Tuesday, October 10, 2023

Free online DC 0-5 training with 16 MA LMHC/LICSW/NBCC/NASW CEUs

For Massachusetts providers only. Get half of your biannual CEU requirement completed for free. It's this October, which is unfortunate for those of us who already have 2022-2023 completed, but fortunate for those who have waited until the last minute. (Or social workers; I think y'all renew in even years?)

I've taken the training in the past and it's actually quite good. I definitely encourage people to sign up if you can, especially if just to let folks know there is demand for online/accessible options for these types of trainings. 

Information here.

[Usual disclaimer that I have no affiliation with this training or organization and just am passing along free/low-cost CEUs.]

Friday, September 15, 2023

Found in the wild: A textbook example of well-meaning adults jumping to conclusions

This Reddit forum, r/foundpaper, is a place where people post, well, found paper – basically any sort of note, doodle, list, etc. that someone found and thought was interesting. The commenters then chat freely about who the author might have been, what they might have intended, and so forth.

Page from a lined composition notebook, in pencil, in what looks like a child's handwriting, and says "I have every right to feel sad. I'm allowed to make mistakes. I can be kind to myself. I'm doing the best I can. My best is good enough. Calm place: Grandma's house."

So, this post and the ensuing comments particularly spoke to me as a child welfare clinician, advocate, and reformer. 

The comments on the original post are largely along the lines of people expressing concern, stating things assuming the child has a very hard life, and expressing that this is extremely sad as an elementary-schooler shouldn't have any reason to have these kinds of thoughts. A number of commenters state that they hope the child is able to go to grandma's regularly, and even a few stating they hope grandma can get custody. (Note: We have no way of knowing who is the primary caregiver.)

I also noticed the post has been reposted to a C-PTSD subreddit, with the headline, "can’t help but think that kid might end up using this subreddit in a few years."

For those who are unfamiliar with Reddit, let me mention that compared to the general population, Reddit's demographics skew very heavily toward young (teens and 20s), male, white, highly educated, and higher income. Reddit also skews sociopolitically toward those who vote democratic, but at the same time aren't particularly who I would call progressive, as they don't have a lot of direct experience with marginalized folks, don't really believe in systemic oppression, and tend toward some savioristic attitudes. 

Those of us who are experienced parents and/or who have worked in schools of course recognize that this journal entry is most likely from a student participating in a standard elementary school social-emotional curriculum. In these groups, students do exercises to teach coping skills for stressful situations and learn about healthy ways of framing things. The students might do something like look through a list of affirmations or a "child's bill of rights"-type document and write down some items that are particularly important to them. They might be given an assignment such as visualizing somewhere where they feel particularly calm, so that they can visualize this place when they are feeling stressed. Those who are only familiar with wealthier, whiter schools may not have encountered this type of learning, which is unfortunate, as students can benefit from this learning without it needing to be a reaction to community trauma. 

Students before late adolescence are not typically authoring these kinds of statements independently nor seeking them out, regardless of stressors in their lives. This wouldn't be language that children would have outside of having learned it from social-emotional media – or from engaged caregivers who are actively teaching their children social-emotional skills at home! 

The attitudes in the thread mirror many of those that I see from well-intentioned adults who make inappropriate reports to the child welfare system or display similarly poor savioristic boundaries with families: 

  • Assumptions that a child using mental health language is traumatized (come on -- are people really not familiar with the current trend of all the pop-psych content on TikTok, some good and some questionable, that gets filtered down to younger kids?)
  • Assumptions that the presence of positive coping skills indicates that these were developed in response to severe issues rather than taught proactively by caring adults
  • Lack of familiarity with child development and failure to recognize that this language is being parroted from somewhere appropriate, likely school, or could be from a scouting program or the OWL health education curriculum
  • Lack of familiarity with what is routinely taught in schools at various ages
  • Projecting adult experiences onto pre-adolescent children ("As a 26-year-old, I only find myself needing to reminding myself that everyone makes mistakes in pretty extreme situations, so this must be the same for someone with only 8 years life experience who is just starting to learn how to tolerate distress")
  • Assumptions that preferring to seek out Grandma or a friend's parent suggests a serious deficiency in the primary caregiver(s) rather than understanding that this is not unusual in healthy children (or recognizing that a child who is prompted to visualize a calm place is not likely to choose home or school, as these places are by definition not a calm respite from routine life stressors)
  • Overidentification with the child, especially involving the logical fallacy of affirming the consequent ("I am an adult with C-PTSD and I use these coping skills, thus a child who knows these skills is experiencing trauma")
  • A "divide and conquer" conceptualization of the primary caregiving unit in which someone believes a child has been through some hard things, therefore this means the child is alone without adequate support ("kids from good families don't have these issues"), rather than the more common scenario in which parents are adequately supportive but this doesn't magically stop the child from experiencing difficult things
  • A lack of familiarity with the experiences of marginalized people, thus not having mental models of communities and families who have experienced difficulty through no fault of their own and have used resources to get through it adequately 

For those who want to support children (and adults!) in a non-alarmist way, you need to be familiar with what constitutes the wide range of normal for kids of all different backgrounds. This requires curiosity, listening, and cultivating a mindset in which the practices of all different races and income levels are seen as valid. 

If your daily interactions with friends and family don't put you in contact with a sufficient degree of exposure to different experiences, social media is free. Follow, but don't engage, in spaces where parents are discussing what's being learned in urban public schools. 

Practice your own mindfulness skills and notice when you are jumping to conclusions or filling in information that isn't there. Use something like the THINK skill from DBT to consider several possible explanations for something that is observed. As clinicians, we should strike a balance between Ockham's Razor (when you hear hoofbeats, it's probably a horse, not a zebra) and Hickam's Dictum (though it could be a zebra, or one of each). We don't want to rule out the possibility that a child writing about coping skills is doing so because of a concerning situation, but it's also most likely that everything we are seeing is pointing to this not being the case based just on what the child has written and what we know about child development and social-emotional curricula. 

Thursday, September 7, 2023

How to put feelers out for a referral without sharing client information


Looking for a therapist for an English-speaking 12-year-old Latino trans boy with a diagnosis of ADHD, taking a stimulant medication, currently attending Lepidoptera therapeutic school in West Batman via public school IEP process, school is appropriate and uses wraparound model where they will want to consult frequently. Has mentor and support group through Esperanza Community. Child witnessed the severe assault of his cousin who he is close to. Child lives in Old Poptart Village with parents and maternal grandparents, family doesn't have a car, able to travel by subway, can get rides if it's on Wednesday evenings when the aunt watches him. Plays Dungeons & Dragons, interested in anime, Minecraft, Roblox, likes to draw, likes 3D printing, likes reading. Has Purple Shield HMO plan and able to private pay on a sliding scale.


  • Looking for a therapist for a middle-schooler (sharing with family's permission)
  • Telehealth or transit accessible in Metro area, some potential for further out areas
  • English-speaking
  • Trauma-informed
  • Willing to collaborate with wraparound providers
  • Competent with multi-generational Latino families
  • Competent with trans/queer/gender-diverse folks
  • Neurodiversity-affirming
  • Arts-based approach and/or approach incorporating gaming/geek culture a plus
  • Purple Shield HMO or sliding scale

See what I did there? When sending referrals to one person, a forum, a listserv, or absolutely anywhere, just state what qualifications the clinician needs. Don't share any information about the client or family. Even when you have permission, don't share personal information. Note that when we focus on the therapist's qualifications, it is easier to focus on broader demographic or clinical needs, rather than specifying exactly what the issues are or to which family member(s) they apply.

Also, don't do this:

Looking for therapist for an 8-year-old.

Even if the person is of the dominant culture in most every regard, there are still cultural considerations, as well as considerations for an appropriate fit for a particular individual and family. Get out of the habit of dominant-as-default. These postings also suggest that the person making the referral isn't trusting that the client/family are the experts on themselves and get to decide what approaches and knowledge are needed, as well as imply a dismissive and saviorlike view of the person in which any therapist is surely an improvement over what is currently happening. Asking someone to engage in therapy is asking them to take extensive risks and do hard work; surely we owe them a little more care than this sort of "any therapist will do" approach. 

Friday, June 2, 2023

The two kinds of pet people on Zoom meetings

I know, I usually write posts that are more directly related to clinical or social justice advocacy topics, but I'm feeling compelled to share this semi-adjacent observation.

So, I've determined there are exactly two types of people when their pet makes an appearance on a work-from-home meeting and someone greets the pet or compliments them.

1) Ignores the remark, seems vaguely annoyed it has been made. May explicitly tell the animal enthusiast they are wrong to have noted the animal*. May express annoyance at the pet for existing. 

2) "Oh, thank you! This is Boots, and he'll be 3 years old next Monday, and his favorite food is cheese, and I just bought him a sweater which I can show you next time."

*I once accompanied a court-involved family on an initial intake meeting with a mental health provider, in which their struggling teen was polite but pretty reserved, the provider's dog appeared, and the teen appropriately complimented the dog and guessed the breed. The provider, apparently deciding not to take the opportunity to build rapport in a moment when a high-needs adolescent was easy to engage, told the kid we were discussing school performance, not the dog. OK then.

Monday, April 10, 2023

Join me on April 18 for a training for feeding professionals on supporting families affected by the child welfare system

I will be presenting a live webinar hosted by esteemed feeding expert Katja Rowell. CEUs are available for OTs and SLPs, and other disciplines can likely submit the training for one-time approval. We will be discussing how this is a system that has been demonstrated to err in both directions as well as dispelling several myths providers typically believe regarding this system.

I have worked with Dr. Rowell on some other projects related to the child welfare system, such as this guide on the NACAC website in which we dispelled an often-repeated myth in child welfare regarding food preoccupation in addition to giving other tips on trauma-informed feeding practices. Clinicians and foster parents are typically taught to view food issues in children as a sign of having not received consistent food or care in previous homes. While this can be one cause, if we set aside biases we are taught regarding families involved in the system, it should be obvious to clinicians with a solid understanding of attachment that experiencing a sudden change in caregivers (such as being removed from home...) will often also cause children to behave in ways indicating they question whether their needs will be met consistently. Children who act unsure as if there will be enough food have not necessarily experienced a shortage of food, but probably have had some sort of caregiving or security abruptly lost – or may have sensory differences, short-term memory difficulties, or other issues that may or may not be related to attachment or loss.

While our upcoming training is geared toward those who encounter children with feeding or eating concerns in their work, it points to a bigger approach I am looking to take these days: rather than continuing to present to communities already engaged in changing/improving/abolishing the child welfare system, who tend to be quite aware of the harms done, I am taking my writing and training to other provider communities that interface with this system but don't have much of an understanding of what goes on in it. My aim is to educate and guide providers to practice in a way in which we fulfill our legal and professional obligations while prevented demonstrated harm done by overreporting and/or carelessness in documenting and sharing information. 

As I will discuss in more depth during the training, I have come to believe that much of the unnecessary child welfare involvement and overreporting results from providers who erroneously assume that 1) the system affords families due process and that 2) investigations involve evaluation by experts in the matter at hand. 

For instance, when I complete clinical child/family evaluations for attorneys through the public defender's office, I typically interview the person who made the initial abuse/neglect report, among other relevant parties. I might have a situation such as a toddler who was removed from home due to a broken arm, and I will ask the provider who made the report to tell me why they believe there was abuse or neglect. They often respond by telling me they don't have any reason to believe this, but they generally report certain injuries in young children so that the CPS agency can determine what happened. When I ask further questions regarding what would need to be done to appropriately determine this, it becomes clear that the provider assumes CPS investigators enlist radiologists with forensic expertise and folks such as accident reconstruction experts – the same sort of things I assumed before I began working closely with this type of case and learned that the decisions are made solely by CPS investigators with a bachelor's or sometimes a master's degree and no specialized training. Providers working in an ongoing fashion with families involved in the system also speak to me using language indicating that they believe a judge determined the child to have been abused with a high degree of certainty – in reality, what happens is the CPS agency petitions the court to take custody of the child based on the CPS agency's determinations, the family is given no opportunity to respond, and the court typically enters the CPS agency's testimony as fact.

It is vitally important for providers to understand this dynamic: When we see children and families in our specific professional roles – in this case, as experts in pediatric feeding and eating concerns – those of us with independent professional licenses and the clinical and research experience that go along with it possess a much higher level of expertise in assessing feeding and eating dynamics than nearly anyone employed by a CPS agency. When we have concerns, our job is, well, to do our job. It is not to pass the buck to someone who does not possess sufficient skills to assess the situation and who has legitimate reasons to err on the side of harming families. The law requires us to report "reason to believe a child has been abused or neglected;" we should not be reporting "concerns" or "referrals for additional services." In order to prevent harm, we need to be employing our own expertise and consulting with and referring to other experts, and only reporting if our expert assessment has in fact revealed abuse or neglect. 

Please note that none of my trainings or writings are intended as criticism of individual workers, many of whom are trusted colleagues doing some pretty remarkable work in a very broken system. Rather, I am working to bring awareness to providers of a system which, by design, affords families considerably fewer rights than the criminal system – and which is frequently argued by experts to be blatantly unconstitutional in its current form. Without a thorough understanding of this system, most clinicians overreport abuse and neglect well beyond what is legally required, as well as defer to biased and perfunctory abuse/neglect determinations as fact. In order to uphold our ethical obligations to refrain from harming our clients, clinicians need to be informed about the workings of this system.

To register for the April 18 training, click here. Please e-mail me as well if you are interested in a similar training either in-person or virtually.