15:31.000 --> 00:15:34.000 too and they can just connect 00:15:34.000 --> 00:15:35.000 and provide that relationship 00:15:35.000 --> 00:15:38.000 with them we have a small small 00:15:38.000 --> 00:15:40.000 caseload oftentimes we see 00:15:40.000 --> 00:15:41.000 people with caseloads in the 00:15:41.000 --> 00:15:44.000 dozens -- fifty eighty I talked to 00:15:44.000 --> 00:15:45.000 some therapists with the VA that 00:15:45.000 --> 00:15:47.000 had caseloads in the hundreds 00:15:47.000 --> 00:15:50.000 my caseload is 12 -- and that's not 00:15:52.000 --> 00:15:54.000 for the entire team so we 00:15:54.000 --> 00:15:56.000 have a very intensive program 00:15:56.000 --> 00:15:57.000 that we're really able to meet 00:15:57.000 --> 00:15:59.000 these people where they're 00:15:59.000 --> 00:15:60.000 at we're also not stuck in the 00:16:00.000 --> 00:16:01.000 office which is my favorite 00:16:01.000 --> 00:16:03.000 part of it because as much as 00:16:03.000 --> 00:16:05.000 I like the sound of my own voice 00:16:05.000 --> 00:16:06.000 I wouldn't want to have to hang 00:16:06.000 --> 00:16:07.000 out with me all the time in 00:16:07.000 --> 00:16:08.000 the office and talk about 00:16:08.000 --> 00:16:09.000 everything we're able to go 00:16:09.000 --> 00:16:10.000 out meet people in the home we 00:16:10.000 --> 00:16:12.000 meet people at restaurants at 00:16:12.000 --> 00:16:14.000 coffee shops I had one client 00:16:14.000 --> 00:16:16.000 who really wanted to be able 00:16:16.000 --> 00:16:18.000 to go out and have a meal with 00:16:18.000 --> 00:16:19.000 friends and be able to feel 00:16:19.000 --> 00:16:21.000 comfortable in doing so so 00:16:21.000 --> 00:16:22.000 it meant we explored a bunch 00:16:22.000 --> 00:16:23.000 of different restaurants in 00:16:23.000 --> 00:16:26.000 town having lunch and walking 00:16:26.000 --> 00:16:28.000 through the process of what he 00:16:28.000 --> 00:16:30.000 was experiencing in the moment and 00:16:30.000 --> 00:16:32.000 anxiety and processing those 00:16:32.000 --> 00:16:34.000 in the moment and you're not 00:16:34.000 --> 00:16:35.000 going to necessarily be able 00:16:35.000 --> 00:16:36.000 to do that when you're just 00:16:36.000 --> 00:16:38.000 sitting in the office -- we 00:16:38.000 --> 00:16:39.000 also have different groups 00:16:39.000 --> 00:16:41.000 we've taken guys out to the -- 00:16:41.000 --> 00:16:42.000 I say guys primarily because 00:16:42.000 --> 00:16:43.000 we seem to have a lot of men 00:16:43.000 --> 00:16:45.000 we've had a very limited number 00:16:45.000 --> 00:16:46.000 of women that come into our program 00:16:49.000 --> 00:16:52.000 we do fishing -- trips 00:16:53.000 --> 00:16:54.000 behind the office so it's 00:16:54.000 --> 00:16:55.000 really easy to take guys out 00:16:55.000 --> 00:16:57.000 and go fishing but we're not stuck 00:16:57.000 --> 00:16:58.000 just doing therapy in the 00:16:58.000 --> 00:16:60.000 office it's really however it 00:17:00.000 --> 00:17:02.000 is that that person is needing to 00:17:02.000 --> 00:17:05.000 be engaged -- looking at the 00:17:05.000 --> 00:17:07.000 cognitive aspects of psychosis 00:17:07.000 --> 00:17:09.000 there's generally four 00:17:09.000 --> 00:17:10.000 different realms that people 00:17:10.000 --> 00:17:12.000 experience psychosis and it's 00:17:12.000 --> 00:17:15.000 drugs anxiety sensitivity and 00:17:15.000 --> 00:17:18.000 trauma and how they present 00:17:18.000 --> 00:17:20.000 with their psychosis is a good 00:17:20.000 --> 00:17:22.000 indicator of where the root 00:17:22.000 --> 00:17:24.000 of that psychosis is coming 00:17:24.000 --> 00:17:27.000 from if somebody is hearing a 00:17:27.000 --> 00:17:31.000 lot of -- dangerous and -- 00:17:31.000 --> 00:17:33.000 threatening voices there's a really 00:17:33.000 --> 00:17:35.000 good chance that the nature of 00:17:35.000 --> 00:17:37.000 that psychosis is coming from past 00:17:37.000 --> 00:17:39.000 trauma that is trying to warn 00:17:39.000 --> 00:17:40.000 them of different things even 00:17:40.000 --> 00:17:41.000 though it's not necessarily 00:17:41.000 --> 00:17:44.000 healthy or what they want so 00:17:44.000 --> 00:17:45.000 if they're constantly feeling 00:17:45.000 --> 00:17:46.000 like they're having voices 00:17:46.000 --> 00:17:47.000 that are threatening them and 00:17:47.000 --> 00:17:49.000 warning them it's going to take 00:17:49.000 --> 00:17:50.000 a very different approach from 00:17:50.000 --> 00:17:53.000 somebody who is experiencing 00:17:55.000 --> 00:17:57.000 they've done too much pot or 00:17:57.000 --> 00:17:61.000 meth -- and we need to have a 00:18:01.000 --> 00:18:02.000 very different approach for 00:18:02.000 --> 00:18:04.000 each person -- I've worked 00:18:04.000 --> 00:18:05.000 with somebody who part of his 00:18:05.000 --> 00:18:07.000 psychosis was a cause such a 00:18:07.000 --> 00:18:09.000 huge amount of isolation and 00:18:09.000 --> 00:18:11.000 that he became very paranoid 00:18:11.000 --> 00:18:13.000 about his social abilities and 00:18:13.000 --> 00:18:14.000 so treatment really needs 00:18:14.000 --> 00:18:17.000 to focus on social aspects and 00:18:17.000 --> 00:18:18.000 we're not working on social 00:18:18.000 --> 00:18:20.000 aspects if we're just sitting 00:18:20.000 --> 00:18:21.000 in the office we can only go 00:18:21.000 --> 00:18:22.000 so far with that we need to take 00:18:22.000 --> 00:18:25.000 it to another level and set up 00:18:25.000 --> 00:18:27.000 social -- interactions 00:18:27.000 --> 00:18:28.000 with this person 00:18:28.000 --> 00:18:29.000 is there a resource 00:18:29.000 --> 00:18:30.000 to be able to dig deeper 00:18:30.000 --> 00:18:32.000 into the cognitive schemas 00:18:32.000 --> 00:18:35.000 of psychosis and yes the name 00:18:35.000 --> 00:18:36.000 that specifically comes to 00:18:36.000 --> 00:18:38.000 mind is a doctor by the name 00:18:38.000 --> 00:18:42.000 of Turkington -- it's more or less 00:18:42.000 --> 00:18:44.000 exactly what it sounds like 00:18:44.000 --> 00:18:47.000 T-U-R-K-I-N-G-T-O-N I believe 00:18:47.000 --> 00:18:48.000 and I know he's 00:18:48.000 --> 00:18:49.000 co authored with a couple 00:18:49.000 --> 00:18:51.000 of other people but I can't 00:18:51.000 --> 00:18:52.000 remember the name off of 00:18:52.000 --> 00:18:54.000 my head -- but Turkington 00:18:54.000 --> 00:18:56.000 specifically is one that 00:18:56.000 --> 00:18:58.000 comes up but also just -- 00:18:58.000 --> 00:18:60.000 doing searches on cognitive 00:19:00.000 --> 00:19:02.000 schemas of psychosis -- would 00:19:02.000 --> 00:19:03.000 be another way to look deeper 00:19:03.000 --> 00:19:06.000 into that -- but those cognitive 00:19:06.000 --> 00:19:07.000 schemas do more than just 00:19:09.000 --> 00:19:12.000 same thing for anxiety and 00:19:12.000 --> 00:19:14.000 depression and pretty much 00:19:14.000 --> 00:19:16.000 it's the basis of there's a reason 00:19:16.000 --> 00:19:17.000 why you're experiencing these 00:19:17.000 --> 00:19:19.000 and why they're presenting in 00:19:19.000 --> 00:19:21.000 a certain way and exploring 00:19:21.000 --> 00:19:23.000 the relationship with that our 00:19:23.000 --> 00:19:25.000 program is entirely voluntary 00:19:25.000 --> 00:19:27.000 we don't force people in we 00:19:27.000 --> 00:19:28.000 want people to be involved 00:19:28.000 --> 00:19:31.000 and we know that some people 00:19:31.000 --> 00:19:33.000 aren't necessarily ready to 00:19:33.000 --> 00:19:34.000 be involved there's a lot of 00:19:34.000 --> 00:19:35.000 people that we've had where 00:19:35.000 --> 00:19:37.000 the family is 100 percent 00:19:37.000 --> 00:19:38.000 on board with jumping into 00:19:38.000 --> 00:19:39.000 this program but the person 00:19:39.000 --> 00:19:41.000 is not quite there yet the 00:19:41.000 --> 00:19:43.000 cool thing about it is we 00:19:43.000 --> 00:19:45.000 don't have to engage sometimes 00:19:45.000 --> 00:19:47.000 engagement means we show up 00:19:47.000 --> 00:19:48.000 with -- to the person's house and 00:19:48.000 --> 00:19:49.000 we just talk with them about 00:19:49.000 --> 00:19:51.000 nothing whatever it is that 00:19:51.000 --> 00:19:52.000 they're feeling comfortable 00:19:52.000 --> 00:19:53.000 with because we're building that 00:19:53.000 --> 00:19:55.000 relationship we go from the age 00:19:55.000 --> 00:19:56.000 of fourteen to twenty five we 00:19:56.000 --> 00:19:58.000 can waiver up to thirty and we 00:19:58.000 --> 00:19:60.000 can waiver down to twelve -- 00:20:00.000 --> 00:20:04.000 technically there is no hard 00:20:04.000 --> 00:20:06.000 age cut off we are technically 00:20:06.000 --> 00:20:07.000 able to see somebody under the 00:20:07.000 --> 00:20:09.000 age of twelve the statistical 00:20:09.000 --> 00:20:11.000 likelihood that we will have 00:20:11.000 --> 00:20:13.000 somebody that is actually 00:20:13.000 --> 00:20:14.000 experiencing schizophrenia 00:20:14.000 --> 00:20:17.000 under the age of twelve is 00:20:17.000 --> 00:20:19.000 very very very low -- my 00:20:19.000 --> 00:20:22.000 psychiatrist -- trying to think 00:20:22.000 --> 00:20:23.000 of how long he's been around for 00:20:23.000 --> 00:20:24.000 he's been around for a long 00:20:24.000 --> 00:20:26.000 time decades he's seen it 00:20:26.000 --> 00:20:29.000 once -- Dr. Melton the 00:20:29.000 --> 00:20:30.000 clinical director for the EASA 00:20:30.000 --> 00:20:32.000 Center of Excellence has seen 00:20:32.000 --> 00:20:34.000 it twice in I want to say the 00:20:34.000 --> 00:20:36.000 twenty years that he's been 00:20:36.000 --> 00:20:38.000 doing EASA and one of them if 00:20:38.000 --> 00:20:40.000 I remember right six months 00:20:40.000 --> 00:20:41.000 in they decided that it was 00:20:41.000 --> 00:20:43.000 something else so it's very very 00:20:43.000 --> 00:20:45.000 rare but we do see a lot of 00:20:45.000 --> 00:20:47.000 kids that experience psychotic 00:20:47.000 --> 00:20:48.000 like experiences but often 00:20:48.000 --> 00:20:50.000 times there's something else to 00:20:50.000 --> 00:20:52.000 explain it -- whether it is 00:20:52.000 --> 00:20:55.000 a developmental issue -- I had 00:20:55.000 --> 00:20:56.000 somebody that was referred to 00:20:56.000 --> 00:20:58.000 me and they were having visual 00:20:58.000 --> 00:20:59.000 hallucinations when they were 00:20:59.000 --> 00:20:61.000 two turns out they weren't actually 00:21:01.000 --> 00:21:03.000 hallucinations it was something 00:21:03.000 --> 00:21:04.000 that they were actually seeing 00:21:04.000 --> 00:21:06.000 and there was a completely 00:21:06.000 --> 00:21:08.000 pragmatic down to earth reason 00:21:08.000 --> 00:21:09.000 why it was that they were seeing 00:21:09.000 --> 00:21:10.000 these things because they were 00:21:10.000 --> 00:21:12.000 literally seen -- flashing 00:21:12.000 --> 00:21:13.000 orbs was what -- was what they 00:21:13.000 --> 00:21:14.000 were seeing they were actually 00:21:14.000 --> 00:21:15.000 seeing them they weren't psychotic 00:21:15.000 --> 00:21:17.000 at all but people didn't 00:21:17.000 --> 00:21:18.000 realize that there was a reason 00:21:18.000 --> 00:21:19.000 why they were experiencing 00:21:19.000 --> 00:21:20.000 those things so a lot of times there's 00:21:20.000 --> 00:21:22.000 something else going on where 00:21:22.000 --> 00:21:25.000 there is a -- even if it is 00:21:25.000 --> 00:21:27.000 a psychotic like experience 00:21:27.000 --> 00:21:28.000 it's not schizophrenia it could 00:21:28.000 --> 00:21:32.000 be trauma or mood or a really 00:21:32.000 --> 00:21:33.000 common thing we also see is 00:21:33.000 --> 00:21:34.000 autism or a developmental or 00:21:34.000 --> 00:21:36.000 intellectual issue going on 00:21:38.000 --> 00:21:40.000 that's really common as well -- 00:21:40.000 --> 00:21:42.000 but our program is really focused on 00:21:42.000 --> 00:21:43.000 just the schizophrenia family 00:21:43.000 --> 00:21:46.000 of illnesses so we're a two 00:21:46.000 --> 00:21:48.000 year program -- that doesn't 00:21:48.000 --> 00:21:50.000 mean that at two years we're 00:21:50.000 --> 00:21:51.000 like oh well good luck you know 00:21:51.000 --> 00:21:53.000 have fun -- we kind of hold on to some 00:21:53.000 --> 00:21:55.000 people especially if they're 00:21:55.000 --> 00:21:56.000 at the end of the programming maybe 00:21:56.000 --> 00:21:57.000 there's a big transition we've 00:21:57.000 --> 00:21:58.000 had somebody that got to the 00:21:58.000 --> 00:21:60.000 end of the two year program and right 00:22:00.000 --> 00:22:01.000 before they did that they moved 00:22:01.000 --> 00:22:03.000 into their own apartment and 00:22:03.000 --> 00:22:05.000 then they lost their job and so 00:22:05.000 --> 00:22:07.000 we weren't gonna just kick them 00:22:07.000 --> 00:22:08.000 out we kept them and we had 00:22:08.000 --> 00:22:09.000 very specific goals of okay we're 00:22:09.000 --> 00:22:10.000 gonna make sure that you're 00:22:10.000 --> 00:22:12.000 able to keep that apartment 00:22:12.000 --> 00:22:13.000 and get you back into work and 00:22:13.000 --> 00:22:15.000 then have a transition process 00:22:15.000 --> 00:22:17.000 for moving them out but just 00:22:17.000 --> 00:22:18.000 because it's a two year program 00:22:18.000 --> 00:22:20.000 the entire time everybody has 00:22:20.000 --> 00:22:21.000 different needs and everybody 00:22:21.000 --> 00:22:22.000 has a different presentation 00:22:22.000 --> 00:22:24.000 just because you have an actual 00:22:24.000 --> 00:22:26.000 psychotic experience and you 00:22:26.000 --> 00:22:28.000 have a psychotic diagnosis 00:22:28.000 --> 00:22:29.000 doesn't mean that you're 00:22:29.000 --> 00:22:31.000 gonna be having the exact 00:22:31.000 --> 00:22:33.000 same intensity of symptoms or 00:22:33.000 --> 00:22:34.000 dysfunction as somebody else 00:22:34.000 --> 00:22:35.000 we have a lot of people that 00:22:35.000 --> 00:22:37.000 come in and they get on really 00:22:37.000 --> 00:22:39.000 low doses of medication and they 00:22:39.000 --> 00:22:40.000 clear up and they really don't 00:22:40.000 --> 00:22:42.000 need anything else from us 00:22:42.000 --> 00:22:44.000 so our job then is just do a lot 00:22:44.000 --> 00:22:46.000 of education about wellness and 00:22:46.000 --> 00:22:49.000 relapse prevention and making 00:22:49.000 --> 00:22:50.000 sure that they have some good 00:22:50.000 --> 00:22:51.000 safety plans in place with 00:22:51.000 --> 00:22:53.000 their family on what happens if 00:22:53.000 --> 00:22:55.000 symptoms pop back up and they 00:22:55.000 --> 00:22:58.000 get to go back to their life whether 00:22:58.000 --> 00:22:61.000 in it is completely up to them 00:23:03.000 --> 00:23:04.000 their own needs they're really 00:23:04.000 --> 00:23:06.000 in the driver seat we emphasize 00:23:06.000 --> 00:23:07.000 the importance of them coming 00:23:07.000 --> 00:23:09.000 up with their goals because the reality 00:23:09.000 --> 00:23:11.000 is symptom intensity is not 00:23:11.000 --> 00:23:13.000 the same as dysfunction 00:23:13.000 --> 00:23:14.000 there are people out there that 00:23:14.000 --> 00:23:17.000 have intense symptoms intense 00:23:17.000 --> 00:23:20.000 loud angry voices screaming 00:23:20.000 --> 00:23:23.000 at them to do bad stuff but 00:23:23.000 --> 00:23:24.000 they're completely functional they 00:23:24.000 --> 00:23:25.000 have good grades in school 00:23:25.000 --> 00:23:27.000 they're able to attend -- 00:23:27.000 --> 00:23:29.000 their work they're able to take 00:23:29.000 --> 00:23:31.000 care of their families there's 00:23:31.000 --> 00:23:32.000 not necessarily any dysfunction then 00:23:32.000 --> 00:23:33.000 there's other people that just 00:23:33.000 --> 00:23:35.000 have a handful of -- symptoms 00:23:35.000 --> 00:23:37.000 that aren't super strong but 00:23:37.000 --> 00:23:38.000 they are really struggling 00:23:38.000 --> 00:23:39.000 to be able to function in all 00:23:39.000 --> 00:23:41.000 the different realms so it's 00:23:41.000 --> 00:23:42.000 important that we look at what 00:23:42.000 --> 00:23:44.000 that person's needs are and 00:23:44.000 --> 00:23:47.000 not just look at the label 00:23:47.000 --> 00:23:49.000 of psychosis because a lot of 00:23:49.000 --> 00:23:51.000 people are still scared to even 00:23:51.000 --> 00:23:53.000 look at psychosis there's a 00:23:53.000 --> 00:23:54.000 statistic I can't remember off 00:23:54.000 --> 00:23:57.000 the top of my head I want to say it's something like 00:23:57.000 --> 00:23:59.000 thirty percent of clinicians 00:23:59.000 --> 00:23:60.000 think that it's detrimental 00:24:00.000 --> 00:24:03.000 to directly address psychosis 00:24:03.000 --> 00:24:05.000 in therapy still I mean and 00:24:05.000 --> 00:24:06.000 we know that's not the case 00:24:06.000 --> 00:24:08.000 but it's still there a lot of 00:24:08.000 --> 00:24:10.000 people hear voices or command 00:24:10.000 --> 00:24:13.000 voices voices telling them to 00:24:13.000 --> 00:24:15.000 kill people or hurt themselves 00:24:15.000 --> 00:24:18.000 or hurt others -- scares people 00:24:18.000 --> 00:24:19.000 and a lot of people don't 00:24:19.000 --> 00:24:21.000 necessarily know how to address 00:24:21.000 --> 00:24:22.000 that or it kind of throws 00:24:22.000 --> 00:24:25.000 people off and our program is 00:24:25.000 --> 00:24:28.000 really focused on normalizing 00:24:28.000 --> 00:24:29.000 and addressing just because you 00:24:29.000 --> 00:24:30.000 hear voices telling you to do 00:24:30.000 --> 00:24:32.000 something doesn't mean you are 00:24:32.000 --> 00:24:34.000 and we really wanna normalize this 00:24:34.000 --> 00:24:36.000 because schizophrenia is 00:24:36.000 --> 00:24:37.000 according to I wanna say it's the 00:24:37.000 --> 00:24:39.000 World Health Organization the third 00:24:39.000 --> 00:24:41.000 most debilitating illness 00:24:41.000 --> 00:24:42.000 including medical illnesses 00:24:42.000 --> 00:24:43.000 mental health illness is 00:24:43.000 --> 00:24:45.000 the third most debilitating 00:24:45.000 --> 00:24:47.000 in the world our goal is to 00:24:47.000 --> 00:24:48.000 keep people on their normal 00:24:48.000 --> 00:24:51.000 life track and part of that 00:24:51.000 --> 00:24:53.000 is stigma reduction and just 00:24:53.000 --> 00:24:54.000 stop with the approach of 00:24:54.000 --> 00:24:57.000 well you kinda have schizophrenia 00:24:57.000 --> 00:24:58.000 mom's basement for the rest 00:24:58.000 --> 00:24:61.000 of your life that's not at all how 00:25:01.000 --> 00:25:02.000 we approach it it is very much 00:25:02.000 --> 00:25:03.000 a what do you want to do with 00:25:03.000 --> 00:25:04.000 your life and how can we help 00:25:04.000 --> 00:25:07.000 you achieve that -- at 00:25:07.000 --> 00:25:08.000 any point during that two year 00:25:08.000 --> 00:25:09.000 program though they are able 00:25:09.000 --> 00:25:10.000 to leave and everybody has 00:25:10.000 --> 00:25:11.000 different needs we have some 00:25:11.000 --> 00:25:14.000 people see them once every other 00:25:14.000 --> 00:25:16.000 week maybe every three weeks 00:25:16.000 --> 00:25:17.000 sometimes we don't need to see 00:25:17.000 --> 00:25:18.000 them at all and we'll just check 00:25:18.000 --> 00:25:19.000 in and they know how to get a 00:25:19.000 --> 00:25:21.000 hold of us if they need us but 00:25:21.000 --> 00:25:22.000 they're transitioning out they're 00:25:22.000 --> 00:25:23.000 really stable everything's 00:25:23.000 --> 00:25:25.000 working really well and we'll 00:25:25.000 --> 00:25:26.000 check in with them at the end 00:25:26.000 --> 00:25:27.000 of the month because they don't 00:25:27.000 --> 00:25:28.000 need anything with us we just 00:25:28.000 --> 00:25:29.000 wanna make sure that things 00:25:29.000 --> 00:25:31.000 are good other people I 00:25:31.000 --> 00:25:32.000 have somebody right now we 00:25:32.000 --> 00:25:33.000 me or my case manager are 00:25:33.000 --> 00:25:35.000 seeing them every single day 00:25:35.000 --> 00:25:37.000 to answer your question about caseload 00:25:37.000 --> 00:25:39.000 we are -- have a caseload of 00:25:39.000 --> 00:25:41.000 around twelve -- within our 00:25:41.000 --> 00:25:43.000 fidelity model fidelity meaning 00:25:43.000 --> 00:25:44.000 we have specific guidelines 00:25:44.000 --> 00:25:45.000 that we try and meet in order to 00:25:45.000 --> 00:25:46.000 call ourselves an EASA 00:25:46.000 --> 00:25:48.000 program so that includes having 00:25:48.000 --> 00:25:50.000 a psychiatrist having a peer 00:25:50.000 --> 00:25:51.000 support and stuff like that 00:25:51.000 --> 00:25:52.000 and part of our fidelity model is 00:25:52.000 --> 00:25:54.000 having a small caseload and 00:25:54.000 --> 00:25:56.000 it's supposed to be twelve but 00:25:56.000 --> 00:25:58.000 according to the EASA Center for Excellence 00:25:58.000 --> 00:25:60.000 we can go up 00:26:00.000 --> 00:26:02.000 to fifteen without them having 00:26:02.000 --> 00:26:04.000 concerns over the fidelity of it 00:26:04.000 --> 00:26:05.000 so her question was do we have 00:26:05.000 --> 00:26:08.000 a wait list absolutely not even 00:26:08.000 --> 00:26:10.000 if I was up to twenty or thirty 00:26:10.000 --> 00:26:12.000 people we are not going to put 00:26:12.000 --> 00:26:14.000 people on a wait list to wait 00:26:14.000 --> 00:26:16.000 for services and the reason why 00:26:16.000 --> 00:26:17.000 is we're an early intervention 00:26:17.000 --> 00:26:19.000 program the data on this is 00:26:19.000 --> 00:26:21.000 super clear the longer you wait 00:26:21.000 --> 00:26:23.000 to intervene with psychosis 00:26:23.000 --> 00:26:25.000 the more damage is done to 00:26:25.000 --> 00:26:26.000 the brain there's something 00:26:26.000 --> 00:26:29.000 called DUP duration of untreated psychosis 00:26:29.000 --> 00:26:31.000 the longer people go without and I'm 00:26:31.000 --> 00:26:33.000 going to emphasize effective 00:26:33.000 --> 00:26:35.000 or appropriate treatment the 00:26:35.000 --> 00:26:37.000 more damage that's done and 00:26:37.000 --> 00:26:39.000 what we can see is -- I'm gonna draw a 00:26:39.000 --> 00:26:44.000 little picture -- so we have 00:26:44.000 --> 00:26:45.000 normal baseline functioning 00:26:45.000 --> 00:26:47.000 right here is everybody able 00:26:47.000 --> 00:26:50.000 to see it cool okay so we have normal 00:26:50.000 --> 00:26:51.000 baseline functioning and 00:26:51.000 --> 00:26:54.000 then say right here the 00:26:54.000 --> 00:26:56.000 person starts experiencing 00:26:56.000 --> 00:26:58.000 psychotic like experiences 00:26:58.000 --> 00:26:59.000 they may be hearing voices or 00:26:59.000 --> 00:26:61.000 they hear noises that nobody 00:27:01.000 --> 00:27:02.000 else is hearing it can be like a 00:27:02.000 --> 00:27:05.000 popping or a tapping or they 00:27:05.000 --> 00:27:07.000 see some visual distortions like 00:27:07.000 --> 00:27:09.000 everything seems more gray 00:27:09.000 --> 00:27:11.000 or there's not as much color 00:27:11.000 --> 00:27:12.000 or they look in the mirror and 00:27:12.000 --> 00:27:13.000 their face doesn't look right 00:27:13.000 --> 00:27:14.000 it just looks different for some 00:27:14.000 --> 00:27:15.000 reason or they have a harder 00:27:15.000 --> 00:27:16.000 time telling the difference between 00:27:16.000 --> 00:27:19.000 their friends faces -- but 00:27:19.000 --> 00:27:20.000 they know that this is crazy 00:27:20.000 --> 00:27:22.000 they know that -- this isn't 00:27:22.000 --> 00:27:23.000 supposed to be normal and they 00:27:23.000 --> 00:27:24.000 feel like maybe their brain's 00:27:24.000 --> 00:27:26.000 playing tricks on them but they 00:27:26.000 --> 00:27:27.000 but they have the ability to 00:27:27.000 --> 00:27:29.000 tell that this isn't really 00:27:29.000 --> 00:27:31.000 normal so this is where we 00:27:31.000 --> 00:27:33.000 see the prodromal phase this 00:27:33.000 --> 00:27:34.000 is where they're starting to experience those 00:27:34.000 --> 00:27:37.000 things but they haven't had 00:27:37.000 --> 00:27:38.000 a full psychotic break they 00:27:38.000 --> 00:27:39.000 still have the ability to say 00:27:39.000 --> 00:27:41.000 this isn't normal this isn't 00:27:41.000 --> 00:27:43.000 the way -- people normally 00:27:43.000 --> 00:27:49.000 experience life and then right here 00:27:49.000 --> 00:27:52.000 is where they lose that insight 00:27:52.000 --> 00:27:53.000 they lose the ability to say 00:27:53.000 --> 00:27:55.000 yeah I know that this is crazy 00:27:55.000 --> 00:27:57.000 but I'm experiencing it anyway this 00:27:57.000 --> 00:27:58.000 is where they start saying 00:27:58.000 --> 00:27:60.000 yeah everybody is talking 00:28:00.000 --> 00:28:01.000 about me and I know they are 00:28:01.000 --> 00:28:03.000 so I need to stay at home because 00:28:03.000 --> 00:28:04.000 everybody's absolutely talking 00:28:04.000 --> 00:28:05.000 about me and maybe they want to 00:28:05.000 --> 00:28:06.000 hurt me so I just need to stay 00:28:06.000 --> 00:28:08.000 here and be safe this is where they 00:28:08.000 --> 00:28:09.000 start losing that ability to 00:28:09.000 --> 00:28:11.000 say okay this isn't normal I 00:28:11.000 --> 00:28:12.000 shouldn't be experiencing this 00:28:12.000 --> 00:28:14.000 and I don't need to be reacting 00:28:14.000 --> 00:28:15.000 to this it's really where we 00:28:15.000 --> 00:28:17.000 see behavior change -- people 00:28:17.000 --> 00:28:19.000 start reacting to the symptoms 00:28:19.000 --> 00:28:21.000 that they're experiencing and 00:28:21.000 --> 00:28:22.000 with this baseline functioning 00:28:22.000 --> 00:28:24.000 that we have at this point is a 00:28:24.000 --> 00:28:27.000 very very quick and sudden drop 00:28:27.000 --> 00:28:28.000 in functioning what we know 00:28:28.000 --> 00:28:30.000 with schizophrenia is without 00:28:30.000 --> 00:28:32.000 any intervention whatsoever 00:28:32.000 --> 00:28:33.000 the person just toughs it 00:28:33.000 --> 00:28:35.000 out so to speak and they get 00:28:35.000 --> 00:28:36.000 through it without talking to 00:28:36.000 --> 00:28:37.000 a therapist without getting 00:28:37.000 --> 00:28:38.000 any medication without any help 00:28:38.000 --> 00:28:39.000 whatsoever what we do know 00:28:39.000 --> 00:28:41.000 is that eventually their 00:28:41.000 --> 00:28:43.000 functioning plateaus and 00:28:43.000 --> 00:28:48.000 even starts to recover but it 00:28:48.000 --> 00:28:49.000 doesn't return to where it was 00:28:49.000 --> 00:28:53.000 before from when we get our 00:28:53.000 --> 00:28:55.000 early intervention say within 00:28:55.000 --> 00:28:57.000 this period what we can see 00:28:57.000 --> 00:28:59.000 is sometimes there's a dip in 00:28:59.000 --> 00:28:60.000 functioning but they're able 00:29:00.000 --> 00:29:02.000 to maintain much closer to where 00:29:02.000 --> 00:29:05.000 they were before -- but the 00:29:05.000 --> 00:29:06.000 damage that occurs is real we 00:29:06.000 --> 00:29:08.000 can actually see the difference 00:29:08.000 --> 00:29:10.000 in brains and PET scans 00:29:10.000 --> 00:29:12.000 and in MRIs we can look at some 00:29:12.000 --> 00:29:14.000 changes in the brain that occur 00:29:14.000 --> 00:29:16.000 between a quote unquote normal 00:29:16.000 --> 00:29:18.000 brain and somebody that has 00:29:18.000 --> 00:29:20.000 schizophrenia specifically the 00:29:20.000 --> 00:29:21.000 ventricles in the front of the 00:29:21.000 --> 00:29:23.000 brain are significantly larger 00:29:23.000 --> 00:29:25.000 and we also see some areas -- 00:29:25.000 --> 00:29:26.000 in the parietal temporal lobe 00:29:26.000 --> 00:29:29.000 area where there are larger 00:29:31.000 --> 00:29:32.000 showing a decrease in overall 00:29:32.000 --> 00:29:35.000 brain mass in those areas -- 00:29:35.000 --> 00:29:38.000 so the thing about the brain is 00:29:38.000 --> 00:29:40.000 it's very plastic it's -- it really 00:29:40.000 --> 00:29:41.000 likes to recover and bounce 00:29:41.000 --> 00:29:42.000 back from stuff but it doesn't 00:29:42.000 --> 00:29:44.000 recover the same way everything 00:29:44.000 --> 00:29:45.000 else in our body does and so 00:29:45.000 --> 00:29:47.000 when these deficits happen 00:29:47.000 --> 00:29:49.000 they're not necessarily 00:29:49.000 --> 00:29:50.000 going to get much better if 00:29:50.000 --> 00:29:52.000 we enter if we had therapy 00:29:52.000 --> 00:29:53.000 and pieces like that we can see 00:29:53.000 --> 00:29:54.000 some improvements but it's 00:29:54.000 --> 00:29:55.000 not necessarily going to be 00:29:55.000 --> 00:29:57.000 where it was before the thing 00:29:57.000 --> 00:29:58.000 about early intervention is if 00:29:58.000 --> 00:29:60.000 we get in there early enough 00:30:00.000 --> 00:30:02.000 we can prevent schizophrenia 00:30:02.000 --> 00:30:04.000 from forming if we do the 00:30:04.000 --> 00:30:07.000 intervention early enough if 00:30:07.000 --> 00:30:08.000 the -- right here is where 00:30:08.000 --> 00:30:09.000 the person -- loses their 00:30:09.000 --> 00:30:10.000 insight into what they're 00:30:10.000 --> 00:30:12.000 experiencing they lose their 00:30:12.000 --> 00:30:14.000 ability to say this isn't normal 00:30:14.000 --> 00:30:15.000 if we can prevent that from 00:30:15.000 --> 00:30:17.000 happening then they won't 00:30:17.000 --> 00:30:19.000 have that active break and 00:30:19.000 --> 00:30:20.000 this is a lot more than just 00:30:20.000 --> 00:30:22.000 physical changes in the body 00:30:22.000 --> 00:30:24.000 it's also the stigma it's 00:30:24.000 --> 00:30:25.000 the culture around it what 00:30:25.000 --> 00:30:27.000 we know about say inpatient 00:30:27.000 --> 00:30:28.000 hospitalizations when somebody 00:30:28.000 --> 00:30:30.000 is forced to go to the psych ward 00:30:31.000 --> 00:30:33.000 positive game changer for 00:30:33.000 --> 00:30:34.000 them it can really get them 00:30:34.000 --> 00:30:35.000 stable and make things better 00:30:35.000 --> 00:30:37.000 for them but at the same time 00:30:37.000 --> 00:30:39.000 we also know that it increases 00:30:39.000 --> 00:30:40.000 the likelihood that they're 00:30:40.000 --> 00:30:42.000 going to come back it increases 00:30:42.000 --> 00:30:44.000 gonna start looking outside 00:30:44.000 --> 00:30:47.000 of themselves for stability 00:30:47.000 --> 00:30:49.000 and -- really often we will 00:30:49.000 --> 00:30:50.000 see people that every time 00:30:50.000 --> 00:30:52.000 they start getting sick their first 00:30:52.000 --> 00:30:53.000 thought is I need to go back 00:30:53.000 --> 00:30:54.000 to the hospital I need to get 00:30:54.000 --> 00:30:55.000 stable and what we're really 00:30:55.000 --> 00:30:57.000 encouraging people is we want 00:30:57.000 --> 00:30:58.000 you to live a normal life we 00:30:58.000 --> 00:30:59.000 want you to be able to not have 00:30:59.000 --> 00:30:62.000 to go there and so this is not 00:31:02.000 --> 00:31:03.000 just the physical stuff but 00:31:03.000 --> 00:31:04.000 it's also everything that comes 00:31:04.000 --> 00:31:06.000 along with somebody that has 00:31:06.000 --> 00:31:07.000 this break because once you have 00:31:07.000 --> 00:31:09.000 that active break there's a 00:31:09.000 --> 00:31:11.000 lot different mentality going 00:31:11.000 --> 00:31:12.000 on in your head than somebody 00:31:12.000 --> 00:31:13.000 that's just kind of experienced 00:31:13.000 --> 00:31:14.000 some weird stuff I don't 00:31:14.000 --> 00:31:15.000 really know what it is and then 00:31:15.000 --> 00:31:16.000 you have a lot of education 00:31:16.000 --> 00:31:17.000 around it and you can tell the 00:31:17.000 --> 00:31:19.000 difference but that's a very 00:31:19.000 --> 00:31:20.000 different story than somebody 00:31:20.000 --> 00:31:23.000 who's saying yeah I experienced 00:31:23.000 --> 00:31:24.000 a time in my life where I 00:31:24.000 --> 00:31:25.000 had no ability to tell the 00:31:25.000 --> 00:31:27.000 difference between my friends 00:31:27.000 --> 00:31:29.000 and these delusional thoughts 00:31:29.000 --> 00:31:30.000 that I had in my head and we 00:31:30.000 --> 00:31:32.000 can also see the severity of 00:31:32.000 --> 00:31:33.000 symptoms starts popping up they 00:31:33.000 --> 00:31:36.000 go from having just murmurs 00:31:36.000 --> 00:31:38.000 and mumblings in the back 00:31:38.000 --> 00:31:40.000 of their head to when they lose 00:31:40.000 --> 00:31:41.000 the insight at that point the 00:31:41.000 --> 00:31:43.000 voices start yelling and they 00:31:43.000 --> 00:31:45.000 get worse or they are more 00:31:45.000 --> 00:31:48.000 frequent so early intervention 00:31:48.000 --> 00:31:49.000 is super important for that 00:31:49.000 --> 00:31:51.000 so that we can actually get 00:31:51.000 --> 00:31:52.000 in and prevent this damage 00:31:52.000 --> 00:31:55.000 from going on so without any 00:31:55.000 --> 00:31:56.000 intervention we'll see this 00:31:56.000 --> 00:31:57.000 eventual -- bit of recovery 00:31:57.000 --> 00:31:59.000 and then plateau and there are 00:31:59.000 --> 00:31:61.000 ways that we can adjust around 00:32:01.000 --> 00:32:02.000 it just like when somebody has 00:32:02.000 --> 00:32:04.000 some sort of physical ailment 00:32:04.000 --> 00:32:06.000 if you break your leg and do 00:32:06.000 --> 00:32:08.000 some real damage to your leg it 00:32:08.000 --> 00:32:09.000 doesn't mean that you're never 00:32:09.000 --> 00:32:10.000 gonna be able to walk again 00:32:10.000 --> 00:32:12.000 naturally your body wants to 00:32:12.000 --> 00:32:13.000 recover on its own regardless 00:32:13.000 --> 00:32:16.000 of medical intervention -- 00:32:16.000 --> 00:32:17.000 but there are -- also are ways 00:32:17.000 --> 00:32:19.000 that we can help with the 00:32:19.000 --> 00:32:22.000 functioning by maybe not making 00:32:22.000 --> 00:32:24.000 their brains heel better but 00:32:26.000 --> 00:32:28.000 how to accommodate around that 00:32:28.000 --> 00:32:30.000 also so the functioning can 00:32:30.000 --> 00:32:31.000 definitely improve whether 00:32:31.000 --> 00:32:33.000 it's just identifying I have 00:32:33.000 --> 00:32:35.000 this thing going on in me and 00:32:35.000 --> 00:32:38.000 go away so how do I surround 00:32:38.000 --> 00:32:40.000 myself with supports maybe it's 00:32:40.000 --> 00:32:42.000 having conversations around 00:32:42.000 --> 00:32:43.000 who's your person when you're 00:32:43.000 --> 00:32:44.000 struggling do you have a person 00:32:44.000 --> 00:32:47.000 to talk to and are they aware 00:32:47.000 --> 00:32:48.000 of what's going on do they know 00:32:48.000 --> 00:32:50.000 what the warning signs are when 00:32:50.000 --> 00:32:52.000 the symptoms get worse because 00:32:52.000 --> 00:32:53.000 like all mental health there's 00:32:53.000 --> 00:32:55.000 kind of this just up and down 00:32:55.000 --> 00:32:56.000 in general whether there's a 00:32:56.000 --> 00:32:58.000 mental health diagnosis or not 00:32:58.000 --> 00:32:59.000 we always have our up days we 00:32:59.000 --> 00:32:61.000 always have our down days and 00:33:01.000 --> 00:33:02.000 it's just that normal stress 00:33:02.000 --> 00:33:04.000 load that we have but we know 00:33:04.000 --> 00:33:05.000 with the stress vulnerability 00:33:05.000 --> 00:33:06.000 model the more stressed we 00:33:06.000 --> 00:33:08.000 are the more likely we are 00:33:08.000 --> 00:33:09.000 to have symptoms of whatever 00:33:09.000 --> 00:33:10.000 whether it's physical illness 00:33:10.000 --> 00:33:13.000 or mental health issues and 00:33:13.000 --> 00:33:15.000 so yeah we can -- we can help 00:33:15.000 --> 00:33:17.000 with that -- we can definitely 00:33:17.000 --> 00:33:18.000 add some accommodations and 00:33:18.000 --> 00:33:19.000 interventions around that 00:33:19.000 --> 00:33:20.000 to help their life be more 00:33:20.000 --> 00:33:23.000 functional but at that point 00:33:23.000 --> 00:33:24.000 the damage done to the brain 00:33:24.000 --> 00:33:26.000 is already done and the brain 00:33:26.000 --> 00:33:28.000 can slowly recover over time 00:33:28.000 --> 00:33:30.000 but not necessarily the 00:33:30.000 --> 00:33:31.000 way it would if we were able to 00:33:31.000 --> 00:33:32.000 prevent that from happening in 00:33:32.000 --> 00:33:34.000 the first place if the person 00:33:34.000 --> 00:33:36.000 is either lacking insight 00:33:36.000 --> 00:33:37.000 or maybe they just don't want 00:33:37.000 --> 00:33:39.000 to be involved in services do 00:33:39.000 --> 00:33:41.000 we have things to offer them 00:33:41.000 --> 00:33:42.000 in the meantime and the answer 00:33:42.000 --> 00:33:44.000 is yes absolutely -- that's 00:33:44.000 --> 00:33:45.000 where you get to really be 00:33:45.000 --> 00:33:47.000 a therapist -- that's the fun 00:33:47.000 --> 00:33:49.000 stuff so especially say with 00:33:51.000 --> 00:33:52.000 for psychosis part that is even 00:33:55.000 --> 00:33:56.000 is that they're experiencing 00:33:56.000 --> 00:33:58.000 and what is the nature 00:33:58.000 --> 00:33:59.000 of why it is that they don't 00:33:59.000 --> 00:33:60.000 want services I mean I've 00:34:00.000 --> 00:34:02.000 worked with people that they 00:34:02.000 --> 00:34:04.000 desperately want services but 00:34:04.000 --> 00:34:05.000 the voice in their head is 00:34:05.000 --> 00:34:07.000 telling them absolutely not if 00:34:07.000 --> 00:34:09.000 you get help you'll die or if 00:34:09.000 --> 00:34:10.000 you get help somebody that you 00:34:10.000 --> 00:34:12.000 know could be very seriously 00:34:12.000 --> 00:34:14.000 hurt or their cognitive state 00:34:14.000 --> 00:34:16.000 is just in such a place that 00:34:16.000 --> 00:34:17.000 they just can't even process 00:34:17.000 --> 00:34:19.000 it and so if the person is able 00:34:19.000 --> 00:34:22.000 to give consent -- what we'll 00:34:22.000 --> 00:34:23.000 do is we'll work with them to 00:34:23.000 --> 00:34:25.000 where they're comfortable at 00:34:25.000 --> 00:34:27.000 but it is either getting them to 00:34:27.000 --> 00:34:29.000 start questioning some of this 00:34:29.000 --> 00:34:30.000 so well maybe you have a voice that 00:34:30.000 --> 00:34:31.000 tells you that if you talk to 00:34:31.000 --> 00:34:34.000 us somebody's gonna be hurt or 00:34:34.000 --> 00:34:36.000 something bad will happen has 00:34:36.000 --> 00:34:37.000 there ever been a time where 00:34:37.000 --> 00:34:38.000 you talk to somebody and the 00:34:38.000 --> 00:34:39.000 voice said you shouldn't and 00:34:39.000 --> 00:34:41.000 nothing happened so we give 00:34:41.000 --> 00:34:43.000 them that seed of doubt and the 00:34:43.000 --> 00:34:44.000 other part is if they flat out 00:34:44.000 --> 00:34:46.000 say I don't want services we 00:34:46.000 --> 00:34:48.000 respect that but we'll counter 00:34:48.000 --> 00:34:49.000 with is it okay if we just stop by 00:34:49.000 --> 00:34:51.000 and say hi sometime can we just 00:34:51.000 --> 00:34:54.000 talk no agenda no therapy we're 00:34:54.000 --> 00:34:56.000 just engaging you as a human 00:34:56.000 --> 00:34:57.000 being maybe we can meet for coffee 00:34:57.000 --> 00:34:59.000 sometime and I've had somebody 00:34:59.000 --> 00:34:60.000 that would turn themselves 00:35:00.000 --> 00:35:02.000 into the police station every 00:35:02.000 --> 00:35:04.000 single day at a specific time 00:35:04.000 --> 00:35:05.000 convinced that they'd committed 00:35:05.000 --> 00:35:08.000 a crime and that person wanted 00:35:08.000 --> 00:35:11.000 help but they were very very 00:35:11.000 --> 00:35:13.000 paranoid and so the next step 00:35:13.000 --> 00:35:15.000 was just meeting them there 00:35:15.000 --> 00:35:17.000 and just having a talk with them so 00:35:17.000 --> 00:35:19.000 that we became normal to them 00:35:19.000 --> 00:35:20.000 we became a normal part of their life 00:35:20.000 --> 00:35:22.000 and a safe part of their life 00:35:22.000 --> 00:35:23.000 to then go to the next step 00:35:23.000 --> 00:35:25.000 of engagement so one with my 00:35:25.000 --> 00:35:28.000 program -- anybody can refer 00:35:28.000 --> 00:35:29.000 to us we do not need to get a 00:35:29.000 --> 00:35:31.000 referral from a professional 00:35:31.000 --> 00:35:33.000 anybody can call us and say Hey 00:35:33.000 --> 00:35:34.000 you know I've got this person 00:35:34.000 --> 00:35:35.000 one thing I always tell people 00:35:35.000 --> 00:35:37.000 is let them know that I 00:35:37.000 --> 00:35:38.000 might be reaching out to them 00:35:38.000 --> 00:35:40.000 because if you're paranoid and 00:35:40.000 --> 00:35:41.000 somebody that works for the 00:35:41.000 --> 00:35:42.000 government reaches out to them 00:35:42.000 --> 00:35:43.000 about their mental health issues 00:35:43.000 --> 00:35:45.000 sometimes it doesn't go so well 00:35:45.000 --> 00:35:48.000 and I've got some good stories 00:35:48.000 --> 00:35:51.000 about that -- the biggest 00:35:51.000 --> 00:35:52.000 part is being supportive 00:35:52.000 --> 00:35:54.000 and validating validating that 00:35:56.000 --> 00:35:57.000 things and that it is disruptive 00:35:57.000 --> 00:35:59.000 for them but the other part is 00:35:59.000 --> 00:35:60.000 just encouraging them to seek 00:36:00.000 --> 00:36:04.000 help and sometimes that's the 00:36:04.000 --> 00:36:05.000 best we can do if the person 00:36:05.000 --> 00:36:07.000 is really struggling -- 00:36:07.000 --> 00:36:08.000 wherever it is that you live 00:36:08.000 --> 00:36:10.000 has different crisis services 00:36:10.000 --> 00:36:13.000 available and I would -- 00:36:13.000 --> 00:36:14.000 educate yourself on what is 00:36:14.000 --> 00:36:16.000 available or available within 00:36:16.000 --> 00:36:18.000 their life I know that Western 00:36:18.000 --> 00:36:20.000 has mental health services 00:36:20.000 --> 00:36:21.000 that are available limited 00:36:21.000 --> 00:36:23.000 amount of them I don't know 00:36:23.000 --> 00:36:25.000 what they are to a certain 00:36:25.000 --> 00:36:26.000 extent because I don't go 00:36:26.000 --> 00:36:29.000 here anymore but explore those 00:36:29.000 --> 00:36:30.000 and know what -- what's 00:36:30.000 --> 00:36:31.000 going on and if there is a 00:36:31.000 --> 00:36:32.000 concern for safety it's always 00:36:32.000 --> 00:36:33.000 appropriate especially if you 00:36:33.000 --> 00:36:34.000 don't think the person is able 00:36:34.000 --> 00:36:37.000 to stay safe it is appropriate 00:36:37.000 --> 00:36:38.000 to call emergency services 00:36:38.000 --> 00:36:39.000 and let them know I think that there's 00:36:39.000 --> 00:36:40.000 a mental health thing going 00:36:40.000 --> 00:36:41.000 on right now and this person 00:36:41.000 --> 00:36:44.000 needs help -- if you're able to 00:36:44.000 --> 00:36:45.000 and somebody's really really 00:36:45.000 --> 00:36:47.000 struggling but they're not 00:36:47.000 --> 00:36:48.000 you can get them there safely 00:36:48.000 --> 00:36:49.000 I would encourage you to get 00:36:49.000 --> 00:36:52.000 them to the emergency room -- 00:36:52.000 --> 00:36:53.000 because that will then turn 00:36:53.000 --> 00:36:55.000 into a crisis assessment and can 00:36:55.000 --> 00:36:57.000 get somebody opened up -- find 00:36:57.000 --> 00:36:59.000 out what local resources 00:36:59.000 --> 00:36:61.000 are -- and offer it to them if 00:37:01.000 --> 00:37:02.000 need be but the biggest thing 00:37:02.000 --> 00:37:04.000 is just being a friend being a 00:37:04.000 --> 00:37:06.000 friend in support of and loving 00:37:06.000 --> 00:37:08.000 and it's okay to question them 00:37:08.000 --> 00:37:11.000 when they have -- symptoms 00:37:11.000 --> 00:37:12.000 pop up and be well you know I don't 00:37:12.000 --> 00:37:14.000 necessarily know if that's true 00:37:14.000 --> 00:37:15.000 or not it doesn't mean they're 00:37:15.000 --> 00:37:16.000 not experiencing them because 00:37:16.000 --> 00:37:18.000 the way especially psychosis 00:37:18.000 --> 00:37:20.000 works it is one hundred percent 00:37:20.000 --> 00:37:22.000 real the brain isn't just like 00:37:22.000 --> 00:37:23.000 thinking that it's hearing 00:37:23.000 --> 00:37:25.000 things it is processing these 00:37:25.000 --> 00:37:27.000 things as if they are one 00:37:27.000 --> 00:37:28.000 hundred percent real so arguing 00:37:28.000 --> 00:37:30.000 with somebody that well 00:37:30.000 --> 00:37:31.000 there's nothing really going 00:37:31.000 --> 00:37:32.000 on that's just all in your head 00:37:32.000 --> 00:37:35.000 one incredibly invalidating 00:37:35.000 --> 00:37:36.000 because well it's like yeah 00:37:36.000 --> 00:37:38.000 maybe it is in my head but I'm 00:37:38.000 --> 00:37:40.000 still hearing it and knowing 00:37:40.000 --> 00:37:41.000 that it's fake doesn't make the 00:37:41.000 --> 00:37:45.000 voice go away so recognizing 00:37:45.000 --> 00:37:47.000 that but just really validating 00:37:47.000 --> 00:37:48.000 and coming from a place of 00:37:48.000 --> 00:37:49.000 support and finding out what 00:37:49.000 --> 00:37:50.000 it is that support looks like 00:37:50.000 --> 00:37:51.000 for them so you can build that 00:37:51.000 --> 00:37:53.000 trust with them so that they can 00:37:53.000 --> 00:37:54.000 feel comfortable enough to 00:37:54.000 --> 00:37:55.000 maybe talk provide them with 00:37:55.000 --> 00:37:57.000 resources if you know there's 00:37:57.000 --> 00:37:59.000 a resource available suggest 00:37:59.000 --> 00:37:60.000 it even maybe offer to go 00:38:00.000 --> 00:38:02.000 with them that can be really 00:38:02.000 --> 00:38:04.000 because who wants to go talk 00:38:04.000 --> 00:38:06.000 to a therapist about stuff I 00:38:06.000 --> 00:38:08.000 mean there's a lot of different 00:38:08.000 --> 00:38:09.000 reasons why people avoid 00:38:09.000 --> 00:38:12.000 therapy and sometimes people 00:38:12.000 --> 00:38:13.000 aren't necessarily ready for 00:38:13.000 --> 00:38:15.000 it but the reality is that most 00:38:15.000 --> 00:38:17.000 people probably are it's just 00:38:17.000 --> 00:38:19.000 knowing how to get them in in 00:38:19.000 --> 00:38:21.000 the first place and if it's 00:38:21.000 --> 00:38:22.000 somebody that you care about 00:38:22.000 --> 00:38:24.000 you'll know them best sometimes 00:38:24.000 --> 00:38:26.000 it can also be even -- 00:38:26.000 --> 00:38:28.000 reaching out to a resource and say hey 00:38:28.000 --> 00:38:29.000 you know I know this person 00:38:29.000 --> 00:38:31.000 and in this case you're asking 00:38:31.000 --> 00:38:34.000 me -- but you can ask them 00:38:34.000 --> 00:38:35.000 you know I know this person I 00:38:35.000 --> 00:38:36.000 think that they fit with what 00:38:36.000 --> 00:38:38.000 it is that you do treatment for 00:38:38.000 --> 00:38:39.000 how can I get them in whether 00:38:39.000 --> 00:38:42.000 it's depression or anxiety or psychosis 00:38:42.000 --> 00:38:44.000 how do we get them 00:38:44.000 --> 00:38:45.000 into a higher level of care 00:38:45.000 --> 00:38:47.000 like a hospital when do we know if 00:38:47.000 --> 00:38:49.000 they need more structure versus 00:38:49.000 --> 00:38:50.000 being in our program how do we 00:38:50.000 --> 00:38:52.000 get them connected to that -- 00:38:52.000 --> 00:38:56.000 did I cover all of it okay -- so 00:38:56.000 --> 00:38:58.000 our program is intensive outpatient 00:38:58.000 --> 00:38:60.000 the goal is not pretty much 00:39:00.000 --> 00:39:02.000 ever to have somebody go into 00:39:02.000 --> 00:39:03.000 the hospital and stay there 00:39:03.000 --> 00:39:04.000 that's really not appropriate 00:39:04.000 --> 00:39:06.000 we do see people over at the 00:39:06.000 --> 00:39:07.000 state hospital these are people 00:39:07.000 --> 00:39:09.000 that have severe persistent 00:39:09.000 --> 00:39:10.000 mental illness and oftentimes 00:39:10.000 --> 00:39:12.000 there's a whole lot of other issues 00:39:12.000 --> 00:39:13.000 going on with that outside of 00:39:13.000 --> 00:39:16.000 just the illness -- with us 00:39:16.000 --> 00:39:17.000 being an early intervention 00:39:17.000 --> 00:39:20.000 program the damage should 00:39:20.000 --> 00:39:22.000 be early on whatever damage is 00:39:22.000 --> 00:39:23.000 occurring to the brain or 00:39:23.000 --> 00:39:24.000 even if we're able to get them 00:39:24.000 --> 00:39:25.000 before they have their first 00:39:25.000 --> 00:39:27.000 active psychotic break the 00:39:27.000 --> 00:39:29.000 damage may not have even started yet 00:39:31.000 --> 00:39:32.000 people out in the community 00:39:32.000 --> 00:39:35.000 and on their normal life track 00:39:35.000 --> 00:39:37.000 so say we get a referral for 00:39:37.000 --> 00:39:39.000 somebody that is currently in 00:39:39.000 --> 00:39:40.000 the emergency room because they 00:39:40.000 --> 00:39:41.000 are having a psychotic break 00:39:41.000 --> 00:39:43.000 a full psychotic break they're 00:39:43.000 --> 00:39:45.000 not really able to tell the 00:39:45.000 --> 00:39:46.000 difference between reality they're 00:39:46.000 --> 00:39:48.000 really not able to be safe not 00:39:48.000 --> 00:39:49.000 necessarily that they're threatening other 00:39:49.000 --> 00:39:50.000 people or themselves but they 00:39:50.000 --> 00:39:52.000 might be in such a cognitive 00:39:52.000 --> 00:39:53.000 state that their ability 00:39:53.000 --> 00:39:55.000 to keep themselves out of a 00:39:55.000 --> 00:39:58.000 dangerous situation may be pretty 00:39:58.000 --> 00:39:60.000 severe -- I have worked with 00:40:00.000 --> 00:40:02.000 somebody that they needed to 00:40:02.000 --> 00:40:04.000 go to this bank and tell them 00:40:04.000 --> 00:40:05.000 that there was a bomb in the 00:40:05.000 --> 00:40:08.000 bank well that doesn't go over 00:40:08.000 --> 00:40:09.000 super well and then that can 00:40:09.000 --> 00:40:11.000 lead to interactions with the 00:40:11.000 --> 00:40:13.000 cops and then what can be seen 00:40:13.000 --> 00:40:14.000 as just normal mental health 00:40:14.000 --> 00:40:16.000 behaviors cops might perceive 00:40:16.000 --> 00:40:17.000 as a threat no matter how 00:40:17.000 --> 00:40:19.000 well trained they are it's a 00:40:19.000 --> 00:40:20.000 completely different level and 00:40:20.000 --> 00:40:21.000 we'd like to avoid that kind of 00:40:21.000 --> 00:40:23.000 thing happening so the person 00:40:23.000 --> 00:40:24.000 is really struggling with 00:40:24.000 --> 00:40:26.000 symptoms usually when they're 00:40:26.000 --> 00:40:27.000 in an emergency room they'll oftentimes 00:40:27.000 --> 00:40:29.000 start getting medication on board 00:40:29.000 --> 00:40:30.000 it's usually like Zyprexa or 00:40:30.000 --> 00:40:33.000 Ativan or something like that and 00:40:33.000 --> 00:40:34.000 we determine based off of a 00:40:34.000 --> 00:40:36.000 crisis assessment this person 00:40:36.000 --> 00:40:39.000 really is not in a place to be 00:40:39.000 --> 00:40:40.000 in the community because they 00:40:40.000 --> 00:40:41.000 might get themselves or others 00:40:41.000 --> 00:40:44.000 hurt so within our agency what 00:40:44.000 --> 00:40:46.000 we'll do is if the person is 00:40:46.000 --> 00:40:47.000 voluntary and we don't think 00:40:47.000 --> 00:40:48.000 that they're going to take 00:40:48.000 --> 00:40:50.000 off or there's not a huge 00:40:50.000 --> 00:40:51.000 threat involved with it they 00:40:51.000 --> 00:40:53.000 can voluntarily stay at the 00:40:53.000 --> 00:40:54.000 emergency room and we'll put 00:40:54.000 --> 00:40:55.000 out referrals to the inpatient 00:40:55.000 --> 00:40:56.000 units there's one in Corvallis there's one 00:40:56.000 --> 00:40:59.000 in Salem those are our major ones 00:40:59.000 --> 00:40:60.000 that we go to but there are 00:41:00.000 --> 00:41:02.000 ones all over the state -- 00:41:02.000 --> 00:41:03.000 if they're not voluntary then 00:41:03.000 --> 00:41:05.000 there can be something called 00:41:05.000 --> 00:41:07.000 a director's hold where we 00:41:07.000 --> 00:41:09.000 legally force them to stay 00:41:09.000 --> 00:41:10.000 there and if they try and leave 00:41:10.000 --> 00:41:11.000 then the security staff 00:41:11.000 --> 00:41:14.000 at the ED can make them stay 00:41:15.000 --> 00:41:17.000 anybody and really don't like 00:41:17.000 --> 00:41:21.000 doing that -- and then the -- as -- 00:41:21.000 --> 00:41:22.000 the same thing we get referrals 00:41:22.000 --> 00:41:23.000 out to the inpatient units to 00:41:23.000 --> 00:41:24.000 get them there but oftentimes 00:41:24.000 --> 00:41:26.000 an inpatient stay is three 00:41:26.000 --> 00:41:29.000 to five days and medication is 00:41:29.000 --> 00:41:31.000 great but what we know about 00:41:31.000 --> 00:41:33.000 mental health medication is most 00:41:33.000 --> 00:41:34.000 of them take four to six weeks 00:41:34.000 --> 00:41:37.000 to fully kick in three to five 00:41:37.000 --> 00:41:38.000 days is a lot shorter than four 00:41:38.000 --> 00:41:41.000 to six weeks and so either way 00:41:41.000 --> 00:41:43.000 if they go into the in patient 00:41:43.000 --> 00:41:44.000 unit we need to have something 00:41:44.000 --> 00:41:45.000 to catch them as they come 00:41:45.000 --> 00:41:48.000 back out -- so part of that is 00:41:48.000 --> 00:41:50.000 ideally say somebody I -- 00:41:50.000 --> 00:41:51.000 ideally this person would never 00:41:51.000 --> 00:41:52.000 get to the emergency room in the 00:41:52.000 --> 00:41:53.000 first place and I'd hear about 00:41:53.000 --> 00:41:55.000 it before that but if they're 00:41:55.000 --> 00:41:56.000 already there and they end up 00:41:56.000 --> 00:41:58.000 going to the hospital -- if we 00:41:58.000 --> 00:41:59.000 get the referral we can start 00:41:59.000 --> 00:41:60.000 working with them while they're 00:42:00.000 --> 00:42:02.000 in the hospital we can start 00:42:02.000 --> 00:42:03.000 getting to know family members 00:42:03.000 --> 00:42:04.000 we can figure out -- what kind 00:42:04.000 --> 00:42:06.000 of needs are going on see how 00:42:06.000 --> 00:42:07.000 clear they are and anticipate 00:42:07.000 --> 00:42:09.000 what kind of risk is going on 00:42:09.000 --> 00:42:11.000 so that as they step down 00:42:11.000 --> 00:42:12.000 they already have a care team 00:42:12.000 --> 00:42:13.000 in place that they've already 00:42:13.000 --> 00:42:14.000 met that they're already 00:42:14.000 --> 00:42:15.000 familiar with that they're 00:42:15.000 --> 00:42:16.000 already growing a relationship 00:42:16.000 --> 00:42:18.000 with so then we can start 00:42:18.000 --> 00:42:20.000 doing the real work of keeping 00:42:20.000 --> 00:42:21.000 them in the community so they 00:42:21.000 --> 00:42:22.000 don't have to go back 00:42:22.000 --> 00:42:24.000 can I speak about what my role is 00:42:24.000 --> 00:42:26.000 as far as managing and having 00:42:26.000 --> 00:42:28.000 multiple types of relationships 00:42:28.000 --> 00:42:29.000 with these clients and within the 00:42:29.000 --> 00:42:30.000 community around us and the 00:42:32.000 --> 00:42:36.000 we work with so -- one be very 00:42:36.000 --> 00:42:37.000 familiar obviously with the 00:42:37.000 --> 00:42:40.000 ethics and the OBLPCT 00:42:40.000 --> 00:42:41.000 and what their ethics 00:42:41.000 --> 00:42:42.000 guidelines are that's a really 00:42:42.000 --> 00:42:44.000 important thing big big thing 00:42:44.000 --> 00:42:46.000 is obviously do no harm it's 00:42:46.000 --> 00:42:48.000 also do no harm includes are 00:42:48.000 --> 00:42:49.000 we setting this person up to 00:42:49.000 --> 00:42:52.000 be dependent on us so a question 00:42:52.000 --> 00:42:53.000 that's always in back my head am I 00:42:53.000 --> 00:42:54.000 doing something for my client 00:42:54.000 --> 00:42:55.000 that I know they're capable 00:42:55.000 --> 00:42:57.000 of doing on their own and am 00:42:57.000 --> 00:42:58.000 I just doing it to make it 00:42:58.000 --> 00:42:60.000 easier for them or even myself 00:43:02.000 --> 00:43:04.000 these people up so that they 00:43:04.000 --> 00:43:06.000 need a therapist for the rest 00:43:06.000 --> 00:43:07.000 of their life have we really made 00:43:07.000 --> 00:43:09.000 them independent some people 00:43:09.000 --> 00:43:11.000 will some people's illness is 00:43:11.000 --> 00:43:12.000 such that they need ongoing 00:43:12.000 --> 00:43:14.000 services and we have that kind 00:43:14.000 --> 00:43:15.000 of thing within Linn County 00:43:15.000 --> 00:43:16.000 or community support services 00:43:16.000 --> 00:43:18.000 is for people that have ongoing 00:43:18.000 --> 00:43:19.000 psychotic illness and maybe 00:43:19.000 --> 00:43:21.000 they don't need ongoing therapy 00:43:21.000 --> 00:43:22.000 but just to check in and make 00:43:22.000 --> 00:43:24.000 sure things are okay -- there's 00:43:24.000 --> 00:43:26.000 also ACT teams which usually 00:43:26.000 --> 00:43:28.000 have like medication delivery 00:43:28.000 --> 00:43:30.000 that they're having more severe 00:43:30.000 --> 00:43:31.000 illnesses and they'll need that 00:43:31.000 --> 00:43:34.000 ongoing support but there's a 00:43:34.000 --> 00:43:35.000 lot of people that don't need that 00:43:35.000 --> 00:43:37.000 and so part of it is keeping 00:43:37.000 --> 00:43:38.000 in mind is this something that I 00:43:38.000 --> 00:43:39.000 am doing or is this something 00:43:39.000 --> 00:43:41.000 that maybe their best friend 00:43:41.000 --> 00:43:43.000 can be doing with them am I 00:43:43.000 --> 00:43:45.000 working with that friend so 00:43:46.000 --> 00:43:47.000 just a client working with 00:43:47.000 --> 00:43:48.000 the families working with 00:43:48.000 --> 00:43:50.000 friends working with girlfriend 00:43:50.000 --> 00:43:53.000 boyfriend spouse and getting 00:43:53.000 --> 00:43:54.000 them on board and doing a lot 00:43:54.000 --> 00:43:55.000 of education with them on how 00:43:55.000 --> 00:43:56.000 to support the person when 00:43:56.000 --> 00:43:58.000 the services are eventually 00:43:58.000 --> 00:43:60.000 closed -- the other part is 00:44:00.000 --> 00:44:02.000 having a good relationship 00:44:02.000 --> 00:44:04.000 with the different partners 00:44:04.000 --> 00:44:05.000 we have I've worked with Oregon 00:44:05.000 --> 00:44:06.000 Youth Authority I've worked with 00:44:06.000 --> 00:44:10.000 Trillium's Farm Home DHS some of 00:44:10.000 --> 00:44:11.000 the different police agencies 00:44:11.000 --> 00:44:14.000 that we have -- I've been to 00:44:14.000 --> 00:44:15.000 every one of the hospitals in 00:44:15.000 --> 00:44:17.000 our area including Good Sam 00:44:17.000 --> 00:44:18.000 over in -- Corvallis which is 00:44:18.000 --> 00:44:20.000 outside of Linn County and 00:44:20.000 --> 00:44:22.000 the more of a relationship we 00:44:22.000 --> 00:44:23.000 have with them the more we can 00:44:23.000 --> 00:44:24.000 understand what their needs 00:44:24.000 --> 00:44:25.000 are and what it is that they're 00:44:25.000 --> 00:44:27.000 looking for because generally 00:44:27.000 --> 00:44:28.000 speaking most people that are 00:44:28.000 --> 00:44:30.000 working with these clients they 00:44:30.000 --> 00:44:32.000 want the best for this person 00:44:32.000 --> 00:44:33.000 but their agency might have a 00:44:33.000 --> 00:44:35.000 completely different or even 00:44:35.000 --> 00:44:38.000 opposing goal and part of it is 00:44:38.000 --> 00:44:41.000 need so we can meet everybody's 00:44:41.000 --> 00:44:43.000 goals I've had people that are 00:44:43.000 --> 00:44:45.000 in Oregon Youth Authority and 00:44:45.000 --> 00:44:46.000 Oregon Youth Authority's their legal 00:44:46.000 --> 00:44:47.000 guardian because they're under 00:44:47.000 --> 00:44:49.000 the age of eighteen and I have 00:44:49.000 --> 00:44:50.000 very little I can do with the 00:44:50.000 --> 00:44:51.000 person but what I can do is 00:44:51.000 --> 00:44:54.000 advocate for their needs and I 00:44:54.000 --> 00:44:55.000 can do so respectfully and not 00:44:55.000 --> 00:44:57.000 pick fights with them except 00:44:57.000 --> 00:44:59.000 for when I need to -- but 00:44:59.000 --> 00:44:61.000 being open to what it is 00:45:01.000 --> 00:45:02.000 that they're needing so that 00:45:02.000 --> 00:45:03.000 we can figure out what those 00:45:03.000 --> 00:45:05.000 different agencies needs are 00:45:05.000 --> 00:45:07.000 to meet them and the biggest 00:45:07.000 --> 00:45:08.000 thing is just advocacy though being able 00:45:08.000 --> 00:45:10.000 to make sure that sometimes 00:45:10.000 --> 00:45:11.000 these clients cannot speak 00:45:11.000 --> 00:45:13.000 for themselves they don't necessarily 00:45:13.000 --> 00:45:14.000 have the ability to do so 00:45:14.000 --> 00:45:16.000 they may be -- specifically 00:45:16.000 --> 00:45:19.000 that's catatonic and part of 00:45:19.000 --> 00:45:21.000 the problem with it was that 00:45:21.000 --> 00:45:23.000 the catatonia presented as a 00:45:23.000 --> 00:45:24.000 kid that just didn't want to 00:45:24.000 --> 00:45:27.000 do what he was told well that 00:45:27.000 --> 00:45:29.000 doesn't go well when you have 00:45:29.000 --> 00:45:30.000 criminal charges and you just 00:45:30.000 --> 00:45:32.000 don't show up to court but had 00:45:32.000 --> 00:45:33.000 people realized that the 00:45:33.000 --> 00:45:35.000 catatonia was in place then it 00:45:35.000 --> 00:45:36.000 would have probably been a very 00:45:36.000 --> 00:45:37.000 different outcome but we didn't 00:45:37.000 --> 00:45:39.000 have the person at the time and 00:45:39.000 --> 00:45:40.000 so being able to talk with them 00:45:40.000 --> 00:45:42.000 about this is what it's going 00:45:42.000 --> 00:45:43.000 to look like for this person 00:45:43.000 --> 00:45:44.000 this is what we can expect and 00:45:44.000 --> 00:45:46.000 anticipate for the recovery 00:45:46.000 --> 00:45:48.000 so that maybe we can get them 00:45:48.000 --> 00:45:49.000 assigned to different levels 00:45:49.000 --> 00:45:51.000 of care or to a more appropriate 00:45:51.000 --> 00:45:55.000 level -- so as far as meeting 00:45:55.000 --> 00:45:56.000 out in the community again just 00:45:56.000 --> 00:45:59.000 being ethics don't get too 00:45:59.000 --> 00:45:61.000 close to your clients with 00:46:01.000 --> 00:46:02.000 EASA there is a real gray 00:46:02.000 --> 00:46:04.000 area because we are out in the 00:46:04.000 --> 00:46:05.000 community we do interact with 00:46:05.000 --> 00:46:07.000 these families for two years 00:46:07.000 --> 00:46:09.000 I mean generally episodic care 00:46:09.000 --> 00:46:11.000 is a lot shorter -- on average 00:46:11.000 --> 00:46:12.000 CBT you're looking at ten to 00:46:12.000 --> 00:46:15.000 sixteen sessions I mean I can 00:46:15.000 --> 00:46:18.000 do sixteen sessions depending on 00:46:18.000 --> 00:46:19.000 need I can have that knocked out 00:46:19.000 --> 00:46:21.000 in three weeks depending on 00:46:21.000 --> 00:46:22.000 how intensive of services these 00:46:22.000 --> 00:46:25.000 people need -- but maintaining 00:46:25.000 --> 00:46:27.000 professional boundaries and 00:46:27.000 --> 00:46:29.000 also knowing where something 00:46:29.000 --> 00:46:30.000 is more appropriate for a 00:46:30.000 --> 00:46:31.000 loved one or a support person 00:46:31.000 --> 00:46:33.000 in their life -- to be able 00:46:33.000 --> 00:46:34.000 to take over that for you or 00:46:34.000 --> 00:46:36.000 preparing somebody else in 00:46:36.000 --> 00:46:37.000 their life to be able to handle that 00:46:37.000 --> 00:46:39.000 when you're gone because our 00:46:39.000 --> 00:46:40.000 goal is to be out of these 00:46:40.000 --> 00:46:41.000 people's life the best thing 00:46:41.000 --> 00:46:42.000 you can do for your clients 00:46:42.000 --> 00:46:44.000 is a appropriate termination 00:46:44.000 --> 00:46:46.000 of services because that means they 00:46:46.000 --> 00:46:47.000 don't need them anymore and 00:46:47.000 --> 00:46:49.000 it means the job's done it means that 00:46:49.000 --> 00:46:50.000 they don't need you and they're 00:46:50.000 --> 00:46:52.000 able to or willing to try out 00:46:52.000 --> 00:46:53.000 things on their own that's 00:46:53.000 --> 00:46:55.000 what we're always striving for 00:46:55.000 --> 00:46:58.000 and so a good helpful tip on 00:46:58.000 --> 00:46:60.000 that is am I doing it because 00:47:00.000 --> 00:47:02.000 I -- it's convenient or am I doing 00:47:02.000 --> 00:47:04.000 it because there's nobody else 00:47:04.000 --> 00:47:05.000 that can handle that for them 00:47:05.000 --> 00:47:07.000 at this time do I try and -- 00:47:07.000 --> 00:47:10.000 build natural supports with the 00:47:10.000 --> 00:47:12.000 clients while creating that 00:47:12.000 --> 00:47:14.000 that balance of relationship 00:47:14.000 --> 00:47:18.000 and boundaries and absolutely 00:47:18.000 --> 00:47:19.000 we as therapists are not 00:47:19.000 --> 00:47:21.000 natural supports we're not 00:47:21.000 --> 00:47:22.000 naturally in these people's 00:47:22.000 --> 00:47:23.000 lives they're being referred to 00:47:23.000 --> 00:47:25.000 us they might be court mandated 00:47:25.000 --> 00:47:26.000 to us and our goal is to 00:47:26.000 --> 00:47:29.000 eventually not be there anymore 00:47:29.000 --> 00:47:30.000 and sometimes it's sad and I 00:47:30.000 --> 00:47:32.000 mean I've had clients who are like man 00:47:32.000 --> 00:47:33.000 this guy is so cool I would 00:47:33.000 --> 00:47:34.000 love to be able to hang out with 00:47:34.000 --> 00:47:37.000 this person just as a dude -- 00:47:37.000 --> 00:47:39.000 obviously we can't and our goal 00:47:39.000 --> 00:47:41.000 is to get out of their life 00:47:41.000 --> 00:47:43.000 because again if we are out 00:47:43.000 --> 00:47:44.000 of their lives that means that 00:47:44.000 --> 00:47:47.000 the job is done -- so building 00:47:47.000 --> 00:47:49.000 those natural supports so that 00:47:49.000 --> 00:47:50.000 they have somebody that can 00:47:50.000 --> 00:47:52.000 support them when we're gone 00:47:52.000 --> 00:47:53.000 and on top of those natural 00:47:53.000 --> 00:47:54.000 supports are generally people 00:47:54.000 --> 00:47:56.000 that knows our clients on a 00:47:56.000 --> 00:47:58.000 way deeper and more personal 00:47:58.000 --> 00:47:60.000 level than we do we know them 00:48:00.000 --> 00:48:01.000 based off of what we see from 00:48:01.000 --> 00:48:03.000 them when they're in session but 00:48:03.000 --> 00:48:05.000 session say you see somebody 00:48:05.000 --> 00:48:07.000 an hour a week that's an hour 00:48:07.000 --> 00:48:08.000 a week there's a whole lot of 00:48:08.000 --> 00:48:09.000 other hours in the day and 00:48:09.000 --> 00:48:11.000 week that go on where that 00:48:11.000 --> 00:48:12.000 person's able do different 00:48:12.000 --> 00:48:14.000 things whether they put on a 00:48:14.000 --> 00:48:16.000 sanitized version of themselves 00:48:16.000 --> 00:48:19.000 for us or they think that 00:48:19.000 --> 00:48:20.000 maybe it's time to really let 00:48:20.000 --> 00:48:22.000 everything show for us and they 00:48:22.000 --> 00:48:23.000 keep it together outside of 00:48:23.000 --> 00:48:24.000 that and they hide everything 00:48:24.000 --> 00:48:25.000 else because they don't want 00:48:25.000 --> 00:48:27.000 anybody to now our goal is 00:48:27.000 --> 00:48:28.000 to get those other people to 00:48:28.000 --> 00:48:29.000 be able to support them and 00:48:29.000 --> 00:48:31.000 transition the care from us 00:48:31.000 --> 00:48:32.000 over to them these people are 00:48:32.000 --> 00:48:34.000 care givers they're providers 00:48:34.000 --> 00:48:35.000 just like we are they're just 00:48:35.000 --> 00:48:37.000 not paid to be providers they're there 00:48:37.000 --> 00:48:38.000 because they want to be and 00:48:38.000 --> 00:48:39.000 those are the people that will 00:48:39.000 --> 00:48:41.000 last when we're not around 00:48:41.000 --> 00:48:46.000 so does that answer your question 00:48:46.000 --> 00:48:48.000 yeah natural supports are 00:48:48.000 --> 00:48:49.000 absolutely essential it's 00:48:49.000 --> 00:48:51.000 huge and we see it within our 00:48:53.000 --> 00:48:54.000 had people come in that just 00:48:54.000 --> 00:48:56.000 literally have nobody they 00:48:56.000 --> 00:48:57.000 have no family they have no friends they have 00:48:57.000 --> 00:48:59.000 nobody around them to help them 00:48:59.000 --> 00:48:61.000 and it is a much more involved 00:49:01.000 --> 00:49:04.000 process than somebody that has 00:49:07.000 --> 00:49:08.000 best friends stuff like 00:49:08.000 --> 00:49:10.000 that it's a very very different 00:49:10.000 --> 00:49:12.000 process -- I don't have any 00:49:12.000 --> 00:49:14.000 data offhand on outcomes but 00:49:14.000 --> 00:49:16.000 the supports are huge 00:49:16.000 --> 00:49:18.000 we are a social creature and 00:49:18.000 --> 00:49:20.000 we -- we need that -- to 00:49:20.000 --> 00:49:22.000 different levels and if they 00:49:22.000 --> 00:49:23.000 don't have it especially 00:49:23.000 --> 00:49:25.000 trying to navigate life already 00:49:25.000 --> 00:49:26.000 is hard enough but then you add 00:49:26.000 --> 00:49:29.000 in mental illness that can add 00:49:29.000 --> 00:49:30.000 cognitive disorganization 00:49:30.000 --> 00:49:32.000 and confusion forgetting about 00:49:32.000 --> 00:49:33.000 appointments forgetting about 00:49:33.000 --> 00:49:36.000 obligations it's huge it might 00:49:36.000 --> 00:49:37.000 be a real impact so those are 00:49:37.000 --> 00:49:38.000 the people that can really 00:49:38.000 --> 00:49:40.000 help keep people afloat feel 00:49:40.000 --> 00:49:42.000 free to email me or call and 00:49:42.000 --> 00:49:43.000 that includes when you get out 00:49:43.000 --> 00:49:45.000 into your everyday practice 00:49:45.000 --> 00:49:47.000 and you graduate and you're big kid 00:49:47.000 --> 00:49:50.000 therapists -- and you're no 00:49:50.000 --> 00:49:51.000 longer just baby therapists in 00:49:51.000 --> 00:49:53.000 training or anything like that 00:49:53.000 --> 00:49:54.000 please feel free to reach out 00:49:54.000 --> 00:49:56.000 another resource that we have 00:49:56.000 --> 00:49:57.000 I believe it should be on our 00:49:57.000 --> 00:49:59.000 pamphlets -- has my phone number 00:49:59.000 --> 00:49:60.000 on it as well this is our 00:50:00.000 --> 00:50:02.000 screening line that's my desk 00:50:02.000 --> 00:50:03.000 phone it goes straight to me and 00:50:03.000 --> 00:50:06.000 so you can call for questions 00:50:06.000 --> 00:50:08.000 or if you're wanting to just 00:50:08.000 --> 00:50:10.000 ask therapy questions or anything 00:50:10.000 --> 00:50:11.000 like that one of the things I 00:50:11.000 --> 00:50:12.000 always tell people when I do 00:50:12.000 --> 00:50:15.000 outreaches I would much rather 00:50:15.000 --> 00:50:16.000 have the conversation about 00:50:16.000 --> 00:50:18.000 a client than not and you 00:50:18.000 --> 00:50:20.000 can speak in generalities you 00:50:20.000 --> 00:50:22.000 can -- protect the 00:50:22.000 --> 00:50:23.000 HIPAA information and all that 00:50:23.000 --> 00:50:24.000 personal information if you 00:50:24.000 --> 00:50:26.000 have a client and you're just 00:50:26.000 --> 00:50:27.000 not sure what to do with them 00:50:27.000 --> 00:50:30.000 just say I know somebody this 00:50:30.000 --> 00:50:31.000 is what's going on don't give 00:50:31.000 --> 00:50:32.000 me any names don't give me any 00:50:32.000 --> 00:50:33.000 numbers or anything what do you 00:50:33.000 --> 00:50:35.000 think I would much rather staff 00:50:35.000 --> 00:50:36.000 a case even if it sounds 00:50:36.000 --> 00:50:38.000 completely inappropriate and 00:50:38.000 --> 00:50:39.000 it doesn't seem like anything 00:50:39.000 --> 00:50:40.000 but you don't know what to do 00:50:42.000 --> 00:50:45.000 my email is on my card as well 00:50:45.000 --> 00:50:46.000 as my work cell and my desk 00:50:46.000 --> 00:50:48.000 phone I'm totally open to having 00:50:48.000 --> 00:50:50.000 conversations with people like 00:50:50.000 --> 00:50:51.000 I said I like hearing my own 00:50:51.000 --> 00:50:53.000 voice -- and there's a lot of 00:50:53.000 --> 00:50:54.000 questions you guys are gonna 00:50:54.000 --> 00:50:56.000 have you're in what term one of 00:50:56.000 --> 00:50:58.000 a two year program yeah I mean 00:50:58.000 --> 00:50:59.000 who here knows if they want 00:50:59.000 --> 00:50:61.000 to do VR or mental health 00:51:01.000 --> 00:51:04.000 yet one well there's a couple more 00:51:04.000 --> 00:51:06.000 okay I thought I wanted to do VR and 00:51:06.000 --> 00:51:07.000 then I loved mental health 00:51:07.000 --> 00:51:08.000 and that's where I'm at now so 00:51:08.000 --> 00:51:10.000 I mean I might change so but 00:51:10.000 --> 00:51:12.000 feel free to ask yes 00:51:12.000 --> 00:51:14.000 did I feel ready to be a counselor 00:51:14.000 --> 00:51:15.000 when I finished the program and 00:51:15.000 --> 00:51:17.000 I think the answer to that 00:51:17.000 --> 00:51:18.000 is I don't think there's any 00:51:18.000 --> 00:51:20.000 program out there that will 00:51:20.000 --> 00:51:21.000 have you completely ready to 00:51:21.000 --> 00:51:23.000 dive in which is part of the 00:51:23.000 --> 00:51:24.000 reason why you have an internship 00:51:24.000 --> 00:51:25.000 though and your internship will 00:51:25.000 --> 00:51:26.000 hopefully provide you with the 00:51:26.000 --> 00:51:29.000 experiences to feel comfortable 00:51:29.000 --> 00:51:31.000 moving into the next stage 00:51:31.000 --> 00:51:32.000 because there's only so much 00:51:32.000 --> 00:51:33.000 you can do in a classroom we 00:51:33.000 --> 00:51:35.000 can practice in the practicum 00:51:35.000 --> 00:51:37.000 you can -- talk about the 00:51:37.000 --> 00:51:39.000 techniques and everything but 00:51:39.000 --> 00:51:40.000 there's only so much that can 00:51:40.000 --> 00:51:42.000 be done in a classroom before you 00:51:42.000 --> 00:51:43.000 need to go out and do it who here learned 00:51:43.000 --> 00:51:45.000 how to ride a bike from a book 00:51:47.000 --> 00:51:48.000 there's no amount of training 00:51:48.000 --> 00:51:49.000 that can be done to prepare 00:51:49.000 --> 00:51:52.000 you because humans are complex 00:51:52.000 --> 00:51:54.000 I mean just within my own 00:51:54.000 --> 00:51:55.000 caseload every single one of 00:51:55.000 --> 00:51:57.000 them is psychotic but everyone 00:51:57.000 --> 00:51:58.000 of them has a completely 00:51:58.000 --> 00:51:60.000 different presentation even if 00:52:00.000 --> 00:52:03.000 they have the same diagnosis so 00:52:03.000 --> 00:52:05.000 to answer your question yes I did 00:52:05.000 --> 00:52:07.000 feel prepared the internship 00:52:07.000 --> 00:52:08.000 was honestly one of the most 00:52:08.000 --> 00:52:09.000 important parts of that though 00:52:09.000 --> 00:52:11.000 so be mindful where it is 00:52:11.000 --> 00:52:12.000 you're doing your internship 00:52:12.000 --> 00:52:13.000 I would really encourage 00:52:13.000 --> 00:52:14.000 you when that happens you're 00:52:14.000 --> 00:52:16.000 still a ways away from it throw 00:52:16.000 --> 00:52:18.000 yourself in really get into 00:52:18.000 --> 00:52:19.000 the thick of it because the 00:52:19.000 --> 00:52:21.000 more you see there the more 00:52:21.000 --> 00:52:22.000 prepared you'll be for the next 00:52:22.000 --> 00:52:24.000 stage they'll set you up for the 00:52:24.000 --> 00:52:26.000 internship use your internship 00:52:26.000 --> 00:52:28.000 and really push yourself -- to 00:52:28.000 --> 00:52:29.000 really figure out what you do 00:52:29.000 --> 00:52:31.000 and even if your internship is 00:52:31.000 --> 00:52:33.000 just miserable at the end of 00:52:33.000 --> 00:52:35.000 it you know what you don't like 00:52:35.000 --> 00:52:37.000 I was lucky enough I did -- 00:52:37.000 --> 00:52:38.000 EASA for my internship with him 00:52:38.000 --> 00:52:42.000 Yamhill County and I kind of joke 00:52:42.000 --> 00:52:43.000 that they ruined me for anything 00:52:43.000 --> 00:52:45.000 else because I'd never have 00:52:45.000 --> 00:52:47.000 any interest in leaving EASA 00:52:47.000 --> 00:52:49.000 it's a very progressive forward 00:52:49.000 --> 00:52:51.000 thinking model on just the 00:52:51.000 --> 00:52:55.000 tip of the research and I fell 00:52:55.000 --> 00:52:56.000 into what I liked but other 00:52:56.000 --> 00:52:57.000 people they try and -- it's not 00:52:57.000 --> 00:52:59.000 really their thing so just really 00:52:59.000 --> 00:52:60.000 push yourself in that internship 00:53:00.000 --> 00:53:01.000 and you'll find something that you 00:53:01.000 --> 00:53:04.000 like and you'll be ready for it 00:53:04.000 --> 00:53:08.000 music 00:53:08.000 --> 00:53:11.000 music