They're Not Just Playing!

I was called to an area elementary school to perform a psychiatric screening on a 12 year old male threatening to harm the school staff. I was familiar with Alfonzo (not his real name) as a current client that I have screened and worked with over several years. Upon my arrival, I met with Alfonzo and his dad as well as his homeroom and special education teachers and the assistant principal.

As we entered the conference room, Alfonzo sat down and immediately started spinning in his seat. I was quickly reminded of his hyperactivity and my need to direct that energy. I gave him paper and a pencil and asked him to write, draw or fold something for me.

According to the special education teacher, Alfonzo kicked open the front door, flew down the hall into his classroom and dove into his seat. When confronted, he went back out, gently opened the door, walked to the classroom and sat in his seat. The homeroom teacher reported that as Alfonzo was given scissors for a craft project, he told her he would cut her like he did a teacher last year but then said he was “only playing.” And the assistant principal added that at the start of the school year when she asked Alfonzo to remove a straw from his mouth, he complied but only after telling her about the plate in his neck after being shot multiple times.

I asked Alfonzo about these behaviors and he readily admitted to each. I asked him to show me what he had done. One side of the picture was four figures with firearms and the other side eight figures with arms outstretched. I asked him to tell me about the picture. He described the scene as zombies versus the survivors, each zombie with differing characteristics and the survivors as he and his friends.

Being an avid gamer, I knew he was describing the zombies from Valve’s Left 4 Dead series. And I know these are games rated as Mature by the Entertainment Software Ratings Board (ESRB). But what I also remember about Alfonzo is that his father is a former gang member, his brother is incarcerated for a drive-by shooting and several other family members as victims and/or perpetrators of urban violence. The horrors in his front yard have been much worse than what he has witnessed in a video game.

I asked what he likes to do in his free time. He said “go outside to play basketball and tag or play video games.” I asked him what are his favorite video games and he mentioned Grand Theft Auto, Saints Row and Left 4 Dead.

The picture that Alfonzo drew is but one example of creative expression that has sent many school kids to psychiatric facilities around the globe. Too often, it is misinterpreted as a precursor to violence or a cry for help. In this case, Alfonzo’s picture represents his attempt to overcome and conquer his circumstances.

As he chooses and engages in his video game play, we can use that to develop rapport, assess strengths and weaknesses, explore sensitive areas and modify his thoughts, feelings and actions. As therapists are able to integrate music, art and movement into their therapeutic skill sets, video games should be seen as an evolutionary tool for multisensory engagement and behavior change.

It's ALIVE!!

One of my colleagues called me on Tuesday and asked me to look online to see if was true?

“If what is true,” I asked cautiously as I did not want to seem oblivious to everything.

“Universal Health Services just bought Psychiatric Solutions!” I had not heard this news,  did a search and confirmed the information. For those of us behavioral health providers in the metropolitan Chicago area, this is huge news. This will consolidate three of the largest freestanding psychiatric hospitals under one corporation. And as a clinician who started my career during the dominance of psychiatric corporate giants like Psychiatric Institute of America (PIA), National Medical Enterprises (NME) and Charter Medical Corporation, I am having flashbacks about why these juggernauts all but disappeared.

During the early 1990’s, I worked at Charter Barclay Hospital in Chicago, one of a chain of premier freestanding psychiatric facilities throughout the country but predominantly in the western and southern regions. Many remember the Charter commercials below that aggressively targeted individuals and families with offers of “free” assessments.

We were trained at the front end to convert calls to assessments and assessments to admissions. We were told never to ask about insurance over the phone. Just get them in, and the service would sell itself.

What we weren’t told was that, once patients were admitted, they would be treated as long as their benefits would cover. The 28 days model was seen as the treatment of choice for rehabilitation from alcohol and drug addictions. Customers were involuntarily hospitalized just because they walked into the locked lobby and realized that they could not just leave when they wanted. Oh, and they had benefits to be exhausted.

Before the turn of the second century, the abuse, fraud and waste began to coagulate into fines and lawsuits and corporations learned that they could no longer exploit the mentally ill and chemically impaired population.

In 2000, I consulted with one of the premier freestanding hospitals to train and develop processes for the front end systems to increase profitability from patient admissions. After six months, I realized that the owner was nostalgic and wanted to recreate the same flawed business model so I bailed before he could resurrect his monster.

As much as I enjoy consultant work and would love to assist in developing real community mental health alternatives offered by private corporations, I realize that profit and greed are enticing and prefer to give helpful advice now before the monster is unearthed.

Don’t:

• pickpocket families and shovel them into medically unnecessary treatments under the guise of providing “free” assessments;
• abuse involuntary commitment procedures that violate basic human rights, freedoms and dignity;
• ignore the continuum of care;
• promise referral sources interventions you cannot support or provide, especially as it conflicts with the needs and wishes of the consumer.

Do:

• provide actual and tangible services useful to the community – employment, consumer education, crisis consultations, level-of-care screenings, referral and linkage;
• develop effective and collaborative networks of referral agents, health providers, educators, payors and others who benefit from an expanded customer base;
• offer accessible treatment options from inpatient to support groups;
• recognize that word-of-mouth can make or break any health care provider; and
• hire and train front-line workers to do clinical work with administrative responsibilities, not the other way around.

It is imperative that behavioral health providers like Universal Health Services offer contextual, responsible and truly community oriented care or join the automobile, banking, oil and insurance corporate entities in putting profits before people. And risk that when angry consumers appear with pitchforks and torches, they will not come looking for them.

Stop Backing Out of Driveways!

In 2007, the National Highway Traffic Safety Administration (NHTSA) of the United States began collecting data about motor vehicle accidents off of public roads and highways. And, in that year alone, 14,000 persons were injured in back over incidents, 2000 of which were children, 221 fatalities and 99 were children.

 

Advocacy groups have called for driver education, teaching kids not to play in driveways, reversing cameras and parking sensors. In the realm of keeping it simple, I advocate an uncomplicated remedy – back in and pull out.

 

Backing into a parking spot, driveway or car port creates several conditions:

 

• You have to drive past and initially view the area you’re backing into and
• When backing up, you must slow down to avoid hitting another vehicle or the residence.

 

Personally, I have always preferred to back into spaces because I take greater care in the process and do not like backing into major thoroughfares.

 

Do yourself, your friends and family a favor. Spread the word! Back In and Pull Out! Start today!

 

How the Video Game Industry Can Save Our Streets

I woke up this morning to a news report of kids using kids for target practice on the southeast side of Chicago. Each time, I am sickened and the only relief I feel is when I hear that they’re in stable condition. Our streets are under siege and our children are the insurgents.

Our children have too much unstructured time. Families have limited resources to connect to meaningful activities. And what outlets do kids who are not athletes, musically inclined or aloof have?

As a youth, I spent many days hanging out at the video game arcade. I only developed proficiency at foosball but enjoyed the sights, sounds and watching others compete and bring those machines to their electronic knees. But now, all of the technology that amazed me then exists in the current generation home console units.

It is time to bring back the neighborhood arcades, version 2010.3. Storefronts and mini-malls remain vacant in these troubled areas and could be quickly modified into a technological drop-in community center. Donations from video game and computer industry corporations would provide hardware, software, consultation and technical assistance needed for start-up. Once locations have been set-up and established, the community impact would be immediate and resonant:

• Area residents hired and trained to manage sites, provide guidance in using the equipment, monitor activity in and around the facilities, etc.
• After-school, weekend and school holiday access for families,
• Multipurpose use for school-sponsored field activities, structured mentoring and tutoring areas, kiosks for product demonstrations, appearances by industry professionals and game celebrities, corporate-sponsored healthy eating café, gross motor activity sections,
• Corporate-sponsored areas with featured hardware and software, opportunities for training, certification and continuing education geared toward video game industry, and
• Support for learning styles and intellectual strengths.

Once established, these educational and entertainment centers can provide needed family and community supports. Students and parents could earn credits through scholarship, stewardship and volunteer efforts; local law enforcement personnel can include the centers as part of their patrol routes and possible off-duty work; legislators and community leaders can show evidence of working and flourishing community-corporate partnerships and educators can encourage game developers to include learning standards in game design.

These are a few benefits of the video game industry directly investing in communities for immediate results. While this will not solve all community ills, it would be a start. And I do not believe we will see news reports of shootings by children with a gun in one hand and a game controller in the other.

Parenting is no game ...

We picked up my seventh grade son from a math competition where he placed second for individual and third for the group. I asked him to what he attributes his success and he said he didn't know. I asked him if he stuck his fingers in his nose to keep the thoughts from escaping and, wisely, he did not answer.

I think I have a fairly good idea of how he spends his time. He attends school and performs pretty well in terms of grades, test scores, behavior and citizenship; does chores, watches television, reads a great deal outside of school requirements and spends about thirty hours playing online computer games. For the past few months, it has been League of Legends. Before that, it was Team Fortress 2. Next, I think it will be Monster Hunter Tri. He had an opportunity to play that at the Nintendo booth of the comics convention we attended last weekend.

Most parents would think that this is too much time for computer gaming for children, one of which would be my wife. My thoughts are that he is not hanging out, tying up a phone or burning up minutes or bringing over hoodlums to eat up the food and tear up the place. Most of the time, I sit right next to him, on my computer, writing, surfing, working or playing while we talk, joke and interact throughout the evening.

We have an adult son as well and I am still trying to figure out this parenting thing. But I continue to follow certain principles. I provide structure so they know where the boundaries lie, what they are allowed to do and warnings that certain choices they make can place them outside of my ability to help. I give them support to do the things they want to do after they've done what they have to do first and provide whatever resources I have or sacrifices I need to make to support them. And they get supervision as I inform them what they can do, make certain that they are able to do it and watch them as they do it. It is no easy task.

Children, especially young black males, need to be surrounded by many layers of protective factors. As a student of my surroundings, I watch and listen and see that most of the time, we are the architects of our own chaos and engineers to our own destruction. Early on, I learned that engagement in technology would keep me out of a lot of trouble and, so far, it's done OK by me and mine.

When you’re smiling … the whole world aims at you.

My wife and I went to a neighborhood popcorn shop this week. I held the door for her, walked in and looked around at their offerings. There was a slice of red velvet cake that I gravitated towards. Thoughts of the exercise I should be doing and the calories presented before me prevailed so I continued to just look. Karen found what she wanted, made her purchase and we left the store.

She then asked me what was wrong. I told her nothing was wrong. She informed me that a store clerk looked at me cautiously and told me that I could be that I don’t smile. I agreed, I don’t smile much but I do make it a point to smirk several times daily and guffaw at least three times daily.

What followed was a lecture from her about how I don’t look happy, others say I don’t look happy, my scowl is so unattractive, ad nauseam. I explained that, in the several times that she mentioned this, I have made great efforts to present a cheerful countenance throughout the day.

And then I began to reflect. I used to smile a lot until third grade when Henry Crawford punched me and knocked out my tooth. I didn’t smile as much but I tried until after I ran a foot race with fifth grade classmates, Lance Campbell tripped me and I chipped a front tooth which needed capping.

No more smiling for me. What I needed was a game face that I would don before I leave home every morning. Throughout the years, I made some adjustments here and there but I still carry it around.

Now I know that I don’t really need the game face as much. I also know that it takes more muscles to frown than smile; people gravitate toward others that have a “winning smile” and smiling releases endorphins which help to prolong life spans. My personal experiences are with others who smile while they sharpen their blades, probe and stab at soft spots and tell you “this will only hurt a little bit.”

“Do as you would be done by” is the Golden Rule and creed that I live by and I believe that everyone is capable of doing kind and noble acts. But as we know, many live by “he who has the gold makes the rules” and run over the disenfranchised, dejected and depressed among us. I believe this is what I carry around on my face.

I want my share of endorphins. I want to live longer. But I will not be a victim to the conquerors and tyrants among us.

Gather up thy sword and shield ...

I love crisis work. In the workplace, whenever I hear any kind of commotion, instead of going in the opposite direction, I stroll into the hornet's nest, offer help where I can or get out of the way, careful not to get stung.

Personally, I greet conflict like a herd of buffalo. I sidestep the thundering issues or retreat from the stampeding situations until the other party stops advancing. I pull out my vast mediation and negotiation skills to manage the confrontation but forget that 1) I cannot be impartial if I am one of the aggrieved parties and 2) others don't necessarily fight fairly. I'll take a non-aggressive stance and take a verbal sucker punch, emotional low blow or rehashed body slam. In the back of my mind, I know I am capable of giving as good as I get by shouting, cursing, stomping, name calling and saying hurtful things but know that things have a tendency to boomerang and I strive to treat others as I would want to be treated. Regardless, sidestepping or retreating is frequently seen as surrender or cowardice.

Crises and conflict usually appear when there are power and control issues, even if those issues are only perceptual. Power and control has always been low on my list of needs or desires. Alas, as I grow grayer and hopefully wiser, I now realize that many things you must fight for in order to protect your peace-of-mind. I stand my ground for those things that are important, even if only to me. At this point, I don't necessarily expect to win every skirmish but will resist valiantly.