6. March 2009 by admin.

Mike and Peg Cronin were recognized at the CBRYC Christmas banquet as each marked their 35th Anniversary at CBRYC! While the number of years is important, it is the thousands of young lives that Mike and Peg have influenced during their careers that are truly important. In 35 years, their caring for the welfare of youth has never wavered. When boys who have been at CBRYC call to “check in” with staff, Mike and Peggy are on the list of people the boys hope to visit with and share what they are doing now. Mike joined CBR in 1973 as a mental health counselor/teacher. Peg joined CBRYC a few months later and they both committed to being houseparents. At that time, being a house-parent meant you were “parents” to 11or 12 boys, on a 24-hour basis. When Mike and Peg began their family, they moved into other positions at CBR. Today, Mike is a program director, and he relates directly with the boys in a number of situations. Mike would be the person listening to a boy share about how great a time he had at an event (perhaps a prom, basketball or football game). Mike would also be the person tying the ends together when something is amiss. Mike has a great ability to connect readily with the boys. Mike’s “high-5’s” are legendary with the boys. “It has been a privilege to work with the boys at CBRYC through the years, and a privilege to work with all youth,” stated Peggy. Peg’s easy smile and approachable style says to the boys (without a word exchanged) that she will be a person who cares about them. Peggy is Activities Director in the Education Dept. In that capacity, she develops class schedules, maintains the master schedule for all student class assignments, participates in the Individual Education Plan (IEP) meetings, and plans special events. Working with youth at CBRYC is rewarding and challenging. Mike commented, “What other job could you do each day and have the potential to impact a youngster’s future, with a pat on the back, a positive word, or by teaching a life-long skill.” You might think that when this couple went home, they happily retired to peaceful quarters. Not so for Mike and Peg. Both are active leaders in the community, continuing to share their caring with community youth. Mike is a past president of Task Resources for Youth, (TRY) an organization that works diligently to make a difference for youth. He is a coordinator for the annual Toy Bowl, which involves many hours of volunteer service. (See related story.) Peggy also shares her time and talent as coach for the girls’ high school track team. This is also an effort of caring that requires many hours to see the results of her coaching efforts. When this busy couple slows down to catch their breath, they check in with daughters Tiffany and Tonja and grandchildren Trenten, Jayven, and the newest addition, Payton. This is a special couple for whom their reward is the difference they make in young lives.

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18. February 2009 by admin.

Martin Masar MSW/LCSW

There is an increasing amount of literature discussing characteristics of environments that encourage and promote change. These environments can support the acquisition of positive learning, appropriate behavior and healthy emotions. This presentation examines the elements of an enriched environment, as it relates to child and adolescent mental health care settings. The more these settings promote the characteristics of an enriched environment, the greater opportunity for individual growth. Healthy environments stimulate memory and learning that can lead to greater awareness, insight and subsequently more functional and adaptive behavior. An extensive literature review, individual surveys with former adolescents of a mental health care facility, and individual interviews with adults not from care settings were conducted within this study. The individual surveys and interviews supported the essential elements of an enriched environment. The more we understand what constitutes an enriched environment within any setting and certainly mental health care settings, the better we become at influencing healthy change for the children in our care.

“Hello John, it is great to here from you!” This would not be the first or last call either myself or the other facility staff would receive from a former resident of our psychiatric care facility. Early on it occurred to us; we should try and ask several questions of our former adolescent population. These questions we felt would help us do a better job with our current residents by learning from those who have gone through and lived in our residential care system; and who to learn better from than those who lived in and experienced it in person. As outside observers and supervisors there is a clear and definitive difference between being in an environment and living in an environment, 24 hours a day. Within these environments, we know there are both formal and informal decision making systems, problem-solving systems and a pecking order of influence and power, to name a few. Independent of the amount of supervision by mental health staff, this undercurrent system exists in every residential care system. No environment is free from the covert power of this undercurrent system; and it has existed for hundreds of years.

So, what can professional and care givers in mental health systems do to positively influence the environment of those entrusted to us?

As a mental health care facility, we have preformed outcome studies for many years. This data dates back to 1987, and involves surveys with over 500 individual youth. Our surveys then and now, focused on those youth who, successfully or unsuccessfully, had left our system of care. While we also surveyed current residents over the past 20 years, we painstakingly contacted former youth. Blending the survey results allowed us to evaluate what our current and former customers thought of our services and care. This was not always a pleasant task. At times, it placed before us some very difficult and challenging learning’s and decisions. Day to day, we prided ourselves in delivering and insuring quality care, in a safe and healthy environment. Yet, we listened to those who live and lived in that same environment as the evaluators of its effectiveness. Some times surprisingly and at other times knowingly, we swallowed our pride to look at ourselves and our system. Thereafter, we instrumented changes in response to our most learned evaluators.

After gathering, analyzing, and assessing the data from our outcome studies, we then began an exhaustive literature search of elements and characteristics of healthy or growth producing environments, called “enriched environments” within the neuroscience literature. (Diamond, 1999) Not unexpectedly, 20 years ago, little published information was available regarding enriched environments. However, in the past 3 – 10 years, an increasingly qualitative mass of literature has been published. While the bulk of the literature has evaluated and reviewed environments using laboratory experiments, much can be learned from the literature and outcomes of the scientific studies. I would not suggest that the human lives entrusted to our care should be equated to laboratory experiments; rather, that if similar conditions were present in human care settings, again enriched environments, we might be promoting conditions that influence healthy change. Finally, as the youth survey data was analyzed, we separated in the data those elements that our residents reported were most effective environmentally and combined them with the health and growth characteristic from our literature search.

As a final piece to this study, informal interviews were conducted with older adults, not from our care system. In these interviews, we sought to determine if there was a relationship or similarity between the results of the youth interviews, the literature review and the adult’s personal experiences of learning environments. The adult surveys were composed of individuals in the average age range of 58+ years old. There was no scientific determination of the adult age group, rather, and most simply, it was the most readily available adult population willing to be interviewed.

The youth surveys have changed in content in the past 20 years. What we felt was important 20 years ago, has changed with time. Our first task was to discern within the data, commonalities and similar concepts in the questions asked. We were also able to rely on the data from the past 10 years where the questions asked remained relatively similar. The survey’s themselves, at least from the past 10 years, were conducted using a neutral assistant. We felt an individual with no experience or emotional connectedness to our system of care would provide for us the most objective data. In addition, the neutral assistant sought second source verification when available. This way we had two sources answering the same questions about the youth. The youth surveys are completed annually, and usually take 6 to 8 weeks to complete. As mentioned earlier, we survey both current residents and past residents. The survey data represented over 500 individual interviews. The average length of stay within our facility was 14.5 months. As a facility that treats youth from across the nation the youth surveyed represented 8 different States and over 70 cities/towns from across the nation. Approximately 35% represented rural areas and the remaining 65% were from communities of 90,000+ population. The average age was 22, with the upper end age group at 28 and the lower end group at 12. The average time away from the facility or after being discharge from our care was 34.5 months. Among all the survey questions ask about our service systems, the following were identified for this study:
• What did you like best about our facility?
• What did you not like about our facility?
• What do you think helped you the most? Why?
• What do you feel helped you in your treatment unit?
• What was the worst thing(s) about your treatment unit?

In the survey results we analyzed for common themes and problems. A summary of the survey results indicated the following:

• What did you like best about our facility?
Survey results: The answers here varied from individual to individual. Some liked their therapist the best; others liked their teacher or child care staff. Some talked about a particular class or activity they enjoyed. Despite the individualized answers, we began to see that interactive, relationship driven activities were meaningful to our youth, and were the most remembered.

• What did you not like about our facility?
Survey results: The answers here took on a significant similarity. The most disliked aspect of our program was the restrictive techniques we unfortunately needed to utilize in the event of a situation of dangerousness. The youth were clear in their understanding between appropriate limit setting and the more intensive restrictive techniques. When asked if experiencing the restrictive techniques was helpful later on in their lives, the answer was essentially the same, as one young man put it, “I hated it then and I hate it now.” Other variables reported to be disliked included not feeling safe, not feeling cared for, and negative peer influence (usually reported as covert).

• What do you think helped you the most? Why?
Survey results: Here we were looking for something we were doing the youth felt positively impacted them. This answer has not changed in 20 years of survey results – relationships. Simple and direct, as one youth recently told me during a phone interview – what was the most helpful, he answered, “You!” When I asked why he felt our relationships meant so much, he answered, “It was you I carried in my memory all these years, it helped me when I needed it most – you were always there.”

Now within that “You” is much more than just a good friend. It is a complex understanding by trained professionals about the varied and interactive, developmental, emotional, maturation, motivational, cognitive and a host of other mental health variables influencing and affecting the youth.

• What do you feel helped you in your treatment unit?
Survey results: Here we were looking for environmental aspects the survey’s reported to promote lasting, healthy and permanent change in the individual. Relationships with the care staff were of course mentioned, in addition, survey results also indicated a feeling of being safe, a lot of interaction with the staff, interactive games played with staff, challenges to learn and do better, “generally” good food, rest/sleep, praise and positive feedback, choices and role models.

• What was the worst thing(s) about your treatment unit?
Survey results: The consensus answers here were not about the physical structure of the living unit, such as the material of the walls, or the indoor - outdoor carpet, or the amount and number of flowers outside or the color of paint, or even the amount of floor space. The consensus answer reflected times when the youth felt alone, fearful, isolated and uncared for. When despite constant supervision and everything that was fancy, ultramodern and brand new within the living units, the youth still felt alone.

As the data from youth surveys was being analyzed, we turned our attention to the literature search for enriched environments. A wealth of information has been published which studied or commented on the characteristics of healthy or growth promoting environments. Marian Diamond (1999, 2006), Marilee Sprenger (1999), Daniel Amen (2006), Louis Cozolino (2002), and Daniel Siegel (1999) to name a few authors have published on healthy or growth promoting environments, referenced as enriched environments. Louis Cosolino (2002) characterizes an enriched environment as one that promotes “a level of stimulation and complexity that enhances learning and growth.” Marilee Sprenger (1999) draws a number of conclusions about enriched environments. She comments that they include “social interactions, care, challenge and play.” We know the brain, or the way a person thinks, changes to reflect the influences’ of our environments. These influences or elements can have a significant positive or negative affect on the individual. I am reminded in a web based article by Ashish Ranpura (1997) who notes that while much is known about the influences of an enriched environment “under laboratory conditions”, correlation does not mean causation. Yet he notes, we know that “children who are exposed to [enriched environments] and varied education early in life develop a great capacity for learning throughout life. Furthermore real learning, not just rote exercise, can have a dramatic influence on the physical structure of the brain.”

The advanced research of Marian Diamond and Janet Hopson (1998) and studies from Josh Trachtenberg, Brain Chen, and Karel Svoboda (2002) has lead to a new awareness of environmental characteristics that promote healthy brain development and growth. The research exposed laboratory animals to different elements within their environments. This shifted from the lack of social interaction, lack of care, poor nutrition, no challenge or stimulation and lack of physical exercise; to environments with plenty of social interaction, appropriate care/touch, a healthy diet, intellectual challenges and physical exercise. They used a variety of techniques to monitor brain development and growth, including a photon laser scanning microscope. Svoboda (2002) summarized the results of their research on the affects or influences of an enriched environment indicating “a pronounced increase in the rate of birth and death of the synapses. [The research concluded] that there’s a pronounced rewiring of synaptic circuitry, with the formation of new synapses [within enriched environments].” These studies confirmed the significant and rapid “neural growth” taking place within enriched environments. (Wylie and Simon, 2005) The growth and development of new brain connections, synapses and dendrites, are associated with learning and memory. (Cozolino, 2002, Sprenger, 1999, Howard, 2002) Whether a classroom, home, therapists office or institution caring for children; the acquisition of new learning and memory are essential to both intellectual growth and behavior change.

Examining the characteristics of an enriched environment involved comparing the identified similar environmental characteristics from the various studies. These elements or characteristics included challenging educational and experiential opportunities that encouraged learning of new skills and expanding knowledge. Education, practicing skills and interactive engagement in mental activities also correlate with healthy growth and development. (Beaulieu, 2006) Compiling the most common themes from the research based literature; we developed the following list of elements that appear to influence health and growth in enriched environments:
• Nutrition = eating well balanced meals
• Repetition = reminders and exercises that lead to memory retention
• Interaction = verbal, social and engaging interactions/conversations with others
• Challenging = not overly stressful, but stimulating, and limit setting
• Care = human touch, emotion
• Learning = games, dialogue, motivation, and participation.
• Restful = a good nights sleep is invaluable to body regeneration.
• Exercise = physical activity
• Praise and Positive feedback = this is essential for corrective learning
• Safety = a sense of feeling safe or the absence of threat to self
• Choices = opportunities to choose from
• Role Modeling = demonstration of healthy behaviors and emotions
• Laughter = though not as clearly defined within the research, laughter promotes powerful interpersonal awareness, a healthy release of body chemicals and engages others in interactive dialogue.

We then turned our attention to literature where the enriched environments characteristics were not present. Obviously, the absence of the enriched environment elements promoted less learning and did at times stop all learning. The literature is fairly well documented in regards to environments that were unhealthy and non-growth promoting. Imagine poor nutrition, the continued presence of fear, overwhelming daily stress, and limited to poor interactions with others. We can clearly see why such environments would not be health promoting. Finally, as our literature search unfolded and volumes of data were analyzed, an interesting phenomenon emerged. Enriched environments should never be assumed to be rich or wealthy environments. Fancy, new age, modern and highly stylized architecture does not promote an enriched environment. None of the identified elements of an enriched environment are about modern conveniences or new-age design; rather they identify at the very least, interactive elements that a potential learning environment can assimilate, replicate and demonstrate.

As we began to merge the results of the above two studies, similarities surfaced We learned from our studies with our youth the characteristics, elements and seemingly most profound memories, which the youth identified as most influential in their life’s journey. We found these elements were similar to the elements identified within the literature.

We learned that an environment can also have a significant deleterious affect on the youth. To conclude the enriched environment alone is responsible for all change would be erroneous and misleading. For example, in the phone call I received, noted above, the young man described his relationship with me as a profound influence in his life. Cosolino (2002) describes it as “empathic attunement”, a “process involved in attachment and bonding.” More than just a good friend or companion, the process of empathic attunement involves the complex understanding of human psychology. In combination within an enriched environment, it is a therapeutic engagement process designed to elicit an emotional response, cognitive awareness, physiological sensation and behavioral correction. Cosolino also points out; the therapist’s office can become an enriched environment, promoting healthy elements in a therapeutic exchange. Therefore, while an enriched environment becomes a catalyst for growth; the care giver, therapist, parent, or teachers are the necessary change agents who assimilate the growth opportunity and potential into cognitive awareness. Learning and memory are the effects of cognitive awareness.

In the final stages of this study, we conducted informal interviews with various adults. We sought to determine from their perspective and life long memories, what environmental factors they felt influenced their lives in a healthy and productive manner. Not surprisingly, they all reference an emotional connection – empathic attunement – with a significant other, in a seemingly enriched environment. These persons ranged from parents, grandparents, teachers, therapists, and friends. The environments where these individuals reported their most profound learning took place were most often described as safe, caring, and interactive. One elderly lady explained it best, “Oh that would have been my grandfather’s home. He was such a kind and gentle man. I remember sitting around the kitchen table, in that old house with brightly colored wallpaper and those old linoleum floors – you know, that kind of house where the screened door slammed each time we went out to play. Grand dad would sit back and tell us kids all about his life and the things he learned along the way. I think we would sit for the longest time and listen to him. Our imaginations would run wild as he wove stories of learning and life – I remember it still to this day.” For this lady, she retained the valuable messages her Grandparent gave her, within characteristically what might be called an enriched environment.

This study has been in development for several years, and while it is a far cry from pure scientific research and methodology, it nonetheless has given us great insight. Examining 20 years of youth survey data and the literature search results, we have been able to make some definite conclusions. We have thought about a host of other measures we might perform and include in our future data analysis. We might redefine the questions and seek greater specifics. We might identify a control group and perform the same analysis and we might give more attention to the actual physical characteristics of an enriched environment. Yet in the end, the study was extremely helpful. The more we understand what constitutes an enriched environment within any setting and certainly mental health care settings, the better we become at influencing healthy change for the children in our care. We know today that enriched environments are essential if we are to help children along in their individual life’s journey; and who better to ask about a healthy learning and growth producing environment than the children themselves.

In summary, I have once again, identified those enriched environment characteristics that serve a positive function in promoting healthy change. They include:
• Personal instruction by parents or care givers
• Supportive and caring human interaction
• A personal feeling of safety
• Love, nurturance and acceptance
• Not feeling along - attention
• Cleanliness or healthy
• Balance nutrition
• Exercise
• Laughter – positive emotion
• Positive Role Modeling
• Educational Opportunities
• Challenges/reasonable obstacles/problem-solving and choice
• Limits
• Opportunities in the form of creativity and imagination

An enriched environment cannot be brought – it is created. An enriched environment is often felt – long before it is seen.

References

Amen, D. (2006). Making a good brain great. Arizona conference presentation.

Beaulieu, D. (2006). Impact techniques: Applying our knowledge of human memory systems to psychotherapy. www.americanpsychotherapy.com; winter annals.

Cozolino, L.J. (2002). The neuroscience of psychotherapy. New York: W.W. Norton Company.

Diamond, M.C. (2006). Response of the brain to enrichment. Web based article. http://www.newhorizons.org/neuro/diamond.

Diamond, M.C. (2006). What are the determinants of children’s academic successes and difficulties? Web based article. http://www.newhorizons.org/neuro/diamond.

Diamond, M.C., Hopson, J. (2006). Characteristics of an enriched environment. Web based article. http://www.newhorizons.org/lifelong/childhood/diamond.

Diamond, M., Hopson, J. (1999). Magic trees of the mind. New York. The Penguin Group.

Howard, P.J. (2000). The owner’s manual for the brain. 2nd. ed. Marietta, GA. Bard Press.

Ranpura, A. (2007). Weightlifting for the mind: Enriched environments and cortical plasticity. Web based article. http://www.brainconnection.com/topics.

Siegel, D.J. (1999) The developing mind. New York: The Guilford Press.

Sprenger, M (1999). Learning and memory: The brain in action. Alexandria, VA. Association for Supervision and Curriculum Development.

Trachtenberg, J., Chen, B., Svoboda, K. (2002). A new window to view how experiences rewire the brain. Web based article. http://www.newhorizons.org/neuro/hhmi.htm.

Wylie, M.S., Simon, R. (2005). How the neuroscience revolution can change your practice. Psychotherapy Networker. www.psychotherapynetworker.org.

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YCI© 2007

Posted in Treatment, Clinical | 1 Comment »

13. August 2008 by vzimmerman.

The popular Latin slogan, Carpe Diem, or “seize the day,” and the equally popular “make the most of every day” are often voiced, but seldom carried out. However, for a boy or young man at CBR YouthConnect, it is vital that today and every day be important and meaningful. Today and every day means that no matter what his ethnic origin, hair color, height, weight, hairstyle or walk, each CBR YouthConnect youth is given an abundance of care and support. “Today and every day” becomes an abiding message that each youth can carry with him throughout his life’s journey.

Such is the case with Josie, who arrived at CBR after unsuccessful placements at various group homes and residential treatment facilities. Jose grew up in a low-income urban neighborhood with a single-parent mother, and several siblings. The only other significant adult in his life was his mother’s boyfriend who physically and emotionally abused Josie from age 5 until he was placed in out-of-home care at age 13. Josie attended public school for a while, but was repeatedly involved in acting-out behavior, including frequent altercations.

At CBR YouthConnect, Josie distanced himself from the other youth and staff and tried to “just fit in.” However, the more attention, support, and care Josie received, the more his acting out behavior increased. We soon discovered that Josie was scared to get close to anyone. He had always felt safer being left alone in the shadows. Despite early resistance, Josie began to respond to the programs and services offered at CBR YouthConnect. He began to view himself as a more significant person with some true potential as an artist. As Josie’s time to leave CBR YouthConnect and return home approached, he talked about his life journey to that point—from being in the shadows to becoming more secure and confident in his role as a contributing member of society.

“I know what has come before and what I have gone through,” Josie explained. “I tried to cope by becoming invisible and distancing myself from others. When the pressures became too great, I would act out to be noticed. It has taken some time, therapy, and working in the programs and services at CBRYC, but I now feel whole. I don’t think I need to shrink or become invisible anymore. I know that I am and can be an important person. I want to be the right person for me. I want that today and every day.”

As with Josie, CBR YouthConnect’s commitment to helping youth and their families make the connections that inspire change continues to happen today and every day.

Posted in Youth, Treatment, Clinical, Parents | No Comments »

23. June 2008 by nvannote.

The purpose of The YouthConnect Chronicle is to provide you with resources, understanding, and insight regarding mental health, as well as a forum for families and teens to discuss dealing with mental illness.

It is our hope that you will find the knowledge and support you desire.

Posted in Youth, Treatment, Clinical, Parents | No Comments »

24. April 2008 by nvannote.

“Youth is happy because it has the ability to see beauty. Anyone who keeps the ability to see beauty never grows old.”  – Franz Kafka, Czech writer

 Our culture tells us that teens should feel happy.  After all, the youth of today have a lot more to be happy – and unhappy – about, right?  Well, this is your place to share what’s really going on in your life.  Do you just want to let other teens know what life is like for you?  Do you want to know if other kids feel the same way you do?  Maybe you can offer your own insights to someone.  We would love to hear from you.

Posted in Youth, Treatment, Clinical | No Comments »

24. April 2008 by nvannote.

Are you a counselor, social worker, psychologist, or other professional who would like to discuss a particular mental health disorder?  Here’s the place to ask questions, post your thoughts, and get feedback from our clinicians and other mental health professionals.

Posted in Treatment, Clinical | 2 Comments »