Preventive Risk Management for Children, Adults and Seniors

1. Preventive Risk Managementfor Children, Adults and Seniors Dr. Bruce E. Kline & Associates, PsyD Dayton, Ohio April 18, 2012

2. Living With Risk • All of us are aware of risk at some level • We all have learned to live with this awareness • Most of us don’t deal with this reality until a crisis occurs • Dealing with risk management can be emotional, overwhelming and, therefore, immobilizing • But we can be proactive about minimizing impact of inevitable life events

3. Two-Fold Opportunity • As care providers, we have a golden opportunity to effect positive change in our own lives as well as educating and supportingthose for whom we are responsible, both personally and professionally.

4. “Good” Stress vs. “Bad” Stress • Human beings need a certain amount of stress to keep us motivated and moving forward. Good stress is what gets our blood pumping and keeps our passions alive. • Stress is bad when there is too much of it, it goes on for too long, or when our ability to cope with it in a positive way becomes impaired.

5. Physiological Responses to Stress • Initial reaction sets off a physical chain reaction including quickened heart rate, mental clarity and improved performance. • Prolonged stress or perceived “bad” stress leads to the same quickened heart rate, but decreased mental clarity and decreased performance.

6. Reaction to Stressors is Not Fixed • “Our goal isn’t a life without stress. The idea is to have the right stress,” says Stanford University neurobiologist Robert Sapolsky in the March/April 2012 issue of Psychology Today. • What is the right stress? “You experience good stress when you feel a sense of control over the event in question.” When you are “voluntarily relinquishing a degree of control and predictability in a setting that is benevolent overall” (page 80).

7. How to Increase Resiliency to Stress and Enhance Behavioral Cooperation • Consistent nurturing at a level high enough to engender trust in its availability. • One person (minimum) who accepts the youth unconditionally, regardless of temperament, idiosyncrasies, behavioral, mental or physical handicaps. • Primary adults who encourage independence. • Primary adults who model and teach assertive and appropriate communication skills. • Primary adults who model and teach self-help skills. • Primary adults who reward acts of helpfulness and caring. • Primary adults who themselves model acts of helpfulness and caring. • Having some responsibility for family tasks. • Living in an emotional environment that is predictable and stable. • Little or no exposure to substance use or abuse, mental illness, interpersonal discord, or legal entanglements. • Family structure of four or fewer children with two or more years between siblings. • Positive adjustment in school, making it a place of security – a “home away from home.”(Werner, Emmy E., Children of the Garden Island. Scientific American, 1989.)

8. A Sense of Control • So what matters most is not the stressful event itself, but our physiological and emotional reaction to it… • Therefore, having as much in place as possible before stressful events occur (and they will), does two things: • Gives us a stronger ability to control our decision making • Teaches us that we are responsible and capable of setting up effective systems and safety nets which can help us believe that “these things happen” as a natural part of life – we can minimize the feelings of “Why me?”

9. How to Begin • Assess overall situation, following Prevention Guidelines • Determine own risk comfort level • Determine risk comfort level of other key individuals in your overall situation (children, parents, other dependents) • Break tasks down into “bite-size pieces”

10. One Small Step • Although it may not seem like it, every tiny step taken, returns exponential benefits.

11. How to Determine Risk Comfort Level • Reflect on your own risk comfort level. • Reflect on the risk comfort levels of your family and/or other key individuals in your life. • Sample Questions: • Scale of 1-10 with 1 being very low and 10 being very high. • When things don’t go right, I tend to be hard on myself. • I often feel that I have few supportive relationships. • I frequently think there is only one right way to do something. • I often feel unable to cope with all I have to do. • I frequently neglect exercise. • I often neglect eating healthfully. • My sleep is often poor or too short. • This information will play a large part in how you build your Preventive Risk Management Plan.

12. How to Build Your Preventive Risk Management Plan • Using the Preventive Risk Management list, determine which areas are high, moderate, and low risk. • Make a checklist of bite-size tasks within each area, starting with those you have marked as high priority. • Begin checking off bite-size tasks – one at a time. • Give yourself credit for each task you accomplish and give yourself a reward for each area you complete. (Doing this is an important part of Preventive Risk Management.)

13. Preventive Risk Management Areas • Lifestyle • Medical/Health • Network and Support System • Family Values, Communication and Culture • Spiritual • Education • Redundancy and Backup Systems • Financial Planning

14. Lifestyle • Diet • Non-smoking • Moderated drinking • Exercise • Leisure activities • Stress

15. Medical/Health • All of the following apply to yourself, family members and family pets. • Diet and exercise • Network of professionals • Non-smoking • Moderated drinking • Moderating stress/leisure activities • Health insurance • Contingency plans and long-term backup

16. Network and Support System • Family • Friends • Professional • Accountant • Lawyer • Mental health professional • Health (physician, alternative therapy professionals, dentist, etc.) • Gym/health club

17. Family Values, Communication and Culture • Members of family share many values • Open lines of communication in place before crisis • Attention and time spent actively building a family culture • Holiday traditions • Shared activities and interests • Family jokes and stories • Photo albums

18. Spiritual • Organized religion and/or spiritual practice • Importance for self • Importance for family

19. Education • Self and/or spouse/partner • Children • Assessment: IQ, special needs, etc. • Public or private – determine best fit for each child • Outside educational opportunities • Extracurricular activities

20. Redundancy and Backup Plans • Backup system for computers • Backup plan for important documents • Health/Medical • Living will • Family knows plan for each family member (including animals) • Financial • Power of Attorney • Knowledge of passcodes for online banking, etc. • Insurance policy numbers, etc. • Family plan in case of disaster (fire, intruder, etc.) • Key supplies in case of disaster (natural or loss of power or heat, etc.)

21. Financial Planning • Budget • Savings • Taxes • Emergency/Contingency • Planning for the future (5-year, 10-year, etc.) • Insurance • Health • Life • Home/other property • Will or trust

22. Acute Management • Now you have done everything you can to minimize the impact of a crisis, but avoiding acute situations is (most likely) not possible. • So, what are the immediate steps to managing an emergent situation?

23. First Steps in a Crisis: How to Minimize Immediate Impact • If not thinking clearly, ask for immediate help from a professional, family member or trusted friend who has good judgment and will keep all information confidential.

24. 2. Do not make any decisions immediately unless it is a life-threatening situation.

25. 3. If it is a matter with legal implications, do not talk to anyone until you have retained a lawyer.

26. 4. Do not overestimate your own abilities to handle the situation – emotionally, physically, or mentally. Get the right people involved as soon as possible.

27. 5. Pay attention to the emotional needs of other adults and/or children involved or present. They may need to be removed from the scene, may need explanations about what is happening, and may need counseling later to process and move on in a healthy way.

28. Remediation: How to Minimize Long-Term Impact • Expect emotional backlash

29. 2. Assess and learn from any mistakes made. You can also go backand fix any that are still repairable. • Examples of mistakes: • Followed poor advice • Didn’t contingency plan well enough • Family culture/values not strong enough to withstand the crisis • Poor family and social network • Mistaken belief that the world is uniformly friendly or helpful • Mistaken belief that world is horrible, scary and depressing

30. 3. Figure out what follow-up is necessary and don’t stop addressing the situation until nothing more needs to be done.

31. 4. Allow yourself and the rest of your family a measured pace to pick up the loose ends and return to your life.

32. 5. When you have done all you can do, look ahead toward the future. Do not dwell onthe past.

33. The Many Benefits of PracticingSelf-Compassion • Practice for yourself, and teach your family, the art of self-compassion. • Growing body of research shows many benefits including: • Increased happiness • Increased optimism • Increased social connectedness • Decreased anxiety • Decreased depression • Decreased rumination • Decreased fear of failure (Monitor on Psychology, July/August 2011)

34. The Many Benefits of PracticingSelf-Compassion • “Everybody who studies this finds that high self-compassion is related to higher emotional well-being across the board,” says Mark Leary, PhD, a professor of psychology and neuroscience at Duke University. “There’s no question there are all sorts of emotional benefits” (“The Curse of the Self: Self-Awareness, Egotism, and the Quality of Human Life,” 2007).

35. “Everybody who studies this finds that high self-compassion is related to higher emotional well-being across the board,” says Mark Leary, PhD, a professor of psychology and neuroscience at Duke University. “There’s no question there are all sorts of emotional benefits” (“The Curse of the Self: Self-Awareness, Egotism, and the Quality of Human Life,” 2007).

36. Practicing Self-Compassion vs. Building Self-Esteem • Self-compassion offers the same positive benefits of self-esteem without the negatives. • Self-compassion is not about letting yourself off the hook, but rather being honest and kind with yourself. “In fact, people high in self-compassion take more responsibility for the bad things that happen to them. One reason we deny responsibility for bad things is it makes us feel bad about ourselves. People high in self-compassion, however, can admit their mistakes without flagellation” (Journal of Personality and Social Psychology, Vol. 92, No. 5).

37. This Practice Allows Us to Look at Difficult Realities and Make Positive Changes • Instead of feeling badly at how much work there is to do,or how out of control parts of our lives have gotten, self-compassion helps us acknowledge that everyone has areas that need improvement, and allows us to focus on making even small, positive steps forward.