You If you were to see any of our children on the street you wouldn't have any idea that they were hospitalized and on pass from an inpatient psychiatric unit.
They're often very cute and engaging.
They're often very much like any other child in their appearance.
I came to the unit from an area of nursing called neonatology which is the care of high risk infants from birth to either five pounds or one month whichever comes first a very intense kind of setting.
A setting in which there were many deaths per week, many intense kinds of critical situations and always had an interest in supporting not only the staff but also the families very much of these children.
In the back of my mind I always knew that I wanted to work within the field of psych.
I never knew exactly how that would pan out, how that would work out but very much have found that it was a real treat to come upon this inpatient unit.
I love working in the inpatient unit.
It's a most unique place.
I've always thought that I was to happen upon it.
It's a fascinating unit in that people really, the staff interact very honestly and caringly with one another.
People ask how we take care of emotionally disturbed children and it's really very simple.
There are a few basic principles that one operates under.
One of which is that honesty is primary and that we work with the children in a very basic day -to -day way using examples of daily care or self -help skills to begin with.
What we often do is, what we always do actually, is to make a point of working with the children from the beginning of an interaction all the way through if that takes two minutes or if that takes ten such that there's an understanding of where the breakdown in communication has taken place.
It's very important to have the patience to do that kind of thing.
We use a lot of behavior modification techniques.
We constantly are aware of poor self -esteem within the children and constantly aware of our need to reinforce their feeling good about themselves.
All of the children coming into the unit have very poor self -images such that they've probably never really ever felt as though they were a good child, good person.
Frequently being told because of their behaviors that they're bad, constantly being punished and new ideas or methods being tried by parents who are very desperate to change behaviors.
And by the time they've arrived at our inpatient unit, which is a locked ward, they feel very bad about themselves.
They feel responsible for their own hospitalization as well as their parents' unhappiness and feel bad.
We constantly are aware of that using a lot of different ways amongst staff to remind each other of the child's need to feel good.
And we very much give what we call strokes, sentences regarding children's good behavior, sentences regarding a very nice attractive smile, really very much making an effort to point out to a child whatever positive attributes he or she has and ignoring a lot of negative behaviors if that's possible.
As the unit is an inpatient unit in the hospital, one of the things that we do is we staff such that there are always adults with the children.
It's not like some long -term care residential centers whereby there's much independence allowed the children.
As a child initially comes into the unit, one staff needs to be with them at all times unless they're very close to the nurse's station and in direct observation of staff.
And as the child's behavior progresses and treatment continues, he or she then becomes less in contact with an adult but still in very close proximity.
There is a very intense working with the child.
We have eight -hour shifts and the same adults are with the children for eight hours at a time and constantly able to see how they interact with children, adults, their families and really work with in an intense way very minute interactions to very complex and very difficult physical tantrums such that we have a great range of behaviors to deal with.
What we do is after each interaction that we target with a child, we do a period of talk with the child called processing whereby we ask the child what kind of feeling precipitated his acting in this way.
What happened to make him so, whatever the feeling word might be, angry? And always make a point of including a feeling, tone to the conversation after we've identified exactly what it is that's happened within the interaction.
The processing can be very brief.
It can also be quite long and can be either individual or group.
With older children we often have group processings whereby children can say to their peers and vice versa what their behavior did for the group in terms of its feel or it can be an interaction in the hall.
It's not common in families to have any kind of processing.
It's a very unusual kind of experience as the child initially comes into the unit unless of course they've been seen in outpatient therapy at which time of course the child would be very in touch with what processing is and how he or she needs to connect behavior and feelings.
Often children that arrive into our unit have not been in outpatient therapy and so we very very slowly begin to work with them around what we call processing.
We very slowly begin to point out to them that there is reason for their behaviors and that those reasons aren't bad or good but simply connected to their behavior and it's important for us as staff to help those people.
People often ask me what kind of children we have on the unit.
It's in one way a simple one.
They are children who have had extreme problems with behavior.
That behavior may be fire setting, may be tantrums of such an extreme nature that teachers in the classroom can't control them, parents at home can't control them.
We have some children on our unit that have what's called anorexia nervosa such that they use food as a way to cope with feelings and so they don't take in food which drives parents crazy.
We have other children who at the very early age of five and six won't listen to any limits at all from parents often tied very much to environment, often tied very much to inconsistency.
We have increasingly in the last couple of years had more disturbed children, children that we call psychotic which means out of touch with reality at either periods of time or continuously.
On the whole however as I work with the children I'm very much struck by how like other children these children are.
They certainly are not healthy emotionally which is the reason for their hospitalization here.
On the other hand we often have a high rate of success in modifying their behaviors as a result of dealing with their feelings whatever those might be.
We have a range of ages with our children anywhere between usually five we have certainly had some younger and about 16.
We divide the children into three groups so that they're with children their own ages.
One of the most exciting aspects of the unit for me is the interaction amongst other staff.
It is phenomenal to watch and to be a part of a group of people that interact so honestly and directly together.
I've grown immensely since coming to the unit as I've seen many many many of my peers do and it's fascinating to watch the parallel process between the growth of staff as we treat children.
Everyone comments that comes through the unit about the uniqueness of the interrelationship of not only million therapists nurses and children but also supervisory staff and I think it speaks directly to the investment that the staff have working together with each other as well as caring for the children.
If you were to see any of our children on the street you wouldn't have any idea that they were hospitalized and on pass from an inpatient psychiatric unit.
