Friday, October 21, 2022

2 free CEUs for LMHC (NBCC), Psychologist, Nursing, Social Work, Educators

I just received an e-mail advertising this course, group therapy via telehealth at William James College. The course is completely free.

I will mention that I have taken it before, and honestly, it's kind of eh. But it is free. 

There was a lot of ableism, such as insistence that group therapists should always have the zoom chat turned off and ignoring of comments by a few of us that using chat is an accommodation for neurodivergent folks, as well as citing neurodivergent presentations as screen-out criteria for appropriateness for group therapy.*

Also, just, why would you not leave chat on? Why would you not want people to be able to type "be right back" if they need to use the restroom rather than interrupting? Why would you not want someone to be able to drop a helpful link in the chat if they're mentioning a resource? If for some reason you find people are saying off-topic or disruptive things in the chat, then you use your group leadership skills and remind people that we need to maintain one conversation at a time, and chat comments need to be on the same topic as the out loud conversation aside from quick "be right back"-type comments. 

*I will die on this hill: The "I don't work with the autistic 'population' though" talk from so many providers is incorrect and damaging. You do work with autistic people. If you work with people at all, about 2-5% of them are autistic. If you work in mental health or medical settings, you might be seeing 10-20% autistic folks, but if you are insisting you don't, you probably are relying on stereotypes of young white boys and don't actually recognize autism. Also, along those lines, some colleagues and I are working on a project about completely abandoning the idea of "populations" and recognizing that cultural competence is primarily a mindset, while at the same time we should all have basic familiarity with experiences that occur fairly frequently. 

Further reading: 

1 in 5 adults presenting to outpatient psychiatry are autistic

Autistic traits found in 20% of young adults seeking addiction treatment

I don't know of any studies on rates of autistic and other neurodivergent presentations in parents involved in the child welfare system, but anecdotally it's very very high, with no acknowledgement whatsoever that it's an area of needed cultural competence.

I have no affiliation with Williams James College other than minimally as someone who periodically supervises interns for them. I post free/low-cost CEUs I find in order to promote equity and representation in the field, and sometimes share my own personal thoughts about the trainings and/or the trainer. 

Tuesday, May 17, 2022

Use accurate language for developmental stages to ensure equity and optimal development

I'm noticing a trend, particularly among the attachment parenting/gentle parenting/peaceful parenting folks, of referring to children using developmental-stage terms that have a pretty clear definition among child development professionals, yet are being used to refer to much older children than intended. To be clear, I endorse the general philosophies of these movements, but I have some concerns regarding 1) these communities' tendency to be very steeped in privilege and 2) the tendency to conflate letting children have a childhood with infantilizing children (and often harshly judging schools or families for perfectly appropriate expectations).

Much has been said in the media regarding the stark differences in age perception of youth depending on their race and class. We see poorer and browner teens referred to as "men" and "women," while richer and whiter adults in their 20s are referred to as misguided little boys and girls.

As a clinician with a background in development psychology, as well as personal and professional interest in how youth of color and youth with disabilities are perceived, I am noticing this trend actually starts much earlier than this. I am regularly seeing parents referring to preschool-aged or school-age children as "toddlers," elementary-aged youths or even teens as "young children," and young adults as "children." While some of this may just be related to general trends toward longer childhoods in industrialized nations, I do see problems arising with the application of many of these terms to older children than they in fact refer to.

The media tends to use infantilizing terms to portray innocence and garner sympathy. A 3- or 4- or 5-year-old child may be referred to as a "toddler" when reporting on a story in which such a child was mistreated. This may not be as problematic when the context of the story is something such as a stranger assault or other crime we can all agree is inexcusable, but it may be problematic when there is debate as to what constitutes appropriate parenting or appropriate levels of independence for a child. A news item stating a parent had a toddler walking to school alone sounds shocking, as toddlers are 1 or 2 years old and certainly should not be alone, but it may be inappropriately sensationalizing the story (thus casting blame on the parent) if the child is 5 or 6 and walks a short distance to school or to a bus stop as many children do at this age. If the child were appropriately referred to as a Kindergartener or a school-aged child, the story would no longer sound as if it depicts a problem. (And it is very likely there is no problem, depending of course on community norms, community safety, and the child's own skill level.) 

Similarly, using "young child" to refer to an 11-year-old can also be extremely misleading. I have something separate in the works regarding the number of bogus child welfare reports I see regarding "inappropriate sexual knowledge" when it is in fact age-appropriate, but sticking to the language issue, an 11-year-old is an adolescent, a school-aged child, and depending on the community is often a middle-schooler. Is it concerning if an adolescent is familiar with basics of sex and drugs? It shouldn't be, and the World Health Organization standards state that they should know these things in the 9-12 range and should be learning them in their middle school health classes, so this knowledge should actually be solid upon entering adolescence. Is it concerning if a young child has extensive knowledge of these things? Depending on context, it may well be. An 11-year-old is twice the age of a young child though, so no one should be referring to an 11-year-old adolescent as a young child.

Correctly applied terms, along with definitions and sources:

Infant: A child from birth up to 12 months of age, or sometimes the age the child starts walking and talking (in a developmentally typical child)

Toddler: A child from the 12 months and/or the walking/talking stage through 2 years 9 months, or through 3rd birthday. May begin anywhere between 12 and 16 months if basing age ranges on child care regulations, thus when the child moves from "the infant classes" to "the toddler classes." 

Young child: A child under the age of 4/5/6 depending on the context. Generally understood to mean a child who has not reached local school age. When referring to a developmental stage or a classroom grouping, this usually means children from about 2nd birthday to 6th birthday. This may sometimes be used to refer to pre-pubescent children (see information regarding puberty below) but "child" or "school-age child" is a better designation. 

Preschooler: This might mean any child who has not yet reached the local Kindergarten age, but as a developmental stage, refers to children from about 3rd birthday to 5th birthday.

School-age child: Depending on local norms, this might refer to children four and older, five and older, or six and older, and also might continue through high school or may end at the end of elementary or middle school. This may include Pre-Kindergarten age or Kindergarten age, or might start at first grade or equivalent.

Child: Generally anyone under the age of 18. May be anyone under the age of 13, if differentiating between children and teens. An organization might have "child" grouping/pricing/rules for those under 10/11/12 and might consider those past the cutoff to be teens or older children. 

Youth: Might be synonymous with "child," particularly in public health contexts. May also be used in programs that divide children into child/youth or child/youth/teen, perhaps making the switch between child and youth anywhere between 6 and 12.

Teen: Anyone 13 to 19. Some organizations may categorize youth as "teens" starting as early as 11 or at late as 15, or based on attending either middle school or high school, and may consider a high-school graduate to no longer be a teen, but the term "teenager" literally refers to an individual whose age has "teen" in the number. 

Adolescent: Anyone 10 to 19. This one is quite clear and doesn't have much leeway. 

Tween: This tends to be a less-formal designation, and refers to youth who are not yet teens, but typically would be independently reading, writing, using technology, and able to spend some time in the community alone (i.e. "in be-tween"). This range may encompass around 8-12.

Older child: This may refer to any child who is not a "young child," i.e., anyone over about 4-6, or might refer to older elementary students, similar to "tween." In specific contexts, it may just refer to children who are older than the typical age for a particular issue or program, for instance, an article on tantrums in the older child or bedwetting in the older child.

Regarding stages of puberty:

It is also worth discussing the stages of puberty, as terms relating to puberty are 1) frequently incorrectly used, with many believing children are "prepubescent" until mid- or late adolescence when puberty is complete, or believing "puberty" refers to one specific event during puberty and 2) incorrectly believed to correlate with emotional or intellectual maturity. Similar to the developmental age ranges, there is a trend toward using "prepubescent" to refer to adolescents or middle-schoolers, who typically will have begun puberty.

Terms relating to puberty should only be used when directly relevant, when physical/sexual maturity are what is being discussed.

It should be noted that these stages can vary based on race/ethnicity and genetic/hereditary factors. Black children assigned female at birth typically reach the stages of puberty a year earlier than white children. 

Prepubescent: This refers to the stage when no signs of puberty have occurred, typically under 8-9 in those assigned female at birth and under 10-11 in those assigned male at birth. The first signs of puberty are referred to as Tanner Stage II, and a child is no longer "prepubescent" once this stage has been observed. 

Puberty: Occurs in stages over a span lasting around five to seven years, which roughly coincides with adolescence for those assigned male at birth. In those assigned female at birth, may begin a year or two before adolescence and be complete by mid-adolescence. 

Pubescent: This term is not clearly defined. Medical dictionaries typically state this term refers to a child who is approaching or has just begun puberty. It is often colloquially used to refer to an adolescent who has completed puberty or reached an arbitrary stage of puberty. Usage varies in different non-medical dictionaries, with some stating it refers to an adolescent with an adult body; probably best to avoid the term as it is not clearly defined. 

A note on youths with disabilities/neurodivergence:

Overall developmental stages are assigned by age, not abilities or interests. The disability community repeatedly informs us that referring to a child or adult as functioning like a younger person is problematic and offensive. A 13-year-old who has minimal language and whose overall skills best match Piaget's sensorimotor stage of development is an adolescent, not a toddler. 

A youth with disabilities may lack skills that prevent them from safely engaging in certain tasks, such as being home alone as long as peers, or driving a motor vehicle. Other youths with disabilities may do these things safely. Barring acute safety risks, it is appropriate for youths to do things in accordance with their developmental stage. It is appropriate for any adolescent to date, watch horror or romance films, hear and use profanity (and be informed that it is not appreciated in certain settings!) Some adolescents with disabilities may not have interest in age-normative tasks, and it is also not appropriate to tell them they are "too old" for hobbies or interests that are not harming anyone. Other adolescents without disabilities may also have no interest in age-normative pursuits for various reasons (for instance: asexuality, focus on religious or cultural pursuits, focus on academics or hobbies, or simply different preferences). 

When assessing whether the level of freedom or exposure to information is appropriate for a given youth, we want to simply look at the age and whether there is an acute safety issue present. Take, for instance, a middle-schooler with Down syndrome who speaks about alcohol and drugs being fashionable. Is this normal behavior in early adolescence? Yes, certainly; professionals working with youth are intimately familiar with all of the substance references present in popular music and films. Is the youth abusing substances? If not, there is no issue. The youth may need reminders as to when discussing substances is appropriate, just as many middle-schoolers do. Should we jump to the conclusion that there is abuse/neglect occurring, based on the fact that many parents of disabled youths shelter their youth? No; this knowledge is normal for the age, and the experts on health education recommend that disabled youths not be excluded from these teachings. There is generally no reason to assume that disabled youths obtained such information from anywhere other than health education materials, peers, or age-appropriate* media. (*Age-appropriate in the sense that it is culturally normal, not necessarily that it is entirely positive for adolescent development.) 

Similarly, when disabled youth report dating, or having a gender identity or sexual orientation, professionals need to be aware of when these things are normal. It is normal for youths to state what their gender is at around 2-3. It is normal to discuss wanting to date or marry a same-gender or different-gender peer around 5-6. (Many LGBTQ+ folks are not aware of their identities until adolescence or adulthood, but a good many are aware during the preschool stage if provided with role-modeling and language to be aware of this.) 

Youths may express that they are "dating" during the pre-adolescent years, and this typically consists of nothing other than stating they are together. This is completely normal behavior for disabled, nondisabled, LGBTQ+, and cisgender/heterosexual youth. During adolescence, dating may progress into spending time together and might involve a physical relationship. Unless there is a reason to believe coercion is occurring, this is normal behavior. A relationship between a disabled and nondisabled person does not necessarily indicate coercion, and consultation should be sought from disabled experts. 

Monday, March 28, 2022

Another free CEU for Massachusetts LMHCs, psychologists, social workers, nurses, educators

Another free one from William James College, April 8 from noon-1pm, on suicide prevention.  

Offers one CEU for Massachusetts LMHC (or any state that accepts NBCC), psychologists, social workers, nurses, educators.

[Usual caveat that I have no affiliation with the training or WJC other than being a field training supervisor at times. I generally post any CEUs I encounter that are free or low-cost regardless of topic or quality, unless they appear seriously problematic, in which case I may post them anyway and encourage people to attend and engage in advocacy as appropriate. I also at times post trainings with trainers or organizations I do personally endorse, and will specify when this is the case.]

Friday, March 18, 2022

Article about food insecurity in those aging out from care

I am quoted in this piece about aging-out youth, which is overall quite well done. The author and I had some interesting conversations, and she seems to have a good handle overall on social justice constructs.

My approach to this problem, which the author alluded to in quoting me but which wouldn't really be a relevant focus for a food policy publication, would of course be that no youth should be aging out of foster care. Research shows that most youth in care do not need to be there, and whatever "neglect" resulted in their removal can usually be remedied with just money. I unfortunately cannot remember whom (please leave a comment if you know), but a presenter at the Columbia Journal of Race and Law Strengthened Bonds conference last year pointed out that middle-class families experience the same issues that result in foster care for poor families (health issues, substance misuse), but solve these by hiring caregivers and homemakers. The reason we don't just use public funds to do the same thing and keep families together is that federal laws provide huge amounts of money for foster care and adoption but incredibly little for family stabilization. This is largely because the primary lobbying group for child welfare policy is connected to a private evangelical adoption agency.

The few children who are truly not safe at home can generally be placed safely with a relative or friend, but usually are not due to the dynamics illustrated in The New Jim Crow and Shattered Bonds, in which an overwhelming number of poor and/or Black adults have criminal records or child welfare records, not because of anything truly unsafe, but because communities are disproportionately policed. The policies that Richard Wexler calls "Better Safe than Sorry" approaches mean that child welfare agencies are typically opposed to placing a child with a perfectly safe relative who has a child welfare history involving school attendance or disagreeing with a medical provider over a minor issue. Children who are with people they know have much better outcomes, grow up knowing their family of origin, and generally go home faster. They also are much less likely to "age out" of care and have nowhere to live even if they turn 18 still living with a relative.

This brings me to my next issue, which is that the children placed in foster care with strangers shouldn't be "aging out" either. We need massive reform in terms of the attitudes and expectations of the child care system. I cannot imagine having the attitude that any child who has ever stayed in home would not be welcome indefinitely. Most people do not kick biological children out of their homes at 18 (and those who do are viewed as harsh and heartless), so I do not know why this is considered acceptable for children in foster care. Children in care are viewed as expendable though, even (especially?) by the system. The system allows parents to "give their notice" in stating that they no longer want a particular child in their home, and then are permitted to continue fostering as if they did not just abandon a child. There is slightly more scrutiny when parents do this with children for whom an adoption has been finalized, but I also see that occur (and have seen it encouraged by clinicians) and again, it is not treated the same way as parents who abandon a biological child. The harm to the child is obviously the same in all cases. 

Monday, March 14, 2022

Free 2 CEU course for LMHC, SW, psychologists, nurses, educators

William James College is offering this free course on group therapy via telehealth. The list of pending and approved CEUs is here.

[Usual disclaimer that I have no affiliation with the presenter or organization other than having been a fieldwork supervisor for the college. I post pretty much any free/low-cost CEUs I find unless they seem highly problematic, and even then I sometimes post them and encourage people to attend and provide healthy pushback.]