Pacific Pulse September 2013

Pacific Pulse Pacific Pulse Official Publication of U.S. Naval Hospital Guam Vol. 1 Issue 2 Surgeon General of the Navy Chief, BUMED Vice Adm. Matthew L. Nathan Interim Deputy Surgeon General Interim Vice Deputy Chief, BUMED Rear Adm. Donal R. Gintzig Force Master Chief FORCM (SS/SW/FMF) Sherman E. Boss Commanding Officer Naval Hospital Guam Capt. Jeff Plummer Executive Officer Naval Hospital Guam Capt. Mike McGinnis Command Master Chief Naval Hospital Guam Robert Burton Public Affairs Officer Jennifer M. Zingalie-Goulart jennifer.zingalie@med.navy.mil

Pacific Pulse is a professional publication of U.S. Naval Hospital Guam. It’s purpose is to educate readers on hospital missions and programs. This publication will also draw upon the medical departments rich historical legacy to instill a sense of pride and professionalism among the Navy Medical Department community and to enhance reader awareness of the increasing relevance of Navy Medicine in and for our nation’s defense.

The opinions and assertations herein are the personal views of the authors and do not neccessarily reflect the official views of the U.S. Government, Department of Defense, or the Department of the Navy.

Guidelines for Submissions: This publication is electronically published monthly. Please contact Jennifer Zingalie at jennifer.zingalie@med.navy.mil for deadline of present issue.

Submission requirements: Articles should be between 300 to 1000 words and present the active voice.

Photos should be a minimum of 300 dpi (action shots preferred) NO BADGES Subjects considered: Feature articles (shipmates and civilians) Quality of Care R&D/Innovations Missions/Significant Events Community Outreach

Content Inside this Issue: 6. Volunteer: Marciar Calnun 8. Sailor Spotlight: Sorrentini 10. Mental Health Department 12. Substance Use 14. Care for the Caregiver 17. Self Harm and Adolescents 18. Suicide Prevention 20. Provider Profile: Mahony 22. The Graduate: Traylor 26.Individual Stress Mangement Plan printout

On the cover:

September is Suicide Prevention Awareness Month. The Military Health System has an important role to play in educating the military community and the civilian communities where we live, on how to recognize the signs of suicide risk, where to access care and treatment, and how to intervene. -The National Suicide Prevention Hotline (1-800-273-TALK), www.militaryonesource. com. Suicide prevention will be a prolonged effort.

Awareness and perseverance matter. We can do more, and we are doing more to strengthen our team. To be better prepared, check out our suicide prevention awareness information and resources at Health.mil.

On the Web:

Thank you for taking the time to rate and provide us with your comments and suggestions.

ICE

http://ice.disa.mil/index.cfm?fa=site&site_id=169&dep=DoD

http://www.med.navy.mil/sites/usnhguam/Pages/default.aspx

Commanding Officer

Capt. Jeff Plummer

Readiness

Whenever I think of September, I think of fall weather and the color change

(ok, maybe not so much in Guam), kids going back to school, football season, end of the fiscal year and the slide to our holiday season. After making it through our summer PCS season, I’d like to personally thank all the backfill reservists and TAD support personnel who worked with us side-by-side to help keep our mission on its successful track. A big thank you also goes out to all the in-house staff who may have had to work extra hard or pull extra shifts during summer gapped coverage. Thankfully, the DoD furlough program came to an end, but not without affecting our dedicated civilian staff as they experienced 6 days of furlough from work. We are glad you’re back to full status, and on behalf of the military staff we thank you for your dedication to our command.

As we welcome and orient those new staff members who arrived this summer, we should also take the opportunity to renew ourselves. During the next few weeks a Franklin Covey training team will be aboard to provide valuable, in-house leadership training. Also, we’ll set aside an afternoon for our annual command picnic, where we can blow off some steam and have some fun. This is also a good time to make holiday travel plans if you’re able to do so. Or, maybe you’ll plan a stay-cation on Guam, and get that dive certification done or hike that boney stomp you’ve always talked about doing.

September can be a time to renew at work, as we close out the fiscal and prepare to close out our calendar year. It’s a good time to think about goals you may have set for yourself at the beginning of the year. How are you doing? Are you on track to accomplish your personal goals or your team’s goals? Do you need any help with that; who can

you go to? Leaders in your chain of command, command mentors, or even your shipmates are good places to “check-in” on your personal and team goals.

Sometimes, goal accomplishment is as simple as getting organized. These days, because of smart phones, chat rooms, FaceBook and Twitter, life comes at us with the speed of a click. We blow right through endless weeks of multitasking. However, “monotasking” may be the new multitasking - which could help you organize, simplify and focus on the right things. Learn more on monotasking from an article on my August Twitter feed: http://fst.co/wGKKF07 .

Lastly, I’d like to take a minute to thank our command Ombudsmen. The Ombudsman Program was introduced to the U.S. Navy on Sept.

14, 1970 by then-Chief of Naval Operations Adm. Elmo Zumwalt. In Z-gram 24, Zumwalt adapted his program from a 19th century Scandinavian custom originally established by the king to give ordinary private citizens an avenue to express their concerns to government officials. Zumwalt recognized issues and concerns that are unique to Navy families.

Ombudsmen are professionally trained information and referral volunteers who serve as a vital two-way communication link between the command and family members. Given our focus on day-today hospital activities, it’s a real comfort to know our command has such great Ombudsmen to provide that vital link between the command and our command families. So to April Salas, Bobbie Lopez, and Sarah Jones, we shout out a big Hooyah! We salute you for your tireless efforts and volunteer spirit!

Have a great September; we’ll see you around the command.

3

Executive Officer Capt. Mike McGinnis

Jointness

Hafa adai Dream Team!

5. Transitional stressors (divorce, school failure,

Where does the time go? The Skipper and I ask ourselves this every day -seems like we’re in a time warp. Summer has flown by and school is back in session. During our busy summer we’ve gone through major staff turnover. Please say hi to our new staff members and give them a warm USNH Guam welcome!

We’ve also conducted SAPR-C training this month. The common theme between both of these awareness programs is the importance of being engaged with our shipmates, and making a difference when the time is right. Through bystander intervention, we all can save a life!

This month is suicide awareness month. Our mental health team has contributed to making this edition of the Pacific Pulse a must read.

We’re focusing on one of the key pillars of the Surgeon General’s command philosophies - shipmate. From the 2012 Navy Medicine review of Navy medical personnel suicides, we know that risk factors for suicide include: 1. Change in duty status 2. Significant personal loss 3. Facing military disciplinary action

relocation)

Be on the look-out for our Franklin Covey experts during the 2nd week of September coming in to give us a hand with our wildly important goal and our implementation of the 4 Disciplines of Execution (4DX). All hands training will be provided, please participate as your schedule allows. We need all hands on deck to move the needle on enhancing our patients’ experience of care.

Have a great month and THANK YOU for all you do for our patients and our command!

4. Excessive or increased use of alcohol

Got News? Know an outstanding Medical Staff member? Please let us know. If you would like to write a story or you have written a story and would like to have it printed, please send it our way! If you have a story idea for the months theme, please let us know. There are two themes for the month of September- Mental Health and Suicide Awareness, if you have an article or idea please submit to jennifer.zingalie@med.navy.mil. See inside the front cover for submission guidelines. Staff--There should be no departmental/association Facebook pages. Questions? Please use the email in this note.

4

Command Master Chief

Robert Burton

Value

The theme this month is suicide awareness. Here is the view from the Command Master Chief level.

My phone rings and on the other end is a Chief or Officer, who briefs to me that a Sailor in the command who was contemplating suicide and it was reported. The command takes various actions and ensures the member is safe. When I hang up the phone, I give thanks to those who took action. Since January 2006, no Sailor in any command to which I have been assigned, or to which my Sailors interacted on a daily basis, has committed suicide after a reported suicide.

During that same period, some of my Sailors did not report a suicidal thoughts and their friend in another command took their own life.

The friends were distraught and gathered in my office. There was no point in telling them they should have reported it. They already knew. They were beginning the rest of their lives knowing they could have done something, but did not take action when their friend verbalized a suicide ideation.

The voyage of life is long and we don’t know when or where it will end. Sometimes the voyage gets tough. Any of us can get to feeling down or a little depressed. Goodness knows I have from time to time. How a mental health professional would describe when this become dangerous is something I will leave to them.

However, from experience I can state that telling a parent or loved one, their loved one is dead or paralyzed for life is not fun. They want answers and there either are none or none that they will like. As a parent, if one of my children expressed a suicidal thoughts, I would want someone to care enough to take action.

This is something all parents want.

Let me finish back at the CMC level. There is no stigmatism associated with a reported ideation. No list is kept and it has no affect on future assignments, orders or duties. It is viewed as Sailors helping a Sailor.

Please, take care of one another.

5

American Red Cross

Volunteer profile

Name: Marciar I. Calunan Hometown: Sta. Cruz Zambales, Philippines Status: Lab Volunteer

Where else in the world have you lived?

I have lived in the Philippines, Korea, Germany, Hawaii and currently Guam.

When did you first know you wanted to be a Red Cross Volunteer?

It was May this year 2013, when I saw a U.S. Naval Hospital Guam post on their Facebook page. They posted that they needed a Red Cross Volunteer, and that was the time I decided to become one of the Red Cross volunteers here.

What do you love most about volunteering?

The one thing I love most is socialization and learning new skills.

What does a day of volunteering include for you?

Building new friendships,learning new skills, gaining some knowledge and helping people out.

Favorite quote. Why? One of my favorite quotes is “The Family that prays together, stays forever� ...Because families that share beliefs,prayers, and feelings tend to be less dysfunctional, have good moral characters and have the strong binds that hold them together.

6

“Cheat”

Sheet

Pre-Deployment Preparedness Tool for Family Members

Around the House

Preparing for deployment can be stressful, both for the service member who is leaving and also for the family members who will stay behind. The American Red Cross offers this overview of practical matters you may want to discuss with your service member before he/she leaves on deployment. Being prepared to deal with challenges that may arise at home can give everyone some peace of mind and help the service member focus on his/her mission ahead.

Your Finances

•

Have extra sets of car and house keys with an neighbor

•

List of repair persons to call; location of service agreements and warranties

•

Know your neighbors share phone numbers and email address

Legal Affairs

Discuss what bills are due and when, where receipts are kept, where tax documents are located, etc. Wills and Child Gardianships up to date

•

Have a will for each adult in the household

•

Have multiple copies of a current power of attorney signed by the service member

•

Have enough money saved to cover an emergency, including emergency travel

•

Have current military I.D. for every eligible family member

•

Create a family budget

•

Communications

Emergency Preparedness

•

Attend mobilization meetings and take notes

•

•

Know the exact name of your service member’s unit

Have a primary and alternate child care plan, short term and long term

•

•

Know how to reach the rear detachment know how to send a Red Cross message

Have a primary and alternate elder care plan

•

•

Have a copy of your service member’s orders

Have emergency plans in place in the event of a disaster – where you will go; how you will communicate

•

Know service member’s full legal name, branch of service, rank/rating, Social Security number, date of birth, and complete military unit address

•

Have an emergency plan for pets in the event of a pet’s illness or injury or the family’s need to shelter or evacuate in a disaster

•

Know your service member’s cell phone number, email address, and any other contact information

•

•

Prepare a communications plan in the event of an emergency and share it with your extended family (What does the service member want to know via

Know how to contact the American Red Cross Emergency Communications Center (1-877-2727337)

•

Know the name, address, and telephone number of your local office of the Red Cross Guam Chapter 472-6217

social media?) What is safe to post?

7

On September 11th many Americans

can remember where they were. Some will never forget the images they saw from that tragic event. For Hospital Corpsman Finesse Sorrentini, of U.S. Naval Hospital Guam’s Staff Education and Training Department, it was what she saw a few days after the event that made an impression on her.

“I remember during 9-11 when the USNS COMFORT (T-AH 20) came to New York City.

I was about 11 years old at the time and I saw it from a window of a place where my dad worked. I saw the big white boat with the red cross on it,” she said.

In 2009, knowing she wanted to be in the medical field, Sorrentini joined the Navy, ironically her first command would be Portsmouth Naval Hospital where she knew the COMFORT detaches from. With the help of a Senior Chief and mentor Sorrentini was able to get orders aboard the ship for its annual mission Continuing Promise that fosters goodwill, and demonstrates the United States’ commitment and support to Central America, South America and the Caribbean.

“Once I got on the COMFORT, I was like ‘what are the odds?’ ‘Who would have thought?’ When I got on it I thought it was surreal,” she said.

During Continuing Promise, because of her Puerto Rican heritage, Sorrentini was able to act as a translator as many of the countries she deployed to were Spanish speaking. This also allowed her the opportunity to work in discharged planning, helping to bring people aboard the ship.

She also learned a valuable lesson in patient care and attention to detail. “One place that stood out for me was Peru. My Spanish is very different from a Peruvian, but I was trying to explain to this patient how to open our pill bottle. The person I was helping never opened something like that before, didn’t know how to use it, had no idea, and it was something I overlooked until I saw them struggling. It

made me realize I needed to pay attention to things that in other countries, they might be used to that I am not and vice versa,” she said.

Attention to detail in the medical field is important whether working with patients or staff.

Currently Sorrentini works in USNH Guam Staff Education and Training. “As a Sailor, having the Education Officer right there, I learn a lot, even about the Navy. People come and ask questions and I have to figure it out.

Some may think because its Education and Training you’ll know the answer but we don’t know everything, but we can find out--I’ve learned a lot,” she said.

Although for Sorrentini, Education and Training requires a great deal of administrative work, she is also part of a team who helps educate, train, and support all medical department personnel within the hospital.

She is a Basic Lifesaving Course (BLS) program administrator and department training representative for the USNH Guam. This American Heart Association (AHA) accredited four-hour evolution is used as both initial training and as a refresher class, and is imperative for everyone in Navy Medicine to have Continued on page 25

HN Finesse Sorrentini:

Full Circle

8

September:National Recovery Month

“Join the Voices for Recovery: Together on Pathways to Wellness”

The Reality

In 2011, 45.6 million

adults aged 18 and older had any mental illness within the past year1

20.6 million

people aged 12 and older were classified with alcohol or illicit drug dependence or abuse2

Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-45, WhatHHS isPublication National Recovery Month?

No. (SMA) 12-4725. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 1.

1

Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p.6.

2

National Recovery Month (Recovery Month) is an annual observance celebrated each September since 1989. In September and throughout the year, Recovery Month spreads the message that: • • • •

Behavioral health is essential to health Prevention works Treatment is effective People recover

Prevention

Who sponsors Recovery Month?

HALF

Recovery Month is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), within the U.S. Department of Health and Human Services (HHS), in collaboration with of all lifetime cases of mental approximately 100 Recovery Month Planning Partners who represent local, state, and national orgaand substance use disorders nizations dedicated to prevention, treatment, and recovery.

begin by age 14

3/4

Where can people find treatment for mental and/or substance use disorders?

24 by age 241 • Many treatment options exist. SAMHSA’s treatment website (http://www.samhsa.gov/treatment) ofThe first symptoms typically fers more than 11,000 specialized facilities that provide rehabilitation services, 14 in the United States precede a mental and/or behavioral therapy, counseling, and medication support, among many services. substance useother disorder by 2 offering two to four years, • SAMHSA’s National Helpline, 1-800-662-HELP (4357) or 1-800-487-4889 (TDD), provides 24a window of opportunity to hour, free and conidential information about mental and/or substance use disorders, and prevenintervene early and often tion, treatment, and recovery referrals in English and Spanish.

The National Academies. (2009). Preventing Mental, Emotional, and Behavioral Disorders among Young People Progress and Possibilities. Retrieved September 7, 2012, from http://www.bocyf.org/prevention_policymakers_brief.pdf, p. 1.

1,2

(See page 12) Learn more by going to: http://www.recoverymonth.gov/Get-Involved.aspx

9

Mental Department

Scope of Services

Services Provided

• • • • • •

• • • • •

Psychiatry Psychology Child Psychology Child Psychiatry (consultive) Social Work Substance Abuse

Diagnostic Evaluations Medication Management Psychological Testing Psychotherapy Substance Abuse Counseling

Patients May self-refer or be referred via consult by a medical staff provider.

Hours of Operation and Access to care • 7:30 a.m. to 4 p.m.

• USNH Guam 2nd floor, D-wing • Phone: 344-9401/9424

All consults are reviewed by a designated provider and scheduled an appropriate appointment within the clinic, including prescreening examination or full intake evaluation with psychiatrists, psychologist, nurse practitioner, or licensed clinical social worker.

• Psychological First Aide using the Stress Continuum Model • Outreach (Educational Prevention Briefing)

Patients requiring an urgent evaluation may require medical clearance if requested by the on-call provider.

In accordance with TRICARE access to care standards, the wait time for an appointment for speciality care referral shall not exceed four weeks (28 calendar days); Acute referrals are screened within 24 hours; routine referrals are screened within 7 calendar days.

For consults that are deemed by the reviewing provider to not require mental health evaluation and are refered to Fleet and Family Service Center, a telephone consult will be placed to state this information and will be signed a designated provider.

10

continued on next page

Health U.S. Naval Hospital Guam Behavioral Health Technicians (left to right): Hospital Corpsman 2nd Class Petty Officer Tijani Bah (back), Hospitalman Amanda Odegard, Hospitalman Third Class Petty Officer Tamarekia Singleton, and Hospitalman Ryan White. (photo to the right:) Leading Petty Officer, Hospitalman Robert Reiser.

Mental Health continued from page 10

U.S. Naval Hospital Guam Corpsmen who work in the Mental Health

Department are known as Behavioral Health Technicians (BHT). A BHT is trained at a special school located at the Medical Education and Training Campus in Fort Sam Houston, Texas.

The role of a BHT can vary depending upon their duty or level of experience. They work

with licensed providers and may be, in some instances, the first line for a Sailor or Marine experiencing a crisis or in need of mental health care. In fact, they are key players in the arena of Psychological Health in ensuring both military and their families are ready for the “battle” or everyday life activities. BHT’s help build resistance, promote resiliance, and aid in recovery.

11

Su

The

Ch

bst

alle

nge

of R

an

eco

ver

ce

yM

ont

h

Us

e

by: Grant Weaver, U.S. Naval Hospital Guam Sexual Assault Prevention and Response (SAPR) Counselor

Every year the Substance Abuse

and Mental Health Services Administration (SAMHSA) challenges the U.S. Navy in Guam, as it were, to go beyond a mechanical implementation of its substance abuse policies and to believe that alcohol use disorders are indeed mental health disorders and that they are preventable and treatable through the Navy’s Substance Abuse Rehabilitation Program. Its challenge is to believe that:

1. Early prevention education and intervention prevents alcohol abuse and alcohol dependency and saves money in lost productivity and health costs.

2. Treatment of alcohol use disorders is effective.

3. Treatment provides a process of change through which they can improve their health and wellness, live a self-directed life, and strive to reach their full potential.

12

Navy policy supports these tenets. Alcohol-related Emergency Room visits and hospitalizations, arrests, and violations of regulations are routinely referred for alcohol screenings but “situations” such as drunkenness may be ignored despite the Navy’s best intentions, policies, and management. Command-referrals to SARP are the exception rather than the rule. In this respect, Recovery Month is indeed a challenge to U.S. Navy Guam.

Recovery Month is a challenge because, despite the Navy’s best efforts to change the stereotype of “drunken Sailors” it still has a reputation for and a long tradition of heavy drinking which engenders a mind-set that raises the bar for Sailors to be considered alcohol abusers. This creates an environment where alcohol abuse is seen as being a legitimate stress reliever and a way to deal with frustration. For some, “holding your liquor” may still be a revered and admirable quality as long as one does not lose their job or violate policy, regulations or the law.

Recovery Month is a challenge in Guam because young members stationed on a remote continued on next page

Substance Use continued from page 13 island in the South Pacific may relax their standards of conduct while off duty. Sailors work hard to make rank and achieve excellence in their rate and they play hard when off duty in this environment. With few expenses, it is fairly easy to acquire a nice car, a girlfriend, and money in the bank. They may find themselves in one of the many nightclubs and discover the oblivion provided by long island iceteas (tall drinks containing upwards of 6 shots of liquor) and entertainment and forbidden fun.

Downtown Tumon’s nightlife beckons Sailors who have a pocket full of money and time to burn. Morals often learned in childhood, may fall by the wayside, adopting an “easy come easy go” and “devil may care” attitude of falling in and out of relationships. Alcohol-related fun often becomes the activity of choice. For many, excessive spending, drinking, and clubbing and promiscuity become routine.

In the process, many Sailors may gradually lose interest in alternatives to drinking. Life goals and productive use of spare time.

Recovery Month is a challenge when an organization’s policies do not completely match its members’ true beliefs about alcohol abuse and alcohol dependency. There is much skepticism concerning the medical establishment’s claim that alcohol dependency is a disease and that treatment is the recommended treatment. In a nutshell, many do not intrinsically

believe that alcoholism is a disease that progresses from normal social drinking to greater amounts, developing an increased tolerance to alcohol, leading to morning-after amnesia and withdrawal distress if drinking is interrupted.

In short, there is the persistent belief that excessive drinking has nothing to do with disease and everything to do with cultural, social, psychological, spiritual, and environmental and situational factors. In addition, many simply do not believe the claims of treatment providers, governmental organizations and the media that medical and paraprofessional treatment and support groups are the best way to deal with alcohol problems.

Finally, Recovery Month is a challenge when an organization seeks to protect itself from external scrutiny. Commands must work hard not to limit referrals to Substance Abuse Rehabilitation Program (SARP)in order to protect members from the stigma of being diagnosed as an alcohol abuser or alcoholic. They must not overlook chronic and habitual binging and drunkenness to preserve reputation or what may seem to be esprit de corps. Command-referals to SARP because of situations involving drunkenness must not be viewed as detrimental to interpersonal relationships and the reputation of senior leadership.

Recovery Month is a challenge.

13

The milk of human kindness is certainly overflowing here at USNH Guam. On any given day the hospital is teeming with family, friends, medical professionals, and support staff that are ready and willing to assist our patients in their times of need. While there are many different cultures represented here, common values, beliefs, and way of life that are easily observed, many of these appear to be based on our shared sense of responsibility, cooperation, and diligence. Whether acting as an informal caregiver, as in someone helping family or friends, or as a formal caregiver like providers, support workers, or volunteers, our guiding priniciple Serivce with Honor seems to motivate our interactions with one another and dictates the many ways we strive to provide quality care to those in need.

A key component to providing quality care to others is the sometimes overlooked practice of self-care. Often times we get so caught up in the “whirlwind” of activities involved in offering excellent patient care that we don’t always 14

recognize or truly appreciate the extent to which we ourselves might be suffering. Therefore, the purpose of this article is to offer some words of encouragement and support to our fine fleet of caregivers and also to share some self help guidelines to ensure that we continue to deliver readiness, quality care, and health where America’s day begins.

The time honored behaviors associated with caregiving have been practiced for as long as there have been those in need of help, but the experience of the caregiver has recently received more attention than in the past due to the world-wide, social, political, economic, and environmental changes our generation has witnessed. The demands placed on both formal and informal caregivers have increased while the availablity of traditional support resources has steadily declined. As a result, there has been a call for more research aimed at strengthening the internal resilience of caregivers to mitigate the impact of the various external stressors associated with the role. continued on next page

Caregiver continued from page 15 While the experience of being a caregiver can be extremely rewarding, it is also a source of chronic stress. It often involves physical, psychological, and financial strain over long periods of time, and the lack of predictability and control inherent in the work can be very taxing. Many of us who choose and/or are requested to provide caregiving services take pride in performing well during times of stress. Our drive, determination, and compassion are sources of esteem and represent the very best of our strengths. However, these qualities can also make it difficult for us to acknowledge the toll our strong work is taking on our own physical and mental health and can also impact our willingness and/or capacity to ask for help. For those of us who are thrown into the caregiving situation unexpectedly and with reservation, the risks for stress and burnout are even greater. There is often a great deal of confusion, fear, resentment, guilt, and shame for those of us that fall into this category. The experience

Signs and symptoms of caregiver stress and burnout: Isolating from family and friends Losing interest in activities previously enjoyed Changes in sleep and appetite Getting sick more often than usual Difficulty concentrating Excessive use of escape mechanisms including alcohol, gambling, binge eating, etc.

ission m r e p f l e urs Give yo e of yourself car plan! r u to take o y o mit t and com

can be so overwhelming we are often not sure of what we are doing, how well we are doing it, what types of support might be out there, and if and when it is ok to ask for help.

Regardless of which caregiver category we fall into, formal or informal, “gung ho” or reluctant, the necessity of practicing self care is the same, as well as the standard recommendations for doing so. Recognizing the signs and symptoms of stress and burnout is the first step to practicing good self-care, followed by developing your own personal self care plan. If the stressors you encounter exceed your capacity for coping on your own, learning how to best utilize available support resources is your best option. A few helpful guidelines for accomplishing these recommended self care tasks are listed below. These and other Care for the Caregiver topics are discussed in greater detail through out this issue and in future issues of the Pacific Pulse, so be on the lookout!

Developing Your own self-care plan: • Identify your current coping strategies and coping skills that have worked well for you in the past. Use what works.

• Think about things you have always wanted to do to better manage your stress and/or admired about the way other people manage thiers and try to incorporate some of these things into what you are already doing.

• Determine possible barriers to being able to meet self care goals, and brainstorm solutions to these obstacles before you are presented with them.

• Know when it is time to seek additional support by consistently looking for signs and symptoms of stress and burnout.

15

: s n e e T r o f Tips th.org

es from kidsheal

ier, cutting — health n a th s le b u o tr ways to deal with l and physical a n tio o m e ith There are better w n erso g at don’t leave a p th ys a w g at led to the cuttin in th st s a -l le b u o long tr e th with ep is to get help st st fir e h T at: . rs a sc ideas for doing th e m so re a re e H in the first place.

Information com

(1)

(2)

16

(3)

ple who have Tell someone. Peo n say the first stopped cutting ofte — admitting to step is the hardest ng. But they or talking about cutti ey open up also say that after th feel a great about it, they often ose someone sense of relief. Cho first (a parent, you trust to talk to at acher, coach, school counselor, te it’s too difficult doctor, or nurse). If c in person, to bring up the topi write a note.

that’s triggerIdentify the trouble ting is a way ing the cutting. Cut ional tension or of reacting to emot t what feelings pain. Try to figure ou using you to cut. or situations are ca e to be perfect?

Is it anger? Pressur e? A painful Relationship troubl n criticism or loss or trauma? Mea tify the trouble mistreatment? Iden tell someone you’re having, then le have trouble about it. Many peop t on their own. figuring this part ou tal health proThis is where a men lpful. fessional can be he

ll someone Ask for help. Te lp dealing with that you want he d the cutting. your troubles an ask doesn’t If the person you assistance help you get the meone else. you need, ask so try to downlts u d a s e tim e m o S s teens have play the problem st a phase. or think they’re ju ling this is If you get the fee , find another happening to you school counadult (such as a ho can make selor or nurse) w . your case for you

(4) Work on it. Most people

nal pain or with deep emotio work with a distress need to ntal health counselor or me rt through professional to so eal past strong feelings, h rn better ways a le to d n a s, rt u h stresses. to cope with life’s a therapist One way to find ask at your or counselor is to t school, or at doctor’s office, a inic in your a mental health cl community

m r a H f l e S and Adolescents By: Shallimar Jones, PhD, U.S. Naval Hospital Guam Pediatric Psychologist

According to the latest statistics,

self harm among adolescents is increasing. Self harm includes deliberate actions by an individual that are intended to cause personal harm. These actions can include, cutting, punching, burning, hair pulling, piercing or poking objects through body openings or even intentionally bruising or breaking bones.

Cutting and burning however, are the most popular forms of self harm. People can perform these actions on any part of their body such as arms, legs, stomach or even genitals. Most people who engage in self harm never intend to permanently harm themselves. However, the act itself can inflict harm. Consistent self harm often results in scarring. Misjudging the depth of a cut can result in stitches or staples, and in some cases permanent nerve damage and/or death. For those that engage in hair pulling the damage can leave bald spots that are sometimes permanent.

It is often difficult to understand exactly why someone would want to engage in self harm.

Many times it is used as a form of coping with strong emotions such as anger, sadness, loneliness, guilt, rejection, or emptiness. These feelings are often associated with related situations such as relationship conflict from romantic or family to friends. Academic problems, or intense pressure from a situation or person can also be a cause.

In some cases, it may be a way of coping with trauma such as abuse or natural disasters. Individuals often report the act of self harm brings relief from their emotions and at times a sense of control or an “awakening” from emotional numbness. In fact for many, they are not attempting suicide; self harm is simply used as a coping mechanism “to feel better”.

According to Coffey and colleagues (2012), it is estimated that one in 12 adolescents engages in self harm. This practice has also been shown to continued on page 24

17

Suicide Prevention

Contributors: U.S. Naval Hospital Guam Behavioral Health Technicians, Hospitalman 3rd Class Petty Officer Tamarekia Singleton, Hospitalman Robert Reiser, Hospitalman Ryan White, Hospitalman Amanda Odegard

On average, 18 veterans commit suicide every day. There are many

reasons why people commit suicide. Three key contributing factors are change, loss, and abuse and neglect. . Examples of some of these factors are: significant changes in duty assignments or relationships with spouse, family members, friends, or colleagues, significant losses such as the death of a loved one or of a valued social relationship, current or previous history of emotional/psychological abuse, and perceived and actual neglect of psychical and psychological wounds encountered during military service.

One mnemonic for remembering the warning signs of suicide is “IS PATH WARM.”

18

• • • • • • • • • •

Ideation- Threatened or communicated Substance Abuse- Excessive or increased Purposeless- No reason for living Anxiety- Agitation/insomnia Trapped- Feeling there is no way out Hopelessness- Feeling hopeless Withdrawing- From friends, family, and society Anger (uncontrolled)- Rage, seeking revenge Recklessness- Risky acts, unthinking Mood Changes- Dramatic changes in mood change

If someone you know is showing some of the warning signs ACTAsk, Care, Treat:

• Ask: Ask the key question, “Are you thinking of harming or killing yourself?”

• Care: Be caring and show concern. Listen carefully.

• Treat: Encourage the person to accept help. Refer the person to professional support.

If you or someone you know is feeling suicidal, get help! Some resources are USNHG Mental Health Department-344-9401, USNHG Chaplain-344-9127, and Fleet and Family Support Center-333-2056.

For your wallet: Cut out the card to the right to keep in your wallet as a quick reference. Remember not all wounds are visible. See page 26 and 27 for an individual stress management plan.

19

Provider Profile Making a difference, It’s more than just one patient at a time

Mrs. Rosita Mahony LCSW by: LT Mark Peugeot, MSC, USN

A native to Guam, Rosita Mahony

edge and provide continuity for the department,” she said and added, obtained her Bachelor’s degree in Seattle, WA “Civilians who are employed in the hospital at Seattle University in 1977, During this time may hold these positions for their entire fedshe spent a year in Austria and went on to eral careers”. She also said her involvement complete her graduate degree at the Univerwith a variety of professional organizations sity of Hawaii in 1979. She then returned to and intra-hospital committees have given her home in Guam to satisfy her desire to give her the advantage of understanding how the back. Mahony has been a part of the U.S, Namental health department fits into the overall val Hospital Guam team since 1981 where as a licensed clinical social worker, she began her hospital operations. In turn, she is often the person counted on by military mental health career in family advocacy. In 1991, following department heads to provide insight into how the decision to integrate family advocacy with the department can align with operational and Fleet and Family Services, she was asked to community needs. join the Mental Health Department providing While she finds the ability to connect to client-centered mental health care treatment.

She has distinguished herself during her career new staff members and share her knowledge by being named senior civilian employee of the rewarding, she notes the experience is bittersweet in realizing all too soon she will be sayyear 5 times. ing “goodbye” to colleagues she has connected With over thirty years of experience Mahony with. holds a unique departmental perspective.

According to Mahony, “Culture is an import“I believe an important aspect of my role is ant part of living on Guam, whether you are to keep and pass forward departmental knowla military service member or a local resident.

20 continued on next page

“My family has an extensive history of military service and my mother also lived through the occupation as a young girl. Both the military community and diverse island populations are incredibly important to me for very personal reasons.”

Mahony continued from page 21 “My family has an extensive history of military service and my mother also lived through the occupation as a young girl. Both the military community and diverse island populations are incredibly important to me for very personal reasons,” she said.

Her connection to the community comes through her Filipino and Chamorro heritage, as well as her work here at the hospital and with other organizations. Mahony has served as Vice President of a local social work organization which is now known as Guam’s Association of Social Workers. She said her daily role in the clinic offers her an opportunity to give back to the military community and the local community.

According to her, the populations she serves provide a continual professional challenge due to the diversity of cases and issues seen.

Her therapeutic style integrates a wide range of techniques drawn from a number of theory-driven and empirically supported interventions. While she primarily works from a Cogni-

tive Behavioral or Dialectical approach, many times problem-focused solutions are needed to overcome social pressures in place on community clients.

“Given the tremendous respect that exists for cultural practices, individual change can sometimes be hampered when a client sees their cultural values as conflicting to what is best for them,” she said. According to her, finding ways to preserve the cultural values while improving the functioning of her clients is one of the most rewarding aspects of the job.

Mahony understands her role is an integral part of USNH Guam’s Mental Health Department. She routinely sees her contributions paying off in the local community and with the military populations she is charged with serving. She, along with many civilian employees, brings that special touch to the department that allows military providers, like me, to operate more efficiently and effectively in treating our clients.

21

The Graduate

One Military Spouse’s story of Resiliency and Accomplishment

4:30 a.m. wake-up calls, handling an

unexpected crisis, and ensuring a uniform is inspection ready while preparing dinner, and working on an academic essay; this is not the life of an active duty service member, but of a military spouse.

Anyone who has been married to the military for long enough knows that life is full of ups and downs, change and adaptation. Because of this, overtime, a military spouse must build up resiliency, which sounds like that film that gets all over the bathtub, but in actuality what it means is oomph or spirit. The idea that, if at first you don’t succeed there are 364 more days in the year to try!

One such military spouse (of an Air Force Security Forces Member) is Nikki Traylor who is also a mother of two and a Conscious Sedation Nurse who works at U.S. Naval Hospital Guam in the General Surgery Department. She also just happens to be a recent college graduate receiving her Bachelors of Science in Nursing.

Traylor began pursuing her degree in 2005 after caring for her husband who had a surgical procedure. “I thought ‘oh I could do this’ and so I went and applied to LPN (Licensed Practical Nurse) school,” she said. Then, a month after school began, with two toddlers in tote, she found out her husband was getting deployed for 9 months.

Although excited to be on this journey, Traylor said during this time there were days she felt secluded. “With a deployed husband, two young 22

kids and going to school full time, I was on such a routine and studying so hard that I didn’t have much time for friends,” she said. What kept her going was something she calls a vision board. “I actually created this poster and every day I got to see what my goals were.”

Her vision board paid off and in 2010 she graduated with an associate’s degree. She began working full time and then made the decision to continue to further her education. “I feel passionate about nursing. The healthcare industry is changing all the time, new research is always coming out. I really want to stay on top of it and make sure the care I am providing my patients is the most current and I am using evidence based practice,” she said, then added with a smile, “Plus, I really enjoy going to school.”

So she began the pursuit of her Bachelors while working full time. This time around her best friend joined her in school and they were able to commute to their clinicals and relate to one another when the job of balancing life became difficult. But military life being what it is, a couple of years into her program, her husband received orders to Guam. He left first and the family was separated for six months while Traylor and her children stayed behind. Because of her previous experience, while working on her associates, the situation she found herself in did not seem as difficult. Thankfully, her school, Central Methodist University, supported her military lifestyle and she was able to easily switch her classes to online. “I often felt like my online classes were more challenging than the classroom,” she said. continued on next page

Traylor on getti ng “ I t ’s n o t like yo a degree: u are g to be a oing lone. T here is ing to gobe som e on through the sam e going encour age pe e thing. I ople to out of t step heir com fort zon e.”

Graduate continued from page 22 Traylor explained that although some nursing classes can be taken online, those who are interested in nursing should keep in mind not all components of the program can be done that way.

“Getting my Bachelors in nursing I didn’t have to sit boards because I already did all of that with my associates degree. For my clinical component I shadowed a nurse manager, so I had a preceptor here at the hospital,” she said.

One of the biggest things she said that helped her through it all was time management in balancing work, school and family and being able to say no to things she was not able to do. Although there were things she missed out on she was still able to do things like travel with her family.

Because she took online classes, she could travel plus work on schoolwork which she did during trips to Australia and Hong Kong. “I specifically remember going to McDonalds to use the Wifi so I could check in with my classes and do homework,” she said as she laughed.

On a more serious note, she emphasized the importance of not being too proud to ask for or accept help from others. “In the military I think we are used to being able to stand on our own two feet. People offer to help often; it becomes a common thing to say ‘if you need anything let me know’ and it is important to accept it,” she said.

“Understand the military that surrounds you is your family, and will help you out if you need something.”

To maintain balance for her family Traylor worked hard to keep her children on a schedule.

This included morning time together and family

evening meals. “I didn’t want them to suffer just because I was going to school. It is not the easiest thing but I would still encourage anyone to do it because it is definitely manageable. As long as you can focus and have the will to make other sacrifices like less time at the beach.”

Traylor believes nursing is a life long journey of learning and exploring and plans to continue to further her education. “My ultimate goal is to go on into my graduate’s degree. I am considering getting my Certified Nurse Anesthetist (CRNA) but we are leaving in February, I don’t know where we’re going in order to apply for graduate school just yet.”

Currently however, she is enjoying a short break from school. While in Guam her family completed their dive certifications. And even though she can’t jump right into her graduate program she plans to use this time to pursue something she has long been interested in. “I have always wanted to be fluent in American sign language,” she said. “I feel it would be beneficial in healthcare and in nursing.”

At the end of the day, Traylor believes spousal support means a lot, not just supporting the military member but being supported by them.

“My husband and I have been married for almost 13 years now and we made a commitment, before I even started, so I didn’t go into this alone.

We went into this together as a partnership, we knew together were going to make it through this,” said Traylor.

23

Self Harm continued from page 17 be especially common among females. Hawton and colleagues (2012) indicate that the behavior becomes “increasingly common from age 12” on; with a 5 to 1 ratio of girls to boys between the ages of 12-15.”

However, this difference decreases with age for girls but increases with boys. Many report trying self harm because other peers do it as well. Research shows that about 90 percent give up the behavior by the time they reach young adulthood.

On kidshealth.org, one girl described her experience with cutting as a result of other peers being involved in the behavior. “It seemed like if I didn’t do it, they would think I was afraid or something. So I did it once. But then I thought about how lame it was to do something like that to myself for no good reason. Next time they asked I just said, ‘no, thanks — it’s not for me.’ “ For some adolescents, the behavior becomes compulsive and if associated with other difficulties such as depression, anxiety, and/or conflict about sexuality, it can become a more serious problem. Another young girl relayed her experience to kidshealth.org by reporting that “It starts when something’s really upsetting and you don’t know how to talk about it or what to do. But you can’t get your mind off feeling upset, and your body has this knot of emotional pain. Before you know it, you’re cutting yourself. And then somehow, you’re in another place. Then, the next time you feel awful about something, you try it again — and slowly it becomes a habit.”

For those where self harm does become a habit, there are often other associated mental health difficulties. According to one study (Coffey et al, 2012), adolescents who had depression or anxiety when they were teens were about six times more likely to self-harm, compared to those with no depression and anxiety when they were teens.

This risk also increases between two to three fold when other factors such as drug or alcohol usage are included. Although the vast majority of adolescents are not attempting suicide when engaging in the behavior, self harm itself is one of the strongest predictors of suicide.

It is important to note complicating mental health difficulties rather than the self harm itself is the biggest danger with regard to suicide.

Regardless to severity of the behavior, seeking treatment for self harm (especially early on) is 24

important as it can help to provide needed coping skills and thereby can aid to offset further complications including the potential lethality associated with the behavior.

There are not always signs that someone is engaging in self harm. There may be some clues, to such as wearing clothing inappropriate for the weather (e.g., heavy sweaters in summer), excessive bracelets or bangles, consistent bruising or bandage usage, social withdrawal, sadness, change in friends, etc. It is important to know that you cannot force someone to stop. Getting angry, yelling, lecturing, or rejecting that person will not discontinue a person from the behavior particularly if it has already developed into a compulsion. Seeking professional assistance is important.

There are different types of treatment options for self harm, some with and without medication depending on the severity of symptoms. Some are available on an outpatient basis and others on an inpatient. Seeking treatment does not mean that you are crazy or weak; it simply means you need more support.

Talk to an adult, your medical doctor, counselor, psychologist, clergy or other professional if you feel you or a friend help. Hotlines with trained professionals are also available at: 800852-8336 (or text “TEEN” to 839863; 800-SUICIDE; or boystown 800-448-3000.

In addition, mental health at U.S. Naval Hospital Guam can also provide assistance at 671-3449401.

Self harm is a serious health issue that can be very frightening and stressful for individuals, family and friends, but there is help available to genuinely feel better.

References: • Moran, Coffey, Ramanjuk, Olsson, Borshmann, Carlin and Patton (2012) The Natural History of Self-Hrm form adolescence to young adulthood: A population-based cohort study. The Lancet, Volume 379, Issue 9812, Pages 236 243.

• Hawton, K, Saunders, K.E., & O’Connor, R. (2012). Self Harm and Suicide in Adolescents.

The Lancet, Volume 379, Pages 2373-2381. http://kidshealth.org/teen/your_mind/men tal_health/cutting.html#

Special thanks to: April Sales Sarah Jones “Bobbie” Lopez

U.S. Naval Hospital Guam Ombudsman September 14 Ombudsman Appreciation Day

Sorrentini continued from page 8 completed, regardless of their current position or rank.

Because she is stationed in Guam Sorrentini has a hope of participating in Pacific Partnership, an annual mission, which serves to strengthen regional stability and security in the Indo-Asia-Pacific region. “If I could do the Pacific Partnership that would be nice, I would have done East and West missions,” she said.

Although she has only been in a short time, it seems this Sailor has already gone full circle. Because of this, Sorrentini is open to whatever comes her way. “Being a Corpsman is different than what I expected. Each experience is different. It’s different for each person, especially being a Corpsman; because you could be doing so many different thingsyou have to be well rounded--I feel the pride of being a Corpsman. There is something special about being a Corpsman,” she said.

The answers to last months Cross word puzzle: Why we Screen

Look for this photo on our Facebook page and share a 9/11 memory with us. Where were you on this day? Is there anyone you would like to remember?

Join us on September 11th at: http://on.fb.me/12NHJrW 25