This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Tuesday, December 6, 2011

Anxiety Scale Rough Draft



ANXIETY SCALE



0 – Cool as a cucumber.
EX: On second day of long vacation, soaking alone at a spa.

1 – Everyday minor stress needed to function. Occasional twinges of minor discomfort.
INTERVENTION: No intervention needed
EX: Alarm clock goes off. First bell rings.

2 - Minor bother.
INTERVENTION: Self-initiated calming skills. No outside intervention needed.
EX: Need to move quickly to get to class. Momentarily can’t find homework. See a cute boy.
3 – Anxiety annoying enough to be distracting.
INTERVENTION: Coping/calming skills still work, but might need outside reminders to use them.EX: Loud, chaotic environment. Quiz you’re prepared for. Ex-boyfriend standing 15ft away.

4 - Can be ignored if you are really involved; still distracting. Somatic symptoms.
INTERVENTION: Brief breaks with adult support and assistance using coping/calming skills. Can be redirected back to class.
EX: People arguing. Test is prepared for. Presenting a well-prepared presentation with a group.

5 - Can't be ignored for more than 30 minutes. Thoughts of hurting self intruding, but controllable.
INTERVENTION: Brief breaks with adult emotional support. Might be able to access coping skills with assistance. Can probably be redirected back to class or work independently in less stressful environment.
EX: Giving a speech to a group. Getting feedback or gentle teasing. Feeling behind in schoolwork

6 - Can't be ignored but still can work. Wants others to keep her safe from acting on feelings of self-harm.
INTERVENTION: Leave stressful environment and continue work. Learning Lab? Talk with behavior specialist. Coping skills might work after calm down a little.
EX: Picked on/teased by peers. Test in class struggling in.

7 - Hard to concentrate, bothers sleep. Can still function. Feels need to escape. Suicidal thoughts. Needs stressors limited by others or will escalate.
INTERVENTION: Leave stressful environment and not able to access cognitive part of brain for school work. Can’t access coping skills.
EX: Feels personally attacked by someone close to her. Overwhelmed because behind in classes.

8 - Activity limited a lot. Can read non-school books and talk with effort. Suicidal thoughts with plan, but not seeking out means. Paranoid others hate her and are out to get her. Acting out behaviors if can’t escape.
INTERVENTION: Reduce stressors as much as possible. Consider hospitalization, but can wait for open bed.

9 - Unable to function. Crying out or moaning. Acting out. Fight/ Flight or Freeze Reactions. Suicidal thoughts with plan and means, threatening, but not actively attempting to commit suicide.
INTERVENTION: Immediate removal from all stressors. Hospitalization.

10 – Totally Stressed Out. Eyeballs explode.

3 comments:

beemommy said...

That.is.awesome!!!!!!Mama Mary, you rock!

schnitzelbank said...

Teacher here. LOL, #10 is sort of funny. I'm glad you can have a sense of humor in all this! I'm wondering if this should be adapted a bit to help the adults at school.

Around #9, the scale seems to start to fall apart (as Kitty does, too?). Does she sleep in school (like you say in #7)? Would she really be crying/moaning in school, even if she were at #9? It seems like, in the past, she has been more quiet in school, even at the dangerous #9 level. I think this might need to be modified for just the adults at school. Some of the things you describe sound like (from what I've read) things that Kitty only does at home, or things that only you and her Dad would confront (like hospitalization). Keep it focused on the adults at school and what they need to do.

First, does Kitty have any visual symptoms they could pick up on? Is there something she does (or doesn't do)
Here are some links to give you some ideas:
http://painconsortium.nih.gov/pain_scales/ChecklistofNonverbal.pdf

Read pg 2 here, about "eye contact" and "posture" and so forth. Could any of these things be clues to where Kitty is on the scale?
http://prc.coh.org/pdf/Psychosocial%20Pain%20Assessment%20Form.pdf

http://www.childcancerpain.org/content.cfm?content=assess07

Next, the adults are going to need to know HOW to use this with Kitty. How do you want them to walk her through it, in getting a reading? Here is an example script:

http://www.iasp-pain.org/Content/NavigationMenu/GeneralResourceLinks/FacesPainScaleRevised/default.htm

Read at least the "General Recommendations" here, to help guide the adults at school in using your scale:

http://www.aspmn.org/Organization/documents/NonverbalJournalFINAL.pdf

Could you also include some instructions, such as, do you want the adults to use the scale, based on observation, and then have Kitty use the scale, based on her self-reporting? And do you want them to document this? Make them a chart! Have them put down the date/time, place, what # the adult thinks Kitty is on (based on observation), and what # Kitty ranks herself at. And do you want them to call you, if she's at a certain number? That seems to be missing in your "interventions" -- what do you want them to do next?

This is off to a good start, but it needs some tweaking. Like, under "interventions," I would focus it on what you want the adults at school to do. In #7, for example, you say she can't access coping skills. But that isn't an intervention. And in #8, you're ready to hospitalize her (but the adults at school aren't going to do that --- maybe at #8, that's when they call you to notify).

If I were going to make a scale like this, I'd do this:

Number = short phrase to describe state, the title for this number ("3 = Distracting Anxiety")

Triggers = situations that could trigger her ("ex-boyfriend in the same room")

Emotions = adjectives that describe how Kitty is feeling ("slightly worried, nervous, butterflies in stomach, sweaty palms")

Symptoms = outward physical symptoms ("fidgeting, lack of eye contact, inattentive, slightly rapid speech, complains of tummy ache").

Intervention = Remind Kitty of coping skills. Recheck in 30 minutes.

Struggling to Stand said...

I read it as a Kitty-rates-herself scale for use at home or school. But Schnitzelbank has a great point in being specific about who is answering the questions and if they are only for when she's at school. Since your biggest concern is school, you do want to be sure that is addressed. But you also don't want to confuse Kitty with multiple scales and you yourself would love to have some clearer indication from Kitty about how she feels, right? I'd be tempted, then, to leave the higher numbers basicallly the way they are. Kitty can say at school or at home that she is a 7 or an 8, but the school personnel wouldn't be expected to see or rate her at an 8 or above. (Doesn't mean it is impossible, just highly unlikely.)

You did great with the kitties, but unfortunately I see the #9 one as cute and playful. Perhaps there is a comic type pic of a cat that would work better? (I had the image of a cat about to be under the wheel of a truck, but even in cartoon form I guess that would be too much for kitty.)