Transcript Title Layout - Black Hawk College

Providing Integrated Care
for Individuals on the
Spectrum & Caregivers
What Works and What
Doesn’t?
A. Charate , MA, LCPC,
CDAC, BCIA Board
Certified
C. McCarthy, MA, LPC
A. Sarup, BA
 Background Information
 Integrative Care Series
Overview
1. Working together as a Team with Caregivers
2. Personalized Individual Therapy & Neurofeedback
3. Working with Schools, Social Workers, and others
 FASD is associated with life-long cognitive and
behavioral impairments
 Primary behaviors are misunderstood
 Inappropriate interventions or punishments are
used
What is Known
 Individuals are left frustrated and discouraged
 Secondary behaviors are pervasive in
adolescence through adulthood
 Develop maladaptive behaviors to cope with a
sense of rejection, failures, loneliness, and lack
of meaningful relationships
 Identify caregivers and providers knowledge on
FASD
 Provide needed education
 How FASD affects that particular individual
Experience at
the Center
 Pre and post treatment Quantitative EEG
(QEEG) analysis
 Connecting abnormal brainwave patterns and
associated behaviors
 QEEG Guided Neurofeedback trainings
 Individual therapy & consultation to parents
 Skills coaching, social skills groups
 Rely on research and what we know
 Brain damage is the most serious aspect of
FASD and presents the greatest challenges to
learning and functioning in school
Patience and
Skill Based
Approach
 Effects:
 Cognition
 Behavior
 Social Skills
* The damage is permanent but it can be
accommodated, but not cured.
Working together as a
Team with Caregivers
The first step into truly integrated care
 Identify where they are in the process of treatment
and their knowledge of FASD
 Corroboratively create a treatment plan to ensure
mutual understanding and an obtainable goal
Caregivers
Initial
Consultation
 Problems experienced from an individual and family
system perspective
 Their support systems and
Caregiver
other strengths
 Their motivation for change
Therapist
 Some parents are willing
to partner, some just rely
on us for treatment
Client
 Validation, identify the issues,
answer concerns, provide explanation,
instill hope
Gears of the Vital Relationship to Impart Change
 Observation of stress management
 How does couple function?
Self-Care for
Parents
 Date night, preferably sans talking about the
child(ren)
 Establish a daily 30 minute routine for self
 Find ways to decompress and relax just like
counselors.
 Case Example: Lou
Personalized Individual
Therapy &
Neurofeedback
The second crucial approach of integrative care.
 Person-centered
Individualized
Treatment
 Provide treatment that is applicable to the
client’s functionality
 Provide one on one treatment
 Develop rapport to facilitate openness and
change
 Assess willingness to change and insight
 Teach them what to do rather than what not to
do
Clients’ Difficulties
Strategies for
working with
clients with
FASD
1. Visual or hearing
impairments
2. Impulsive decisions
and statements.
3. Difficulty with
Abstract Concepts
4. Memory Deficits
5. Attentional Issues
6. Difficulty with
Transitions
Counter Difficulties
1. Use Visual Cues
2.
Role Play
 Clients often need to
practice situations with
counselors repeatedly
3.
Create attainable goals
4.
Model appropriate
behavior
 Teach how to get
someone’s attention in an
appropriate way
 Reinforce desired behavior
 1980’s: Marsha M. Linehan for adults with Borderline Personality
Disorder symptoms:
Individual
TherapyDialectic
Behavioral
Therapy
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Unstable self-image
Unstable relationships
Unstable emotions
Inappropriate, intense anger or difficulty managing their anger when
it occurs
 Significant impulsivity
 act before thinking
 Symptoms for BPD and FASD overlap
 DBT aims to teach the children coping skills which directly targets these
symptoms
 Therapist will help clients identify triggers to emotions, label and
rate her emotions, and teach strategies such as:
 Mindfulness
 Asking for help appropriately
 Recording emotions daily
 Emotional regulation
 Acceptance and Commitment Therapy:
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Individual
Therapy- ACT
Accept thoughts (don’t fight them)
Learn skills to cope with thoughts
Allow them to come and pass
Staying within the present moment, i.e. mindfullness.
 The opposite of mindlessness.
 Mindless lives involve constantly thinking about the past,
schedules, plans, work, etc. without taking time to be in
the present moment.
 Focus on becoming aware of all incoming thoughts and
feelings and accepting them, but not attaching or
reacting to them
 Mindfullness allows our clients to more aptly deal with
current stressors and distressing feelings with a flexible
and accepting mindset
 Most individuals, will experience their thoughts
as facts.
Cognitive
Defusion
 Therapist can help “defuse” these thoughts
into much broader statements.
 Separating themselves from facts
I am anxious!
I am having a
feeling…
I have noticed
that I am having
a feeling
 Pre treatment and post treatment Quantitative EEG Analysis
(QEEG)
Assessments
 Pre and post treatment CNS Vital Signs testing
measures core neurocognitive brain. Attention, memory,
executive control, processing speed, cognitive flexibility, social
anxiety, reasoning, working memory and more… (computerized
tests)
 Human brain is plastic
 It can change and adapt under the correct circumstances
 If the brain experiences trauma to one location, then other location takes
over it’s specific function
 It requires some cognitive efforts and trainings in order to make
the needed changes
Neuroplasticity
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Mental & emotional states
Sensory informational processing
Memory formation and retrieval
Cognitive and decision-making processes
Communications from all of the above
THE BRAIN CAN BE STRENGTHENED AND CHANGED, IF IT IS
CHALLENGED
 Pre-treatment helps us develop protocols based on the presenting
symptoms and brain-mapping results
 A QEEG offers comparative norms for clients based on age,
gender, handedness
Pre-Treatment
Q-EEG
 Completely non-invasive treatment
 Measures brain waves which produce a signal that can be used as
feedback on brain activity to teach self-regulation
 Typical treatment includes 30 minutes neurofeedback followed by
30 minute parent consultation and behavioral modification
through psychotherapy
 Skills coaching using DBT/ACT therapy skills
 Social Skills groups/ Project Good Buddies
 Parent support groups
 Charting progress every 10-15 sessions
Normal QEEG
https://www.google.com/search?q=Normal+QEEG
18 months
Post
Treatment
Follow Up
Three Years
Post Treatment
Follow Up
 The EEG helps people objectify the symptoms in a world where
symptoms are often reported in the subjective
 Helps explain the child’s behavior is somewhat out of their control at
the moment.
Instilling Hope
 Tangible evidence that you can see and helps family understand
that the client IS trying but their brain is not functioning optimally
 For the child or the young adult, it’s much more understandable as
to why they are struggling in school and they have more
willingness to come for treatment
 Neurofeedback helps regulate overstressed or underactive brains and is
helpful with issues of focus and attention, behavioral issues, sleep
concerns, headaches, and emotional issues
 The essence of neurofeedback / eeg biofeedback is that when a
monitor displays your brainwave activity, you can quickly learn to
change that.
 Audiovisual feedback system based on the principle of Operant
Conditioning
Neurofeedback
 Crucial that clients come regularly and twice a week
 Begin to see results at 20-30 session mark
 Re-assess and possibly change location
 During and Post Treatment QEEG
 Other conditions that can benifit from
neurofeedback include: ADD / ADHD, Anxiety,
Insomnia, Headaches Migraines, Chronic Pain,
OCD, Anger, Conduct Disorders, Learning
Disorders, Sensory Processing Disorders,
Neurodevelopmental conditions, and ASD
Would
Medications
Interfere with
Training?
 Based on a survey with over 150 clinicians, it was widely
reported that more than half their neurofeedback
clients started neurofeedback while taking one or more
medications.
 Neurofeedback is complimentary to many treatment
approaches and tends to act synegistically to
medications.
 May improve the response or stabilize the effects.
 The theory about reducing dosages is that as the brain
becomes more activated during training, it works more
efficiently. The same dosage seems to have a stronger
effect on a more efficient brain, and thus reduction
may be required.
 Low Energy Neurofeedback Stimulation (LENS)
Other
Neurotherapies
 Uses feedback directly from the skin of the scalp and requires no
visual or conscious feedback
 The result is a changed brainwave state, and much greater ability for
the brain to regulate itself
 It addresses the underlying neuropsychological functions as a
rehabilitation tool increasing the self-regulatory capabilities of the
brain
 Disrupts the dysfunctional patterns and letting the brain re-establish
the connections.
 Coherence Training
 Measures how well-coordinated the communication is between one
area of the brain to the other
 If two areas are communicating too little or too much, it can
interfere with the efficiency of the brain
 QEEG brain map is a tool that helps assess coherence
Abnormal
Asymmetry &
Coherence
Training
Results
Working with Schools,
Social Workers, and
others
The Final Step of fully integrative care
Indiscriminate
Lack of
Knowledge
throughout
Multiple
Systems
 Secondary behaviors place an immense
emotional, financial, and social burden on
individuals and their caregivers
 Need for constant vigilance to manage their
cognitive and behavioral challenges
 Extremely limited support from providers,
community members, and extended family
 Delayed diagnosis
 Difficulty in qualifying for services
 Limited availability for required services
Barriers at the
Systems Level
 Difficulty in maintaining services and supports
 Lack of knowledgeable professionals
 An inadequate amount of effective services
 A shortage of providers who accept Medicaid
 Ability to care for self, interact in a social world and
function in the community
Fetal Alcohol Spectrum Disorder
Adaptive
Behaviors
 Demonstrate lower level of adaptive behavior
relative to their intellectual functioning
 Significant executive functioning deficit
 Plan, organize and shift attention in a goal directed
way
 Adolescents and young adults are required to
inhibit impulses, plan goal directed activities in
increasingly complex and social situations
 Gap widens between peers
What is
needed?
1. Access to disability services based on level of
disability functioning rather than IQ
2. A quality neuropsych assessment to help
develop learning and behavioral plans
3. Additional educational support to enable
these children to stay in the school
environment
4. An FASD expert in every school district,
judicial system and employment services
that will act as advocate
5. Assistance in planning leisure and
unstructured times
What doesn't work?
What works vs.
What doesn't
What does?
Tell them what
not to do
Speaking slow
and using
visualizations
Teach them
what they
should do.
Punishment
Lecturing in the
moment .
Cool Down
Breaks before
lessons
Repeat,
repeat, repeat
Expecting
immediate
learning
Giving up too
quick
Reward
appropriate
behavior
Understand
they are trying
Using analogies
and complex
instructions
Complex
instructions
Clear concise
instructions
Common Issues for Teachers
to Understand
How Students with FASD
Learn Best
 Lower than average IQ
 Difficulty with planning and organizing
 Concrete hands on learning
 Short term memory problems
 Good expressive language
skill but difficulty
understanding what others
say
 Context-specific learning and difficulty
accessing information on demand
 Poor grasp of abstract concepts
In the Schools
 Developmental delays in language,
motor, and social skills
 Teach how to ask for help
 Difficulty reading social cues for
appropriate behavior
 How to appropriately handle
frustration and
disappointment
 Poor sensory integration
 Teach self talk
 Math deficits causing difficulties in
 Limit transitions
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Counting money
Making change
Maintaining budgets and
Reading analog clocks
The
Neurofeedback,
Counseling, and
FASD Institute
of Illinois.
24W500 Maple Ave.
Naperville, IL 60540
PH: (630) 548-4501