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

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Facilitating Resilience and Independence

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

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