B1WelcomeBook1/2017

WELCOMEBOOK

WestchesterMedicalCenter

AdolescentInpatientUnit:B1

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WELCOMETOUNITB1!

YourTreatmentTeamwouldliketowelcomeyoutoB1,theadolescentinpatientunitatWestchesterMedicalCenter.B1isamultidisciplinarytherapeuticmilieu.Thismeansthatwehavemanydifferenttypesofcliniciansandtreatmentprovidersthatwillworkwithyouduringyourstay.Weunderstandthatthismaybeaverydifficulttimeforyou.Ourmissionistoprovidecompassionateandcomprehensivecarewhilehelpingyoutofosterself-resilience.Itisourgoaltohelpyoutoliveafullandfunctionallifeasyoumovetowardindependence.Welookforwardtoworkingtogetherwithyoutomakethishappen! Aswegettoknowyouandotherimportantpeopleinyourlife(i.e.,caregivers,therapists,schoolpersonnel,clergymembers,communityresourceproviders),wewouldalsolikeforyoutogettoknowwhoweareandwhatwedo.Thisbookisdesignedtohelpfamiliarizeyouwiththeunitstaff,schedule,andrules,andtobecomemoreclearaboutthetreatmentweofferhereonB1.

THEUNIT

B1hasspacefor20malesandfemales,stayingsometimesinsingleroomsandothertimessharing.Thereisalsoadiningroomandtwo“dayrooms”wheregrouptherapies,communitymeetings,andunitactivitiesareheld.Teensalsoattendschoolforabouttwohoursperday,eitheronoroffoftheunit.

Offofthemainunit,thereisaweightroom,arttherapyroom,musicroom,gameroom,andfullsizegymwhereteenscanparticipateintherapeuticgroupsandactivities.Teensmayalsogooutsideintoanadjoininggatedcourtyard(weatherpermitting)togetsomefreshair,playbasketball,tendtotheunitgarden,enjoyaBBQ,orsimplyrelax.Wealsohavebooks,toys,journals,cards,puzzles,movies,magazines,andotheritemsforleisuretime.

CONTACTINFORMATION

NursingStation (914)493-7182PayPhones(toreachpatients)(914)592-9237/9219

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YOURSTAFF

Weareveryproudofourhighlyqualifiedanddedicatedstaff.Allstaffmembershavebeenspeciallytrainedtoworkwithchildrenandteensthathavevariousproblems,includingdepression,anxiety,historyoftrauma,difficultymanaginganger,andtroubleacceptinglimits.

TheUnitChiefisthedoctorinchargeoftheunit.LicensedClinicalSocialWorkers,MentalHealthCounselors,ExpressiveTherapists,CertifiedTherapeuticRecreationSpecialists,andLicensedCreativeArtsTherapistswillleaddailytherapeuticprogramsandgettoknowyouduringyourstay.Everyday,youwillalsointeractwithournursesandPCTs,whowillhelpyoutoworktowardsyourtherapeuticgoals.

DivisionChief:AbrahamBartell,MD(914.493.1818)Dr.Bartellisaboardcertifiedchildandadolescentpsychiatrist.HeoverseestheDivisionofChildandAdolescentpsychiatry,includingclinicalservicesthetrainingprograms.

UnitChief:ChristopherKarampahtsis,MD(914.493.1816)Dr.Karampahtsisisaboardcertifiedchildandadolescentpsychiatrist.Heoverseesthetreatmentontheunitandsupervisesthepsychiatryfellowsandresidents.NursePractitioner:ElisabethMaher, MSN,PMHNP-BC(914.493.7343)Elisabethisaboardcertifiedpsychiatricmentalhealthnursepractitioner.Sheconductsindividualandfamilytherapy,andwillworkwithyouandyourcaregiverstodetermineyourmedicationandtreatmentoptions.

ChildPsychiatryFellow/ResidentWestchesterMedicalCenterisateachinghospital;therefore,yourdoctormaybeapsychiatryfelloworresident.AllfellowsandresidentsareunderthedirectsupervisionofDr.Karampahtsis.RegisteredProfessionalNursesandLicensedPracticalNurses(914.493.7182)WeareveryproudofourRNsandLPNswhowillensurethatyouaresafe,haveyourmedication,arewellsupervisedandcaredfor,andhavesomeonetotalkto.Therearealwaysatleasttwonursesworkingpershift.ClinicalSupervisor:MariaBarreto,LCSW-R(914.493.6473)MariasupervisestheMentalHealthTherapists,RecreationalTherapists,andArtTherapists.Shealsoconductsgroups,teachesmedicalstudents,andoverseesthePCTstaffontheunit.UnitSocialWorkers:EuniceOpoku,LMSW(914.493.1894);ElyseGehring,LMSW(914.493.5580)EuniceandElyseconductsocialassessments,leadtherapygroups,andprovidesupportivecounselingandfamilytherapy.

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CaseManager:AdwoaKonadu,BA(914.493.1908)Adwoawillmeetwithyouandworkwithyourschoolandoutsideproviderstocoordinateyourdischargeplanning.

RecreationTherapist:JennyFavre,MSJennyisaTherapeuticRecreationSpecialistwholeadsdailyRecreationTherapy(RT)groups.Thesegroupsaregoaldrivenandfocuson:improvinghealthandwellness,developingnewleisureinterests,learningcopingskills,andimprovingcopingskills.Groupallowsforactiveparticipationinphysicalactivities,aswellasdiscussiongroupsthatfocusoneducation.ExpressiveTherapist:KristenHattier,MT-BCKristenisaboardcertifiedmusictherapistwholeadsdailyExpressiveandCreativeArtsTherapy(ET)groups.Shemayalsoworkwithyouonanindividualbasistohelpyoutodevelopyourexpressiveandcreativetalents.Thegoalofthesegroupsistoprovideasafeandalternativemeansofself-expression.PatientCareTechnicians(PCTs)PCTswillworkcloselywithyoutoprovideforyourdailyneeds,addresscrisesshouldtheyarise,andensuresafetywhileonandoffoftheunit.Theywillalsoleadtherapeuticactivitiesandmakesurethatyoureceiveyourstatusprivilegeswhenearned.MedicalStudentsandVolunteersAsWestchesterMedicalCenterisateachinghospital,medicalstudentsandvolunteersmayassistontheunitduringyourstay.Theymayco-leadgroupswithstaffmembersorassisttheTreatmentTeambycontactingimportantpeopleinyourlifetogathernecessaryinformation.AdministrativeAssistant:LorraineHarperLorraineworkscloselywithallstaffmembersandoverseestheunit’sadministrativeresponsibilities,includingorderingsupplies,managingtheunit’smedicalcharts,andcoordinatingadmissionsanddischarges.TeachersOurschoolprogramismanagedbyEducationInc.Wearefortunatetohavewonderfulteacherswithinourschoolprogram.Yourteachersleadclassesthroughouttheday,contactyourschool,coordinateyourassignments,andassistyouinreachingyouracademicgoalswhileinthehospital.SpeechandLanguageServicesWehavearelationshipwiththeSpeechandLanguagePathologyDepartmentatNewYorkMedicalCollege’sSchoolofPublicHealth.Ateamofstudentsandtheirsupervisorcomeweeklytocompleteassessmentswithreferredteenstohelpthemtoimprovetheirsocialskillsandreceptive/expressivelanguageabilities.AdditionalStaffMembersTherearemanyotherhospitalpersonnelthatarereadilyavailabletoyouduringyourstay.TheseprovidersincludephysicianswithintheAdolescentMedicineDepartment(toaddresschronicandacutemedicalproblems),dieticians,translators,andreligiousleaders.

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WHATWEDO:MILIEUTHERAPY

Whatwillyoudoallday?Themilieu(pronounced:mill-you)isthecommunityorenvironmentthatyouwillbeapartofwhileontheunit.Itisahighlystructuredtherapeuticsettingthatisunderdirectandcontinuoussupervisionbystaff.

Uponarrival,youwillbeseenbythedoctors,nurses,socialworker,andothermembersoftheTreatmentTeamforanevaluation.Thisisamulti-stepprocess.Thephysicalassessmentwillincludeaphysicalexam,bloodwork,andurinalysis.Thepsychiatricevaluationwillincludereviewingyourreason(s)foradmission,obtainingadetailedhistoryofprogressatschool,home,andinthecommunity,andgatheringinformationaboutfamilyandsocialrelationships.Duringthistime,thedoctors,nurses,andsocialworkersmayaskquestionsaboutearlydevelopmentalhistory,school,medication,andotherissuesthatmayhavecontributedtotheneedforyourhospitalization.

Uponyouradmissionandthroughoutyourstay,theTreatmentTeamwilltalkwithyou,aswellasotherimportantpeopleinyourlife,suchascaregivers,residentialstaff,schoolpersonnel,outsidetherapists,andcaseworkers.TheTreatmentTeamwillmeetdaily(during“Rounds”)totalkaboutdiagnoses,atreatmentplan,goalsfortreatment,medication(ifneeded),anddischargeplans.Wewillalsoreviewhowyouaredoingingroup,inyourindividualwork(includingmedicationcompliance),andontheunitoverall.Althoughyouwillnotattendthesedailymeetings,youwillstillbeacrucialpartoftreatmentplanning.Thedoctorwillspeakwithyouaboutmedicationbeforestartingormakingchangestoyourregimen.

Everyday,youwillbeinvolvedingrouptherapy,whichisledbyaclinicalstaffmemberincludingthepsychiatrist,socialworkers,creativearttherapists,nurses,andchildpsychiatryfellowsandresidents.GroupsarerunusingapprovedprotocolsthathavebeendevelopedbytheTreatmentTeam.Varioustopicsareaddressed,includingidentifyinganddiscussingstressors,learningandpracticingcopingskills,improvingsocialskills,psychoeducationregardingmedicationandhealthissues,anddischargeplanning.ExpressiveTherapyandRecreationTherapygroupsarerecoverybasedandgoaldrivengroupsdesignedtoassistinhealingandreestablishingindependence.Theyareofferedtwicedaily.CategoriesofExpressiveTherapyandRecreationTherapygroupsinclude:processing(talking),creativearts,educational,lifeskills,wellness/self-management,competitiveskills,communityresources,andsocialization/recreationalactivities.Off-unitRT/ETgroupsprovidealessrestrictiveenvironmentandinclude:afullsizegym,afitnessroomwithatreadmill,ellipticaltrainer,andweightsystems,agameroomwithvideogamesandapooltable,ping-pongtable,andfoosballtable,anartroomwithmultipleartsupplies,amusictherapyroomwithadigitalpianoandfullsizedrums,andanoutdoorsite.

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Ahelpinghandcanchangetheworld…...

GETTINGSTARTEDAtthetimeofyouradmission,youwillbeintroducedtothemilieuandgivenatouroftheunit.Ourprogramisdesignedtohelpyoutoidentifythedifficultareasinyourlifeanddiscovermorepositiveandsociallyacceptablewaystomanagethoseareas.

Shortlyafteryouradmission,youwillalsohavetimetomeetyourstaffandpeers.Tohelpustogettoknowyouandforyoutofeelmorecomfortablewithus,youwillbeinterviewedbytheTreatmentTeam.Thisisagreattimetoshareconcernsandaskanyquestionsthatyoumayhave.Wewillalsoworktogetheratthistimetoidentifyyourtreatmentgoalsandcreateyourtreatmentplan.Pleasenotethatwhenyoufirstarrive,youwillnotbeabletoleavetheunittoattendoff-unitprograms.ThisisNOTapunishment.Wejustwanttogettoknowyoubettertomakesurethatyouaresafetoleavetheunitandwillenjoyandbenefitfromthesegroups.

CONFIDENTIALITY

Forconfidentialitypurposes,youareNOTpermittedtotakepicturesontheunit(thisincludesbothwithcamerasandwithcellphones).Wealsoaskthatyourespecttheprivacyofothers.Forexample,youmayseesomeoneyouknowfromyourneighborhood-pleasekeepthisinformationtoyourself.

Confidentialityalsohasitslimits.Allstaffmembersworkcollaborativelyandshareinformationtoensurethatwearemeetingallofyourtherapeuticneeds.

Additionally,wewilltakethenecessarystepstoprotectyouandothersifyoushareinformationregardingabuseandpotentialthreat(toyourselforothers).Furthermore,ifapeerdisclosesadangeroussituationtoyou,pleasespeakwithastaffmemberimmediatelysothatwecansupporttheirneedsandhelptomaintaintheirsafety.

UNITRULESANDSAFETY

B1hassomebasicrulesweexpecteveryonetofollow.Someoftheseruleswillbefamiliartoyou,suchasrespectingtherightsofothers,includingusingsafelanguageandrefrainingfromphysicalcontact(“NoPC”).Wehaverulesagainstfighting,stealing,destructionofproperty,andharmingselforothers.Somerulesmaybenewforyou(i.e.,timesforcurfewandmeals).Westronglyencourageyoutoparticipateinallaspectsofyourtreatment(grouptherapy,medicationmanagement,school,recreationtherapy,andgeneralunitactivities).

Uponarrivaltotheunit,oneofthenurseswillmeetwithyouindependentlytocompleteanIndividualizedCrisisPreventionPlan.Thisplanhelpsustogettoknowyouandbepreparedfordifficultsituationsthatmayarise.Forexample,youandthenursewilldiscusstriggersandemotionalwarningsigns,aswellasthevariouswaysthatourstaffcanprovideyouwithindividualizedcareandsupport.TheIndividualizedCrisisPreventPlanwillbeutilizedthroughoutyouhospitalizationandhelpstomaintainyoursafetyandthesafetyofothersontheunit.Ourtrainedstaffemploysmanytechniquestoassistyouinfollowingunitrulesandmaintaininggoodbehavioralcontrol.Someexamplesofthesetechniquesare:verbalde-escalationwhentheyareupset,redirection,distraction,calmingtechniques,positivereinforcementofhealthybehaviors,

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anduseofour“comfortroom.”Ourcomfortroomisasmallroomwithsoftcomfortobjectsthatyoumayutilizetoregaincontrolwhenyouareupset.

PATIENTROOMS

Teensareofteninroomswithpeers,butoccasionallymaystayinasingleroom.Werequestthattheroomsbekeptneatandthatbedsaremadeeachmorning.Weexpectthatpatientsrefrainfromdestroyingordefacingpropertyandrespecttheenvironmentoftheunitandotherprogramareas.Pleasenotethatpatientsarenotpermittedtoenteranotherpatient’sroom.

CLOTHINGANDLAUNDRY

Weencourageteenstoweartheirownclothing.Wewouldappreciatethatclothingbesentfromyourhomeorplacement.Awasheranddryerareavailableforyoutouse.However,caregiversdohavetheoptionoftakingitemshometobewashed.Also,pleasenotethatsharingofclothingisnotpermitted.

DRESSCODE

• Shirtsmustbewornatalltimes• Tanktopsandsleevelessshirtsarenotpermitted• Jeansmustsitonthehipsandmaynothangbelowthe

buttocks• Skirtsmustbeatleastknee-length• Shortsmustreachthemid-thigh• Socksmustbewornatalltimes• Lacesonshoeswillbedeterminedonanindividualbasis• Clothing(i.e.,hoodies,pants)maynotcontaina

drawstring• Clothing,ofanytype,cannotbeskintightortoo

revealing• Hooppiercingsandnecklacesarenotpermitted• Hatsandheadcoveringsmaynotbewornindoors,

exceptwhenworninreligiousobservance• Hoodsfromhoodiesmaynotbewornup• Theprivilegeofwearingmakeupmaybeearned

VALUABLES

Wecheckeachpatient’sclothingandbelongingsuponadmission.Valuablesaresenttothepropertyofficelocatedinthemainhospital.Wecannotassumeresponsibilityformoneyorvaluablesthatarebroughtontotheunit.Werecommendthatvaluableitemsbykeptathomeorinyourplacementwhenpossible.

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PERSONALITEMS

Havingpersonalitemscanbeveryimportanttoteenagers.Theycanbecomfortingandfamiliar,andcanhelpkeepyoucalmwhenemotionsgethigh.Assuch,youmaywishtohaveafewthingswithyouduringyourhospitalization.Belowisalistofsomethingsthatarepermittedandprohibitedontheunit.Ifanitemofpersonalinteresttoyouismissingfromthelist,pleaseaskstaffifyouareallowedtohaveitwhileonB1.Also,pleasenotethatstaffisnotpermittedtostoresnacksandotherfoodordrinkitemsontheunit.Additionally,pleasebeadvisedthatweareapeanutandtreenutfreefacility.

OK(pleasebring) NotAllowed(donotbring)clothes(equalto5outfits) radios,tapes,CDs,iPodspajamas TV,DVD/MP3player,iPadsunderwearandsocks expensive(electronic)toysslippers plasticbagssneakers toyguns,swords,etc.schoolwork sharpordangeroustoyspillow/blanket itemsinglassbottlespicturesfromhome(notinframes) cellphonesbooksormagazines(ageappropriate) gumjournal cigarettesandlighterstoiletries(toothpaste,brush,facewash) cologne,perfume,

“You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose.” - Dr. Seuss

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Thisisourweeklyschedule.Doctors,socialworkers,nurses,andRT/ETstaffwillmeetwithyouatdifferentpointsthroughoutthedayandweek.Also,thereareoftenotherunitactivitiesthatoccur

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duringtheweekandweekend.Thesemayinclude:gymtime,artsandcrafts,movies,board/cardgametournaments,andsports.Youwillbeseenbyadoctoreveryday,evenduringtheweekend.

TELEPHONEGUIDELINES

Youareallowedtomakeandreceivephonecallswhenyouareinthehospital.Ifyouareingroup,school,orparticipatinginaunitactivitywhensomeonetriestocallyou,wewillnotifyyouofthemessageandencourageyoutocallyourfriendorcaregiverbackduringadesignatedtime.Pleaselimitallphonecallsto10minutesandtwopershiftsothateveryonecanhaveachancetousethephoneandsothatyoucanbesuretoattendscheduledactivities.

Ifyouhaveanyupsettingnewstosharewithyourchild,pleasecallthenurse’sstationfirstsothatwecanbepreparedtoprovidesupporttoyourchildshouldhe/shebecomeupset.Inaddition,ifyourchildsharessomethingwithyouthatyoufindupsettingorareconcernedabout,pleasecallusimmediatelysothatwemayworktoresolvetheissuetogether.Thenumbertothenurse’sstationis(914)493-7182.

B1UNITPAYPHONES

(914)592-9237(914)592-9219

DAILYVISITINGHOURS

1:30-3:00pm6:30-8:00pm

Ourdaysarefullyscheduled.Wethinkitisimportantforyoutobevisitedbyparentsandothercaregivers.However,wehaveafewrulesaboutvisitingthatwewouldliketosharewithyou.

1. Allvisitorsmustbeatleast21yearsofageinordertocomeontotheunit2. Pleaselimitthenumberofvisitors(2atatime)andkeepittoimmediatefamilyand

caregivers3. Pleasecomeduringvisitinghoursunlessotherarrangementshavebeendiscussedwith

theTreatmentTeam4. Nocellphonesorcamerasontheunit,please(thatisahospitalwiderule)

BUDDYBENCH

The“BuddyBench”isachairontheunitthatteenscanchoosetositinwhentheyarefeelinglonelyorareinneedofsomeextrasupport.Sittingonthe“BuddyBench”isaneasywaytosignaltoothersthatyouwouldliketochat,evenifyouhaveahardtimesayingitoraskingforhelp.

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PATIENTCRISISRESPONSEPLAN

Intheeventthatabehavioralcrisisarises,youwillhearthewords“CodeGrayUnitB1”announced.Whenthishappens,youareexpectedtofullyfollowallinstructionsfromstafftomaintainyourownsafetyandthesafetyofthosearoundyou.Noncomplianceorgettinginvolvedinthecrisismayresultinconsequencesforyouaswell.

COOLINGOFF

Patientsmayrequestto“take5”iftheyneedsometimetothemselvestocalmdownandusecopingskillsafterbeingtriggered.Staffcanalsoencourageyouto“take5”asawaytohelpyoutocooloff.Typicallya“take5”occursinyourroom,butcanalsotakeplaceinadifferentlocationontheunitifyoureceivepermissionfromstaff.“Take5”isagreatwaytoshowyourselfandthestaffthatyoucanmakesafe,mature,andresponsiblechoicesandthatyouareworkingonyourgoals.Patientscanalsobedirectedbystafftotakea“chill-out.”A“chill-out”isa15minutebreakfromthecommunitythatcanoccurinyourindividualroomorthequietroom.Patientswillbeinstructedtotakea“chill-out”iftheirbehaviorisstartingtobecomedisruptivetothecommunity(i.e.,yelling,excessivearguing,beingdisrespectfultopeersorstaff,generalnoncompliance).Whiletakinga“chill-out,”patientsareencouragedtousetheircopingskillssothattheycanstayingoodcontrol.Patientsthatareabletoeffectivelyusetheir“chill-out”canreturntothecommunityafter15minutes.Iftheproblematicbehaviorcontinuesorescalates,additionalconsequencesmayresult.

LEVELSSYSTEM

TherearetwolevelswithinourLevelsSystem.Level1isabasicstatusandyouareconsideredtobe“onLevel1”whenyouarefirstadmitted.“Level1s”whoareingoodstandingareallowedtoparticipateinallonunitactivities,includingschool,RT/ET,leisuretime,andmealtimes.“Levels2s”arepermittedtogooffunitwhenaccompaniedbystafftoparticipateinoff-unitprivileges,includingtheweightroom,gameroom,musicroom,andartroom.“Level2s”arealsoinvitedtoattendaweeklypizzapartyonFridays.InordertobeeligibleforLevel2,youmustexhibitsafeandrespectfulbehavior,complywithyourmedicationregimen,attendandparticipateinschoolandgroup,andshowgoodself-care.Ifyoufeelthatyoumeettheserequirements,youareinvitedtosubmitaLevel2Application.Level2ApplicationsaredistributeddailyduringthemorningSAP(goals)Group.Pleasenotethat“just”completingtheLevel2ApplicationwillNOTguaranteeyourpromotion.Assuch,theTreatmentTeammaygiveyoufeedbackandrequestthatadditionalgoalsaremetpriortoyourpromotionbeinggranted.Additionally,self-injuriousbehavior,actsofaggression,destructionofproperty,medicationnoncompliance,andpoorADLsmayresultinthedropofyourLevel.YoucanearnLevel2againbyshowinggoodemotionalandbehavioralcontrol,complyingwithunitrulesandyourindividualizedtreatmentplan,andresubmittingaLevel2Application.

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SELF-AWARENESSPROGRAM(SAP)

ThepurposeoftheSelf-AwarenessProgramistoencourageyoutounderstandyourresponsetoanygivensituation,andtoreplaceproblematicbehaviorwithmoreeffectivecopingskills.ByparticipatingintheSelf-AwarenessProgram,youwilllearnhowtomaintainand,ifnecessary,regaincontrolofyouremotionsandbehavior.

Youwillhaveapointsheettotrackyourdayandthepointsthatyouhaveearned.Youearnpointsbaseduponyourbehavior.Youcanearnupto5pointsperperiodforarrivingontime,participating,actinginarespectfulmanner,maintaininggoodbehavioralcontrol,andworkingtowardsyourpersonaldailygoal.Youcanalsoearnbonuspointscontinuouslythroughoutthedayforpositivebehaviorssuchasusingcopingskills,seekingstaffforassistanceindealingwithadifficultsituation,takinginitiativetobetterthecommunity,andknowingyourmedicationregimen.Pointsareaddedupattheendofeachdaytodetermineifyouwillbe“onprivileges”or“offprivileges”forthefollowingday.

Onceyouhaveearnedapoint,itisyourstokeepandcannotbetakenawayfromyou.However,pleasekeepinmindthatyourbehavior,notjustthenumberofpointsthatyouearn,willdetermineyourprivileges.Forexample,yourprivilegesmaybedroppedifyouareaggressivetowardsothersorattempttodestroyunitproperty.

ON/OFFPRIVILEGES

OffPrivileges• Youare“offprivileges”whenyouarefirstadmitted.Youwillalsobe“offprivileges”if

youdonotattendprogramming,engageinself-harmbehavior,oractinanaggressivemannerwithintheunit.Anyepisodesofrestraintorseclusionwillautomaticallyresultinlossofprivilegesfortheremainderofthedayandwillmakeyouineligibleforprivilegesthefollowingday.

OnPrivileges• Inordertobepromotedto“onprivileges,”youmustearnatleast50points(outof70)

daily,aswellasparticipateinprogramming,demonstratesafebehavior(notharmfultowardsyourself,others,orunitproperty),complywithyourmedicationregimen/labwork/medicaltests,andtakecareofyourADLs(activitiesofdailylivingincludeshowering,brushingyourteeth,changingyourclothes).

• Examplesof“OnPrivileges”include:o PersonaluseofportableDVDplayertowatcha

movieo Personaluseoftheradiotolistentomusico Personaluseoftablettoplaygameso “Spending”pointsintheUnitPointStoreo Sign-outgamesfromthegamecloseto StaffandRT/ETassistant

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o AttendtheunitPizzaPartyonFriday

OUTOFPROGRAMPROTOCOL

PatientswillbeconsideredOutofProgram(OOP)iftheyengageinbehaviorthatendangersthemselves,thosearoundthem,and/orthecommunityatlarge.ThelengthoftimethatpatientswillremainOutofProgramdependsuponthebehaviorthatwasexhibited.PatientswillberemovedfromthecommunityandconsideredOOPforatleast24hoursintheeventthatanyofthefollowingoccurs:

• Physicalaggressiontowardspeersorstaff• Destructionofproperty• Physicalrestraintorseclusion

PatientswillberemovedfromthecommunityandconsideredOOPforatleast6hoursofprogramintheeventthatanyofthefollowingoccurs:

• Menacingorthreateningbehaviortowardspeersorstaff• Medicationnoncompliance• Excessivedisruptionwithinthecommunity

GuidelinesandProcedures:

• Patientswillberemovedfromthecommunityforaperiodof6-24hourso Note:thisdoesNOTmeanthattheyarerestrictedtotheirrooms.Patientsmay

spendtimeinotherareasoftheunitifnopeersareintheirimmediatevicinity• PatientsareexpectedtocompleteanOOPpacketandreviewtheworksheetswithastaff

member• Patientsareexpectedtocompleteallschoolworkandapplicablegroupactivitieswhile

OOP• The“timeclock”isputonpausewhenifthepatientisnotcompliantwiththeplan.As

such,timewillbeextendedasneededuntilthepatienthascooperatedwiththeOOPplanforafull6-24hours

• Duringtheperiod,patientsthatareOOParenotpermittedtogooutsidetothecourtyard

• Level2statuswillbeheldordroppedtoLevel1atstaff’sdiscretion• PatientsareallowedtowatchtelevisionwhileOOP,assumingthattheyhavecompleted

theirOOPpacketandarecooperatingwithstaffandtheOOPplan• WhileOOP,patientsareencouragedtocolor,draw,write,organizetheirrooms,practice

theircopingskills,completewordsearches/sodukopuzzles,etc.

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DIALECTICALBEHAVIORTHERAPY(DBT)PROGRAMMING

DialecticalBehaviorTherapy(DBT)isatreatmentprogramthatisdesignedtohelppeoplechangepatternsofbehaviorthatarenoteffective,suchasself-harm,suicidalthinking,aggression,impulsivity,andsubstanceabuse.DBThelpspeopletolearnaboutthetriggersthatleadtoreactivestatesandfigureoutwhichcopingskillstousetomanageunsafebehavior.WithinUnitB1,theDBTskillsaretaughtduringdaily60-minutegrouptherapysessionsandarereinforcedthroughoutthedaybyallmembersoftheclinicalandmilieustaff.Thefollowingisanoutlineoftheskillsyouwillbeencouragedtolearnduringyourhospitalization.Core Mindfulness Skills Module The Core Mindfulness skill module is the foundation for all other skills taught in DBT. DBT recognizes three separate but equally important states of mind: Emotion Mind, Reasonable Mind, and Wise Mind. While in Emotion Mind, emotions drive interpretations and ways of acting upon the environment, and decisions are made regardless of logic or consequence. In Reasonable Mind, our thoughts and actions are step-wise and objective, and decisions are made based upon logic and reason, abstracting out emotions. Wise Mind describes a state of awareness of both emotion and reason. Making a “Wise Mind” decision is seen as an ultimate goal of the Core Mindfulness skills within Dialectical practice. Core Mindfulness Skills- paying attention “on purpose” DBT “WHAT” skills:

o Observe: notice your experience of the present moment o Describe: label what you observe with words o Participate: fully throw yourself into the present moment

• DBT “HOW” skills: o Non-judgmentally: notice without evaluating something as “good” or “bad” o One thing at a time: let go of distractions o Do what works: do what you need to do to achieve your goals

Emotion Regulation Skills Module The Emotion Regulation skills module aims to provide teens with skills necessary to manage their mood on a daily basis; these strategies function to increase positive emotions and decrease vulnerability to negative mood stats. The Emotion Regulation skills include a number of strategies: education about the relationship between feelings, thoughts and behaviors; engagement in daily pleasant activities; self-care practice; learning to accept and “wait out” uncomfortable emotions; and, engagement in behaviors that represent the safe/effective opposite of dangerous/ineffective impulses. Emotion Regulation Skills

• Behavioral activation and opposite action • Reducing vulnerability to negative emotions • Cheerleading statements • STRENGTH: How to Stay Out of Emotion Mind

S - balance sleep: make sure you are getting enough sleep on a daily basis T - take care of self: treat yourself well and practice healthy living habits R - resist target behaviors: stay away from triggers E - exercise: participate in physical activities daily

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N - nutrition: have a well-balanced diet G - gain mastery: work towards a goal, feel accomplished T - take time for yourself: make time to ignore distractions and focus on yourself H - healthy self-talk: use positive self-talk to encourage yourself

Distress Tolerance Skills Module The Distress Tolerance skills are related to “Crisis Survival” and teach you how to tolerate and cope with difficult situations without making them worse. These skills are directed towards helping individuals to abstain from engaging in unsafe behaviors as a response to emotionally difficult moments. Distress Tolerance Skills

• Distract with ACCEPTS: A - activities: do something to distract yourself C - contribute: do something nice for someone else C - comparison: compare yourself to someone else to help you handle a situation more skillfully E - emotions: create a different emotion P - push away: temporarily push the painful situation out of your mind T - thoughts: replace your thoughts or change the way you are thinking S - sensations: utilize your senses to distract and self-soothe

• IMPROVE the moment: I - imagery: imagine a safe, calming place

M - meaning: find or create a purpose for the difficult situation, “make lemonade out of lemons” P - prayer: open your heart to your own wise mind R - relax: unwind, do something you enjoy, practice muscle relaxation O - one thing at a time: put your mind in the present, focus on 1 task at a time V - vacation: take a brief vacation in your mind or take an actual break from the situation E - encouragement: cheerlead yourself

• Pros and Cons • Radical Acceptance

Interpersonal Effectiveness Skills Module The Interpersonal Effectiveness skills module teaches individuals how to interact with others within their environment in a more skillful manner. It includes “wise mind” strategies for maintaining self-respect, nurturing healthy or desired relationships, and requesting that one’s needs be met, even during emotionally challenging situations. These skills help teens to identify their goals in different interactions and relationships, and use communication skills that balance emotional expression and behavioral control.

Interpersonal Effectiveness Skills

• DEAR MAN: How to TRY to Get Someone to do What You Want D - describe: stick to the facts, clearly describe the situation E - express: express your feelings, opinions, and needs using “I” statements A - assert: ask for what you want or say “no” clearly R - reinforce: reward the person either ahead of time or afterwards for their help M - mindful: keep your focus on what you want and avoid distractions A - appear confident: show that you have confidence in yourself N - negotiate: be willing to give to get

• GIVE: How to Keep a Good Relationship G - gentle: be gentle, nice, and respectful I - interested: listen and act interested in what the other person is saying V - validate: show that you understand the other person’s feelings or opinions E - easy manner: smile, use a little humor, use a “soft shell”

• FAST: How to Keep your Self Respect

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F - fair: be fair to yourself and the other person A - avoid needless apologies: don’t over (or under) apologize S - stick to your values: stick to your own values and opinions T - truthful: be truthful and don’t exaggerate or act helpless when you are not

CONTACTLISTUNITB1

ChrisKarampahtsis,MD (914)493-1816UnitChief,B1 ElisabethMaher,MSN,PMHNP-BC (914)493-7150NursePractitioner,UnitB1 EuniceOpoku,LMSW (914)493-1894MentalHealthTherapist,UnitB1 ElyseGehring,LMSWMentalHealthTherapist,UnitB1

(914)493-5580

AdwoaKonadu,BA (914)493-1908CaseManager,UnitB1 B1NursesStation (914)493-7182LorraineHarper (914)493-7182AdministrativeAssistant,UnitB1 Patientphones (914)592-9237UnitB1 (914)592-9219

ADMINISTRATIONAbrahamBartell,MD (914)493-1818Chief,ChildandAdolescentDivision DeniseDavis,RN (914)493-7775DirectorofNursing BambinaMeyers,LMSW (914)493-7381DirectorofSocialWork MariaBarreto,LCSW-R (914)493-6473ClinicalSupervisor,Child&AdolescentUnits MelissaNord,PsyD (914)493-7129DirectorofTherapeuticProgramming,BHC StevenDickstein,MDProgramDirector,Child/AdolescentPsychiatryFellowship

(914)493-7343

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BHCAdministration (914)493-1149MentalHygieneLegalServices (914)592-4275PatientRelations (914)493-8877MedicalRecords (914)493-8803

Wehopethatourhandbookhasbeenhelpfulandansweredmanyofyourquestions.Wearecommittedtoprovidingyouwiththebestpossiblepatientandfamilycenteredcareavailable.Pleasedonothesitatetocontactusatanytimewithanyquestionsorconcerns.