Wednesday, November 20, 2013

Recreation Therapy: Play is Medicine

Ok, so I completed my internship in Recreation Therapy at the VA.  17 weeks of unpaid work, but it was recreation, so it's not really work anyway, right? Wrong. I have had so many questions about my internship and Recreation Therapy, I thought I would do a post to explain what it is I actually DO.

My professor came up with the phrase, I came up with the pestle and mortar idea, and Timothy designed this amazing logo that has been used nationally!

I split my time between two programs, a locked psychiatric facility (520D) and a substance and alcohol abuse rehabilitation residential program (First Step).

520D is for people who are considered a danger to themselves, others, or gravely disabled (i.e. suicidal, homicidal, or unable to meet their own basic needs). Patients stay as long as they need/want; any where from a few days to a few weeks.  The goal is to stabilize and discharge and then continue outpatient mental health services.  It's like an ER for mental health.  There are nurses, psychiatrists, social workers, pharmacists, dieticians, clergy, and recreation therapists on the team. Recreation Therapy taught classes all day on how to improve mental health, increase independence, and increase the quality of life.  The classes I taught were:
Recovery: how to get better, and what that looks like for each individual
Relaxation: guided imagery, deep breathing, progressive muscle relaxation, and other tools to relax and focus the body and mind were taught and practiced.  This offers an opportunity for people to learn how to take control.
Exercise: we focused mostly on stretching and simple exercises that can be done while sitting.  Essentially demonstrating that they don't have to be Olympians to do something to get the blood flowing. For people who have mental health issues, exercise is a huge contributor to feeling better.
Leisure Education: How do you fill your free time? People who are suffering in mental health are more likely to do very little in their free time.  The more you participate in activities that make you happy, the happier you are.  I know it sounds obvious, but when you are experiencing depression, you just don't feel like doing much with anyone.
Coping Skills: This group is all about how you deal with life, and all the ups and downs.  It takes practice. How do you handle your emotions? What do you do when you get really mad? What do you do when you get really sad?
Healthy Living: We talked about creating a  lifestyle that works for you, like creating schedules, putting reminders on your phone so you don't miss your medication, exercising first thing so you can fit it in, making time to socialize, meeting ones owns basic needs first, etc.
Nutrition: it is amazing how much a poor diet can affect our mental health.  We talked about small changes we can make to help us feel better, even if it is something as simple as NOT eating that chocolate that you crave every time you get a migraine, but every time it makes your migraine worse (that's what I am working on).

On top of this we also played the Wii, had arts and crafts, and spent time on the patio.  Each of these are a great way to unwind, practice the skills taught in groups, and socialize.  So yes, playing the Wii with a patient is playing, but as a Rec Therapist, I am also helping the individuals meet their goals. For example, if a patient has identified that he isolates when his mental health is getting really bad, then while he is playing the Wii, we work on social skills between him and other patients.  It's not quite so hard to practice meeting your goals when you are having fun doing it.

When your self esteem is low, it certainly is helpful to be able to casually play a game, do well, and have others cheer for you.
So in 520D, we worked to help people make very basic changes in their thoughts, behaviors, and feelings. And recreation is the tool we used to help that happen.

In First Step, I did not teach as many classes because that is not how the program worked.  Instead, we provided a lot of one on one education and community integration. 

One on one education was done through assessments and assignments.  We started by identifying what purpose using substances served (i.e. numbing emotions, increasing energy...), what prevents you from doing activities you want to do (i.e. lack of money, lack of time, lack of transportation, lack of motivation, drug use...) as well as identifying what activities they have done and enjoyed as well as activities they have never done but think they might enjoy.  This process helps identify what they enjoy, what they want to do, how they can make it happen, and how their substance use negatively affects their life.

It takes a lot of courage to try new things, especially when you have spent so much of your life focusing on a very narrow set of activities (i.e. using drugs, obtaining drugs, watching TV).  In recreation therapy, I was able to help provide a safe place to try new things, to process the emotions before, during, and after, and to find ways to increase positive emotions.

Here are some examples of interventions I helped facilitate:

This is Webb, he is a animal assisted therapy dog.  He works on the Menlo Park campus and his job is to socialize. When dogs go through training, not all dogs pass on to be a service dog that will work as one individuals helper.  Webb didn't pass on because, well, he's pretty lazy.  Which makes him perfect for being a facility dog.  He comes and visits people.  Animals make people happy (not all people), but we also used Webb and other dogs to teach responsibility to the veterans.  If you have to train a dog and positively hold them accountable, it helps teach you how to be more consistent and interact positively with others when they do something you don't feel they should.  Also, if you have been struggling to take care of yourself, now you are responsible not only for yourself, but another living creature can really help some people step up.

We had drum circles.  Everyone sits in a circle with a drum and we play the drums together (don't worry, I did not facilitate this, I ain't got no rhythm. We had a professional drummer come and help with that part!) So besides the benefit of wailing on a drum to get out some pent up frustration, we worked on communication skills, self expression, self control, and personal emotions. We had people take turns leading by playing their own beat that others followed, we had "call and answer" which involves someone playing a beat and others returning the beat or building off that beat, we got louder and softer, and we just let loose to have some fun.

Here is a perk of my job, we took our vets to a golf clinic. I got free golf lessons and was able to drive a golf cart all day! We took any veterans who were interested in going, whether they had played before or not. They were split into smalls groups, each with a volunteer who had experience teaching, and played 9-holes. It was such a blast being out in the sun all day. The men I played with were able to work on being part of a team, focusing on themselves and what was working and was not working with how they played, work through frustration, and get some physical activity.

Look, horses! We took several vets to groom and ride horses.  One gentleman, we learned during his initial visit, used to own horses, but his ex-wife got them in the divorce they had after a catastrophic event.  The divorce and event led to his drinking.  By taking him to take care of these animals he was able to work through some of his trauma, take control, and remember what it felt like to be involved with his passions prior to alcoholism. 

We took a tour of Alcatraz! (My first time there!) Besides getting out, outings like this provide an opportunity to practice the skills being learned in the program. Many vets had to face things that make them uncomfortable/have feelings of post traumatic stress from the boat ride, being back in a prison, seeing/hearing gunshots...

This is a surprisingly fun one, tying fly's for fly-fishing.  One vet who suffers from severe depression talked about this for weeks, "I made that.  I can't believe I actually created something. I did that!" Feelings from completing activities like this can instill hope, inspiration, and drive.

 We took them to the casting ponds in San Francisco. Here they practiced their cast for fly fishing. They were able to enjoy some fresh air and try something new, as well as meet new people who genuinely want to help.  The people that run this pond will help people get into this sport at no cost if they are really interested! One of the volunteers is a recovering alcoholic, and this is the sport that helped put her on the right track.

Oh, a walk on the beach is just what the doctor (or rec therapist in this case) ordered.

For my final project I created a Coping Skills Faire for the participants to practice the skills they learn in the program. We played Coping Skills Jeopardy. We experienced a progressive muscle relaxation while taking note of our pulse and breath rate before and after in order to demonstrate what a difference it makes when we focus on relaxing. Freeze tag where we have to ask for help in order to get unfrozen. And several others, including this one in the picture, an anger thermometer. I read out scenarios that might make people to feel upset and then they stood next to the number that corresponded to how angry they thought that might make them feel. ("Someone tells you to calm down." "You are charged a fee from your bank." "You're cut off on the freeway." "A close friend is diagnosed with a terminal illness."...) Zero is in the shade next to the fountain, ten is out in the hot sun. Some people got upset at always being in the hot sun, which was a perfect opportunity to talk about why they were always at a ten.

During my internship I also spent time in other facilities.  This first picture is a duet bike at the senior living facility.  People who have little to no balance and/or are wheelchair bound can still go on bike rides! This therapeutic intervention is proven to help reduce depression in older adults, so they take their residents who have depression out on bike rides once or twice a week to help reduce it!

And this is a bike that I rode with residents at the Blind Center. Yes, we took people who are blind on bike rides! This is a side by side tandem bike.  I steered, but we both peddled.  If you look in the background, there is another bike that is a front and back tandem bike. 

So that's what I did all summer, and I saw people make huge changes in their lives because of the impact recreation therapy had in their recovery.

Thursday, November 14, 2013

Momma's world coming to an end...

So the world is coming to an end. Oh what a world, what a world. Momma's little baby is growing up.

Blast, the video won't load... But just in case I can't get this to work later. Bobby was scooting around onthe floor after some magazines Sarah was going through. She pushed them out of his reach, but he just pulled himself forward and got them again. Luke, Leona, Emma and I are way excited, but Sarah is getting worried. She misses her little baby.  Love you all, Thom.

Abby's Princess Party!

Yesterday at my mom's work (the MATC in Lehi) they had "Princess Party!" and Abby had a blast! First they did her hair, then her nails, put some cute makeup on her, and then the princess party. She had so much fun!

Abby sat so still while they did her hair, I was so impressed!

Her cute braid! How the girl did this with her short hair I am not sure but it looked so cute!

Cute curls in the back.

Painting her finger nails. Abby wanted pink and purple.

Abby's cute makeup!

Cupcake time!

What a cute girl!

Abby the princess!

Friday, November 1, 2013

Trick or Treat?!

On Saturday we went to Jody and Erik's ward Trunk or Treat to be with all the cousins. Adelaide had a great time. After a few cars, she learned the she just had to stand there, look adorable, and people handed her candy! After a row of cars I suggested we stop since we didn't need the candy, but Addie was so excited and enjoying it so much we kept going. Needless to say, mommy and daddy made out like bandits. 

I'm glad we went to the ward activity because Adelaide had surgery today to put tubes in her ears. She had 6 double ear infections last winter, persistent fluid in her ears all summer which was starting to affect her hearing, and has already had two double ear infections this October. Because of this chronic history, the doctor decided to put Adelaide on a breathing treatment leading up to the surgery. This was to clear up any wheezing or coughing and get her in tip top shape for surgery. 

This is her nebulizer, Lu Seal. She has been such a champ with her medicine. We actually use it as blackmail. 
Us: Let's put your Jammie's on. 
Addie: Noooooooooo!
Us: Do you want your medicine? 
Addie: yea. 
Us: Then you have to put your Jammie's on. 
Addie: ok. 
What kid does that?!

This morning we had to be at the hospital by 7:10. Yea, kiddo went in her pajamas. 

Adelaide became overwhelmed with anything we or the nurses asked her to do. Even offering to put on her wrist band was like offering to burn her with acid. So Minnie Mouse being all over her hospital pajamas was really the only way we got her to cooperate with changing. 

She also brought her buddy with her and had fun giving him treatment too! That is a foam nose. She wasn't interested I wearing it, but it was hilarious if daddy or buddy did. 

They gave her a relaxant to make administering the anesthesia easier. It made her all groggy. They gave us bubbles to blow for her and she was reaching out for them saying pop pop pop. Remember the scene in Young Frankenstien when the Monster comes to life and he's reaching in the air in a daze? Yea, that was Adelaide. This is just before going in for surgery. 

Putting the oxygen/anesthesia mask on her, watching her fall asleep,and walking away was terrible. We had to wait in the waiting room for the doctor to come tell us how it went. That was such a long 13 minutes! Tim timed it. In reality it is a very short and simple procedure, but when it's your child in there, that doesn't matter, you just want it over with. 

After she woke from anesthesia she was very fussy and disoriented. I held her close and softly sang songs. She fell back asleep, which was a great way to help the anesthesia wear off. 

After we got her home, this happened:

Then this happened:

Then this happened:

The THIS happened:

Thank you Gee Gee and Papa! These little fairies were just the trick to help her settle back in at home. 

She took a good nap in her crib, then woke up burning up. We gave her Tylenol and she snuggled and napped on and off for a while with daddy who was finally winding down from the stress of the day. 

While daddy was out getting more medicine (and animal crackers as a treat), Adelaide and I relaxed on the couch, ate Cheerios, and watched Phineas and Ferb. Adelaide LOVES any time Perry the Platypus is on or when there is dancing. 

I also decided her zebra costume was just going to be too hot for our feverish girl, so I put her in a lightweight white dress and, voilĂ , she was a ghost!

Just to top it off, we threw a white blanket over her. Anytime we put a blanket on her head she rocks side to side, says ghooooost, pulls off the blanket and yells "boo!" 

Despite it being a rough day, we also managed to enjoy celebrating Danielle's birthday too!

Can't wait to see everyone else's costumes!!