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Facilitating Resilience and Independence

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Power Point Program for 'Facilitating Resilience and Independence' Workshop at the ACSW Conference, Edmonton, Alberta; March 19, 2010

Power Point Program for 'Facilitating Resilience and Independence' Workshop at the ACSW Conference, Edmonton, Alberta; March 19, 2010

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  • 1. Val Lougheed Northern Lights Canada 1-800-361-4642 www.northernlightscanada.ca [email_address] Facilitating Resilience and Independence -- Inspired to Serve Lessons From Lived Experience ~ Keep Your Fork ~
  • 2. “ You don’t want your impairments to define you – you want them to inform you.” (Hanita Dagan, personal communication, 2005)
  • 3. Twitter: #NLCAN Slideshare: Book: Be Still
  • 4. Agenda
    • Beginning …
    • Middle …
    • End …
  • 5. Three Essential Recovery Questions
    • What does it mean to be resilient?
    • What can clients do to gain (or return to) a life that is fulfilling, autonomous and independent?
    • What can social workers do to facilitate resilience and positive change in people’s lives?
  • 6. Rated PG-113 People Strongly Cautioned! May contain bad language, brief nudity, sexual overtones, and drug usage.
  • 7. Social Workers believe:
    • in the worth, dignity, and creativity of every human being;
    • all people should have equal access to the resources, services and opportunities that one requires to promote their well-being; and
    • that each person has the right to self-determination with due regard for the interest of others.
  • 8. Social Work Goals
    • Enhance the problem-solving and coping capacities of people.
    • Help people better use resources in the environment.
    • Effect Changes in society toward the social justice for all.
  • 9. Value of Our Honourable Work
    • We witness people facing life- altering challenges.
    • We participate in their making major changes in their lives.
    • We help people.
  • 10. Happy Birth Day
  • 11. Beginning My Story
  • 12.  
  • 13.  
  • 14.  
  • 15. Sept. 9, 2003 - morning
  • 16. Sept. 9 – p.m.
  • 17. Sept. 15 2003 – Jan. 19 2004 Journey Back to Life
  • 18.  
  • 19.  
  • 20.  
  • 21. Oct. 3 – Dec. 11
  • 22. Dec. 11/03 – Jan. 19/04
  • 23.  
  • 24. In acute care: * What do people need? * How can we help? Key Questions
  • 25.  
  • 26.  
  • 27.  
  • 28. Research
  • 29. Researcher’s Position Paradigm
    • Interpretive/Constructivist
    Ontology
    • multiple realities
    • socially constructed
    • time and context dependent
    Epistemology
    • research is an ongoing, interactive process
    • confirmability and rigor vs. objectivity
    Approach to Research
      • Qualitative
      • Grounded
    • insights and hypotheses emerge from the data
    • evidence illustrated by characteristic examples from the data
    • inductive
    (Glaser and Strauss, 1967; Mertens, 1998)
  • 30. Research Methodology Narrative Inquiry
    • the “story” provides a window into lived experience and its meanings
    • phenomenological
    Data Analysis Method
      • Open Coding
      • “ opens” up the data so meaning can be discovered
    Findings Must Be …
    • practical
    • useful for patients/clients and practitioners
    • a foundation for further research
    (my own requirements) (White and Epston, 1990: van Manen, 1998) (Mertens, 1998; Strauss, 1988; Glaser and Strauss, 1967)
  • 31. Dominant Themes
    • Narcotic Pain Killers
    • ABI
    • Pain
    • Trauma
    • Depression
    • Methods of Helping
      • Return to Work
      • Life
  • 32. Foundation for Understanding Experience
  • 33. Rehabilitation “ Neither the type nor the degree of impairment can foretell the pattern or extent of the psychosocial impact.” (George Nelson Wright, 1980, p. 72)
  • 34. Body-Mind Connection Psychoimmunoendocrine Network
    • The nervous, endocrine, and immune systems are functionally integrated – the brain is only one part of this non-hierarchical network
    • Memories, emotions, behaviours and physiology are all connected at the molecular level
    • (Candace Pert, 1997, p. 171 – 179)
  • 35. February 2004 – Present Starting Point
  • 36. Identity Disintegration and The Re-organization of Self March 2004
  • 37. “ In the aftermath of traumatic life events … [the] sense of self has been shattered.” (Herman, 1992, p. 61) “ An existential crisis …” (Hanita Dagan, personal communication, 2005)
  • 38. Sliding Down the Slope
  • 39.  
  • 40. OxyContin ™ Research (Dalhousie, March 2005) 783,762 prescriptions for OxyContin ™ dispensed in Canada Nov. 2003 – Oct. 2004 OxyContin ™ is one of Canada’s 3 most-prescribed narcotic painkillers 2003 OxyContin ™ earns Purdue more than $1 billion U.S. 2002 Approved in Canada 1996 Purdue Pharmacy (USA) launches OxyContin ™ – controlled-release formula 1995 Oxycodone ™ developed in Germany Early 1900’s
  • 41. A Foothold
    • Mild – moderate ABI
    • Depressed (dysphoria)
    • Working memory problems
    • Hiding pain
    1 st Neuropsychological Assessment June 2004 -- Results
  • 42. ABI – Measuring Loss “ Pre-morbid intelligence is a crucial variable …” Subjective Report – difficulty retrieving words and communicating ideas Objective Report – above-average performance on neuropsychological measures (Prigatano, 1999, p. 59)
  • 43. Losing My Grip My IWRP August 2004
  • 44.  
  • 45. Rescued in the Valley of Despair Head Injury Program Oct. – Dec. 2004
  • 46.  
  • 47. HIP Oct to Nov – Full-time December – Part-time
  • 48. GO TO WORK
  • 49. GRTW – The Plan Jan. 3 – Feb. 7, 2005 (5 weeks)
  • 50. GRTW – The Reality
  • 51. GRTW – The Reality
  • 52. GRTW – The Reality
  • 53. GRTW – The Reality
  • 54. GRTW – The Reality
  • 55. GRTW – The Reality
  • 56. GRTW – The Reality
  • 57. GRTW – The Reality
  • 58. GRTW – The Reality
  • 59. How do we help people transition from acute recovery to community life and work? Key Question
  • 60. Rescue Attempts
    • Case Manager
    • Job Coach
    • Colleagues/Friends/ Psychologist
  • 61. Sliding Back Down Into The Abyss
    • Non-compliance
    • Malingering
    • Trying too hard
    • Not trying hard enough
    2 nd Neuropsychological Assessment May 2005 -- Edmonton
  • 62. Test Results
    • Mild to Moderate ABI
    • Pain?
    • Depression?
    • Motivation?
    • “ a high flyer”
    • “ phobic avoidance”
    • Future plans – “live off dividends” [from company]
  • 63. Lesson ASSUMPTIONS REVEAL BIAS
  • 64.
    • Mild – moderate ABI
    • Good prognosis
    • Post-Traumatic amnesia
    • Pain?
    • Depression?
    • “ Adjustment Disorder with Anxiety and Depressed Mood”
    3rd Neuropsychological Assessment August 2005 -- Calgary
  • 65. Symptom Overlap (co-morbidity) (Michael Sullivan, Centre for Research on Pain and Disability, McGill University, September, 2006) Pain, Trauma, Depression, ABI
  • 66.  
  • 67. Oct. 3 – Dec. 11
  • 68.  
  • 69. Pain Research 1600’s – Rene Descartes (philosopher)
  • 70. Pain Research 1950’s – Wilder Penfield (brain surgeon)
  • 71.  
  • 72. Pain Research Patrick Wall (physiologist) Ronald Melzack (psychologist)
  • 73. Pain Research
    • Gate Control Theory
    • Acute and chronic pain
    • Pain sensation travels up the central nervous system to the brain through a “gate”
    • “ Gate” – triggered by cell changes – sends descending messages that alter sensory input
    • Pain isn’t pain until it reaches the brain
    • Emotions, context, etc. affect pain sensations
    • Pain is a negotiable, individual experience
    • Pain centres in the brain – they just keep moving around
    • (Jackson, 2002, p. 21)
  • 74. Pain – The Future SCN9A (Globe and Mail, March 24, 2007) Poppy Genes (U of Calgary -- Calgary Sun, March 15, 2010) Glia (Scientific American, November, 2009)
  • 75.  
  • 76.  
  • 77.  
  • 78.  
  • 79.
    • Limbic System
    • The centre for emotional expression
    • (Prigatano, 1999, p. 132)
    • Amygdala - attaches emotional tags to memories
    • (Dr. Suffield, personal communication, 2004)
    • Hippocampus - controls the laying down of new memories
    • (Ramachandran & Blakeslee, 1998, p. 15)
    • Hypothalamus – controls the outward expression of emotions
    • (Ramachandran & Blakeslee, 1998, p. 177)
    Trauma Research
  • 80. “ In every encounter, basic trust is in question.” ( Herman, 1992, p. 92) “ Survivors feel unsafe in their bodies – and in any relationship with other people.” (Herman, 1992, p. 160) Rehab & Recovery
  • 81. Trauma Personal Experience
    • Dissociation & Cocoon = Safety
    • System on High Alert Always = Survival
    • World is black & white = Trust
    Trust (Safety) = Love No Trust (Life Threatening) = Hate
  • 82. Trauma Personal Experience
    • Listen to me
    • Understand me
    • Respect me
    • Are competent
    I trust (love, feel safe with, will try hard for) practitioners who:
  • 83.  
  • 84.  
  • 85. “… depression [caused by trauma] is not the same as ordinary depression.” ( Herman, 1992, p. 118) Depression
  • 86. “ Emotions are not in the head – they are in every cell in the body.” (Pert (1995), in Bolen, 1996, p. 7) Pscyhoimmunoendocrine Network
  • 87.  
  • 88.  
  • 89.
    • Affects more than IQ ….
    • We are sensitive to changes in higher cerebral functioning
    • Very important to a person’s sense of self
    • Touches core … of a person’s self-esteem
    • (Prigatano, 1999, p. 58)
    ABI
  • 90. Back to Wilder Penfield – 1950’s ABI Localizationist
  • 91. Paul Bach-y-Rita – 1934 – 2006 Scientist and Rehab Doctor Neuroplasticity - 1969
  • 92. Michael Merzenich Neuroplastician Neuroplasticity
  • 93. Harnessing the Power
  • 94.  
  • 95. “ The words and attitudes of others … are potent. They help or hex healing and recovery.” “ Expectations are powerful.” “ Neutrality can be deadly.” (Bolen, 1996, p. 94) Body-Mind Connection
  • 96.
    • Hypothalamus
    • Peptides
    • Receptors
    • Biochemical Events
  • 97.  
  • 98. Quantum Connection
    • “ There is something essential about the Now which is just outside the realm of science.” Albert Einstein, 1963, in Oschman, 2003, p. 43
    • The Living Matrix -- 1995
    • A type of energy exists that has previously gone unnoticed.
    • Cells/DNA influence matter through this form of energy.
    • DNA Phantom effect. Braden, 2007, p. 45
  • 99. The Rest of My Story
  • 100. “ Loss of identity can evoke a personal crisis, creating a need for change.” (Ornelas, in Smith & Johnson (Eds), 1997, p. 172) The Re-Organization of Self Identity Research
  • 101. Scaling the Canyon
  • 102. Sept., 2005 Waskesiu
  • 103.  
  • 104.  
  • 105.  
  • 106.  
  • 107. Breast Cancer Reconstructive Surgery March 2006
  • 108. Convocation M.Ed. -- June 2006
  • 109. Back in “a” Saddle September 2007
    • Officially change role/ title
    • Re-organize NL
    • Work part-time
  • 110. Keep Your Fork
  • 111.  
  • 112. Three Essential Recovery Questions
    • What does it mean to be resilient?
    • What can clients do to gain (or return to) a life that is fulfilling, autonomous and independent?
    • What can social workers do to facilitate resilience and positive change in people’s lives?
  • 113. Inspired to Serve - 101 Resilience
    • Ability to return to original form after being bent (bounce back)
    • Thriving in constant change, ability to be:
        • Flexible
        • Creative
        • Adaptable
        • Learn from experience
    • http://www.resiliencycenter.com/articles/5levels.shtml
  • 114. Inspired to Servce -- 201 Rehabilitation (habiter – to live inside) “ Rehabilitation is the learning to live inside not only one’s body, however it is after an injury or illness, but inside one’s very being.” (Kabat-Zinn, in Meili, 2003, p. 241)
  • 115. Inspired to Serve - 301 Recovery Crombez, October, 2003 Focus on the person [inside] Healing Focus on the illness/ impairment [outside] Curing
  • 116. Be Still
  • 117.
    • Northern Lights Canada is a person-centred organization committed to providing innovative, responsive links to real work.
    • We offer 4 major divisions of service:
      • Vocational Rehabilitation Services
      • Employment Services
      • Employer Services
      • Corporate Training
    • For more information, please contact us:
    • 1-800-361-4642
    • www.northernlightscanada.ca
  • 118. Voc Rehab Canada (VRCAN) is a national consortium of experienced regional vocational rehabilitation companies. VRCAN provides customers with single-point access to VR services anywhere they are needed in Canada, whether on an individual service or contract basis. Member companies include: For more information, please feel free to contact us at 1-800-361-4642 Rehabilitation Focus Genesis Rehabilitation Ltd. Diversified Rehabilitation Group Western Rehabilitation Specialists Inc. Occupational Rehabilitation Group of Canada (ORGOC) Northern Lights Canada CVE Inc. OPTIMA Rehabilitation Rehabilitation Alternatives Limited / Vocational Alternatives Software Advantage Rehabilitation Consultants Ltd. Sandra Preeper & Associates Argus Management Consultants, Inc.
  • 119.