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Official publication of the Delaware County Medical Society

FALL 2016

Glen Mills Schools Health Services

d e s m m i t r c i o V f e s n u I b A e B Child r o f s e c Resour

TEEN HEALTH WEEK


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TABLE OF CONTENTS

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OFFICERS 2016 Ronald B. Anderson, M.D., President Joyann Kroser, M.D., President Elect George K. Avetian, D.O., Vice President Fredric N. Hellman, M.D., Treasurer Salvatore A. Lofaro, M.D., Secretary Richard V. Buonocore, M.D., Past President

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DIRECTORS Stephen N. Clay, M.D. Aviva Fohrer, M.D Margaret T. Hessen, M.D. John A. Kotyo, M.D. Joseph W. Laskas, D.O. Virginia McGeorge, CCS-P, CMM Michael A. Negrey, M.D. Chike N. Okechukwu, M.D. Stephanie Tanner, M.D. Jill Venskytis, CMM, HITCM-PP DCMS STAFF David A. McKeighan, Executive Director Rosemary McNeal, Administrative Assistant

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CONTACT INFORMATION Publisher, Tracy Hoffmann Hoffmann Publishing Group, Inc. Design, Kim Lewis 2921 Windmill Road Reading, PA 19608 HoffmannPublishing.com 610.685.0914 ADVERTISING Karen Zach 484-924-9911 Karen@HoffPubs.com Any opinions expressed in this material are for general information only and are not intended to provide specific advice or recommendations for any individual. All rights reserved. No portion of this publication may be reproduced electronically or in print without the express written permission of the publisher. Delaware County Medicine & Health is published quarterly {Spring, Summer, Fall, Winter}.

Official publication

of the Delaware County

FALL 2016

Medical Society

Glen Mills Schools Health Services

rmr Cehdild Abuse Victim o f n I e B ources fo

s

Res

TE EN HE ALTH WE EK

ON THE COVER

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2 Glen Mills Schools Health Services 6 Vaccine Development in Delaware County 8 Oxygen Safety Tips 10 Be Informed: Resources for Child Abuse Victims 14 A Personal Journey Into Adult Literacy 18 Teen Health Week 20 Fraud Prevention 22 Grief & Loss Through the Holidays 26 Updates from the office of Senior Medical Advisor 28 Jill’s Timeless Tidbits DELAWARE COUNTY MEDICINE & HEALTH

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ON THE COVER

Glen Mills Schools Health Services By Enrique Josephs & John A. Koyto, MD

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he Glen Mills Schools (GMS) is a residential facility for troubled youth, devoted to providing quality services for students. The mission of the Glen Mills Schools is to change anti-social behavior to pro-social behavior and provide the necessary life skills to sustain change. The philosophy surrounding the Glen Mills Schools creates a strong school culture where students are treated with dignity and respect in an environment without imprisonment behind bars. Founded in 1826, GMS is the oldest continuously operating school of its kind in the United States. Located in Delaware County, Pennsylvania, the school sits on an 800-acre open campus with educational programs tailored to the unique needs of each student and designed to unlock the potential for personal growth. One of the main goals of GMS is to educate the whole child. To this end, the school offers an array of innovative programs and services in youth behavioral and educational development as well as a comprehensive healthcare delivery system for the 1,141 students that attend the school each year. Each student has access to high quality healthcare services including behavioral health, a Health Center, optical, dental and, even, co-occurring substance abuse treatment. 2

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Because GMS provides high-quality health care services, students are better able to focus on their studies and personal development. Some of the services the school provides are as follows:

Health Center The Health Center at GMS provides comprehensive services to meet physical and medical needs to students and staff. The Health Center is staffed with three full-time nurses and four physicians who work on site Monday through Friday. The nursing staff also provide on call coverage for health-related issues that arise after hours and on the weekends. It is important that the medical needs of each student are addressed fully. Upon entry into the school, every student is assessed by medical staff and given a full physical with lab work, PPD skin test, and vision and hearing exams. Many students find that they are in need of glasses after the vision exams. A fully functioning optical lab (that doubles as a career and technical educational training program) provides glasses and sports goggles to students. Physicals and exams are required to maintain regulatory compliance, but the Health Center goes beyond that. Students are treated for many medical issues including acne, allergies, asthma, alopecia, fungal infections, hypertension, obesity, skin disorders, sexually transmitted diseases, migraines, lacerations, wound care, suture placement/removal, staple removal, warts, sprains, knee and shoulder repairs, cardiac repairs, ingrown toenails, dandruff and more. If a student is in need of care, the medical staff at the Health Center provides that care. GMS also administers missing vaccines to students (as required by state law) and those recommended by the American Academy of Family Physicians. Recently, the school began giving the flu vaccine to the entire student body. Since implementation, the number of flu cases on campuses has been significantly reduced. The Health Center houses key pieces of equipment that help provide care to students including liquid nitrogen for cryosurgery, an ophthalmoscope for eye related issues, an ear flush system to clean out impacted cerumen and a urinalysis machine. In addition, the medical staff is dedicated to teaching students how to care for themselves in regards to the administration of medicine and prevention.

The staff teaches students how to use Epipens, complete blood sugar checks and administer injectable medications, eye drops, ear drops, inhalers and creams. The medical staff teaches students about a multitude of disorders and help to teach proper personal hygiene practices. GMS has an active sports program on campus and the Health Center works closely with the athletic training department to provide sports-related care. The physicians work together with trainers to evaluate student injuries and provide care and treatment for each injury. The Health Center also serves as the location for the administration of behavior modification medications for students as prescribed by a psychiatrist. Most importantly, students, and staff as well, have access to the Health Center. Students have the opportunity to visit with medical staff Monday through Friday to discuss any medical needs that they want addressed.

Dental Center For many students, dental care is not available to them due to lack of availability or coverage by medical insurance. For over 30 years, GMS has provided dental care services to students and staff in a state-of-the-art 3,000 square foot dental office. The office can address all dental needs using its six fully equipped operatories. On average the Dental Center provides treatment to 350 patients each month with oncall care available 24/7 for students. The Dental Center staff includes a full-time dentist, fulltime hygienist, three part-time dentists and two part-time hygienists. A full range of services is provided including prophylaxis, composite fillings, periodontal scaling and root planning, and crown and bridge work. Two endodontists provide root canal treatments and an oral surgeon comes in as needed for extractions. Each and every student who comes to Glen Mills is treated at the Dental Center with an initial exam, treatment plans and follow-up care. The Dental Center also houses the Dental Assisting programs, which is offered as one of the school’s 25 Career and Technical Education (CTE) program. Within the program, students work alongside dentists and specialists to learn the field. Students learn the sterilization process, how to use the biosonic cleaner and both the autoclaves and statims. Students in the dental assistant program are prepared for a career in the dental field if they choose to pursue that career path.

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DELAWARE COUNTY MEDICINE & HEALTH

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ON THE COVER

Optical Lab

Co-occurring Substance Abuse Program

Like the Dental Center, the Optical Lab doubles as a medical center and teaching facility. In operation for over 35 years, the Optical Lab provides glasses, created on site, to students, staff and the general public.

GMS currently partners with Onward Behavioral Health (OBH) to provide mental health and substance abuse counseling (co-occurring) to its youth population. The OBH program is a Commission on Accreditation of Rehabilitation Facilities (CARF) accredited program, offering comprehensive care in a format teens can understand and trust. The different levels of care available include intensive outpatient group sessions, general outpatient group sessions, individual sessions and family sessions.

Students in the CTE Optician program are taught hands-on skills including production through surfacing, finishing and retail operations. They learn the skills needed to work in industry-level optical stores. Students have gained employment in the optical field in locations such as Wills Eye Hospital, LensCrafters, Pearl Vision and other community-based companies across the United States.

Wellness & Nutrition GMS participates in the National School Lunch Program (NSLP) and has a wellness policy in compliance with Pennsylvania Law. The school also has a Wellness Committee, which is comprised of members from GMS departments and student representatives. The monthly meetings focus on health and physical education curriculum, drug and alcohol classes, food and nutrition, outside community service and the Big Dawgs Club, an individualized program for students with a BMI over 35.

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Family sessions are designed to develop effective and appropriate communication, boundary setting and create a plan for a structured environment for the student to return to upon completion of their time at GMS. Fourteen students are currently enrolled in the OBH program. Group session topics have included prevention, anger management, positive communication, disease model of addiction, negative consequences of substance use, goal setting, positive coping skills and impulse control.


Diagnostic Evaluation Center The Diagnostic Evaluation Center is responsible for providing mental health services at GMS. A board certified licensed child psychiatrist, two licensed psychologists, a licensed clinical social worker and a full time grief and loss counselor are available to students. The psychiatrist monitors students on behavioral health medications and is available to all GMS students as needed. The psychologists screen all new students to determine if mental health services such as individualized therapy sessions or grief and loss counseling are needed. Therapy and counseling services are provided by the psychologists, clinical social worker and grief and loss counselor. During the 2016 fiscal year 996 individual counseling sessions and 209 family counseling sessions were conducted for GMS students.

Athletic Trainers The main GMS athletic training room, team film room, and locker rooms are located at the Field House. The facility is staffed by three nationally certified, state licensed athletic trainers (ATC). The athletic trainers work

in conjunction with the GMS Health Center under the direction of the attending physicians. Athletic trainers specialize in the prevention, management, evaluation and rehabilitation of athletic injuries. The athletic training room has an array of equipment essential in providing student athletes with quality health care services including therapeutic modalities, therapeutic rehab equipment and strengthening equipment. Treatments are designed to avoid conflicting with class schedules. Approximately 3,500 treatment sessions are conducted annually. In addition to the above services, GMS also has close working relationships with several local hospital systems, such as Crozer, Main Line Health, the Children’s Hospital of Philadelphia, and A.I. DuPont. For over 190 years, GMS has provided quality health care services to its students. Today, the school continues to be committed to focusing on the overall well-being of its students and provides the finest of healthcare services. When students are healthy they are free to focus on their education, their personal development and, most importantly, plans for a successful future.

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DELAWARE COUNTY MEDICINE & HEALTH

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FEATURE

Vaccine Development

in Delaware County By Robert E. Weibel, MD

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n 1960, annual outbreaks of contagious childhood viral diseases occurred, and researchers isolated, grew and attempted to attenuate the virulence of viruses in tissue cultures. Measles virus had been partially attenuated by John Enders, but induced unacceptably high fever when administered by injection to susceptible children. Joseph Stokes had demonstrated that human immune measles globulin (HIMG) administered to a susceptible individual shortly after the exposure to a case of measles could reduce the severity of the disease with persistent long-term immunity. Merck Institute for Therapeutic Research under Maurice Hilleman produced Enders measles vaccine that reduced the fever to an acceptable level for general use when administered just prior to HIMG. Proof that this combination could protect susceptible individuals from natural measles virus required a controlled clinical trial among susceptible children. In July 1960, Robert Weibel, a Children’s Hospital of Philadelphia (CHOP) trained pediatrician, returned after two years in the Army to practice general pediatrics in association with George Starkweather who had an office in Havertown and staff privileges at Lankenau Hospital. A few months later Weibel met with Joseph Stokes to obtain staff privileges at CHOP, and learned it would be necessary to conduct a clinical trial to evaluate the efficacy of Enders measles vaccine and HIMG under the auspices of Merck and CHOP. Weibel volunteered to accomplish

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that task, and obtained about 200 names of children in kindergartens and nursery schools operating in churches. Meetings with the parents of the children were held at several sites in Havertown where the clinical trial of a live measles vaccine with HIMG and a killed measles vaccine was discussed. The trial to administer measles vaccine with parental consent was initiated in December 1960. A report card with Weibel’s telephone number was provided the parent of each vaccinee to record daily temperatures and report any high fever or rash. Blood specimens were obtained prior to and one month after vaccination with the assistance of Ronald Halenda to determine the presence or absence of immunity to measles. Live measles vaccine was also administered in the Lankenau Hospital Well Child Clinic to determine the optimal age for immunization. In January 1961, an outbreak of natural measles began among recipients of the killed vaccine while all susceptible recipients of live measles vaccine with HMG did not contract measles. The diagnosis of the measles cases was confirmed by physician observation and measles antibody one month later. Live measles vaccine (Rubeovax) with prior HIMG was licensed for general use in the US on March 23, 1963. Our group continued to evaluate potentially further attenuated live Enders measles vaccines in small clinical trials. A further attenuated live measles vaccine (Schwarz strain) was licensed in 1965, and Merck licensed the Moraten strain in 1968.


Jeryl Lynn Hilleman developed mumps in March 1963. Mumps virus was isolated from a throat swab obtained by her father and attenuated in tissue cultures by Eugene Buynak at Merck Laboratories. In 1965, mumps vaccines tested in small groups of susceptible mentally retarded children in group homes demonstrated a vaccine that induced antibody without sickness. Society’s historical acceptance of trials with experimental vaccines in retarded children has changed.

Robert Weibel injecting Kirsten Hilleman with Jeryl Lynn strain of mumps vaccine in 1966 with Jeryl Lynn Hilleman observing. That fall a controlled clinical trial of live mumps vaccine and an inactivated respiratory vaccine was conducted among 867 nursery and kindergarten children and families in the Havertown-Springfield area. Report cards with Weibel’s telephone number were provided, and nurses visited the schools twice weekly to determine sickness. Both groups were followed for 20 months for the acquisition of a laboratory-confirmed case of clinical mumps by virus isolation or antibody response or the documented exposure to a laboratory- confirmed case in a classroom or home. Several months later, an outbreak of mumps occurred. Five cases of mumps occurred among 174 children who received mumps vaccine compared with 133 who had not. On March 30, 1967 the live mumps was licensed. The 1963-1964 rubella epidemic in the U.S. infected thousands of pregnant women resulting in fetal death and defective newborns. The next epidemic of rubella virus was anticipated between 1970 and 1973 based on past epidemics. Rubella virus was isolated from the throat of an 8-year-old child in Aston Township. In January 1965, clinical trials of the Merck-Benoit strain of live rubella vaccine were initiated in mentally retarded group homes.

A vaccine prepared in duck embryo cells induced antibody without illness in children. However, a decision was made to use the NIH developed Parkman-Meyer HPV-77 rubella vaccine grown in duck cells to expedite development. In September 1966, the first large-scale family-study of live rubella vaccine initiated in the Havertown area among seronegative children less than 15 years of age demonstrated antibody responses in 97% of 265 vaccinees without illness and no contagious spread to 262 siblings and 34 seronegative mothers. Further studies in institutions showed no cases of serologically diagnosed rubella among exposed vaccinees. In May 1968, the seronegative mothers while on suitable pregnancy control received rubella vaccine and developed clinical rubella with transient arthritis and arthralgia like natural rubella in adults. At the same time to simplify immunization, clinical trials of combined measles, mumps and rubella vaccine (MMR) among 715 seronegative children, 7 months to 7 years of age, in the Havertown-Springfield area demonstrated 90% antibody responses without a significant increase in illness. Live HPV-duck vaccine was licensed in 1969, and MMR vaccine was licensed in April 1971. In 1964 at the Wistar Institute in Philadelphia, Stanley Plotkin grew rubella virus from an aborted fetus kidney. The virus labelled RA27/3 was attenuated in aborted fetal tissue cultures and provided broader protection without increased illness. After the FDA approved vaccines grown in human cells obtained from aborted fetuses, RA27/3 replaced the HPV-duck vaccine in MMR in 1979. In the 1960s, Weibel obtained vesicular fluid from area children with chickenpox, and varicella-zoster virus (VZV) was isolated in human diploid cells at Merck. In the 1970s, KMcC vaccines were developed at the 40th and 50th passage level of VZV. Clinical trials involving small groups of local children resulted in excellent antibody responses and rashes in 30% and 6% of recipients, respectively. At the same time, Michiaki Takahashi at Osaka University in Japan developed the Oka strain of varicella vaccine. An initial comparison trial of the KMcC and Oka strains conducted in Havertown that showed the Oka strain to be superior was confirmed by further studies. Hilleman obtained Takahashi’s vaccine manufactured as Oka/Merck. A double-blind placebo-controlled efficacy trial of Oka/ Merck vaccine among 914 seronegative children in suburban Philadelphia demonstrated 39 cases of varicella only among placebo recipients. The vaccine was licensed in 1995. The physicians, nurses, administrators and families in the Delaware Valley, especially Delaware County, are major contributors to the development of childhood vaccines.

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DELAWARE COUNTY MEDICINE & HEALTH

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FEATURE

Oxygen Safety Tips By Linwood Haith, Jr., M.D. Co-Director of the Nathan Speare Regional Burn Center

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xygen use at home has become a common sight, and portable oxygen users can be seen throughout our community going about daily activities. Supplemental oxygen use has become so common, it considered completely safe. And it is safe as long as proper precautions are taken. Although oxygen itself does not explode, it does support combustion, which means that anything that is already burning or sparking will burn much more quickly and hotter than if concentrated oxygen was not nearby. And that is how patients suffer oxygen-related burn injuries. Oxygen concentrators were introduced for home use in the 1970s as a way to avoid large or heavy tank storage in the home. However, the fire danger caused by concentrated oxygen is delivered to a patient’s airway is the same.

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“As a certified burn center, The Nathan Speare Regional Burn Treatment Center at Crozer-Chester Medical Center treats many different kinds of burn injuries and infectious skin disease, and patients suffering oxygen line-related fire injury are seen every month. They are all preventable. Just as the campaign to eradicate smoking in bed saved scores of lives and prevented countless severe burn injuries our goal should be to eliminate O2 line fires,” says Linwood Haith, Jr., M.D., medical director of the Crozer Burn Center. Though supplemental oxygen is a life-saver for many people suffering from pulmonary and heart disease, it does pose a serious risk to fire safety in the home. The chart below shows how flames can react with oxygen in otherwise harmless situations to threaten the well-being of a concentrated oxygen user.


Causes of home oxygen fires in the USA, 2003–2006. Data from the US National Electronic Injury Surveillance System.

If you or a loved one requires the use of oxygen, there are some steps that can be taken to prevent facial and upper airway burn injuries. •

electric razors and electric heating pads – although these seem like harmless appliances, they pose a risk of sparking.

Make sure your home is set up to be a safe space for oxygen tank/concentrator use. Consider posting a NO SMOKING sign in the room where you store your oxygen tanks as well as an Oxygen Tank in Use sign on your front door to alert visitors and emergency workers that concentrated oxygen is being used in your home.

Make sure your oxygen system is kept away from aerosol cans or sprays, including hair spray and air fresheners – these products are highly flammable.

Always store your oxygen tank and equipment in a well-ventilated area, unplugged without anything on top of or crowding it.

Check that all of the electrical equipment in the area near your oxygen tank is properly grounded and never use extension cords with medical equipment. Prevent tripping while using your oxygen system by making sure there aren’t any loose cords, extra tubing, or loose floor mats or rugs.

And, finally, make sure you have functioning smoke detectors and a fire extinguisher in your home at all times.

Don’t use any cleaning products or any other products that contain grease or oils, petroleum jelly, alcohol or flammable liquids on or near your oxygen system – they can cause oxygen to become flammable.

While you or someone else is using any oxygen system, do not smoke or allow others to smoke in the same room. Sparks from a cigarette can cause facial burns! SMOKING IS THE MOST COMMON CAUSE OF PATIENT’S INJURIES CONNECTED WITH OXYGEN USE. Similarly, you should stay at least five feet away from any open flame or heat source such as candles or a gas stove when using oxygen. And do not use any type of petroleum-based products like Vaseline on your face when using oxygen.

You also need to make sure your oxygen tank is stored away safely when not in use. It should never be stored near any heat sources or open flames. Neither should it be exposed to electrical appliances like hair dryers,

Home concentrated oxygen is a valuable tool to improve the quality of life for many patients, and with adequate precautions can be used safely, without risk to the patient and the patient’s home.

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DELAWARE COUNTY MEDICINE & HEALTH

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FEATURE

Be Informed: Resources for Child Abuse Victims By June Elcock-Messam, MD, Child Abuse Pediatrician, and Stephanie Tanner, MD, Third Year Pediatric Resident

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s physicians who care for children who are the victims of sexual and physical violence we are sometimes faced with many unique challenges. In addition to diagnosing and treating these victims, as physicians, we are mandated reporters so we must report these cases and assist in the collection of evidence for the investigation that must follow. After making sure that the patient is safe to leave the office or hospital, we then have to ensure that our victims and family members are referred for additional resources to begin the process of healing. It takes team work. We have to work well with many disciplines, including other physicians and allied medical staff, police officers, prosecutors, Children and Youth Services caseworkers and behavioral health providers. Our work is challenging, but very rewarding when we are able to protect our most vulnerable patients. We have seen a lot in the news recently about child abuse, especially as it relates to House Bill 1947 or as we see it in the newspaper: “The Battle for HB 1947.” We have no doubt that with the increased media coverage surrounding this discussion, victims and survivors of all types of abuse are feeling stressed. These people need to know that there are a multitude of resources available to them. They need to know that they are not alone in their suffering. They need to know that when they feel overwhelmed and sad and afraid, there are safe places to go and phone numbers to call where there will be a live, caring person on the other end of the phone to help them in the moment. As a physician who has been serving the child welfare community in Delaware County for sixteen years and a third year Pediatric Resident who is dedicated to serving this same community in the near future, Dr. Tanner and I have put together a list of resources for our victims, their caretakers and family members.

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Child abuse, whether is it physical abuse, sexual abuse, emotional abuse or neglect, has devastating consequences on a child’s life. Despite our best efforts, child abuse continues to be pervasive in the United States and around the world. According to recent statistics reported by the Pennsylvania Family Support Alliance, 10 of every 1,000 Pennsylvania children were reported as victims of suspected abuse in 2014. This translates to 29,273 cases of suspected child abuse in Pennsylvania in 2014. Of these children, there was enough evidence to support a child abuse charge in only 3,340 (11%) of these cases. According to the Childhelp, another organization that serves child abuse victims nationally, almost five children die every day as a result of child abuse in the United States. If we cooperate with each other, we can improve these statistics. Over the last sixteen years there are many families who have been referred to me more than once for child abuse medical evaluations. There are too many families where there is a history of mutigenerational abuse, sometimes at the hands of the same person! As a result of child abuse of any kind, children are more likely to be depressed, have a sleeping disorder, be diagnosed with anxiety, have eating disorders, have suicide attempts, run away, have academic problems in school and have difficulties connecting with others, to name just a few of the adverse effects. Child abuse impacts every aspect of a child’s life and then these children grow up and become adults and the cycle continues. Intervening on their behalf is essential. Below are a number of agencies and organizations that can be of help to victims. Some of them are located in Delaware County and victims and their loved ones can receive face to face intervention. For others who have difficulties talking with someone face to face, some of the resources are national ones so that victims can reach out anonymously.

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Resources for Child Abuse Victims The Pennsylvania ChildLine and Abuse Hotline Registry

Delaware County Crisis Connections Team (DCCCT)

ChildLine is located in Harrisburg. If there is a suspicion of child abuse and/or neglect, mandated reporters must make a referral to ChildLine either online or on their toll free number. They are available 24 hours per day, 7 days per week. This organization also provides a wealth of information including counseling and referral services for families and children to ensure the safety and well-being of children in Pennsylvania. Website: www.compass.state.pa.us/cwis/public/home Phone: 1-800-932-0313

Delaware County Children and Youth Services (CYS)

This agency provides a wide array of services to abused and neglected children from birth to 18 years old and their families. CYS investigates all allegations of child abuse and neglect as mandated by Pennsylvania state law. There are two regional CYS offices that serve Delaware County: CYS Website: www.delcohsa.org Upper Darby Office: 610-713-2000 Eddystone Office: 610-477-1000 Phone: 1-800-416-4511 Afterhours, holidays and weekends: 610-892-8400

Delaware County Women Against Rape (DCWAR)

This agency has been providing comprehensive direct services to victims of rape, sexual abuse and sexual assault who live in, or were victimized in Delaware County since 1974. They accompany victims to the hospital, police station, court proceedings and provide counseling and a wide array of other services for victims and their families. Website: www.delcowar.org 24 hour hotline: 610-566-4342

Crime Victim Services (CVS) Department of DCWAR This department began providing direct services to victims of other serious crimes in Delaware County in July, 2001. Website: www.delcowar.org (click the Victim Services tab of the menu) Phone: 610-566-4386

The Domestic Abuse Project of Delaware County, Inc. (DAP)

This agency was founded in 1976 and provides services for victims of domestic abuse in Delaware County. These services include counseling, legal services and housing. Website: www.dapdc.org 24 hour hotline: 610-565-4590

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– This invaluable suicide prevention service is provided by Elwyn, in collaboration with Delaware County Office of Behavioral Health and Magellan Behavioral Health of Pennsylvania, Inc. The goal of this team is to reduce the loss and suffering caused by suicide and suicidal behaviors. A phone helpline is available as well as a mobile crisis team. Website: www.delcosuicideprevention.org Phone: 1-855-464-9342 Mobile Crisis Service: 1-855-889-7827

Pennsylvania Family Support Alliance (PFSA):

This organization has been supporting mandated reporters for twenty years. They train mandated reporters in how to recognize, how to respond to and how to report child abuse in Pennsylvania. Website: www.pa-fsa.org/Mandated-Reporters Phone: 1-800-448-4906

Life Beyond Abuse (LBA)

This organization provides a wide array of services for survivors of domestic abuse, domestic violence, child abuse and neglect, dating violence/abuse and sexual assault, including counseling and support groups. Website: lifebeyondabuse.org Phone: 610-565-3399

Delaware County District Attorney Victim Witness Assistance and Restitution

This program helps to empower and assist crime victims and witnesses in reconstructing their lives through advocacy, support, information and referrals. Website: delcoda.com/das-office/county-service Phone: 610-891-4231 (when the offender is an adult 18 years or older) Phone: 610-891-5140 (when the offender is a juvenile under 18 years old)

Victims Compensation Assistance Program (VCAP)

This agency helps crime victims with money lost because of crimes that were committed against them. This can include money paid for medical expenses, counseling, loss of earnings, child care, travel cost, funeral costs etc. Website: www.pccd.pa.gov/Victim-Services Phone: 1-800-233-2339


Child Guidance Resource Centers (CGRC)

This organization which is located in Haverford provides community-based behavioral healthcare services for children, adolescents and families with mental health, developmental disabilities and residential needs. Website: https://cgrc.org Phone: (484) 454-8700

Widener University Community Counseling Center

This center is located in Chester and provides a wide range of psychological and counseling services including educational assessment, psychological testing, individual therapy for children and adults, couples and family therapy, substance abuse counseling and sports psychology. Website: www.widener.edu/academics/support/counseling Phone: 610-499-1261

Empower Youth, LLC

This counseling facility for youths aged 11 – 24 years old dealing with substance abuse and mental health issues provides individual therapy as well as supportive groups. They provide education on risky behaviors, substance abuse, healthy boundaries, emotional awareness and impulse control. “Empowering Youth to Make Healthy Choices” is their motto. Website: www.empoweryouth.net Phone: 610.565.4360

The National Center for Missing and Exploited Children

Website: www.missingkids.com 24 hour hotline: 1-800-THE-LOST (1-800-843-5678)

National Suicide Prevention Hotline 1-800-273-TALK

National Runaway Safeline

Website: http://www.1800runaway.org/youth-teens 24 hour hotline: 1-800-786-2929

Parents, Families and Friends of Lesbians and Gays (PFLAG) - PFLAG Media

Providing support, education and advocacy for the LGBTQ community. Website: www.pflag.org Phone: (610) 368-2021

New App for Pennsylvania Physicians: Download to iPhone and Android

Family Support Line

This organization is located in Media and has been serving sexual abuse victims in Delaware County since 1988. They address the trauma of child sexual abuse victims in multiple ways. They provide free therapy groups for children and adolescent victims of sexual abuse as well as parent therapy groups. Website: www.familysupportline.org Phone: (610) 268-9145

Crisis Units

Provides intervention for patients experiencing behavioral disturbances like suicidal thoughts, homicidal thoughts, psychosis, depression and anxiety. The two in Delaware County are Crozer Chester Medical Center Crisis Unit at (610) 447-7600 and Fitzgerald Mercy Crisis Unit at 610-237-4210.

Staying up to date on the latest news and advocacy issues impacting Pennsylvania physicians just became easier with the launch of the Pennsylvania Medical Society’s new mobile app. Go to: www.pamedsoc.org/app to download this app to your iPhone or Android device to receive daily news updates and act on important advocacy issues.

Childhelp - A National Child Abuse Hotline

A non-profit organization that provides prevention, intervention and treatment programs. Website: www.childhelp.org Telephone: 1-800-4-A-Child (1-800-422-4453)

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DELAWARE COUNTY MEDICINE & HEALTH

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FEATURE

y e n r u o J l a n A Perso

Into Adult Literacy

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By Robert M. Berley, MD, President, Delaware County Literacy Council t was my Mother who led me to the Delaware County Literacy Council, but in a very indirect way. As a young child she thrived on reading. However, because her foreign-born father felt reading and higher education were not meant for girls, she had to ask her Mother to intervene and help her obtain a library card. She read voraciously, even under the covers at night. She did well in school and was college-bound, when the Great Depression intervened. She had to forego her dream of higher education and go to work to support her parents’ family. But her joy of reading stayed with her throughout her life. She was probably more wellread than most college graduates.

A few years after she passed away, as our sons grew up and out of the house, I began to think of doing some volunteer work. I thought of my Mother’s lifelong love of reading and thought of teaching reading to those less fortunate than her. I found the Literacy Council in 2002, took their 12-hour course in literacy tutoring, and began working with “Joe,” a 34-year-old man whose partial loss of hearing from an early childhood illness had greatly hampered his scholastic development. Once the early stages of reading from first grade are missed, the child is increasingly behind his peers; and so it was with Joe, whose hearing impairment further complicated his learning. As he fell farther and farther behind in school, he was placed at the back of his classrooms. He left school shortly after completing eighth grade, but his reading level had not progressed beyond second grade.

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Joe knew he was missing something important by not being able to read, but he told very few people about it. He persisted in seeking out help because he felt that by learning reading he could advance his job prospects, enjoy more thoroughly his interests in history and sports and put the shame of low literacy behind him. These motivations and Joe’s character made him a great student for me – always punctual, responsible and enthused, like many other DCLC


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students are. The only missing ingredient was the habit of study. His Mother died when Joe was 12, and his Father did not encourage or push him with his school work. Despite this, we persevered. We shared strong interests in history and baseball, and these subjects often served as springboards for specific lessons in reading. And I learned through his eyes how difficult it is to go through life being unable to read. (You can’t travel very far from home if you can’t read the road signs and street names.) I learned of the shame he felt both from his low literacy and partial deafness, all part of the personal battles people with these impairments are fighting.

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and operations. It’s been a pleasure and an ongoing learning experience for me, working with the other Board members, and then realizing how talented and dedicated the DCLC staff is, not to mention the 150-plus volunteer tutors who provide much of the basic training to the students. As a practicing family physician, I had become increasingly attuned to the communication between doctor and patient and how critically important

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the content and method of that communication is to the patient’s health. Lost, missed or misunderstood communications between doctors and patients are now well-known causes for so many errors in the health care system or, in the least, so many patients’ health falling short of optimal. Continued on page 16.

DELAWARE COUNTY MEDICINE & HEALTH

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FEATURE

About the Delaware County Literacy Council and Our Adult Students

As I’ve come to understand the pervasive effect of low literacy on any person, it was an easy next step for me to answer the call in 2013 from David McKeighan, the Executive Director of the DCMS, to help form a group devoted to improving health literacy in Delaware County. That group, now known as the Delaware County Health Literacy Coalition, has begun work in several areas, raising awareness among patients, physicians and all others providing health care regarding the hidden problem of low health literacy. We hope that the processes used by the Literacy Council in teaching people how to read, write and speak English can be applied to the many people throughout the county who have low levels of health literacy. We want to help them feel comfortable asking questions, asking for clarification when their doctors are relaying information or giving advice, and we want to provide them and their families with the skills to better interpret the instructions they receive from us and their prescription bottles.

Learning to read and learning to navigate one’s health care both require a lot of time and patience on the part of the teacher and the learner. But the time spent is well worth it when the result is a better quality of life and better health for those around us.

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The Delaware County Literacy Council serves adults who lack the basic reading, writing, math, and English language skills they need to achieve their potential. DCLC focuses services in Delaware County communities with the greatest intensity of low literacy adults, the City of Chester and Upper Darby Township. Upper Darby has become home to a sharply increasing number of first and second generation immigrant families who have no or limited English skills. The Upper Darby public high school student body includes students from 120 nationalities with a significant number of foreign-born students. During the 2015-16 program year 58% of the 188 adults who enrolled in English language classes at the Literacy Council had beginner or low intermediate skills. These students are motivated, but lack the skills they need for competitive, family sustaining employment. According to 2015 U.S. Census data Delaware County has 9.6% of the population, or 53,000 people, who were foreign-born. Among those over age five, 35% spoke English less than “very well” and 20.9% of foreign-born households report no one age 14 and over who speaks English only or speaks English “very well.” Though only 5.4% of Delaware County’s foreign-born residents are unemployed, 42% of the adults who came to the Literacy Council to learn English were unemployed. Our adult students come from many backgrounds with different life experiences. Last week, we interviewed adults who wanted to attend English classes here at the Literacy Council. Classes are free to students and funded through a grant from the PA Department of Education and donations from the community. Three women shared striking stories. They were in their 30s, two sister-in-laws from Yemen and one from Liberia. None of the women had ever attended school in their home country because girls simply did not go to school. These women cared for their families, one woman ran a small business in her home country, and were working hard to transplant their lives here in America, but they had never been to school.


DCLC remains committed to our lower skill level (reading below the 6th grade level) students’ success. Government funding only covers a portion of the costs to serve DCLC adult students and requires that potential students be fast-tracked into employment. For many of our lower skill level students, improving their reading, writing, and English language skills will improve their lives and the lives of their families fairly quickly, but they need time to increase their skills to levels needed in the workforce. The good news is that unemployment rates are dropping and high school graduation rates across the country are rising, but there are still neighborhoods and adults who have been left behind. The 2015 US Census Fast Facts documented that inn the city of Chester 21% of individuals over 25 years old did not have a high school diploma and 33% of all individuals live below the poverty level. The US Bureau of Labor Statistics reported that for 2015, the difference between having or not having a high school diploma has a significant impact on an individual’s job prospects. For individuals without a high school diploma, the unemployment rate is 8% compared to 5.4% for those with a high school diploma. For those lucky enough to find a job without a high school diploma they can only expect an average of $493 per week, compared to $678 per week for those with a diploma. During the 2015-16 program year, DCLC served 96 adults

from Chester of whom 48% were unemployed and looking for work and 52% were reading below the 6th grade level. Census data and our own program data tell the same story that adults who lack basic skills struggle to find family sustaining employment. For forty years DCLC has worked to provide our neighbors with the skills they need to reach their highest potential. Some adult students need a second chance, for others this is the first step toward achieving the American Dream. By improving their skills, earning a GED or U.S. Citizenship, getting a job, or moving onto trade school or college, our student change their lives. DCLC’s programs are built upon research-based practices and forty years of experience. DCLC works with the PA Department of Education to design instruction that follows the College and Career Readiness standards that were created by the US Department of Education to provide adults the skills they need to successfully obtain and retain employment. DCLC also incorporates researchbased practices like including employment counseling and awareness embedded in basic skills instruction. To learn more about the Delaware County Literacy Council go to www.delcoliteracy.org or call 610-876-4811.

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DELAWARE COUNTY MEDICINE & HEALTH

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FEATURE

TEEN HEALTH WEEK By Laura A. Offutt, MD

To Get a 2017 PA TEEN HEALTH WEEK TOOLKIT go to: http://realtalkwithdroffutt.com/teen-health-week.html

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his past January, Gov. Wolf has proclaimed Jan. 25-29 as the first ever Pennsylvania Teen Health Week, a week focused specifically on the important topic of holistic health in teenagers. Pennsylvania is the first and only state to have such a state-wide proclamation and observance. Based on a successful First Pennsylvania Teen Health Week in 2016, plans are already underway for the 2nd Annual Pennsylvania Teen Health Week, which is scheduled for January 9-13, 2017. Pennsylvania Teen Health Week has been developed by Real Talk with Dr. Offutt, LLC, and in collaboration with the College of Physicians of Philadelphia and the Pennsylvania Department of Health. The Delaware County Medical Society and the Pennsylvania Medical Society have been strong supporters of this

initiative since its inception. The establishment of a Teen Health Week calls upon adults and health care and educational institutions to focus on the health needs of this special population. Many wrongly assume that teen health is synonymous with sexual health. However, teen health encompasses far more. Health behaviors resulting in illness later in life, that start or are reinforced in the teen years, include substance abuse, diet and exercise habits, violence, and mental illness. Specifically, worldwide, suicide is the 3rd leading cause of death amongst adolescents, and as many as half of mental health disorders start by the age of 14, many are left untreated. Sexual development occurs during these years, and it is critical to teach youth means to reduce unwanted pregnancy and communicable diseases such as

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HIV and other sexually transmitted diseases. Health behavior patterns established during adolescence both affect the individual’s current and future health, and have the potential to lay the foundation, either positively or negatively, for adult health. Thus it stands to reason that promoting healthy behavior in teens promotes a healthy population in general. In Pennsylvania, more than a quarter of youth are overweight or obese and fewer than half of high school students report getting the recommended amount of daily physical activity. Teens account for nearly half of the cases of chlamydia and gonorrhea in Pennsylvania. Nearly half of students in 6th-12th grades report having had alcohol. A fifth of 12th graders report using marijuana in the past month. Depression symptoms and suicidal


thoughts are increasing, with 15 percent of our teens reporting seriously considering a suicide attempt. It is often described that the adolescent brain develops reward pathways faster than it develops pathways responsible for planning and emotional control, but often what is less discussed is the remarkable capacity for the adolescent brain to adapt. Thus it is recognized that exploring and experimentation are normal activities during teen years; but one should also consider that questioning, learning, and engaging with accurate health information will help adolescents develop the necessary skills to advocate for their own health.

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Since adolescents often are agents of change, including them in discussions and really listening to what they have to say about improving adolescent health behaviors is critical. Pennsylvania Teen Health Week is intended to inspire adults and teens in our communities to work together to protect and improve the health of Pennsylvania teens. Individuals, schools and other organizations that wish to become involved can do so easily. Each day has a specific broad health focus to serve as a suggestion or guide around which to focus activities: Healthy Diet and Exercise; Violence Prevention; Mental Health; Sexual Development and Health; Substance Use and Abuse. Involvement can be as simple as hanging a flyer announcing the week in the office or wearing lime green, the official color of Teen Health Week. A comprehensive toolkit has been developed which includes a timeline that can start at any point in the fall, through the week itself. The toolkit includes youth activities and lesson ideas, many of which can be used to meet highlighted Pennsylvania Academic Standards with which schools must comply. Activities, sample social media posts, and a

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variety of resources are grouped around the broad themes covered in the week. Student clubs, youth groups, school teachers and administrators, medical practices, local businesses and other community organizations are all invited and encouraged to participate in the week. The week will kick off with a formal presentation of Governor Wolf ’s Proclamation by the Pennsylvania

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Department of Health under the Capitol Rotunda in Harrisburg at the State Capitol Building. The week will close out with a Good Teen Health Depends on More than Good Luck celebration in Philadelphia on Friday the 13th. Teens and adults alike are both invited to participate in these 2 events, which will be free and open to the public.

DELAWARE COUNTY MEDICINE & HEALTH

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FEATURE

By Leigh Balcom, Fraud Risk Manager, M&T Bank

A

Comptroller at a mid-sized company got an email that appeared to be from the CEO, instructing him to wire $400,000 to an attorney the CEO was working with to acquire an overseas company. After several email exchanges, the Comptroller initiated the wire transfer. A few days later, the CEO noticed the transfer and asked the Comptroller about it. The CEO never authorized the transfer. Instead, the CEO’s email account had been hacked by a fraud ring, who engaged in a crime known as “Executive Impersonation” fraud. The money was never recovered. In another incident, an Office Manager for a medical practice thought she needed to get a $125,000 wire processed as soon as possible. One of the doctors told her in an email it was an urgent request and they needed to move quickly if they were going to be able to purchase the equipment at a great price. So, you could probably see the color leave her face the next day when she told the doctor the funds were sent and his puzzled look told her he had no idea what she was talking about. They immediately called the bank to recall the wire, but the funds had moved to a foreign country and the receiving bank said the fraudster had already withdrawn the money. These examples are just a small portion of numerous companies who have fallen victim to an Executive Impersonation scam. There are a few different iterations of how the fraud is perpetrated but all entail the scheme of duping a company employee into sending money via wire, ACH or even check to a fraudulent account because they think an executive at their company wanted it sent.

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The FBI estimates that Business Email Compromise, in which a criminal hacks into a legitimate business email account in order to conduct unauthorized transfers of funds, has cost individuals nearly $3.1 billion in the two and a half years from October 2013 to May 2016. The fraudster will simply take advantage of an employee’s desire to do what their manager requests. There are different ways this can be done. In a simple Executive Impersonation scam, the bad guys will simply change a letter or two from the manager’s email address to make it look like the email matches the company’s email domain. If an email is telliott@abc123.com, a simple camouflaged address could be telliott@abcI23.com. They look similar but the ‘1’ has been changed to a capital ’i.’ The employee thinks the email is the same and responds to the bad guy, thinking they are conversing with the manager. How does the fraudster know who’s who in the company? That might be the easiest part of the whole scheme…social media or a simple Internet search. It’s easy to look up a company on the Internet or on social media and get names or e-mail addresses. Another form of this crime is known as Business Email Compromise. This is a more sophisticated scam where the company’s email account has already been compromised via a virus or other form of malware. The fraudster is remotely monitoring conversations between company employees. They know who authorizes payments and who processes the wires. They’re well aware that the CFO goes by “Tom” and not Thomas or Tommy. They know when someone is out of the office or on vacation.


All this information is gathered by reading the emails of the company employees. The bad guy can then craft a message to the person sending payments that will make sense to the receiver of that email. If the fraudster has seen a reference to Tom being out of the office, he can send an email to the sender of payments and refer to their absence: “I’m out of the office and can’t talk right now but I need money sent to xyz.” The bad guy has already set up a fraudulent account at another bank in order to make the movement of money quick and simple.

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Another version is known as “Vendor Impersonation.” In this variation, the fraudster will hack into a company’s email and look for customers. They then send emails to these nonsuspecting customers and tell them an invoice is due but the payment information has changed. They’ll then give ACH or wire instructions to their own fraudulent account.

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In these cases, the fraud takes longer to detect because the paying customer thinks they’ve paid a bill and might not find out it hasn’t been paid for 30, 60 or even 90 days. By then, the money has been moved and is long gone.

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It’s not all hopeless. Executive Impersonation events can be prevented. The FBI encourages anyone sending a wire to use the following steps to prevent this type of fraud: • Confirm all requests for money transfers in person. If confirming over the phone, make sure the confirmation is completed via known phone numbers between parties. • Verify changes in vendor payments. Call your contacts and make sure any changes are legitimate. •

Keep business and personal information safe. It’s best to start with good, basic computer security like changing your passwords regularly; don’t open email attachments from unknown senders; keeping virus software up to date; and being very careful about posting personal and business information on social media.

Educate yourself and your employees. Create a payments policy and follow it. Keeping your employees educated about the latest fraud trends is a key to preventing fraud or recognizing it quickly to reduce potential losses.

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Choose a financial partner who can help. Partnering with a financial institution that keeps you informed on fraud developments and is invested in helping to protect your organization from fraud is also key. As a partner in fraud prevention, your financial professional should: • Possibly help retrieve the money if a fraud occurs and the money is still available • Keep you informed on relevant fraud industry data • Provide help on identifying fraudulent activities early to reduce organization losses • Advise you on fraud prevention best practices • Offer necessary fraud protection products and procedures, such as the dual authorization and the separation of duties, to reduce your risk of becoming a fraud victim • Help you to reconcile account activity daily • Encourage out of channel verification of any payment

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Christopher Silvia is the Branch Manager of M&T Bank. csylvia@mtb.com

www.delcomedsoc.org

Leigh Balcom is a Fraud Risk Manager in the Enterprise Security department of M&T Bank. He has been with M&T for more than eight years. Previously he was with The Buffalo News and Rich products.

DELAWARE COUNTY MEDICINE & HEALTH

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FEATURE

Grief & Loss Through the Holidays

The question is two-fold: How do we recognize prolonged grief in ourselves or in loved ones? And, what can we do to ease the grief we experience, particularly over the holiday season?

By Terri Erbacher, PhD, Philadelphia College of Osteopathic Medicine

The fall weather is here and Thanksgiving is right around the corner. It is a time to be thankful and express gratitude for the people and the love in our lives. But, what if you have recently lost a loved one? The holiday season can feel gut-wrenching and bereaved individuals may find themselves feeling depressed, exhausted, and forlorn. It is important to note that the majority of bereaved individuals cope with their grief relatively well, are able to function as effectively as before their loss, and are able to feel joy and happiness despite intense sadness (Bonanno, 2009). However, the grief process is quite individualized (Erbacher, Singer & Poland, 2015), and may vary greatly depending upon life experiences, faith, and previous losses. The first holiday without a loved one can send a grieving person spiraling back into the depths of sorrow, yet many bereaved people say that the second year can actually feel worse. During that first year, friends and loved ones often gather around to ensure those grieving are kept busy. But, many bereaved individuals report finding themselves more alone during the second holiday without their loved one. Humphrey and Zimpfer (1996; cited in Regehr & Sussman, 2004) suggest that the grieving process can easily last up to two years. And, those experiencing prolonged grief, especially after a traumatic loss such as a suicide, may experience grief for years on end, if not forever (Bonanno, 2009).

What are signs that you or a loved one are still in the midst of grieving? • You feel tired more often or have trouble sleeping well. • You may have trouble concentrating as you find your thoughts constantly return to how much you miss your loved one. • Activities you used to enjoy no longer seem worth the effort.

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It is important during this season that we each nourish our soul, engage in self-discovery regarding what we truly need, and find ways to express gratitude and cherish simple joys during this difficult time. It is important to give ourselves permission to grieve. The trajectory for grief is different for each of us, so we cannot compare our experiences to that of others. We must be patient with ourselves and do what feels right to us in the moment. Most importantly, there are often hidden gifts in our grief. Perhaps we can each find new meaning this holiday season.

A few suggestions for healing over the holidays:

You may find yourself consumed with thoughts of blame – perhaps blaming yourself, blaming your loved one for not taking care of themselves, or blaming doctors for not being able to save your loved one.

Allow yourself to feel. Accept feelings of sadness and be open to again experiencing joy.

Create new traditions. Perhaps have dinner at a new place or plan a night before Thanksgiving movie and pajama party for kids.

Communicate what you need and be with those who you feel supported by and who will accept you as you are.

Take care of yourself and honor your own needs, even if that means saying ‘no.’

Establish rituals to honor your loved one; light a candle or read a remembrance poem before dinner.

Plan ahead as knowing what to expect can alleviate stress. Maybe shopping online will provide relief from hectic malls.

Don’t allow the elephant in the room; mention your loved one and share memories to keep their love alive.

Practice mindfulness; enjoy the taste of that pie, inhale deeply to smell the tree, truly hear the laughter of others, feel the heat from the menorah, or watch the snowflakes fall….and really see each of them.

• You may find yourself questioning how your God could do this to you. • You find yourself being more irritable and easily angered. • You are more sensitive to sad events or things like gloomy movies.

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DELAWARE COUNTY MEDICINE & HEALTH

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FEATURE

Are you concerned about a friend, colleague or loved one? The best thing you can do is to simply be available (Erbacher, Singer & Poland, 2015). Be sure to ask your friend or loved one if they want to talk, ask direct questions, and listen without judgement. Sometimes people are afraid that you do not want to hear their ‘sob story,’ so make it clear you care and want to be there. Help your loved one get through the season by initiating contact, re-establishing routines, and asking how you can ease their burden of holiday shopping, cooking, etc. Try not to take irritability personally as your loved one is making sense of their pain. Finally, share your own feelings and concerns honestly. And, if you think that your loved one might benefit from therapeutic support, help your loved one seek additional resources.

Here are some signs to look for that your friend or loved one may need additional support: • • • • • • • • • •

A friend is questioning if life is worth living without his/her loved one. You notice a colleague has withdrawn from all social interactions. A friend is having trouble getting out of bed for anything, even fun events. A loved one is having trouble functioning effectively at work. A friend mentions that he/she feels like a burden to loved ones. You see a friend or loved one engaging in extremely risky behaviors (such as drug use), without a care in the world about potential consequences. A friend, loved one, or colleague cannot stop crying throughout the day. A colleague is terrified to leave the house for fear that something bad might happen. A loved one is talking about a wish to die or is making a suicide plan. A friend is talking about seeking access to suicide means, such as a gun.

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Terri A. Erbacher, Ph.D. is a School Psychologist and Clinical Associate Professor of Psychology at Philadelphia College of Osteopathic Medicine

References Bonanno, G.A. (2009). Why we’re wrong about grief. Thriving in the Face of Trauma [Blog]. Psychology Today. Retrieved from https:// www.psychologytoday.com/blog/thriving-in-the-face-trauma/200910/ grief-doesnt-come-in-stages-and-its-not-the-same-every Erbacher, T.A., Singer, J.B., & Poland, S. (2015). Suicide in schools: A practitioner’s guide to multi-level prevention, assessment, intervention and postvention. New York, NY: Routledge. ISBN-13: 978-0415857031. Regehr, C. & Sussman, T. (2004).Intersections between grief and trauma: Toward an empirically based model for treating traumatic grief. Brief Treatment and Crisis Intervention, 4(3), 289-310.

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If you have a friend or loved one experiencing grief, try to remember them during the holidays even if their loss was long ago. Notice if your loved one is feeling depressed or suicidal and ASK them how they are doing. The single best thing you can do is just be there and offer to spend time together, even if you simply enjoy a quiet cup of coffee together. If someone you love is in crisis, they can call 9-1-1 or the 24-hour National Suicide Prevention Lifeline at 1-800-273-TALK (8255). An online chat feature is also available at http://suicidepreventionlifeline.org.

fall 2016

Please contact our staff at (610) 892-7750 or email delcomedsoc@comcast.net.


VOLUNTEERS NEEDED For more information, please contact Marie Frey at mfrey@cvim.org or 610.836.5990 x106 Community Volunteers in Medicine (CVIM) provides compassionate primary medical and dental care and health education to people who live or work in Chester County who lack access to insurance, in order to support their goals to lead productive, healthy, and hopeful lives. As a non-profit, supported 100% through philanthropy, we are committed to remaining the safety net provider for medical and dental care in our community. Volunteers are the heart and soul of CVIM. Our volunteer licensed healthcare professionals and support volunteers embody a “Culture of Caring” that is shared with our patients through the provision of compassionate, culturally competent and dignified care. These doctors, nurses, dental hygienists, pharmacists, interpreters and more come from all over to volunteer over 53,000 hours a year of service work in the pursuit of better health for the community.

DENTAL: •

Dental Hygienists

General Dentists

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Orthodontist

Endodontists

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Public Health Dental Hygiene Practitioner (for outreach/ education)

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Chiropractor

Orthopedic Physicians

Diabetes Educators

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Music Therapist

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THIRD QUARTER UPDATE

UPDATES from the office of

Senior Medical Advisor

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By George K. Avetian, DO, FCPP, Senior Medical Advisor he Delaware County Heroin Task Force, chaired by District Attorney Jack Whelan, has met regularly over the past five years to focus on local efforts to deal with this national epidemic. Members of the Heroin Task Force, established by District Attorney Jack Whelan, Delaware County Council and Chairman Mario Civera, focus on activities to deal with this nationwide epidemic. Recently Councilman David White, Common Pleas Court Judge John Capuzzi, and Mike Raith, director of adult probation and parole in Delaware County, have joined the Task Force. We have expanded our activities in the rehabilitation process with the addition of two trained certified recovery specialists (CRSs). Our CRSs are available to respond to reports of an overdose with the end goal of connecting those overdose victims to a treatment program. The two CRSs will be alerted when an overdose victim is taken to a hospital. While working within the guidelines of the Health Insurance Portability and Accountability Act (HIPPA), the hospital staff will advise the patient and their family about the CRS resource. In addition, Delaware County has established permanent drug disposal sites at forty locations strategically placed in secure sites throughout our county. This initiative involves our local police departments and we are very pleased to have their support and participation securing the drop off sites. We are also fortunate to have the participation of our local law enforcement in the Nasal NARCANÂŽ (naloxone HCI) program. Since November 2014, when police officers in Delaware County were authorized to administer naloxone to overdose victims, over 300 lives have been saved. According to the U.S. Centers for Disease Control and Prevention (CDC), naloxone has saved 26,463 lives nationwide over the past 20 years. Nasal Narcan is now available over the counter at many Delaware County pharmacies for purchase by family members and friends for individuals at risk. Over the past several months Councilman White, District Attorney Whelan, Executive Director Grace and I have met with community groups promoting awareness

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of this epidemic while educating our partners on preventative measures and treatment resources. Inhibiting the heroin epidemic is a challenging project and we are pleased to have numerous community groups working collaboratively with us. Further information on activities of the Heroin Task Force are available at www.co.delaware.pa.us/heroin or can be reached via links on the Delaware County web site www.co.delaware.pa.us and on our District Attorney’s web site www.delcoda.com.

2016 marks the seventeenth year that Delaware County conducted a West Nile Virus Surveillance and Control Program to prevent the potential public health effects of the West Nile virus on county residents. The program, funded through a grant from the Pennsylvania Department of Environmental Protection (DEP), ran May through October, which marks the high season for mosquito activity. As we exit the peak months of mosquito activity it is wise to remain vigilant of the West Nile threat. It would be prudent to educate and encourage the public to take precautions to eliminate any potential breeding places for mosquitoes such as pools of stagnant water. The Department of Intercommunity Health works on educating Delaware County residents with informational brochures on best preventative measures in addition to providing educational pieces on social media and on the Delaware County web site. In the third quarter we had one case of West Nile Disease in Delaware County. Statewide as of this date there have been thirteen reported cases in 2016. Of the thirteen cases five were West Nile Fever and eight were meningitis/encephalitis. More information on West Nile activity can be obtained at the state website: www.westnile.state.pa.us/faq.htm.


This is the opportune time to stress to our community the importance of receiving the influenza vaccine. On Friday October 14, 2016 our annual influenza vaccine clinic was conducted at the Ridley YMCA. Free influenza vaccines were provided to Delaware County residents from 10:00 am till 2:00 pm. As in years past there was a brisk turnout. I would like to extend my gratitude to The Delaware County Council and Executive Director Marianne Grace for purchasing and providing the vaccine free of charge to our community. I would also like to express my gratitude to our partners in this venture which included members from The Pennsylvania Department of Health, members of The Delaware County Medical Reserve Corps, members of The Delaware County Department of Intercommunity Health, and members of the Delaware County Medical Society. The benefit of receiving the vaccine is promoted on the Delaware County web page and we look to your support in encouraging all County residents to receive the vaccine.

Together with my colleagues in the Department of Intercommunity Health I attend regular meetings of the Health Advisory Board. This Board is comprised of representatives from the three Delaware County Health systems, the Delaware County Medical Society, our Delaware County Medical Examiner, and physician representatives. Topics discussed focus on issues relevant to the residents of Delaware County. Twice a year the meetings are open to the public and the most recent public meeting was held May 25, 2016. Our next public forum will be conducted at The Delaware County Government Center on Wednesday, November 16, 2016 at 8:30 am. Our Department of Intercommunity Health Coordination under the leadership of its Director Lori Devlin together with our Department of Emergency Services directed by Ed Truitt remains focused on the Delaware County Strategic National Stockpile (SNS) Program. Delaware County’s plan is based on a national initiative mandated through the federal government to ensure adequate levels of preparedness in the event of a disaster. County Council is committed to protecting the lives of all residents in the event of a catastrophic incident.

proficiency in our evaluation by the Centers for Disease Control (CDC) and the Pennsylvania Department of Health. On a regular basis we conduct exercises and reviews to maintain our excellence in preparedness. Communication efforts continue as it is our Department of Intercommunity Health Coordination’s priority to inform and educate our community. Postings on social media included pieces on Zika and West Nile, the flu vaccine, activities of the Delaware County Health Literacy Coalition, FDA updates, and updates on activities of The Heroin Task Force. Lori Devlin and I continue to work with David McKeighan, Executive Director of the Delaware County Medical Society, promoting the activities of the Health Literacy Coalition. The focus of the Health Literacy Coalition is to improve a patient’s ability to access services, understand health-related information and follow medical instructions. Many seemingly well-educated people suffer from limited health literacy and their care may be less than optimal because they simply don’t understand. Problems that may occur as a result of low health literacy include missed appointments, medication errors, patients getting misleading information from websites, and an overall lack of compliance with medical advice. Our efforts will be to enhance communication and understanding between medical personnel and patients; to promote use of diagnostic tools as well as resources and activities and to have a positive impact on the health of the community and to enhance patient outcomes. This past summer two retreats were conducted to fine tune a strategic plan. The coalition will meet again in mid November to place the finishing touches on the strategic plan. In conclusion, we continue to meet quarterly with our municipal health officers and provide educational programs that are of benefit in their communities. At each meeting Lori Devlin and I update our health officers of the progress of The Heroin Task Force in addition to other health initiatives throughout the County. Our educational programs with municipal health officers cover topics of discussion based on relevance to the health officers. I welcome your feedback and suggestions; I ask that medical practitioners feel free to contact me with any issues or concerns that may have an impact on our community. ---------------------------------------------------------------------------

This is a collaborative venture of many County departments and much credit is to be given to our County Council and Executive Director for their strong support of this program and for providing necessary resources which enable us to continue to demonstrate

www.delcomedsoc.org

George K. Avetian, DO Senior Medical Advisor Office of Intercommunity Health Government Center Contact for feedback and suggestions: (610) 891-5311 avetiang@co.delaware.pa.us

DELAWARE COUNTY MEDICINE & HEALTH

27


JILL’S TIMELESS TIDBITS

MEDICAL PRACTICE MANAGEMENT

Jill’s Timeless Tidbits

Creative ways to foster comaraderie and teambuilding with your office staff or family and friends.

U

se fun and wacky holidays, also referred to as Unofficial Holidays, to create small celabrations or big events. Use of these unofficial holidays is increasing in popularity in today’s culture. I have been in healthcare for 28 years and have always enjoyed incorporating these into my workplace to help boost morale, create a positive focus, and strenghten our team. I also enjoy doing this with my own family. These can be used as humorous distractions and excuses to share laughs with friends. There are many websites offering official and unofficial holiday dates. Most of the dates referenced in my articles are from www.holidayinsights.com. Here are some of my favorites coming up. Celebrate these dates too or some of the many others not listed here and let your imagination be your guide! Some memorable dates to consider celebrating this winter are: November 13 – World Kindness Day – This day encourages individuals to overlook boundaries. Make your kindness “contagious”! December 1 – Eat a red Apple Day – stay healthy this holiday season, maybe share a red apple with others this day. December 18 – Bake Cookies Day – participate in Cookie swaps at work or with neighbors or at family gatherings. Some suggested Holiday office entertainment: With the Holiday season is upon us there is so much fun to be had with your staff to help lighten the stress this time of year can bring. For Thanksgiving I like to give staff a note “We give Thanks for you” and include a coupon for a ‘free hour’ of work to be redeemed before the end of the year. Other fun things to do these months are: Have an office snowball fight with crumpled paper…Have an ugly sweater or holiday shirt contest…Decorate your office with paper snowflakes made by the staff….

28 DELAWARE COUNTY MEDICINE & HEALTH

fall 2016

Jill Venskytis, CMM, HITCM-PP Practice Administrator Drexel Hill Pediatric Associates DCMS Board Member Vice President Delco PAHCOM Chapter At my annual Holiday party I like to break into teams (each team containing a mix of doctors and staff) and do random organized games/activities. My activities usually follow a theme and promote cognitive thinking, coordination, skill, and fun. Every employee gets very competitive; the staff likes having physicians on their team; all see each other in a new light. One of the “hands on” activities at my party one year was having a few members from each team replicate a “Gingerbread House” I made. The house was made from graham crackers, icing and candy. It had additional details like snowy (aka icing) surroundings and marshmallow shrubs. It was fun to hear team members yelling “no, no, it’s green then red” and “turn the cracker sideways.” Good thing I had wipes for cleanup because the knives got thrown aside and their hands were covered in a fun mess. The gingerbread house game was the last activity for the party and for a parting gift I made everyone mini gingerbread house kits presented in a large mason jar dressed with a bow.

Make sure you have fun with your staff this Holiday season!!


Call to schedule an appointment at one of our convenient locations: Crozer POB II, Suite 324 Glen Mills Brinton Lake 300 Evergreen Drive, Suite 200 Media 200 East State Street, Suite 108 Wilmington St. Francis Hospital, Suite 600 North Wilmington 2004 Foulk Road, Unit 3

610-876-0347 or 302-656-2643 premierortho.com

Delaware County Medical Society members trust Stratix Systems to take care of their technology needs.

www.delcomedsoc.org

DELAWARE COUNTY MEDICINE & HEALTH

29


A UNIQUELY DIFFERENT MODEL of

CANCER CARE CROZER-KEYSTONE REGIONAL CANCER CENTER AT BROOMALL Like many cancer programs, we offer the latest technologies and procedures, plus experienced specialists and personal navigators. But only one cancer program in our region employs a cutting-edge model of care that consistently ensures that quality, efficiency, and communication is delivered to patients: The Crozer-Keystone Regional Cancer Center at Broomall. A NEW STANDARD IN CANCER CARE. • Oncology patient-centered Medical Home®

• New patient appointments within 24 hours

• Concierge level of services dedicated to patient satisfaction

• Multidisciplinary care in one location

• Evidence-based radiation therapy and partnership with Philadelphia CyberKnife

• Access to the latest state-of-the-art technologies, such as the Varian TrueBeam Linear Accelerator and 4D PET-CT

FOR MORE INFORMATION VISIT CROZERKEYSTONE.ORG/BROOMALL

CROZ ER-KEYSTONE at BROOMAL L Delaware County’s New Standard in Care 30 Lawrence Road, Broomall • Just off Rte. 3 and I-476

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