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Aug 28, 2020 - Seattle Children's Hospital Has a Good Cobb Salad

In the title of this blog entry there is so much information, and so much more information that could be said. But Children's really does have a great cobb salad - not in the cafeteria, but on the menu you can order from the patient's room. I particularly like the lemon olive oil dressing. My family is one that accesses medical services more than typical I would say, we are a wacky combination of accident-prone and a few health conditions running around. And, of course, the sheer number of people can contribute to it as well (we currently have six kids at home). So when we had an ER trip this week it was unusual, but it was probably the fourth one in the past year. And this one wasn't for a broken ankle like the last one had been, but a very sore tummy - what I know is a very vague symptom for the ER doctor to try and assess. But, thinking of one of my best college friends who spent several weeks in the hospital with her little girl this summer battling appendicitis, I thought better to be safe than sorry. And I had to do the first ten hours on my own because they only allow one parent in the ER due to COVID. It wasn't appendicitis, but much to everyone's surprise it did necessitate being admitted to the hospital in the pre-dawn hours and having surgery the following day. And now we're in that whirlwind of boredom that is the hospital - too many professionals to remember popping in, discussing pain management and food and fluid intake, trying to make large decisions on only a few hours of stolen sleep, and being so grateful that my child is going to be okay. The only empty bed for her was in the cancer treatment ward, and as I've travelled to and from our room I've been reminded just how fortunate I am.

When I was a child I was in this very hospital a few times for some very specialized surgeries that my home town of Walla Walla wasn't able to provide. I remember asking my mom to stay the night with me and assuming she would be there when I woke up in the morning. In those days patients were in large rooms with other kids, and parents weren't as encouraged to spend the night. The doctors had assured her that I wouldn't wake up, so she went back to the hotel with my Dad and they planned to return early in the morning. I woke up before they returned, however, and was terrified when I realized that she wasn't there. In the strange post-anestesia feelings of my body waking up, I found that I could look around but not move my body very well yet. One of my roommates across the room had a heart monitor, and the lights were flatlining. I panicked, assuming that she was dying and for some reason the alarm wasn't working. I tried to move to alert someone, but didn't have control of my limbs. Gradually I got control back and I pushed the nurse button to be greeted by a cheerful nurse. "She's dead!" I croaked out, pointing to the girl across the room. With calm assurances my panic resided when I was told the alarm was turned off because the monitor wasn't working right not because the girl died, but I still felt scared until my parents got there. So here are what I do when my kids are in the hospital:

Kids don't get left alone. I mean, if I need to run and get a cup of tea or something sure, but not longer than that. When my adult daughter was hospitalized I offered to stay and she said it was okay for me to leave, but I would have stayed if she'd wanted me to.
Kids get to make choices about their bodies. Unless it's an emergency kids don't get held down or forced to do anything, and even then there's usually an alternative. I've had my needle-phobic child put under for surgery with gas and then they put in her IV after she was out.
People heal better when not in pain. This is not the time to rough it without pain meds, and also remember that trauma can affect the experience and expression of pain.

And I've also been reminded how many times over the years I've been in the hospital with kids, and how being in the hospital has triggered kids trauma, and being dismissed by professionals to take my child's symptoms seriously because of their trauma history. This time we had a clear reason for the pain and a relatively easy solution - but so many times that has not been the case. And even this child once had a broken arm it took hours to realize because trauma can interfere with the experience and expression of pain.

I pass other parents in the hallways at Children's Hospital and I wonder about their stories - how are their children? Why are they here? Are they in the indeterminable whirlwind that surrounds me whenever my child is in the hospital? But I also know the look that we would rather be anywhere but here. Children's is a fantastic hospital, and home is always better.

Here's what I do to take care of myself when my kids are in the hospital or receiving other medical treatment:

Get as much sleep as reasonable. This can be hard, especially as it is often on a plastic fold-out couch if at all. I swear if I'm ever a millionaire I'm going to donate comfortable chairs for parents to sit in in the ER rooms. There have been so many times I've been in those rooms all night and a recliner would have been so nice.
Eat healthy food. Grabbing fast food is so tempting at this point, but my body feels terrible if I do. I try to make sure that I'm getting some fruits and veggies.
Get out of the hospital. I try to get home once a day for a few hours to shower, change clothes and see the other kids. This helps my sanity.
Tag out with someone if you can. Given the current COVID situation I can only tag out with my husband, but other times my kids have been hospitalized I have had a friend come and stay with them so my husband and I could go grab a bite to eat.

When your child is hospitalized is when you kick into high parenting gear. To survive you're going to have to engage in some Olympic level self care. And try the Cobb salad.

Pictured: my husband catching some zzz's on our fold-out bed. He technically consented to this picture, but he was pretty sleepy at the time.

Aug 20, 2020 - Teaching About Adoption With a Puppy

Several of my friends got pandemic puppies, and I enjoyed pictures of their cute additions. One rescued a terrier mix from through a pet rescue from Texas and another a shepherd mix from a shelter in Wenatchee. And the campaign of over two years by one of my daughters finally gained more traction - a pandemic is a great time to get a puppy. The last thing we really needed was a third dog, but my daughter was right - it wasn't fair that her sisters had dogs to sleep with and she didn't. And my heart had been yearning for another dachshund since I lost my Izzy five years ago, so it was decided that we would find a puppy or young dog that met our criteria.

We tried rescue organizations first, but we were rejected out of hand because we have younger children and other issues that made us a less than ideal home (like a hamster). Also, sometimes a traumatized dog is not the best match for traumatized children. We have one dog that has a trauma background, and we are lucky that her sweet personality helps compensate for the inevitable triggers that happen in our home. In my practice I have seen other pet owners not be so lucky when a pet with a trauma background is triggered by inevitable dysregulation in a traumatized child.

And so we began to search for a dog that met our criteria - coming from a reputable and ethical breeder, not too far from home, and a miniature long haired dachshund male. This was not an easy task if anybody else has tried to find a puppy during the pandemic - apparently everybody else wants a puppy too. But finally we found a breeder I was happy with, and put a deposit on a puppy the day after he was born. Fergus was soon to become part of our lives. Our family trip to pick up the little guy was full of kisses, licks, pictures, and about as much cuteness as allowed on color TV. I mean, seriously.

The act of adopting a dog - whether from a shelter or a breeder, can mean something very different for an adoptive family then it can for a typical family. Questions are much more loaded, such as, "Will Fergus miss his mommy? Does Fergus's mommy miss him?" If your child was older when they came, feel free to say things like, "We need to make sure Fergus feels safe, this is all new to him. Remember when you first came and everything felt strange and new?"

Tips for a trauma informed pet adoption:

Use adoption positive language for the pet as you would for a child - don't focus on "rescuing" the dog, but on adopting them.
Realize that your child might express their feelings about adoption through the dog, so pay attention to what they say. Sometimes it's easier for kids to ask questions on behalf of a puppy than for themselves.
Talk about your excitement for your pet to join your family, and how much you are excited to love them and care for them.
Have the child partner with you in helping create felt safety for the dog - talk about how to help the dog feel safe and how to build trust with the dog. Ask them for ideas on how to build trust with the dog.
Keep everyone supervised. Overly enthusiastic kids can cause harm, and if kids aren't used to dogs they might not understand that a playful nip isn't an act of aggression.

Aug 19 2020 - Back to School COVID style

This is where I found this meme: https://images.app.goo.gl/SEbQcG9uz3EJ9eWr7

I love this meme, because this is how parents are feeling right now. Parents feel stuck between so many bad options - there just aren't any good ones. No parent wants their child to catch COVID-19, but it can often be also really difficult to try and educate your child at home for a myriad of reasons. And the reality of parents having to work is not to be dismissed either - getting little Robyn on that Zoom call at 10:15 may be a heroic feat, and throw in some ADHD or some oppositional behavior due to trauma and that heroic feat may become nearly impossible. And keeping the child on the call and not trying to play with buttons and backgrounds? It's no wonder parents are begging for other options. My children just wistfully ask me when schools are going to open, and sigh heavily when I honestly tell them that I have no idea. I have one daughter that is a senior in high school this year, and she has already resolved that she is probably not getting a homecoming dance like she dreamed, but is hoping against hope that she gets Prom.

Parents with adopted and foster children are in a more challenging spot in this crisis than most other parents. Studies have shown that children adopted out of foster care have a higher incidence of ADHD and autism, and even without those comorbid conditions they access mental health care at a much higher rate than their non-adopted peers. Early childhood trauma affects the brain in real ways, and in a situation like schooling during the pandemic parents are going to feel it acutely.

So what can you do to get help? First of all, if your child has ADHD or autism and you haven't talked to your teacher or school about it yet, this is a good time to talk to them about accomodation. It just isn't realistic for a child with ADHD to be expected to sit still and interact on a screen in a zoom meeting beyond their capability. Negotiate with the teacher what is reasonable for your child. Give them breaks to move their body, create an environment where they can thrive. Some schools that are closed to typical students are giving some special needs kids some in person instruction because they realize how hard it is for special needs kids, so see what your school has to offer.

Secondly, support your child, but try to let the teacher be the authority. Help your child get on Zoom meetings and organize, but try to stay out of power struggles as much as you can. This is especially tricky with homeschooling right now, but it is super important that you are not the authority your child is tangling with about school related issues. You only have so much parenting capital, don't spend it all in one place. So if your child wants to pick a fight about homework, redirect them to their teacher or the house rules - "Oh I'm sorry, house rules are that homework has to be done before video games. Bummer. I hope you get it done soon, I know how much you wanted to play this afternoon."

Also, give yourself a break. Yes, it's true that your child will probably not get as good of instruction or experience as they would if they were in the classroom. However, there are going to be a lot of children in the same boat. There will be lots of kids missing critical socialization during this time, as well as access to high quality instruction. Yes, it sucks. Yes, COVID has stolen so much from us and from our children. Right now we are trying to survive a horrific virus that has become the third leading cause of death in the US. Let's hope that we get that prom, because right now hope is what we need to get us through this.

August 18th 2020 - The End of Vacation Blues

Today marks the end of vacation for me, and the return to work. I love my work, and I love seeing my clients and hearing how they're doing. And with my book launching in mere days, I have a lot to look forward to. But I still can't help but to feel a little. . . blah. There wasn't an exciting destination vacation - we went out on our boat with some friends in their boat, floated around the San Juan Islands, and subsisted on as many Dungeness Crabs as we could catch and crack. There wasn't any glitz or glamour to our vacation, we washed our own dishes and cooked our own meals. But I found the vacation sublimely relaxing. We were still careful and socially distanced and wore masks, but when you are just floating around you don't have to. I got to spend time with some friends whom I love deeply, I hardly cracked open my laptop the entire time, we had a new puppy with us for when we needed entertainment, and long silly talks with my kids about nothing and everything. And when I thought of calls I needed to make or laundry I needed to do I realized that not only didn't I have reception but I didn't have a washing machine. Sublime.

And as I come back to my home, unpack, organize, and figure out a long, hot shower and working tomorrow - reality is setting in. School starts in two weeks. School will be online. My book launches in less than two weeks. Laundry . . . oh, the laundry. My to-do list is growing rapidly. When my husband suggests Teriyaki for dinner I just nod in grateful comradery. I'm going to dream for just a few more minutes about the San Juan Islands and go hold my puppy.

July 6th 2020 - Locked down with Trauma

At the very beginning, I remember thinking that there was no way our kids could be out of school for two weeks, that I could move to online therapy for my clients, or that I could order groceries online. Now, what feels like ten years later, I laugh at my past self. Past Barbara thought half days during conferences were difficult to schedule, how about a pandemic!

During the early days of the pandemic, I survived like most parents - establish an early routine, figure out online school, and when all else goes south bake some banana bread. My husband took our bedroom for online calls, I set up my therapy practice in my nine-year-old’s bedroom with a bedsheet hung on his bunkbed.

But now things have become routine - we’ve sewn masks, we have the hand sanitation routine down, we know how to make homemade bleach wipes, and have a weekly order from Costco coming. So what do we do now? What are the long term effects of social distancing on our kids?

Many parents are feeling overwhelmed at this time, but there are issues that are unique to those parenting kids with early childhood trauma that re different than the typical kid. There are several things that I see both in the kids that I’m raising and the kids that I see on the other side of the computer screen in my makeshift office:

Lockdown fatigue - This is the weariness that we’re all feeling with the length of time that we’re having to be on lockdown and away from our normal lives.
Lack of sensory input - For children that have high sensory needs due to their trauma backgrounds, being at home is very difficult. Kids like this should be playing soccer, riding their bikes, bouncing on a trampoline, and wrestling with friends for hours every day. Being away from school, day camps, and even just the roving hoard of the neighborhood makes this difficult. Most of the self-care I recommend are things that are interactive.
The volcano situation - emotions get buried for a long time and suddenly erupt because people aren’t coping well with the small stuff and it builds up.
Parents start running short of patience because they are running on fumes themselves. Parents are unable to do the self-care they usually engage in as well, and they are overburdened by trying to work, teach, and parent at the same time. Or, perhaps they are stressed by employment or financial insecurity.
Lockdown is a compliance warzone - for kids with compliance issues, every day can be drought with power struggles - hand washing, mask-wearing, not going to friends’ houses, staying at home - all of these situations can be fraught with difficulty if you have a child that is oppositional.
Triggers - a trigger is something that reminds a child of their earlier trauma and induces a fight/flight/freeze reaction. There might be situations with the pandemic that remind kids of their trauma background. Some kids come from a background of neglect and the staying at home necessary for the pandemic may feel like that. For other children, hearing reports from the news or random other sources might add to the low hum of menace that makes up the background of their lives. For others, they may worry about practicalities such as food, parental employment, or potentially losing their parent to the illness.
Kids with early childhood trauma are more likely to require additional supports academically, so they are more vulnerable when they are educated online.

Here are some things I have found that helps:

Try to figure out new and fun things. I know, I know. You’re running out of ideas yourself. This week instead of our normal 4th of July celebration we pulled out a rusty fire pit bowl and had a fire and roasted marshmallows, and it’s amazing what a few scavenged bits of wood and a bag of marshmallows can do for your mental health.
Increase sensory input - I tell people to think of it as a diet; just as you think about how much protein and fruits and veggies your kids get, also think about how much sensory input they’re getting throughout the day. All five senses are valid - taste, touch, smell, sounds, and sight. However, for many kids, the large muscle movement will have the most lasting impacts on their ability to regulate. Think yoga ball, trampoline, dance party, jumping jacks, basketball, bikes, etc.
Try to check in about emotions before they boil over. Good structures to have in place are things like doing a high/low at dinner, talking about emotions in the car where it feels safer, those kids of things. But if there is an explosion, help your kid weather it in a kind, regulated way.
Self-care, self-care, and then again some more self-care. I know parents get really sick of hearing it, but you can’t parent on an empty tank. But the challenge of self-care during a pandemic is difficult too, as most of what I recommend - connecting with friends, taking a pottery class, engaging in your faith community - are decidedly not pandemic friendly. It can be very hard to find good self-care options at this time, but it is imperative to do so. These are what I’ve found - biking around the neighborhood, re-discovering my love of quilting, sewing masks, zoom calls with friends, creative date nights with my husband, and starting a blog.
Try to avoid power struggles as much as possible. This can definitely be easier said than done, but knowing that this is a set-up for them should help.
For triggers, it is a good idea to handle it as you would handle any other triggers - reassurance, creating safety, and soothing using sensory input that the child finds soothing.
Help your child make a plan for academics, even in the summer, to help them so they don’t fall behind. If your child qualifies for extra supports, ask the school how they intend to offer those supports during the lockdown.

As this pandemic is increasingly looking like a long-haul rather than a short term thing, we need to think about how it’s going to affect our kids long-term. Some good parenting techniques can help make some of it easier for kids, but in the long run what kids need most is a loving, empathetic parent that creates a place of safety for them. Most kids with trauma already believe that the world around them isn’t safe, Covid-19 just confirms their beliefs. Our job as parents is to try and help them feel as safe as they can.

July 2nd 2020 - The conception of The Book and the tyranny of self-doubt

It has been well over a year now, longer than any of my human pregnancies lasted. It was a fateful spring day when my husband and I, out on a date to give ourselves a chance to reconnect in the busyness of our lives, and we were talking about our respective jobs that week. I am a therapist that specializes in working with people who have been affected by early childhood trauma, especially as it relates to adoption and foster care. I had been frustrated that week by several people who did not live close enough to me to see me in my practice ask me what books they should read, and the answer really was ten books. And no struggling parent of a traumatized child had time for that!

"What I really need is an easy to read, fun book that has all the information people need in one place," I told him. "Something with good science but not too complicated, but with lots of stories so it's interesting."

"You could write that," he told me.

His words, casually given over an evening of sushi, struck my core. I could write that, I told myself as I went to bed that night. I had always loved to write; most of my childhood had been spent writing stories, and my favorite part of college and graduate school had been writing papers. I had already written the manual we used with parents for our trauma protocol, how much harder could a book be?

For the record: much harder; but it was also way more fun. Every spare moment I spent writing - every cancelled client, every night after the kids went to bed, every slow hour on a Saturday. As I sat with clients my list of topics to cover expanded, as well as questions I got from parents at talks that I gave. Yes, it would be great to cover how to choose a good child therapist. Yes, parents need more help on how to navigate schools. Did I really cover birthparents enough? But even as I wrote I had doubt in the back of my mind - was this an exercise in creating a book that I would self-publish? I felt called to do this, but where was this going?

I had been through trying to publish a novel before when I was in my mid-twenties and idealistic, and in the end I had given up and decided I was someone who wrote for my own amusement. So with much trepidation I waded into this again, deciding that I would give myself a year to find a publisher, and if I was unsuccessful then I would self-publish on Amazon. I did some research on some likely publishers, sent out a round of query letters, started a spreadsheet to keep track of my progress, and prepared for the wait. Everyone says you won't even likely hear back from a publisher for 3-4 months, so don't get your hopes up.

Two weeks. Yep, I had a couple of nibbles from some other publishers that I wasn't as excited about, but then I got some solid interest from a publisher I was very excited about, North Atlantic Books, and I just about exploded in excitement. I tried to play it cool, walking through the different negotiation stages, the offer, having a lawyer look over the offer, and then finally signing. It all seemed unreal.

And then they assigned me a developmental editor that had two different masters in the fields of English and writing, and that was the first of many times I felt the tyranny of self-doubt. I don't have any sort of degree in English - my undergraduate degree was in biology, chemistry and psychology and then my masters was in counseling psychology. I love to write, but I hadn't done any really intensive grammar anything since I edited my high school newspaper. How was I going to stand up to the professional scrutiny of the editing process?

To my surprise, I found the editing process actually kind of fun. My developmental editor was actually very helpful, and the questions he asked improved my book and how I thought as a writer immensely. Even though he had no background in the foster/adopt world, he was able to ask logical questions and see holes in my book in ways that my colleagues hadn't. My book went from 60,000 words to over 100,000 under his encouragement.

And now I'm in that place of waiting - the book is finished, the foreword by Deborah Gray secured, several great endorsements including one from one of my favorite professors gathered, and now it's time to start promoting the book. And a part of me is scared about this process too - just like facing down an editor with two masters in English. This is where my self-doubts niggle at my mind. They can range from the mundane (are all my continuing education requirements up to date? They are, I triple checked) to the more reasonable (will anybody read my book if they know that none of my kids are perfect, nor am I?) to the truly tyrannical (who are you to write a book like this? There are plenty of therapists that have been in practice a lot longer than you and can probably write better as well).

Whenever I tell my husband about this doubt, he kind of shrugs and says, "But writing this book is clearly your calling, don't stress about the other stuff."

So in the interest of leaning into my calling and not stressing about the other stuff, I shall endeavor to be honest on this blog. I am not perfect, nor are my kids, nor is my husband. I have seven children, two of whom I gave birth to, and six of whom live at home. One lives with her fiance and my grandson nearby. I have been married nineteen years to a man from New Zealand whom I love fiercely, even on days I could clobber him over the head. And I have made many mistakes along the way, and still make them. But I have also learned a lot along the way, and that is what my book is about - what I have learned. I have learned about trauma, how to calm a trigger, how to talk about a child's story, and how to create felt safety. I wrote the book that I had wished I had at the beginning of my journey. And as long as I focus on the fact that this is the book I have written - it's not about perfection, but about the journey.

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