FWM 2012 07

FamilyWorks Summer 2012

Helping Kids Communicate

Long Term Care: Quality-of-Life Insurance

Published by

Getting Your Teens to Turn the Page

Therapy & Life Skills Center familyworks.org

415-492-0720

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“Like us” on Summer 2012

3 Getting Your Teen to

Turn the Page

By Ginny Grimsley

4 Longtem Care:

Quality-of-Life Insurance

By Mary Jane DeWolf-Smith, PHN, MA, MFT,

6 Stop the Fighting:

10 Solutions to Sibling Rivalry

By Sharon Nolfi, M.A., MFT.

APPLE FamilyWorks 11 Parenting Programs 12 Therapy Programs

20 Talk to Your Teens About Acne

22 Perimenopause

14 Parenting Support and

Independent Living Skills

16 Helping Kids Communicate

By Melissa Chefec

How Do I Manage It?

by Stacy BischofF, RN, NP

In the Adult World

by Dottie DeHart

FamilyWorks Magazine is published by APPLE FamilyWorks® Executive Director: Mary Jane DeWolf-Smith Editor & Design: Lew Tremaine Copy Editors: Pat Saunders

Diana Wilkins Katherine Arnsbarger Website: Web Publisher: Art Severe Printed by: S.W. Offset

APPLE FamilyWorks® Board of Directors: Anjana Berde, President Mark Clark, Secretary Maria Villani, Treasurer Vicky Smirnoff Rita Trumbo

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APPLE FamilyWorks® 4 Joseph Court, San Rafael, CA 94903 email: familynews@familyworks.org Sponsorship Information: Doug Silberstein Phone: (415) 492-1022 FAX: (415) 492-1099 email: community@familyworks.org Editorial Information: Lew Tremaine Phone: (415) 492-0720 x231 FAX: (415) 492-1099 email: familynews@familyworks.org

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Content is the responsibility of FamilyWorks.

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Circulation: This major family magazine is published quarterly and widely distributed FREE throughout Marin and Sonoma Counties: through home deliveries, distribution to over 150 community locations - stores, public and private schools, medical offices, hospitals, and family-related businesses – and direct mail to thousands of active participants and sponsors of FamilyWorks®. © 2011 APPLE FamilyWorks®, All rights reserved. APPLE FamilyWorks is a nonprofit agency serving families in the Bay Area. No portion of FamilyWorks Magazine may be reproduced without written permission of the publisher. Appearance of articles, editorials, author’s point of view, advertisements or announcements for products and services in FamilyWorks Magazine does not necessarily constitute an endorsement by FamilyWorks® and FamilyWorks® is not responsible for its content or the reactions of readers to its content. FamilyWorks Magazine reserves the right to refuse advertising for any reason. Unsolicited manuscripts and photographs are welcome and should e-mailed to: familynews@familyworks.org.

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Getting Your Teen to Turn the Page

By Ginny Grimsley

Being able to read well is more important than ever for young adults to achieve economic success.

But more than 60 percent of middle and high school students score below “proficient” in reading achievement, according to a report by the Alliance for Excellent Education.

“Teen literacy is a huge problem in the United States – our 15-year-olds rank 14th among developed nations in reading – behind Poland, Estonia and Iceland,” says Rhiannon Paille, 27, an advocate for teen literacy whose new fantasy novel, Flame of Surrender (www.yafantasyauthor.com) targets young adults. (South Korea, Finland and Canada rank 1st, 2nd and 3rd.)

“Kids need strong reading skills if they hope to graduate from high school AND they really need to plan for college – 59 percent of U.S. jobs today require some post-secondary education, compared to 28 percent in 1973.”

Paille Offers these Suggestions:

• Buy them comic books. “Boys persistently lag behind girls in reading, according to the National Center for Educa-

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tion Statistics,” Paille says. “If your son isn’t a reader, try getting him hooked on comic books. Stephen King started off reading comics, ‘Tales From the Crypt.’

Hey, if it was good enough for him …! From comic books, they may move into graphic novels, a popular young adult genre. As long as they’re reading, they’re building comprehension skills and vocabulary, so it needn’t be ‘War and Peace’.”

• Look for book-to-film novels. Chances are, if it was a great movie, they saw it, and that’s often enough to get a non-reader curious. “This is another especially good hook for boys,” Paille says.

• Tune into what they’re interested in. What kinds of video games do they play? Gears of War? Even gaming guides, which players read to unlock new clues to advancing in the game, can motivate a teen to crack a book.

• Read the same book your teen is reading. Book clubs are popular because people like talking to others continued on page 9

The best thing parents can do to help boost their 12- to 18-year-olds’ literacy is to get them reading... anything.

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“Quality-of-Life” Insurance

by Mary Jane DeWolf-Smith, PHN, MFT

It was two AM Sunday. She was 83 years old. Like many her age, she couldn’t sleep. She went into the kitchen for a snack. On her way back to the bedroom she rounded a corner, holding onto the back of a chair for support. Oops! The chair went over and so did she - pulling the chair on top of her. Boom! She lay there on the floor in agony. Her upper arm had shattered. She remembered to push the button on her Lifeline Locket and help was summoned. Minutes later my phone rang.

My heart raced. I heard, “This is Lifeline calling. The paramedics are with your mother. She has fallen. They’ll be taking her to the hospital. She is conscious but they think her arm is broken.” I got dressed.

After over an hour drive across the Bay, I found my mother in Emergency waiting to be taken up to her room.

Her arm was wrapped in ace bandages. She was usually quite lucid, but the pain and morphine were blurring her speech and thoughts. She could not advocate for herself.

Luckily, I had a list of her medications, surgeries, allergies, and doctors in my purse. I made sure that her usual medications were ordered.

I was prepared because, unfortunately, this wasn’t the first time she had fallen. In fact her balance had become increasingly unsteady. She’d fallen once in a doctor’s parking lot, breaking her wrist, and twice in her bathroom with bad bruises and a concussion. Each time she had managed fairly well with an emergency room visit, an 4

Summer 2012

overnight hospital stay, and a long weekend at our home and then, as is so common for seniors, she insisted we take her back home to be alone.

This time was different. The arm required extensive surgery, a new shoulder joint, and ligament repairs. The general anesthesia was rough on her and the pain extensive. Two weeks in the hospital weakened her and she had mini post-operative strokes. She required another two weeks in a skilled nursing facility (SNF). And while at the SNF, she fell out of her wheelchair, ripping her arm out of the shoulder socket and tearing more ligaments.

Another surgery was scheduled and this time the repair was not successful. Now she could not raise her hand past her forehead. This was a permanent condition. She spent the next month in a skilled nursing facility. I visited after work each day.

A month after the accident we hired a home caregiver.

My mother protested loudly. We insisted. While she had “only” a broken arm, it was her right arm. She needed both arms to use her walker. Thus she could not walk alone, dress herself, fix meals, shower, or do laundry. Her mini-strokes had affected her balance and her macular degeneration had worsened.

We wanted her to stay with us while she recovered, but she did not want to leave her home. Her “things”, her friends, and her world were there. “Why don’t you just come live with me for awhile,” she said. Her memories

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of the skilled nursing facility (often called convalescent hospital) haunted her – the patients crying out (day and night), the smell of urine, the gruff and often unavailable staff, and the tasteless, lukewarm food. She made it clear that she NEVER wanted to be in any kind of facility again.

Finding the right caregiver was a big job. After many calls, I contracted with an Eldercare referral agency and began interviewing home health aides.

We found a good match and my mother could have her wish. The cost at that time was $5,000 per month. And yes, over the years she had several caregivers.

How could she afford this? Because before she turned 80, we insisted that she purchase Long-Term Care Insurance. We initially paid half the premium to persuade her to sign up for the insurance. Unfortunately, we didn’t prevail in our wish for her to choose the lifetime plan, but she did sign up for the ($150 /day plan for a total “pool of funds” of $110,000. and payment of the monthly Lifeline bill. ($38.) This was the best purchase ever made. Three years later she began using her insurance. Over time, she received $110,000 for only $9,000 in premiums. But the biggest bonus was that my mother was more content, more alert and better nourished than she had been prior to her fall.

My mother lived 10 more years, and because she managed at one point with part-time caregivers, three years of her care were free. It would have been great if the additional seven years had been covered as well. She often said, “ I only wish that I’d listened to you and enrolled in the lifetime plan.”

insurance is not available (e.g. Parkinson’s, Multiple Sclerosis, Cancer, Alzheimer’s, Dementia, Emphysema, Diabetes, etc.). With your younger mind, you can research and choose the best policy for your family.

Medicare Doesn’t Do It

After three days of acute hospital care Medicare will pay for up to 101 days in a skilled nursing facility- SNF. (Medicare will try to limit the stay to as few days as possible.) It does not cover homecare or retirement facilities care.

What about my health insurance?

Read your policy and find out how many days you are covered for post hospital/rehabilitation care. Generally there is a limit of 90 days or less.

Life Insurance Is Misnamed

Life insurance is death insurance – only collectable when you or your loved one dies. Long-Term Care Insurance is actually “quality of life

Mary Jane DeWolf-Smith is a licensed Marriage & Family Therapist specializing in couples, parenting and co-parenting concerns. She is a renowned family educator. Learn more great parenting skills in her Positive & Peaceful Parenting class. Call (415) 492-0720 to sign up or make an appointment for counseling services.

insurance” - for what will be the most vulnerable and expensive years of your or anyone’s life- the last five to ten years.

Assisted Living Facilities

Many facilities only provide services to those who can walk and care for themselves. Assisted Living services continued on page 8

Long Term Care Insurance is actually “Quality-of-Life insurance”.

Long-Term Care Tips Purchase As Soon As Possible

The earlier you purchase Long-Term Care Insurance, the lower the premiums. Once disabling conditions set in, familyworks.org

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Stop The Fighting!

10 Solutions to Sibling Rivalry

By Sharon Nolfi, M.A., MFT.

about particular issues are really about trying to win the exclusive love of one or both parents. It’s common and normal for a child to wish occasionally that his siblings simply didn’t exist. These feelings may be intensified in stepfamilies, because children feel they are competing with the stepparent as well as stepsiblings for parental attention.

You will never completely eliminate sibling squabbling. Your goals should be lessening its intensity and reducing its frequency. Follow these tips to increase peaceful coexistence in your family:

1 Many parents wonder why their children fight with each other. All of us are hurt and stressed by the level of nastiness that sometimes passes between brothers and sisters.

The good news is that you can reduce sibling rivalry by understanding its causes and addressing the issues it raises.

“Sibling rivalry” is the formal term psychologists use to describe the normal squabbles among children in the same family. Every child craves the individual attention of each parent, and each wants to be the child loved most by Mom and Dad. Children lack the mental maturity to understand that a parent’s love expands with the birth of each additional child so that each child is loved equally.

Each of your children views her siblings as rivals for first place in your affections. Many fights that seem to be

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Accept Your Child’s Negative Feelings

Accept that anger, envy, and even temporary hatred are normal and real feelings experienced between siblings. Respond to these outbursts by first acknowledging that you can understand how he could feel as he does, and that you accept it. You can suggest solutions after your child has calmed down.

2

Provide Alone Time With You

Spend some time completely alone with each child on a regular basis. Plan an activity for the just two of you, or just sit and snuggle. Whatever you do together, give that child your undivided attention and really listen to her.

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Give Recognition

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Plan Family Sharing

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Provide Special Spaces

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Stop Teasing

Be ready with praise for individual achievements. All family members should behave this way. Every child does something well, so celebrate even small accomplishments.

Have a designated time each day or week during which each child shares his successes and receives praise from other family members. Dinner is the traditional time for family sharing, but if individual schedules prevent this, set aside a regular meeting time when everyone is free, at least weekly. Teach you children to praise each other.

Many sibling disputes are “territorial,� as one child disturbs another’s belongings or enters his space. Every child, like every adult, needs a space exclusively his, no matter how small. Everyone should respect the room, corner or desk set aside for each family member.

Even well intentioned teasing can quickly turn into emotional abuse. Recognize that children can be deeply hurt by repeated teasing. Some people tease as a way of giving affection, but there are more direct and positive ways to show you care.

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Forbid All Types of Physical Aggression

Pushing, hitting, biting and other kinds of physical attacks are abuse and can quickly escalate into actual injury.

These behaviors have no place in a healthy family. Restrain yourself and make sure you employ non-physical solutions to disagreements.

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Discuss and agree on a consistent approach to sibling disputes. All strategies work better when both parents react to discord in the same way.

You will never eliminate sibling rivalry, but you can reduce its frequency and intensity. This benefits everyone in the family, now and in the future. Siblings will find it easier to forge strong long-term relationships that can continue into adulthood, and you will enjoy a more peaceful home.

Be A Good Role Model

Treat each family member with respect. Settle disputes with fairness. Your own behavior is the best teacher of all.

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Get the Other Parent On Board

Help Children Design Solutions

Show your children how to calmly settle differences on their own, keeping their focus on problem behaviors instead of personalities. Help them learn the skills of active listening and mutual compromise.

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You will never completely eliminate sibling squabbling.

Your goals should be lessening its intensity and reducing its frequency.

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Long Term Care Insurance continued from page 5

are often limited. Thoroughly research your options. What is the staff ratio?

(Homecare is 1:1. Most other settings are, at the very best, 1:6 or more.)

What are the credentials and training of staff? Can the resident have his or her own belongings? Must a room be shared? Find out the charges for the various levels of care. Consider safety, wheelchair accessibility, size of the room, and access to cooking. And, most important, with assisted living services, unless you have an ample suite, there is no one in the room/apartment 24 hours a day to protect from falls, encourage healthy nutrition, exercise, and recreation. Finally, do you want to move to an institutional setting at a skilled nursing facility when you or your loved one can no longer walk to the dining or care for themselves? Are additional services provided such as bathing, medication, etc.? And it is key to be prepared for the add-on charges for each type of assistance you require. (Charges would be for each medication administered (E.g. $50 per medication per month), bathing, housekeeping, assistance walking to the dining room, meals brought to your room, etc.) Plus, you may want to hire an aide to be in the assisted living space to avoid moving to a skilled nursing facility or in with a family member. This could add up to well over $10,000 per month.

Life-Care Facilities

In facilities with Life-Care, the occupant is moved from their Assisted Living Apartment/Room to a separate location where low level nursing services are provided. (Not IVs, wound

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care, etc.) They often are beds lined up and an LVN per six people. It is important to know how many skilled nursing spaces are set aside. Is there a waiting list? Is the setting pleasant and home-like or institutional? Is it onsite or are you moved to a SNF? The basic cost per month for Life-Care may be about over $8,000 per month.

Alzheimer and Dementia

Toward the end of life, most seniors have memory loss and reduced capacity to care for themselves. When Alzheimer disease or moderate dementia is involved, the senior needs round the clock care to stay safe and prevent getting lost. In most other ways, the seniors may be able to bathe, dress, and feed themselves, but they may become easily agitated, angry, and frightened. Nighttime waking and wandering is common. In these cases, it is essential to have someone sleeping near the person who can manage being awake at night. Hired help are paid to do this. Family members become overwhelmed and depressed when shifting into this role.

There are few facilities set up for Alzheimer and dementia care, and once again, the cost increases. You cannot get a long-term care insurance policy if you show signs of dementia.

If We Get Long Term Care Insurance, What Do We Look For?

First, research and make sure the company has assets to cover insurance payments. Take your time to decide on the policy that is right for you and yours.

Various Options:

• In-home, skilled nursing, and asfamilyworks.org

sisted living care.

• Discounts for second party insured (E.g. husband/wife).

• Termination of insurance premiums when the insured begins receiving payments.

• Inflation coverage (the daily coverage rate increases by a certain percent each year).

• Choice of waiting period (30, 60, 90,120 days) based on your assets/ savings.

• Daily benefit that matches current costs (currently $250/day or more).

• Specific documentation required from you in order to be reimbursed for costs.

• Clear definition of “activities of daily living” (ADL) that the elderly are unable to manage. (Common ADL’s are meal preparation, bathing, dressing, walking, and personal hygiene).

• Coverage when ONLY two ADL’s cannot be performed according to doctor’s certification.

• Minimum hours per day and days per week of needed care, in order to be covered. Four hours a day, five days a week can give you huge relief, but if coverage only comes with eight hours per day, seven days a week, you will have more care than you need and spend more of your pool of funds – unless you purchase a lifetime policy – which I recommend if you can manage it.

Ask questions. Your insurance broker should have completed specialized training in Long-Term Care Insurance and be able to offer you a choice of several different policies.

Many folks make the mistake of assuming that partners can take care of each other if one becomes incapacitated. Moving someone into and out of a wheelchair, bed, commode, bath, or shower is physically dangerous. Being trapped at home 24 hours

a day is mentally unhealthy. Missing a night’s sleep, night after night, can disable the helping family member.

If you are fortunate to have many family members close by willing to do shifts, you may not need Long-Term Care Insurance. Otherwise, if your parents are still living and eligible, encourage them to purchase LongTerm Care Insurance when you get your own. If your elders will not do so, get the family together and purchase it for them. Purchasing long-term care insurance is the best investment we can make for everyone’s mental,

physical and economic health.

I know from personal experience that it is terrifying to receive phone calls in the middle of the night to find that your parent is in danger. Going away for the weekend, let alone a vacation, is nerve racking. Few of us retire early today. Most households have two income families to handle basic costs plus those of the children’s education. It is rare for us to easily remove ourselves from work to care for our elderly parents. Imagine their frustration and yours to see every bit of savings, and/or your or your chil-

Getting Your Teen to Turn the Page continued from page 3

who’ve read the same book. Your teen may not be ready for an evening of petit fours and grape juice while discussing the pacing of “Hunger Games,” but it can make for some interesting conversation on the way to soccer practice.

And you can always nudge them along with comments like, “Oh, you haven’t gotten to that part yet? It’s really good!”

“People tend to think their young adults aren’t reading if they’re not reading novels,” Paille says. “But novels aren’t for everyone, and whether it’s a comic book or a gaming guide, all reading helps build comprehension skills and vocabulary.”

Good magazines, with shorter articles suited for distractible adolescents, might include Sports Illustrated, People, Seventeen or Mad magazines.

“When you’re out shopping, think about what they’re interested in and pick up something just for them. Sometimes,

dren’s inheritance drained in the last few years of their lives.

You and your parents have spent much time and many dollars investing in the early years of life. Now it is time to invest in the later years.

Protect your sanity, your memories, and your parents. When insurance is covering most of the costs, everyone feels comfortable and delighted to be providing and receiving the care they deserve.

it’s as simple as putting the right reading materials right into their hands.”

Rhiannon Paille is an active advocate for youth literacy and an avid reader of young adult novels.

Her first book, the non-fiction Integrated Intuition: A Comprehensive Guide to Psychic Development, remains a popular seller on amazon.com She’s married and the mother of two children.

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Tiburon San Anselmo • Ross

2012

Making a Difference At Bank of Marin you’ll bank with people who share your same values and commitment to the community.

We invite you to get to know us.

www.bankofmarin.com

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Member FDIC

Therapy and Life Skills Center ©

Positive & Peaceful Parenting Classes We invite you to join us in a fun and interactive class, in which innovative, practical and effective skills will be shared and learned to: ll • Increase cooperation • Receive respect & appreciation Ca • Get chores & homework completed • Enhance discipline & social skills • Enjoy time with your family • Be at peace & enjoy adult activities

Topics include: • Deciding your goals and principles • Listening completely • Turning opposition into cooperation • Taming “Dino Brain” behavior • Knowing abilities & Temperament • Using the “New Time Out” • Giving effective directions • Applying “When...Then” • Setting clear consequences • Creating charts & reinforcements

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on n-up

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or S

Four Tuesday evenings: July 24 - August 14, 2012, 6:30 - 8:30 pm

Sept. 18 - Oct 9, 2012, 6:30 - 8:30 pm

Refreshments, Parenting Manuals and Graduation Certificate Included

Child-Centered Co-Parenting Parents who are living apart learn to raise their children in harmony keep children “out of the middle”, while the children remain in each parent’s life. Parents attend separate classes and learn to: • Deal with each other respectfully • Increase cooperation • Design consequences that work • Make co-parenting decisions calmly • End rudeness & backtalk • Divide child-rearing tasks equitably Seven Tuesday evenings: • Manage constantly shifting Sept 18 - Oct. 30, 2012, 6:30-8:30 pm schedules July and August call for • Stop tantrums and dawdling private classes Refreshments, Parenting Manuals and Graduation Certificate Included

Exploring Motherhood Groups For Expectant & New Mothers (and infants birth to walking) meet every week from 10 to noon at a Marin Community Clinic NOVATO: Spanish speaking: Tuesdays SAN RAFAEL: Spanish speaking: Thursdays • Share experiences, ideas, and support • Learn about pregnancy and new parenthood • Learn how to increase infant health & happiness • Learn ways to manage change and decrease stress • Reduce anxiety and depression Mothers of Toddlers Group: Call for details.

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(415) 492-0720

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Therapy and Life Skills Center FamilyWorks Integrative Therapy® (FIT)

“I hear and I forget.

I see and I remember.

I do and I understand”

Ancient Proverb

FamilyWorks Integrative Therapy® (FIT) has been developed over three decades to help you and your family reach your life goals.

FamilyWorks trained therapist*, utilizing interviews and assessment tools, will guide you to establish your goals, identify your individual strengths, and note patterns, thoughts, and behaviors, which may be causing discomfort and frustration.

Your therapist will meet with you, your partner or family members in our specially designed FIT suites as you learn and/ or practice time-tested and effective skills.

You will benefit from choices of many therapeutic approaches, including state of the art technology, such as the emWave® biofeedback stress relief system, one-way mirror sessions with audio-visual feedback, and DVDs, to track and celebrate positive emotional and behavioral change. You will also benefit from easy to implement written materials to reinforce skills at work, play and home. *Therapists are FamilyWorks Positive and Peaceful Parenting© as well as Child-Centered CoParenting© practitioners. Triple P® materials are also available.

familyworks.org (415) 492-0720 12

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Therapy and Life Skills Center APPLE FamilyWorks is here to help you to reach your goals and to find peace, harmony and joy within yourself, with partner, friends, co-workers, children, and family. We are here for you to make a positive difference in your life.

We welcome you to join us in: • Resolving conflicts • Overcoming depression • Managing grief & loss • Enhancing social skills • Insuring mutual respect

• Dealing with anxiety • Managing ADHD & ODD • Improving intimacy • Overcoming addictions • Coping with separation & divorce

• Coping with transitions • Managing anger • Regulating emotions

• Enhancing Co-Parenting • Reducing domestic violence

Adult and Family Therapy Individuals, couples or families identify their concerns, hopes and dreams, and learn practical and effective relationship tools.

Therapeutic approaches include talk therapy, family sculpting, psychodynamic, person-centered, humanistic, narrative, dialectical behavior therapy, AEDP, EFT and FIT . The result is reduced stress and conflict with increased understanding, empathy, and cooperation.

Child and Teen Therapy APPLE FamilyWorks’ skilled therapists work with children and adolescents to support their journey through childhood and into adulthood. Therapeutic approaches are chosen which best match parent-child goals, including expressive arts, sand play, music, movement, and other interactive activities. Children and teens find new ways to resolve problems, develop healthy life skills, increase emotional wellbeing, build greater self-esteem and enhance social skills in ways that support their healthy growth and development.

Home-visits, school observations and IEP assistance is available.

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(415) 492-0720

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Therapy and Life Skills Center Support for Individuals with Developmental Disabilities

Parenting Support Services • Parenting and co-parenting • Childbirth education • Child development and family planning • Behavior management and stress reduction • Early intervention in postpartum depression • Positive and peaceful discipline

• Injury prevention, nutrition, and exercise • Household management, and transportation • Financial management and budgeting • Development of social support systems • Linkage with others services

Independent Living Skills • Academic growth

• Housekeeping

• Behavior management

• Transportation skills

• Stress Reduction skills

• Community access

• Injury prevention

• Employment readiness

• Nutrition

• Financial management and budgeting

• Health promotion and exercise • Hygiene and self-care

• Development of social support Systems Serving eleven greater Bay Area Counties

CPR & First Aid Classes Saturday: July 21, 2012 CPR - 9:30 AM to 1:00 PM First Aid - 1:15 to 4 PM

Learn infant, child and adult choke-saving and CPR and how to apply these skills in emergencies. You will have hands-on practice, receive a CPR skill book and a National Safety Council Certification upon completion.

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Summer 2012

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Summer 2012

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Helping Kids Communicate in the Adult World

By Dottie DeHart

Like many skills, the ability to meaningfully and productively communicate takes practice.

Maribeth Kuzmeski tells parents how they can organically teach their kids to connect with others—so that when they do become teens they can do more than shrug, grunt, and send another text.

Teens and technology – these days they’re as inseparable as toddlers and their teddy bears. When your teens (and, increasingly, tweens) aren’t updating their Facebook pages they’re probably texting friends or blaring music through mp3 players. And here’s the irony: Today’s young people are more “connected” than any other generation in history, but they have a general inability to, well, connect. In fact, says Maribeth Kuzmeski, many can barely carry on the most basic conversations and have trouble articulating what they want or need.

“I’m not saying the digital world is the reason why young people struggle to function in the real one,” says Kuzmeski, author of the new book, The Engaging Child: Raising Children to Speak, Write, and Have Relationship Skills Beyond Technology. “At least it’s not the only one. It’s more like a crutch.

Because technology is so pervasive, teens use it as a substitute for real conversations. And so they don’t hone those critical skills. “The ability to engage and collaborate with others in a meaningful way is critical in a global society,” she adds. “So when young people don’t learn how, they really do hurt their chances for a successful life.”

Learning to engage and connect, of course, begins long before the teen years.

Kids learn by doing. And just as we must push kids to clean their rooms and do their homework, it’s up to us as parents to encourage them to interact with others in persuasive, polite, and engaging ways.

Technology is only part of the problem, Kuzmeski points out. The other part is that we tend to do things for our kids that we need to be teaching them to do for themselves. We set up their dental appointments, for example.

We place their orders in restaurants. We talk to their teachers. We do these things because we’ve always done them—and in the process we squander what could be rich learning opportunities. “The truth is, parents just don’t think about turning these tasks over to their kids,” says Kuzmeski. “It’s never occurred to them. But when they step back and let kids manage these kinds of everyday situations—and provide plenty of coaching along the way—they’re surprised by how quickly they begin to blossom.”

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Have Them Place a Restaurant Order.

If you’re like many parents you’re eager to hurry things along in restaurants so you get in the habit of ordering for the whole family. The next time you’re dining out, though, use it as an opportunity for your child to interact with the server in a way that gets results. Instruct him to order his own meal, complete with requests to hold the pickles or bring extra ketchup or ranch for the fries. You can also prompt your child to thank the waitress when his meal is delivered and encourage him to engage with her in positive ways when she checks in throughout the meal.

“This is a good chance for your child to see firsthand which words and even which tone get results,” Kuzmeski explains. “During this type of interaction, kids learn to manage and impart several specific, personalized details.

Be sure to explain to them how much more smoothly all transactions go when you, the customer, are clear and accurate. You can also point out that you get better treatment—more attentive service and maybe even free dessert—when you are polite and respectful as opposed to demanding or rude.”

Help Them Return an Item to a Store, Especially at a Busy Time.

At some point, your child is going to receive a birthday gift she already owns, a sweater from Aunt Grace that might have fit her two years ago, or a toy that’s damaged or missing a part. When you make the trip to the customer service desk, be sure to bring your daughter along. Ask her to explain why she is returning the item and to specify whether she’d like an exchange, cash, or store credit. And (as always) remind her to use “please” and “thank you.”

“Dealing with long lines, hassled employees, and confusing return policies can be a challenge even for adults!” continued on page 18 familyworks.org

Small Talk Made Simple Small talk is an important skill for any connector to master, regardless of age.

From the check-out line at the grocery store to the person sitting next to you on a flight, you just never know which connection can result in something big or wonderful. When you look at it that way, every connection you don’t make is a potential opportunity missed, so engaging meaningfully is a skill that’s best learned early. Five strategies your kids can use to connect with people in any scenario: • Share Something Extra About Themselves. When adults meet a new child, they’ll often ask easy-to-answer stock questions like, “What’s your name? How old are you?” In addition to providing the “bare bones” answer, help your children think of something extra they can offer.

For instance, your son might say, “Hi, I’m Billy. I’m five years old and I love to play baseball!” Voilà! What might have been a standard teeth-pulling session has just been transformed into a bona fide conversation.

• Be Complimentary. Whether you’re seven or seventy-seven, a compliment is always a great way to break the conversational ice. To get started, teach your kids to comment on something interesting the other person is wearing.

For example, “I love that necklace you’re wearing. It’s so pretty!” Or, “Wow, your shirt is my very favorite color.”

• Talk About the Weather. Sure, commenting on the weather has a rather “blah” reputation, but the fact is, it works, and it’s a great way to ease into a conversation with someone you don’t know very well. Teach kids to pay attention to their surroundings so they can comment on them during small talk. For example, “Have you been enjoying the nice weather?” Or, continued on page 19 Summer 2012

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Kids Communicating continued from page 17

Kuzmeski admits. “Having your child take the lead might take a bit more time, but it’ll be an invaluable lesson to her in negotiating using what she knows (the store’s return policy) for the outcome she wants (like a sweater that fits). Especially if the customer service rep is frazzled or if your child is in the wrong (for example, she lost the receipt), she’ll be able to see firsthand that politeness and understanding can—sometimes—smooth things over. Also, seeing positive results will teach her that it’s worth the effort to correct a problem rather than just ‘letting it go’ and absorbing the financial loss.”

Ask Them to Set Up an Appointment.

Whenever he needs to visit the doctor, dentist, or hairstylist (or even when your dog needs to go to the vet!), ask him to call and book the appointment. Instruct him to be as detailed as possible when requesting a visit time, and help him to look at the calendar before confirming to make sure there’s not a conflict.

“Making his own appointments will help your child fine-tune his phone etiquette and ability to pay attention to details,” Kuzmeski points out. “He’ll also learn to make decisions and navigate his own schedule while working with someone else’s. As he gets older, you can

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begin to let him request specific services, relay insurance information, and more. Lastly, if you need to cancel an appointment for any reason, allow your child to make the call and reschedule. The lessons he learns about time management and dealing with uncomfortable conversations will be invaluable well into adulthood.”

Help Them to Decline Invitations.

Between friends’ birthday parties, cousins’ graduation celebrations, classmates’ bar mitzvahs, and more, your child is going to be invited to events that she is unable to attend. Once she has looked at the calendar and seen that she’s already busy (or in a more extreme instance, you’ve looked at plane tickets and decided they’re too expensive), go over polite refusals with her so that she knows what to say. Then ask her to call the event’s host and explain why she can’t attend.

“Even in adulthood, it can be difficult to say no, even when it’s in our best interests,” says Kuzmeski. “It’s uncomfortable to disappoint people. That’s why we so often ‘cop out’ and send an email or just don’t show up. We may even make up a reason we can’t go to spare people’s feelings. It’s smart to teach your kids early how to say no, and to do it without softening the blow with a lie. By learning to politely decline requests when they’re young, your kids will be more fully in control of their lives. Plus, by seeing the world didn’t come to an end when

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they said no, they’ll learn to tell the truth.”

Equip Them to Converse with a Stranger.

Most youngsters are very comfortable “LOLing,” “BRBing,” and “TTYLing.” But when it’s time to have a good old-fashioned verbal conversation, especially with someone they don’t know well, many kids tend to clam up. Whether your child is a chatterbox at home or not, opening up to strangers (in your presence, of course!) can be quite intimidating. The next time your family is in a larger-scale social setting (like a holiday party, family reunion, or worship service), give him a few ideas of how he can strike up a discussion with people he doesn’t see every day.

“Even before the days of smartphones and Facebook, it was completely normal for youngsters to feel reluctant to approach older adults,” Kuzmeski points out. “You’ll be doing your kids a big favor if you arm them with icebreakers that they can use to proactively connect. Before social events, discuss what some good topics of discussion might be and help them to make a list of strategies for drumming up conversation.

They’ll also be able to power through any awkward lulls in conversation that might otherwise discourage them from taking the connecting initiative in the future. And they might also find a new friend or mentor!”

At some point between kindergarten and high school graduation, most children will be asked to participate in fundraising. Whether she is selling cookies for her Girl Scout troop, magazine subscriptions to raise money for a band trip, or coupon books for her school, require that your child do all of the selling herself.

Instead of taking her catalogue and order forms to work, let her come to the office—if only for thirty minutes during lunch—and make her pitch

in person. You can also prompt her to approach people she knows at church and in your neighborhood, and to phone friends and relatives.

“I think that many parents avoid door-to-door fundraising in particular because they don’t want to annoy the neighbors or put them on the spot,” Kuzmeski points out. “No, it’s not my idea of an ideal Saturday either, but taking an hour to help your child fundraise is worth it. It’s a great coaching session. She’ll learn a lot about how to persuade others to help her, as well as build her confidence, assertiveness, and general conversation skills. She’ll learn how to accept ‘no’ gracefully. And she’ll feel a huge sense of accomplishment when her order form is full.”

By the way, if your child is already a teen, don’t worry that he or she is a lost cause. While many of Kuzmeski’s tips are aimed at younger children, others are appropriate for teens as well—or easily adapted for them.

“Teens can take the lead in planning and hosting their own parties,” says Kuzmeski. “They can pet sit and babysit for friends and neighbors. You can even conduct mock interviews with them to prepare for future jobs, and suggest that they work part-time in the summer if they’re old enough. All of these activities—and many more— will accustom them to interacting and collaborating effectively.

“Regardless of your child’s age, making these connections might not be easy at first,” she adds. “Depending on your kids’ ages and personalities, they may balk at being asked to get into the proverbial driver’s seat (and in fact, that might be one reason you’ve always spoken for them!). But be insistent and consistent. Your children’s comfort levels will increase, and especially as they begin to experience positive connecting outcomes, they’ll become more and more proactive.” familyworks.org

Small Talk continued from page 17

“I hope it doesn’t rain next week, because my Girl Scout troop is supposed to march in the parade.”

• Find Things in Common. If you can find a common interest with the person to whom you’re speaking, small talk can turn from mediocre to meaningful in an instant.

Teach your kids to be aware of conversational and external cues. If your daughter notices that someone is wearing a Braves’ jersey and she’s also a fan, she can strike up a conversation about the latest game. Or if your son hears someone say that s/he’s from Columbus, Ohio, he might say, “My grandparents live near Columbus. Don’t you love the zoo there?” (Hint: If you are going into a situation and think of some common interests ahead of time, go ahead and arm your kids with them!)

• Wrap It Up Well. One of the trickiest parts of small talk is the conclusion.

Give kids a few lines they can use to wrap up a conversation before it veers into awkward silence. “It was great to meet you. I hope to see you again soon!

Have a nice vacation!”

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Talk to Your Teens About Acne

By Melissa Chefec

While there have been big advances in the way we treat teenage acne in the past few years, there is no single approach that works for every patient. For the best results, dermatologists need to match the treatment to the teen. According to Dr. Valerie Goldburt, a leading expert on teen acne and dermatologist at Advanced Dermatology and its Center for Laser and Cosmetic Surgery, there’s more to finding the best treatment than just examining the patient’s pimples: “If you want to see results, you need to consider a teen’s active lifestyle,” she says. Despite the fact that today’s therapies can effectively treat the problem, patient compliance is often as important as the therapies themselves.

Acne often causes serious social, emotional, and psychological problems, she adds, and its symptoms can vary dramatically with age, heredity, habits, and beliefs. “Lots of teens have misconceptions about the causes of acne and unrealistic treatment expectations. They often have trouble incorporating the treatment into their daily lives or sticking with it long-term after they start to see results. Doctors and patients need to discuss the patient’s lifestyle, family history, and habits, as well as his or her expectations-and then decide together which medicines are best,” she explains.

Acne Explained

“Although acne is hardly something new – the ancient Greeks and Egyptians were battling pimples, and practically every teenager today has them – the exact cause of acne remains unknown,” Dr. Goldburt says. It is caused by several related factors, including the rise in male sex hormones that occurs in all adolescents, which sends the sebaceous (oil) glands into overdrive. Another important factor is heredity: Most pimply teens have one (or two) parents with their own history of acne. There are also several other factors that are typical for most teens: Psychological stress, cosmetics (too much or inappropriate makeup), pres-

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sure from a sports helmet or uniform, exposure to oil in the air (think of the fry vats at most fast-food places), and overly zealous scrubbing. Additionally, there is new evidence that suggests processed foods with a high glycemic index may promote break outs. Dairy foods have also been implicated as a cause of acne, but further research to confirm this preliminary finding is required.

Treatment Options for Teens

Dermatologists most often recommend topical medications for teens with acne. The most common nonprescription options are benzoyl peroxide, mild acids like salicylic acid, and sulfur-based products. Prescriptionstrength topical medications include topical antibiotics,

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sulfer based products and retinoids (derivatives of Vitamin A) such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac). All of these medicines are available as gels, lotions, creams, soaps, liquids, and pads. They require compliance, meaning the teen needs to be consistent in using them. Dr. Goldburt says, “I always ask teenagers, if I prescribe a topical medicine, will you use it?

Half the time, the answer is no.”

She believes that, especially among the young male population, there is a stigma associated with cream use.

“Liquid soaps are sometimes a better topical choice, because the soaps can be used in the shower, where there is already an activity in progress.”

Be Patient Additionally, many a teen has heard their dermatologist tell them that sometimes things get worse before they get better. “That’s because the medications speed up the life cycle of all the pimples, including the little baby pimples that would have taken a lot longer to come to a head without medicine.” Also, topical acne

medicines can easily be over-used, especially by teenagers who follow the more-is-better mantra, because they are often desperate to get an instant clear complexion. Most acne medications need to be used in small amounts so this approach can cause side effects like dryness, irritation, burning, or redness. This will force patients to stop using the medications before they’ve had a chance to work.

Some medications may interact with the sun. Dr. Goldburt recommends that the dermatologist needs to talk with the patient about ways to minimize and manage the side effects.

Stronger options include prescription oral medications: antibiotics, isotretinoin (Sotret, Claravis, Amnesteem, formerly sold as Accutane), and hormonal therapy (birth control pills and spironolactone). These pills could interact with medication or birth control pills, so care must be taken. As with any pill, these drugs need to be taken as prescribed, meaning a teen who is less-than perfect at sticking to a schedule may not do very well on them. However, many teenagers prefer pills to creams, since there is a perception that they are easier to use. Frequently, the teen who won’t use topical medications will be extremely compliant with oral medicines. Occasionally, Dr. Goldburt comes across a teen who hasn’t learned how to swallow pills. “Most pills are smaller than the bites we take out of food, so there’s definitely a psychological barrier. You can get practice with tic tacs, and once you swallow those little pills, you realize familyworks.org

the other pills are only slightly bigger and go down easily with some water.”

She recommends teenagers discuss how to take pills properly with their dermatologist.

In addition, dermatologists can use in-office procedures such as laser or light therapy, acne surgery and corticosteroid injections for large or painful pimples and to permanently fix the acne scarring. These procedures don’t require compliance (with the exception of making it to the appointments), and as a result are usually a good option for teen patients.

Reduce Stress

Dr. Goldburt says “In many cases, adolescent acne goes hand-in-hand with psychological issues. Research shows that psychological stress can definitely exacerbate acne, and numerous other studies have shown that having acne can create or worsen depression and social anxiety. Whichever way you look at it, being depressed or anxious can significantly affect your compliance with a treatment plan. It might be better to bite the bullet and pull out the ‘big guns’ to treat acne in these patients. The stronger medicines can lead to more dramatic results, which create big improvements in the patient’s emotional well-being and complexion.”

About Dr. Goldburt: Valerie Goldburt, MD, PhD, is board-certified in dermatology and a fellow of the American Academy of Dermatology.

She is an authority on dermatology, with expertise in cosmetic and surgical procedures. She is a Clinical Assistant Professor at NYU Langone Medical Center and practices with Advanced Dermatology, P.C., Center for Laser and Cosmetic Surgery, www. advanceddermatologypc.com.

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Perimenopause How Do I Manage It?

by Stacy Bischoff, RN, NP

This article is addressed to women who are between the ages of 35 and 50. Men who are in relationship with these women might want to read this as well so they can begin to understand, together, what is going on with her physical and emotional well being.

Sometime between the ages of 35 to 45, women may begin to experience irregular menstrual cycles.

This can impact changes such as sleep, energy, mood swings, depression, weight gain, decline of libido, hot flashes, breast tenderness, heavier bleeding with her period or irregular periods. Also, her children may be entering high school or college representing a huge change in what has been possibly her main focus.

How can these women be helped? First it is important to understand that the various hormones produced in our bodies are the key, along with nutrition, emotional support, exercise and ideally a good relationship with her partner.

Here are some tips for relieving some of these unwanted symptoms:

Irregular Periods

An herb called Chaste tree is helpful + vitamins B6, C, E and zinc; birth control pills or small doses or bioidentical progesterone, oral or under the tongue (sublingual)

Heavy Bleeding

Acupuncture, drink some cinnamon tea, add soy, nuts, seeds and vegetables to your diet + vitamins A, B, C and zinc.

Breast Tenderness

Organic eggs, kelp, stop caffeine, B vitamins, Omega 3 fish oils twice daily, (1 to 2 grams); wear a soft bra to bed

Flushing/Night Sweats

Stop caffeine, sugar, smoking; improved diet of greens, lean protein and fruits such as blueberries and citrus; add teas such as black cohosh, chaste tree, dong quai and maca; meditation techniques are helpful, and slow deep abdominal breathing.

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Vaginal Dryness

Topical estrogen cream or suppositories of Vitamin E may be helpful.

Sleep

It’s important to try to go to sleep at the same time each night. Do not do strenuous exercise before bed. A soothing bath, herbal tea like cammomile is restful. If

awakening, keep Lavender oil by your bed and sniff if to help return to sleep.

As a Nurse Practitioner who focuses on Integrative medicine, I recommend a saliva panel for women in this period of life. There are various choices depending on each person’s symptoms or issues. Women who are fatigued, an Adrenal Panel would be indicated but if she has irregular cycles and many symptoms, a hormonal

panel done over her cycle is the better test. Blood test may be indicated as well.

I also prescribe bio-identical hormone therapy at the lowest dose possible to correct the symptoms as a treatment option.

Stacy Bischoff, RN, NP can be reached at 415-492-WELL (9355). Her offices are at 880 Las Gallinas Ave., Suite 1, San Rafael, CA. 94903.

Film Night in the Park 2012 A Project of

An Outdoor Summer Film Festival ACROSS THE UNIVERSE Friday, July 13 · San Anselmo FIRE ON THE TRACK - The Steve Prefontaine Story Friday, July 20 · San Anselmo THE HELP Saturday, July 21 · San Anselmo RATATOUILLE Friday, August 3 · Hal Brown Park at Creekside, Greenbrae THE ARTIST Friday, August 10 - San Anselmo THE MUPPETS MOVIE Saturday, August 11 · San Anselmo SURF N TURF Friday, August 17 · San Anselmo KUNG FU PANDA II Saturday, August 18 · San Anselmo MAMMA MIA Friday, September 7 - Mill Valley THE ADVENTURES OF TINTIN Saturday, September 8 · San Rafael (China Camp) MISSION IMPOSSIBLE: GHOST PROTOCOL Friday, September 21 · San Anselmo HUGO Saturday, September 22 · San Anselmo SPELLBOUND Friday, September 28 · San Anselmo HARRY POTTER AND THE DEATHLY HALLOWS PT. II Saturday, September 29 · San Anselmo THE HUNGER GAMES Friday, October 5 · San Anselmo WILLY WONKA Saturday, October 6 · San Anselmo familyworks.org

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