Orientation/ 6/17

Before starting my practicum experience at Jones Memorial Health Center, I was required to attend a new employee orientation session. Jones is a separate campus from the hospital, and so the orientation was a general one in which I was acquainted with the whole facility

There were a number of issues that we larned about. Some of the things discussed included infection control, patient bill of rights, HIPAA, basic patient management, and domestic violence. We were also given a lifting demonstration, and learned about security and safety in the hospital. After this all day session and the necessary paper work was completed, I was ready to begin.

My first day was a fairly easy day in which I was just getting familiarized with the office setting. When I first arrived I was given a tour of the department including the chemical dependency wing, and the adolescent inpatient unit. After that, I met the other counselors and secretaries that I would be working closeley with, and was issued a set of keys because all doors must be locked behind us at all times. One of the things I was told I would be doing were scoring any testing that patients have taken so their results would be ready for their diagnostic interview appointment. The first two I learned how to score were the Child Development Interview (CDI) and the Child Behavior Checklist (CBCL). After learning to score these two assessments I then did one of each for three different patients who would be coming in that afternoon.

After I completed the scoring, I was taken to sit in on a couple intake interviews for two new admissions. In this interview, basic information about the patient is obtained, neccessary consents are signed, and any assessments and history that their counselor or psychologist wanted done were explained and given. After the paperwork is completed the new patient meets with his or her counselor or doctor and the first session is scheduled. The first one I sat in on was with a 28 year old male who claimed he was in because he was depressed. He was given a personality inventory to fill out for us. The second was for an 8 year old boy in with his mother. The two were separated for the interview so each were free from the opinion of the other. The boy was given a development survey and a personality inventory to fill out. He had difficulty with reading comprehension so I remained in the room to assist him while the counsleor left to start his mother on all her consents, and surveys about her child. I read the questions out loud to him as well as the answers he had to choose from. Sometimes I had to repeat them 2 or 3 times for him as well as explain the meaning of some of the questions. After we got through it, we got to go to the child center to play video games while waiting for his mother to be done. He was very excited about this, which was the first emotion he seemed to show the whole time. After the two had left, I was told that soon, intake interviews would be something that I would be conducting on my own while I am there.

6/19

When I arrived for my second day the head psychologist was waiting for me. He took me up to the Psychology Mental Health Clinic and explained to me what goes on there. The psychology department is separate from the psychiatry and clinic area, but there is a close working relationship between the two. As I watched him update the charts for three new patients that I will get to meet soon, he caught me up on their histories, how they've been treated so far, and what their next sessions will hold for them. The first was a patient with reactive attachment disorder which brough on a project idea from Dr. V. for me to get started on. Since the patient was a child, he asked me to put together a video library composed of children's movies with a theme centered upon attachment and/or anxiety. This new video library would be used as part of therapy for some of the children with those types of problems. By the end of the day that I had come up with two to start: Angels in the Outfield and Matilda. The two other patients that I learned of in the clinic were both adolescent boys who were severly autistic, one being preoccupied with photography, specifically pictures of the cows on his family's dairy farm, and the other preoccupied with the Wii video game system. The boy who likes the Wii is also echolalic and repeats what yous ay back to him. I was also told that he mimics gestures as well which I have come to understand is rare.

After being shown around the clinic and familiarizing myself with how it works up there as well as catching up on some clients I would be meeting, I was taken to sit in on an intake interview for an adolescent inpatient who was new. I administered a fire setting/gang risk/technology use screening evaluation, which is given as a standard to all adolescent inpatients. This is when I learned that Dr. V. specializes in arson and trauma, and surprisingly that my homewtown area has a gang problem. After completing the interview, I was taught how to score the Connor's Parent Rating scale, the Woodcock Johnson, and the Vanderbilt teacher behavior evaluation. I'm finding that many of thse assessment instruments are familiar from Assessment class. I am getting opportunities to apply some of what I learned in class to this part of my practicum.

6/22

Today one of the first things I did was sit in on a supervision meeting with one of the other counselors and Dr. V. In these meetings reports are gone over about patients. Things that need to be added are put in, any questions that need to be cleared up are cleared up, and any progress with the patient is recognized. The particular counselor today deals with a lot of ADHD kids. The patient that we were going over was a hispanic boy and some of his history was missing from his report. We needed to find out about what his primary language was and how his school was handling that in case his problems were due to a language barrier instead of true ADHD. An interesting piece of information that I learned during this was that if any language at all other than english is spoken in the home even a little bit, the kids are considered as English as a second language in the school. This child was also given a CPT-test and the printed scores were included in his file. Dr. V. decided that although the test results are automatically printed, he did not like the fact that he didn't know how the child acted during the actual exam and so any extraneous variables can not be taken into consideration by simply looking at the printed test results.

Before Dr. V. set em to work on fixing that problem, I first had to be familiarized with the CPT test itself. First I was given a script to read the instructions to the test taker. I practiced administering teh test to the other intern. Then I took both versions of teh test myself jsut to see what it was like. The kids' one is 7 minutes long and the one for agest 6+ is about 15 minutes long. Letters flash and disappear on the screen at different time intervals and the task is to click the mouse every time a letter appears with the exception of the letter X. Both testes, even the shorter one, turned out to be extremely boring, which is the point given that it's testing for attentivity. Even so, it is easy to see hwo anyone could become off task and it then made sense to me as to why the doctor wanted to know what else went on during the test session.

The solution I came up with was to create a time sampling sheet which broke the test down into 30 second intervals, and left space to make any notes that are necessary. I came up with a key to represent some common behaviors that the doctor told me occur during the session. I made a bank at the top with all the codes for easy notetaking. I worked on this new project for a while until a counselor needed a WISC scored for later in the afternoon so I learned to score that on the computer and then I was taken to sit in on an intake interview and to meet a woman who was coming in for PTSD and panic disorder to to rape and multiple deaths in her recent past. The issues that this woman is facing are the most serious I have come into contact with yet. I was surprised that she was open to talking about this in front of me, and it was hard to sit there and listen to this woman without feeling some pain for her.

Finally, I was taught how to score both the GARS and GADS assessments. Dr. V. sat down with me and we discussed the differences and similariteis between Aspergers and Autism since I will be meeting several patients on the spectrum. I noticed that for each of the two patients I scored one of each for and they both scored high on both the assessments. Our discussion was cut short however for now I have been made aware that diagnosing patients on the spectrum may not be a simple task given the similarities between them. It was a very eventful and productive day. A lot of new information was thrown my way, and my eyes were opened a little bit to the types of people and experiences I could be encountering from here on out.

6/24

Today I was informed of a new inpatient on the adult unit who was just referred. He is a 23 yr. old who has been hospitalized before more than once for such things as agitated behavior, PTSD, ADD, and drug use/abuse. My job was to do some testing with him. I administered the Brown Adult ADD Assessment which was 40 questions long, the Personality Assessment Inventory (PAI) which was 344 questions long and then the CPT which is 15 minutes long. This patient could read however wanted me to read through all 40 of the ADD test for him while he wrote down his answers, and so we got through that smoothly. Next we were supposed to do the PAI, but he decided that he could do it on his own. After I gave him all the instructions and the materials I sat and waited for him to finish. After a few minutes I realized that he was taking a lot of time. He wasn't blatantly off-task, but it was apparent that he was struggling. He started fidgeting and scratching his head and sometimes just staring at the page. He kept trying to make progress but was doing so at an extremely slow pace. I wondered several times if I should interrupt and ask if he wanted me to read a few again, but I wasn't sure so I waited and he finally asked for my help again. He had only made it to question 76 and even when Ii started reading them again he didn't sit still and needed several questions repeated.

After that, we still had the CPT test to do. We were up in the unit and the computer was down in the psych. office, so I had to ask permission to take him down for the test. When people leave, they must be escorted at all times which would be my responsibility, and which also made me nervous. But, all went well and I brought him down and gave him the test. My time sampling sheet isn't finished yet and so I just took my own notes. During this test, he struggled to stay on task. Though I felt he was trying very hard to cooperate and do his bet, it seemed to frustrate him. He shook his legs almost constantly, shifted in his seat, sighed several times, and even stood up twice throughout the duration. After the test was complete I brought him up to the unit. This whole testing process took over 2 hours from start to finish.

Afterwards, I learned how to score both the ADD and PAI assessments and then spent the rest of my time putting the finishing touches on my time sampling sheet so it could be used.

Today was fun for me because it was really one of the first timesI got to spend time with a patient in this clinical setting. I think that administering these first steps of a patient's diagnostic and therapy processes is so interesting. For instance, it is a pretty good assumption to make that he will be diagnosed with ADD, and before today I never witnessed anyone displaying these characteristics, I've only learned about it from class.

6/26

Friday was spent doing office work. I spent the day mailing out discharge letters and missed appointment letters. I also updated some clinic patients' files on the computer and scored several assessments. What I learned from today was to appreciate the small tasks that keep an office organized and functioning efficiently. Doing well isn't always the result of being in the action all the time. The not so fun sutff has to be done as well.

6/29

Monday morning I was given a project to help one of Dr. V's patients. she asked for help devleoping a letter asking several different authority figures in the state for financial assistance. she gave me her rough draft and my job was to proof it, fix any mistakes, and put it into business letter format for her so she can send them out.

When that was finished, I sat in on a supervision meeting and they ahppened to going over the file for the man I did all the ADD testing with. In discussing his excessive history, an interesting point was brought to my attention that I wouldn't have put together myself. I was sent to do all that testing with him on the very next day that he was admittied, and the results of the tests showed him very likely of having the disorder, however I never thought about the fact that he used and abused substances. Dr. V told us we had to keep in mind that withdrawl and detoxification symptoms could, and probably did have an effect on his performance. So, in light of his substance abuse history, and his reported agitated behavior they were discussing the problem of treatment methods. Obviously, one would be weary of prescribing drugs and on the other hand he may turn out to be too impulsive for use of other treatment methods. I am learning that all these things need to be taken into consideration in cases like this. Having seen and worked with this patient from the beginning of his visit is definitely an enlightening experience for me.

After that, I sat in on a session with the doctor who was explaining a child's IQ test results to his parents. He was in to determine whether he had autism or not and he was previously told that he was mentally retarded. His non verbal scores ended up in the low average range and his verbal was down in the MR range. However, it was explained that if the child was indeed MR, he would not have been able to achieve an average score at all. That was also news to me. While this was going on the child was so restless and climbing all over everyone so eventually we went to play video games while his parents finished up. For some follow up with the parents I was asked to send a copy of the DSM descriptions of MR and autism to the parents for them to have.

7/1

Today I was asked to play with a child who was suspected of Asperger's syndrome, and I had to pay attention to his behaviors and communication skills during play and to take notes after to discuss. In the play center there is a huge selection of toys that would appeal to all kinds of interests. Some of the big things I noted were that he was very content playing on his own and when I tried to get involved he was polite but short with me. At one point though when we were turning on the play station, he was comfortable enough to use my knee to balance himself. Also when he spoke, he mostly asked about the "bad guys" in the video game or the action figure bad guys. He made eye contact but it almost seemed like he wasn't all the way there with you, and lastly, he was very preoccupied with one toy in particular that made a squeak noise. He kept going back to that toy repeatedly. A copy of my notes were kept for his chart.

7/6

I met a little boy today who suffered from both encopresis and enuresis. This was the first time I've ever heard of these disorders. His goal was going to be working on his independence by learning to have a cell phone alarm be his reminder to use the bathroom rather than drawing attention from a teacher, parent, or other adult reminding him. My part in this was pretty extensive. My first task was to teach the boy and his mother how the alarm worked and to make sure they would be able to set it up themselves. I also had to make sure the boy understood that the alarm ringtone or vibrate meant that it was time to use the bathroom. The doctor decided that a disabled cell phone would be the best way to go about this because it is inconspicuous and since it was disabled with no other uses beisdes the bathroom alarm, there would be no confusion as to its purpose.

A problem with all this however, was that despite the boy having a 504 plan, the school was not cooperative, especially with the cell phone plan. My job was to do some research and to find suggestions on things to add to the 504 plan along with information to put together about the disorders to send to the school. The information would be sent to the school straight from the doctor's office in an effort to raise awareness and cooperation within the school. Information I included were basic overviews of the disorders, foods like diuretics that help and foods that constipate that hurt the situation, and the importance of exercise. I had to start by familiarizing myself with the details of the disorder, which eventually became quite unpleasant. I gathered my information together and put it together into a pamphlet and packet to send to both the school and to keep in the office.

7/9

A few interesting things happened in the office today. The first thing I did was go up to the adolescent unit to do a fire/gang risk screening for a 14 year old female. This young girl turned out to be an active member of the Latin Kings gang in my neighborhood. As we were going through the questions, I felt sorry for her. She expressed to me that she had to choice but to be a member and that it was a family protection issue. By the end of the interview she switched gears a little and said that she was proud to be a member, but I can't help but to think that's not the true case.

When that interview was over, I went back down and was quickly brought into the CPT testing room and told to observe a young boy and to take notes to be included in his chart. He was really young so it was the 6 minute version. it is sometimes difficult to do this because they get distracted and bored and ask you questions and you're not allowed to talk to them or interfere with the test. This little boy got so bored that he constantly clicked the mouse so he wouldn't have to pay attention and he could distract himself in other ways in the meantime, like looking around and giving me dirty looks. He whined and sighed a lot, but told me he was relieved when it had ended.

After that was over, I joined the interoffice meeting that they have with everyone to go over any issues they might have within the faculty or department. One issue that came up was how backed up the scoring of the assessments was. The solution to the problem was of course to make it my project to catch it up and empty the "to be scored" drawer.

7/13 - 7/17

This week I was dedicated to scroing all the incomplete charts. Some of the regular assessments used include the Connor's Parent Rating Scle, CDI, Vanderbilt teacher eval., WISC IV, WPPSI, CBCL, GARS, GADS, Brown ADD, PIY, and PAI. Some new ones that I ran into and was taught how to score included the BDI-2, BAI, and TSCC. After this week I have become very familiar with the content of the tests and what they are getting with the questions they pose.

Some cases were interesting to me because I actually met the pateints before or helped administer the tests so I could see the score and relate it to the behaviors and mannerisms that I observed myself. I was able to understand how several of these assessments provide valuable information on the patients. Assessment class ahs come in very handy for me during this practicum. I think that taking Childhood Mental Disorders would have been helpful before this as well.

Week of 7/20

I was presented with a few interesting tasks this week at my site. At the beginning of the week I met a 22 year old male patient who was there to see the doctor. My job was to work on college searching with him. he was interested in finding a mechanic program not very far away from home. After a little while of picking out schools and programs we narrowed the list down to a couple. My impression during this tiemwith him was that he was really impatient and little bit aggressive. I also felt like too much information at one time would discourage him from following through with this so I tried to make it as easy as possible for him.

He decided that he was really interested in applying to Alfred University. We printed out al lthe necessary application materials and checklists that the website provided, and then i typed up a step by step to-do list with directions of what needed to happen for to be be officially applied. I used that and the checklist as a cover sheet and made everything into a packet for him so it was all very straighforward and simple. I also included websites of other schools as back ups should he want to check those out later. I hope that he left encouraged and more positive than when I first met him.

In the middle of the week I was sent up to the adolescent unit to do a normal screening. When I got there, the boy wouldn't leave the play room, so they sent me in there instead of in an office. When I got in there he was with his head down and his arms folded over. He yelled that he wasn't talking to me before I even sat down. After several attempts at reasoning with him I was almost ready to give up but I noticed that he had been coloring before I interrupted, so I started to color too. After a couple minutes he peeked up at me and I asked if he could pass the red crayon that his arm was blocking. That broke the ice. We related by participating in a common activity that wasn't as offensive as me asking personal questions while unexpectedly interrupting his play time. I understood why he would be angry. I snuck a few questions in that were easy like about his siblings, video game use, and technology use, and by then he waws comfortable enough to answer the rest. I took that as a small victory for myself that I could make this boy go from completely uncooperative to comfortable. Later I found out that he wouldn't talk to anyone else the rest of the day.

7/27 - 8/10

For the last 2 weeks, Dr. V. has been away on vacation. My excitement has been doing screenings with the children for the most part. Most of the time they go pretty smoothly and I am exposed to children who are there for all types of problems. I see a lot of children who are firesetters or who are in gangs, since that is what is specialized in there. I also work with autistim, aspergers, and behavioral problems. There is a wide range of patients here. During these last two weeks of mainly conducting these interviews, I've had to deal with adolescent boys speaking inappropriately to me, abused children who don't want to speak, lying and proud gang members, and intense detoxification symptoms from heavy drug users in for rehab. Maintaining professionalism and still having control were sometimes hard. I've had to become creative in order to get the information I need. For example one girl wouldn't talk to me but she would point or write. I split up interview sessions for inattentive kids who couldn't do it all at once. I've had to confront lying, make friends, gain trust, or be extremely assertive or extremely cautions all depending on the type of child I was working with. It was definitely challnging at times, but a great learning experience for me. I learned again that there are several ways to go about talking to patients, kids especially. I've found that relating to them on their level, and making it seem easy and convenient for them works so much better than demanding. If they don't like you, they won't let you get through to them and that is a very big lesson learned these last 2 weeks.

Some of the other tasks I have completed while the doctor was away was to help administer some ADD rating scales and testing for 2 adults in the chemical dependency wing. I also did a few outpatient intake interviews and in between I scored tests for charts. I learned to score the ABAS and TSCYC assessments which were new to me.

Week of 8/17

During my last week of practicum I got to meet a middle aged woman who had some definite cognitive problems. She was suspected of some kind of identity disturbance, but also had been in with a history of substance abuse before, along with some trauma issues and PTSD. The doctor explained her history to me and told me he wanted me to administer a CPT test with her. From just the half an hour I spent with her I noticed some changes. When I first met her she seemed normal and every day. Then all of a sudden, she switched to talking this extremely thick southern accent and claimed she was having eye sight problems and needed her glasses. She put them on and while she was southern she was having word find problems like the words she wanted were on the tip of her tongue but she couldn't find them. I watched as she went over some sutff with the doctor and she took off her glasses, lost the accent and started speaking very intelligently with some medical terminology and no word find problems. She could also read the paperwork from a considerable distance across the table without her glasses.

When I took her over to start the test she was normal again, but soon into the long ADD test she switched to southern again and got angry and annoyed with me especially when I didnt answer her while the test was still going on. She swore at me a few times in in her southern accent. When the test was finally over she walked out of the room completely pleasant and normal with the doctor. The switch was drastic.

This experience has definitely been eye opening for me. I got a lot of good learning experiences out of this. I have been exposed to a number of patients, disorders, and tests that I was both familiar with as well as eager to see first hand. I learned a lot about myself and how I interact with people. Children are definitely better for me but I'm glad I got expose to both to make the distinction. Applying concepts learned in class to a real setting is an advantage as I continue my psychology education. Abnormal, Assessment, and Developmental classes prepared me and applied here. Taking techniques of counseling and child psychopathology I think would also have been helpful to have to enhance this all together positive experience.