Category: For Parents and Families

By Amber Thomas, LPC, Clinician

How many times have you looked at your to-do list for the day and felt a sense of defeat and dread, paralyzed by the idea of needing to complete them and anxious of the consequences if they do not get done. You do not have a character flaw, and you are not “lazy.” You are likely experiencing Executive Dysfunction.

What is Executive Functioning?

Executive Functioning is the set of cognitive processes that help us manage our day-to-day lives and achieve goals. Think of your brain like a busy airport. You have planes (thoughts), passengers (tasks), and runways (actions). Executive Functioning is the Air Traffic Control tower. It is the set of mental skills that helps you manage time, pay attention, and switch focus. When the tower is understaffed or overwhelmed, the planes circle indefinitely, and nothing lands.

Three Important Executive Functioning Skills

1. Working Memory: This is your brain’s “post-it note.” You have likely experienced walking into a room and immediately forgetting why you are there. This is a short circuit in your working memory.
2. Inhibitory Control: This skill helps you filter and resist urges. Inhibitory Control helps you to stop scrolling online and instead prep for an important meeting.
3. Cognitive Flexibility: This is your ability to adapt to change and routines. When Cognitive Flexibility is working, you can see that your gym is closed and easily create a new plan.

Building New Systems

As frustrating as Executive Dysfunction can be, there is hope. Here are some skills to test and see if they work well for you:

• Externalize Everything: Create a physical calendar or a to-do list. We cannot always trust our brains to remember everything that we need to know.
• 5-Minute Rule: Try not to let tasks pile up. If you estimate that a task will take less than 5 minutes, do it right away. A good example of this is taking out the trash.
• Body Doubling: Some tasks that we need to accomplish are just boring. Call on the help of a friend to talk with you on the phone or come to your home and sit with you while you work through that task. Being in the presence of someone else can “trick” your brain into focusing.
• Break Down Steps: Break down a task into incredibly small tasks. For example: rather than “clean the kitchen” you can say, “wash the forks.” Usually once you get started, the momentum will carry you through the rest of the greater task.

The Bottom Line

Executive Functioning struggles are not a reflection of your intelligence or potential. They are simply a set of skills that sometimes require a little extra support. Be patient with yourself – you are doing better than you think.

 

 

Daniel B. Horne, LPCC-S, LSW, Clinical Director, Clinician — 

If someone you love has been referred to a therapeutic community, you may be feeling a mix of emotions — relief that help is finally within reach but uncertainty about what this kind of program really means. This guide is written for you.

At Hopewell, healing doesn’t happen in isolation. It happens in relationship with the land, with community, with meaningful work, and with compassionate support.

So, What Exactly Is a Therapeutic Community?

A therapeutic community (TC) is a type of residential treatment environment where the community itself — the people, the daily routines, the shared responsibilities — is the primary tool for healing and growth.

In a therapeutic community, treatment is something lived. Every meal shared, every chore completed, every honest conversation in a group session, all of it is part of the healing process. Rather than simply managing symptoms, a TC focuses on helping a person rebuild a whole life: their sense of identity, their relationships, their sense of purpose, and their ability to function in the world.

What Makes Hopewell Unique: Healing on the Farm

Hopewell is a therapeutic farming community. We believe what farmers have always known: working with the land is good for the human spirit. At Hopewell, residents participate in farm life and engage with nature as a core part of their treatment from tending to the vegetable garden, caring for animals, collecting maple sap, or hiking in the woods.

What Does a Typical Day Look Like?

Structure and routine are critical for people living with severe mental illness. Having a predictable, meaningful daily rhythm can help stabilize all of us.

A resident’s day might include:

• Morning work crews such as farm, housekeeping, kitchen, or garden
• Group therapy or community meetings
• Individual therapy
• Medication management with psychiatric and nursing support
• Shared meals where residents and staff come together as a community
• Social recreational time and creative activities

What Role Do Families Play?

Your role as a family member is significant, and Hopewell is committed to supporting you as much as your loved one.

At Hopewell, we encourage families to:

• Stay in regular contact with your loved one’s treatment team to understand their progress and care plan.
• Take care of yourself. Seek your own support through therapy, support groups like NAMI (National Alliance on Mental Illness), or trusted community resources.
• Be patient with the process. Recovery from severe mental illness is not linear, and progress may be slow or even difficult to recognize in the immediate moment.

Common Questions Families Ask:

How long will my loved one be at Hopewell?

Therapeutic community treatment is intentionally longer term than hospitalization, months rather than days or weeks. Meaningful change can occur for some individuals over the course of 3-5 months, but more typical lengths of stay are 6-9 months. Some individuals benefit greatly from a stay of a year or more.

 Can I visit?

Family visits are an important part of the healing process and are encouraged at appropriate points in treatment. Your loved one’s care team will work with you to arrange visits in a way that supports their recovery.

 What if my loved one doesn’t want to be there?

Ambivalence is extremely common, especially at the beginning of treatment. Our staff are experienced in meeting people where they are with compassion and without judgment to build trust over time.

 Is this a locked facility?

Hopewell is a voluntary residential program, not a locked psychiatric facility. Residents choose to be here and participate in their own care.

What Recovery Can Look Like

Recovery from severe mental illness looks different for every person. For some, it means returning to work or school. For others, it means living more independently, or simply experiencing longer stretches of wellbeing between difficult periods. We do not define recovery by the absence of symptoms alone, but by a person’s ability to live a life that feels worth living.

We’re Here to Talk

Hopewell’s team is always willing to answer your questions, explain our program, and help you understand whether a therapeutic farming community might be the right fit. To learn more about Hopewell or to speak with a member of our team, please contact our Admissions Team at admissions@hopewell.cc or 440.426.2009. We welcome your questions.

By Savannah Schindelar, Admissions Coordinator

Families considering Hopewell for their loved one’s residential mental health treatment may raise concerns about financial arrangements. We are a nonprofit private pay facility with some limited access to insurance coverage and we understand that long-term treatment may strain the pocketbook. However, we pride ourselves in doing everything that we can to reduce the financial burden.

Insurance Coverage

One of the first questions families ask is whether Hopewell accepts insurance. Due to our average length of stay (6-9 months) and our niche type of care, we rarely see full coverage from any insurance provider. Here is a brief summary of the current options.

• Commercial and Private Insurance: We are in network with Anthem Blue Cross/Blue Shield plans that are not Medicaid. We work to get authorization but coverage is never guaranteed.
• Medicare and Medicaid policies unfortunately do not cover our room, board, and treatment costs. Those policies generally cover individual costs such as doctors’ appointments and medications.

Financial Assistance

Many generous donors and foundations support Hopewell’s programs, and fortunately we are able to offer significant financial assistance to those who are eligible. We ask all families who request financial assistance to fill out an application. We can then determine a percentage reduction to our daily rate, reducing the fees as much as 75%. At present, up to 85% of our residents receive some level of fee assistance in this way.

The Utilization Review Process

As a courtesy, for any individuals who have a commercial insurance provider, we will run a Verification of Benefits. This verification lets us know if a policy offers in- or out-of-network benefits. This is important for those residents who come from outside the state of Ohio, as out of state policies can differ in what coverage they offer for services outside of the providing state.

Families can learn about policy details ahead of time by calling the member services number located on the back of their insurance card. Member services is a great resource for inquiring about facilities that are in network with the insurance plan.

An important takeaway: Due to ever-changing provider/program relationships, we advise families to always check with their insurance provider AND the treatment program they are interested in to make sure this information is the same.

What does authorization entail?

Authorization for insurance coverage is not a guarantee of payment but rather a green light for services that could be covered by the insurance provider. Authorization is pursued within 24 hours of a resident’s admission to Hopewell. A call is placed to the insurance provider’s authorization line. Clinical information is given to the clinical case manager assigned. A determination is made by the clinical case manager on the basis of diagnosis, severity of symptoms, and need for residential level of care.

Upon approval, the insurance provider offers a number of days of treatment. At the end of the authorized days given, another call is made to either pursue further authorization or provide discharge updates to close the case.

Why does insurance provide such limited coverage at Hopewell?

Hopewell provides a residential level of care for mental health, a categorization that is common knowledge to insurance providers. However, most insurance companies are used to levels of care such as 7-10 day stays for inpatient care in crisis scenarios and involuntary admissions, or up to 30 days for stabilization and medication management. Hopewell does not provide these types of care; therefore, discussions with insurance providers often require educating them about our treatment model.

Hopewell offers a very niche, longer-term level of care (up to an average of 9 months) that does not have 24/7 observation, crisis admissions or a related medical component to the program outside of medication management services. Due to this, insurance often finds it hard to justify coverage as we are unique in our treatment for mental health.

Since Hopewell is a unique environment offering independence for our residents, an unsecured campus and freedom to make choices in their treatment plan, insurance will often ask why residents couldn’t simply participate in a Partial Hospitalization Program or Intensive Outpatient services. (Note: These treatment models are non-residential full and half-day programs, which Hopewell does not offer.)

Our clinicians do their best to thoroughly document clinical recommendations for residents. They are careful to explain the need for longer-term participation in our program to help give residents time to improve their living skills in a safe and stable environment.

A Final Word

I am dedicated to pursuing help for individuals who need the kind of residential care the Hopewell offers. The conversations that I have with most clinical case managers on the insurance end revolve mostly around educating about our type of our type of program. Every day I see Hopewell residents benefitting from the care that Hopewell provides. It takes a village, and I am happy to have this role in the community.

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Your child’s mental health journey might begin as soon as they set foot onto their college campus. The first year of college is packed with new experiences, as your child will be off on their own, maybe even for the first time. Big life changes such as college could prompt those predisposed to them to experience a psychotic episode and your child might experience major depression, bipolar disorder or other underlying medical issues.

Your child might try therapy, medicine and self-help techniques as a first defense in combating mental illness. However, if they are not able to manage symptoms on their own, they have three additional options as a next step: outpatient care, inpatient care or a residential community.

Outpatient care and inpatient care for mental health are like what you would experience if you went to a doctor’s office or a hospital for a physical illness. Inpatient care is for those who require constant supervision to manage the symptoms of their mental illness, and is commonly quite brief and oriented towards resolving an emergency, rather than helping someone cope with their illness.

Outpatient care does not involve overnight stays and is most often employed for those with mild symptoms; it includes group therapy and often necessitates familial involvement since your child still spends most of their life outside of the program.

Residential treatment programs fall somewhere in between outpatient and inpatient. They are often more intensive programs like inpatient care, but allow patients more independence, similar to outpatient care.

Signs Your Child Needs a Residential Treatment Program

Residential treatment programs are often used for patients who require a step above outpatient care or need more tools to ease back into their routines after inpatient care.

Consider a residential treatment program when your child’s mental illness is not manageable through therapy, medication and self-help techniques, and has gotten to a point at which they need a level of supervision you cannot provide. Those who enter residential treatment programs do not need to be monitored constantly, but they do need to have more immediate access to mental health care, which typically cannot be provided at home.

While residential treatment programs require overnight stays, residents have the freedom to participate in activities and field trips. They might have jobs within the residential program, eat with friends within the community and engage in group therapy or go on walks. If your child is in college, all of these types of interactions can help them return to school mentally and emotionally prepared.

What to Look for in a Residential Treatment Program

Effective residential treatment programs create an individual treatment plan, which should include therapeutic offerings and a transition plan to get your child out of the residential facility in a timely manner while allowing enough time to heal and recover with the tools they need for success in college and beyond. A daily routine can help your child handle their mental health symptoms and, as they progress through their residential treatment program, this stability creates a long-term positive impact on their lives.

As a part of their daily schedules, residents should contribute to the community in some way, inspiring a sense of pride when they accomplish a task. Some therapeutic communities choose to work with outside businesses or nonprofits whereas others engage residents in meaningful work right on campus.

The primary difference between a residential treatment program and an inpatient program is social isolation; this is where residential treatment programs excel. These programs allow your child to be surrounded by staff who care about their wellbeing and peers who are experiencing similar mental health issues.

The transition from high school to college can be difficult for young adults. Many may experience symptoms of depression that fade after a few weeks or months (situational depression). Still others experience depressive symptoms that persist. This might be major depression, the leading cause of disability in the U.S. for individuals ages 15 to 44. Catching your young adult’s symptoms early can help them make it through college and lead more productive lives.

Pay close attention to the following symptoms recognized by the Anxiety and Depression Association of America. If your child exhibits five or more of these depression symptoms, they may be suffering major depression, and you should discuss contacting a mental health provider.

Symptoms of Depression

• Loss of interest in day-to-day activities
• Typically presents as sad or attempts to cover up sadness by pretending to be happy
• Eats less than usual or eats in excess
• Inability to sleep (insomnia) or sleeps too often (hypersomnia)
• Manic movements such as pacing, wringing their hands or tapping (psychomotor agitation) or decreased movement such as lying in bed all day
• Lack of energy during the day (fatigue)
• Feelings of worthlessness or displaced guilt
• Suicidal ideation and/or frequent discussions about death
• Inability to recall details, make decisions and/or concentrate for extended periods of time

When college students experience situational or major depression, there are some strategies to aid in their recovery.

Therapy

Cognitive Behavior Therapy is a common therapy used for young adults with depression. A therapist supports your child’s wellbeing by acting as a sounding board for their issues, teaching coping skills that enable long-term symptom management. Some colleges offer free counseling, and even if your child has a counselor at home, encouraging them to visit their school’s counseling center can be conducive to recovery.

Your child may function best in a group therapy setting where they can interact with people dealing with similar symptoms. They might also benefit from creative expression to work through their feelings, using art and music therapies. If major depression is a known issue, residential treatment may be a good step before college. Investing time into a variety of therapies early on provides your child the best chance at overcoming major depression.

Medication

For teens who have suicidal thoughts or ideation, medication may help lessen those negative ideas. Medication effectiveness and side effects are different for everyone, and it may take a few tries to find the right fit for your child. Talk with your medical provider to determine what will work best for your child and adhere to their recommended medication plan. Those who experience major depression typically have therapy, medication, and self-help techniques in their treatment plans.

Self-Help Techniques

Self-help techniques should be used in addition to taking advantage of the above treatment options; however, they are most effective against depression when performed on a daily basis. Help your child find a support group or community where they feel welcome and are able to express their feelings openly rather than keeping them locked up. When they are able, young adults should engage with others regularly, attending social functions with friends and meeting up with family members. Eight hours of sleep per night is a goal your child should set for themselves, and if they live with you, you can assist them in getting to bed on time. If your child is away at college, be sure to check in with them about these types of activities. At home, at college, or in a residential therapeutic community, a structured schedule lessens the effects of depression. Additionally, regular exercise, yoga and other forms of relaxation (massages, meditation, etc.) can boost mood.

Above all else, be present. If your child is in college, allow them the freedom to be independent, but pay close attention to shifts in behavior, and talk with them if you think there is a more serious issue. But if your child is diagnosed with major depression, keep in mind that programs including medication, group counseling, meditation and life skills, among other activities may be necessary to cope with the illness.

Your child made it: he or she finished 13 years of school and graduated! You have prepared them for the academics they will face in college — perhaps through years of tutoring, test prep, honors and AP classes. Their application is filled with extracurricular activities and hours of community service and volunteer work. Their dorm room is going to be decked out with all the comforts of home.

They are ready…right? But are they emotionally and mentally ready?

Psychosis occurs when an individual has difficulty separating what is real from what is not. The term “psychosis” casts a wide categorical net. Psychosis is actually a symptom of an overarching illness, so it is important that you and your child seek treatment as soon as you recognize a potential psychotic episode. Often, the first experience of psychosis – or first episode – occurs during a time of significant stress, such as college.

It may be difficult for an individual experiencing psychosis to be aware of what is occurring, and family and friends are often the first to notice changes in their loved ones. Signs of psychosis include delusions, hallucinations, abnormal behaviors including lack of hygiene, confused speech, and a decrease in activities and social engagement. Alone, each of the following symptoms may not seem like much to note – and may even be considered normal teenage and young adult behavior. But if your child exhibits multiple symptoms, these may be early signs of psychosis.

Erratic Behavior

Changes in behavior – specifically delusions and hallucinations – occur before and during psychotic episodes, and are the first warning signs.

Delusions are strong fixed beliefs that remain even when faced with clear contradictory evidence. While different with every individual, common delusions include beliefs that people or organizations are going to hurt the individual; beliefs that they are famous, wealthy, or have special talents; beliefs that cues from the environment such as songs, news stories, or patterns, are directed at the person; and beliefs about the individual’s health and organs.

Hallucinations are seeing, hearing, or feeling things that are not present. This may appear as hearing voices, or seeing objects, figures, or distorted images of the world. You may notice your child talking to themselves or unseen others, or reacting strongly to something unseen. While hallucinations may be distressing, they can also be humorous to the individual, which may result in sudden giggles or laughter.

Both delusions and hallucinations are characterized by general uneasiness and may be fairly recognizable, especially if your child is responding out loud to voices in their head. Not all psychosis symptoms are as apparent.

Being Disengaged

Young adults who experience psychosis may withdraw from their typical social patterns in favor of alone time. The way this presents in teens and young adults may be consistently canceling plans with friends or avoiding family members. If they are involved in extracurricular activities, you may notice a new reluctance to attend events and meetings.

You may also notice a decrease in emotional expression, including tone of voice, facial expressions, and body language.

Children may naturally become overwhelmed during their transition from high school to college, but since disengagement is one of the major warning signs of psychosis, monitor your child’s behavioral patterns. If you feel they should get an assessment, help them get one.

Disorganized Speech or Behavior

Young adults experiencing a psychotic episode may have mood swings and might even slip into a catatonic depressive state. If your child seems confused, incorporating irrelevant information regularly into conversation, or laughing during inappropriate situations, these patterns are considered disorganized speech or behavior. You might notice a drop in your child’s grades at school because they are unable to focus or they may begin to exhibit poor personal hygiene.

Other Types of Psychosis

A brief psychotic disorder may signal that your child’s stress levels are too high. Triggers could include college applications, a rigorous school schedule, a familial death or any number of factors. Brief psychotic disorders generally stop after a few weeks or might only last a few days.

Organic psychosis can occur when your child experiences an injury or infection. That type of bodily trauma can affect the brain or even the way an individual perceives the world.

It is common for drug and alcohol use to occur during college, and some have found such activities increase their psychotic symptoms. In substance-induced psychosis, drug use can mimic signs of psychosis, and psychotic symptoms have been present for some during periods of withdrawal, or for significant lengths of time following use. Your teen may also experience drug-related psychosis with prescription drugs.

Find Treatment Early

Seek to understand your child’s experience and feelings. Refrain from attempts to prove what is true or argue, as this will lead to further distress rather than help.

You and your child need to find a treatment that works best for your family. Sometimes that means putting college on hold to learn new life skills within a therapeutic community setting, allowing them to interact with others going through similar symptoms. Meaningful work may increase your child’s chances of sticking to a treatment plan, with fewer relapses and even symptom reduction.

If you feel your child is demonstrating signs of psychosis, contact a mental health professional and get them the help they need so they can continue to thrive. Familial involvement early on is one of the most effective ways you can aid in your child’s recovery.

HIPAA, the Health Insurance Portability and Accountability Act, passed in 1996, governs medical insurance practices in the U.S. If your child is transitioning from one job to another, HIPAA ensures they do not lose health insurance coverage – so they can still receive care for their mental illness.

Another facet of HIPAA is its privacy rules, which combat discrimination against those with psychiatric disorders and other illnesses. Moreover, under HIPAA’s privacy rules, your college student is in charge of their own medical records (if they are 18 or over), so you will need to have a conversation with them about how much information they are willing to share with you about their mental health and other medical records.

What is HIPAA?

There are four titles within HIPAA that may directly affect the average college-aged patient. Title I ensures health plans do not reject individuals with pre-existing conditions such as bipolar disorder or depression. Title II outlines the requirements for transmission of health-related electronic files and the necessary safety measures insurance companies, hospitals and other medical companies are required to take with all patients. All medical care guidelines and tax-related issues are covered in Title III, while Title IV defines health insurance reform in detail, further explaining how your child cannot lose coverage because of a psychiatric disorder or any other health issue.

How HIPAA Applies to Parents and College Students

Your child’s name, address, social security number, physical/mental health condition, details about their care at health facilities and information regarding how they paid for medical services are all considered personal health information (PHI).

By law, the HIPAA privacy rule not only demands PHI records be kept safe and confidential, but it also allows your child to access their records at any time. Your child is allowed to determine who else views their records, so consider having a discussion with them about this, especially if you need to access their health records while they are away at college. If your child allows you access to their medical records after they turn 18, their doctor’s office should have a HIPAA authorization form for each individual parent to complete. You child can even choose exactly what information you see. If their health information is shared, your child can find out why as well.

Education records are not considered PHI under HIPAA. FERPA, the Family Educational Rights and Privacy Act, grants parents access to educational records until children turn 18. If you are concerned about the impact your child’s psychiatric disorder will have on their grades, you will need to obtain a FERPA consent form. On-campus health centers and counseling centers are considered a part of the university and, as such, produce treatment records protected by FERPA rather than PHI under HIPAA. You may not need a FERPA consent form to access any treatment records if you still claim your child as a dependent on your taxes or if, at any time before your child turns 21, they are caught drinking underage or doing drugs.

At a time when your college student may encounter a great deal of stress, you might be concerned about the potential discrimination your child could face regarding their mental illness. HIPAA protects them against healthcare coverage discrimination, which allows you to rest easy knowing your child will not be denied continued coverage for therapy, medication or a stay at a therapeutic community if they require one.

Some parents are surprised to learn that once their child turns 18, that they no longer have a right to be informed about their child’s care, unless their child grants it. While there are some legal avenues that may provide some relief in some circumstances, it is important you keep the lines of communication open as your college student becomes more legally independent.

Note that most (but not all) mental health providers welcome your input, which can be especially valuable if your child is new to their care, and/or is in a new crisis. But listening to you creates no obligation on their part to share protected information back with you, unless your child has so authorized.

The ability to engage in important discussions about their mental health will improve their college experience and offer them long-term coping strategies knowing their parents are on their side.

Have you noticed your child’s mood shifting inexplicably? Young adults with bipolar disorder have periods of extreme happiness only to drop to a depressive state soon after. Bipolar disorder is manageable with an effective treatment plan, which could include therapy, medication, a consistent schedule and anything else that will keep your child on track.

Recognizing the telltale signs of bipolar disorder can be tricky. With bipolar disorder, the feelings and habits your child cycles through are moments of high energy – mistaken for Attention-Deficit/Hyperactivity Disorder (ADHD) – and extreme lows which may be misdiagnosed as major depression.

Identifying Mania

Those experiencing mania exhibit drastically different mood shifts than their typical demeanor.

• Easily distracted – They might become easily distracted, going back and forth between multiple topics without reason.
• Reckless – Pay close attention if your child is acting more reckless with their spending—something you can monitor especially if they live at home.
• Sleeplessness – Children going through a manic episode do not get much sleep and typically do not feel tired despite their lack of sleep. If they are away at college, ask them about their sleep habits.
• Inflated sense of self – You might also notice your child has an inflated sense of self to the point where they might believe they are omnipotent.

Identifying Depression

Much like major depression, catching when your child is sad, low energy and cannot seem to think clearly could allow you to get them the help they need before they experience more severe side effects like suicidal ideation. Other aspects of a depressive episode may be:

• Pain – complaining about a pain that will not go away,
• Diet – drastic changes to eating habits
• Isolation – favoring being alone over interacting with friends or family.

Treatment for Bipolar Disorder

If you believe your child has major depression or ADHD, look at all the warning signs together. If they have manic episodes as well as depressive episodes, your child might have bipolar disorder. It is important to speak to a medical health professional about the different illnesses your child could be experiencing. Certain medications – such as medications used to treat ADHD – may intensify the symptoms of bipolar disorder, and antidepressants may be helpful only when taken with a mood stabilizer or antipsychotic.

Combining medication with cognitive behavior therapy will also help your child cope with their illness. If your child is away at college, encourage them to access to their school’s counseling center, as most colleges offer those services to their students free of charge.

Reach out to your child at least once every few days; allow them the freedom to be away at school, but also recognize the transition to college can be particularly tough. Pay close attention to if there are any changes in the ways they discuss their time at school to monitor whether medications and therapy are effective.

Recognizing the early signs of bipolar disorder can be tricky; especially because young adults jump back and forth between extreme moods much more rapidly than older adults. Observe what they are going through, listen to them and offer your help.

Your child may want to treat their bipolar disorder with minimal involvement from others, or they may benefit from a therapeutic community environment. Regardless of treatment type, the first step is identifying the illness and taking the necessary steps to manage your child’s bipolar disorder.