Papers, papers, papers...

This past week has been very writing intensive. Social work classes have always been more paper heavy than exam focused, but besides finals week I usually don't have a lot due all at once. Last week though... First, I had a paper due on Sunday by noon. Technically I didn't have to turn it in until a couple of weeks later, but it's the first part of a two-part paper and if I wait to turn it in later then the entire thing is due at one time. If we turn the first part in early, our instructor said that she would give us feedback on it so we can make possible revisions. This paper was for my advanced policy class on family and child welfare policy. For the first part of the paper we have to pick a problem statement related to children or families and write a review on the literature. Basically, what is the problem, why is it a problem?, what social, environmental and biological factors influence the problem? The second part of the paper, due later in March, will be exploring two different programs/policies that address the problem and evaluating them.

The problem statement that I chose was on childhood obesity. With the rates having more or less tripled over the past 30 years and Michelle Obama starting her first big initiative on the issue, it's definitely something that I knew I'd be able to find a lot of research on. However, I wasn't thinking about the fact that many of the consequences of childhood obesity are health-related. So to review the literature on the medical consequences of childhood obesity, I had to read all kinds of articles from medical journals that took me quite a bit of time to get through, mostly because I had to look up a lot of words. I'm a social worker -- I have no idea what C-reactive protein is or what "biliary excretion of cholesterol" means! However, once I learned a lot of the most common conditions and terms, I was able to get through things much quicker, and also became a pro at reading abstracts, introductions and then skimming down to the results and discussion parts of research articles. Because I'm big on corroborating -- I'm not going to write that childhood obesity can cause precocious puberty unless I can cite more than one piece of literature -- I had to read a lot of what was basically the same thing over and over. However, now I feel a whole lot smarter. I wanted to tell my instructor that she's lucky she now has a very comprehensive overview of the consequences of childhood obesity that has been translated into understandable language! I also looked at the social and economic costs as well as the different possible causes or influences. It was quite the paper and I was up until 3:30 AM last Saturday finishing it. Haven't been up that late finishing a paper since undergrad.

I felt like I had barely finished that paper when it was time for me to write the next one. I had another paper due on Wednesday for my working with immigrants class. This paper was very similar to the other one, in that it was meant to be a lit review on a problem statement. Only this problem statement had to do with a problem in the delivery process of social services to one or more immigrants/refugee groups, and unlike the 10-15 pages that my last paper was, this only had to be 5-6 pages. I had gathered my research already, but hadn't read through any of it yet and hadn't started writing. Tuesdays are my days off, so I had planned to spend all day working on it. My initial plan was to write about the lack of cultural competency in completing mental health screenings with immigrants and refugees. I read a few articles Tuesday morning, went to the gym, ate lunch, then settled myself into my favorite neighborhood coffee shop.

I started to get increasingly frustrated with the lack of research and finally realized that my problem statement was much, much too broad. So I decided to narrow it down, but this meant that I had to do all new research. Since I already have quite a bit of knowledge on the Somali community thanks to my diversity project from last semester, I decided to make my problem statement on the under-identification of mental health needs among Somali children. I was surprisingly able to find quite a bit of research on Somali mental health, and many of the research articles actually focused on the Somali community in Minnesota. I found some fascinating articles, but unfortunately once the time came for me to go home and get ready to leave for tutoring, I had just finished reading and hadn't even begun writing.

I got home from tutoring around 7:20 and immediately got to work, finishing the paper at just about 11:30. In the paper I reviewed the history of the Somali community, explored the mental health concerns and cultural considerations relating to the population, and explained the need for more accurate mental health screenings of Somali youth. I think it turned out to be a very interesting paper, and I got to write about one of my main areas of interest, which is treatment of trauma and intergenerational trauma transmission. Perhaps I'll even post the paper on here, if people are interested.

So finally I got to have a break from papers, although then it was time for me to study for a quiz in my Friday mood disorders class. There's never a break in the life of a student! At least this semester, the papers that I'm writing actually make me feel as though I'm learning something. That always makes for a nice change!

My Weight-Loss Journey

For the most part I've kept my posts pretty much confined to issues of school and work, and nothing much from my personal life. Plus, it makes me a little uncomfortable to talk about losing weight. Mira and I were discussing this issue and how it feels weird when people talk about how good you look now, sort of indirectly saying that before you looked like a fat cow. I know that's not what most people mean, but it still feels a little uncomfortable. However, tonight I just ran 4 miles for the first time, and really feel like sharing my little story of the past several months. Although 4 miles may not seem like a whole lot, believe me, it's about 5x more than I could do when I was first starting!

My weight has really fluctuated a lot over the years. Between 8th and 9th grade I went from about 110 pounds to close to 130, something which I attributed to going on the pill. When I started college I was down to about 120 and feeling pretty good about my body. Over the next 5 years I really put on the weight. Due in part to poor eating habits and not being particularly active, among other things. At my lowest point (or I guess, highest) I hit 150. Then I moved to Minnesota and in a few months time I dropped about 10 pounds without even trying, just from having a more regular schedule, eating better and getting out more. I remember when I went to have my annual exam and the nurse read my weight -- 137 -- and I was shocked. I felt good, but I knew that I wasn't yet where I wanted to be.

For me it was never really about losing the weight, although being thinner is of course nice. It was more about feeling good and being healthy. I just didn't feel so good, my energy was low, I didn't have a good control over my diet, and I knew that I was terribly out of shape. I was eager to make a change, and Mira and I decided to join a fitness center last summer. The best part of this was that the gym is just around the corner from our house, which made it much easier to motivate myself to go. I started going a couple days a week. I was feeling good and enjoying that endorphin rush that I would get after a workout. Working for a week at Camp Sunrise and doing that canoe trip really inspired me to keep it up. For some reason the girls in my crew really saw me as this strong woman, and I thought, "Yes. That's what I want to be." It was slow going, but by Christmas I was down to 130 and felt amazing. I had more energy than I had ever had before, which is partly attributable to some other things, but I know a lot has to do with the exercise.

There was still something else though... I still knew that I needed to make some serious changes in my diet. It wasn't a problem of eating too much, it was more an issue of not eating the right things. Mira, who has slimmed down significantly over the past several months, had been using a website called SparkPeople.com and really liked it. So I decided to give it a try. SparkPeople is a free website that creates personalized fitness and "diet" programs and allows you to track goals and other things. Apparently it's super popular, although I had never heard of it until Mira started. I put "diet" in quotes because really the focus is on creating healthy eating patterns and a healthy lifestyle -- something that is sustainable. So when you first join you have to enter in information about yourself, height, weight, etc. including goal weight and when you want to reach it. It then generates you a nutrition and fitness plan. It does require you to restrict and count calories. You have to enter in all of the food that you eat each day, although their database has nearly everything in it already. So if I have a 1/2 cup of Preferida refried beans I just type that into the search and it pops up with all the nutritional info and I can add it to my meal plan. They also give you meal plans that you can follow.

Although it requires calorie restriction, I actually feel like I'm eating more than I ever have before. I eat five or six times a day to meet my goals. The goals that they automatically give you are for calories, carbohydrates, fat and protein and then you can add other nutrients to track as well. So for me, I am supposed to consume 1200-1550 calories, 163-236g carbs, 32-56g fat, and 60-127g protein. I also have slowly added other nutrients to track so that now my goals are also to consume 25-35g fiber, 0-250g cholesterol and 500-2300g sodium. You also track how many cups of water you drink each day with a goal of drinking 8. In terms of my fitness routine, I am supposed to do 160 minutes of cardio, burning 1000 calories. I'm also supposed to be doing strength training, but I haven't added that on yet. I'm a little intimidated by all of the weight machines to be honest!

I've been doing this for about two months now, and it has honestly changed the way that I eat and think about food. First of all, I have to pay attention the serving sizes and measure out what I eat. It's very interesting when you realize what the actual serving sizes of things are, and really helps with portion control. Tracking my nutrients was also a big wake up call for me as to what exactly it was that I was consuming each day. Restricting the calories wasn't that hard, but I realized that I was getting nowhere near enough protein or fiber in my diet. I've really had to work to up my protein intake, but now I'm typically consuming close to 90g of protein a day and meeting my goals for fiber almost every day as well. I pay attention to what's in things now, and am actually consuming milk again! I've never been a huge milk fan, but I make sure to have at least 8oz each day in my morning cereal. Archer Farms (Target Brand) Cinnamon Start with Protein is currently my breakfast of choice -- one serving (3/4C) has 15g of protein in it. So along with the milk, I get 24g at the start of the day. Finally, this really forces me to plan out my meals in advance. I've made a few batch items, including delicious Vegan Lentil Burgers (taste really yummy with cheese and avocado) and Spicy Chicken Peanut Soup. Typically I plan out my days meals at the beginning of the day.

The other thing that I really like about SparkPeople is that it has tons of really informative and helpful articles on health, nutrition, fitness and even motivation. As an example, some of the articles that I've saved are "How to Meet My Protein Needs Without Meat", "Easy Ways to Boost Fiber Intake", "Daily Stretching Routine", and "De-Stress in 3 Minutes or Less." The other thing is that you can create your own goals to track besides just the fitness and nutrition. So I've added in getting 8 hours of sleep, journal 5 minutes per day and 10 minutes of deep breathing before bed.

It's not just a healthy lifestyle that I've been developing here, there have also been results! It's been slow going, with just about a pound lost each week but as of this past Tuesday I was down to 122! I've also lost inches everywhere. They have you weigh yourself just once a week (my day is Tuesday) and measure yourself once a month. The goal weight that I made was 115, but honestly I would be happy right here as well. I feel fantastic, I'm eating great, and those chocolate and junk food cravings have miraculously gone away! I still get them now and again, but there's always a little room for "splurging." I really enjoy the Sugar-free Jell-o pudding packs because they have only 60 calories and 2g of fat while still allowing the occasional chocolate indulgence! Also good are the Skinny Cow ice cream products. The ice cream sandwiches are delicious and have 140 calories, 2g of fat and 4g of protein.

So all in all I'm very satisfied with how things have been going. Obviously it's not something that I plan to do forever -- tracking my calories and nutrients. The goal is to eventually be able to develop eating habits that are naturally going to keep me in good ranges. I will also definitely be maintaining the work-out routine because I really enjoy it, and hopefully I will add strength training eventually :) It's amazing to me how much I've progressed since I started last summer. When I first started I would use the elliptical trainer and go for about 25-30 minutes at about 4.5 mph with no incline and would be exhausted by the end. Now I do it in the hill mode for 35 minutes and am going 8+ mph. I've also added on the treadmill, which at first I was intimidated by. I could only do about 10 minutes at 5mph and I would be ready to collapse. Tonight I did it for 45 min (with 5 min cool down), ran 4 miles and probably could have kept right on running! Mira's really gotten into the running since the summer and ran a 5K over Thanksgiving and is now planning to do a half marathon this summer. I'm definitely not ready for something like that, but I just might consider doing a 5K sometime! I can tell that my legs have gotten so much stronger and I actually can see muscles when I flex! The only downside to all of this has been that most of my clothes are too big, even stuff that I bought in the late fall/early winter is loose. I can't really afford to get a new wardrobe, and I'm not looking forward to when summer comes, when pretty much nothing that I own will fit. I'm going to have to hit up the thrift stores big time! Oh and this might be oversharing, but I also had to get all new bras because I've gone down an entire cup size :(

Well, I realize that this was incredibly long. So thanks for reading if you made it all the way through. I promise that I haven't become some kind of crazed nutrition or exercise nut. I'm just really happy and proud of myself and wanted to share, especially since I've gotten so many questions and comments regarding my weight loss. Love to you all XOXOXO

Amy, August 2009

Amy, February 2010

Okay, they're not super obvious, but you can sort of see some muscle there!

Attachment Theory

I know that I said such a long time ago that I would put something in here about attachment theory, so I'm finally doing it. Attachment theory is really at the foundation of child development and many models of intervention for childhood mental health problems. The following is part of a literature review that I did for one of my final papers last semester. It details a lot of the key elements of attachment. If you have a desire to learn more ... let me know! I'd be happy to ramble on about this stuff forever :)

Attachment is a foundational experience for children. Cairns (2002) refers to it as “formative” because it provides the models upon which children will base their views of self and others; attachment also shares an important function in the development of the young brain. What is attachment? Essentially, attachment describes the responsive relationship between an infant and its caregiver. It involves the appropriate and attuned responses of a caregiver to an infant’s needs; it provides the infant with a sense of security and competence. Through the caregiver, the infant learns how to regulate emotions. Later, a secure attachment will result in the confidence to explore the world and learn and grow. (Cairns, 2002).

Insecure attachment, therefore, results from caregiver behavior that is not supportive to the infant. The parent is unable to provide appropriate soothing, or does not interact with the child in a way that is interactive or attuned to his or her needs (Lieberman, 2004; Hipwell, et al, 2000). Parents who form insecure attachments with their children often have insecure adult style of attachment. Many parents of insecurely attached children are suffering from their own unresolved traumas (Cairns 2000; Liotti, 2004; Lyons-Ruth, Bronfman, & Parsons, 1999; Scheungel, Bakermans-Kranenburg, & Ijzendoorn, 1999). Insecurely attached children have been classified into three different subtypes: avoidant, anxious/ambivalent, and disorganized. The disorganized attachment style is most often linked to “fright without solution”, or the experience of the infant feeling scared or frightened by a caregiver’s behavior while at the same time feeling the desire for comfort and protection from the same person who is frightening them (Lieberman, 2004; Liotti, 2004; Lyons-Ruth, Bronfman, & Parsons, 1999; van der Kolk, 2005). Lyons-Ruth, et al (1999) also discuss the idea of “failure of repair.” Under this hypothesis, disorganized attachment results after neither anxious or avoidant attachment styles work to change parental responses. The child is left not knowing what to do. The authors’ other hypothesis is one of “competing strategies” in which parents might use conflicting parental attachment styles with their children – sometimes yelling, sometimes soothing, without any pattern.

Disorganized children frequently come from environments with high risk factors. Their parents are more likely to suffer from psychopathology or substance abuse (Lyons-Ruth, Bronfman, & Parsons, 1999). Impeded by their mental illness or chemical use, these parents are less able to interact with their children in ways that are meaningful or reciprocal (Hipwell, et al, 2000). The results for the children are often very devastating. Secure attachment has been found to be an important component of healthy brain development, while disorganized attachment hinders the development of important neural pathways, most notably in the right hemisphere of the brain (Cairns, 2000; Hinshaw-Fuselier, Boris, & Zeanah, 1999; Liotti, 2004; Schore, 2001).

It has been found that caregiver-induced trauma, otherwise known as “relational trauma”, alters the healthy development of socio-emotional functioning. Schore (2001) explains, “Early traumatic events that induce atypical patterns of neural activity interfere with the organization of cortical-limbic areas and compromise brain-mediated functions such as attachment, empathy and affect regulation” (p. 220). The stress connected to relational trauma alters the development of these areas of the brain, which has significant consequences. For example, the prefrontal cortex is unable to reach its full adult capacity (Cairns, 2002); this is the part of the brain where executive functioning, such as planning, impulse control, abstract thought, etc. occurs. The amygdala can also be affected, which causes changes in the formation of social bonds and regulation of emotions; Schore (2001) notes that these changes have even appeared to increase in magnitude over time.

A child affected by disorganized attachment and its resulting neurobiological challenges will have many different presenting issues. They will often respond inappropriately to stress because they have no good strategies for handling stress; they will use aggression, hyperactivity, dissociation, or other techniques as a way to deal with stressful situations (Cairns, 2002; Hinshaw-Fusellier, Boris, & Zeanah, 1999; van Der Kolk, 2005). They have difficulty developing trust, since the inner working model that they have developed is one in which they anticipate trauma; they often have a sense of shame, and have a difficult time distinguishing other feelings from those of shame (Cairns, 2002; van der Kolk, 2005). Disorganized children are often controlling, often with a great deal of anxiety; new experiences are frequently seen as threatening (Cairns, 2002; Liotti, 2004; van der Kolk, 2005). Most significantly perhaps, disorganized children have difficulty relating to others socially because of their lack of trust, empathy, and unmodulated affect (Cairns, 2002; Van der Kolk, 2005).

Unless disorganized children are able to receive intensive interventions that can change their inner working models and allow them to form secure attachments, the outlooks are grim. Disorganized children are at great risk for developing psychopathologies later in life, especially dissociative disorders or personality disorders such as Borderline Personality Disorder (Liotti, 2004).

References

Cairns, K. (2002). Attachment, trauma, and resilience: therapeutic caring for children. London, UK: British Association for Adoption and Fostering.

Hinshaw-Fuselier, S., Boris, N., & Zeanah, C.H. (1999). Reactive attachment disorder in maltreated twins. Infant Mental Health Journal, 20(1), 42-59.

Hipwell, A.E., Gossens, F.A., Melhuish, E.C., & Kumar, R. (2000). Severe maternal psychopathology and infant-mother attachment. Development and Psychopathology, 12, 157-175.

Lieberman, A.F. (2004). Traumatic stress and quality of attachment: reality and internalization in disorders of infant mental health. Infant Mental Health Journal, 25(4), 336-351.

Liotti, G., (2004). Trauma, dissociation, and disorganized attachment: three strands of a single braid. Psychotherapy: Theory, Research, Practice, Training, 41(4), 472-486.

Lyons-Ruth, K., Bronfman, E., & Parsons, E. (1999). Maternal frightened, frightening or atypical behavior and disorganized infant attachment patterns. Monographs of the Society for Research in Child Development, 64(3), 67-96.

Schuengel, C., Bakermans-Kranenburg, M.J., & Van Ijzendoorn, M.H. (1999). Frightening maternal behavior linking unresolved loss and disorganized attachment. Journal of Consulting and Clinical Psychology, 67(1), 54-63.

Schore, A.N. (2001) The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22(1-2), 201-269.

van der Kolk, B.A. (2005). Developmental trauma disorder: towards a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35(5), 401-408.

Semester Two at Wellstone

It already feels as though I've been at Wellstone forever, even though it's only been about five months. I started back up on January 4th, the day that the St. Paul Public Schools got back into session. This past month I feel like I've really gotten a flow going, and have found where and how I fit in. I also was finally able to finish my own schedule, so that more or less every part of my day is loosely structured. Granted, working in a school requires flexibility and there are always changes in the schedule, but it's nice to have something to work off of on those days when things are slow and there aren't any crises.

I'm down to only two days a week now, since I now have a class on Friday right in the middle of the day. There was never much going on on Friday anyway, just supervision and 6th grade girls group. Nevertheless, I was disappointed to have to say good-bye to that group. I had enjoyed working with those girls, but at least I'll still see them around all of the time. So here's a sample of my schedule so you can get a feel for what I do during the day. This is my Wednesday schedule:

9-9:30 Individual work with 6th grade girl, working on building relationship skills, independent living skills, etc.

9:30-10:00 1st grade classroom -- Spending time working with some of the kids who have IEPs

10:00-11:30 Dog therapy program -- Our darling dogs, Maybelle and Dusty arrive with their owner Michelle and I run the schedule, going to get the kids from their classrooms to go read with the dogs. I have small 15 minute breaks between getting kids during which I check in on various students, write e-mails, finish up any last minute group lesson plans.

11:30-12:00 1st grade group -- This is a brand new group that is being run all by me! Miss Amy's Friendship Group is composed of three 1st graders (2 girls and a boy). We're working on basic social skills and things like feelings vocabulary, sharing, manners, respect. Last week we practiced safe ways of "getting your angries out." They are so much fun!

12:00-12:15 Usually eat lunch really quickly, but if I don't have time, I eat later.

12:15-12:45 5th grade boys group -- This is the same group that Julianne and I have been working with all year. It's a great group of 5 boys with varying levels of cognitive and social skills. I love working with this group. Right now we've been focusing a lot on impulse control and not interrupting.

12:45-1:40 This is a time when I can eat lunch if I haven't already and kind of go wherever I might be needed.

1:40-2:30 Individual work with 6th grade boy. I'm working with him both in the classroom and outside of the classroom. We're working on writing and reading and also some math.

2:30-3:15 Individual work with 1st grade boy. This is the boy that I wrote about once before (I think I referred to him as "Ian"). He's a kiddo with ADHD and some impulse control. He's also one of the few African American students in the dual immersion program. I'm giving him classroom support to provide on-the-spot help with his focus and impulse control. He's such a sweet boy. It's always fun to go into that class.

3:15-4:00 This is all dismissal time. I usually go down to one of the kindergarten classrooms and help them finish up snack and get their things together. Then I go with them for the first round of buses, come back to the classroom and read with them, then go with them for second round as well. These kindergartners are some of the most darling, entertaining kids in the world. I love ending my day with them!

So now you see some of what goes into my day at Wellstone. As you can see, I'm doing a lot more individual work this semester, including working with my very own group. Mondays I work with a couple of the same kids plus some others (a 2nd grade girl and boy, a 5th grade boy, a kindergarten group, and a group composed of a 4th,5th, and 6th grader.) I'm enjoying my new responsibilities, and am loving the chance to get to know so many of the students.

Second Semester Commences

First off, so sorry for the recent lack of entries. I didn't feel much a reason to update over winter break though, since I was home for most of it and not doing much exciting. Plus I got to see most of you during that time anyway!

Now that second semester is in full swing, I thought it was time to update. This is going to be fairly brief, as I'm getting ready to head to bed soon (yes, it's 9:00... I had a long day!) But hopefully I'll update again in the next couple of days.

I'm taking four classes again this semester, plus my field seminar. Field seminar, however, is a joke because we only meet every other week for 45 minutes. We're supposed to discuss what's going on in our field placements, etc., but that amount of time gives us little opportunity to get much accomplished. When I was completing my BSW at UW-Madison, our field seminars met every single week for 2 hours, and we were really able to process and expand upon what we were learning in our field placements. I was pretty annoyed when I discovered how it works here at the U. It ends up just feeling like a waste of time.

However, my four "real" classes are all going quite well. I'm much more satisfied than I was last semester, which is great. My first class of the week is on Wednesday evenings from 5:00-7:00. That class is called "Working with Immigrant Populations." The thing that I really enjoy about this class so far is that almost every week we have a guest speaker for the first half of class. Last week it was a man that worked with refugees at a resettlement agency. He talked all about the resettlement process and what refugees have to go through prior to and after coming to the U.S. I feel like in a place such as the Twin Cities, home to so many immigrant and refugee populations, a class like this is necessary for any social worker.

Thursday I have class from 8:30-11:30 and 1:55-4:55. The first class of the day is "Interventions with Families." That class is basically about teaching us how to do family therapy, which is quite useful. We'll be learning various different models of family therapy and then practicing them intensively in role play situations. I really like the instructor, Judy Hoy. She's a community faculty member and has her own practice. She's been doing family therapy for years and years, and just has a wealth of stories to share.

The second class of the day is my policy class, which was a requirement. There were a couple of policy classes to choose from (health & mental health policy, global policy, etc.), and I chose family and child welfare policy. I chose this first of all because my focus is in the area of children and families, and also because Mira took the class last year with the same instructor and highly recommended it. The instructor, Tammy Kincaid, worked for years and years in the area of child welfare and is now the director of human services in Pierce County, Wisconsin (just across the border). She's extremely knowledgeable about policy.

My last class of the week is on Fridays from 11:45-1:40 and is entitled "Mood Disorders: New Directions in Clinical Care." It obviously focuses on mood disorders, including depression and bipolar disorder. I thought it would be a very valuable class to take since so many people suffer from mood disorders, and since bipolar disorder is "the ADHD of the new millennium", with ridiculous numbers of very young children being given the diagnosis and being put on dangerous atypical antipsychotic medications that have not been tested in children. The class will be looking at models of assessment and intervention for clients with mood disorders. We'll be learning about cognitive-behavioral therapy, family therapy and pharmacological treatments. We'll also learn about cultural, class, race, gender, age differences in treating and identifying mood disorders. Again, I really like the instructor for the course, Mark Meier. He's another community faculty. He's a licensed clinical social worker as well as the CEO of Creative Workplace Solutions, a consulting firm dedicated to raising awareness about depression.

So that's a quick summary of my course load for the semester. In the very near future (I would say tomorrow, but I don't want to make any promises) I will update with some info about what I'm doing at Wellstone for the second half of the year.

Love to all!