WEBVTT 1 00:00:13.680 --> 00:00:15.080 You 2 00:00:41.080 --> 00:00:47.560 If you were to see any of our children on the street you wouldn't have any idea that they were hospitalized and 3 00:00:48.400 --> 00:00:55.200 on pass from an inpatient psychiatric unit. They're often very cute and engaging. They're often very 4 00:00:55.200 --> 00:01:05.000 much like any other child in their appearance. I came to the unit from an area of nursing called 5 00:01:05.000 --> 00:01:13.540 neonatology which is the care of high risk infants from birth to either five pounds or one month 6 00:01:13.540 --> 00:01:19.400 whichever comes first a very intense kind of setting. A setting in which there were many deaths 7 00:01:19.400 --> 00:01:26.220 per week, many intense kinds of critical situations and always had an interest in supporting not only 8 00:01:26.220 --> 00:01:34.300 the staff but also the families very much of these children. In the back of my mind I always knew 9 00:01:34.300 --> 00:01:39.800 that I wanted to work within the field of psych. I never knew exactly how that would pan out, how 10 00:01:39.800 --> 00:01:46.960 that would work out but very much have found that it was a real treat to come upon this inpatient unit. 11 00:02:07.820 --> 00:02:14.000 I love working in the inpatient unit. It's a most unique place. I've always thought that I was 12 00:02:15.080 --> 00:02:24.440 to happen upon it. It's a fascinating unit in that people really, the staff interact very honestly and 13 00:02:25.420 --> 00:02:33.040 caringly with one another. People ask how we take care of emotionally disturbed children and it's 14 00:02:33.040 --> 00:02:41.880 really very simple. There are a few basic principles that one operates under. One of which is that 15 00:02:41.880 --> 00:02:50.240 honesty is primary and that we work with the children in a very basic day-to-day way using 16 00:02:51.100 --> 00:03:01.240 examples of daily care or self-help skills to begin with. What we often do is, what we always 17 00:03:01.240 --> 00:03:06.780 do actually, is to make a point of working with the children from the beginning of an interaction 18 00:03:06.780 --> 00:03:13.920 all the way through if that takes two minutes or if that takes ten such that there's an understanding 19 00:03:13.920 --> 00:03:16.580 of where the breakdown in communication has taken place. 20 00:03:43.000 --> 00:03:56.480 It's very important to have the patience to do that kind of thing. We use a lot of behavior 21 00:03:56.480 --> 00:04:05.060 modification techniques. We constantly are aware of poor self-esteem within the children and 22 00:04:05.360 --> 00:04:14.400 constantly aware of our need to reinforce their feeling good about themselves. All of the children 23 00:04:14.400 --> 00:04:22.480 coming into the unit have very poor self-images such that they've probably never really ever felt 24 00:04:22.480 --> 00:04:27.660 as though they were a good child, good person. Frequently being told because of their behaviors 25 00:04:27.660 --> 00:04:34.960 that they're bad, constantly being punished and new ideas or methods being tried by parents who 26 00:04:34.960 --> 00:04:39.680 are very desperate to change behaviors. And by the time they've arrived at our inpatient unit, 27 00:04:39.700 --> 00:04:47.200 which is a locked ward, they feel very bad about themselves. They feel responsible for their own 28 00:04:47.200 --> 00:04:53.980 hospitalization as well as their parents' unhappiness and feel bad. We constantly are 29 00:04:53.980 --> 00:05:00.960 aware of that using a lot of different ways amongst staff to remind each other of the child's 30 00:05:01.100 --> 00:05:08.500 need to feel good. And we very much give what we call strokes, sentences regarding children's 31 00:05:09.180 --> 00:05:16.920 good behavior, sentences regarding a very nice attractive smile, really very much making an 32 00:05:16.920 --> 00:05:23.880 effort to point out to a child whatever positive attributes he or she has and ignoring a lot of 33 00:05:23.880 --> 00:05:32.000 negative behaviors if that's possible. As the unit is an inpatient unit in the hospital, 34 00:05:32.540 --> 00:05:39.540 one of the things that we do is we staff such that there are always adults with the children. 35 00:05:39.600 --> 00:05:45.900 It's not like some long-term care residential centers whereby there's much independence allowed 36 00:05:45.900 --> 00:05:52.020 the children. As a child initially comes into the unit, one staff needs to be with them at all times 37 00:05:52.020 --> 00:05:57.900 unless they're very close to the nurse's station and in direct observation of staff. And as the 38 00:05:57.900 --> 00:06:05.000 child's behavior progresses and treatment continues, he or she then becomes less in 39 00:06:05.000 --> 00:06:07.740 contact with an adult but still in very close proximity. 40 00:06:33.880 --> 00:06:42.440 There is a very intense working with the child. We have eight-hour shifts and the same adults 41 00:06:42.440 --> 00:06:48.740 are with the children for eight hours at a time and constantly able to see how they interact with 42 00:06:48.740 --> 00:06:55.700 children, adults, their families and really work with in an intense way very minute interactions 43 00:06:55.700 --> 00:07:02.920 to very complex and very difficult physical tantrums such that we have a great range of 44 00:07:02.920 --> 00:07:04.320 behaviors to deal with. 45 00:07:27.260 --> 00:07:35.680 What we do is after each interaction that we target with a child, we do a period of talk with 46 00:07:35.680 --> 00:07:43.860 the child called processing whereby we ask the child what kind of feeling precipitated his 47 00:07:43.860 --> 00:07:51.600 acting in this way. What happened to make him so, whatever the feeling word might be, angry? And 48 00:07:51.600 --> 00:07:59.820 always make a point of including a feeling, tone to the conversation after we've identified exactly 49 00:07:59.820 --> 00:08:07.580 what it is that's happened within the interaction. The processing can be very brief. It can also be 50 00:08:07.580 --> 00:08:13.980 quite long and can be either individual or group. With older children we often have group 51 00:08:13.980 --> 00:08:22.400 processings whereby children can say to their peers and vice versa what their behavior did for 52 00:08:22.400 --> 00:08:29.040 the group in terms of its feel or it can be an interaction in the hall. It's not common in 53 00:08:29.040 --> 00:08:36.260 families to have any kind of processing. It's a very unusual kind of experience as the child 54 00:08:36.260 --> 00:08:41.560 initially comes into the unit unless of course they've been seen in outpatient therapy at which 55 00:08:41.560 --> 00:08:48.580 time of course the child would be very in touch with what processing is and how he or she needs 56 00:08:48.580 --> 00:08:56.380 to connect behavior and feelings. Often children that arrive into our unit have not been in outpatient 57 00:08:56.380 --> 00:09:05.180 therapy and so we very very slowly begin to work with them around what we call processing. We very 58 00:09:06.260 --> 00:09:15.300 slowly begin to point out to them that there is reason for their behaviors and that those reasons 59 00:09:15.300 --> 00:09:23.900 aren't bad or good but simply connected to their behavior and it's important for us as staff to 60 00:09:23.900 --> 00:09:34.580 help those people. People often ask me what kind of children we have on the unit. It's in one way a 61 00:09:34.580 --> 00:09:42.000 simple one. They are children who have had extreme problems with behavior. That behavior may be fire 62 00:09:42.000 --> 00:09:48.380 setting, may be tantrums of such an extreme nature that teachers in the classroom can't control them, 63 00:09:48.480 --> 00:09:53.320 parents at home can't control them. We have some children on our unit that have what's called 64 00:09:53.320 --> 00:10:01.060 anorexia nervosa such that they use food as a way to cope with feelings and so they don't take in 65 00:10:01.060 --> 00:10:07.020 food which drives parents crazy. We have other children who at the very early age of five and six 66 00:10:08.020 --> 00:10:15.360 won't listen to any limits at all from parents often tied very much to environment, often tied 67 00:10:15.360 --> 00:10:24.880 very much to inconsistency. We have increasingly in the last couple of years had more disturbed 68 00:10:24.880 --> 00:10:31.040 children, children that we call psychotic which means out of touch with reality at either periods 69 00:10:31.040 --> 00:10:39.580 of time or continuously. On the whole however as I work with the children I'm very much struck by 70 00:10:39.580 --> 00:10:43.600 how like other children these children are. 71 00:12:14.120 --> 00:12:22.040 They certainly are not healthy emotionally which is the reason for their hospitalization here. On the 72 00:12:22.040 --> 00:12:28.940 other hand we often have a high rate of success in modifying their behaviors as a result of 73 00:12:29.240 --> 00:12:38.720 dealing with their feelings whatever those might be. We have a range of ages with our children 74 00:12:38.720 --> 00:12:46.940 anywhere between usually five we have certainly had some younger and about 16. We divide the 75 00:12:46.940 --> 00:12:49.620 children into three groups so that they're with children their own ages. 76 00:13:23.300 --> 00:13:29.000 One of the most exciting aspects of the unit for me is the interaction 77 00:13:29.000 --> 00:13:37.400 amongst other staff. It is phenomenal to watch and to be a part of a group of people that 78 00:13:37.400 --> 00:13:45.820 interact so honestly and directly together. I've grown immensely since coming to the unit as I've 79 00:13:45.820 --> 00:13:56.620 seen many many many of my peers do and it's fascinating to watch the parallel process between 80 00:13:56.620 --> 00:14:05.520 the growth of staff as we treat children. Everyone comments that comes through the unit about the 81 00:14:05.520 --> 00:14:16.220 uniqueness of the interrelationship of not only million therapists nurses and children but also 82 00:14:16.220 --> 00:14:23.240 supervisory staff and I think it speaks directly to the investment that the staff have working 83 00:14:23.240 --> 00:14:31.880 together with each other as well as caring for the children. If you were to see any of our 84 00:14:31.880 --> 00:14:38.100 children on the street you wouldn't have any idea that they were hospitalized and on pass 85 00:14:38.100 --> 00:14:39.920 from an inpatient psychiatric unit.