March is National Social Worker Month. Chances are, a social worker has impacted the life of someone you know – a patient, a friend or a loved one. Social workers provide our patients with emotional support, help them find solutions to difficult situations and connect them with vital services and resources. Freeman has social workers in a variety of departments at Freeman. For instance, dialysis social workers connect patients with resources that help make their dialysis experiences better, such as transportation, food, medical equipment and in-home services. In other departments, social workers may help ensure a patient’s discharge from the hospital is safe by connecting him or her with home care providers, medical equipment, rehabilitation and more. Today, we're interviewing Kim Bernot, Freeman Dialysis Social Worker, to learn about her experiences as a social worker.

Tell us about your career in social work – how you got started and what you do now.
I have been a social worker for the past 25 years. I obtained my bachelor’s degree in social work at Pittsburg State University and my master’s degree in social work at Kansas University. I started my social career with Ozark Center in 1991, working with people with mental illness and substance abuse issues. This truly got my feet wet in the field as this population has so many needs. Next, I worked at the Joplin Regional Center as a case manager for people with developmental disabilities. I continued to work with people with developmental disabilities in Kansas City for Pathways Supports while I finished my master’s degree. I oversaw in-home support for people with disabilities and also facilitated an autism support group.

Then, I went to work at Lansing State Prison to counsel sexual offenders. I continued to counsel sex offenders out of the Kansas City, KS parole offices until I went to work as a hospital social worker at Independence Regional Hospital near Kansas City. Most of my time at Independence Regional was spent as a social worker in the emergency room and on the geriatric psychiatric unit. I liked the hospital setting, and remained there until my family made a big move to Florida. I worked for nine years as a trauma social worker at Baptist Hospital in Pensacola, FL, a major trauma center. I spent most of my time in the intensive care unit and ortho-neuro floors, and the majority of my patients suffered from head and spinal cord injuries. This was probably the most challenging and rewarding position of my career. Currently, I work in the outpatient dialysis unit at Freeman East. I have so much respect for the patients and staff at this unit. The sacrifices that our patients make daily is amazing, and I am honored to help them along their journey.

Why do you like being a social worker?
I have always wanted the world to change for one reason or another – social work was a career where I felt I could actually make a difference. Instead of sitting back and wishing people or systems would change, I can actually help them along the way. Sometimes, that person or group just needs a little support and social work has allowed me to provide that. Most of the heroes in my life came in the form of patients or clients whom I've had the opportunity to meet because I was their social worker. In reality, they have probably blessed me much more than I did them.

Why did you choose Freeman?
What I love most about my current position is that I have the freedom to just jump in and make things happen. I can think outside the box and connect my patients with the things they really need to succeed while on dialysis. The team I work with shares my goals and genuinely cares about our patients. I want to make a difference and I can do that in my own way at outpatient dialysis. I've been given the opportunity to partner with a local food pantry and this has helped meet the nutritional needs of some of my patients. It’s nice to work in a place that supports me and my sometimes not-so-conventional ideas.

People around the world – drivers and nondrivers alike – can relate to the meaning of the colors red, yellow and green in terms of traffic control. Traffic lights help drivers determine whether to go, slow or stop. This understanding of a traffic light can be applied to good mental health interactions with children so well.

As I discussed in my last blog post, the benefit of using the behavior traffic light metaphor is that children see traffic lights in everyday activities and understand how the lights apply to car behavior. For example, children learn from adults about how “running a red light gets you a ticket” or “the yellow light means slow down.”

However, the messages of go, slow and stop as applied to mental health are not always as clear – there is wiggle room for what each of those terms means. For example, “control” does not have to have a negative meaning attached to it. The meaning a child attaches to the colors gives us clues to his or her perception of power, control and authority (of his or her own and with others). Adults can help cultivate healthy perceptions of self-control.

Children may hear the messages of go, slow and stop only as external forces that manage their thinking, feeling and doing (i.e., behavior choices). For good mental health, children must also develop the use of internal strengths to manage their behavior. Regularly exercising inner strength builds resiliency – the ability to face challenges. Resiliency helps children grow into adulthood with healthy perceptions of power, control and authority.

If the messages of go, slow and stop only come from the outside, the child’s capacity to face adversity may become compromised. One way that this can impair resiliency is the potential contempt for force of any kind – including the child’s own force. A child may direct resentment for outside forces inward and, therefore, not see himself or herself as important or having a purpose. The result is a child who could become dependent on external decision-makers. Contempt can also be directed at others, and the child may become too independent in his or her own sense of importance and purpose. Some children cycle through the objects of contempt, so it depends on whose importance and purpose they resent most in the current situation.

Summary:

• Contempt for self: too dependent
• Contempt for others: too independent
• Revolving contempt: cycles depend on direction of contempt

Thus, interactions about the colors of go, slow and stop can show how a person interprets navigating issues of power, control and authority.

Check back next week for more information about the colors of the traffic light as they apply to children’s mental health!

This quote reminds me of my hike in the Grand Canyon last summer with 23 other women. We set out on our journey to hike the Grand Canyon, rim to rim, on Friday June 13, 2014. The last set of switchbacks on the trail seemed never-ending by the end of day. One day had a heat index of 125 degrees Fahrenheit. Just when we thought we were near the end of the trail, there would be another set. Our group made it to camp with only a few hours to sleep before waking up to begin our climb out of the canyon.

The next morning, upon awakening with aching muscles, I thought for a moment, “I don’t think I can hike out of here.” I prayed for a mule to come by and take me out, or a helicopter to pick me up – even if it cost $1,000! I shared this thought with my friend who encouragingly said “You are going to get out of here and on your own two feet.” She mixed me an electrolyte solution that I drank and then I began feeling better.

The nine mile hike out for my group was difficult as well. The heat continued and even with stopping for water and snack breaks, there were times when it seemed that our hike would never end. But, it did. I cannot explain the feeling of joy, relief, accomplishment that I felt all at the same time as I took my last step out and was greeted with hugs from those who had come out before me.

I share this experience to let you know that you can reach your goals and you can overcome any challenges that may be in the path of your success. Don’t let your moments of weakness or doubt keep you from accomplishing your dreams or marking something off your bucket list. The straight stretches and the switchbacks will end, and you will cross the finish line and have a sense of accomplishment like none other!

When babies are born prematurely, their mothers’ bodies automatically begin to produce breast milk that is specifically designed for the baby’s stage of development. The breast milk aids the fragile early baby in developing the immune system, stomach, lungs and brain to catch up to their full term counterparts.

The first breast milk called colostrum is a thick yellowish liquid filled with antibodies, which help build the immune system. Colostrum is easy for the baby to swallow and digest – it has a natural laxative to aid in stooling which helps prevent jaundice. The colostrum also coats the intestines to prevent foreign substances from entering the body, lowering the risk of allergies and kills disease causing germs.

As mother continues to provide mature breast milk, she gives the baby antibodies and probiotics to build the immune system preventing serious infections such as necrotizing enterocolitis, (NEC), meningitis and RSV, a serious respiratory infection. It also helps develop the gut maturity and improve feeding tolerance.

The brain receives DHA and ARA, 2 fatty acids, as well as the milk sugar lactose from breast milk, which enhances brain and nerve development as well as the development of the retina of the eye. Studies show the more breast milk the infant receives, the more benefit the baby will receive. Many of pre-term babies are on a ventilator and oxygen, and statistics show that babies who breastfeed tend to have fewer days of oxygen therapy.

There are many benefits of providing breast milk to any baby, but these benefits are even more significant for premature babies. Breast milk protects these babies from harmful and in some cases, deadly, infections and helping the baby develop more quickly and thus go home sooner.

The behavior traffic light can be used to gain insight but also to enhance areas that improve mental health. One area of insight has to do with resiliency – if you’re concerned about your child’s resiliency, helping him or her build capacity for meeting challenges can help. You can help your child learn to have an accurate perception of the problem and a helpful interpretation of the necessary problem-solving steps.

Behavior traffic light activities can help children learn when it is best to go, slow or stop. For example, frequently reviewing the colors in different situations can help children rehearse important skills such as paying attention to relevant information, following a decision-making process, and/or activating a problem-solving plan. This process is important because, as usual, when referring to human experiences, they are a matter of perception. Situations hold different opportunities for each individual to use the behavior traffic light for finding insights and areas for improvement.

Each of the individual colors has a meaning related to going, slowing or stopping. Here is a brief overview for the colors in this behavior traffic light metaphor. (More in-depth posts for each color will follow in the future.)

Red: Stop
Valuable insight for this color is in the form of cultivating the perception that red is important due to safety issues. Also, its purpose is to send a message of protection. Red words typically communicate boundaries: “This is okay, but stop that because that is not okay.” The color red signals an alarm, heightens alertness and activates protective factors. Red light words are statements that include “no,” “not,” “don’t,” “can’t,” “quit,” and “stop” directives.

To enhance mental health, use red light words as little as possible. Reserve these red color phrases only for the purpose of immediate safety and protection issues. In other words, red color phrases activate a fight, flight or freeze response. Ask yourself, “Is this the color I want to use to cultivate child followership?”

Yellow: Slow
Valuable insight for this color is in the form of cultivating the perception that yellow is important to meeting the brain’s need for feel-good hormones. The electrical and chemical processes would then help the person to stay fully active in both thinking and feeling processes. The purpose of yellow in this metaphor is to reinforce a message of confidence in one’s abilities to make the connections between what is happening with thinking, feeling, and behavior choices. The use of this color typically comes in the form of a question to prompt the child to slow down and think. The color yellow in the behavior traffic light heightens awareness of thought patterns and activates a list of choices in doing something in response.

To enhance mental health, use yellow light words as much as possible. The purpose is to communicate choices and/or strategic questions through statements that provoke the brain’s fill-in-the-blank processes. For example, insert a lingering sing-song phrase before continuing a sentence and it helps open attention for the receiver. For example, “Ohhh…is that a calm voice to talk about a disagreement?” In other words, use Yellow color phrases to activate the thinking brain. Ask yourself, “Is this the color I want to use to cultivate child followership?”

Green: Go
Valuable insight for this color is in the form of cultivating the perception that green is important to growth in the physical, psychological, social, cultural and spiritual domains. In addition, its purpose is to promote child development into adulthood and beyond. The use of green light words typically comes in the form of “can do” statements such as, “Feel free to…” and “You’re welcome to…” The color green in the behavior traffic light heightens motivation and activates imagination, creativity and wonder.

To enhance mental health, use green light words as the back-up if a yellow phrase is not readily available. This way of speaking highlights what you want to happen – the expected behavior. Expressions may come in the form of statements that include the “when/then” phrase, emphasis on cause and effect and self-determination type of options. For example, “When your room is clean, then you can play outside,” points the focus on the child’s response rather than the adult’s reaction in the situation. Ask yourself, “Is this the color I want to use to cultivate child followership?”

Also, green color words can replace red color words, i.e., find a way to say “no” by saying “yes.” “No,” is typically followed by the fill-in-the-blank answer to the question of “Because why?” Green color words are typically communicated as “Yes,” and then followed with by the answer to the question of “Under what conditions?” Several teaching moments exist to invest in internal motivation issues. In other words, use green color phrases to activate the whole brain.

“No because” – a reason why the child can’t
“Yes under these conditions” – clear expected behavior

Just as there are automobile safety features, choice of car makers, and advancements in efficiency, the analogy applies to human psychosocial functions of thinking, feeling and doing. There are many other parallels between traffic lights and the behavior traffic light. For example, the lights must work in rhythm with each other; one direction may have a red light while the opposite direction has a green light. Yet, as with all metaphors, they only stretch so far. More specifically, a traffic light for cars moves from green, to yellow to red, and back to green. Beyond this metaphor, behavior moves from red to yellow to green with a preference for staying in the yellow zone as much as possible. Yellow words reinforce thinking for problem solving. Children can use the lessons of go, slow and stop to learn the social rules of the road while navigating the environment. The behavior traffic light is another way of investing in children.

In the overall theme of the behavior traffic light, the purpose of the red light is to cultivate the perception that red is important due to safety issues. Adults use red light words to send a message of caution. When a person is using the red light in their behavior traffic light, it is as if they are on alert and using fight, flight or freeze defense mechanisms. There are healthy and highly valued effects of activating the red light, detrimental effects can happen if the red light stays on too long.

Healthy red light examples:

• “We stay safe by playing in the yard.”
• “Check the label for ingredients so that we know this is safe.”
• “I care about you, so please buckle up.”

The above examples show how to phrase red light communication so that it sounds as much like choice as possible. It helps children to see how their own behavior keeps them safe. However, there are times when the explicit “No,” is required – keep the “no” clearly linked to the potential safety issues. Although “stop” “don’t” “quit” and “can’t” phrases are red light words, children are more receptive if we keep the message about using our adult power to serve.

Additional healthy red light examples:

• “No, we keep the crayons out of our mouths.”
• “No, we must go home before late night driving begins.”
• “Stop; it is glass and could break.”

The use of red typically comes in the form of boundaries: what is okay and what is not okay. Red in the behavior traffic light heightens alertness and activates protective factors in the realms of thinking, feeling and doing. Adults want to cultivate a healthy respect for boundaries so that the child makes safe choices on his or her own. Yet, if the red light is overused, misused or abused, there can be detrimental effects. Rather than perceiving a red light as a safety problem that needs to be solved, children can interpret it as “trouble” related. For example, when asking children about the purpose of the red light, how do they answer? If they answer “So you don’t wreck” it may indicate the child associates boundaries with safety. If they answer “So you don’t get a ticket” may indicate the child associates boundaries with getting in trouble.

Hence, a repeat of caution about the use of red light words: only for safety reasons. We want children to respond to danger with problem solving that will result in safety. Children will, otherwise, perceive Red light words as an attempt to veto their power to make choices. Such a perception automatically activates the defense mechanisms of fight, flight or freeze. Control loss could look like fight: overtly pushing in to over control. Control loss could look like flight: covertly pulling back to under control. Control loss could look like freeze: stunned in place to conserve what little control is left.

Unhealthy red light examples:

• “Don’t play with your food.”
• “You can’t sit in the chair like that.”
• “Quit playing your game and do your homework.”

When anyone feels like they are in a power struggle, defense mechanisms are activated. Rather than responding with ability, children may default to reacting with revenge to keep as much control as possible. In other words, when you talk to kids in NOTs, it ties them up inside because their minds perceive a threat of loss of control. This kind of alarm hijacks the brain until it goes through the process of fight, flight or freeze. Children will be spending more time looking like they are being naughty instead of operating in the green zone.

Therefore, I say, “Nots turn into knots turn into naughties.” So, remember to use your green light words!

In the overall theme of the behavior traffic light, the purpose of the green light is to cultivate the perception that we have a choice throughout many important parts of daily living. Adults use green light words to convey freedom of choice. When a person is using the green light in their behavior traffic light, healthy, safe and happy effects are predictable. Children need to become accustomed to what is in the green zone.
Healthy green light examples:

• “Feel free to go to your friend’s house when your homework is done.”
• “You’re welcome to watch television when the chores are done.”
• “I’ll be glad to give you a snack once the laundry is put away.”

The above examples show how to phrase green light communication so that your request sounds as much like choice as possible. It helps children to see how behavior choices are ever-present. Green and red light words show us how we share control through choices. Adults who use “No” because of a particular reason (based on controlling power) can provoke a negative reaction in children. Rather, help adults can find a way to say “no” by saying “YES” under conditions.

Red light: No (The adult has all the control)
Green light: Yes (The adult shares the control with when/then statements)

Red Light Words
No you can’t go to the ball game because your room is a disaster!
You can’t have dessert because you didn’t eat all of your dinner.
You won’t be going to your friend’s house because you didn’t do all your chores.
 
Green Light Words
You are welcome to go to the ball game when your room is clean.
When you finish all your dinner then you can have dessert.
Feel free to go to your friend’s house when all your chores are done.

The interesting thing about green light words and cultivating child followership: compound interest! Just like a savings account rewards for depositing new funds, children are like a bank. They build up resiliency and the ability to cope with stress when they are used to using their green light. If adults are consistent in offering acceptable options to problem solving, children will follow along expecting that they, too, can figure things out

As summer approaches and our children are drawn outside into the sunshine once again, protecting our children from sunburn is key. Now more than ever, sun protection matters. Episodic sunburns during childhood and adolescence have been shown to increase the lifetime risk of melanoma, the deadliest form of skin cancer. In addition, sunburns hurt! Three ways to help your children avoid sunburn include sun avoidance, protective clothing and sunscreen. Try the tips below!

Sun avoidance

• Avoid or minimize sun exposure between 10 am and 4 pm when the sun’s rays are hottest.
• Be careful when the child is near water, sand, snow or concrete since these can reflect the sun and cause sunburn.
• The risk of sunburn during certain activities, such as water sports, is high.
• Clouds are not sufficiently protective against sunburn since the sun’s rays on a cloudy day may only be reduced by 20% to 40%.
• Seeking shade is somewhat helpful, but a child can still sunburn because light is scattered and reflected.

Protective clothing

• Clothes offer the simplest, and often most practical, sun protection.
• Tight weave clothing lets in less sunlight than a looser weave.
• Clothes that cover more of the body provide better protection.
• Consider dressing children in lightweight long pants and long-sleeved shirts if sunburns are possible.
• Rash guards or swimming clothes that cover the arms and chest can be helpful when children are playing in or near the water.
• Hats with bills or a 3 inch brim can be cooler and more comfortable than a bare head in the summer and can help shield the face, ears, neck and eyes.
• Don’t forget sunglasses!

Sunscreen

For children and teens:

• Sunscreen should be used any time a child spends time outdoors.
• Use sunscreen for sun protection, not as a reason to stay in the sun longer.
• Choose a sunscreen that states broad spectrum with a SPF of at least 15; SPFs of 15-30 work for most children, but 50 can be a good choice for a fair skinned child or infant. SPFs 70-100 do not likely offer any greater protection than 50.
• Use enough sunscreen to cover all exposed areas – especially the face, nose, ears, feet, hands and even backs of the knees. Each application should be 2 ounces of sunscreen (2 tablespoons) or more! Rub it in well!
• Apply sunscreen 15-30 minutes before the child goes out into the sun to allow time for the sunscreen to absorb.
• Reapply sunscreen every two hours. Remember that no sunscreen is waterproof or sweat-proof –reapply after a child swims, sweats or uses a towel.
• Lip balm with sunscreen will help protect a child’s lips from sunburn

For babies:

• Ideally, infants younger than 6 months should be kept out of direct sunlight.
• Infants should be dressed in cool, comfortable clothing with a tight weave and wear hats with brims.
• Babies do not sweat as well as big kids, so exposure to the heat of the sun may increase the risk of heatstroke and dehydration.
• Sunburn may occur easily because infant skin has less pigment than at any other time in life.
• Apply sunscreen on small areas, if needed.

In the overall theme of the behavior traffic light, the purpose of the yellow light is to help children understand that many important parts of life need to be thoroughly considered. Adults use yellow light words to send a message of “slow down.” When a person is using the yellow light in their behavior traffic light, he or she are aware, resilient and self-directed – healthy, safe and happy effects are predictable. Children need to become accustomed to life in the yellow zone.
Most of the thinking, feeling, and doing in life happens in the yellow zone. It is the opposite of the automobile traffic light. The signal moves from an extended green, to a brief yellow, with another transition to a long red. The yellow light highlights staying engaged by staying calm.

Healthy yellow light examples:

• “Ohhh…how do we sit on the chair?”
• “Hmmm…what is the rule when using the tablet?”
• “Yeah, that’s frustrating. What are you going to do?”

The above examples how to phrase yellow light communication so that it sounds as if you are sending the powerful message of “You can figure this out.” Notice that each of the phrases could have a slightly drawn out pace and a sing-song tone. These are also considered “strategic questions” – purposeful ways of stating a question so that it engages motivation. These types of techniques help reduce the possibility of a perceived threat that would start a fight, flight, or freeze response. But neither is it a simple matter of figuring out the obvious action in the situation. Yellow light emphasizes the “slow down” process so that children can focus on problem solving.

As a parent, you can role model this process by verbalizing your yellow light. When approaching a task, list three possible options to completing the task. Then, list the consequence of that option. Finally, discuss the decision you would make on the best-fit consequence. Over and over, children can be exposed to cause-and-effect, weighing of consequences, accurate perception of time, moral development, empathy, reasoning skills and more! Those “what if” scenarios help children internalize important life lessons.

Using the yellow light means a person is purposefully checking what is happening in his or her thoughts. The person is checking the facts and challenging him or herself for accurate perceptions and helpful conclusions. The person becomes aware of his or her feelings – like a thermometer reading, a person checks the intensity and determines whether he or she can cope. Yellow light also signals a review of the menu of actions that could accompany the thinking and feeling. These all work together and slowing down helps ensure that the person is completely reviewing all options.
Red lights are quick, “Stop!” Green lights are quick, “Go!” Yellow lights tell us, “Slow: proceed with caution.” All three are important for the development of happy, healthy and safe children.

According to the 2008 Physical Activity Guidelines for Americans, you need to do two types of physical activity each week to improve your health – aerobic and muscle-strengthening. Adults need at least 150 minutes of moderate-intensity aerobic activity per week and strength-training activities on two days of the week. With summer upon us, in order to avoid heat related illness, it is important to follow safety guidelines while exercising in the heat.

Avoid exercising during the hottest part of the day from 10 am – 3 pm. The risk of heat exhaustion rises as the heat index climbs above 90.
Drink water before, during and after your workout. According to the American College of Sports Medicine, you should drink 4 – 16 ounces of fluids every 15 – 20 minutes during your workout. If you are working out more than an hour, you may need to hydrate with an electrolyte solution. Drink water often, even if you don’t feel thirsty, to avoid heat exhaustion.

Wear sunscreen and exercise in the shade if possible.

Wear light-colored, breathable clothing. You may want to wear clothing that actually wicks the moisture (sweat) away from your skin which can help make you more comfortable. Sweating is the body’s way of regulating your temperature. If you or someone else should stop sweating while exercising in the heat, experience nausea or vomiting, feel light headed or dizzy, seek immediate medical attention as you may be experiencing a heat stroke.

If you suspect someone is having a heat stroke – which is a life threatening condition – move the individual to a shady place if possible, and you may want to remove some clothing to make them feel relaxed. Pouring cold water on the person’s body may help in reducing heat. If you have water or electrolyte fluid on hand, get him or her to drink what they can as long as they are conscious.

By following the suggested guidelines you can still exercise safely in the summer months. So why not exercise first thing in the morning for safety’s sake and have the rest of the day to yourself?