Tuesday, June 21, 2011

June 21, 2011 - Post #5

Not much new has happened since last post. Last week I went on a school visit with one of the social workers. I assumed that I was going to be going to the school with her, but when I got to the clinic in the morning, I was told that she was already out at a home visit and was going straight to the school from there.  So they told me to take the bus, and that it was on 138th and Alexander. That meant nothing to me. So after asking a couple questions, while trying to keep from sounding like a complete amateur, I found myself waiting in my dress clothes at a bus stop in the middle of the Bronx. If I wasn't sticking out like a sore thumb while walking down the street before, plop me into a bus stop in dress clothes and I was a black swan...only...the opposite. After kind of guessing which bus to get on, and kind of guessing where to get off, and then guessing where to walk from there, I finally found the school. After signing in with the cop at the front door, I waited in the office until they told me where the social worker was. When I went in to meet her, she was with a client already; we'll call him Matt. He was 7 years old, and had the most severe ADHD I had ever seen. I thought Matt was a girl at first, under he started talking. He had long, frizzy hair tied back in a pony tail. He was bouncing all over the room, was counting the numbers on the calendar and then counting them back on his fingers, and was constantly being asked to refocus and stay seated. The issue that him and the social worker were talking about when I came in was the fact that he doesn't fully understand the concept of "friends." He thought that everyone he met was his friend, and considered every single kid in his class a friend. The social worker was explaining that he had to get to know someone before they could be called a friend. She asked him if I was his friend...and he quickly responded, yes! She asked if he even remembered my name (she introduced me when I came in), and he replied. "ummm...well, I know that his favorite color is blue!" And she was like, well how to do you that? And he said, "everyone's favorite color is blue!" So she told him to ask me. "What's your favorite color?" And I felt bad lying...so I answered with blue. "A ha! See I told you! Oh, and I forgot to tell you, I'm a mind reader too!" Then out of the blue, Matt asked, "Hey, were you in the auditorium earlier?" And I was like...ummm no? So he dropped everything he was doing, and stood up. (Apparently his class put on a show for the rest of the school earlier that day). He began to sing "Man in the Mirror" by Michael Jackson, and had this intense choreographed dance to go along with it, and was completed serious the whole time. So as the school counselor, who was also in the room, and the social worker were saying "Okay Matt, that's enough, lets sit back down," I was clapping and laughing hysterically. After his performance, it was time for him to go to lunch. So as he left, he said, without being prompted, "Nice to meet you." And I said "Nice dancing!" And he turned around in the door and goes "So you were in the auditorium!" And then walked away.

Afterward, his teacher came in and gave us some insight into his actual presenting problems. He was in a special education class because of his behavior; aggression, lack of focus, and hyperactivity. She said that if it weren't for his behaviors, he'd not only be in a normal classroom, but because of how smart he is, should be in a normal classroom with kids a year older than him. He has told the teacher that other kids say he's annoying, and he admitted that sometimes he is annoying. When he gets frustrated, he pounds his hand on the desk saying "I hate myself, I hate myself" and seems pleased when he looks at his hand afterward and finds that it's bruising. The teacher also said that she's heard himself mumbling to himself, "I wish I was dead." Sooo...obviously Matt suffers with ADHD, but also a whole host of other issues as well.

The whole experience of being in a room with the social worker though once again proved to me that these are the kind of kids I want to deal with; one's that have issues, some really serious issues, but are also really sweet, fun, and funny kids. I'm excited to start the summer program in July so I can actually interact with these kids.

Tuesday, June 14, 2011

Tuesday June 14th, 2011 - Post #4

So, another full day at the clinic down. Was a little more productive than yesterday. I sat at the front desk today and learned how to work the front of the building...remotely open the doors, answer the phone, transfer phone calls, put people on hold, how to correctly pronounce everyone in the building's name in Spanish. I'm serious when I say that had I known 5 years ago that I'd be in this position, I would have continued to take Spanish through college. It would be HUGELY useful here....especially as I sit here with my two roommates in the living, while they both speak Spanish to each other. I'm hoping if I just sit here listening to them and watching the Spanish channel...I'll absorb enough, and I'll wake up one day and realize I know how to speak it again. Oh, and my other roommate Diego moved back in on Sunday (he was in Spain for 6 weeks).

After working the front desk, I had lunch, then was taught how to complete the electronic logs of patients that come through the clinic. We have to record whether they were a No-Show, cancelled, or if they came, what kind of visit it was (individual, parent without child, parent with child, full family session, or group family session). So that was somewhat interesting to see what kind of mix of appointments they get at the clinic, and it took about 2 hours to enter all 140 entries. After, I spoke with the clinic supervisor for a while, just about my general interests, and she told me a ton of stories about cases that she's seen her. Her specific interest within clinical psychology is trauma...which makes this clinic the perfect place for her. She told me about a 15 y.o. girl who was the youngest of four girls, who was brought to the clinic by her mom because she had been cutting herself. The mother was extremely protective over this girl because the rest of her daughters had been sexually and physically abused by the her boyfriend. After trying to treat the girl, it became obvious that the major issue with helping the girl, was the fact that her mother was very controlling and protective over the girl. It was suggested that the mother see a therapist a couple times also....and that led to the clinician finding that the mother had been raped and abused by her step father as a child. And this doesn't seem to be an uncommon pattern for families in the clinic. She also talked about a boy who had become violent to the point of hitting his pregnant teacher. And then another boy who would have these huge anger outbursts at school. After beginning therapy with him, it was found that he was being picked on and bullied in school because, as a kid from Jamaica (and she told me that he was very dark), he stood out like a sore thumb in the school of 90% hispanic kids. They moved him to a new school, and the outbursts stopped. The combination of family, poverty, peer issues, and internal mental issues related to trauma or otherwise, is so fascinating, and it is no surprise that these kids have a huge range of issues to deal with.

Apparently they could really use help trying to control the kids when in the waiting room, because they often come with parents and other siblings who will have therapy. There are kids who will run up and down the halls and kick on every therapists door, they've had a kid grab the fire extinguisher and spray it around the waiting room...yet they also said that they're pretty easily occupied with coloring or playing a bored game or just talking to someone, since they don't usually have someone at home who is willing to just listen to them talk about whatever. Another thing that the supervisor mentioned is that when the guy who is in charge of billing works the front desk, the kids immediately fall in love with him. And this guy was pretty cool and fun, but she also told me that they like him mostly because he's a guy. And I wasn't really sure why that was at first. But then she reminded me that very few of these kids have men in their life. Most don't have a male of any kind in their lives, and a vast majority that do, have one that provides only a very negative impact. Also, a majority of the people who work in the clinic are females (I think all of the clinicians are female, and one of the two psychiatrists is a guy). That's really sad to think about, but also makes me feel good...that I can be another male figure in their lives that's at least more worth looking up to than the male figures they currently have in their lives, if they have any at all.

Monday, June 13, 2011

Monday June 13th, 2011 - Post #3

First day at the clinic complete. It was my first time being in the South Bronx, and it was definitely as "rough" as everyone had told me it would be. It looked kind of similar to where my apartment is in harlem, but about 5x worse. You can see the difference in poverty just by the people walking around and the stores and buildings in the area. The neighborhood that the clinic is in is called Mott Haven, and as the Children's Services Director explained to me today, the neighborhood consistently falls at the very bottom of the rankings of NYC neighborhoods in terms of income, poverty level, and overall child life outlook.

The clinic itself is really nice, and very secure (every single door in the whole building is only accessible with a key card, and there's a security guard who stands in the lobby from starting at 12pm for the rest of the day [and not like one of the fat, donut eating, barely fit into their chair while "watching" the cameras on a monitor security guards]). There are 5 different programs housed in the clinic building, and I'm going to be involved in several of them throughout the summer. My time is going to be divided doing some billing/insurance/paperwork stuff; involved in the clinic itself, helping with some paperwork there, and possibly overseeing the children while their parents are in therapy sessions (a lot of families that are referred to the clinic primarily for the kids are also suggested that the parents seek some additional therapy as well); and then helping out a couple days a week with the summer program they have for kids, whose main goal is to get the kids out of their troubled homes and provide them with something productive to do, while at the same time keeping "therapy" the main focus.

In order to avoid trouble with HIPAA, I'll try and keep the personal information of the cases to a minimum, but I can give the general statistics of the kids who come through the clinic. They have to have an IQ over 70, or else they are deemed incapable of benefitting from any kind of therapy they'd be offered. The most common disorders diagnosed (and all children who are seen in any way at the clinic need to have a diagnosed mental disorder in order for their insurance to be billed) are ADHD, depression and other mood disorders, anxiety, post-traumatic stress disorder, bipolar disorder, conduct disorder, and oppositional defiant disorder. 85% of all children seen are raised by a single mother, 5% raised by another relative, 4% by a single father, 2% other living arrangements, and only 4% have two parents with custody...4% of the kids live with two parents. And while a single parent can in many cases provide just as good care as two parents, put them in this neighborhood, and the story changes. In a general survey conducted of all the kids seen in one year (median age is 10-11), 90% had heard gun shots that weren't in a movie or on TV, and a majority had seen a dead body, aside from one in a funeral parlor, and not on TV. Now, I have never heard a gun shot in real life before, besides those coming from the woods or fields by my house or in Geneseo (and there certainly aren't woods or fields around here where people are hunting), and I have definitely never seen a dead body, outside of one at a funeral. And I'm twice the age of the average child that comes through the clinic. The difference between these kids lives and my own is ridiculous to me. Yet, when I looked at the kids who were coming in and out of the clinic today, they look like typical kids. Coloring in coloring books on the table in the waiting room, listening to iPods, running around the hallways. But when they leave the clean, air-conditioned, safe clinic, their lives are probably like nothing I, or many of us, could imagine.

When looking at the evaluation forms used during the therapy sessions, I got really excited. While it's obviously very sad, I can really see myself doing this and enjoying it. Evaluating a child's family history, drug usage (and yeah, they have elementary and middle school aged kids with substance abuse issues), family drug usage, educational background, sexuality issues, peer issues, sexual or physical abuse history, history of trauma or other traumatic events. And then a treatment plan is molded to address the major issues the child deals with, and progress is marked very specifically over a long-term period (a couple months to a couple years). And progress doesn't usually mean progress in the normal sense of the word. Progress for these kids may simply be talking about the issues they deal with at home, and simply realizing that it's actually not the norm for 10 people to be living in a one bedroom apartment, or to have an absent father, or to have parents addicted to drugs, or to only eat 1 meal a day, etc etc. It's also major progress for the children to realize that, unlike their family members (in most cases), there are people who care and can remain constant in their lives and are willing to listen and help them. I definitely find it really, really exciting.

While it's definitely sad that areas like this still exist (and it certainly doesn't stand alone as far as that goes), it's the perfect place to have a clinic such as this one, and as the clinic expands its services into schools throughout the neighborhood (which they have been in the process of doing for a couple years now) and become more well-known and reputable, it can eventually make a large impact.

Thursday, June 9, 2011

June 9th, 2011 - Post #2

So as I knew I would, I'm becoming settled in good old Spanish harlem. My clearances for work STILL aren't processed yet. So my first official day is going to be this coming up Monday...which means that I'll have lived in the city an whole week without doing anything at all, which to be honest, has been a dream of mine for a long time. To be able to live in NYC without having to work or worry about making money...completely a fake life. I'll take advantage of it while I still can.

I have accomplished a couple things this week though. I had my orientation for the internship; we just watched some videos about the long history of the Visiting Nurse Service of New York. It was founded in 1893, making it the oldest visiting nurse service in the country. The organization itself is HUGE, employing over 15,000 people in the NYC area, and seeing over 30,000 patients everyday (about 2.4 million patients per year). And while it started at purely a service where nurses would visit patients in their homes, there are now many other services as well, including clinics like the one I'll be working at.

It's taking extra time to get me started because all of the other summer interns were either in Human Resources or Finance, and didn't need to get child abuse background checks or fingerprinted.

Like I said, I'm getting a lot more comfortable with the area I'm in. I still can't tell if its "dangerous" or just that it's an uncomfortable feeling still. I have walked around a little at night, and yes, I'm the only white person (unless I'm walking Meredith Stevens back to the subway stop), but as my cousin who lives in Brooklyn said, you can get robbed in ANY area of NYC, you just have to be conscious wherever you are. After hearing about it from multiple sources, I decided to order my first load of groceries through Fresh Direct online, and it is being delivered to my apartment on Saturday. The prices are comparable to those in a grocery store, and it's only $6 delivery charge. So we'll see how well it works. And my roommate is really nice, and we're getting along fine. She is a native of Spain, and still has a very thick accent. She speaks pretty fluent English, but there is a clear language barrier for many topics we've tried to talk about. It's looking like my sarcasm may go over her head most the time, which is a hard thing for me to deal with, since I'm very sarcastic a lot of the time.

I'm definitely ready to get started, 3 more days of waiting and just living up city life. Hopefully I'll have some more interesting stuff to talk about soon.

June 5th, 2011 - Post #1

Well I guess this will be the best time to begin my blog of Summer 2011, since it’s 9:00PM, which in my mind is too late to walk around this area not fully knowing it yet, and because my internet is not working. It may sound like a trivial thing, but there is really nothing to do around here within walking distance, and I don’t mind being by myself when I can be online. Call me spoiled or just a child of the technology age or reliant on electronics or whatever, but I do feel lost without being able to get on the internet. I tried reading, but don’t have any good books around. There’s a piano in my new apartment, which is great, but the keys are too sticky to actually play. So writing is my next best option, which I guess I don’t mind at all.

So I moved to my new apartment on 110th and 3rd in New York City yesterday. To those who are only somewhat familiar with the city, you’d think this is the Upper East Side. To those who know the city a little better, this is Spanish Harlem. And once you’re here, Spanish Harlem it certainly is. Disclaimer: I am not racist, not even a little. But it’s a strange, somewhat uncomfortable feeling to be the only white person walking on the street. Last summer, with a friend of mine, in Bridgeport, CT, it was a little less uncomfortable, because there were also two white people walking on the street; it became kind of a funny, running joke. It’s a little less funny when you’re by yourself, though. I haven’t had any encounters that should make me feel uncomfortable here yet, and my roommate is very nice (she is from Spain), but it’s an eerie, and somewhat humbling feeling to be a minority, and an extreme minority at that. I love diversity, and have always said that, after growing up in an extremely white town, and going to a small, extremely white college, I want to eventually be in a place with a large mix of people of all races, nationalities, religions, etc. Last summer, I thought I’d accomplish that for a couple months in Bridgeport, but that didn’t really end up being the case. It was a lot like being dropped in the middle of Africa (again, nothing against the people living there at all). And what better place for wide varieties of people than New York City. But I guess I wasn’t fully aware that while New York City as a whole is diverse, the neighborhoods are quite homogenous, and that while walking neighborhood to neighborhood may offer a nice mix of cultures, being set within a single neighborhood is a lot like being set in the middle of another country. Which is actually an incredible experience, besides the strange looks from the other people of that “country” and that I end up feeling like an international tourist.

As a side note, to further emphasize the fact that I am not racist, and embrace other cultures, my original plan for this summer was to volunteer at an orphanage in Ghana, where I obviously would be have a minority once again. This is something that I’ve wanted to do for a very long time. Maybe subconsciously, I enjoy being the minority. Or maybe, it is something that bothers me, and I’m subconsciously trying to get over it. Who knows?

Anyway, I am here this summer because I’ll be working for Visiting Nurse Services of New York (VNSNY), at a children’s mental health clinic in the South Bronx. According to the woman in charge of Child Services through VNSNY, the neighborhood that the clinic is in is the most distressed in the New York City area, and top 5 most distressed in the country. I’m not sure whether or not she was just trying to be honest, trying to prepare me, trying to scare me away, or all of the above, but I’m pretty sure that the children in that area are pretty troubled. I can imagine it will make for an eye-opening, challenging, and hopefully rewarding experience. Similar to what I was expecting while mentally preparing for my trip to Africa, these kids have been through things that I, or many of us, probably can’t even imagine. And while I really want to help, and will try to do everything I can to act as a resource for them, I definitely have my doubts. While I may not be able to fully relate to what they’ve gone through, or are going through still, what I can provide is a sense of constancy that they surely do not get at home. If they can come to the clinic every day, and see that the same people keep coming back to help them, and that people do actually care, who knows what that can do to a child’s outlook on life.

When explaining what I’d be doing to my uncle, he asked if I really thought I’d make a difference, and whether or not clinics like this are actually worth it. “You really think a clinic is going to help children out of the South Bronx and get them into a healthy, successful lifestyle?” I told him that even if I could help one kid this summer, I’d be happy. Yet, I wasn’t really sure if that was true or not. I’m here for 3 months, and helping one child enough to eventually be able to get out of the lifestyle their in…is that really fulfilling enough for me? I brought this topic up to my other aunt and uncle, both teachers for 25+ years. And they assured me, without a doubt in their mind, that helping a SINGLE child, in ANY period of time, is a success. One child helped, is one more child helped than before anyone stepped in. A small difference made, is still making a difference.

I’m hoping that once I get started, I’ll feel a little more purpose in living in this area. And hopefully that will help me deal with the strangeness I feel of living here in the first place. And I really believe that any experience that not only gently pushes you out of your comfort zone, but forcefully throws you out of it, is an experience worth having.

And I LOVE pickles. Like, I really enjoy eating a good, Kosher, dill pickle. But one time, I went a little overboard, and ate probably about 40 of those little mini pickles, and had no desire to go near a pickle for months after. I’m beginning to feel that way about living in a place like this. I have no problem at all with Latino music. But I really hope that I can continue to deal with it, after 3 more months of being woken up by people riding bikes with a 1980s boom box attached to the back blaring latino music. It’ll sure be an experience, if nothing else.

I love New York City, and have wanted to live here for years. And now I’m here, and getting settled in. It’s not ideally where I wanted to be, but this is just one part of the city, and I respect the differences and uniqueness of the many neighborhoods. Maybe I just have to take some time to find the neighborhood that’s best for me. And maybe that doesn’t mean the one that I’m most comfortable in at first. An open mind is my major goal for this summer, as it was for last summer.

If my internet were working, I’d start brushing up on my Spanish. Not so I can fluently speak it, but so I can at least understand what people are saying as I’m walking around. That’s something we take for granted a lot…being able to listen to and understand what people around us are saying. I’m sure I’ll notice a lot of things I take for granted being here. And that’s definitely not a bad thing.