Thank you for listening!
In this enlightening episode, we delve deep into the critical topic of behavioral health through the expertise of our special guest, Nisha Wright. As a Marriage and Family Therapist, Nisha sheds light on the interplay between mental health and the support systems surrounding individuals with developmental disabilities. Our hosts, Trisha Jamison and Dr. Jeff, navigate the conversation with warmth and understanding, addressing the common misconceptions that often cloud the field of behavioral health and emphasize the importance of empowering individuals to embrace their independence.
Listeners are treated to an engaging discussion that covers the role of caregivers—discussing not only the physical demands but also the emotional challenges that often lead to caregiver burnout. Neesha shares effective strategies for self-care that listeners can implement into their daily lives, reminding everyone that their well-being is just as important as those they care for. Through storytelling and shared experiences, the episode illustrates how understanding and empathy play key roles in fostering meaningful connections with those they care for.
Tune in for a significant discussion about how behavioral health empowers individuals and families alike, as we explore real-world strategies for navigating complexities with grace and resilience. Whether you're a caregiver, a family member, or someone interested in mental health, there's something in this episode for everyone. Don't miss the opportunity to learn, grow, and connect in our community. Remember to subscribe, share, and join us as we strive for a healthier, happier tomorrow together.
For questions or comments, please email us at trishajamisoncoaching@gmail.com.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
Hello and welcome to the Q&A file, the ultimate
health and wellness playground.
I'm your host, tricia Jamieson,a board-certified functional
nutritionist and lifestylepractitioner, ready to lead you
through a world of healthdiscoveries.
Here we dive into a tapestry ofdisease prevention, to
nutrition, exercise, mentalhealth and building strong
relationships, all spiced withdiverse perspectives.
(00:29):
It's not just a podcast, it's acelebration of health, packed
with insights and a twist of fun.
Welcome aboard the Q&A Files,where your questions ignite our
vibrant discussions and lead toa brighter you.
Speaker 2 (00:42):
Welcome, friends, to another episode of the Q&A Files
.
I'm your host, trisha Jameson,a functional nutritionist and
lifestyle practitioner and alife coach, and, as always, I'm
joined by my incredible co-host,dr Jeff Jameson, a board
certified family physician.
And we don't have Tony here withus today, but we've got another
(01:02):
amazing guest that we're soexcited to introduce here.
So glad to have you here, jeff,and I'm so excited for this
episode and I think so manypeople are going to resonate
with our guest and a listenerquestion from Jodi that we'll
share later in the episode.
So this week we're diving intobehavioral health, a topic that
(01:27):
affects caregivers, families andindividuals with developmental
disabilities and mental healthchallenges.
Today we have an incredibleguest with us, someone who
brings not only amazingexpertise but also a deep
passion for helping individualsand families navigate the
(01:47):
complexities of behavioralhealth.
Nisha Wright is a Marriage andFamily Therapist, associate MFTA
, with a Master's in ClinicalPsychology and extensive
background in clinical andcounseling work.
Her journey in this field beganin 2012 as a substance abuse
counselor at the iconicHaight-Ashbury Clinic in San
(02:10):
Francisco, where she sawfirsthand the challenges people
face when dealing with mentalhealth and behavioral struggles.
Since then, nisha has workedacross various roles with
diverse populations, alwaysbringing her knowledge,
compassion and problem-solvingskills to the table.
(02:31):
Today, she serves as clinicalcoordinator for a supported
living agency in Spokane, whereshe plays a crucial role in
improving the lives ofindividuals with disabilities.
She provides home visits, staffsupport, hands-on training and
behavioral intervention coaching, while developing
person-centered, positivebehavior support plans that
(02:54):
truly make a difference.
We are beyond excited to haveher here today, not just because
of her expertise, but becauseshe's also a great friend of
ours.
She's been both a patient ofJeff's and a client of mine, and
now we get to pick her brain onthis podcast.
Speaker 3 (03:13):
Which we're so excited about too.
She's so awesome.
We're glad to have Nisha withus.
Speaker 4 (03:18):
Thank you so much, Tricia and Dr Jeff, for inviting
me.
I'm super grateful for theopportunity.
Speaker 2 (03:23):
Yes, absolutely, we are so excited.
So, nisha, one of the thingsthat we start with and you're
going to be familiar with this,and this is one of the reasons
why I wanted to wait for you tobe on right now and introduce
you first and then docelebrations, because when we
started our sessions, firstthing that we would do would be
(03:45):
celebration.
So we're going to start againand I'd love to hear a
celebration from you and Dr Jeff.
Speaker 3 (03:51):
And I'll start, okay, so it gives you a chance to
think about it for a second.
Okay, so my celebration is thatlast night I got to spend time
with my sister and her husband,jill, and Drew Nelson.
They're wonderful people andsometimes you just have to sit
down with your people, and theyrecognized how incredibly
(04:14):
helpful it was to just beourselves and have a great time
talking about family life andthings.
And Tricia hasn't been feelingthat well, so she wasn't able to
join us, but she encouraged meto be able to go and do that,
and that little effort on herpart is so appreciated by me.
So my gratitude is to Triciafor allowing me to do something
(04:39):
that isn't something I normallydo and take care of me with an
enjoyable time with them.
So thank you, tricia.
Speaker 2 (04:49):
Absolutely.
That is definitely a good one.
There's something about siblingenergy that you just need to be
part of Yep.
Speaker 4 (04:58):
I would say my win is something also family-oriented.
I had the opportunity to findsome old recipes.
So a little bit about me.
On my mom's side of the family.
She's Filipino and Chinese andmy grandma used to cook and bake
a lot.
My mom always tells me thatshe's not much of a baker.
I love baking and cooking.
(05:19):
It's something I just love todo in my spare time.
We spent some time together andI had the opportunity to find
one of my grandma's old recipesfor this.
It's like a bun.
It's like a.
It's called shupao in Tagalog,but it's just a little Chinese
bun and it seems to be complex.
It's a steamed bun Should beeasy.
It was not my mom and I tried tomake this recipe using my
(05:39):
grandma's recipe failed thefirst time.
It was just hilarious and funto make that mistake, but our
second batch turned out perfectand I'm just grateful.
Like I sat with that, I waslike this is a moment, like it
was just like a core memory,like locked in, spending time
with my mom and trying to dosomething.
My grandma right now hasAlzheimer's and so her memory of
(06:01):
cooking is not there, so shecan't teach it to us.
So we had to go off of what wethought best out of a recipe.
Speaker 3 (06:08):
Wow that is really cool.
Speaker 2 (06:10):
Yeah.
Speaker 3 (06:11):
And isn't it something how those flavors and
smells all bring back thosepositive memories of that time
during your childhood.
Isn't that just wonderful?
Speaker 4 (06:20):
Yes, I definitely had like my heart was like just so
warm.
Speaker 3 (06:24):
After that I was just like, oh my gosh, it tastes in
the oven and I just would lovethat Now, when I smell chocolate
(06:48):
chip cookies or any cookiesreally in the oven, it brings me
back to that wonderful time inmy childhood.
Speaker 4 (06:55):
It's so interesting how our mind just kind of
remembers that and hasassociations with smells and
taste.
Speaker 3 (07:00):
Yep.
It's very interesting.
Speaker 2 (07:02):
That's so fun.
Speaker 3 (07:03):
Okay, Tricia, what's yours?
Speaker 2 (07:06):
and taste.
Yep, it's very interesting,that's so fun.
Okay, tricia, what's yours?
Well, I have two celebrations.
First one is about Dr Jeff,because he just got off a
grueling six weeks of beingalone in the office.
His other provider has been outon medical leave and it's been
(07:28):
pretty rough and he got beat uppretty good but he did it.
And I feel kind of bad because Iwas out a week with our son,
chase, and that's going to be mysecond celebration I'm going to
share.
But I came home from an eventand I got super sick and he kept
(07:51):
me alive.
He literally did.
He placed his hand on my backone night just to make sure I
was still breathing because Iwas so sick.
But he just worried about meand I just I did feel terrible
because he worries about so manypeople and I didn't want him to
have to worry about me too.
But it was so nice to have himbe there and just show up like
(08:16):
he would normally show up andI'm just so grateful for him and
the knowledge that he bringsbecause he made me all better.
So that's my first celebrationis I'm thanking Jeff.
And then my second celebrationis I got to go to Vegas and
actually Jeff was the one thatwas supposed to go with me, but
because our provider mid-levelprovider was unable to cover,
(08:40):
because she had a medical issuethat was really important, and
so I took our son and it wasphenomenal.
We had so much fun.
We went to a.
It was basically almost a weeklong.
It was like a rock concert forentrepreneurs and I don't know
(09:01):
if you've ever heard of RussellBrunson or ClickFunnels or
Funnel.
Speaker 3 (09:06):
Hacking Live yeah, Funnel.
Speaker 2 (09:07):
Hacking Live.
He just he's this amazing,amazing marketer and got to
enjoy him.
And then, at the end of theweek, Tony Robbins.
We got to be part of that wholeexperience and it was crazy
because he was there for fourhours.
I don't think anyone left theroom.
(09:29):
There's 5,000 of us and he hadthe whole room.
There was so much energy.
It was literally one of themost phenomenal experiences I
probably have ever had, the mostphenomenal experiences I
probably have ever had, and hejust shared some of the most
incredible, inspiring storiesand, anyway, I learned so much
(09:50):
this whole week, came home,shared it with Jeff and anybody
else I can.
It was just so inspiring.
So sad Jeff wasn't there Was soglad our son was able to come
and he's also on our team andhelping us with a lot of
different things, so we'reexcited to have him on board.
Speaker 3 (10:08):
That's awesome.
Speaker 2 (10:10):
Okay, so before we share our listener question from
Jodi, we have several questionsthat we would like to ask you
first, nisha.
All right, all right, you ready.
Speaker 4 (10:21):
I think so.
Speaker 2 (10:22):
First of all, what inspired you to pursue a career
in this field and what led youto Spokane?
Speaker 4 (10:30):
I was born and raised in Spokane.
My family Air Force, so myfamily were both in the Air
Force and I was born atFairchild.
So I went to college atEvergreen State College in
Olympia and that was my firstjourney for college.
And then I went to college atEvergreen State College in
Olympia and that was my firstjourney for college.
And then I went to schoolfurther in San Francisco where I
(10:53):
don't know something just cameout in me I've always been a
helper.
I've always wanted to help myfamily really instilled
volunteer work.
At a young age People feltnaturally drawn to talk to me
and open up and I just I don'tknow it felt really natural.
It didn't really I didn'treally notice like the whys of
(11:14):
it just made it was a fluidchange into why I ended up in
the field.
I started out with substanceabuse, substance abuse clinic,
working as a counselor there.
I did my trainee experiencethere.
Yeah, it was just reallypositive.
I don't know the support thereat the Haydash Berry Free Clinic
really was a good foundation.
I loved learning.
(11:34):
I loved just being there andfinding ways to support people
with different challenges.
Whether it was substance abuse,it expanded into family Again.
Mental health and substance useaffects the whole family, so
there was never a time where I'mworking one-on-one with someone
where the whole family isn'tconsidered and I think I just
(11:55):
really appreciated that.
It made me reflect on my ownlife, my own family systems.
I have had family members,extended family, who have
struggled with substance use andmental health issues and I
think part of that also justsparked my interest.
Speaker 2 (12:11):
Excellent, well, thank you.
Okay, so I want to start withthe bigger picture.
People hear behavioral healthall the time, but many don't
fully understand what itencompasses.
How would you define it in away that makes sense to the
average person?
Speaker 4 (12:30):
I would say that's a great question.
I would say behavioral healthjust as kind of encompasses, I
think, a little bit ofeverything our mental health,
our daily, our environmental,our social I think it's an
overarching word to say likeeverything in our social,
environmental life.
I'm trying to like think ofthat question.
(12:51):
It's a big one.
I don't know where to startbecause I think it's a big word
to say it's a little bit ofeverything.
Like mental health is underbehavioral health.
Behavioral health is justeverything about how we are as a
person, why we do the things weare, who we are.
I'm not exactly sure how I wantto even answer that.
Speaker 3 (13:10):
So I like to listen to this.
Have you ever heard ofHitchhiker's Guide to the Galaxy
?
Yes, okay, and it's kind oflike the answer to life, the
universe and everything.
Okay, and that's kind of what Ilook at behavioral health as
like the answer to life, theuniverse and everything.
Okay, and that's that's kind ofwhat I look at.
Behavioral health is like theanswer to life, the universe and
everything.
It sort of encompasseseverything and, by the way, if
(13:31):
you look at the Hitchhiker'sGuide, the answer to life, the
universe and everything is what?
Yes, it's 42.
Speaker 4 (13:39):
Okay, I mean that's, that's a.
Speaker 3 (13:42):
it's just a hilarious look at that, but I just
appreciate where you're comingfrom and kind of struggling with
that answer because there's somuch.
Okay, Tricia, give her aneasier one next time.
Speaker 4 (13:54):
Yeah, I was like that was the first start and all I
could think of is an onion.
Speaker 3 (13:58):
So I think a lot of things is an onion, I was like
this is a big word and I'mpeeling back, but the more I
start to talk, then I'm going tokeep wanting to add more to
this onion and I don't even knowwhere it's going to end up.
Yeah, but that's an answer inand of itself, right there.
Speaker 2 (14:13):
So the end we can even, as time goes on, we can
just continue to answer thatquestion as well.
So yeah, definitely.
Now, in your experience, whatare some of the most common
misconceptions people have aboutbehavioral health and
developmental disabilities?
Speaker 4 (14:32):
individual with disability cannot do anything
for themselves, that they need100% support all the time, that
they can't strive for moreindependence, and that people
(14:55):
who provide supported livingservices to that individual take
away all choice and power ofthat individual.
In reality, a person who'ssupporting a person with a
disability, they're working onhelping that individual find
their independence, find theirpower and choice, and they're
more of an advocate.
Speaker 3 (15:16):
Oh, I love that.
That's beautiful.
Speaker 4 (15:19):
And that's really.
Yeah, I see that every day.
It's like you're not allowingthem to be more independent, or
sometimes the stigma that aperson with disability and
mental health issues does nothave the ability to make choices
or make mistakes, that they'renot in a mental capacity where
they could make decisions andallow that just natural.
(15:41):
Hey, I can make a mistake andlearn from it, and
reality-supported living reallydoes allow enough space when I
mean depending on situation,obviously, but does allow a
space for an individual to makea choice, make a mistake, learn
(16:03):
from it and grow.
Speaker 3 (16:05):
I think one of the things that I see is the
opposite too.
If a person is they have somemental disability, or they have
some disability, whatever it is,and they want to be treated
like they don't have anyproblems, and then sometimes
people expect them to do morethan they actually can.
People expect them to do morethan they actually can
(16:29):
no-transcript what they can doand what they are striving to do
, and helping them, helping aperson reach those goals without
getting in their way.
That is just.
That is a a challenge and agift for those who do it.
Speaker 2 (16:46):
So congratulations on that yeah, I I have to agree
with that, and we've we've gotsituations that we are dealing
with too here, and it definitelyis challenging because you want
to be able to give them so manyopportunities and then when you
(17:08):
recognize that those are toomany, but then when you have to
kind of reel them in a littlebit, then they get frustrated.
It's like, well, how come youtook that back, or but it's,
they're not ready and so, yeah,it's a lot sometimes.
Speaker 3 (17:24):
Yeah, it's a moving target.
Speaker 4 (17:26):
Absolutely, and I think I give kudos to anyone
who's a family caregiver orfamily support not doing it with
the support of like agency.
So I think the difference inthe agency level is we have
different support people, wholeteam.
But if it's your own familymember that's struggling with
that disability and you'retrying to help them be the best
they can be, but also set upreasonable goals and help them
(17:47):
find a place where, hey, this iswhat's doable.
Right now I think it's evenmore.
It can be heartbreaking.
It could be just a lot tohandle.
So, I always give kudos toanyone who's doing it without a
support network.
Speaker 2 (18:03):
Yeah, excellent, okay , well, thank you for that.
So this question is for bothyou and Jeff.
From a medical standpoint, Isee the physical and behavioral
health are closely connected.
I see the physical andbehavioral health are closely
connected.
Can you talk about whyunderstanding both is essential
for providing the best care?
Jeff, you want to start?
Oh, this is great Sure.
Speaker 4 (18:23):
I know that is a good question.
Speaker 3 (18:25):
Yeah, this is a great question and one that I
consider in every patientencounter, because nobody shows
up in an appointment or in acare situation that they don't
bring the baggage with them ofwhatever their problems or
things that are going on intheir life present, and very
(18:46):
often there is a mind-bodyconnection between whatever
that's going on with their bodythat they're coming to talk to
me about.
Usually it's something physical, a pain, something that is not
properly working in theirabdomen or whatever the case may
be.
One of the things that I try todo is decide how much is
(19:14):
strictly physical, whichsometimes it is, and also how
much that their own environmentand the ways that they're
reacting to it is entering intothe physical manifestation of
their disease.
Sometimes, especially when itcomes to abdominal pain, bowel
function, twitches in their faceor eyes there's all kinds of
things that really quicklymanifest in a person that's
(19:37):
under high stress, and stresscan be manifested in so many
different ways.
You know it could be a familythat the mother and father are
at odds and they're not doingwell and they're trying their
best to hide the problems thatthey're having from their
children, and so they're clampeddown on the emotions that are
(19:58):
going on inside them so theydon't show them to their
children.
That can cause manifestationsin so many ways.
I mean, that's just one thingthat comes to mind, but keeping
in mind the psychosocial parthelps me with the physical part.
And the other thing that I thinkabout too is sometimes I forget
(20:21):
to get to know a person first,and that's one of my first
things that I like to do when Imeet a new patient is not to
just say okay and launch rightinto what their problem is,
which is the way that mostdoctors do.
They say they look at theirchart or their paper in front of
them or the computer, andthey're not looking.
I'm holding my hand in front ofmy face, so the person can't
(20:44):
really see me.
And what they do is they say,oh, looks like you're here
because you have back pain.
Okay, and so how long have youhad back pain?
And they don't even knowanything about what happened to
this person.
They just launch into theirstandard questions.
You know my way to do this andI'm not saying that I'm the only
way to do it, but this is myway to do it is to walk in the
(21:09):
door and say, okay, hi, I'm DrJameson Tell me about you, but I
don't want to know anythingmedical about you right now.
Speaker 2 (21:16):
I just want you to tell me who you are.
I love that.
There you go.
Speaker 3 (21:20):
Tell me about your family, tell me about your.
What kind of work do you do?
What kind of stress are youunder, what are the things that
are happening in your life thatare important to you?
And I take a minute or two justto understand the human being
and then ask the other questionshuman being and then ask the
other questions and usually in anew patient encounter the
(21:44):
person is like I've never hadanyone ask me that before.
I don't know what to do.
I don't even know what to say.
They're totally deer in theheadlights when I ask them that
question.
So I have to prompt them, sayokay, tell me about your family.
What kind of work do you do?
Oh my gosh, you are under a lotof stress, you know, or
whatever it is that we you know.
So I get to know the person.
And when you can get to knowthe person, the human being
(22:04):
behind the problem, often theproblem will reveal itself
easier.
And the other part is theperson is disarmed about you as
a physician coming in and notbeing a human being yourself.
Dr Jeff Yep, go ahead.
Speaker 4 (22:20):
I was going to say.
I can attest from that from myown experience too.
It is slightly alarming ifyou're used to providers not
asking you, hey, how's it going?
And getting to know you and Ithink it's you know it does make
you feel safe.
I think setting up that safespace and that safe foundation
you'll get to learn so muchabout what that person's going
(22:40):
through, and I think what youmentioned about it being mental
health and physical health gohand in hand I mean back and
forth.
And the only way you could kindof unpack and decide where
that's coming from or what theissue is if the abdominal pain
is an emotional pain is gettingto know that person, and I
definitely appreciate how youprovide that safe space as a
(23:03):
practitioner.
It's super important and it'sso crazy how different it feels
when someone asks you, evenstarting with how are you doing?
How was your day?
That?
Speaker 2 (23:13):
was a common practice and it's really shocking for
Jeff.
When somebody asks him hedoesn't even.
He's like huh what.
When somebody asks him abouthow are you doing, are you doing
okay and shows that kind ofcare for him.
Speaker 3 (23:29):
Yeah, that's been really super the last few weeks
that we've been working with noother provider but myself in the
office.
That's been a little bit of achallenge and my staff has been
very good about letting peopleknow you may have to wait a
little longer than normal.
You may have to wait a littlelonger than normal to get in
these things, so that patientsare understanding and then they
(23:52):
do ask me and you know I'mreally lucky to have patients
who we care about each othermore than just a okay, I'm here
to get my needs met and I'm outthe door kind of doctor-patient
relationship.
And that's one of the greatgifts I think of family medicine
is being able to have anongoing relationship with people
(24:13):
, is being able to have anongoing relationship with people
.
Speaker 2 (24:16):
Yeah, beautiful, I love that.
Thank you both so much.
Nisha, you talked about how youcreate behavioral support plans
for individuals withdisabilities.
Can you walk us through theprocess?
How do you go from assessmentto an actual plan that works?
Speaker 4 (24:38):
Yeah, that's a good question.
Most of the time it's as youknow.
We've been talking aboutalready getting to know the
individual.
It's spending a lot of time.
It's doing visits.
Before I even start a plan I'mlike what do they like, what do
they dislike, what do they enjoyto do?
For?
Like the very, very basics.
What do I know about theirfamily history?
What impacts them?
What have they told me hasimpacted them day to day and
(24:59):
makes it hard to do A, b, c, d.
So getting that foundation,that's my start of writing a
plan.
After that it's working on ateam.
What have we tried?
What are the behaviors going on?
So there's that, identifyingwhat's working, what's not
working.
The whole goal of the plan isto find proactive strategies to
prevent something that's notgoing great and find those
(25:21):
coping skills to throw in thereand help the individual work
through before it gets tosomething super, super negative.
Speaker 3 (25:30):
What are a couple of specific behaviors that you see
a lot that you have to work with.
Speaker 4 (25:36):
Absolutely so.
Right now, ones that I'm seeinga lot are property destruction
just due to not getting adesired meal.
So it's something it can besuper simple.
So, okay, they're punching ahole in the wall because they're
not getting their desired food.
What's really going on?
So I think you know at my jobwe spend a lot of time in teams.
(25:59):
Okay, what is this persontrying to communicate right
there?
What is their need?
Are they hungry?
Are they just bored?
Do they not like the staffthey're working with?
And we need to build morerapport in the home with that
staff.
That's a lot of again, pickingthe pieces and trying to learn
this individual and what worksand doesn't work.
(26:20):
And once we find that kind oflittle like green area or that
like area where they're in acalm state, we could practice
and see what works with copingskills.
So we're not going to jump into take a deep breath or let's
pause and do some mindfulnessskills.
I've already experienced we'renot doing that when they're
already throwing and punchingthings in the wall.
So what we want to do is findthings that work when everything
(26:43):
is fine and then build off ofthat and then also just looking
at the strengths Everyindividual I've worked with has
so many strengths.
I have individuals that arejust really strong readers, and
so they're going to read theskills to me and we're going to
practice it.
I'll model it, they'll model itback.
All of these things are what goin the plan, and it's kind of
(27:06):
almost like a guide andinstruction for the staff who
work with that individual 24seven on how can we help them
when things are getting tough,before it's at the red or at the
escalation point.
Speaker 3 (27:20):
So it sounds like that every individual's plan is
as individual as the individual.
Speaker 4 (27:27):
Absolutely, and that is the goal.
We want it to be strength-based.
We want it to be so specificthat if you write it without a
name on it, you know exactly who, which individual, we're
talking about, down to theirfavorite color, their favorite
food, who their support networkis, who they want to talk to
when things get tough.
Speaker 3 (27:47):
Well, that's interesting because it seems
like you could translate thoseskills into working with anyone,
really Absolutely.
I mean, they may not even havea developmental or other
disability, but just getting toknow another human being and
then using those skills to notnecessarily, I mean, I wouldn't
(28:11):
say to use it as a manipulationtool, but as a way to get to
know them and to be able toimprove your relationship with
them, not to be a chameleon forthem, but to be a person that
understands that individual.
Speaker 4 (28:28):
It's almost like an instruction guide on how to best
.
Speaker 3 (28:32):
How to win friends and influence people.
Speaker 2 (28:34):
Yeah, I love that and I really I love how you adjust
when something isn't working.
It's not like this is the planand it's going to fit for
everybody.
You find a very specific planthat works for each individual,
so go into.
What kinds of things would youlike to include to help with
(28:58):
that assessment?
Speaker 4 (28:59):
I would say like again their strengths,
behaviorally, just things theycan also do like skills they've
tried, that they've reallysucceeded in and so we can build
off of that.
It makes it a little bit easierto keep adding skills if we
know what worked and didn't work.
Instead of taking deep breaths,I'm not going to say, okay,
let's start again with take moredeep breaths.
Speaker 2 (29:20):
Yeah, let's just keep breathing.
All day, the more breaths theytake.
Speaker 4 (29:24):
Yeah, so I think you know communication style.
That's huge.
If someone likes more spacewhen they're upset, we want to
acknowledge and respect thatspace is really important.
Or if they need someone to sitwith them, next to them while
they're in a behavior and havinga hard time, but they don't
(29:44):
want that person to talk to them.
We're going to be noting thatand really the only way you
could get the information forthose pieces is spending time
with them, talking to people whospend time with them, their
family and anyone in theirsupport network.
Those pieces is spending timewith them, talking to people who
spend time with them, theirfamily and anyone in their
support network.
Speaker 3 (30:02):
But one of the things that I sorry for interrupting
you there, but one of the thingsthat I recognize about you,
nisha, is that you're fun, youhave high energy and you're
funny, okay yeah.
And so I wonder how you usethose strengths in communicating
with and being with thosepeople you're working with.
Speaker 4 (30:20):
I mean I try to stay positive as much as possible.
Speaker 2 (30:23):
She gets along with everyone.
Speaker 4 (30:25):
Not always, I try but also, you know, I have to
always remind myself, like wherethe individuals are.
They have staff 24-7.
It's got to be a lonelyexperience to not have as many,
maybe as many close friends andsupport.
That's not paid staff.
(30:45):
That always comes to my mind.
I'm walking into their home, myinteractions with them.
I mean, I am a paid staff too,so I want it to feel as like hey
, no, I'm actually here for you.
Speaker 3 (30:57):
And you're kind of there because you want to be too
.
Speaker 4 (30:59):
And I definitely want to be there and that shapes
like my mindset.
I always have to remember mymindset when I'm writing a plan,
when I'm visiting a client, anyof those situations, and that
keeps me positive.
I mean, just this week, oneactivity, activity.
I'm working with a gentlemanwho has been diagnosed with
(31:19):
autism and some otherdevelopmental disabilities and
one of his strengths is reading.
So we have these communicationlike what do you see going on
here?
What is the behavior on thiscard?
They're just communicationcards.
They have pictures going onhere.
What is the behavior on thiscard?
They're just communicationcards.
They have pictures and you getto guess what's going on in
there.
And he will read the cards,tell me a story based on what
(31:41):
their feelings are, and whatI've learned from this is that
he's super caring and thoughtful.
Like his first instinct is tothis person looks hurt.
I would ask them if they need afirst aid kit.
Like forgetting that, likethere's so much more to the
person than just the diagnosis.
Speaker 2 (31:57):
Um sure.
Speaker 4 (31:58):
That always keeps me in a positive mindset and that
you can have fun and joke, and Imean what.
I bring my personality to thehome.
I I try to be positive andfunny because, like, it brings
the same out of them and it's,it's enjoyable.
Speaker 2 (32:11):
Oh.
Speaker 3 (32:12):
I think that that's so important.
For sure, and you know just, Ican just imagine you know,
knowing you as we do that thatyou're just a breath of fresh
air when you walk in the door.
So I'm sure that you bring alight and a fun that many others
I mean other people bring otherstrengths, but I can just see
(32:33):
that as a light for you to cometo a person's care in a positive
way and I love that about you.
Speaker 4 (32:40):
Thank you.
I think it's a little differentin the crisis situations.
Maybe it's less bubbly, morepractical.
But I mean, when I have theopportunity to, why not be as
happy as you can be?
Why not bring?
Speaker 2 (32:55):
some joy in that moment.
Well, that energy is soimportant too.
You know you affect the roomand so if you bring in that
lightness and a little bit ofthat fun, even though you're
being very professional, youknow people feel that and they
just feel more at ease.
So I totally can see that.
Thank you so much.
Okay, so you work closely withcaregivers and staff.
(33:18):
What are the biggest mistakes,you see, when people try to
support someone with behavioralchallenges?
Speaker 4 (33:25):
I would say a huge piece is not not being
self-aware of how they arefeeling.
So when things get tough, whenthey're working a lot of shifts,
I think sometimes caregivers orstaff can really forget that
they need to be mindful of, like, what their needs are, so not
(33:47):
forgetting about their own needs.
Making sure they ate lunch yes,we're providing food and we're
spending time with ourindividuals, but did you eat
your own lunch?
How are you feeling when thisbehavior is happening?
Are you feeling frustrated?
It really changes the energy,as you mentioned, the energy in
the room.
If you're hungry, if you'refrustrated from the individual
on how they're talking to you,are you approaching this calmly?
(34:11):
I see a lot of staff getfrustrated and then they almost
get upset with, like, theindividual they're working with
and really the staff are theones that need kind of like the
same skills in a behavior plantaking that pause, learning what
works and doesn't work, findingyour strengths.
I think it's the same both ways.
Speaker 3 (34:30):
So you have to do your own work as a caregiver
before you can actually do agood job of caregiving?
Is that what you're saying?
Speaker 4 (34:36):
Absolutely, and I think that's for job related
caregiving, but even in your ownpersonal life caregiving, I
agree 2000%.
Speaker 2 (34:45):
Yes, when you're feeling that stress, to be able,
like you said, take that pause,separate yourself for just a
moment, so you can just kind ofget your wits about you once
again.
So, yeah, excellent.
Speaker 3 (34:59):
I should tell you a story that happened about 10, 15
years ago, I guess, where I letmy own feelings and stuff get
out of control in a patientenvironment when I was with a
patient, in a patientenvironment when I was with a
patient.
And now I can look back on itand say, yeah, I probably
(35:25):
behaved inappropriately, but Ifelt like I was justified at the
time.
But yeah, there was a gentlemanwho was seeing me for diabetes
and had been seeing me forseveral years and the one thing
I knew about him is that nomatter what I tried to provide
him, no matter what I said, hewould always do something else
and he wouldn't listen to myadvice.
He wouldn't do any dietcontrols, he barely ever took
(35:47):
the medicine that I prescribedfor him and his diabetic
laboratory work proved the factthat we were not getting
anywhere.
So he comes into me this lastday that I saw him and he told
me after I tried to get him tostart some insulin to get his
(36:08):
sugars under control, gonethrough all the education
regarding it, had peoplesupporting him with dietary and
other supports, and he said thathe went to the bar and he
talked to a guy at the bar whosaid if you drink a shot of
whiskey in the morning and ashot of whiskey at night, that
will take care of all yourdiabetic needs.
Speaker 2 (36:29):
Oh my gosh.
Speaker 3 (36:31):
And I lost it.
I just said no way, and that'swhat he'd been doing.
He actually took that advice.
So instead of taking the adviceof the doctor, he took the
advice of some bartender thatyou know all I need to do this.
Well, so it came down to thathe didn't like having diabetes,
(36:53):
he didn't want to have diabetes,and so he wanted to act like he
didn't.
And he thought if he just didthese other things, that it
would just take care of him andhe wouldn't have to worry about
it.
Well, I, I right then, andthere I just stopped him and I
said this relationship isn'tworking.
I don't like what you're doing.
I hate that you take the adviceof a bartender over your doctor
(37:15):
.
And so this will be our lastvisit.
And I just was furious at thisguy, oh wow, and I walked him
out the door and I sent him aletter.
Yep, he got fired and the sadpart is I took care of other
(37:36):
members of his family, and stilldo, but he didn't last long.
He died in just a few shortyears after that encounter.
It's because sometimes, as muchas I hate to admit it, we
actually do know more than someof these.
Speaker 2 (37:53):
Than bartenders.
Speaker 3 (37:54):
Than bartenders yes.
And so, and sometimes when Idon't know, it just hit a chord
in me that I can only imaginehow you, nisha, have got to keep
those things in check when youabsolutely know more, you
absolutely have understanding ofwhat's going on, and that the
(38:16):
client, the patient, justdoesn't know what they don't
know.
Speaker 2 (38:20):
Well, and I think it's got to be so impressive too
, when you've got a client thatis reacting really poorly, maybe
calling you names, throwingthings, I mean you have to learn
how to handle that in a waythat is respectful.
It's not about you, but it'sall about you.
I mean you feel it's being doneto you.
(38:42):
It's about the patient and justignoring those comments.
The bad behavior go back towhat the things in that you've
learned from the beginning andgoing back to those basics and
just being able to keep yourcool.
I think that that's just got tobe so impressive and it takes a
(39:03):
toll too, I'm sure, on you.
Speaker 4 (39:05):
I think for me, I do more of the behind the scenes
work, so I'm working with theindividual less than the support
staff, who are there 24 hours,and part of my role is doing the
teaching and training.
So the behavior plan is alsoalmost a teaching guide for the
staff on.
Hey, we've spent a lot of timewith this person.
We know a lot about them.
(39:26):
This is to help you really putinto perspective what this
person has for goals, what theirbehavioral concerns are and how
can we best help them withoutmaking things way worse.
And so I definitely agree,sometimes it is hard to put your
emotions in check.
For me, I find it more so whenit's teaching the staff.
(39:48):
If I'm like, hey, you guys arejust sitting on your phone, this
person.
Of course, if I were beingsupported by someone and they
were not engaging with me forthe whole day, I would have a
behavior too.
It doesn't feel good to beignored in your own home.
So part of my role, yeah, isspending time with the staff and
(40:09):
saying like, hey, can youempathize with this?
What would it feel like if youwere in this role?
Can you practice the breathingskill with them?
Is there some things?
And then I try to model it inthe home in hopes that they can
handle these big, big situationswith the skills that they have.
Speaker 2 (40:27):
Oh, I love that.
This is a great segue into mynext question.
This is talking aboutcommunication, so caregivers
often struggle to get through totheir loved ones.
What are some key communicationstrategies that work well for
individuals with developmentaldisabilities?
Speaker 4 (40:46):
That absolutely is a good question.
I think patience a huge pieceis being patient and not setting
an expectation that you'regoing to get the answer the way
you want the answer, and reallyjust honing in and sitting there
with your individual, with yourfamily member, and getting to
know them.
I think that is the key pieceover and over again Really
(41:10):
listen and figure out or listenwhat they're saying, what they
need, and I think that gives youa lot of answers.
Speaker 3 (41:19):
How do you help a person in that situation
understand the boundaries,though?
I mean.
You can't just let them getaway with every bad behavior
just because you're beingpatient.
Speaker 4 (41:32):
Oh, absolutely no.
I'm being patient with thelistening to learn about what
their needs are.
I think being comfortable andpracticing, setting healthy
boundaries are the boundariesthat need to be set.
I think it's hard to answerwithout, like, a specific
scenario in mind.
But yeah, I think the self-careis going to get you a long way
as a caregiver, a family member,being open to listening, not
(41:56):
just putting your ownexpectations on the individual
or family member.
I definitely see that a lot.
I want this person to get a joband go to school and where they
are developmentally with themental health things going on,
that's just not a reasonable orgoal, at least at that time it's
(42:18):
not an expectation that'srealizable.
Yeah, maybe not realizable atthat moment.
So I think, being mindful of,is this goal, or is the
communication that we arewanting from that individual or
person something because we wantit, or is this something that
can?
Is it reasonable?
(42:38):
Yeah, that's kind of what.
Speaker 2 (42:40):
I'm thinking about Okay, excellent, thank you.
Then I've got one more question, then we're going to ask our
listener question.
So how can medicalprofessionals, doctors,
therapists, caregivers workbetter together to create a
well-rounded support?
Speaker 4 (42:56):
system, I think.
Just again back tocommunication.
That's a huge piece.
At the job I work at, we meetregularly.
We have quarterly clinicalmeetings, we have check-ins, we
have documentation notes thatreally help us know what's going
on.
I think, being open tocollaborating with folks,
(43:19):
especially the medical providers.
So we're talking aboutbehavioral health, mental health
and physical health.
Those go hand in hand.
Sometimes, the physical healththere's an issue like a UTI or
something and it's causing abehavior.
So we can't just say, hey, thisbreathing skill doesn't work.
They might just have a medicalissue that needs to be addressed
.
So having everyone on the samepage, communicating, is really
(43:39):
helpful so we could rule out allthe different things that it
could be.
That's what, yeah, I would saythat's a big piece.
Speaker 2 (43:46):
Okay, Any thoughts?
Jeff yeah.
Speaker 3 (43:48):
It's something that I feel like when I'm working in
combination with a mental healthprofessional on patient care.
I really appreciate theinsights that the mental health
professional gives Because often, even though I try to get to
know the person, I can only doso much in 15 minutes, where a
(44:08):
person that is in a mentalhealth position often has longer
time that they're able to spendwith them.
So it helps me a lot ifsomething is going wrong, if a
medical issue is happening or ifthere's an adjustment in their
mental health medication that'snecessary.
It's so helpful to have thatinput and it helps me make
(44:29):
better choices and decisions forthat patient.
Speaker 4 (44:32):
I agree and I think it goes in all directions.
Having the medical input helpsthe mental health piece, because
we could say, okay, this is nota proactive skill, that's going
to be helpful because ofwhatever's happening medically,
but also even at the educationalor wherever job coaching level,
wherever that person is in life, having that communication and
(44:52):
being open to hey, this mightimpact, this is always going to
be helpful.
I really think.
Speaker 3 (44:59):
Well, and I think also you know if there's a
medication change, becausealmost universally in the
population that you're workingwith, they're on medication
Absolutely Okay, and themedication changes can make
abrupt and very dramatic changesin a person, whether they could
be good or bad.
(45:19):
And so understanding from aprovider of you know whoever's
prescribing the medication,helping know what you might
expect as a change or a positiveor negative thing, like this
particular drug might make yourclient very sleepy, or this
particular medication may make aperson wake up more or be
(45:40):
irritable, and so having thatunderstanding ahead of time is
going to be really helpful forthose who are in 24-7 care or
even if you're a family memberwho's watching their ADHD child
and change.
So, whatever the case may be,staying in good communication
(46:03):
with the and understanding howthe medications work is a really
helpful, important part, Iwould think things like sleep
(46:24):
habits, eating habits, timeswhen they're agitated, times
when they're focused and notfocused.
Speaker 4 (46:27):
Those are such helpful pieces of information to
give to your primary doctor andto share with other people who
are maybe adjusting medications.
Speaker 3 (46:33):
It's not only helpful , it's crucial.
Speaker 4 (46:35):
Yes.
Speaker 3 (46:36):
So I love what you just brought up there.
Very good, excellent.
Speaker 2 (46:39):
Thank you brought up there Very good, excellent,
thank you.
Okay, so we're going to go toour question.
We've received a powerfulquestion from Jodi, one of our
listeners, and this is what sheasks as someone with a family
(46:59):
member struggling with both adevelopmental disability and
anxiety, I often feel lost inhow to support them without
overwhelming myself.
What advice do you have forcaregivers trying to balance
their own well-being whileproviding the best support
possible?
Speaker 4 (47:13):
That is a wonderful question and I definitely hear
that often.
I think the most crucial pieceis setting those boundaries,
giving yourself time to haveyour own time self-care.
I don't know if there's reallyone fit all response to how to
(47:34):
fix that.
However, I think reallyconnecting with like support
groups, other family members orpeople who've been in similar
situations.
I can't tell you how importantit is to reach out to someone
who might be in the samesituation, because caregiver
burnout is huge.
It's such a big thing and itimpacts people's health so much.
(47:55):
I've seen it with caregivers inthe agency, but I've also just
seen people who have familymembers.
They take care of mental healthand physical health issues with
their family members and it's alot.
Speaker 3 (48:10):
In my situation.
I see so many.
You know it's like a husbandthat's caring for an Alzheimer's
wife or a parent that is theprimary caregiver of a disabled,
but not completely dependentchild.
You know where the child can dothings, you know, but what they
always have is 24-hour, sevendays a week on call, so they can
(48:37):
never sleep.
Speaker 2 (48:39):
We have a family member like that and they just
never, hardly get a break, andit's just exhausting for them
about the age of a three orfour-year-old at least 22.
Speaker 3 (49:07):
So he can do some things, but he likes to get up
in the middle of the night andcome into the parents' room and
get them up, and you know it's achallenge for them to get any
sleep at all, and so it's a verydifficult thing for them to get
the personal care they need,and especially the mom.
The dad often will sleep rightthrough when this happens, but
(49:30):
the mom is always up and takingcare of it, so she ends up not
sleeping well and has putherself in a high alert
situation all the time, so shebarely sleeps.
Speaker 4 (49:41):
Yeah, I think in those situations we see a lot of
caregivers feeling superisolated because of that Cause
it's 20, the job is 24, seven,almost like you don't really get
a break.
It might even be challenging toget that time to talk to
someone about it, because it'sall day, every day.
So I think those support groupsI know there's online support
(50:01):
groups that have been helpful tofolks, but also I see a lot of
times people who are caregiversfor loved ones or anyone with
mental health or physical health, just any kind of caregiver
rule that it's hard to see thesmall victories and the small
wins.
If you're with someone 24-7, itcan just feel like a job it
(50:22):
could feel really hard to take apause.
It could be really hard to seethat, okay, they're not doing
the whole task, but they did onething more than like.
Seeing the little little winsis really, really challenging, I
think when you're a caregiver.
Speaker 2 (50:37):
Is there much support for respite?
Speaker 4 (50:39):
care.
You know funding changes sooften with respite care I don't
know a lot are available.
I think a good start is lookingat DSHS, so Washington State's
Department of Health and HumanServices website, and looking
specifically at the needs.
So if it's disability, it wouldbe DDA.
I don't know a lot of respitesavailable.
(51:01):
Sometimes it's available foryouth 18 and under.
I see that more common.
We used to have respiteavailable for elderly.
I don't know what the status ofthat is, but I think a good
start is going to like statewebsites looking at the National
Association of Mental whateverNAMI is.
(51:22):
Hold on, I always forget thatN-A-M-I.
N-A-M-I.
That website has a lot ofcaregiver and mental health
information and talks aboutsupport groups that are local to
our area.
I know Facebook even placeslike Facebook have support
groups and so those are goodplaces to ask specific questions
.
Like I have a family membergoing through this, I'm feeling
(51:44):
overwhelmed.
What resources are there forrespite?
I know it changes so oftendepending on what the funding is
and where you're located.
Speaker 3 (51:53):
I can really see how a person in that situation could
feel so isolated, and they alsofeel like no one else can
provide the care this personneeds better than me or as good
as me but I think they also feelthat people don't care yeah,
yeah.
and so they get locked intotheir own cycle of of kind of
(52:19):
almost abusing themselves by notgetting the self-care that they
need.
And so I appreciate that youknow looking into those things,
recognizing that if you're inthat situation that you need
your own care, you need to beable to take care of yourself,
even if it's just taking a breakto go to the grocery store by
(52:41):
yourself or, you know, seekingout a friend that you haven't
chatted with for a while andspending time with them, and
recognizing that it's okay, evenif it's for an hour, to have
somebody else do something foryou.
Speaker 4 (52:57):
I agree Absolutely.
I think it's so easy to fall inthat pattern of feeling
hopeless and this is my life andthis is all it's going to be,
Instead of thinking what can Ido to give myself some self-care
and it's okay to take a breakfrom this role.
Speaker 2 (53:16):
Excellent.
This conversation has been sopowerful and I want to thank
Nisha Wright for being here withus and sharing her vast
knowledge, and for Jodi forsending in that great question.
But we're just getting started.
In part two, we'll be divinginto caregiver burnout,
self-care strategies andreal-life success stories that
(53:36):
highlight the transformativepower of behavioral
interventions.
Make sure you subscribe and youdon't want to miss this next
episode.
And if this episode spoke toyou, please share it with
someone who needs it.
If you have a question, pleasedon't forget to send it to
trishajamesoncoaching atgmailcom.
And until next time, take careand keep thriving wellness
warriors, and we'll see you nexttime.
(53:58):
Bye-bye everyone.
Speaker 3 (54:00):
Bye.
Speaker 2 (54:00):
Bye.
Speaker 1 (54:06):
Thanks for tuning in to the Q&A Files, delighted to
share today's gems of wisdomwith you.
Your questions light up ourshow, fueling the engaging
dialogues that make ourcommunity extra special.
Keep sending your questions totrishajamesoncoaching at
gmailcom.
Your curiosity is our compass.
Please hit subscribe, spreadthe word and let's grow the
circle of insight and communitytogether.
I'm Trisha Jameson, signing off.
(54:27):
Stay curious, keep thriving andkeep smiling, and I'll catch
you on the next episode.
Hello and welcome to the Q&A file, the ultimate
health and wellness playground.
I'm your host, tricia Jamieson,a board-certified functional
nutritionist and lifestylepractitioner, ready to lead you
through a world of healthdiscoveries.
Here we dive into a tapestry ofdisease prevention, to
nutrition, exercise, mentalhealth and building strong
relationships, all spiced withdiverse perspectives.
(00:29):
It's not just a podcast, it's acelebration of health, packed
with insights and a twist of fun.
Welcome aboard the Q&A Files,where your questions ignite our
vibrant discussions and lead toa brighter you.
Speaker 2 (00:42):
Welcome, friends, to another episode of the Q&A Files
.
I'm your host, trisha Jameson,a functional nutritionist and
lifestyle practitioner and alife coach, and, as always, I'm
joined by my incredible co-host,dr Jeff Jameson, a board
certified family physician.
And we don't have Tony here withus today, but we've got another
(01:02):
amazing guest that we're soexcited to introduce here.
So glad to have you here, jeff,and I'm so excited for this
episode and I think so manypeople are going to resonate
with our guest and a listenerquestion from Jodi that we'll
share later in the episode.
So this week we're diving intobehavioral health, a topic that
(01:27):
affects caregivers, families andindividuals with developmental
disabilities and mental healthchallenges.
Today we have an incredibleguest with us, someone who
brings not only amazingexpertise but also a deep
passion for helping individualsand families navigate the
(01:47):
complexities of behavioralhealth.
Nisha Wright is a Marriage andFamily Therapist, associate MFTA
, with a Master's in ClinicalPsychology and extensive
background in clinical andcounseling work.
Her journey in this field beganin 2012 as a substance abuse
counselor at the iconicHaight-Ashbury Clinic in San
(02:10):
Francisco, where she sawfirsthand the challenges people
face when dealing with mentalhealth and behavioral struggles.
Since then, nisha has workedacross various roles with
diverse populations, alwaysbringing her knowledge,
compassion and problem-solvingskills to the table.
(02:31):
Today, she serves as clinicalcoordinator for a supported
living agency in Spokane, whereshe plays a crucial role in
improving the lives ofindividuals with disabilities.
She provides home visits, staffsupport, hands-on training and
behavioral intervention coaching, while developing
person-centered, positivebehavior support plans that
(02:54):
truly make a difference.
We are beyond excited to haveher here today, not just because
of her expertise, but becauseshe's also a great friend of
ours.
She's been both a patient ofJeff's and a client of mine, and
now we get to pick her brain onthis podcast.
Speaker 3 (03:13):
Which we're so excited about too.
She's so awesome.
We're glad to have Nisha withus.
Speaker 4 (03:18):
Thank you so much, Tricia and Dr Jeff, for inviting
me.
I'm super grateful for theopportunity.
Speaker 2 (03:23):
Yes, absolutely, we are so excited.
So, nisha, one of the thingsthat we start with and you're
going to be familiar with this,and this is one of the reasons
why I wanted to wait for you tobe on right now and introduce
you first and then docelebrations, because when we
started our sessions, firstthing that we would do would be
(03:45):
celebration.
So we're going to start againand I'd love to hear a
celebration from you and Dr Jeff.
Speaker 3 (03:51):
And I'll start, okay, so it gives you a chance to
think about it for a second.
Okay, so my celebration is thatlast night I got to spend time
with my sister and her husband,jill, and Drew Nelson.
They're wonderful people andsometimes you just have to sit
down with your people, and theyrecognized how incredibly
(04:14):
helpful it was to just beourselves and have a great time
talking about family life andthings.
And Tricia hasn't been feelingthat well, so she wasn't able to
join us, but she encouraged meto be able to go and do that,
and that little effort on herpart is so appreciated by me.
So my gratitude is to Triciafor allowing me to do something
(04:39):
that isn't something I normallydo and take care of me with an
enjoyable time with them.
So thank you, tricia.
Speaker 2 (04:49):
Absolutely.
That is definitely a good one.
There's something about siblingenergy that you just need to be
part of Yep.
Speaker 4 (04:58):
I would say my win is something also family-oriented.
I had the opportunity to findsome old recipes.
So a little bit about me.
On my mom's side of the family.
She's Filipino and Chinese andmy grandma used to cook and bake
a lot.
My mom always tells me thatshe's not much of a baker.
I love baking and cooking.
(05:19):
It's something I just love todo in my spare time.
We spent some time together andI had the opportunity to find
one of my grandma's old recipesfor this.
It's like a bun.
It's like a.
It's called shupao in Tagalog,but it's just a little Chinese
bun and it seems to be complex.
It's a steamed bun Should beeasy.
It was not my mom and I tried tomake this recipe using my
(05:39):
grandma's recipe failed thefirst time.
It was just hilarious and funto make that mistake, but our
second batch turned out perfectand I'm just grateful.
Like I sat with that, I waslike this is a moment, like it
was just like a core memory,like locked in, spending time
with my mom and trying to dosomething.
My grandma right now hasAlzheimer's and so her memory of
(06:01):
cooking is not there, so shecan't teach it to us.
So we had to go off of what wethought best out of a recipe.
Speaker 3 (06:08):
Wow that is really cool.
Speaker 2 (06:10):
Yeah.
Speaker 3 (06:11):
And isn't it something how those flavors and
smells all bring back thosepositive memories of that time
during your childhood.
Isn't that just wonderful?
Speaker 4 (06:20):
Yes, I definitely had like my heart was like just so
warm.
Speaker 3 (06:24):
After that I was just like, oh my gosh, it tastes in
the oven and I just would lovethat Now, when I smell chocolate
(06:48):
chip cookies or any cookiesreally in the oven, it brings me
back to that wonderful time inmy childhood.
Speaker 4 (06:55):
It's so interesting how our mind just kind of
remembers that and hasassociations with smells and
taste.
Speaker 3 (07:00):
Yep.
It's very interesting.
Speaker 2 (07:02):
That's so fun.
Speaker 3 (07:03):
Okay, Tricia, what's yours?
Speaker 2 (07:06):
and taste.
Yep, it's very interesting,that's so fun.
Okay, tricia, what's yours?
Well, I have two celebrations.
First one is about Dr Jeff,because he just got off a
grueling six weeks of beingalone in the office.
His other provider has been outon medical leave and it's been
(07:28):
pretty rough and he got beat uppretty good but he did it.
And I feel kind of bad because Iwas out a week with our son,
chase, and that's going to be mysecond celebration I'm going to
share.
But I came home from an eventand I got super sick and he kept
(07:51):
me alive.
He literally did.
He placed his hand on my backone night just to make sure I
was still breathing because Iwas so sick.
But he just worried about meand I just I did feel terrible
because he worries about so manypeople and I didn't want him to
have to worry about me too.
But it was so nice to have himbe there and just show up like
(08:16):
he would normally show up andI'm just so grateful for him and
the knowledge that he bringsbecause he made me all better.
So that's my first celebrationis I'm thanking Jeff.
And then my second celebrationis I got to go to Vegas and
actually Jeff was the one thatwas supposed to go with me, but
because our provider mid-levelprovider was unable to cover,
(08:40):
because she had a medical issuethat was really important, and
so I took our son and it wasphenomenal.
We had so much fun.
We went to a.
It was basically almost a weeklong.
It was like a rock concert forentrepreneurs and I don't know
(09:01):
if you've ever heard of RussellBrunson or ClickFunnels or
Funnel.
Speaker 3 (09:06):
Hacking Live yeah, Funnel.
Speaker 2 (09:07):
Hacking Live.
He just he's this amazing,amazing marketer and got to
enjoy him.
And then, at the end of theweek, Tony Robbins.
We got to be part of that wholeexperience and it was crazy
because he was there for fourhours.
I don't think anyone left theroom.
(09:29):
There's 5,000 of us and he hadthe whole room.
There was so much energy.
It was literally one of themost phenomenal experiences I
probably have ever had, the mostphenomenal experiences I
probably have ever had, and hejust shared some of the most
incredible, inspiring storiesand, anyway, I learned so much
(09:50):
this whole week, came home,shared it with Jeff and anybody
else I can.
It was just so inspiring.
So sad Jeff wasn't there Was soglad our son was able to come
and he's also on our team andhelping us with a lot of
different things, so we'reexcited to have him on board.
Speaker 3 (10:08):
That's awesome.
Speaker 2 (10:10):
Okay, so before we share our listener question from
Jodi, we have several questionsthat we would like to ask you
first, nisha.
All right, all right, you ready.
Speaker 4 (10:21):
I think so.
Speaker 2 (10:22):
First of all, what inspired you to pursue a career
in this field and what led youto Spokane?
Speaker 4 (10:30):
I was born and raised in Spokane.
My family Air Force, so myfamily were both in the Air
Force and I was born atFairchild.
So I went to college atEvergreen State College in
Olympia and that was my firstjourney for college.
And then I went to college atEvergreen State College in
Olympia and that was my firstjourney for college.
And then I went to schoolfurther in San Francisco where I
(10:53):
don't know something just cameout in me I've always been a
helper.
I've always wanted to help myfamily really instilled
volunteer work.
At a young age People feltnaturally drawn to talk to me
and open up and I just I don'tknow it felt really natural.
It didn't really I didn'treally notice like the whys of
(11:14):
it just made it was a fluidchange into why I ended up in
the field.
I started out with substanceabuse, substance abuse clinic,
working as a counselor there.
I did my trainee experiencethere.
Yeah, it was just reallypositive.
I don't know the support thereat the Haydash Berry Free Clinic
really was a good foundation.
I loved learning.
(11:34):
I loved just being there andfinding ways to support people
with different challenges.
Whether it was substance abuse,it expanded into family Again.
Mental health and substance useaffects the whole family, so
there was never a time where I'mworking one-on-one with someone
where the whole family isn'tconsidered and I think I just
(11:55):
really appreciated that.
It made me reflect on my ownlife, my own family systems.
I have had family members,extended family, who have
struggled with substance use andmental health issues and I
think part of that also justsparked my interest.
Speaker 2 (12:11):
Excellent, well, thank you.
Okay, so I want to start withthe bigger picture.
People hear behavioral healthall the time, but many don't
fully understand what itencompasses.
How would you define it in away that makes sense to the
average person?
Speaker 4 (12:30):
I would say that's a great question.
I would say behavioral healthjust as kind of encompasses, I
think, a little bit ofeverything our mental health,
our daily, our environmental,our social I think it's an
overarching word to say likeeverything in our social,
environmental life.
I'm trying to like think ofthat question.
(12:51):
It's a big one.
I don't know where to startbecause I think it's a big word
to say it's a little bit ofeverything.
Like mental health is underbehavioral health.
Behavioral health is justeverything about how we are as a
person, why we do the things weare, who we are.
I'm not exactly sure how I wantto even answer that.
Speaker 3 (13:10):
So I like to listen to this.
Have you ever heard ofHitchhiker's Guide to the Galaxy
?
Yes, okay, and it's kind oflike the answer to life, the
universe and everything.
Okay, and that's kind of what Ilook at behavioral health as
like the answer to life, theuniverse and everything.
Okay, and that's that's kind ofwhat I look at.
Behavioral health is like theanswer to life, the universe and
everything.
It sort of encompasseseverything and, by the way, if
(13:31):
you look at the Hitchhiker'sGuide, the answer to life, the
universe and everything is what?
Yes, it's 42.
Speaker 4 (13:39):
Okay, I mean that's, that's a.
Speaker 3 (13:42):
it's just a hilarious look at that, but I just
appreciate where you're comingfrom and kind of struggling with
that answer because there's somuch.
Okay, Tricia, give her aneasier one next time.
Speaker 4 (13:54):
Yeah, I was like that was the first start and all I
could think of is an onion.
Speaker 3 (13:58):
So I think a lot of things is an onion, I was like
this is a big word and I'mpeeling back, but the more I
start to talk, then I'm going tokeep wanting to add more to
this onion and I don't even knowwhere it's going to end up.
Yeah, but that's an answer inand of itself, right there.
Speaker 2 (14:13):
So the end we can even, as time goes on, we can
just continue to answer thatquestion as well.
So yeah, definitely.
Now, in your experience, whatare some of the most common
misconceptions people have aboutbehavioral health and
developmental disabilities?
Speaker 4 (14:32):
individual with disability cannot do anything
for themselves, that they need100% support all the time, that
they can't strive for moreindependence, and that people
(14:55):
who provide supported livingservices to that individual take
away all choice and power ofthat individual.
In reality, a person who'ssupporting a person with a
disability, they're working onhelping that individual find
their independence, find theirpower and choice, and they're
more of an advocate.
Speaker 3 (15:16):
Oh, I love that.
That's beautiful.
Speaker 4 (15:19):
And that's really.
Yeah, I see that every day.
It's like you're not allowingthem to be more independent, or
sometimes the stigma that aperson with disability and
mental health issues does nothave the ability to make choices
or make mistakes, that they'renot in a mental capacity where
they could make decisions andallow that just natural.
(15:41):
Hey, I can make a mistake andlearn from it, and
reality-supported living reallydoes allow enough space when I
mean depending on situation,obviously, but does allow a
space for an individual to makea choice, make a mistake, learn
(16:03):
from it and grow.
Speaker 3 (16:05):
I think one of the things that I see is the
opposite too.
If a person is they have somemental disability, or they have
some disability, whatever it is,and they want to be treated
like they don't have anyproblems, and then sometimes
people expect them to do morethan they actually can.
People expect them to do morethan they actually can
(16:29):
no-transcript what they can doand what they are striving to do
, and helping them, helping aperson reach those goals without
getting in their way.
That is just.
That is a a challenge and agift for those who do it.
Speaker 2 (16:46):
So congratulations on that yeah, I I have to agree
with that, and we've we've gotsituations that we are dealing
with too here, and it definitelyis challenging because you want
to be able to give them so manyopportunities and then when you
(17:08):
recognize that those are toomany, but then when you have to
kind of reel them in a littlebit, then they get frustrated.
It's like, well, how come youtook that back, or but it's,
they're not ready and so, yeah,it's a lot sometimes.
Speaker 3 (17:24):
Yeah, it's a moving target.
Speaker 4 (17:26):
Absolutely, and I think I give kudos to anyone
who's a family caregiver orfamily support not doing it with
the support of like agency.
So I think the difference inthe agency level is we have
different support people, wholeteam.
But if it's your own familymember that's struggling with
that disability and you'retrying to help them be the best
they can be, but also set upreasonable goals and help them
(17:47):
find a place where, hey, this iswhat's doable.
Right now I think it's evenmore.
It can be heartbreaking.
It could be just a lot tohandle.
So, I always give kudos toanyone who's doing it without a
support network.
Speaker 2 (18:03):
Yeah, excellent, okay , well, thank you for that.
So this question is for bothyou and Jeff.
From a medical standpoint, Isee the physical and behavioral
health are closely connected.
I see the physical andbehavioral health are closely
connected.
Can you talk about whyunderstanding both is essential
for providing the best care?
Jeff, you want to start?
Oh, this is great Sure.
Speaker 4 (18:23):
I know that is a good question.
Speaker 3 (18:25):
Yeah, this is a great question and one that I
consider in every patientencounter, because nobody shows
up in an appointment or in acare situation that they don't
bring the baggage with them ofwhatever their problems or
things that are going on intheir life present, and very
(18:46):
often there is a mind-bodyconnection between whatever
that's going on with their bodythat they're coming to talk to
me about.
Usually it's something physical, a pain, something that is not
properly working in theirabdomen or whatever the case may
be.
One of the things that I try todo is decide how much is
(19:14):
strictly physical, whichsometimes it is, and also how
much that their own environmentand the ways that they're
reacting to it is entering intothe physical manifestation of
their disease.
Sometimes, especially when itcomes to abdominal pain, bowel
function, twitches in their faceor eyes there's all kinds of
things that really quicklymanifest in a person that's
(19:37):
under high stress, and stresscan be manifested in so many
different ways.
You know it could be a familythat the mother and father are
at odds and they're not doingwell and they're trying their
best to hide the problems thatthey're having from their
children, and so they're clampeddown on the emotions that are
(19:58):
going on inside them so theydon't show them to their
children.
That can cause manifestationsin so many ways.
I mean, that's just one thingthat comes to mind, but keeping
in mind the psychosocial parthelps me with the physical part.
And the other thing that I thinkabout too is sometimes I forget
(20:21):
to get to know a person first,and that's one of my first
things that I like to do when Imeet a new patient is not to
just say okay and launch rightinto what their problem is,
which is the way that mostdoctors do.
They say they look at theirchart or their paper in front of
them or the computer, andthey're not looking.
I'm holding my hand in front ofmy face, so the person can't
(20:44):
really see me.
And what they do is they say,oh, looks like you're here
because you have back pain.
Okay, and so how long have youhad back pain?
And they don't even knowanything about what happened to
this person.
They just launch into theirstandard questions.
You know my way to do this andI'm not saying that I'm the only
way to do it, but this is myway to do it is to walk in the
(21:09):
door and say, okay, hi, I'm DrJameson Tell me about you, but I
don't want to know anythingmedical about you right now.
Speaker 2 (21:16):
I just want you to tell me who you are.
I love that.
There you go.
Speaker 3 (21:20):
Tell me about your family, tell me about your.
What kind of work do you do?
What kind of stress are youunder, what are the things that
are happening in your life thatare important to you?
And I take a minute or two justto understand the human being
and then ask the other questionshuman being and then ask the
other questions and usually in anew patient encounter the
(21:44):
person is like I've never hadanyone ask me that before.
I don't know what to do.
I don't even know what to say.
They're totally deer in theheadlights when I ask them that
question.
So I have to prompt them, sayokay, tell me about your family.
What kind of work do you do?
Oh my gosh, you are under a lotof stress, you know, or
whatever it is that we you know.
So I get to know the person.
And when you can get to knowthe person, the human being
(22:04):
behind the problem, often theproblem will reveal itself
easier.
And the other part is theperson is disarmed about you as
a physician coming in and notbeing a human being yourself.
Dr Jeff Yep, go ahead.
Speaker 4 (22:20):
I was going to say.
I can attest from that from myown experience too.
It is slightly alarming ifyou're used to providers not
asking you, hey, how's it going?
And getting to know you and Ithink it's you know it does make
you feel safe.
I think setting up that safespace and that safe foundation
you'll get to learn so muchabout what that person's going
(22:40):
through, and I think what youmentioned about it being mental
health and physical health gohand in hand I mean back and
forth.
And the only way you could kindof unpack and decide where
that's coming from or what theissue is if the abdominal pain
is an emotional pain is gettingto know that person, and I
definitely appreciate how youprovide that safe space as a
(23:03):
practitioner.
It's super important and it'sso crazy how different it feels
when someone asks you, evenstarting with how are you doing?
How was your day?
That?
Speaker 2 (23:13):
was a common practice and it's really shocking for
Jeff.
When somebody asks him hedoesn't even.
He's like huh what.
When somebody asks him abouthow are you doing, are you doing
okay and shows that kind ofcare for him.
Speaker 3 (23:29):
Yeah, that's been really super the last few weeks
that we've been working with noother provider but myself in the
office.
That's been a little bit of achallenge and my staff has been
very good about letting peopleknow you may have to wait a
little longer than normal.
You may have to wait a littlelonger than normal to get in
these things, so that patientsare understanding and then they
(23:52):
do ask me and you know I'mreally lucky to have patients
who we care about each othermore than just a okay, I'm here
to get my needs met and I'm outthe door kind of doctor-patient
relationship.
And that's one of the greatgifts I think of family medicine
is being able to have anongoing relationship with people
(24:13):
, is being able to have anongoing relationship with people
.
Speaker 2 (24:16):
Yeah, beautiful, I love that.
Thank you both so much.
Nisha, you talked about how youcreate behavioral support plans
for individuals withdisabilities.
Can you walk us through theprocess?
How do you go from assessmentto an actual plan that works?
Speaker 4 (24:38):
Yeah, that's a good question.
Most of the time it's as youknow.
We've been talking aboutalready getting to know the
individual.
It's spending a lot of time.
It's doing visits.
Before I even start a plan I'mlike what do they like, what do
they dislike, what do they enjoyto do?
For?
Like the very, very basics.
What do I know about theirfamily history?
What impacts them?
What have they told me hasimpacted them day to day and
(24:59):
makes it hard to do A, b, c, d.
So getting that foundation,that's my start of writing a
plan.
After that it's working on ateam.
What have we tried?
What are the behaviors going on?
So there's that, identifyingwhat's working, what's not
working.
The whole goal of the plan isto find proactive strategies to
prevent something that's notgoing great and find those
(25:21):
coping skills to throw in thereand help the individual work
through before it gets tosomething super, super negative.
Speaker 3 (25:30):
What are a couple of specific behaviors that you see
a lot that you have to work with.
Speaker 4 (25:36):
Absolutely so.
Right now, ones that I'm seeinga lot are property destruction
just due to not getting adesired meal.
So it's something it can besuper simple.
So, okay, they're punching ahole in the wall because they're
not getting their desired food.
What's really going on?
So I think you know at my jobwe spend a lot of time in teams.
(25:59):
Okay, what is this persontrying to communicate right
there?
What is their need?
Are they hungry?
Are they just bored?
Do they not like the staffthey're working with?
And we need to build morerapport in the home with that
staff.
That's a lot of again, pickingthe pieces and trying to learn
this individual and what worksand doesn't work.
(26:20):
And once we find that kind oflittle like green area or that
like area where they're in acalm state, we could practice
and see what works with copingskills.
So we're not going to jump into take a deep breath or let's
pause and do some mindfulnessskills.
I've already experienced we'renot doing that when they're
already throwing and punchingthings in the wall.
So what we want to do is findthings that work when everything
(26:43):
is fine and then build off ofthat and then also just looking
at the strengths Everyindividual I've worked with has
so many strengths.
I have individuals that arejust really strong readers, and
so they're going to read theskills to me and we're going to
practice it.
I'll model it, they'll model itback.
All of these things are what goin the plan, and it's kind of
(27:06):
almost like a guide andinstruction for the staff who
work with that individual 24seven on how can we help them
when things are getting tough,before it's at the red or at the
escalation point.
Speaker 3 (27:20):
So it sounds like that every individual's plan is
as individual as the individual.
Speaker 4 (27:27):
Absolutely, and that is the goal.
We want it to be strength-based.
We want it to be so specificthat if you write it without a
name on it, you know exactly who, which individual, we're
talking about, down to theirfavorite color, their favorite
food, who their support networkis, who they want to talk to
when things get tough.
Speaker 3 (27:47):
Well, that's interesting because it seems
like you could translate thoseskills into working with anyone,
really Absolutely.
I mean, they may not even havea developmental or other
disability, but just getting toknow another human being and
then using those skills to notnecessarily, I mean, I wouldn't
(28:11):
say to use it as a manipulationtool, but as a way to get to
know them and to be able toimprove your relationship with
them, not to be a chameleon forthem, but to be a person that
understands that individual.
Speaker 4 (28:28):
It's almost like an instruction guide on how to best
.
Speaker 3 (28:32):
How to win friends and influence people.
Speaker 2 (28:34):
Yeah, I love that and I really I love how you adjust
when something isn't working.
It's not like this is the planand it's going to fit for
everybody.
You find a very specific planthat works for each individual,
so go into.
What kinds of things would youlike to include to help with
(28:58):
that assessment?
Speaker 4 (28:59):
I would say like again their strengths,
behaviorally, just things theycan also do like skills they've
tried, that they've reallysucceeded in and so we can build
off of that.
It makes it a little bit easierto keep adding skills if we
know what worked and didn't work.
Instead of taking deep breaths,I'm not going to say, okay,
let's start again with take moredeep breaths.
Speaker 2 (29:20):
Yeah, let's just keep breathing.
All day, the more breaths theytake.
Speaker 4 (29:24):
Yeah, so I think you know communication style.
That's huge.
If someone likes more spacewhen they're upset, we want to
acknowledge and respect thatspace is really important.
Or if they need someone to sitwith them, next to them while
they're in a behavior and havinga hard time, but they don't
(29:44):
want that person to talk to them.
We're going to be noting thatand really the only way you
could get the information forthose pieces is spending time
with them, talking to people whospend time with them, their
family and anyone in theirsupport network.
Those pieces is spending timewith them, talking to people who
spend time with them, theirfamily and anyone in their
support network.
Speaker 3 (30:02):
But one of the things that I sorry for interrupting
you there, but one of the thingsthat I recognize about you,
nisha, is that you're fun, youhave high energy and you're
funny, okay yeah.
And so I wonder how you usethose strengths in communicating
with and being with thosepeople you're working with.
Speaker 4 (30:20):
I mean I try to stay positive as much as possible.
Speaker 2 (30:23):
She gets along with everyone.
Speaker 4 (30:25):
Not always, I try but also, you know, I have to
always remind myself, like wherethe individuals are.
They have staff 24-7.
It's got to be a lonelyexperience to not have as many,
maybe as many close friends andsupport.
That's not paid staff.
(30:45):
That always comes to my mind.
I'm walking into their home, myinteractions with them.
I mean, I am a paid staff too,so I want it to feel as like hey
, no, I'm actually here for you.
Speaker 3 (30:57):
And you're kind of there because you want to be too
.
Speaker 4 (30:59):
And I definitely want to be there and that shapes
like my mindset.
I always have to remember mymindset when I'm writing a plan,
when I'm visiting a client, anyof those situations, and that
keeps me positive.
I mean, just this week, oneactivity, activity.
I'm working with a gentlemanwho has been diagnosed with
(31:19):
autism and some otherdevelopmental disabilities and
one of his strengths is reading.
So we have these communicationlike what do you see going on
here?
What is the behavior on thiscard?
They're just communicationcards.
They have pictures going onhere.
What is the behavior on thiscard?
They're just communicationcards.
They have pictures and you getto guess what's going on in
there.
And he will read the cards,tell me a story based on what
(31:41):
their feelings are, and whatI've learned from this is that
he's super caring and thoughtful.
Like his first instinct is tothis person looks hurt.
I would ask them if they need afirst aid kit.
Like forgetting that, likethere's so much more to the
person than just the diagnosis.
Speaker 2 (31:57):
Um sure.
Speaker 4 (31:58):
That always keeps me in a positive mindset and that
you can have fun and joke, and Imean what.
I bring my personality to thehome.
I I try to be positive andfunny because, like, it brings
the same out of them and it's,it's enjoyable.
Speaker 2 (32:11):
Oh.
Speaker 3 (32:12):
I think that that's so important.
For sure, and you know just, Ican just imagine you know,
knowing you as we do that thatyou're just a breath of fresh
air when you walk in the door.
So I'm sure that you bring alight and a fun that many others
I mean other people bring otherstrengths, but I can just see
(32:33):
that as a light for you to cometo a person's care in a positive
way and I love that about you.
Speaker 4 (32:40):
Thank you.
I think it's a little differentin the crisis situations.
Maybe it's less bubbly, morepractical.
But I mean, when I have theopportunity to, why not be as
happy as you can be?
Why not bring?
Speaker 2 (32:55):
some joy in that moment.
Well, that energy is soimportant too.
You know you affect the roomand so if you bring in that
lightness and a little bit ofthat fun, even though you're
being very professional, youknow people feel that and they
just feel more at ease.
So I totally can see that.
Thank you so much.
Okay, so you work closely withcaregivers and staff.
(33:18):
What are the biggest mistakes,you see, when people try to
support someone with behavioralchallenges?
Speaker 4 (33:25):
I would say a huge piece is not not being
self-aware of how they arefeeling.
So when things get tough, whenthey're working a lot of shifts,
I think sometimes caregivers orstaff can really forget that
they need to be mindful of, like, what their needs are, so not
(33:47):
forgetting about their own needs.
Making sure they ate lunch yes,we're providing food and we're
spending time with ourindividuals, but did you eat
your own lunch?
How are you feeling when thisbehavior is happening?
Are you feeling frustrated?
It really changes the energy,as you mentioned, the energy in
the room.
If you're hungry, if you'refrustrated from the individual
on how they're talking to you,are you approaching this calmly?
(34:11):
I see a lot of staff getfrustrated and then they almost
get upset with, like, theindividual they're working with
and really the staff are theones that need kind of like the
same skills in a behavior plantaking that pause, learning what
works and doesn't work, findingyour strengths.
I think it's the same both ways.
Speaker 3 (34:30):
So you have to do your own work as a caregiver
before you can actually do agood job of caregiving?
Is that what you're saying?
Speaker 4 (34:36):
Absolutely, and I think that's for job related
caregiving, but even in your ownpersonal life caregiving, I
agree 2000%.
Speaker 2 (34:45):
Yes, when you're feeling that stress, to be able,
like you said, take that pause,separate yourself for just a
moment, so you can just kind ofget your wits about you once
again.
So, yeah, excellent.
Speaker 3 (34:59):
I should tell you a story that happened about 10, 15
years ago, I guess, where I letmy own feelings and stuff get
out of control in a patientenvironment when I was with a
patient, in a patientenvironment when I was with a
patient.
And now I can look back on itand say, yeah, I probably
(35:25):
behaved inappropriately, but Ifelt like I was justified at the
time.
But yeah, there was a gentlemanwho was seeing me for diabetes
and had been seeing me forseveral years and the one thing
I knew about him is that nomatter what I tried to provide
him, no matter what I said, hewould always do something else
and he wouldn't listen to myadvice.
He wouldn't do any dietcontrols, he barely ever took
(35:47):
the medicine that I prescribedfor him and his diabetic
laboratory work proved the factthat we were not getting
anywhere.
So he comes into me this lastday that I saw him and he told
me after I tried to get him tostart some insulin to get his
(36:08):
sugars under control, gonethrough all the education
regarding it, had peoplesupporting him with dietary and
other supports, and he said thathe went to the bar and he
talked to a guy at the bar whosaid if you drink a shot of
whiskey in the morning and ashot of whiskey at night, that
will take care of all yourdiabetic needs.
Speaker 2 (36:29):
Oh my gosh.
Speaker 3 (36:31):
And I lost it.
I just said no way, and that'swhat he'd been doing.
He actually took that advice.
So instead of taking the adviceof the doctor, he took the
advice of some bartender thatyou know all I need to do this.
Well, so it came down to thathe didn't like having diabetes,
(36:53):
he didn't want to have diabetes,and so he wanted to act like he
didn't.
And he thought if he just didthese other things, that it
would just take care of him andhe wouldn't have to worry about
it.
Well, I, I right then, andthere I just stopped him and I
said this relationship isn'tworking.
I don't like what you're doing.
I hate that you take the adviceof a bartender over your doctor
(37:15):
.
And so this will be our lastvisit.
And I just was furious at thisguy, oh wow, and I walked him
out the door and I sent him aletter.
Yep, he got fired and the sadpart is I took care of other
(37:36):
members of his family, and stilldo, but he didn't last long.
He died in just a few shortyears after that encounter.
It's because sometimes, as muchas I hate to admit it, we
actually do know more than someof these.
Speaker 2 (37:53):
Than bartenders.
Speaker 3 (37:54):
Than bartenders yes.
And so, and sometimes when Idon't know, it just hit a chord
in me that I can only imaginehow you, nisha, have got to keep
those things in check when youabsolutely know more, you
absolutely have understanding ofwhat's going on, and that the
(38:16):
client, the patient, justdoesn't know what they don't
know.
Speaker 2 (38:20):
Well, and I think it's got to be so impressive too
, when you've got a client thatis reacting really poorly, maybe
calling you names, throwingthings, I mean you have to learn
how to handle that in a waythat is respectful.
It's not about you, but it'sall about you.
I mean you feel it's being doneto you.
(38:42):
It's about the patient and justignoring those comments.
The bad behavior go back towhat the things in that you've
learned from the beginning andgoing back to those basics and
just being able to keep yourcool.
I think that that's just got tobe so impressive and it takes a
(39:03):
toll too, I'm sure, on you.
Speaker 4 (39:05):
I think for me, I do more of the behind the scenes
work, so I'm working with theindividual less than the support
staff, who are there 24 hours,and part of my role is doing the
teaching and training.
So the behavior plan is alsoalmost a teaching guide for the
staff on.
Hey, we've spent a lot of timewith this person.
We know a lot about them.
(39:26):
This is to help you really putinto perspective what this
person has for goals, what theirbehavioral concerns are and how
can we best help them withoutmaking things way worse.
And so I definitely agree,sometimes it is hard to put your
emotions in check.
For me, I find it more so whenit's teaching the staff.
(39:48):
If I'm like, hey, you guys arejust sitting on your phone, this
person.
Of course, if I were beingsupported by someone and they
were not engaging with me forthe whole day, I would have a
behavior too.
It doesn't feel good to beignored in your own home.
So part of my role, yeah, isspending time with the staff and
(40:09):
saying like, hey, can youempathize with this?
What would it feel like if youwere in this role?
Can you practice the breathingskill with them?
Is there some things?
And then I try to model it inthe home in hopes that they can
handle these big, big situationswith the skills that they have.
Speaker 2 (40:27):
Oh, I love that.
This is a great segue into mynext question.
This is talking aboutcommunication, so caregivers
often struggle to get through totheir loved ones.
What are some key communicationstrategies that work well for
individuals with developmentaldisabilities?
Speaker 4 (40:46):
That absolutely is a good question.
I think patience a huge pieceis being patient and not setting
an expectation that you'regoing to get the answer the way
you want the answer, and reallyjust honing in and sitting there
with your individual, with yourfamily member, and getting to
know them.
I think that is the key pieceover and over again Really
(41:10):
listen and figure out or listenwhat they're saying, what they
need, and I think that gives youa lot of answers.
Speaker 3 (41:19):
How do you help a person in that situation
understand the boundaries,though?
I mean.
You can't just let them getaway with every bad behavior
just because you're beingpatient.
Speaker 4 (41:32):
Oh, absolutely no.
I'm being patient with thelistening to learn about what
their needs are.
I think being comfortable andpracticing, setting healthy
boundaries are the boundariesthat need to be set.
I think it's hard to answerwithout, like, a specific
scenario in mind.
But yeah, I think the self-careis going to get you a long way
as a caregiver, a family member,being open to listening, not
(41:56):
just putting your ownexpectations on the individual
or family member.
I definitely see that a lot.
I want this person to get a joband go to school and where they
are developmentally with themental health things going on,
that's just not a reasonable orgoal, at least at that time it's
(42:18):
not an expectation that'srealizable.
Yeah, maybe not realizable atthat moment.
So I think, being mindful of,is this goal, or is the
communication that we arewanting from that individual or
person something because we wantit, or is this something that
can?
Is it reasonable?
(42:38):
Yeah, that's kind of what.
Speaker 2 (42:40):
I'm thinking about Okay, excellent, thank you.
Then I've got one more question, then we're going to ask our
listener question.
So how can medicalprofessionals, doctors,
therapists, caregivers workbetter together to create a
well-rounded support?
Speaker 4 (42:56):
system, I think.
Just again back tocommunication.
That's a huge piece.
At the job I work at, we meetregularly.
We have quarterly clinicalmeetings, we have check-ins, we
have documentation notes thatreally help us know what's going
on.
I think, being open tocollaborating with folks,
(43:19):
especially the medical providers.
So we're talking aboutbehavioral health, mental health
and physical health.
Those go hand in hand.
Sometimes, the physical healththere's an issue like a UTI or
something and it's causing abehavior.
So we can't just say, hey, thisbreathing skill doesn't work.
They might just have a medicalissue that needs to be addressed
.
So having everyone on the samepage, communicating, is really
(43:39):
helpful so we could rule out allthe different things that it
could be.
That's what, yeah, I would saythat's a big piece.
Speaker 2 (43:46):
Okay, Any thoughts?
Jeff yeah.
Speaker 3 (43:48):
It's something that I feel like when I'm working in
combination with a mental healthprofessional on patient care.
I really appreciate theinsights that the mental health
professional gives Because often, even though I try to get to
know the person, I can only doso much in 15 minutes, where a
(44:08):
person that is in a mentalhealth position often has longer
time that they're able to spendwith them.
So it helps me a lot ifsomething is going wrong, if a
medical issue is happening or ifthere's an adjustment in their
mental health medication that'snecessary.
It's so helpful to have thatinput and it helps me make
(44:29):
better choices and decisions forthat patient.
Speaker 4 (44:32):
I agree and I think it goes in all directions.
Having the medical input helpsthe mental health piece, because
we could say, okay, this is nota proactive skill, that's going
to be helpful because ofwhatever's happening medically,
but also even at the educationalor wherever job coaching level,
wherever that person is in life, having that communication and
(44:52):
being open to hey, this mightimpact, this is always going to
be helpful.
I really think.
Speaker 3 (44:59):
Well, and I think also you know if there's a
medication change, becausealmost universally in the
population that you're workingwith, they're on medication
Absolutely Okay, and themedication changes can make
abrupt and very dramatic changesin a person, whether they could
be good or bad.
(45:19):
And so understanding from aprovider of you know whoever's
prescribing the medication,helping know what you might
expect as a change or a positiveor negative thing, like this
particular drug might make yourclient very sleepy, or this
particular medication may make aperson wake up more or be
(45:40):
irritable, and so having thatunderstanding ahead of time is
going to be really helpful forthose who are in 24-7 care or
even if you're a family memberwho's watching their ADHD child
and change.
So, whatever the case may be,staying in good communication
(46:03):
with the and understanding howthe medications work is a really
helpful, important part, Iwould think things like sleep
(46:24):
habits, eating habits, timeswhen they're agitated, times
when they're focused and notfocused.
Speaker 4 (46:27):
Those are such helpful pieces of information to
give to your primary doctor andto share with other people who
are maybe adjusting medications.
Speaker 3 (46:33):
It's not only helpful , it's crucial.
Speaker 4 (46:35):
Yes.
Speaker 3 (46:36):
So I love what you just brought up there.
Very good, excellent.
Speaker 2 (46:39):
Thank you brought up there Very good, excellent,
thank you.
Okay, so we're going to go toour question.
We've received a powerfulquestion from Jodi, one of our
listeners, and this is what sheasks as someone with a family
(46:59):
member struggling with both adevelopmental disability and
anxiety, I often feel lost inhow to support them without
overwhelming myself.
What advice do you have forcaregivers trying to balance
their own well-being whileproviding the best support
possible?
Speaker 4 (47:13):
That is a wonderful question and I definitely hear
that often.
I think the most crucial pieceis setting those boundaries,
giving yourself time to haveyour own time self-care.
I don't know if there's reallyone fit all response to how to
(47:34):
fix that.
However, I think reallyconnecting with like support
groups, other family members orpeople who've been in similar
situations.
I can't tell you how importantit is to reach out to someone
who might be in the samesituation, because caregiver
burnout is huge.
It's such a big thing and itimpacts people's health so much.
(47:55):
I've seen it with caregivers inthe agency, but I've also just
seen people who have familymembers.
They take care of mental healthand physical health issues with
their family members and it's alot.
Speaker 3 (48:10):
In my situation.
I see so many.
You know it's like a husbandthat's caring for an Alzheimer's
wife or a parent that is theprimary caregiver of a disabled,
but not completely dependentchild.
You know where the child can dothings, you know, but what they
always have is 24-hour, sevendays a week on call, so they can
(48:37):
never sleep.
Speaker 2 (48:39):
We have a family member like that and they just
never, hardly get a break, andit's just exhausting for them
about the age of a three orfour-year-old at least 22.
Speaker 3 (49:07):
So he can do some things, but he likes to get up
in the middle of the night andcome into the parents' room and
get them up, and you know it's achallenge for them to get any
sleep at all, and so it's a verydifficult thing for them to get
the personal care they need,and especially the mom.
The dad often will sleep rightthrough when this happens, but
(49:30):
the mom is always up and takingcare of it, so she ends up not
sleeping well and has putherself in a high alert
situation all the time, so shebarely sleeps.
Speaker 4 (49:41):
Yeah, I think in those situations we see a lot of
caregivers feeling superisolated because of that Cause
it's 20, the job is 24, seven,almost like you don't really get
a break.
It might even be challenging toget that time to talk to
someone about it, because it'sall day, every day.
So I think those support groupsI know there's online support
(50:01):
groups that have been helpful tofolks, but also I see a lot of
times people who are caregiversfor loved ones or anyone with
mental health or physical health, just any kind of caregiver
rule that it's hard to see thesmall victories and the small
wins.
If you're with someone 24-7, itcan just feel like a job it
(50:22):
could feel really hard to take apause.
It could be really hard to seethat, okay, they're not doing
the whole task, but they did onething more than like.
Seeing the little little winsis really, really challenging, I
think when you're a caregiver.
Speaker 2 (50:37):
Is there much support for respite?
Speaker 4 (50:39):
care.
You know funding changes sooften with respite care I don't
know a lot are available.
I think a good start is lookingat DSHS, so Washington State's
Department of Health and HumanServices website, and looking
specifically at the needs.
So if it's disability, it wouldbe DDA.
I don't know a lot of respitesavailable.
(51:01):
Sometimes it's available foryouth 18 and under.
I see that more common.
We used to have respiteavailable for elderly.
I don't know what the status ofthat is, but I think a good
start is going to like statewebsites looking at the National
Association of Mental whateverNAMI is.
(51:22):
Hold on, I always forget thatN-A-M-I.
N-A-M-I.
That website has a lot ofcaregiver and mental health
information and talks aboutsupport groups that are local to
our area.
I know Facebook even placeslike Facebook have support
groups and so those are goodplaces to ask specific questions
.
Like I have a family membergoing through this, I'm feeling
(51:44):
overwhelmed.
What resources are there forrespite?
I know it changes so oftendepending on what the funding is
and where you're located.
Speaker 3 (51:53):
I can really see how a person in that situation could
feel so isolated, and they alsofeel like no one else can
provide the care this personneeds better than me or as good
as me but I think they also feelthat people don't care yeah,
yeah.
and so they get locked intotheir own cycle of of kind of
(52:19):
almost abusing themselves by notgetting the self-care that they
need.
And so I appreciate that youknow looking into those things,
recognizing that if you're inthat situation that you need
your own care, you need to beable to take care of yourself,
even if it's just taking a breakto go to the grocery store by
(52:41):
yourself or, you know, seekingout a friend that you haven't
chatted with for a while andspending time with them, and
recognizing that it's okay, evenif it's for an hour, to have
somebody else do something foryou.
Speaker 4 (52:57):
I agree Absolutely.
I think it's so easy to fall inthat pattern of feeling
hopeless and this is my life andthis is all it's going to be,
Instead of thinking what can Ido to give myself some self-care
and it's okay to take a breakfrom this role.
Speaker 2 (53:16):
Excellent.
This conversation has been sopowerful and I want to thank
Nisha Wright for being here withus and sharing her vast
knowledge, and for Jodi forsending in that great question.
But we're just getting started.
In part two, we'll be divinginto caregiver burnout,
self-care strategies andreal-life success stories that
(53:36):
highlight the transformativepower of behavioral
interventions.
Make sure you subscribe and youdon't want to miss this next
episode.
And if this episode spoke toyou, please share it with
someone who needs it.
If you have a question, pleasedon't forget to send it to
trishajamesoncoaching atgmailcom.
And until next time, take careand keep thriving wellness
warriors, and we'll see you nexttime.
(53:58):
Bye-bye everyone.
Speaker 3 (54:00):
Bye.
Speaker 2 (54:00):
Bye.
Speaker 1 (54:06):
Thanks for tuning in to the Q&A Files, delighted to
share today's gems of wisdomwith you.
Your questions light up ourshow, fueling the engaging
dialogues that make ourcommunity extra special.
Keep sending your questions totrishajamesoncoaching at
gmailcom.
Your curiosity is our compass.
Please hit subscribe, spreadthe word and let's grow the
circle of insight and communitytogether.
I'm Trisha Jameson, signing off.
(54:27):
Stay curious, keep thriving andkeep smiling, and I'll catch
you on the next episode.
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