Tag Archives: Mental Health

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New interpretation of public charge rule poses health threat to immigrant groups

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Recent immigrant mass detentions and deportations, including the practice of family separation and detention of children, have been controversial enough. Now, a new interpretation of the public charge rule, based on a provision of the Immigration and Nationality Act, will enact changes that some states claim target poor immigrants of color.

Immigration policy already makes it very prohibitive to become a U.S. citizen without additional rules. Since 2016, the citizenship application wait was an average of 4 to 6 months. Now, it takes up to an average of 10 months to a year.

In major cities, like Atlanta; Washington, D.C; and New York City it can take up to two years. The old public charge rule is being enforced to make it more difficult to achieve legal residency, and states are already challenging this mass green card denial in street protests and lawsuits.

Public charge has been used in immigration law since 1882, when the Chinese Exclusion Act targeted: “…convicts, lunatics, idiots, or any person unable to take care of himself or herself without becoming a public charge.” Given this wording, one can imagine how wide the net is here.

Predictably, it was used then to discriminate against single mothers and working-class people.

It is now being employed to further the Trump administration’s immigration policy goals, which have been controversial since Trump announced he would build a border wall and make Mexico pay for it.

According to the National Immigration Law Center, public charge has been applied in two ways: “(1) when a person applies to enter the U.S. or (2) when a person applies to adjust immigration status to become a lawful permanent resident (to get a green card). You apply for a visa or green card by submitting information on a form. Using the information from that form and from the interview that follows, the government decides if you are likely to become a public charge.”

With this expansion, public charge includes any noncitizen resident/worker who seeks permanent legal citizenship and may rely on Medicaid, housing, vouchers, and food stamps.

But it goes even further. The law also includes noncitizen residents who have ever used the programs. Will they go into old government records to search for people who once used these programs as an excuse to deny permanent citizenship?

In June 2018, the Department of Health and Human Services (HHS), which handles children’s detention, started sharing fingerprint submissions, “background checks, proofs of income and home visits” directly with Immigration Customs and Enforcement (ICE).

Does the public charge rule open up grounds for HHS to collaborate more directly with ICE in a broader capacity? Is the agency tasked with overseeing essential health services poised to become an agency along the lines of ICE or the Department of Homeland Security?

The Kaiser Family Foundation reports that: “The rule will likely increase confusion and fear broadly across immigrant families about using public programs for themselves and their children, regardless of whether they are directly affected by the changes.”

There are anywhere from 11 to 22 million noncitizen residents in the U.S. Many may experience poverty due to financial hardships in their native countries (frequently the reason they leave in the first place.)

They also have a difficult time getting housing and jobs because they cannot use proper documentation. There’s even the health toll of migration itself — especially for people crossing the weaponized U.S. border from Mexico and Central and South America. This is not to mention the additional mental health stressors resulting from the “confusion and fear” facilitated by the HHS and other noncombat-style government agencies.

The new rule considers noncash benefits and uses factors such as “age, health, household size, income, assets, debts and education and skill levels” to determine citizenship eligibility. These criteria add an additional speculative dimension to the rule, leaving it open to charges of profiling and wild bias.

California, Maine, Pennsylvania, Oregon, and D.C. are seeking an injunction to halt the rule, stating that the rule unfairly targets: “marginalized populations, such as children, students, individuals with disabilities, older adults, and low-wage working families.”

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5 ways to reduce alarm fatigue at your hospital

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Working at a hospital, you know that alarms on monitoring equipment in your ICU, step-down unit and general wards are a major challenge for your staff and patients. When false alarms happen, patients panic unnecessarily and staff become desensitized, increasing the chance of a missed emergency.

The noise pollution can fray nerves and keep patients from resting so they can heal faster. Stumped as to how to handle this issue? Science can offer you innovative answers.

Try implementing these pieces of research-driven advice to ease strain and make your wards more peaceful:

Make sure alarms are checked out promptly.

A study from the Acoustical Society of America found in a survey of patient experiences that 90% of clinical alarms went unanswered at bedsides. Make a mandatory policy that staff members in each ward use a time-sensitive system to check every alarm for patient safely.

If staff members are busy, work out a relay system so there’s always someone available to get to a bedside quickly.

Fix faulty equipment immediately.

This should be a no-brainer, but the Acoustical Society of America study also found that there are, on average, an astonishing 8 million alarm errors in hospitals per day.

Make sure malfunctioning equipment is not adversely affecting your patients in any way. Reprogram or replace the items immediately.

Use daily patient assessments to cut back on use.

Researchers at Cincinnati Children’s Hospital report that daily assessments of patient needs can help desensitize caregivers to alarms, either by safely allowing for patients to be taken off monitoring or by pinpointing an increased need to pay immediate attention if an alarm goes off for specific patients.

Keep team members in the loop regarding patients’ changing needs throughout each day.

Tailor alarms to each patient’s needs.

A study from the University of California, San Francisco found that 2.5 million alarms went off in one surveyed hospital in a single month. That prevalence of alarms can lead to patients experiencing anxiety and depression. In cardiac patients, it can cause small changes that could be responsible for ignoring a life-threatening heart rhythm crisis.

Tailoring alarms specifically to a patient’s condition, especially for cardiac patients, can alleviate these concerns dramatically. Work with your cardiology teams to facilitate this and ask your doctors to clearly explain why alarms will go off and in what situations.

Decrease “warning” alarms audibly.

A study from Boston University Medical Center found that differentiating between “warning” alarms and “crisis” alarms can decrease noise in hospitals can decrease audible noise significantly.

“Crisis” alarms should be audible and responded to instantly, while “warning” alarms can be programmed to sound different and can be rigged to be silent but viewed immediately at the nurses’ station.

Warning alarms should never be ignored — but they can be responded to more efficiency using this kind of strategy. Patient safety is always your first priority — deliver it as calmly and promptly as you can in all situations.

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Providing students opportunities to self-regulate

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Our students have a lot going on inside and outside of school. Our students might be undergoing trauma, stress, and anxiety. To support the social and emotional well-being of our students, we must teach and provide space for students to learn how to self-regulate.

The Collaborative for Academic, Social, and Emotional Learning (CASEL) defines self-regulation as, “the ability to successfully regulate one’s emotions, thoughts, and behaviors in different situations — effectively managing stress, controlling impulses, and motivating oneself.”

Our goal is to normalize stress, anxiety, frustration, and the overall idea that, “It is OK to not be OK.”

As such, we need to also teach our students that there are various coping strategies and acknowledge that we all will use different techniques to self-regulate. We want our students to learn how to use the strategy that will help them handle their emotions so that they can do their best learning in our classrooms.

By allowing students a few moments to use their coping technique when needed, they can learn how to transition back to participating as a productive classroom citizen. Just as we would provide students explicit instruction on academic content, we want to provide explicit instruction and expectations with the various coping strategies we allow students to use to regulate emotions.

For younger students, I recommend beginning by modeling and sharing just a few choices; for older students, let them try out a few to see which technique will support them with self-management. All students benefit from clear expectations, areas of the classroom that allow for various self-regulation techniques, and time to discuss and reflect on their chosen strategy and how it helped them self-regulate various emotions.

This list below is not an exhaustive list of coping strategies but a great starting place to provide students choice to self-regulate based on their respective moods and emotions.

Calming Techniques

  • Deep breathing with a pinwheel
  • Deep breathing with bubbles
  • Deep breathing with prompts
  • Deep breathing shapes
  • Deep breathing with a favorite toy
  • Deep breathing with a feather
  • Deep breathing monitoring your pulse with your hand
  • Explosion breaths
  • Hands to shoulders
  • Hoberman sphere
  • Volcano breaths and check your air
  • Focus on sounds
  • Take a mindful yoga break
  • Imagine your favorite place
  • Have a mindful snack break
  • 54321 grounding technique
  • Grounding self-talk about the present
  • Think of your favorite things
  • Picture the people you care about
  • Say the alphabet slowly/backwards
  • Remember the words to a song you love
  • Run water over your hands
  • Toss/squeeze a squishy ball
  • Touch things around you — velcro strip, porcupine pen, etc.
  • Make a fist and then release it
  • Progress muscle relaxation
  • Positive self-talk (provide visual stems examples/talk bubbles)
  • Take a drink of water
  • Counting to 5 or 10
  • Block out sounds with noise-cancelling headphones
  • Watch a lava lamp or sand timer
  • Plow a miniature Zen sand garden
  • Shake a glitter/calming jar
  • Use your senses
  • Trace a pattern or therapeutic color book

Distraction Techniques

  • Write a story/poem about the issue or solving the problem
  • Crossword/Sudoku/game
  • Write about an act of kindness to you, or one you want to share
  • Creative thinking
  • Create your own problem/question for content material
  • Write about a fun event
  • Laughter (watch 30 seconds of something funny)
  • Sort something (blocks, straws, etc.)
  • Learn something new
  • Count backwards from 100
  • Repeat a mantra, “I am calm.”
  • Blow bubbles
  • Sing a song
  • Squish some putty/clay
  • Gratitude journaling
  • Rock in a rocking chair

Physical Techniques

  • Squeeze something
  • Use a stress ball
  • Shred paper
  • Pop bubble wrap
  • Use a sand tray
  • Climb steps
  • Hold and toss a small stone
  • Shuffle cards
  • Make something
  • Use a fidget
  • Walk
  • Roll a golf ball under your feet
  • Push against a wall
  • Dance or pace in marked area of the classroom
  • Punch a safe surface or air
  • Swing on a swing
  • Chant or sing (flocabulary.com)
  • Brain break (gonoodle.com)
  • Stretch
  • Yoga
  • Crinkle tissue paper
  • Take a coloring break
  • Fold up like a pretzel
  • Hop like a bunny

Our goal is to provide our students with the tools and techniques they need to focus and pay attention, keep their emotions in check, adjust to change, and handle the frustration that is sometimes a part of interacting with others or learning something new.

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VA disability compensation claims: Avoiding the pitfalls

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If you’re considering filing a claim with the VA, you should know that there are good three reasons why you should do it.

The first is that, if you were injured while in the military, you should have your medical problems determined to be “Service Connected.” This allows you to have the problem treated at no cost to you, and depending on your rating level, it may allow you access to higher levels of medical care within the VA healthcare system.

In my case, I decided to pull the trigger on filing a claim because my orthopedic surgeon told me that I would eventually need hip replacements due to service-connected injuries, and those are not cheap.

The second reason to file a claim is that guaranteed income greatly increases your credit worthiness. It could make the difference between getting a home loan or not. Lenders assign a higher value to disability compensation income than earned income because it is not taxed.

The third reason is that increased numbers of claims lead to an increased budget for the VA, which translates to better care for vets.

Before you file, please consider the following.

Never Go It Alone

The relationship between the VA claims department and the veteran is adversarial in nature. The claims process is analogous to a personal injury civil suit or a worker’s compensation claim.

The VA is under no obligation to help you with your claim. Oddly enough, the VA seems to be the only U.S. government agency that actively tries to spend less of their budget (by denying claims).

There’s no need to feel daunted. There are numerous Veterans Service Organizations (VSO) that have been established to help veterans with their needs, especially in filing a disability compensation claim. The best, in my opinion are the DAV, the VFW and the American Legion.

Your state of residence may also have a Department of Veterans Affairs, but I believe you will have a better result if you go with one the previously listed organizations. Of the big three, the DAV is the best at claims assistance, in my opinion.

The first step is to call a VSO office and make an appointment to speak to a VSO representative. There are local chapters in most cities. However, if you are within a reasonable driving distance, I recommend going to an office that is co-located with a VA Regional Office.

The VSO representatives who work in these offices know the VA raters personally. They have coffee and lunch and receive training from them. So, they are in a good position to stay on top of your claim.

When you go to your meeting with the VSO, you will want to take your medical records, a DD-214, and any civilian treatment records. Also, take photocopies of prescriptions for any medication that you are taking, or have taken in the past that pertain to your claim.

If you are married or have dependent children, take copies of your marriage certificate and birth certificates. The VA adjusts your monthly payment upward if you have a spouse or children.

You will also want to take buddy letters, as these are very important supporting documents. I will discuss buddy letters further in this article.

If you are filing a claim for a behavioral disorder, such as PTSD or depression, you should take any court records or employment records that pertain to the claim. Also, take any records of counseling that are relevant.

You will have to sign a special power of attorney authorizing the veterans’ organization to represent you with the VA. The VSO representative will review your files and fill out a claim for you.

At this point, you should start an account at ebenefits.va.gov. It’s a website for tracking the progress of your claim. Using the website can be frustration because it has functionality problems.

Once you have completed these first steps, it’s time to hurry up and wait.

A Word about Buddy Letters

The term “buddy letter” is a nickname for VA form VA FORM 21-4138, Statement in Support of Claim. If you’re filing for PTSD, there is a different form, VBA-21-0781-ARE, Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD).

These forms allow you and your unit members to explain what happened in your or their own words. When you are filling out these forms, be truthful and try to put down every detail about the incident that you can remember.

The Compensation and Pension (C&P) Exam

The VA contracts private healthcare providers to perform C&P exams. Within a few weeks or months of filing your claim you will receive a letter from either the VA or a contracting company informing you that you have an appointment.

Do everything humanly possible to make this appointment, because if you miss it, it will take “forever” to get another one. The only valid reasons to miss the C&P exam involve the loss of life, limb, or eyesight.

When you go to the C&P exam, they should have copies of your claim and records. But you can take copies if you like.

At the C&P exam, do not be a tough guy or tough gal. You were taught to “suck it up and drive on” in the military, but the C&P exam is the time to complain. If it hurts, be honest. If you can’t lift more than 20 pounds, be honest. Be yourself but complain like you’ve never complained before!

Playing the Waiting Game

After your C&P exams, it will be awhile until you hear from the VA again. You may be asked to submit to further examinations. Just be patient. If you are curious about the status of your claim, it’s best to call your VSO representative. You can check the status on the eBenefits website, but the information is often not up to date.

Whatever you do, do not contact the VA directly.

After much time has passed, you will one day open your mailbox and find the “Big White Envelope.” This will contain the VA’s determination regarding your claim.

If you are happy with the claim, then your journey is complete. If you are not happy with your rating, then you should definitely contact your VSO rep and submit an appeal.

In Summation

The three things that you must do are; get buddy letters, make all of your appointments, and ask for help from a Veterans Service Organization. There is a reason they exist.

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For well-being, natural is almost as good as nature

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Numerous research studies have shown that people experiencing stress, fatigue, trauma, and recovery from illness respond positively to natural settings, natural elements (such as indoor plants and water features), and views of nature.

But what of nature imagery or patterns similar to those found in nature? Does exposure to sensory stimuli that simulate or remind us of being in a natural setting produce a similar effect? Several recent studies indicate that they do.

Psychologists Elyssa Twedt of St. Lawrence University in New York and Reuben Rainey and Dennis Proffitt of the University of Virginia were interested in determining the attributes of the natural environment that have visual appeal for people in need of restoration. Further, they wanted to know if these attributes affected people differently in nature than in built environments.

As in previous studies, they found that more visually appealing and more natural environments were perceived to be more restorative than less visually appealing and less natural environments. However, visual appeal ranked somewhat higher than natural environments, suggesting “that the relationship between naturalness and perceived restorative potential may in part be due to how natural environments are generally more visually appealing than built environments.”

In some case, the quality of the aesthetics mattered more than the actual setting.

A similar finding occurred in an investigation of office window views conducted by a team of researchers at the Open University of Hong Kong. They discovered that while employees generally prefer having an office with a window view, not all window views produce beneficial effects.

One might expect that offices with views of natural settings would be more appealing than those with views of other buildings or cityscapes. In fact, though, the researchers determined that some nature views can actually be detrimental to employees.

They concluded, “Whether the view is natural or urban, the specific features of window views had the greatest impact on employees’ psychological, physical, and job-specific well-being.”

Employees taking part in the study responded more positively to views that exhibited features of coherence (symmetry, organization) and mystery (arousing curiosity). Negative views were those that looked out onto scenes with high complexity (considered visually overwhelming) and with places of potential refuge (where potential dangers might hide).

The authors suggest that employees with undesirable window views may want to improve their offices’ visual appeal by closing the curtains and putting up pictures of attractive nature scenes and cityscapes.

Another study looked at whether the use of a virtual nature experience could produce beneficial effects similar to those of natural settings for people with dementia. A memory care unit in an assisted living facility was modified with the use of a flat-panel television installed to simulate a window frame.

A one-hour unedited nature video was played, with the same scene showing a waterfall in the foreground and a distant view of mountains in the background, with naturally occurring sounds. Plants and nature photos were added to the room, to enhance the feeling of the presence of nature.

Participants in the study alternated spending time between the test room and an ordinary sitting room used as a control for a total of three separate occasions for each room. Monitoring of the participants revealed that they exhibited reduced stress and negative emotions as well as an increase in pleasure. Although the study was small and preliminary, the authors note that it shows promise for providing the benefits of exposure to nature when access to a natural setting may not be available or advisable.

These findings add to the body of research that indicates nature imagery and natural patterns when integrated into interior environments can have positive effects for occupants similar to those experienced in nature itself. This has important implications for healthcare, workplace, education, and institutional design especially, where reducing stress and negative moods can greatly improve occupant health, well-being and performance.

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Knowing when our timing is off in healthcare

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As healthcare providers, we know only too well that when the timing is off, people can suffer. Asynchronous heart rhythms, unchecked cellular growth and medication mistakes all can lead to death. Less tragically, blood sugar spikes and dips, sleep anomalies, and bowel disturbances can make folks miserable.

“Sequencing affects outcome,” my dear deceased friend would often quote me from the yoga sutras. A world-class professional photographer and yogini herself, she knew precisely when she nailed the shot or missed the mark. Musicians certainly experience this — it’s all in the timing.

So it is with each of us emotionally. Consider all the “could ofs, should ofs, might ofs, if onlys” of our lives. If I had only taken this turn, made this choice, married this person instead of the one I did. And the consequences, commitments and concomitant ripples resulting from each of these decisions.

I know of a phenom opera singer whose career was derailed because of a missed call back in the pre-cellular days. An aspiring nurse anesthetist became pregnant and was promptly discharged honorably from military service due to archaic rules back then.

Some remain resigned to their obligations; others have reclaimed what they considered theirs. Movies are made of this stuff.

I’m reminded of an ophthalmologist client and his wife. For years they had looked forward to his retirement so that they could rev up their RV and travel the U.S., dog in tow. They had planned it “to a t.”

A pancreatic cancer diagnosis turned their world upside down just as he stopped working. What timing! While he survived for more years than most, their journey then became one of just trying to keep him alive.

Sometimes, there’s an opportunity later in life to course correct. While wandering through a glorious orchid farm years ago, I happened upon the elderly Taiwanese owner. Reticent at first, he slowly shared his story as to how he came to be there.

As a child, he was drilled to become a doctor from the get-go. His Asian parents expected it, so on he went to medical school and became chief oncologist at one of the major medical centers in America. For 20 years he dutifully toiled, doing right by his patients and family, all the while wishing he was growing orchids.

When his parents became ill, he took an extended leave of absence and returned to Taiwan to attend to them until they died. Afterwards, there, in the orchid capital of the world, he stayed for two more years finally learning the trade he had yearned to do all his life.

Upon returning to the States, he formally left his oncology practice, bought the land and started his farm. Now, in a sublime sanctuary full of vibrant and resplendent beauty, he’s doing a very different kind of doctoring.

It takes courage to reckon with our missed steps. Authenticity and honesty, too. It can be difficult, and many won’t feel the need or be willing to do it. I have a physician colleague who somberly admits he sometimes defaults to fooling himself instead.

Yet, to gain closure with equanimity or to even be witness to or help shepherd it along can be some of the most precious and poignant moments of our lives, personally and professionally.

Whether dealing with actual death or with all the little dyings that our decisions deliver, we may reopen layers of grief.

Dr. Elizabeth Kubler-Ross, the psychiatrist, humanitarian and hospice pioneer, describes five stages: denial, anger, bargaining, depression and acceptance. Will we, can we go there?

The bottom line is we need to hold grief with gratitude, hand-in-hand. Go into our loss and move through it. Remember, grieving takes as long as it takes. The aim is to find peace. Until we do, our choices and timings of the past will continue to trip us.

The meaningfulness, soulfulness and rawness of such reexamination and reconciliation makes me willing and worth it to take such travels. Tennessee Williams urges us on, “Make voyages. Attempt them. There is nothing else.”

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Struggling readers have no time to lose: Social-emotional learning

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People are social and emotional beings. Some have great social and emotional understanding and skills; others barely squeak by.

Generally, those with greater social and emotional understanding and skills do far better in every major aspect of life than those who struggle. Compared to those who struggle, they’re happier, healthier, and more productive. Usually, they enjoy and keep their friends and tend to avoid the life-threatening dangers of loneliness.

Unfortunately, difficulties with the social-emotional aspects of life severely wound many struggling readers (SRs).

Many feel ridiculed and rejected by their peers — because they are. Many feel dreadfully lonely — because they are. And many shrink from or show active disinterest, resistance, or hostility toward academic activities to avoid the pain, humiliation, and bewilderment they feel when stumbling over words and answers that so many of their peers’ glide through effortlessly.

As Jules Abrams, a well-respected psychologist who specialized in reading disorders, made clear:

“It is almost inevitable that a child who is experiencing severe difficulty in reading will develop intense feelings of frustration. As reading failure continues, many symptoms of social and emotional maladjustment will appear.

Children, increasingly bewildered by their inability to meet the expectations of their parents, their teachers and their peers develop a hypersensitivity to the possibility of failure. This fear of further wounds to their pride exacerbates the problem simply because children cannot risk any further humiliation. Instead, all too often, children act out aggressively, withdraw, become depressed or choose any one of many other maladaptive solutions.”

How does this start? Is it genetic, experiential, or both? My guess, both.

Clinically, however, we should stop searching for the original causes, especially if they’re immutable. Instead, we need to focus on active causes critical to accelerating SRs’ reading and writing success as well as their social and emotional competence.

How helpful is it to improve reading and writing alone if SRs remain devastated by social and emotional baggage? Thus, the need to emphasize social-emotional learning (SEL).

SEL, however, is important for all students, not just SRs. Consider this. Many academically successful teens and younger children feel anxious, lonely, and confused.

Annually, America’s suicide rates for teens and younger children continue to trend frighteningly higher: “A study of pediatric hospitals … found admissions of patients ages 5 to 17 for suicidal thoughts and actions more than doubled from 2008 to 2015.” Yes, age five.

Though SEL is not a therapy or cure for deep emotional problems, attempted suicide, or mental illness, high-quality SEL programs might help to minimize or prevent problems. By helping teens and younger children improve their understanding of themselves, their perspectives, their thoughts, and their abilities to work with peers, make and retain friends, and make better decisions, SEL might help them better understand and solve day-to-day social and emotional issues, such as stress, bullying, loneliness, rejection, sadness, peer pressure, peer conflicts, friendship difficulties, and so on. Thus, another important reason to emphasize SEL programs.

Social-Emotional Learning (SEL): Research

Much of the research on the academic effects of SEL is positive, very positive. It’s another reason for IEP and Section-504 Teams to emphasize SEL as an important component of remedial-reading programs.

CASEL, the highly-regarded Collaborative for Academic, Social, and Emotional Learning, defines social-emotional learning (SEL) as“the process through which children and adults understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions.”

Instructionally, CASEL focuses on five components critical to positive mental health and the ability to function effectively within families, other groups, and our quickly changing society. These components are self-awareness, self-management, social awareness, relationship skills, and responsible decision-making.

This sounds good, but what does the research say? In 2011, much of the research related to CASEL’s five core components of SEL was evaluated and summarized in a meta-analysis (a study of studies) published in Child Development, a highly respected academic journal:

“This article presents findings from a meta-analysis of 213 school-based, universal social and emotional learning (SEL) programs involving 270,034 kindergarten through high school students. Compared to controls, SEL participants demonstrated significantly improved social and emotional skills, attitudes, behavior, and academic performance that reflected an 11-percentile-point gain in achievement. School teaching staff successfully conducted SEL programs…. The findings add to the growing empirical evidence regarding the positive impact of SEL programs. Policymakers, educators, and the public can contribute to healthy development of children by supporting the incorporation of evidence-based SEL programming into standard educational practice.”

For teachers and schools who haven’t routinely used cooperative learning to strengthen students’ SEL, now’s a good time to start. Here’s why. As a component of SEL, it works.

Most students and many teachers enjoy cooperative learning activities. The activities help to strengthen academic achievement, problem-solving, and interpersonal skills. They help to motivate and integrate students with different learning profiles, including SRs. And they help students enjoy learning, a gift that can last a lifetime.

Does cooperative learning succeed with all SRs? No. No instructional program does. None suddenly catapult SRs problems into oblivion. But cooperative learning helps many SRs.

Cooperative Learning: Think-Pair-Share

Below are two cooperative learning strategies for teachers. The first, Think-Pair-Share (TPS) is relatively simple to use. And I’ve rarely seen students, including SRs, tire of it.

As Reading Rockets notes, TPS starts with students independently reading assigned material. The teacher then asks the students to engage in three stages, which I’ve edited lightly:

T: (Think) Teachers begin by asking a specific question about the material. Students independently “think” about what they know or have learned about the topic.

P: (Pair) Each student is then paired with another student or a small group.

S: (Share) Students share their thinking with their partner(s). Teachers expand the “share” into a whole-class discussion.

As with all new strategies, methods, and the like, it’s wise for teachers to “think big but start small” and to routinely analyze how they might improve their efforts. By the third or fourth time they’ve used TPS, most teachers have become confident, highly proficient fans. Such confidence and proficiency help make the second strategy, Jigsaw, relatively easy to use.

Cooperative Learning: Jigsaw

Though Jigsaw is relatively easy to use, it initially requires teachers to carefully plan their lessons and feel confident in sharing the control of learning with their students. I’ve often used TPS and several variations of Jigsaw in general education classes, in special education classes, and in graduate school classes. Why? The cooperative learning structures themselves tend to spur students’ engagement and interest. They encourage student cooperation, help them learn about and appreciate one another, and improve academic achievement. They help students adopt the highly important mindset, “I want to learn.”

Here’s a basic approach to Jigsaw that’s moderately easy if teachers carefully plan the activity and clarify each step until students are comfortable with them.

The Pre-stage: Discuss and model the Jigsaw approach with the class. Make clear that for groups to succeed, their members need to help one another.

Stage 1: Break the class into equal groups of 3 to 5 students, including SRs. These are the home groups.

Give each home group member a different text to read, such as different newspaper articles or parts of articles about a specific subtopic. Alexis’s subtopic might focus on Lincoln’s first inaugural address, Kierstin’s his second.

These subtopics need to be at each student’s independent or instructional reading level, the level at which she (or he), including SRs, is comfortable and can probably read with at least 95-98% word recognition accuracy and correctly answer 70-to-89% of questions.

Ask the students to quietly and independently read and study their subtopics. Their texts should be short enough to independently read and study in five-to-10 minutes. Their individual subtopics are the pieces of the jigsaw.

Stage 2: Have the students join a new group, called their expert group. Alexis would join the group studying Lincoln’s first inaugural address; Kierstin the expert group studying his second; and so on. In other words, each home group student would join the expert group that matches his or her subtopic.

Appoint a discussion leader for each expert group.

Have the students independently reread their expert subtopic. Then ask the discussion leader to have her (or his) experts share their expertise about their subtopic. Alexis’s group would discuss Lincoln’s first address; Kierstin’s group his second; and so on.

Tell the discussion leader to ask her members to correct any mistakes or omissions the experts make. If members can’t, the discussion leader should do so. This may involve rereading and studying.

Stage 3: Have the experts rejoin their home groups. Have them share their expertise with their home group until they’re comfortable that the group fully understands their subtopics. This helps pull the jigsaw pieces together.

Stage 4: Have one member of each home group present her group’s most important findings to the class. Again, this helps pull together the jigsaw pieces.

Stage 5: Give the students a quiz on the home group’s broad topic. Each home group’s median or mean score becomes the score for each member.

Take Home Points

Struggles with reading are far more complex than word recognition and comprehension.

Instruction needs to systematically address SRs’ social-emotional development.

IEP and Section 504 Teams should avail themselves of high-quality SEL programs.

Note: This is the second of two articles on Struggling Readers Have No Time to Lose. The first article discussed the instructional practices that exemplary teachers used to teach reading.

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Teachable moments through death

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“So how can we possibly incorporate some of the contemplative care practices we learned at ‘Being With Dying’ into real-life clinical practice? There’s absolutely no time,” he bemoaned. He was the director of medical education at a large teaching hospital. He also worked there as an attending MD — with outstanding teaching accolades.

I had given him a call after attending one of the earlier iterations of this professional training program for clinicians. We both lived and practiced in the same city; he had participated in the program prior to me. “Let’s see,” I said as he challenged me with an invite to participate in ICU rounds.

At the appointed time, I arrived at his office and we raced up the stairs taking two at a time. Once in the ICU, with the chief resident and three other doctors at his side, my colleague did the usual do.

Zooming in and out of critically ill patients’ rooms — a nod here, a few words with families there, greeting mostly unconscious patients, mini-briefings with staff, some new orders. It had been a quite a while since I’d been on ICU rounds — nothing had changed.

Then, a few minutes for a “huddle” with the group. We scooted off to the side, gathered close and he asked his mentees for their reports.

The chief resident noted he’d had two deaths the night before, one autopsy that morning and gave a quick update on each person on his patient roster. My colleague asked if there was anything else — there wasn’t — before dismissing them. No one but the chief resident had spoken the entire time. I was aghast.

We charged back down the stairs to his office where he immediately proclaimed, “So, you see, there’s no time.”

I asked if he wanted my input — there certainly was time and he’d missed it. He was all ears. So, I proceeded:

What if you had paused for even five minutes and did the following?

First, given empathy to the chief resident who looked exhausted and had dealt with death three times in the last 12 hours? Maybe start by saying “that’s a lot” and then wait for his reply.

Might that have triggered some discussion or even emotions? The other three doctors may have engaged in some way. To have been heard and seen at the human level could have been helpful and healing for them.

What ripples would such an intervention generate? Instead of trudging forth through the rest of the day, perhaps these four physicians (plus you and I) would have felt tended to and been transformed in some tiny way. Such care might have influenced all of our forthcoming interactions — and beyond.

He seemed astounded, then agreed.

Not long after this experience, this doctor decided to become palliative care certified and, upon doing so, went off to steer head a new palliative program elsewhere. I am certain, once there, he incorporated many of the tools we learned at that “Being With Dying” training.

A challenge for all of us as providers: to be mindful and make the most of the myriad of teachable moments in our practice. They are there, there IS time and the education is invaluable. Lives are changed.

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Simple tips to refresh, refocus your mind before returning to school

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Whether summer break for you includes travel or just a change in routine, you can increase your enjoyment of it with these simple mindfulness practices. Beyond a multitude of health benefits associated with mindfulness, it is basically an attitudinal shift that promotes greater satisfaction with life.

“Being mindful makes it easier to savor the pleasures in life as they occur, helps you become fully engaged in activities, and creates a greater capacity to deal with adverse events,” explain writers of a Harvard Health article.

The objective of any mindfulness technique is to maintain a state of alert, focused relaxation by deliberately paying attention to thoughts and sensations without judgment. This allows the mind to refocus on the present moment.

Fortunately, this practice can be taken practically anywhere. Additionally, there are a variety of techniques, so finding one or two that resonate with you shouldn’t be too difficult.

Acquainted yourself with your breath

The breath as a focal point is common to several ancient meditation practices — for good reason, it’s always with us. Additionally, the breath is universal; regardless of beliefs, religion or nationality, we all breathe.

To practice, close your eyes and focus on your breathing. With your attention fixed on in the entrance of your nostrils feel the breath move in and out naturally. While best practiced comfortable seated with an upright spine, if having to sit up impedes you from trying it, take a reclined position.

Alternatively, you can fix your attention on the movement of the rib cage as you breathe. Either way, remain in simple observation of the movement caused by the breath. When you notice that thoughts or other sensations take your focus away, simply return to observing the breath without berating yourself.

Once familiar with this practice, you can turn to it when you notice your mind getting agitated. For example, I’ve done this technique with my eyes open when I’m stuck in a traffic jam to de-stress.

Tune into your body sensations

Similar to breath, physical sensations are always present in our bodies, so tuning into them is an excellent tool for shifting our attention from the constant brain chatter that we often experience.

This practice is the basis for vipassana meditation, which has been taught and practiced for 2,500 years. In my personal experience, taking a course with a teacher has made practicing this technique much easier.

To begin, sit with closed eyes and practice observing the breath for a couple of minutes. Then, move your attention to the top of your head and notice whatever sensation you feel there. Observe for a short time without judging or trying to change it, then move to an adjacent part of the body in a process of passing through each part of the body in succession from head to toe.

The body sensations can be subtle like heat, an itch, pulsing or tingling.

Once you are able to notice body sensations easily, it’s fun to practice on the go. While you are moving, feel your body from within. Notice the pressure in the soles of feet pushing into the ground or the caress of your clothes against your skin as you walk or run.

Engage all your senses

Engaging all the senses is one simple way to heighten your awareness and get your mind back to the present. You can do this while setting the table or walking in the park. On vacation it can help you deepen your enjoyment of your time away.

Here’s an example. While walking on the beach, feel the sensation of sand and water on your feet. After some time notice the sensation of the air on your skin to sound of waves tiny sea foam bubbles popping as the waves wash out. Noticing small details with eyes, breath in smell through nose, taste through mouth.

Notice how long you remain in this state of pure focus on the senses without thinking or planning. Suddenly you might notice a train of thought something like this…”Wow, this feels so good I have to do this more often, wouldn’t it be wonderful to have a home here on the beach, if I get that promotion or…”

When you realize that you have gone off into thought regardless of the content, start again with feeling the sand and water with your feet. Breathe deeply of the salty air, etc.

Experience the power of nature

If you’re having trouble being mindful, get outside. Getting into nature is perhaps the easiest way to give yourself an automatic jump-start into better mental health.

The great outdoors has been proven to be a boost to the human organism, with studies over the past 25 years uncovering a plethora of body-mind benefits. Among the 12 science-backed reasons for spending time in nature, per a 2018 Business Insider article, are reduced levels of mental fatigue, anxiety and inflammation; and lower blood pressure and heart rates. Add to the list improved memory, mood, self-esteem, cognitive functioning, immune system and ability to focus.

If the wilderness isn’t accessible this summer, green spaces in cities have been shown to give many of the benefits of being nature.

With both mindfulness and being in nature being so beneficial to your well-being, if you can do both this summer, just imagine how reenergized you’ll be when school starts this fall.

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5 easy ways to repair a relationship with a patient

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As a primary care physician or specialist, you know that patients stop coming to a physician for a wide range of reasons — some of which are understandable, some not. Perhaps a patient has had a frightening experience during a test or procedure, or maybe a patient feels he or she hasn’t had their concerns taken seriously enough.

A patient may simply not want to be compliant in terms of adopting the health plan you recommend. Or a real or perceived mistake in care may have eroded a patient’s trust in you or your staff.

The good news is that you can easily stop a patent from switching practices, or worse, avoiding medical care altogether, with these proactive and effective tips.

Ask your patient when they began to feel unsure about you.

A study from Ohio State University found that a bad first impression can create a sense of doubt that will remain for the length of a relationship. The faster you step in to repair any negative feelings, the better chance you have of instilling trust between you and your patient.

If your patient tells you, “I felt like a number, not a person, the first day I walked into your waiting room,” then address welcoming behavior with your staff. If your patient tells you, “You didn’t seem to have time for me the first appointment I had with you,” apologize, and prove you do have time by listening closely and addressing all of your patient’s concerns on the spot. Then, work on improving your overall practice scheduling pronto.

Reassure, reassure, reassure.

If you have a patient who is very scared about an upcoming procedure, ask him or her to tell you specifically what they are afraid of. Then, take the time to factually explain to them why their fears are unwarranted.

Cite the safety of a procedure; outline exactly what the patient will go through during the procedure; arrange for a healthcare worker to stay in the room to offer support during the procedure, if possible; and ensure that your patient gets results quickly after the procedure so their stress levels will fall immediately.

Give a new perspective.

If you have a patient who is not compliant with the treatment plan you prescribed for them — maybe even saying says he or she doesn’t want to take meds or come to appointments anymore — focus their energy on a quick result to reboot their outlook.

Researchers from Case Western University report that if you focus your attention tightly on the most desired aspect of something you want, your interest and enthusiasm will increase. Ask your patient what they most want to do when they get better or stronger. Is it playing with a grandchild? Taking a trip?

Use that specific desire to motivate him/her to stay on their treatment course. Ask him/her in detail about what they want to do, and then say, “Let’s get you there.” Act as a partner toward this goal, reminding your patient of how much closer it is as their health improves.

Reboot a rebel.

Some patients who don’t want to comply with health instructions are simply contrarians by nature who don’t like to be told what to do. If you have a patient who is rebelling against a diet plan, appeal to their rebellious nature in reverse. How?

Researchers from the University of Chicago’s Booth School of Business find that showing rebellious teenage boys who ate too much junk food the manipulative ways these products may be advertised made the boys reject unhealthy food for nutritious snacks and beverages. This strategy can work on any noncompliant patient — once they have the knowledge and power to make good choices, chances improve that they’ll want to exert it.

Address mistakes immediately.

If you or your staff make an error, it goes without saying your patient deserves an immediate apology and an immediate rectification. Never try to push errors under the rug or get too busy to fix an issue, no matter how small, on the spot.

Keep a daily dialogue running with your office manager so that you are aware of any complaints or problem in real time, and be honest with your patients. Honesty is the best policy when it comes to preserving your patient relationships, period.

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