As soon as a body lands in the pool, water is pushed out to make room for the plunging object. Since the water has no other place to go, it shoots upward and outward. A precision dive might produce a slight splash, but a cannonball splatters and leaves a ripple effect. Within the compassion continuum, similar risk exists for caring child-serving adults who help children during intense emotional situations. Calm waters can be disturbed by unfortunate events. Without an awareness and after-care plan for the possible cannonball, the helper may be vulnerable to significant water loss of their own.

Vicarious trauma and secondary traumatic stress can impact the helper’s own emotional state. These two terms are similar because the starting point of the water splatter is not due to the helper’s own events in the moment – rather, the helper intends to be a resource and knows that being authentic is crucial to build rapport. The helping alliance brings a person-to-person connection, with the helper serving as a resource. The helper must keep his or her heart open to let their sources pour in the direction of children. During the helping relationship, however, an event that acts like a cannonball can happen. After the cannonball, the helper may be experiencing waves of emotional distress, challenging the helper’s strength.

Vicarious Trauma
When vicarious trauma occurs, it’s as if two swimming pools are next to each other. The helper is one pool. In this place, the helper is empathetic and sensitive to the needs of the children. The helper is aware and ready to respond to the children’s needs. Openness is necessary for the relationship to be beneficial.

However, exposure to someone else’s trauma can disrupt the calm pool of the helper. In the second pool, when the person being helped experiences an unfortunate event, the situation could catapult like a cannonball into his or her swimming pool – leaving water to splatter across and begins to ripple the water in the helper’s pool. A swell of emotions impacts the helper due to empathy. The helper may be keenly able to identify with the other person’s pain and loss – so much so that the helper is now flooded with the intense emotions of the other pool. The unfortunate event did not happen for the helper, but he or she may react as if it did. The helper may be exposed to pictures, sounds or other sensory input that is overwhelming. He or she is able to imagine the pain and loss of the other to the point that it feels so real. At the vicarious trauma point along the continuum, the helper is underwater due to waves of empathy.

Secondary Traumatic Stress
Secondary traumatic stress happens when the cannonball splats into the helper’s pool! During secondary traumatic stress, sensory immersion takes place: heart racing, sweating and confusion. A helper may experience secondary traumatic stress if his/her own history is similar to the child’s. The helper may be reminded of his or her own challenges, and this realization can activate the threat mode and produce a defensive reaction. If the helper is not self-aware and using self-care strategies, unanticipated events can burst in like a waterfall as if the helper had no warning signal. This surprise can bring disorientation and survival reactions. Additionally, the helper may be exposed to elements of the cannonball through another person but internalize possibilities for him or herself. For example, if child is in a crisis situation that has a lot of similarities to characteristics of the helper’s own life (e.g., same kind of car in an accident, same age of child, or the “that could have been me” realization), a helper may feel the weight of fear. Similar to the first hand experiences of those who are helped, the helper may then proceed to his or her own first hand experiences with intrusive memories, second guessing, and other avoidance and alarm reactions. At the secondary traumatic stress point along the continuum, the helper feels as if he or she is sitting empty and frightened.

Vicarious trauma and secondary traumatic stress prevention and intervention strategies:

• Use checklists to frequently evaluate stress levels
• Participate in healthy self-care in the areas of thinking, feeling and doing
• Utilize mindfulness practices
• Engage in reflective supervision

The health insurance marketplace opens for enrollment on November 1. According to the Affordable Care Act, most Missourians are required to have health insurance or pay a penalty. 
 
To date, nearly 254,000 Missourians have obtained coverage through the Missouri Health Insurance Marketplace, according to the U.S. Department of Health and Human Services. In the past enrollment period, 90 percent of Missouri Marketplace enrollees qualified for premium tax credits to lower their costs, which lowered the average premium payment from $363 to $85 per month. 
 
Additionally, the United States Supreme Court voted to uphold subsidies for health insurance purchased through federally-run marketplaces like the Missouri Marketplace in June. Thanks to this ruling, Missourians who rely on this financial help don’t have to worry about choosing between health insurance and other basic needs – vital health services will continue to be available at an affordable cost.
 
The Cover Missouri Coalition works to build awareness, facilitate enrollment, increase health insurance literacy and support Medicaid transformation. As part of Cover Missouri, Freeman participates in the coordinated statewide outreach effort during open enrollment to help our neighbors get covered.
 
Please contact the Freeman Marketplace Team at 417.347.8888 or toll-free, 855.355.PLAN (7526) to visit with one of our certified specialists. You can learn more about financial help and coverage options or schedule an appointment. For additional information, visit covermissouri.org or call 800.466.3213 for the Cover Missouri call center. Don’t delay – open enrollment ends January 31, 2016!

The American Academy of Pediatrics recommends exclusively breastfeeding for about the first six months of a baby's life, and then gradually adding solid foods while continuing breastfeeding until at least the baby's first birthday. The first few days after your baby’s birth are important for establishing a successful breastfeeding relationship. Try these tips to get the process started:

Breastfeed within the first hour after delivery. Tell your health care provider you would like to breastfeed as soon as possible after delivery. The best way to accomplish this and help your baby transition outside the womb is to place your baby skin-to-skin on your chest.

Keep your baby with you in your room at the hospital. Your baby can stay with you from delivery until discharge if both of you are stable. Rooming in allows you to get to know each other. Newborns are often sleepy in the early days and rooming in will help you learn early hunger cues. Additionally, families usually rest better knowing baby is safe and content beside them.

Breastfeed on demand. This means to breastfeed as long and as often as baby desires. Watching for these early hunger cues will help in getting frequent feedings:

• Starting to wake
• Smacking or licking lips
• Opening and closing mouth
• Sucking on lips, tongue or hands

Try to avoid artificial nipples, such as bottles and pacifiers, for the first few weeks. The American Academy of Pediatrics recommends waiting until breastfeeding is well established, about 3 weeks for most babies, before introducing a pacifier to a breastfeeding baby. Pacifiers can keep you from noticing early hunger cues and can interfere with a baby learning to breastfeed.

Breastfeed exclusively. Only offering breast milk to the baby encourages a better milk supply to be established. The first two weeks after delivery are when prolactin, a hormone that helps make breast milk, increases to produce adequate milk for the baby. Plenty of time spent with your baby breastfeeding and holding him or her will aid in stimulating prolactin levels.

Source: Missouri Show Me Five Hospital Initiative link: http://health.mo.gov/living/families/wic/breastfeeding

“The greatest healing therapy is friendship and love.” – Hubert H. Humphrey, Jr.

I recently received an invitation apply for an award to recognize Freeman WellBalance, our employee wellness program, for its social wellness offerings. I have been promoting wellness for over 10 years and have never been asked specifically about our social wellness initiatives. Typically, when we think of wellness or health promotion, we often reference or expect to see information on healthy eating or increasing our physical activity. Both of these areas of wellness have a social component, but you may be wondering, what is social wellness?

Social wellness has been described by the University of California as one's ability to interact with people around them. It involves using good communications skills, having meaningful relationships, respecting yourself and others, and creating a support system that includes family members and friends. It’s important to note that face-to-face interaction with friends and loved ones is crucial for social wellness. We may feel that we engage in social wellness on a regular basis through social networks such as Facebook and Twitter, but those interactions do not take place in person.

Research shows there is a direct correlation between the degree to which a person feels connected to others and mental and physical health. Individuals who don’t feel connected to others have a greater likelihood of developing chronic illness, such as diabetes and heart disease, than someone with strong social connections. They may suffer from more occurrences of cold and flu and/or take longer to recover from illness. These individuals may also be more likely to develop depression and to have lack of energy or interest in activities. It has also been noted that they may have shorter lifespans.

Here are a few ways you can help improve your own social wellness:

• Set a time to meet in-person with a family member or friend you haven’t seen in a while
• Volunteer your time at a local event or nonprofit
• Invite a friend for a walk or hike
• Make a habit of logging off social media when you are in a group setting
• Develop good listening skills and stay present when people are talking to you

Take time this week to try one of the ideas above and see if you have more energy or excitement for life. 

When the weather begins getting cooler, nothing is better than a bowl of delicious, hearty chili to warm you up! This recipe for garden harvest chili is chock-full of fall vegetables – and it’s diabetes-friendly.

Ingredients

• 1 medium sweet red pepper, chopped 
• 1 medium onion, chopped 
• 4 garlic cloves, minced 
• 2 tablespoons canola oil 
• 1 tablespoon chili powder 
• 1 teaspoon ground cumin 
• 1 teaspoon dried oregano 
• 2 cups cubed peeled butternut squash 
• 1 can (28 ounces) diced tomatoes, undrained 
• 2 cups diced zucchini 
• 1 can (15 ounces) black beans, rinsed and drained 
• 1 can (8-3/4 ounces) whole kernel corn, drained 
• 1/4 cup minced fresh parsley 

Cooking instructions
In a large saucepan, sauté the red pepper, onion and garlic in oil until tender. Stir in the chili powder, cumin, oregano, butternut squash and tomatoes; bring to a boil. Reduce heat; cover and simmer for 10-15 minutes or until squash is almost tender. 
Stir in remaining ingredients; cover and simmer 10 minutes longer or until heated through. 
Serves 7. Nutritional analysis per serving: 193 calories, 5 g fat, 0 g saturated fat, 0 mg cholesterol, 167 mg sodium, 33 g carbohydrates, 0 fiber, 8 g protein. 

Like many holidays, Christmas can be a challenge for those on the autism spectrum. Holidays often disrupt routines and bring an array of new foods, sounds and smells – all of which can be overwhelming or distressing for individuals with autism. By planning ahead, you can help your child have an enjoyable holiday.

Family gatherings
To prepare your child for a family gathering, start by telling a story with visual clues to let him or her know what to expect. He or she will want to know when the gathering will start, when it will end and the activities that are planned in between.

Bringing a reinforcing item can also help. For instance, if your child likes a particular video game, and you have a large and family gathering coming up, don’t allow the child to play the video game the day before the event. Then, during the gathering, make the game available to your child. Your child may also have specific food preferences for meals – pack a sack lunch if your child won’t enjoy some the foods that will be served.

Try talking with your family ahead of time to address your child’s needs. For instance, your family may want to arrive to the party a little early so your child can adjust, and you may need to leave early as well. Ask if there is a quiet place where your child can rest if needed. The party’s hosts may also want to make a few arrangements in their home before you arrive – for instance, if your child likes to open doors, they may want to lock all doors they do not want opened. If your child likes to tap on objects, it may be a good idea for glass and other breakables to be moved out of reach.

Your family members may ask you for ideas for appropriate gifts for your child. As with all children, receiving a lot of gifts can be overwhelming for your child. Let your family members know about your child’s individual interests, preferences and strengths. Gift certificates for activities that your child enjoys, such as a bounce house or roller-skating, make great gifts.

Decorating for the holidays
Holiday decorations around your home can be disruptive for your child. My best tip is for parents to remember that their vision for their home for Christmas may not quite match up with the reality of how your home will actually look – and that’s OK! Consider selecting decorations that are child friendly, non-breakable and interactive. Instead of worrying about what your family or neighbors might think of your decorations, try looking at Christmas through the eyes of your child. Your child will always have special memories of how you decorate your house. If your tree is decorated with toy cars only, that’s alright. If decorations have to be hung five feet or higher on the wall, that’s OK, too! 

Holiday travel
Whether traveling by plane or car, pack comforts of home for your child. Having familiar items can be comforting during stressful situations. For instance, if a special blanket or pillow would make your child more comfortable at night, bring that along. If your child uses a special bowl or spoon during breakfast, bring this item, too! Pack your child’s reinforcing items. Be sure to go over all the plans with your child so he or she knows what will happen in advance. Try not to cram too many activities in a short period of time, and schedule in rest time once you’ve arrived at your destination and in between activities.

Holiday family photos
Family photos are a wonderful holiday tradition. Whether planning for a large family photo at a gathering or a photo for your Christmas cards, it’s important to remember some children with autism have difficulties making eye contact with a camera. A photographer friend of mine had a great tip for photographing children with autism – try not to have the expectation that the child has to make eye contact with the camera. Instead of having everyone smiling and looking at the camera, have everyone interacting with each other in the photo and smiling. Mom or Dad can interact with the child. This will put less pressure on your child for the photo, and you’ll still get a wonderful family photo and great memories to look back on for years to come.

“One person caring about another represents life's greatest value.” – Jim Rohn, author and motivational speaker

During this season of giving, I often think about those across the country who are providing long-term care to a family member. The Centers for Disease Control and Prevention reports that an estimated 21% of households in the United States are impacted by caregiving responsibilities. The report shows that caregivers have difficulty finding time for themselves (35%), managing emotional and physical stress (29%), and balancing work and family responsibilities. Many caregivers do not get adequate sleep or physical activity. They don’t take the time to see their own doctor or get their own preventive screenings. Caregiving can be emotionally taxing, resulting in abuse of alcohol tobacco, or other drugs to deal with stress and depression.

Caregivers – give yourself the gift of self-care this holiday season! Try these tips:

• Care for yourself first. Imagine yourself on a plane that is experiencing turbulence. If the oxygen mask falls down, you are instructed to put it on yourself first so you can help others, including your children. When you take care of your needs first, you can more effectively help your loved one.
• Accept help when it is offered. The next time loved ones offer to help, let them do so! Make a list of responsibilities that others could help you complete, such as picking up groceries or prescriptions or staying with your loved one so you can take a 15-minute walk. Call someone who has asked to help in the past and take him or her up on the offer.

If you are not a caregiver but know someone who is, give him or her a call or stop by and donate your time. What better way to celebrate the holiday season than by truly giving to others?

Keeping a personal health history is important. Not only can it save you time and money by avoiding unnecessary tests and procedures, it could also save your life.

Keep a card or sheet of paper in your purse or wallet with the following information:

Past medical history: Include all diagnoses that you've received from a medical provider such as high blood pressure or thyroid problems. Also include any history of stroke and record of childbirth. No problem is too minor – for example, knowing that you have dental decay is important because cavities can increase risk of heart disease.

Past surgical history: Include minor procedures such as cataract removal and colonoscopy/endoscopy as well as major procedures such as hysterectomy, cardiac stents and gallbladder and appendix removal. By knowing what has been done, you can help avoid unnecessary tests such as a gallbladder ultrasound for abdominal pain when you've already had your gallbladder removed.

Family history: Include important things such as diabetes, heart attacks, stroke, cancer and thyroid disorder. Also include inherited diseases such as muscular dystrophy or cystic fibrosis because these can give doctors clues to diagnoses that are not initially considered.

Prevention services: Include dates and results of last Pap test, mammogram, PSA, colonoscopy and bone density testing. This can also help you avoid redundant testing and enhance prevention of life-threatening diseases.

Medication allergies and intolerances: Include a list of medications that you cannot tolerate and be sure to list the reason why you cannot take each medicine. In some cases, the drug "allergy" may actually be an intolerance, and knowing this could save your life if a certain medicine is needed to treat a disease, such as a drug-resistant bacterial infection.

Current medications: Include dose and frequency, reason for taking medicine, how long you have taken the medicine (months and years), name of the prescribing physician and your pharmacy name and phone number.

Contact numbers: Include the name and phone number of your emergency contact person, the person who has your power of attorney, and primary care physician. If applicable, be sure to include your advance medical directives, which may include instructions such as "do not resuscitate" or "do not intubate."

Having this information available makes check-in easy with each and every doctor visit. Additionally, having it accessible in your wallet or purse could save your life in an emergency situation. If you need help composing your health history, ask your family doctor for help; he or she should be able to provide you with needed information.

In the United States, approximately 6.5 million people are affected by chronic wounds (wounds that fail to heal) each year. As a wound healing expert I am often asked, “Why do some wounds heal without any trouble and others not heal?”

Several factors determine whether a wound will heal or not:

• The wound must get adequate blood supply
• The wound must be free of dead tissue
• The wound must not have any active infection
• The wound should be managed with moist healing techniques

If all of the above criteria are met, then the wound should eventually heal. If you have a wound that has not healed completely in 2-4 weeks, we would consider it a chronic – or problem – wound that needs specialized care.

If you have a problem wound, I encourage you to call and make an appointment at Freeman Wound Care. No referrals are needed. To make an appointment, call 417.347.4800 or request an appointment online.

For good mental health, it’s important to anticipate reactions to the anniversary of a traumatic event. For children, the timing can be about a specific date something happened (for example, May 22, 2011), a key event that happens on an annual basis (a birth date or specific holiday) or seasonal (visual cues in nature or decorations people may use during the time frame). The anniversary of events such as these serve as a strong reminder — it may renew early feelings and spark worries that a similar event may happen in the near future.

Understand that each child attaches his or her own meaning to the original event. Therefore, one child may be more reactive to information or reminders about the event than another. Around the anniversary of a traumatic event, your child may become irritable, anxious, withdrawn or even aggressive.

• Young children tend to express fears at home, such as fears of sleeping alone or worries about the safety of their loved ones.
• School-aged children may acquire new fears because they are imagining worse-case scenarios; everyday situations may now be perceived as risky.
• Adolescents may respond to an anniversary with more reckless behavior and by acting out.

Adults can respond to anniversaries by validating the child’s vulnerability and apprehension. Try saying, “I can see why you feel that way”. Then, let children acknowledge the anniversary in their own way. Some children may express a lot of interest, while others may choose to ignore the anniversary altogether. Don’t force children to either acknowledge or ignore the anniversary.

Be prepared that internally, the children are wondering, “Could the event happen again”? While the answer may be “Yes” you can help by emphasizing the importance of having a plan and being in control of the situation — this helps build resilience and coping skills. For example, be clear about what the routine will be during an emergency. Show your child where and how to use emergency kits. Practice for an emergency during a calm time and reinforce the message that it’s important to be prepared, whether or not an emergency occurs.

Adults can prepare themselves by detecting distress signals from the child. Protect your children from unnecessary exposure to troubling reminders, such as news stories. When your child expresses a concern or worry, respond in a calming and reassuring manner. It may be helpful to talk about current sadness as well as what has gone well since the event.

If the event is disrupting eating, sleeping or physical/emotional well-being, please seek help from a mental health professional.