CURRENTS Fall 2021 - Riverbend Community Mental Health

CURRENTS FALL 2021

Breaking Down Treatment Barriers This is My Brave Spotlight Supporting Young Children

A PUBLICATION OF RIVERBEND COMMUNITY MENTAL HEALTH, INC.

CURRENTS IN THIS ISSUE...

01 A Letter From Lisa Madden Happy Fall!

02 Breaking Down Treatment Barriers: Riverbend’s Collaboration with Schools

04 This Is My Brave Spotlight: Mental Health Mayday By: Todd Donovan 06 Supporting Young Children through Evidence-Based Practices

12 Save the Date Champions for Mental Health Awards

A letter from Lisa Madden

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HAPPY FALL!

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Greetings everyone, I hope you are enjoying your summer, finding time to reconnect with friends and family, and even partaking in an adventure or two! At Riverbend we have been working closely with our state colleagues to develop and implement several enhancements to our services. Earlier this spring the Commissioner of Education, Frank Edelblut, reached out to the Community Behavioral Health Association to ask for assistance in equipping summer camp counselors with mental health training to best support students at various camps throughout the state. While the pandemic has impacted every one of us in some way, we know that students have had to make countless adjustments and sacrifices. Providing trained counselors to young people through the summer camp system has been a great way to help students deal with COVID trauma, socialize with peers, and prepare for the next school year.

We are also working closely with the DHHS Bureau of Mental Health Services to advance the emergency response system of care for those across the state of New Hampshire experiencing a behavioral health crisis. Beacon Health Strategies has been awarded the contract to operate the call center, known as the Rapid Access Point. This center will be staffed by clinical professionals trained to respond to calls from people in psychiatric crisis. If the situation cannot be resolved on the call, a Rapid Response/Mobile Crisis Team will be deployed. Riverbend was the first in the state to have a Mobile Crisis Team with Manchester and Nashua quickly following. We are thrilled for New Hampshire that all 10 Community Mental Health Centers will have Rapid Response/Mobile Crisis Teams in the coming year. While our Emergency Services Team at Concord Hospital will continue to provide psychiatric evaluations, stabilization and disposition to the appropriate level of care as needed, our goal is to remediate the emergency room boarding crisis that we all have been hearing about in the news.

Strengthening and expanding community-based services is critical to support those living with mental illness. In response to an identified need for more supported housing opportunities, the state has asked every CMHC to increase bed capacity by six in their region, allowing 60 more people access to supported housing or residential treatment in

Lisa Madden, CEO, Riverbend Community Mental Health

NH. Riverbend is eager to be part of the solution to this housing crunch and plans to expand capacity accordingly.

Stay tuned for more information in the coming months as this important project progresses.

Thank you all for your support and kindness. I am continually impressed by the dedication and commitment of the team at Riverbend and all the amazing things they’ve accomplished in a time of tremendous uncertainty. I am honored to be here and look forward to another successful year.

Wishing you and your families a happy and healthy fall season.

With gratitude,

Lisa Madden CEO - Riverbend Community Mental Health

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BREAKING DOWN TREATMENT BARRIERS: RIVERBEND’S COLLABORATION WITH SCHOOLS For the last decade, the New Hampshire Department of Education (DOE) has been funding projects to expand mental health awareness and access for youth by focusing efforts within school systems.

“The need for school mental health and better relationships between schools and mental health providers is only

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increasing. COVID has shown us that as well. We know that kids are suffering and they spend a very large portion of their day in school,” said Ellen Desmond who, at the time of writing this article, worked in the Office of Social and Emotional Wellness at the NH DOE.

including school-wide curricula and classroom management, as well as interventions for students with additional needs.”

home. But we need collaboration with community mental health providers. They should be part of the conversation from the start,” said Desmond.

TIERED PREVENTION F R A M E WO R K

The school will serve as a hub for the program.

A federal grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) will be used as part of the state’s ‘system of care’ to integrate community mental health providers and school districts.

Supports are delivered across three tiers:

“We’ve had a number of different grants but this is a new level that we haven’t tried before. It will be a closer collaboration between the school systems and the mental health centers,” said Desmond.

The grant provides the state up to $3 million per year and will last up to four years.

Beginning in the 2021-2022 school year, Riverbend Community Mental Health will be working with the Merrimack Valley School District, one of several communities implementing NH’s Multi-Tiered System of Supports for Behavioral Health and Wellness (MTSS-B).

According to the DOE, the goal of MTSS-B is to incorporate socialemotional learning and mental health “throughout school culture,

Tier 1: School-wide approaches Tier 2: Targeted supports for at-risk students Tier 3: Individualized services for highest-needs students Source: NH DOE

“One of my major goals is to constantly evaluate and improve how we work together with schools,” said Melissa Colby, Riverbend’s Children’s Program Director.

“We are already in 26 schools in our catchment area where we have a clinician there for the day who sees students during school hours for individual therapy. But this higher level collaboration with the school is what I have long envisioned.

We want our young people to get everything they need,” she said.

A joint effort between parents, school officials, and mental health experts is key, said Desmond.

“Educators and their administrators are people who know students the best, second to their caregivers at

A portion of the grant will go toward hiring a licensed behavioral health clinician who will serve as a liaison between the school systems, Riverbend, and the state. The liaison will work with school officials such as guidance counselors, administrators, and families.

“We have a plan but we are going to learn as we go, to figure out how to best serve the community,” said Colby.

The grant allows for four years of funding and data collecting. Ideally, that data will serve as the reference for developing a statewide, longterm approach.

“It’s important that there’s a consistent model but there’s definitely room for local control. It’s an attitudinal change, it’s a culture change,” said Desmond.

“All of us want to help every child succeed in their school and home life. We are there to support the family and all of us are working for them,” said Colby.

“If we don’t do this we’re missing out on an opportunity to break down silos,” said Desmond.

“The end goal is that we have an active implementation of a school mental health framework in every school in New Hampshire.”

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THIS IS MY BRAVE SPOTLIGHT: MENTAL HEALTH MAYDAY By: Todd Donovan TRIGGER WARNING: SUICIDE My story begins at the age of eight when I first attempted suicide. My parents were not aware of my suicide attempt.

In the 1970s there was not much hope, and no one ever talked about this topic. My life story does not include childhood trauma or any “reason” to want to die. I was never abused, sexually assaulted, or lived through any childhood trauma. My parents were an intact, lowermiddle-income and loving family.

I do not remember why I tried to die other than I was furious, and I did not want to live. You see, I visualize my violent suicide in my mind repeatedly, over and over and over. Not a day goes by that I do not see my violent suicide visually. This visualization is so graphic that it is difficult to tell what is real and not factual. The desire to accomplish what I see in my mind is so powerful and lonely.

At the age of 14, while hiking with a friend, we were near a 65-foot-high cliff. I could see my suicide that day in my mind, but that day, I heard a voice for the first time. That voice came from the right side of my head and into my right ear. It was not my voice and sounded like a drill sergeant.

The voice said, “Do it!” “Do it!” I shook my head, placed my hands over my ears, and begged, “No.” However, I obeyed the voice and attempted suicide under clear skies and bright sun and ended that beautiful hike. I have the physical scars and the aches and pains after a vertebral

fracture that overshadow the hike’s beauty, but reminds me that I survived.

At the age of 18 I attempted suicide yet again. I was slowly but actively dying and I had peace about it. I exhaled and just relaxed. I succumbed to the voice and the images, but mainly to the voice. It was the voice that I was powerless against. It beat me down, stood over me at my weakest moments and scolded me. The spoken word has power, doesn’t it?

A police officer abruptly halted this suicide attempt. He was furious at first, but his countenance changed and all he said was, “You’re having a bad day.” I was hospitalized this time at a psychiatric hospital. I was diagnosed with major depressive disorder with psychotic episodes and placed on antidepressants and anti-psychotics. These first-generation anti-psychotics afforded me mild facial tics that you’ll see me do. They do not bother me anymore. I have learned to live with them.

I am now 51 years old, and since around my 18th birthday, I have tried 11 different medications and many, many iterations of those medications. Those medications did not adequately treat me; they either did not work at all or gave me intolerable side effects. In 2008 I tried Electroconvulsive Therapy, or ECT, but that did not provide me with relief. ECT

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works for many people, but it did not work for me. One of the side effects of ECT is memory loss and, indeed, I lost roughly three months of memory. I was the best man at my brother’s wedding and I have no recollection of that wedding day! I remember the chocolate fondue! That is it.

One morning, my wife placed a cutout from the local newspaper on our refrigerator. It was a story of a new treatment being offered at a hospital near us called Transcranial Magnetic Stimulation, or TMS. TMS was a new therapy using an MRI-sized magnet over the brain’s prefrontal cortex where mood is regulated. It was shown to be 66 percent effective in reducing the symptoms of depression.

That newspaper clipping stayed on the refrigerator for several months. It was there for me to see every time I walked by or opened that door. Hopelessness was my dominant emotion of that time. It was a feeling, an emotion that I was keenly aware of and well acquainted with. Helplessness fed my hopelessness. All of those years of seeing my suicide and hearing that voice led me to realize that I had nothing to lose.

There was not much wind in my sails. Still, in the fall of 2014, I tried Transcranial Magnetic Stimulation after looking at that flyer on the fridge for three months and finally coming to a place where I was willing to try one more possible solution.

TMS involves 36 daily treatments where an MRI-sized magnet sends three thousand magnetic impulses into the prefrontal cortex over a twenty-minute time frame. Each magnetic pulse causes neurons to discharge, which causes the next neuron to discharge and then the next, and so on.

Eventually, your neurons create new pathways, sort of like retraining neurons.

After my 22nd daily treatment of TMS, I woke up the following day without any suicidal images and no voice!

My mind was oddly quiet and the new silence was almost deafening. I lied in bed conjuring up suicidal thoughts, but as soon as I stopped thinking about suicide, the images disappeared. This was new for me! After this remission from depression, I discovered music. Music had never been a part of my life. I had never listened to music growing up.

After remission, the music I first heard was Eric Church and I fell in love with it.

The fall colors! Where have these colors been all these

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years that I’ve lived in New England? The oranges, yellows, and reds were popping! The transformation of live trees to dormant trees was the opposite of what I was experiencing — my mind was beginning to bloom, bud, and grow. I discovered that I did not want to die; I had just wanted the pain to go away.

I found that I could have friends and that I could be a friend.

I rediscovered my wife and children! Now, my wife and I have a new motto: “No Regrets”. She and I travel to New York City to see Broadway plays 4 to 5 times every year. My coworkers and I hike to remote trout ponds to fish them. I attend these adventures with enthusiasm.

I have ups and downs, just like everyone on the face of the earth, but my brain recognizes that the downs are not the end of the world. I also continue to work with a psychologist to learn how not to live with depression. I see my psychiatric nurse practitioner to help with the two lowdose medications I take. I also have one maintenance TMS session every six weeks. All of these activities keep me high functioning and depression-free.

I share my story with first responders and other audiences all over New England now. It is my way of giving back. My message to everyone is simple. If you are suffering from intrusive thoughts or thoughts of suicide, please reach out for help. Treatment works! I am living proof.

Experiencing a mental health crisis?

Call Riverbend’s 24/7 Crisis Line: 1-844-7HELP4U

T R E AT M E N T W O R K S

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Peer Living Room at Riverbend’s Behavioral Health Crisis Treatment Center

SUPPORTING YOUNG CHILDREN THROUGH EVIDENCE-BASED PRACTICES How parents and teachers can work together to address behavior problems following trauma The beginning of a school year marks growth, change, and new challenges for parents and children alike. How we handle those challenges is influenced by what we’ve experienced in the past and the coping skills we have developed.

The past can have a strong influence on children entering the school system and their ability to adapt, thrive, and form new relationships. A majority of children (more than two-thirds) have witnessed a traumatic event by the age

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of 16, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

Potentially Traumatic Events Source: SAMHSA

• Psychological, physical, or sexual abuse • Community or school violence • Witnessing or experiencing domestic violence • National disasters or terrorism • Commercial sexual exploitation • Sudden or violent loss of a loved one • Refugee or war experiences • Military family-related stressors (e.g., deployment, parental loss or injury) • Physical or sexual assault • Neglect • Serious accidents or lifethreatening illness For young children that have witnessed trauma, those experiences may impact how they form relationships outside of the family dynamic. Chronic trauma can cause serious problems with learning and behavior.

Riverbend Community Mental Health employs several kinds of evidence-based practices to help clients of all ages.

“It is how we ensure that the quality of care is the best it can possibly be,” noted Holly Walton, Riverbend Child & Family Therapist.

Parent-Child Interaction Therapy

(PCIT) is an evidence-based model that works with a parent and a child of age 0-6 years. It is designed to provide structure for families that have experienced adversity and has proven to support the healing process.

“It’s especially important that we involve caregivers in treatment when we’re working with young children because caregivers are hands down the most important people in their lives,” said Walton.

The treatment process begins with 4-10 sessions that are focused on understanding what the family has experienced.

Walton urges her clients to be as forthcoming as possible so she can better help them.

“We often see children acting out, getting into trouble, getting kicked out of daycare, and parents having a hard time managing those behaviors.

Instead of simply addressing the behavior we are trying to understand the meaning of the behavior and the context in which it has emerged.”

Walton strongly reinforces the message to caregivers that feelings emerge as the result of experiences and events in their lives. This helps clients let go of the fear and stigma that often accompany difficult feelings.

PCIT also gives the caregiver the opportunity to ask: What’s happened in my life that has been traumatic, stressful, or upsetting?

How does that impact my own

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behavior and feelings?

How does that translate to my relationship with my child?

For many adults, this may be the first time they have shared details about their past. This is a very important step in the healing process for the family.

After understanding the family history, the PCIT treatment model requires a daily routine of the caregiver. This involves attending to and interacting with the child using the PRIDE skills:

Praising, Reflecting, Imitating, Describing, and Enjoying.

Research has shown that just five minutes of PRIDE interaction a day can have a therapeutic effect.

“When children feel safe in the world and in their immediate relationships they’re able to generalize that safety beyond the bounds of that relationship. When children don’t feel safe it makes it really hard for them to go out into the world and trust other people.

This is especially true for children who are new to a school setting,” Walton said.

The best approach for parents who have a child that has witnessed adversity is to be open with school providers.

“We really encourage families to share as much as they feel comfortable with so that the school

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system can help support the family. In order to build a positive relationship with a child, the teachers don’t need to know all the details. They need to know that the child hasn’t felt safe, or has had a separation from a primary caregiver, or has had exposure to something that has challenged their sense of safety in the world,” Walton said.

While recognizing that teachers are already stretched thin, Walton hopes that educators can be trained to view a child’s behavior through a trauma-informed lens.

“We would ask a teacher to work to form a relationship with the child who’s struggling rather than implement a behavior plan or sticker chart. We need to help the child not feel judged.”

“There are many ways that we can help children feel safe at school and it all starts with the relationships and the understanding that a child’s behavior is a form of communication. Our goal is to work to understand what’s causing the behavior and collaborate with families to help them,” Walton said.

A critical part of children’s recovery is having a supportive care giving system, access to effective treatments, and service systems that are trauma informed. - According to SAMHSA “My view is that every human being, grownups and children alike, are doing the best they can with the resources that they have,” Walton said. “Sometimes that’s not good enough for the expectations that the world has for us and our behavior but we are where we are and we need to work together to get to the other side.”

Another results-driven therapy that Riverbend Community Mental Health has seen immense success with in treating common behavioral health issues in children is the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma or Conduct Problems (MATCH).

MATCH is a family-focused, structured therapy plan designed for children ages 5 to 17 years old and encourages clients to identify issues and triggering events, practice

solutions, and reflect on how those solutions can be used in the future.

MATCH is a Cognitive Behavioral Therapy that would benefit 70% of community mental health center clients, according to studies.

“We understand that parents and children can be overwhelmed and don’t know what to expect when they begin treatment. With MATCH we lay out the program and the plan,” said Kathleen Egan, a MATCH trained clinician at Riverbend.

“We begin by showing the top three problems on a chart and then we can visually show the parents and client how the graph is changing over time,” Egan said.

“This structure has been great for clients and we’ve seen it work in many cases. Our goal is to find the anxiety and then help the client see the reality. Ultimately, they can understand that addressing fears can be a positive experience,” Egan said.

Riverbend clients have addressed concerns over school environments, doctor’s visits, fear of animals, social interactions, and more.

“This is a structured, consistent, family-focused, and strength-based plan. It’s particularly helpful for parents who are looking for direction and skills on how to deal with problems as they arise,” Egan said.

The MATCH plan is typically 8 weeks or longer to give the client time to accomplish each module before moving on to the next. There are several worksheets that are completed between therapy sessions to help the client

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practice their new approach. The charts are accessed with the clinicians weekly to gauge treatment response and create plan adjustments.

“I am trained in many evidence-based practices and I just love this because it is structured and It keeps the client on track. I love looking at the graphs and helping the client meet those completed steps,” Egan said.

“There’s a finish line to reach.”

BOARD OF DIRECTORS

SENIOR LEADERSHIP

ABOUT RIVERBEND COMMUNITY MENTAL HEALTH

John Barthelmes, Chair James Doremus, Vice Chair

Lisa K. Madden,MSW Chief Executive Officer

Founded in 1963, Riverbend Community Mental Health is a private, nonprofit organization providing specialized behavioral health services in central New Hampshire. Core programs include:

Leslie Combs

• Addiction Treatment and Recovery

Frank Boucher John Chisholm Christopher Eddy Benjamin Hodges Nicholas Larochelle, MD Rabbi Robin Nafshi

• Counseling & Mental Health Services for Children and Adults

Bradley Osgood

• Psychiatric Emergency Services

Glenn Shepherd

• Residential Programs for Adults • Wellness Education Currents is a publication of Riverbend Community Mental Health, PO Box 2032, Concord NH, 03302-2032. All Rights reserved. Mailed free of charge to friends and supporters, Currents is also available at riverbendcmhc.org.

LET’S GET SOCIAL:

James Snodgrass, Med Carol Sobelson Johane Telgener Kara Wyman EX OFFICIO Lisa K. Madden, MSW Chief Executive Officer Riverbend Community Mental Health Robert P. Steigmeyer Chief Executive Officer Concord Hospital

Chris Mumford, LICSW Chief Operating Officer Jaime Corwin VP of Human Resources Sarah Gagnon, LICSW VP of Clinical Operations Kevin Irish VP of Information Services Karen Jantzen, CFRE VP of Community Affairs Sheryl Putney VP of Quality Assurance

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PO BOX 2032 CONCORD, NH 03302-2032

SAVE THE DATE

15TH ANNUAL CHAMPIONS FOR MENTAL HEALTH AWARDS W E D N E S DAY | O C TO B E R 2 0 , 2 0 2 1 | 5 : 3 0 P M BA N K O F N H S TAG E