Name: Jillian Fitch
AIM: eva1837
Year: Senior
Major Interests: hockey, music, shopping, reading, hanging out with my rommates, movies, working in the Psych Department, Treasurer of Psych Club and Psi Chi
Future Plans: Masters in Clinical or Counseling Psychology (hopefully grad school out of state), possibly a PsyD at some point in the future
Psychology: I am most interested in the area of clinical psychology and would like to be doing something maybe with counseling in the future

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Annotated Bibliography

TOPIC: Anger Control in Schools

WHY I CHOSE THIS TOPIC:
I believe that violence in schools is something that seems to be on the rise. I think that students not being able to control and channel their anger is a big reason for this increase in violence in the schools. Anger control is something that needs to be taught to kids so that they can prevent violence against others and against themselves. Aggression is being reported more and more in schools, where violence is starting to run rampant. I think it would be useful to learn about the research that has gone into this area of school psychology.

PSYCINFO SEARCH:
I have used PsycInfo before, but I did not know about the thesaurus option so this was my first time using it. I originally started out using the term "anger management" and was given the term "anger control" to use in my searches. When I typed in "schools" I got results like violence in schools, but when I searched this I did not get many results, so I decided to keep a braoder serach and use "anger control" and "schools." I think I will use this tool in the future, it was very handy. I had good luck doing my search in that I found enough articles with full text citations in order to do my bibliography. I ended up using both the term "anger control" and "anger management" because I got a lot fo similar results with both terms. I also ended up finding one of the articles we used in class about the Second Step program, so it's good for me that I have one source I am already familiar with.

WRITING THE BIBLIOGRAPHY:

• It's taken me some time to get started on this project because my articles are very long and wordy. It takes time to read through them and get a feel for the article before I can begin writing anything. My goal is to try and write 1-2 reviews a day so that I can be finished before the due date. It is very hard updating my wiki page however, because mine freezes a lot for some reason.

• As I read through my articles, I really started to leanr about my topic. I discovered that this is a huge area in school psychology that really needs more research done. Many of the studies I am reading about used very small sample sizes and others focused on specific groups in the study. One of the most well developed programs for anger management that I found was the Second Step intervention. The program was very well developed and had clear directions and goals. Unfortunately, it needs to be studied more because the findings are kind of unclear and can't be applied across a large population size.

• I have also found that out of my 10 original articles, 2 of them are not empirical studies. One was a very good article, it discussed different forms of anger managment programs out there, but did not present any studies or evidence on any of them. I also decided not to use one of the articles because the content was very heavy and I couldn't follow it enough to summarize it well. I went back to PSYCInfo and did a few new searches, this time borrowing terms that I had found in the articles I had been reading and writing up. Some of the new terms used included aggression in schools, violence in schools, and conduct disorder in schools. This is becasue many of the articles I had previously done talked about using anger management programs on individuals in schools who had high occurences of aggressive or violent episodes or had been diagnosed with conduct disorder. In the new search I found many more articles and actually found some that related to my topic of anger control. Aggression and violence are 2 topics that are highly related to the area of anger management and many of the programs or interventions dealt with teaching anger management to these individuals. I also found some studies that related these topics to bullying, a common occurrence in schools.

• This project took longer than I anticipated because I had to really read my articles to understand the methods and goals of the intervention and programs talked about. Luckily I chose a topic that was really interesting to me and I am really learning a lot as I go along. The hardest part for me was picking and choosing what to write about and deciding what the most important aspects f the article were. I think am doing a good job because my summaries make sense and flow together. Hopefully anyone reading my bibliography will gain some insight into the topic that I am covering.

CONCLUSION:
I learned a lot doing this project. Some of the intervention programs we had gone over in class, like Second Step, but I really had no idea all of the work that has gone into this area of school psychology. Unfortunately, many of the studies were performed on small samples and cannot be applied to the general public. Also, some of the results of these studies have been inconclusive or unexpected. This project has shown me that so much more needs to be done in the area of aggression and anger management in schools. THe most important thing i learned is that if we don't intervene early in schools with aggressive children, they are almost certain of developing a steady pattern throughout life of aggression and violence. If we can catch something like this at a young age and change it, why not? We need to do more broader research on the programs currently being used and proposed and develop other intervention strategies that could perhaps be more successful.

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I will be interviewing Janet Orser from Ellicott Elementary in Orchard Park on February 17th at 9:30am. I will be going there with AllisonSuriani.

Questions to ask the School Psychologist
1. Dr. Bayer's Questions
-Which providers of services in the community do you use for outside referrals?
Janet explained that becasue Ellicott is located in Orchard Park, many of the students come from families where the parents are usually well-educated and somewhat well off. Most of the parents prefer to seek private treatment and don't go to agencies but rather private practitioners.Another reason for this is that most of the parents have jobs where they have good insurance policies that will cover any treatment they are seeking. She said that there are places that can be utilized like Catholic Charities and the Hamburg Counseling Center, but they usually aren't the chosen method used by parents. There is one school in Orchard Park where this is not the case,at Windom Elementary the kids usually come from lesser-privileged families and are more likely to seek community services.

-What special intervention services do you offer in your building(s) that you think are particularly effective?
Janet was very positive about the intervention services offered in the building. She called them a "very effective intervention team." One service is AIS (academic intervention support), which is remedial math and english classes for kids who either scored low on state tests or who were referred by a teacher. Janet pointed out that the students usually score very well on state tests, so most are usually referred by teachers. Some of the other services at the school include a Special Education program and resource rooms, where kids are required to spend 180 minutes a week on skill development and are supported by 2 teachers working together. There are also people who come in for special needs of blind and deaf students and there are physical therapists. Another service Ellicott provides is that the students needing aids and special help are in classrooms attached to the classrooms of the kids who do not need help so that all of the students still interact and blend with each other and somtimes have combined group lessons. This is to ensure the kids don't feel isolated.

-What outside agency educational programs does the district use? Any impressions on their strengths and weaknesses?
Janet talked about 2 programs that Ellicott uses the most. One being BOCES, which provides services the distract can't, like for students who are legally blind or deaf, or who have profound learning problems. BOCES provides intense programs for them. Another program the distract uses is called SETRC, which is a sort of training base where people are trained to know all of the latest knowledge and legislation that is coming out so that anyone in the school system can contact them to learn about new developments in the world of school psychology.

2. Our Questions
-What courses would you recomend taking in college besides the required classes that either helped you or would have been helpful?
Janet had a very interesting answer for this question. She felt that everyone could take all of the same classes, but th ekind of school psychologist they became depended on who they were as a person, not what classes they took. She said the people who make the best school psychologists have the following personal characteristics: flexible in thinking, ready to learn and always be learning new things, caring, able to look outside themselves, and most importantly, like to work with children. Janet did feel that the biggest benefit to a student studying school psychology would be to take courses in counseling, becasue it teaches you how to communicate, listen, reflect, and develop relationships with people. Janet stressed that counseling was a big factor of school psychology.

-What are some of the common issues they have to deal with everyday?
Janet is mostly involved in assessing childrena dn developing intervention plans for the parents and teachers to implement. Janet also said that she used to work on projects like grants and research that were short-term, but does not anymore.

-What kind of training have you had?
Janet explained to us that when she attended Canisius, there was no school psychology course; rather, she learned about the field from doing a practicum in the area. After undergrad, Janet attended Alfred University where she earned her Master's degree in School Psychology in a 2 year program. Today the program is now 3 years, with the third year being for internships. When Janet attended Alfred, the grad students worked in a counseling center and the program really emphasized the counseling aspect of school psychology, which Janet pointed out is not done by many schools now. Janet also said the program at Alfred really emphasized learning techniques for interviewing and observation and was not just focused on doing assessments and developing "numbers."

-What is your typical day like?
One thing that Janet stressed was that every day is different. There is no set schedule and she never knws from day to day what is going to happen. She could be working with teachers on referrals or to develop intervention plans for them to apply. She could also be in communication with parents about plans for their child or making arrangements to assess the child. She also really enjoys the lack of routine her job allows for. She says that a school psychologist must be very flexible in order to work like this day to day. Also, Janet previously split her time in between 2 different schools, but is now full-time at Ellicott. She says she prefers this much more becasue it allows her to know the children and the teachers more and she can develop closer relationships with them.

-How often do you work with the teachers of the school?
Janet works very closely with the teachers at Ellicott. The teachers refer children whom they think need assessment and/or intervention. Janet then works with the teachers and parents to develop an intervention that will work for everyone involved. This means that Janet must know the likes and dislikes and strengths and weaknesses of all of the teachers so she can develop an intervention plan that they can successfully implement.

-How much time do you spend on assessments, consultations and interventions?
Janet spends the most time doing consultations, which is mostly "problem solving" with school staff and parents. Next, Janet spends the most time on assessments, where she performs cognitive assessments, behavioral observations, and emotional scales. Janet spends the least amount of time on interventions, because she only plans them whereas the teachers and parents actually participate in the interventions. Janet is involved in certain parts of intervention, like developing a behavioral plan, providing short-term counseling, and doing crisis intervention.

-Do you do anything specific to develop social skills?
Social skills development was one thing Janet used to work with, but does not anymore. She participated in an experimental intervention program created by social workers and psychologists at UB. The program was used on all 3rd grade classes and helped them develop and use social skills. Janet says that school psychology these days is more about intervention rather than prevention.

-Do you enjoy your job?
One thing I noticed about Janet was that she was one of those people who genuinely seemed to enjoy her job. She says she really likes working with kids, and people in general. She says her job is challenging, but she learns new things every day, especially from interns.

-Any advice for aspiring school psychologists?
Janet had some really good advice for anyone entering the field. She wanted everyone to remember that when you are entering a school system, you are on your own. You need ot understand the school system and the politics that go on. She said you need to remember who runs the building (the secretaries) and realize that there is a pecking order. You need to also realize who you are in terms of experience and you will see that you really can learn a lot from the "veterans" if you are open to learning. People will be willing to teach and guide you if you are open to the experience.

-Anything she does now that follows NASP guidelines.
-data based decision making and accountability: Janet assesses children and then monitors their progress through the intervention plan
-interpersonal communication, collaboration, and consultation: Janet stressed the importance of being able to work with parents and teachers
-sociaization and development of life competencies: Janet develops the intervention plans and monitors their progress
-school structure, organization, and climate: One of the big points Janet made was that you have to understand the school system in order to function in it
-prevention, wellness promotion, and crisis intervention:This is the main thing Janet's job entitles every day
-home/school/community collaboration: Janet must know the strengths and weaknesses of all involved in an issue so that she can help solve the problem


I really enjoyed this interview. Janet was a very genuine woman who has been working in the field of school psychology for a very long time and really enjoys her job. She was very knowledgeable about all of the things involved in being a school psychologist and even tried to convert Allison and I to the field. Janet was very helpful to me in learning about everything a school psychologist is and does.

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MyPracticumFall05

BryLin Psychiatric Hospital

Hours Logged:
8/16 9-10 (1)

• I contacted BryLin in May and asked about doing my practicum. They told me to call 2 weeks before I wanted to start, so I called towards the middle of August. They told me I would need a physical, bloodwork, and a drug test done and that I could have my own physician perform them. I scheduled my appointment and had my doctor do all the tests.

8/18 10:30-11:30 (1)

• interviews
• I met Debbie, the head of the Therapeutic Activities Department, which is the department I will be volunteering for this semester. She asked me about myself: what my goals were, why I wanted to work at the hospital, my strenghts and weaknesses, the usual interview stuff. She seems like a very nice lady and I think I will enjoy working for her.

8/31 10:30-11:30 (1)

• interviews
• I went back to talk to Debbie again, when Allison had her interview. She explained what the TA department does. Basically, they run activites for the patients to participate in in order to get them moving around and doing stuff instead of sitting around all day. Some of the activites are active, allowing the patients to move around, while others are more craftlike and therapeutic so the patients can channel their creativity into something useful and productive. There are 5 people working under Debbie who run these groups. There is an older man and woman and then 3 younger women in the mid 20s. They all have different titles and go about their own way of providing therapeutic activities.

9/1 1-3 (2)

• Today we went to BryLin to fill out paperwork. We had to go to Human Resources where Francine, the head of the department, had us fill out paperwor. Volunteers at the hospital are treated like employees: we have to have physicals and drug tests, we have to go through orientation, and we have to read anf follow the employee handbook. We also had our pictures taken for our id tags (which are pretty cool). We filled out and read at least 6 packets of information, plus the handbook. This was time consuming, but it was good to get all the paperwork out of the way.

9/6 1-2 (1)

• fingerprinting at Buffalo Psychiatric Center This was pretty cool, I didn't know fingerprinting was done electronically now. Also, I had never been in the BPC and that was an experience...

9/7 8:30-10:30 (2)

• drug testing and blood samples taken at Quest. What an experience this was. I was the youngest patient in the waiting room by at least 20 years. And I happen to have the smallest veins in the world, so I still had no blood taken after 2 needle pricks. I finally got some taken out of my hand (ouch) and was able to leave after 2 hours. The natives in the waiting room got pretty restless and I was not their favorite person by the time I came out. Fortunately, I now have all my testing and interviews done. All I need is orientation (maybe) and I can start volunteering.

9/16 8-5 (9)

• Orientation at BryLin
• Day 1 of orientation. Basically, we learned all the rules of the hospital and the state/federal rules that regulate mental health facilities. We got a packet that was almost 8 billion pages long. We learned all the codes of the hospital (Code 10= psychiatri emergency), got copies of the schedules of all the different groups at the hospital, and leanred the requirements to be admitted into the hospital and what the patient's rights are once they are admitted. It was all very interesting stuff, but it was a lot of information to remember. I am really excited about doing this volunteer work, but it is serious work and a little daunting. We had a couple of different speakers at the orientation, but our main host was Mary, a mental health nurse as she called herself. She told us all sorts of stories about her experiences on the job, including a somewhat scary one about getting attacked in the stairwell by a patient trying to break out! Along with Allison and I there were 3 others at orientation. One was already working in the social work department at BryLin, another was being hired as a Mental Health Tech (she was a Cansius graduate!) and the 3rd was being hired as a secretary for the Alden branch of the hospital. Day 2 of orientation will be on Monday, but I can't wait to get started volunteering.

9/19 8-12 (4)

• Day 2 of orientation/training/info session
• Similar activities we did on Friday. This time we met in Mary's office (the nurse) and watched power point slides. This time we learned about the signs of hallucination and delusion sin patients and what to say to a patient when they express one of these things to you. You're supposed to tell them they are in a safe environment and that no one would harm them, and you are also supposed to remind them that they are ill and the experiences they are having are side-effects of their illness. Another big thing I learned today was that BryLin medicates certain patients with ECT (electroconvulsive shock therapy). I was surprised by this, because I didn't think it was used in practice very frequently anymore. I did learn that ECT is only used in very specific cases (for inpatients and out patients), and the patients are given anesthesia and muscle relaxants so there is no stereotypical twitching and jerking when it is performed. We also learned how to communicate with patients and pay attention to what they are saying so they do not feel ignored. This is especially important with patients with suicidal ideation, because if they are handled incorrectly there can be grave circumstances. All in all, I learned much more helpful information today than I did Friday, because today's topics were more along the lines of dealing with patients rather than the rules and regulations the government puts on mental health facilities.

10/4 12-5 (5)

• Finally the first day of actually getting to work in the hospital! I am working as a volunteer in the therapeutic activities department. This means we go with the registered therapists to their group meetings. Each group is seperated into either children or adults/geriatrics, and then every day some kind of activity is done with the patients. I was assigned to the 1st floor for the first 2 weeks. This means that I will be working with the children for the next 2 weeks. Today their activity was a trip outside to the "Greenspace" aka the backyard where they could play games and just enjoy being outside. This activity is only offered to kids who are on Level 4, which is the highest level possible (meaning they have had the best behavior). Seeing how this was my first day, when I met the kids I was taken by surprise. I thought that these kids didn't look or act any different than anyone else. Unfortunately, it didn't seem to be too thrilling for the kids. The hospital doesn't get a lot of funding, so the toys are in the best quality and not really for all age groups. Also, playing outside usually means some kind of sport or competition and when you have a bunch of kids with psychological probelms all competing with each other, trouble can occur. One of the boys tried ot run away becasue he was not doing so good with the baseball game. I later learned that the patient is very aggressive and has conduct disorder. All in all, it was an interesting first day and I am really excited to go back.

10/7 9-12 (3)

• Today for morning group with the kids we had to stay inside becasue it was raining. THe kids were a little restless, but we got them moving by playing a volleyball game in their lounge. We also played mum ball, which wasn't very successful becasue the kids were not feeling very quiet today. We only had one major issue, when one of the boys got upset and threw a some chairs and a table. He was escorted to timeout, which means they have to leave the room and go to the hallway where their room is. None of the other kids are allowed near them as a safety precaution and the #1 goal of timeout is to isolate the distressed child in order to protect the others from harm. The groups we have with the kids are meant to teach them to function with others. The groups are run by the Therapeutic Activities department and the leaders bascially tey and get the kids to cooperate in a manner that would be acceptable out in the "real world." The kids are taught boundaries, manners, and skills they might not have learned in their homes. It was very sad for me to learn that many of these kids come from foster care, where they didn't have real families, even real lives. To a lot of these kids, the hospital is a safe haven for them and many of the younger ones don't want to leave. The hospital provides a stable environment where people actually care what they eat for dinner and make sure they bathe every day. This is not the place to vent on the foster care system, but working in thsi hospital really allowed me to see how much the system needs to be fixed.

10/11 11:30-5:30 (6)

• Today was once again spent on the children's floor. This time, I learned how to do notes for the children's charts. At BryLin, after any activity is done, the people who run it are required to take "notes" aka fills out forms on each of the children who were in the group. Based on their behavior, the kids can earn points that will move them through the 4 levels. Level 1 means a child has been very uncooperative;it usually occurs after the child has had a "bad day." Level 4 is the highest, whic means the kids have certain privileges like going on outings, getting to play outside, and eating lunch down in the cafeteria. The people filling out the notes for the charts decide wheter or not each child earned their points by their behavior in the group. THey are also required to put what activity the child did and any observations they had of them. This means any mood the child seemed to be in, anything they might have said that is of interest, and how well they participated and responded to the group activity. These notes are then put into the charts of each child so that anyone can look back and see how that child was on a particular day and the doctors can monitor their behavior.
• Another interesting thing worth mentioning is that today I met one of the older girls who is suffering from a personality disorder. She has been at the hospital for quite a long time. She is uncooperative and is very negative and hostile. She also craves attention and goes to extremes to get it. I learned that she has escaped from the hospital on more than one occasion, but was caught every time becasue she stayed close to the hospital's property. Meeting this patient was interesting to me, because unlike the children, she outwardly acted like she had a psychological disorder to such an extreme that she was being massively impacted by it in her life.

10/14 8-12 (4)

• Today was a crazy day. I think someone secretly fed the kids sugar for breakfast, becasue they were wound. My theory is that when you have so many kids in such a small setting, when 1 or 2 kids are bouncing off the walls, they all start to react. We tried playing some games with them, but they couldn't stop arguing and fighting with each other. Before half an hour was up, we had to give one timeout to one of the younger girls because she was throwing a very loud temper tantrum because she lost a game (I should mention here that when we do activity groups with the kids, they are split up into 2 groups- the younger kids have activity while the older kids go to school or tutors and then they switch). We had to have a timeout with the lights off becasue everyone was fighting and no one would listen to the group leader. One of the 6 year old boys decided this was the time to act out. He got up on the table and was danching while suggestively grabbing his private parts. He then ran around the room tipping over chairs becasue he was mad about timeout and wanted to play games. He started calling everyone names and swear words and resisted time out. He even bit the leader who tried removing him from the room (she had to go to the hospital next door to get a shot in order to make sure nothing became infected). After that incident, the kids were only allowed to play quietly at their tables for the rest of the time. This didn't really work though, because they were all too energized to play quietly. Today was one of those days where I really don't think I want to work with children. This is good though, becasue one of my hopes for this job was that it would help me try and figure out what I want to do with my life.

10/18 11:30-5:30 (6)

• Today I was on the adult and geriatric floors for activity groups. With the geriatric patients we did communication cards. These are used basically to get them talking and coherent. Communication cards are a stack of index cards, each with it's own question on it. The group leader asks a question and then everyone in the room takes their turn answering. MOst of the questions are based on positive thoughts, like memories from their lives, favorite things of theirs, and what some of their dreams and wishes are. It got interesting at the end becasue everyone got tired and decided to stop answering or to copy other people's answers becasue it was easier. It was also right after lunch and they all seemed to get very sleepy.
• I had some extra time before the adult group so I got to go to the children's floor for a little while. The activity that was called "categories." Everyone gets into teams and then they are all given a category like modes of transportation. They have to write down as many things they can think of in the span of a few minutes and then they all read through their lists. Each team gets a point every time they have an answer no one else had. My favorite response for this one was "a dragon."
• The adult session activity was therapeutic arts. They chose to paint stained glass and I got to make my own becasue one of the older patients asked me to do it with her and help becasue she had never done it before. What I learned was how therapeutic something like painting a piece of plastic can be. It was very soothing and time flew by. I had a nice conversation with the woman about her grandchildren and before i knew it the hour was up. I was kind of questioning the idea of using arts and crafts as a form of treatment, but it really seems to calm the patients and get them to interact with each other.

10/21 8-12 (4)

• Today I did morning group with the geriatric patients where we did simple stretching exercises to get them feeling awake. They were ot very receptive to this, and many of them were still asleep, so we made it a short group. We then decided to make a scavenger hunt for the older kids (group 2) becasue they had been begging for one. We spent over an hour thinking of clues that were tricky yet still easy enough these kids to get since many of them weren't there long term and might not get some things. We posted all of our clues around the basement of the hospital (where the therapeutic activities department is) and then brought the older kids down. They loved the hunt, especially since they got prizes at the end. They were really good at figuring out the clues, but that's probably becasue they were all girls today haha! We then went upstairs to their lounge and played some board games with them so that they weren't just sitting around. I was glad that everyone seemed to have a lot of fun and they really got into the activities, which sometimes is hard to do.

10/25 11:30-5:30 (6)

• Today I got to do something really interesting. I got to sit in on the assessment of a new adult patient (with their permission). During an assessment, you try to learn as much as you can about the new patient- what their life is like, why they think they are there, what their hobbies are, are they depressed/anxious/suicidal, and much more. The patient we did today was there for the second time in a short period of time. She seemed very nice and accommodating, but when we looked at her chart from before it was a completely different story. Before she had been angry and upset and this time she was extremely nice. It was really interesting though to hear right from the patient's mouth what they thought was wrong and why they were in the hospital. The person I observed who was doing the assessment said that a lot of times when a patient first comes in they are in an extreme type of mood-wither very happy or very depressed. Either way, the patient usually has some kind fo explanation as to why they are there, but it is usually a distorted view of the truth.
• For the afternoon group I went onto the children's floor for group 1 (the younger children). Today we did quiet time, which means board games, coloring, basically anything you find that you want to do as long as you are quiet and calm. This was becasue the kids had not been behaving well as a wholethat day. They all seemed to be good during quiet time until 2 of the boys decided to play tag and when one of them wouldn't stop, he got taken to quiet time. i didn't see what happened, but I found out that he had apparently gotten very upset about this and had tried to hurt nimself. In the process, he damaged some hospital property and threatened some of the other kids and when I returned to the hospital on Friday, I found out he had been moved off the floor because he was a danger to the younger children. This was scary to me, becasue I cannot imagine sending my child somewhere that was supposed to be helping them and instead having them be exposed to danger and violence. I think that there should be separate locations for the patients who are dangers to others, because when children get scared they begin to manifest signs of their illness.

10/28 8-12 (4)

• Today the kids were very excited for Halloween. Some of them get to go out on pass, meaning they are approved to go out on a supervised visit with a family member. Usually they are awarded passes for their good behavior. However, most of the kids are going to be staying in the hospital for Halloween, so the staff tries to provide fun activities for them to do. Today, we made chocolate suckers in preparation for the Halloween activities with group 2. There were about 7 older kids participting in this activity, so it was somewhat low key. It was good for them though, because they got to leave their floor and come down to the basement where the kitchen is to make the suckers. They got to listen to the radio and get away from the younger kids for awhile, which is good becasue sometimes the older kids get annoyed by the younger ones. It's hard for them to relate becasue they are on completely different levels. It reminds me of when I was younger and i thought my little sister was the stupidest and most annoying thing in the world, so I can relate to some of these kids when they get frustrated. They are in very close quarters for long periods of time and sometimes it really gets to them.
• I also got to go to a "multi" meeting today. This is when nurses, social workers, doctors, and art therapists get together to discuss patients. They discuss things the patient may have said or done, how they have been feeling, and what their treatment plans are. Everyone has to present the patients to the doctors in order to keep them informed on what the patients are doing when they are not around. The doctors give recomendations on activities and plans for the patients and the staff get advice from the doctors while giving their input also. I also got to meet a lot of the staff that I hadn't met yet, like some of the social workers and a couple of the doctors.

10/29 11:30-4:30 (5)

• Today was the Halloween party for the kids. They all got to have their faces painted by somene who brought in an air brush. They looked very cool and professional, it was like what you see at a carnival. The kids were served pizza and wings for lunch, which was a rare treat for them. It was also really cool to see how the hospital set up trick or treating for the kids. They were lead around the building to the various offices and departments where they were given candy. The kids were allowed to keep their own candy separate for themselves, but locked up in the cabinet so that the intake was moderated. There was one child who could not participate in the trick or treating, but it was sweet to see the other kids collecting candy to give to that person. The kids then were allowed to stay in the lounge for the day playing games and coloring. They were also allowed to eat the chocolate suckers that the older kids had helped to make. They painted pumpkins and overall, got to partake in Halloween activities. It was awesome to see all the stuff the hospital did for the kids so that they still felt part of the holiday. Halloween can be very important to kids.

11/1 11:30-5:30 (6)

• Today we met a new trainee in the Therapeutic Activities Department. This is a good thing, becasue the department was very understaffed and now everyone won't be doing doubles all the time. She has worked in many environments similar to BryLin so I think she will do very good here. Also, she is interested in working with the geriatric patients, which is hard to come by.
• I think the kids were on a sugar high from Halloeen still. And for some reason, we decided we were going to have an ice cream party with them, to kind of keep the holiday spirit up. While they all behaved well, they were full of energy and it was a tiring day. We played some more games with them like charades, but tried to keep it somewhat low key.
• Today I also got to read some of the patients' charts while I was filing them and observing assessments. I go to see the actual admittance sheets that the patients fill out when they come in to the hospital. This is where they put down the problems they are having and why they came to the hospital. This technique is used when adults are admitted, but when kids come they are interviewed and someone fills it out for them. In the charts there are also treatment plans from their doctor and any medications that have been prescribed to them. Also, there is a history of the patient if they have been in the hospital before. I went on an assessment of a new adult patient and then I got to read her chart, which was interesting becasue she tried to downplay what was wrong with her but when I looked at her chart there was some serious stuff in there. During the assessment she never mentioned suicidal thoughts, but when I looked at her admittance form it was written everywhere. I guess this is why it is a good idea to get things in written and verbal form, becuase if there is a discrepancy and someone doesn't know about one or the other it could harm the patient. It was interesting to see how people change their attitude when they are writing things down and when they are in front of people- I think perhaps this woman was ashamed to admit why she was really in the hospital.

11/4 8-12 (4)

• Today I was with the kids of group 1 for their morning group and they were not getting along. We tried to play games with them, but when things get very competitive they fight. I think the biggest factor was that one of the younger patients had been taken off their meds and they were very unhappy. They were yelling and disobedient and fighting with all of the other children. The child spent most of the time sulking in the corner and doing everything they could to get attention, like slamming doors and crying. Unfortunately, the child's mother had not given permission for her child to be medicated and refused to do so. This is considered a form of neglect when you refuse a sick child medication. I was told that they were trying to take the mother's rights away so that they could medicate the child again and help her get better.
• I also learned about the store today. For every group activity at the hospital, every child has the chance to earn 10 points for participation and good behavior. Those who obey and do what they're told earn all 10 points, while those who are disobedient lose points. All the points are added up at the end of the week and then the kids use them like money at the "store." THe items from the store are brought to the children and they can use their points to purchase things like cards, toys, makeup, hair accessories, and so on. The kids can also request certain items to be put in the store for them to buy. I think this is a very good idea, becasue it rewards the children with small items for good behavior and gives them an incentive to participate in the groups. When they cooperate and listen to the instructions, it teaches them how to interact with others and how to get along with other children. It's a win-win situation when the kids are learning valuable skills and being rewarded for learning them.

11/8 11:30-5:30 (6)

• Today I observed the assessment of a new patient on the first floor (under 18). THe assesment of a new patient on the chiildren's floor is different from the ones adults do becasue the children are asked the questions instead of filling them out themselves originally. This makes sense because many of them can't write or describe the feelings they are having in understandable terms. The kids are asked questions like why they think they are there, what their lives are like outside of the hospital, any hobbies and likes/dislikes they may have, and so on. They are explained the rules of the hospital (if it's their first visit) and told what the days will be like at the hospital. All new patients begin on Level 1 (the lowest level) and are told how they can rise levels by earning points for participation in groups and good behavior. It's kind of sad in the way that many of the kids who are there for a first time seem very confused and angry or sad as to why they are there. They blame thier parents (or whoever had them sent there) and many of them claim there is "nothing wrong with them."
• I also learned a disturbing statistic. While discussing the new patients, i heard some of the T.A.'s talking about patients that had come back. When I commented that it sounded like they knew many of the new patients, I was told that was becasue many of them had already been there before at least once. According to them, it is estimated that out of 5 children admitted, 3 have been there before. This is sad to think about when you realize how young they are and what their life is going to be like i things don't get better. I can't imagine a life interrupted by recurring trips to a psychiatric hospital.

11/10 8-12 (4)

• Today I did another assessment of a new patient for the children's floor. This was an interesting one, becasue the patient claimed to be in the hospital becasue his family didn't like the fact that he built lasers. I later found out that the patient has a history of hallucinations and delusions. He hears voices a lot and often seems to be talking to himself- unfortunately, this is not his first stay in the hospital. Today was a pretty calm day on the first floor, the kids were all getting along somewhat and the activities passed smoothly. I helped do notes for the group activities, which is where the group leaders comment on each child's behavior during group and then file their comments in each child's folder.

11/15 11:30-5:30 (6)

• It seemed like there were a bazillion children today on the first floor. There were a lot of kids in group 1 (under 18) and it almost seemed like there were too many in order for them to cooperate. When you have that many kids, it's a guarantee that some of them will not get along with each other, and when they start to argue all the other kids get involved. It also seems at times that there aren't enough aids to help with groups and it gets to be kind of overwhelming. Sometimes there are kids and situation that need more attention, but it is just impossible to give it when the patient to staff ratio on some days is 4 or 5 to 1.
• One of the T.A.'s at BryLin that I have been shadowing very closely used to work at the Alden location of BryLin and she was talking about it to me today. I learned that many staff members in the hospital are from Alden becasue when it closed down, they had seniroity and they were allowed to be transferred. She told me that it was hard at first, becasue people were not very accepting of them. I picture it as kind of the new kid at school- everyone knows each other and they tend to stick to what they know. However, in a psychiatric hospital it is not a good idea to have divisions like that becasue the patients might see it and become uncomfortable or unsure of the help they are getting. It seems to be ok now, but there are definitely little groups of staff who "hang' together and seem to prefer each other's company more than that of others. From what I heard of the Alden facility, it sounded kind of scary. The TA told me about how many of the patients were substance abusers and perpetrators of violent crimes like rape or robbery. She said it was very difficult being a woman trying to get the patients listen to her. However, she enjoyed that fact that the hospital was out of the city, giving them more outside space to work with the patients. She also said the rules were less strict there and they were allowed to do more with the patients. It's sad that the branch had to close down due to lack of funding- it is sad that for people in this area, there is not much of a treatment choice, it's either BryLin or a worse off fate.

11/18 8-12 (4)

• There is a patient in the hospital who has been there long-term and today I found out that she has been moved to jail. The patient was a 17 year old girl- still considered a child- who was living on the adult floor because she was considered a threat to the children. The patient has aggression problems, a history of substance abuse, and has been diagnosed with borderline personality disorder (according to her chart). She has run away from the hospital numerous times- she pulls the fire alarms and gets out the emergency exit. SHe is usually found wandering in the are after her escape, which shows that she really just wanted people to come after her rather than really running away. I found out that she also had a history of assaulting the staff, and this time someone pressed charges. Aparently the patient had punched a staff member in the face and then proceeded to cause damage to hospital property by breaking her door and the door frame. It was decided that she was too much of a harm to others and she was arrested and taken to jail for the incident.
• This is really a sad incident when you think about it. Part of this person's illness is the desire for attention in any way, shape, or form. It seems this patient lashes out at others in order to get it; however, in the process she is hurting people and endangering those around her. It stinks that she is in jail now, becasue what help can she get there? If she is there for a period of time, all of the progress she may have made in the hospital will be down the tubes. If she learns that she can get attention this way, she will spend the rest of her life in and out of jail because it gets her the attention she wants. She won't receive the help she so desperately needs becasue she doenst want to help herself. I see a bad future for this patient and it makes me feel sick because I don't feel like she will ever get the help she really needs. The bad part of the mental health profession is that there are only so many things you can do to help another person and I can see that it will get frustrating at times when you feel helpless.

11/19 12-4 (4)

• Today I went in to make up some extra hours since I will not be able to come in the day after Thanksgiving. All the kids who are level 4 get to go on an outing today to see the new Harry Potter movie. I am not really allowed to go because I am justa volunteer, so I stayed back at the hospital with the kids who didn't get to go. Many of the kids try to get to a level 4 just so they can go on an outing and get out of the hospital for awhile, especially when the outing is something really exciting. I htink it also helps make them feel like normal kids again, doing normal activities. We decided to show a movie to the kids back at the hospital so they could feel like they were doing a similar activity to those on the outing. For the most part the kids behaved, but it's hard to get them to all agree on something, like a movie. Luckily, there were a lot of kids who were level 4, so there weren't a whole lot left at the hospital. We watched the new Willy Wonka movie with them and they loved it. They actually made it all the way through the movie without all of them getting distracted or bored. I think this says a lot about the movie haha. Afterwards, we had quiet time where the kids got a snack and were allowed to do things like color and play quiet games. In general it was a low-key day, which was good after all the hectic atmosphere we had in the previous week. I think it helped that there weren't as many children there today and it seemed like they were all getting along better.

11/22 11:30-5:30 (6)

• Today was my last day at the hospital before Thanksgiving break. The kids seemed kind of gloomy today and when I was on the adult floor there was the same kind of mood. I learned that the number of patients around the holiday season skyrockets becasue people tend to get down and depressed a lot. I could tell many of the patients were sad they would not be home for the holiday. I also hear many of the kids saying they can't wait for christmas and they hope they will be home by then. I hope so too, although for some of them they might have a better Christmas in the hospital.
• I was sad today because over the weekend, one of my favorite kids was released and allowed to go back home. She had been there since I had started volunteering in September and it was good for her to be able to finally go home, but she was very entertaining and had gotten very well behaved. When she was first at the hospital she had temper tantrums all the time and was often sent to time out. She used to get angry when she lost games and pick fights with the other kids. However, I noticed throughout her stay at the hospital she had really improved- I didn't see a tantrum in over a month and she became very sociable. She was always dancing and singing and playing with the other kids. She was very creative and I even have one of her pictures hanging on the refrigerator. I was sad to see her go, but also very happy for her. I really hope she can keep it up and not become one of the numbers who return to the hospital.
• I also learned that 2 more of the other long term patients were going to be released this week. One boy was being released into the care of his mother and a foster family had been found for one of the girls. She was very excited becasue she had met the family and had been allowed to go on outings with them. She liked them a lot and cou;dn't wait to go home. I hope everything works out for the both of them.

11/29 11:30-5:30 (6)

• Today was my first day back at the hospital since before Thanksgiving break. Since it had been a week, I dodn't know that to expect since a lot can change there in a week. I was interested to see how many new patients there were and who had left. Unfortunately, I learned that one fo the kids who had been released on Thursday had been brought back to the hospital already on Monday. I am not sure what happened, but apparently the child had an "episode" and had been brought back. I don't know if it was becasue of the holiday season or becasue the dynamics changed with new patients, but the atmosphere was bad. As soon as we walked into their lounge I could tell it was going to be a bad day. The kids were ganing up on each other and starting fights, calling each other names, and swearing. Some of the kids had to be put on separate sides of the room because it got so bad. One of the new patients had a tick or twitch and one of the girls she was fighting with began to mock it, so she threatened that she was gonna fight everyone and stab them. The thing that really bothered me today was that we seemed to be very understaffed and I didn't really feel like enough was being done about the situation. It's hard to criticize the staff though, becasue I have heard many times that they are understaffed and since they are privately owned, they don't get any aid from the state. I just feel like sometimes the staff sin't as doing as much as they or they feel like they don't have a means to do what should be done. It got to the point that I was trying to help calm the kids down just becasue it was getting so bad and no one knew what was going on.
• I also learned a really cool idea that one of the T.A.'s did on the geriatric floor. They went through all the patients and required things of them to be done liek answering questions and doing physical activities and the patients earned "BryLin money" for the tasks they completed. Then an auction was held at which the patients could use the money they earned in order to buy things like crafts, toiletries, games, and much more. I thought this was an awesome way to get the patients involved in a type of awrds system like they use on the children's floor. They get to feel like they play a part in getting rewards and they get to choose their rewards. The auction was a big success and the patients got really into it.

12/2 8-12 (4)

• Today was calmer than Tuesday. The kids who were all fighting ferociously on Tuesday were getting along much better just 3 days later. For the group 1 activity we did cooperative drawing, which is where youdraw soemthing on a paper and then pass it along to the person next to you so when you get your paper back you have a contribution from everyone. You can really tell a lot from this I think, because we learned in Assessment about projective personality tests where kids are asked to draw specific things and then the pictures are analyzed to find areas of disturbances. As I was observing, I picked out one child who kept drawing odd things on his picutres. The topic of the drawings was supposed ot be "something that makes you happy" and this child kept drawing characters from horror mivoes, like Jason, Freddy, and Michael Myers. This was strange to me becasue most 8 yr olds would not normally be drawing horror movie figures as things that make them happy. I think this really gives an insight to what the child's homelife might be lie or maybe a disturbance they might have.
• Another thing I have begun to notice is that there is a almost a cookie cutter type to the teenage female patients. I can't keep one straight from the other because they talk, dress, even act alike. These girls usually dress all in black and wear band t shirts every day. THey only wear black "skater" shoes and their hair is usually died some dark color. It disturbs me that there is a feeling that they come from a mold and sometimes I wonder if there is really a disturbance in all of the cases, or if there is sometimes a stereotype factoring in. Perhaps society is pressuring these girls who are "different" and making them feel like that have problems. I really don't know the answer to this, but it just jumped out at me as strange.

12/6 11:30-5:30 (6)

• When we got to the hospital today we found out that some of the T.A.'s were going shopping to get ingredients to make baked goods for a fundraiser they were doing. Every year they sell candy and baked foods in order to earn money to put towards Christmas presents for the kids. I thought this was awesome becasue they really devote a lot of their time to make sure these kids have a good Christmas. A lot of the kids are allowed out on a pass for the day on Christmas, but some really have nowhere to go. The hospital relies on donations of the staff and outside public to give the kids a good Christmas and they really try to give the kids the best they can. The hospital also takes toy donations from the public and the workers. Each child who is there is asked to list a few gifts they might want and when it gets close to Christmas the staff goes shopping for the kids they know will still be in the hospital. I think this is a great idea, because the kids are getting things they really like and toys they want instead of random gifts.
• Since I am an officer in Psych Club, I decided that next semester I would like to try and do a fundraiser or donate some of the money earned from Psych week to BryLin for the kids. I see how tight money is there sometimes and I think it would be awesome if we could help in some way. I know it would be a good cause and I would feel good knowing if there was something I could do to help.

12/9 8-12 (4)

• Last day at BryLin.
• Today was kind of sad. I have really gotten used to seeing people at the hospital twice a week and it's going to be weird not going every Tuesday and Friday. I did the 2 morning groups with the kids today becasue I decided to spend my last day with the patients I spent the most time with. There weren't as many kids today, but there was one patient back who had just been released a couple weeks ago. As I said before, the rate of children returning to the hospital is very high, so I wasn't surprised but it's still very sad to see the small amount of time some patients spend out of the hospital before they come back. When this patient had left they were so excited about going home and I thought everything would go well. Unfortunately, they had continued have hallucinations and the patient claimed to hvae been listening to the "voices." Sometimes I wonder with the kids who come back so quickly about some of the circumstances surrounding their return to the hospital. Were they really ready to leave or were they forced out becasue of insurance issues (ie. hospital stays not paid for)? Are the parents not equipped or educated to help their kids and are therefore being detrimental to their children getting better? To some kids know how to "cheat" the system and know what to do and say in order to get out? Every case is different but a lot of the time I just wish I knew what the whole situation is and I wonder if the doctors even know the whole situation.
• Group 2 was small today, only 5 or 6 kids were there today. All in all it was a nice way to go out, without any problems or major conflicts. It was also nice that all of the people I had shadowed throught the semester were all working today so I got to say goodbye to them and thank them for everything they had taught me and for letting me follow them around.

CONCLUSION



Total Hours Logged as of 12/9: 124


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