1 The Academy of Rehabilitative Audiology Institute Providence Rhode Island September 9, 2012 Patient Stories and The Role of The Audiologist As Listener in Hearing Loss Treatment Peggy Ellertsen, M.Ed., CCC-SLP Tram Lai, M.P.A. James O Donnell, Esq. Candy Saunders, M.S.W.
2 Patient Stories And The Role of Audiologist as Listener in Hearing Loss Treatment Panelist Question Set The original format for this presentation was planned as a group discussion with the Aural Rehabilitation Social Worker, Cathy Kooser, participating as facilitator. Because Ms. Kooser was not able to attend the Institute, the panelists have each developed their stories as a narrative in response to 5 question prompts: 1. What do you experience as the worst thing about hearing loss? (This is a prompt used in aural rehabilitation group therapy and comes from the work of Rehabilitation Counselor, Anthony Hogan.) 2. Of all of the challenges that hearing loss has presented to you in your life, is there one event or crisis that stands out as having been the most difficult for you? How did that difficulty affect your ability to participate, and how did it affect you emotionally? 3. Was the challenge that you described eventually resolved, or has it persisted? What resources have you found to help you cope with this difficulty? 4. Are there aspects of hearing loss that affect your ability to participate in areas of your life that are important to you? Are there physical or emotional repercussions of those restrictions that concern you? 5. In receiving hearing health care, what qualities do you think you most need from the professionals who provide your audiologic care?
3 Introduction: Peggy Ellertsen [Peggy Ellertsen earned the Certificate of Clinical Competence (Speech/Language Pathology) from the American Speech-Language-Hearing Association in 1971, and a Certificate of Advanced Study in Reading and Human Development from Harvard University Graduate School of Education in She has worked as a Speech/Language Pathologist and Reading and Language Specialist in clinic, public school and private practice settings for over thirty years. In 2011, she became a Certified Peer Mentor for Hearing Loss through the professional certificate program at Gallaudet University, and continues to learn about best practices in aural rehabilitation through ASHA s Special Interest Group 7, The Academy of Rehabilitative Audiology and the Ida Institute. Peggy currently serves on the steering committee for HLAA s Boston chapter, and coordinates the chapter s speaker program and its outreach initiative to audiology practices. She consults to persons with hearing loss around active management of communication through the use of assistive technologies and communication strategies. I trained as a speech language pathologist and reading specialist, and have practiced in public school, clinic and private practice settings. I have a severe, progressive, sensori-neural hearing loss and currently practice as a hearing loss management coach for persons with hearing loss. And so I wear two hats: one as professional, and one as hearing loss patient. My interest in the use of patient stories in hearing health care began from a consumer perspective, and has grown as I ve learned about best practices in aural rehabilitation. My appreciation of the value of audiologists listening to their patients stories was consolidated when I studied with Dr. Matthew Bakke and his graduate students at Gallaudet University in the Peer Mentoring for Hearing Loss program, the extraordinary aural rehabilitation training program originally envisioned by Dr. Bakke and Drs. Scott Bally and Mark Ross. When I arrived on the Gallaudet campus in the fall of 2008 for my orientation session, I brought my audiogram with me, as had been requested. My new classmates and I spent some time during our first morning together examining each others audiograms and sharing what we knew about interpreting patient audiograms, but most of the orientation session was spent with my classmates and me sharing with each other and with our instructors stories about our life s journeys with hearing loss. It was an extremely powerful experience for each of us, not only
4 because we were given an opportunity to talk with candor and in depth about this central struggle in our lives, but, more importantly because, as we did so, the audiologists who were to be our instructors over the next two years listened with such rapt attention. During our two years of study, my classmates and I both examined the audiograms of many people with hearing loss, and we also read extensive accounts of patient stories that were contained in detailed case histories. We were encouraged to use these as important resources for recognizing and understanding several important factors. These included: differences in individual patient treatment preferences; the impact of life events especially previous traumatic loss - on the individual s rate and style of adaptation to hearing loss treatment; the presence of possible emotional and physical stressors as a result of living with the challenges of hearing loss, as well as patient strengths in coping with and adapting to hearing loss; importantly, specific participation restrictions of individual persons that, for one reason or another, had either been addressed superficially in treatment, or had not yet been identified or addressed at all. Finally, we were encouraged to think about possible technical and non-technical options beyond hearing aids and cochlear implants for helping people resolve some of the specific, unaddressed difficulties that were revealed in their stories. I would like to briefly point out to you the list of references in your packets. This is only a modest sample of some of the exciting literature on patient centered hearing health care and the use of the patient narrative as an important resource for creating a treatment plan that optimizes adherence to recommendations. Especially relevant to today s discussion is the investigation of
5 a model of shared decision making by Drs. Louise Hickson, Arienne LaPlante-Levesque and Linda Worall. Their research reveals important insights about the significance of the use of the patient s story in terms of the patient s perception of his/her treatment, and the impact that the use of the patient s story has on the development of trust in the encounter between patient and audiologist. As we begin, I d like to draw your attention to three copies of a needs assessment which are included in your packet to help you structure your thinking as you listen to each of the panelists narratives. Patient Story: Tram Lai [Tram Lai immigrated to the United States from Vietnam with her family when she was nine years old and began to acquire English as her second language. She experienced sudden, profound hearing loss when she was in her mid teens. In 1997, two years after receiving her cochlear implant, Tram was awarded multiple scholarships, including the Boston Guild for The Deaf and Hard of Hearing Scholarship, and studied Environmental Science at Suffolk University in Boston, where she earned her Bachelor of Science Degree in In 2011, Tram earned a Master s Degree in Public Administration from Suffolk. Currently, Tram is the Laboratory Manager in the Department of Chemistry at Suffolk. She was recently recognized as the 2012 Outstanding Young Adult by the Hearing Loss Association of America.] Good evening, everyone, my name is Tram Lai. When I was in my mid-teen, within a period of one week, I lost all of my hearing in both of my ears. During my junior year in high school I got a cochlear implant. I believe the worst part of losing my hearing was losing hope along with my hearing. I was a young teenager full of dreams and hope for my future. The day when the doctors told me that I will never regain my hearing, I felt that all my dreams and hopes were gone. My bright future was gone before my eyes. Maybe to other people this would not be the end of the world, but to me was it the end of my world. There was not a light at the end of the tunnel for me. My bright and beautiful world was now filled with pain, sadness, and loneliness. My family didn t
6 understand what I was going through because they had never encountered this illness before. When I was able to hear, to me the guessing game was fun. But now that I can no longer hear, the guessing game to me is no longer FUN! For two years of my life the only way I could communicate with people was through writing. There has not been one specific worst crisis, but rather an ongoing set of problems that I ve had to face. As a person living with hearing loss, waking up in the morning, I like to boil my water in the kettle to make tea so that I could do offering to my ancestors. I usually boil the water before I put on my external device. Then I get ready for work, and sometimes I forget about it. My family thinks that I am going to burn down the house one day because I can t hear the kettle and the smoke detector going off. If there were someone at the door knocking and telling me that my house is on fire I wouldn t even know it. Another problem would be that I am very nervous at work when I have to pick up the phone or I have to call other than my friends. I resolved my problems with anxiety and worry caused by hearing loss by working through them. I often invented my own solutions For example, I remember back when I was in high school during the years that I was deaf, we have two teachers who are notes takers with us while we are in class to help us with note taking. Since I could not hear, and was shy, whenever I had to talk to a teacher, these teacher s aids would talk to the teacher for me. I like it, but when I got into college, these teachers aides were no longer with me. I was in the real world. I was alone! There was a class I didn t do very well but I need to know my grade from my final. I was scared! - too afraid to talk to my professor. But I keep on telling myself that I could do this, I have to do it. No one will do it for me. I went and talked to her and I got an A as my final grade. I felt so good afterward, not only because I got A for my grade, but because I finally broke
7 through another barrier that forced me to do something that I would have never done in the past if I had my teacher s aide with me. A few months ago a friend of mine recommended that I should begin to utilize my T coil with a looping system or with an FM system. When I got my Freedom upgrade a few years ago this wire came with it, I tried it out with my friends and it has too much static, so I am discouraged from using it. As for the phone, I trained myself to be confident by calling my friends. I try to talk to them on the phone as much as I can so that I can get used to listening to their voices. As times went by I became more comfortable picking up the phone. Once I got better at it, with my implant, I was able to tell the difference between voices. For example, if my friends Alena or Linda call and say it s me my brain will start scanning to figure out who I am talking to. Within a few minutes I can tell who I am talking to. On June 19, of this year I went to a HLAA (Hearing Loss Association America) convention here in RI. They have a booth that was set up about caption call phone. It is free. They had a demo booth and I tested it by calling my boyfriend. I love it! I could hear most of what he was saying to me over the phone, but it was nice having the caption call subtitle available in this way so I know that I am 100% sure that I understood everything in our conversation. There are areas of my life in which my ability to participate in certain activity has become limited because of my hearing loss. When I am with my friends, having our girl s night out at a restaurant, it can be very loud and hard for me to hear as we speak in multiple languages. The people around me love to travel but I don t. The reason I don t like to travel is because I always worry that my implant might malfunction when I am in a foreign country. They
8 don t have the technology like we do. I haven t even stepped out of the house, and already I feel all this anxiety so traveling for me is a big NO NO!! With my story, I would like audiologists, doctors, friends, to take with them. When I am at the audiologist office the services are great and I have their undivided attention. But when I go home with my new device, I feel a little lost. It would be helpful to get an to check on how I am doing with it. For me, this is important but for other people, especially for older people, they might need more help than just an in order for them to learn how to use their devices, walk them through it so they don t become frustrated. In one of my Health class, I studied that in the old days patients viewed their doctors like god. But this is the 21 st century; I want to see my doctor as my partner. We explore the new technologies together. Patient Story: Jim O Donnell James F. O Donnell practices law in Boston in the area of disability law, with emphasis on advocacy for children with disabilities in educational settings. Jim served as Massachusetts Deputy Commissioner for the Deaf and Hard of Hearing from 1999 to 2003 and subsequently worked as Special Education Administrator in the Boston Public Schools. Before initiating private practice, Jim was Executive Officer of the Boston Retirement Board and a member of the Commission for Persons with Disabilities. He has also worked as a specialist in employee benefits and taxes in private industry. Jim holds degrees from Suffolk University Law School and Simmons College, where he earned a Masters Degree in Special Education. In addition, he has served as a volunteer in leadership positions for a variety of non-profit organizations, including the Boston Guild for The Hard of Hearing, Association of Late Deafened Adults, and Hearing Loss Association of America. He currently is a member of the Steering Committee of HLAA s Boston chapter, I was born with a severe hearing loss and had to adapt early on by using a hearing aid, rely on my vision as an aid to read lips and constantly strategize on how to engage with people and communicate. The worst thing about hearing loss - there are many - is lack of directionality, that is I cannot tell where sound is coming from. I ll give you two examples from my experience which reoccur often: I am with a group of six or seven people in a coffee shop and people are kibitzing about this and that but I am falling behind, missing out on words, because I don t know
9 who just spoke. That means that I miss the first few words of someone s sentence and that usually contains the subject of the conversation. I get frustrated and try harder to get the gist or begin to ask questions. Bust asking questions draws attention to me and my hearing loss and that means embarrassment to me. I ll explain why that is in a minute. In a professional meeting, I can ask speakers one at a time with notice (raising hand) or the like but in a social setting, it s very difficult to ask for accommodation. This feels humiliating and depressing; I get down on myself although I know it s the lack of hearing and the environment, not me personally. A second example: I am alone in the house or in the yard and I hear a sharp, loud noise. It prompts my attention, but I don t know where it s coming from. I don t know where to look and so I begin to check out everything. This is fearful to me - frightening in that I cannot tell what the sound is - is it a problem or a threat? Or where the sound is so I can t visually go and see what it is and whether it represents harm. My fear is that I do not know if I can protect myself. The worst challenge I had was when I lost my mother at the age of ten: I had denied myself the reality of the sickness my mother had despite the obvious clues because I was so dependent on her as my communication link and supporter that I could not contemplate my existence without her around. So when she died, the news, the realization, was a huge shock to me. To cope, I fell back into denial and continued to deny that she was gone by believing that God would bring her back to me. Looking back, that seems absurd but I was desperately afraid and reached for any kind of comfort. Of course that did not happen, I became very angry - very angry at God and very angry with myself. I blamed myself as the cause of her death because I knew I was disabled and not being normal caused her leaving. I took this anger and became determined to prove I was as good as anyone else who s normal. This determination became a relentless drive to prove myself when given the opportunity.
10 This anger became a drive to prove myself and subsequently, I went to law school, practiced law at the corporate and tax level, and then achieved a lifelong goal to be an administrator in a government agency when I became the Director of the Boston Retirement Board for ten years. For the last eighteen years I have practiced law in the disability area in one form or another. I accomplished more than was expected of me because of this drive. I still have this drive although I don t need to any more since I retired from government but I still have a small law practice in disability law and do pro bono work in courts. I recognize the cost to me has been a constant amount of low level anxiety and a state of denial that made it very difficult to ask for accommodations even though I am an advocate for others. It was hard work. Every time I am in a three person or more conversation, I miss things that are said: I miss the jokes and some of the information from others that flows in conversation. Every time I hear a song, I may enjoy the melody but I can t make out the words. When the phone rings, I let it go to message rather than pick up to avoid difficult conversations. This happens almost every day and sometimes several times a day. Because I still have this desire to be normal unrealistic as it is - I do get frustrated when any of these instances occur. And I feel my personal worth becoming dis-abled. It s a constant effort to keep a positive perspective on myself despite what I have been able to do. Patient Story: Candy Saunders Candy Saunders, LICSW, is an assistant clinical professor at Simmons College Graduate School of Social Work and coordinates its Post Graduate Clinical Certificate Programs in The Treatment of Psychological Trauma. For 25 years she has taught in Boston graduate schools of social work. While at Boston College School of Social Work she coordinated and taught in a National Institute of Mental Health funded program for Hard of Hearing and Deaf Masters in Social Work Students. She has presented to professionals throughout New England on the impact of trauma on attachment relationships, neurobiological development and behavior, and on the challenges of treating children, adolescents and adults who have experienced chronic psychological trauma. Candy is a consultant to greater Boston agencies, including The Massachusetts Department of Children and Families, where she trains social workers in the treatment of trauma. She has a private psychotherapy practice in Newton, Massachusetts.
11 My name is Candy Saunders. I have a severe, progressive, genetic, sensorineural hearing loss, diagnosed in the second grade. In considering the worst things about having a hearing loss, I am intrigued that I have spent my career teaching about the ways in which a person s attachment relationships define who she is, how she develops, and how she adapts to and survives trauma if she experiences it. For me the very worst thing about having a hearing loss is the relational aloneness that I can often experience in the midst of potential relational connections. It is hard to define the actual experiences of hearing only a portion of what is being said in your presence. There are the accumulated feelings of longing, shame, numbness, rage, disappointment, and sadness that can accompany these moments. And there is the exhaustion from the investment of energy in efforts to survive them. There is the anxiety in anticipation of these moments. There is the helpless, frustration in the midst of these moments. And there is the vast range of feelings and reflections that gnaw at you long after these moments have come and gone. If I am with other people, I am in one of these three states, always. Separate from this kind of aloneness, there is another kind. As a hard of hearing little girl, as a very social adolescent, and as an committed, adult Mom, partner, friend, and professional, determined to thrive in a world of hearing people, there has always been the aloneness of having to figure out how to deal with all of these experiences by myself. But you do SO well, Candy, You are SO amazing at adapting, Candy, If you didn t tell us, we would scarcely know that you were hard of hearing. I have heard these things countless times from audiologists, friends, family, and colleagues. The art of doing SO well as a hard of hearing person is often the art of pretending. It is the art of being able to appear to hear while hiding the psychologically and somatically consuming aloneness of chronically trying to
12 figure out what it is you are hearing, while rarely knowing for sure. The extent to which a hard of hearing person is successful is often contingent on the extent to which she hides her feelings, not only from others but also from herself. The only persons that I have sought to understand the true meaning for me of having a progressive hearing loss over the years are my audiologists. I am fortunate for the adaptations I have discovered. I also know that my having had to discover them on my own has been costly on many levels that are hidden from even the closest relationships in my life. Being asked to identify a single event or crisis of all the challenges that hearing loss has presented to me is very difficult. There are so many. An event that continues to carry pain for me happened around 25 years ago at the height of my career as a child and family therapist. I had had a lifelong passion for working with children and a reputation for doing it well. I taught courses in child development and child and family therapy in graduate schools and in organizations throughout New England. Because of the progression of my hearing loss, I decided to stop accepting referrals of young children and of families with young children in my active private practice. It was a painful but unquestionable ethical decision. I could ask my graduate students and young colleagues in classes that I taught, What?, What? Sorry, say it one more time? for a fourth or even a fifth time and use my usual strategies of explanation and humor to stay connected to them. I knew that it was not OK to try and do the same with my young clients. I am lucky to have known considerable success as a teacher and child therapist. The intrusion of my progressive hearing loss on both of these areas in my career has been hard. The loss of working with kids is one that I have adapted to, but I would not place it in a category of having been resolved. As I acknowledge this, I experience one of those moments of rage and sadness in remembering another event that happened just four years ago. A beloved friend who
13 is also hard of hearing and who had attended her first Hearing Loss Association of America (HLAA) conference showed me a product that she had learned about there and then purchased. It was a personal fm system. The transformation that has occurred in my professional and personal life as a result of going to my audiologist and asking her to order this product for me is monumental in ways that I could talk about for hours. What I am less inclined to talk about is what it would have meant to me, to my family life, especially with my children, and certainly to my teaching and child therapy career had the only person with whom I shared my frustrations and from whom I sought solutions for them, introduced me to this product years earlier. So what do I want from an audiologist? I want to work with a hearing health care professional that carries skills beyond hearing aid dispensing. I want that person to be knowledgeable about the most useful strategies in hearing rehabilitation such as auditory training and listening skills improvement. I want to see HLAA journals in the waiting room and to hear from my audiologist about the latest articles and research addressed in these and other journals that are relevant to my hearing needs. Currently HLAA is not listed in the resources for patients on the Academy of Doctors of Audiology (ADA) web site. Something that I teach about in my own graduate classes is the documented resilience that persons who have known trauma can experience when, in the midst of their trauma or following it, they know the relational containment of those who can empathize with the trauma that has been theirs. I want an audiologist who understands this and who will invest in putting me in touch with others who share my experiences. After testing my hearing a month ago, an audiologist in one of the world s most renowned hospitals told me that I was now eligible for a cochlear implant in my left ear. She was in a hurry and let me know that someone would give me a list of implant surgeons in the waiting
14 area, where I could now take a seat. A few minutes later a nice gentleman in a white coat handed me the list and wished me well. I am afraid of getting an implant. I am not ready to give up my career should anything go wrong. There is much that I want to learn about what this surgery will and could mean for me. What gave me the strength to rise from the waiting room chair and reduce the familiar numbness that had begun to rise inside me was my certainty that I would be able to connect with my friend, with my brother, and with implanted persons I met at my first HLAA conference last June who gave me phone numbers and cards and said, Call me. I was grateful as I walked down that hospital hallway that I did not feel alone. Conclusion: Peggy Ellertsen One day last June, as I was considering the possibilities for presenting at this symposium, I had lunch with my friend, Toni Iolacolucci, an active member of the Manhattan chapter of HLAA. She is a remarkable person who inspires me and makes me appreciate the power of the human spirit. Toni has lost all of her hearing, yet still, she remains engaged in living, giving to the people around her in ways that are unparalleled. I wanted to know what her ideas were about the merits of patient stories as resources for audiologists in caring for their patients needs. She later sent me an , and this is what she wrote: I m just starting to realize that the 'psychology' of hearing loss... overides everything else... You wouldn't be expecting audiologists to 'counsel', but I think it's the nuance of hearing loss (which will come out in the stories) that helps to target what people really need. If you don't go there in the client session, then how would you really know how what I need differs from what you need...and what options I would be willing to accept versus what you would accept?... My relationship with my audiologist is collaborative rather than hierarchical (as often
15 exists between doctor and patient/client.) There is clear recognition and respect for the fact that my communication needs are unique My audiologist has worked and interacted with people with hearing loss in many different capacities beyond the office setting, and this adds great value to his understanding of the impact of this condition and an ability to empathize with my experience.
16 References Compton-Conley, Cynthia. (2008). Assistive technology for receptive communication. Annapolis: Single-handed Productions, LLC. Harvey, M. (2010). What your patients may not tell you: combating deep metaphors and the rationale for audiological-psychological collaboration. Hearing Review. Retrieved February 2, 2012, from Hickson, L. Defining A Paradigm Shift. Seminars in Hearing, Vol 33 (No. 1), February, 2012, pp Kochkin, S., Beck, D. L., Christensen, L. A., Compton-Conley, C. Fligor, B. J., Kricos, P. B., et al. MarkeTrak VIII: the impact of the hearing healthcare professional on hearing aid user success. The Hearing Review, Vol 17 (No.4), April 2010, pp Laplante-Levesque, A., Hickson, L., & Worrall, L. (2010). Promoting the participation of adults with acquired hearing impairment in their rehabilitation. Journal of the Academy of Rehabilitative Audiology, 43, von Hapsburg, D., & Tjornhoj-Thomsen, T. The Encounter Model and Audiological Clinical Encounters. Seminars in Hearing, Vol 33 (No. 1), February, 2012, pp
New Beginnings: Managing the Emotional Impact of Diabetes Module 1 ALEXIS (AW): Welcome to New Beginnings: Managing the Emotional Impact of Diabetes. MICHELLE (MOG): And I m Dr. Michelle Owens-Gary. AW:
Health Management Limited has been appointed as the supplier to deliver Fit for Work (previously Health and Work Service) in England and Wales. The following is a personal account of a service user s journey.
Life with MS: Mastering Relationships with Family and Friends Getting the Support You Need The bonds we have with friends and family are linked to our happiness and well-being. They bring us joy during
A GUIDE TO SURVIVING YOUR FIRST YEAR IN THE NUR SING WORLD By Jennifer R. Tucker Graduation Day to NCLEX Finally, the long awaited graduation day had arrived: a day that had been five years in the making,
I had come to the United States dreaming of finding my mother but I ended up discovering so much more about myself. My name is Ana Maria Alvarez and I am 20 years old. I am from Guatemala I came to Mary
Sample Process Recording - First Year MSW Student Agency: Surgical Floor, City Hospital Client System: Harold Harper, age 68, retired widower Date: November 18, 20xx Presenting Issues: Cardiologist observed
Student Essays on NASA Project The trip to Washington D.C. for the Quarterbacks of Life program was enlightening for various reasons; it goes without saying that being able to visit the nation's capital,
The Breast Center- Smilow Cancer Hospital at Yale-New Haven 20 York Street, North Pavilion New Haven, CT 06510 Phone: (203) 200-2328 2328 Fax: (203) 200-2075 2075 THE EMOTIONAL IMPACT OF A CANCER DIAGNOSIS
Treating Cancer with Proton Therapy Webcast March 2011 Host: Jaime Méndez Ester Lombrozo Marc Delclos Please remember the opinions expressed on Patient Power are not necessarily the views of MD Anderson
ISI Debtor Testimonials April 2015 ISI Tackling problem debt together The following are the words of debtors who have availed of the ISI s debt solutions and are real cases. They have reviewed and agreed
Grades 9 to 12 Personal Health Series KidsHealth.org/classroom Teacher s Guide This guide includes: Standards Related Links Discussion Questions Activities for Students Reproducible Materials Standards
Process #22 Moving Up the Emotional Scale From Ask and It Is Given, By Ester & Jerry Hicks When to Use This Process: When you feel bad and are having a difficult time feeling better. When something has
This brochure suggests some strategies for helping someone you know who is living with a terminal condition. Finding out that someone you know a relative, acquaintance, workmate, or friend - is going to
I M NOT AN ADDICT How could I be an addict? My life is great. I live in a very good area of Los Angeles, drive a nice sports car, have a good job, pay all my bills, and have a wonderful family. This is
Convincing More Patients to Get Help Practical Communication Skills from the Trenches by Gyl A. Kasewurm, Au.D. According to the National Institute of Health (NIH) sensory hearing loss is one of the most
Mental Health Role Plays Goals: To discuss various mental health issues and mental illnesses. To discuss stigma, support and treatment options surrounding mental health issues and mental illnesses. Requirements:
STEP 1 Start Learning American Sign Language In this section: The Top 5 American Sign Language Myths The 7 Best Ways To Learn American Sign Language Don t Just Sign... Communicate!: A Student s Guide to
1 Kids Have Stress Too! Especially at Back to School Time As a Parent, You Can Help! Stress can infect and affect the physical, emotional, intellectual and academic well being of children. It can interfere
Interview With A Teen. Great Family. Outstanding Education. Heroine Addict I recently had the incredible opportunity to interview a young man, Gregor, who very quickly fell into a dependent situation with
Profiles in Social Work Episode 23 James Felstiner Intro - Hi, I m Charmaine Williams, Associate Professor and Associate Dean, Academic, for the University of Toronto, Factor-Inwentash Faculty of Social
Connectedness and the Emotional Bank Account Directions This is a self-guided activity that can be completed by parents, teens or both. It contains five parts and should take about 45 minutes to complete.
Kim Fredrickson, M.S., MFT Author and Coach How Do I Handle Unsupportive Friends and Family While Pursuing My Goals and Dreams? Relationships are at the core of everything we do, whether this is in our
tips for dealing with a depression diagnosis 2011 www.heretohelp.bc.ca No one wants to feel unwell. Talking to your doctor or other health professional about problems with your mood is an important first
Pastor Spotlight Martha Fisher, CBC Women s Pastor Inspiration Martha Fisher, Women s Pastor at Community Bible Church, leads with a passion to reach, teach and help the women of our community for Jesus.
Testimony of Susie Trotochaud of Georgia Before the Labor, Health and Human Services, Education and Related Agencies Appropriations Subcommittee of the U.S. House of Representatives Committee on Appropriations
Life with MS: Mastering Early Treatment Essential Information About MS Multiple sclerosis (MS) is a disease that attacks the central nervous system (CNS). Approximately 2.5 million people worldwide and
INTRODUCTION The Seven Rules of Highly Worried People WORRYING IS SECOND NATURE to you, but imagine that someone who has been raised in the jungle and knows nothing about conventional modern life approached
Chapter SIX Set personal, academic, and career goals. Keep your expectations high. It is today that we create the world of the future. Eleanor Roosevelt When seventy-one adults with specific learning disabilities
Announcer: Adolescent drug abuse and the impact of the family dynamic. This is Stay Happily Married: Episode #279. Welcome to Stay Happily Married; your source for weekly updates on the latest tips and
BOOK 1, PART 3, LESSON 4 THE FORGIVING FATHER THE BIBLE: Luke 15:11-32 THEME: We can discover what Jesus wants us to do and be by hearing the parables Jesus told. PREPARING FOR THE LESSON MAIN IDEA: Jesus
ESOL Customer Service Training: Unit 1 1: 1 Unit 1: Talking With Your Customer ESOL Customer Service Training: Unit 1 1: 2 What are your goals? Note to Instructor: If you have permission, use Stand Out
FEATURED ARTICLE: SU DCC-NEWS: Stories of a Deaf Identity by Kate Corbett Pollack [Names have been changed where appropriate.] No one ever told me I was Deaf growing up. I didn't know that I would ever
This assignment was one that I gave to my EDU 360 class. By the time students get to this point in the TESOL (Teaching English to speakers of other languages) major, they have learned a lot about writing,
www.complexchild.com Using Fun, Humor to Help Children through Hospital Stays and Procedures by Pattie Curran I could write a book on helping children cope with hospitals and medical procedures. Having
PreK to Grade 2 Personal Health Series KidsHealth.org/classroom Teacher s Guide This guide includes: Standards Related Links Discussion Questions Activities for Students Reproducible Materials Standards
ONLINE SPEECH THERAPY FOR VIRTUAL SCHOOLS Shari Robertson, PhD, CCC-SLP Jenny Kendall, M.A., B.S. INTRODUCTION TO SPECIAL EDUCATION SERVICES FOR VIRTUAL SCHOOLS By Shari Robertson, PhD, CCC-SLP I m sure
Devotion NT224 CHILDREN S DEVOTIONS FOR THE WEEK OF: LESSON TITLE: The Woman at the Well THEME: Jesus knows all about us and He loves us. SCRIPTURE: John 4:1-42 Dear Parents Welcome to Bible Time for Kids!
! Their stories are tragic. A new chapter starts now. now.! Bully is a movie that tells powerful stories about children and their families dealing with extreme pain and tragic consequences related to bullying.
12 Step Worksheet Questions STEP 1 We admitted we were powerless over alcohol that our lives had become unmanageable. The first time I took a drink I knew it wasn't for me. Every time I drank I got drunk
p T h e L a s t L e a f IN A SMALL PART OF THE CITY WEST OF Washington Square, the streets have gone wild. They turn in different directions. They are broken into small pieces called places. One street
Networking: Don t Just Do It - Do It Well How to Network Your Way to Effective Relationship-Building By: Kristin Rizzo, Esq. [Kristin Rizzo is a graduate of University of San Diego School of Law, serves
Dear Billy, I am writing to let you know how much I am missing you. I have some good news. I am going to be an auntie. I am so excited about finding out what my sister is having. I am very proud of you,
Activity 3: Observe Psychological First Aid In this activity you have the opportunity to hear a conversation between a survivor of bomb blast and a Red Cross behavioral health volunteer. This role play
University of Minnesota NSCI 4100 001 Fall 2012 01/10/2013 Number of questionnaires = 17 Page 1 of 2 Dr. McLoon was one of the best instructors I have ever had. He presented difficult material in an interesting
15 Toughest Interview Questions and Answers! Reference: WomenCo. Lifestyle Digest, email@example.com 1. Why do you want to work in this industry? I love to shop. Even as a kid, I spent hours flipping
Association of College Educators-Deaf/Hard or Hearing 2010 Conference Lexington, Kentucky Deaf Education Faculty Recruitment Begin at the Beginning: The Undergraduate Level A Panel Discussion Saturday,
Scripts for Recruiters Companion Script Guide for The New Recruiters Tool Kit www.greatrecruitertraining.com Copyright 2010 Scott Love 1 How to Use This Guide Use this companion script guide while watching
Addressing Family Needs FAMILIES How Can I Build Stronger Family Ties? Everyone in the family is affected by TBI. * Your role within the family has changed and the role of your family member with TBI may
2. Planning your support how to use your Personal Budget About this guide A Personal Budget is money from a local authority that can be used to pay for social care services and support. The money may be
56 Key Profit Building Lessons I Learned from Jay Abraham s MasterMind Marketing Training. Jay Abraham is a man you should all know. If you do not - go to the library and start learning - just do it! He
Stories of depression Does this sound like you? D E P A R T M E N T O F H E A L T H A N D H U M A N S E R V I C E S P U B L I C H E A L T H S E R V I C E N A T I O N A L I N S T I T U T E S O F H E A L
Stepping Outside the Box: Some Additional Thoughts Part II Robert Brooks, Ph.D. This will be my last article until September. I want to wish my readers a relaxing summer and to mention that in addition
p T w o T h a n k s g i v i n g D a y G e n t l e m e n THERE IS ONE DAY THAT IS OURS. THERE IS ONE day when all Americans go back to the old home and eat a big dinner. Bless the day. The President gives
What does student success mean to you? Student success to me means to graduate with a B average with no failing grades. Ferris is ridicules tuition rates don t affect me since I was fortunate enough to
Invisible Disability Mark Brogan was serving as an Army captain when he was severely injured in Rawah, Iraq, on April 11, 2006. He suffered a penetrating head injury, multiple shrapnel wounds and a nearly
Back to School: Working with Teachers and Schools Starting school each fall is a challenge for the student and parents. The following article offers some valuable suggestions as your child starts a new
TASK I: Communication and Cultural Competence Module A: Customer Service California WIC Training Manual 6/1/2010 Task I/Module A Page i TABLE OF CONTENTS OVERVIEW..... 1 What Is Customer Service?......
Weaving the Pieces Together By Annette Unten Life is a woven tapestry. All the people and the events that enter my life become a part of the threads in my tapestry. Bright colors are woven with pastels.
[ ] [live] Copyright 1983, 2008 by Narcotics Anonymous World Services, Inc. All rights reserved. World Service Office PO Box 9999 Van Nuys, CA 91409 USA TEL (818) 773-9999 FAX (818) 700-0700 WEB www.na.org
Deedee Blais, '09 Kigali, Rwanda When I, Deedee Blais boarded the plane at JFK airport I had no idea what was in store for me. After taking the semester long preparatory class I had heard plenty of stories
Matt Szpara December 9, 2004 Gottlieb Memorial Hospital Emergency Volunteer When first going into the Scholars Program at Triton College, I was told by counselors and other people I talked to that I would
Opportunity Awareness Center Martha Raines High School Behavior Transition Program Becky BracewelI-Tucker, Principal Katy Independent School District Dear Selection Committee, As Principal of the Opportunity
My WRAP Plan 1995-2005 Mary Ellen Copeland, MS, MA All Rights Reserved P.O. Box 301, West Dummerston, VT 05357 www.mentalhealthrecovery.com Copeland Center for Wellness & Recovery P.O. Box 6464, Chandler,
Juan and Sasha Discover How Their College Education Relates to Work and Career By David McVey, M.S., Career Counselor Debra Marcus, M.S., Career Counselor Juan received his acceptance letter to Sacramento
Telling Family and Friends That You Have Been Laid Off Overview Ways to talk about your job loss with family and friends. Telling your spouse or partner Telling your children and helping them adjust to
Leadership for MS Science EDU 587-630 Instructor: J. Pizzo Paper by Rich Matthews MISEP Cohort II My Leadership Philosophy Leadership experience prior to MISEP I can remember early in my career, as somewhat
Texas Ob/Gyn Practice Leverages Patient Portal to Connect with Patients The number one question people ask me is, When did I have my PAP test? Now they can go back and see when they had the test and the
Adoption Awareness Month Daily Prayers Begin each day with prayer for the children, their families and those who seek the best for each child. Remember, Seek the Lord and His strength; seek His face continuously.
Tricia Stouch I lost my daughter Pamela on March 27th 2010 to a heroin overdose. She was nineteen years old. Pamela's struggle began when she was a senior in high school. Pamela left me a journal on her
ONLINE SPEECH THERAPY FOR CHARTER SCHOOLS Shari Robertson, PhD, CCC-SLP Joe Pacheco, Director of Student Services at Leadership Public Schools Shawn Whitney, Director of Special Education, Edison Charter
Theory U Toolbook 1.1 Dialogue Interviews for regular updates: www.presencing.com Dialogue Interviews At a Glance Dialogue interviews are intended to engage the interviewee in a reflective and generative
4 Asthma and Your Emotions drkoop.com Kathleen Dougherty, of Keuka Park, New York, knows when she s having too much fun. Caught up in an enjoyable moment, she may find herself short of breath, and then
cover story l by Liz Kohman // Photos by Silas Crews Lance Pitlick has built two careers from his passion for hockey H ockey coach Lance Pitlick was trying to teach his team to improve their stick handling
Read the following article and consider the following questions for the individual involved: 1. What were the threats and poor decisions? 2. What were the positive actions and good decisions? 3. What would
What people who attend Linton Sellen s Leadership Training have to say: Excellent course, couldn t have been better. Training content and knowledge and delivery are exceptional. I've been to many management
Alli Hall Senior Seminar Skit It s Drug Abuse! Narrator: This is a three-scene skit entitled It s Drug Abuse! representing three different ways prescription drugs are and can be abused by teenagers. It
Page 1 MS Learn Online Feature Presentation Pediatric MS: Partnering with Your Child s School Featuring >>Kate Milliken: Hello, I m Kate Milliken, and welcome to MS Learn Online. Parents of children with
Post-Secondary Education and Training The Big Ideas: Post-secondary education and training Section 504 of the Rehabilitation Act Americans with Disabilities Act Reasonable accommodations Two year colleges
Energy, Momentum, Motion Changing Community Perception Strategies for Reversing Outmigration Copyright 2012 by, Inc No part of this presentation can be reproduced or distributed without written consent.
Devotion NT320 CHILDREN S DEVOTIONS FOR THE WEEK OF: LESSON TITLE: The Gift of Love THEME: God desires for us to demonstrate His love! SCRIPTURE: 1 Corinthians 13:1-13 Dear Parents Welcome to Bible Time
a threat made in school ADAM S BACKGROUND LEADING UP TO THE CRIME Adam, 15, is the youngest of four children. His parents are divorced. He lives with his mother, has regular contact with his father, and
Question #1: Why did you want to enter the healthcare field? in St. Louis Graduation date: April 26, In April 2012 I gave birth to twin boys, Sam and Charlie. During my pregnancy I was diagnosed with what