Lessons from a Hateful Video: A UCLA Student's Racial Tirade

UCLA Authorities are up in arms about a "repugnant," racist video that went viral last Friday, and for good reason. The YouTube video is both embarrassing for the University and shameful to our generation; but far worse is this student's clear lack of insight, awareness, and empathy for her fellow classmates.

As a social worker, I am trained to look at this incident from multiple perspectives, including the perspective of Alexandra Wallace, the student who created this video. In no way am I defending her behavior, but I will say that generating a hateful discussion about this person is both counterproductive and dangerous. It is critical that we divert our energy and attention to the lessons we all can learn from this horrific YouTube posting:

1. Our actions have consequences
2. Racism is driven by hate, but it is also driven by ignorance
3. There is a difference between being politically incorrect and racist
4. Emoting on YouTube is passive-aggressive and childish
5. The term "American Manners" does not exist
6. Extended familial support is a beautiful thing
7. If you don't like your environment, feel free to change it
8. Attaching specific behaviors to ethnic, racial, or religious groups is stereotyping
9. Imitating another culture's language is rude, embarrassing, and downright repulsive
10. Racism can be subtle or obvious

Wallace will undoubtedly pay for her actions. She will most likely not be able to finish her degree at UCLA, show her face on campus without feeling immensely shameful, or find a respectable job if she graduates from college. While I believe it is important that we all take part in a communal discussion about the social implications of her video, I believe it is equally important to proceed with caution and limit our knee-jerk reactions. Contributing to the demise of an individual, even if it is through an anonymous posting online, is in some ways just as hateful.

I ask my fellow social workers to be cautious when discussing this video with others. Let's try to make it a productive conversation, rather than a hateful one.

Photo Credit: Peter Cade

My Secret Weapon: Psych Notes Pocket Guide

Please let me introduce you to Psych Notes Clinical Pocket Guide. I often refer to this as my "secret weapon" while I'm at my internship, because it contains all kinds of great assessment tools, disorder overviews, intervention techniques, and a lot of other useful information for professionals who work at an inpatient psychiatric hospital.

I am constantly referring to it when I conduct biopsychosocial assessments, interact with new patients, or write notes in patient's charts. I think this is a great tool for anyone who is entering the field of psychiatry, whether it be nurses, therapists, social workers, etc. The notebook is dense, but really compact (note its size compared to a computer mouse), making it great for portability. 

Psych Notes is divided into seven distinct sections including basics, assessment, disorders/interview, drugs/lab, drugs A-Z, crisis, geriatrics, and tools/index. This makes it incredibly easy to locate the information I need.

The basics tab contains an overview of various psychological theories including psychodynamic (pictured), psychosocial, and interpersonal. Additionally, biological aspects of mental illness, issues related to confidentiality, HIPAA, and patient's rights are also covered.

I frequently use the assessment tab, as it guides the components I must cover during a biopsychosocial interview of incoming patients.

Because the DSM is a bit cumbersome to reference (especially when time is of the essence), the disorder overviews are particularly helpful when trying to evaluate a patient's presenting symptoms, and a possible diagnosis.

Considering the low cost, I think Psych Notes is a great investment to students or new social workers to the field of mental health. Plus, it's water proof, which really came in handy last week when I spilled coffee all over my desk!

















The entire notebook is also available to download via Scribd. Enjoy!

Psych Notes - Clinical Pocket Guide Scanned

How to Engage a Difficult Patient

Alyssa* is a 45-year-old Eastern European female admitted to the inpatient psychiatric unit for being a danger to others and for being gravely disabled. Alyssa’s landlord contacted Santa Monica Police after she threatened to kill tenants living in her building. Law enforcement brought her to the hospital after she verbally threatened to stab the police with a knife hidden in her nightstand. Upon arrival, Alyssa was extremely paranoid and claimed that numerous individuals are plotting to kill her. Upon a Biopsychosocial assessment, Alyssa threatened the social worker numerous times, stating that if she wasn’t discharged immediately, she plans to sue the hospital and have the treatment team arrested.

The above vignette is a common example of the type of patient I see on the inpatient unit at Harbor UCLA Medical Center. As a social work intern, interacting with patients who believe they do not belong on the unit is incredibly challenging. When interviewing or assessing newly admitted patients, it is not uncommon for patients to verbally threaten me, make snide or rude comments, or sit in silence. To be fair, it is completely understandable that patients are frustrated, angry, or embarrassed when they are legally required to stay at the hospital.

After trying a number of different ways to engage with patients like Alyssa, I now have a few go-to strategies that strengthen rapport, and ultimately, increase my ability to help patients during their stay.

1. Encourage Med Compliancy: While this might be controversial, I often tell patients that a surefire way to expedite discharge is through medication compliancy. This is a great way to align patient goals with those of the treatment team, as patients tend to stabilize much quicker when consistently adhering to medication regiments. Plus, there is no question that length of stay for those who take medication is shorter than those who don’t.

2. Alleviate boredom: Whether it’s retrieving a bible, a magazine from the hospital gift shop, or requesting the occupational therapist to play a song during exercise group, finding small ways to alleviate boredom allows me to form an alliance with patients.

3. Contact Collateral: Contacting patients’ family or friends can be a great way to connect with a difficult patient. Because patients do not always have change for the payphone or have access to the phone at the nursing station, I will often bring patients back to my office to make a phone call. The sentiment is definitely appreciated, especially when a patient is calling long distance.

4. Catch Patients Doing Good: Due to the nature of the inpatient milieu, the treatment team often focuses on patients who are either disrupting the unit, or refusing the take their medication. I have found it to be extremely important to “catch” patients who exhibit good behavior. Verbally reinforcing these instances is not only a chance to build rapport, but also shows the patient that the treatment team genuinely wants to see improvement.

5. Internet Research: Whether its providing patients with a brochure to an outpatient care provider or looking up an address so they can write a letter, conducting quick internet searches for patients can help link them to outside resources.

*Patient identity has been concealed.

UCLA MSW Program: Recruitment Materials

Each year, the Diversity Caucus at UCLA's MSW program holds "Diversity Day," an on-campus event for prospective students. It's a really unique event that goes beyond just receiving general information about the program. It's a great opportunity to speak with faculty, staff, and current students about how UCLA is different, while also gaining advice for how to increase your chances of acceptance.

In a previous post, I wrote about how helpful the event was in guiding me through the application process. Program staff gives you a packet of information with all kinds of tips, recommendations and helpful hints about the application process. Since I know it's geographical challenging for all those applying to UCLA's program to attend the event, I thought I'd post the most recent Diversity Day Recruitment Materials packet (apologies for being a few months late!). Hope you find it as helpful as I did.

UCLA MSW_Recruitment Materials_2010

UCLA MSW Program: A $50 Million Gift

UCLA alumnus, Meyer and Renee Luskin, announced that they are donating $100 million to UCLA, half of which is going directly to The School of Public Affairs. Because of this generous donation, the school will be renamed The Meyer and Renee Luskin School of Public Affairs (officially on March 18, 2011). According to the LA Times, this is the second largest donation in UCLA's history (David Geffen holds the top spot at $200 million for the Geffen Medical School).

This gift could not come at a more pressing time. Governor Jerry Brown recently announced budget cuts of $500 million in funding for UC campuses. Tuition is increasing for students across the board (8% for MSW students for the 2011-2012 academic year), and the Restructuring Steering Committee is looking for ways to trim fat in any way they can.

According to Chancellor Block, the money will be used to fund an endowment, build a new conference building for the Luskin Center, support research, and develop new programs in urban planning and social justice.

What does this mean, specifically for students in the MSW program? I'm not quite sure. What I do know is that in order for the program to continue to attract talent, in addition to compete with USC, tuition costs must remain affordable and competitive.

LCSW Licensure Exam Changes

The National Association of Social Workers (NASW) California Chapter just announced changes to the LCSW Licensure Exam. Starting on January 1st, 2013, those sitting for the exam no longer have to take the Clinical Vignette Exams. Associate Social Workers will just have to take the California Law and Ethics Exam along with a Clinical Exam. Wohoo!

Read the full story in NASW CA's January newsletter.

A Biopsychosocial for Jared Lee Loughner

For those who are new to the social work field, the biopsychosocial is a tool mental health professionals utilize to capture relevant biological, psychological and social information about a client. In any psychiatric inpatient setting, the biopsychosocial not only provides a holistic vantage point from which to understand the client, but it also allows the treatment team to start connecting the dots and formulating an action plan to treat mental illness.

While it is a travesty that Jared Lee Loughner never entered treatment, I believe social work professionals and students can benefit immensely from identifying and understanding the warning signs of someone who could commit such a horrific crime.  

The following is a brief and speculative biopsychosocial of Loughner, based off of internet articles and the like:

Loughner is a 22 year-old, white male that has reached a state of crisis after attempting to assassinate Representative Gabrielle Giffords, successfully killing five other individuals, and severely wounding 14 others. Loughner's homicidal ideation towards the Congresswoman started in 2007, after receiving an invitation to a local meet and greet with the politician. 

Loughner's erratic and disturbing behavior started to unfold in 2007. Loughner was fired from a minimum wage job, let go from a volunteer position at an animal shelter, and had several bizarre confrontations with classmates at his local community college. Pima Community College police were contacted five times within an eight month span. As a result, Pima Community College required that he seek a mental health screening, to deem that he was no longer a danger to himself (suicidal ideation) or a danger to others (homicidal ideation). It is likely that the patient reached his breaking point after he was asked to leave Pima Community College. 

In regards to his mental health status, it is clear that Loughner is suffering from a severe and persistent mental illness. YouTube videos and other internet rants on social networking sites, reveal that Loughner exhibited extremely disorganized thinking and bizarre thoughts. Additionally, Loughner harbors extremely paranoid and persecutory delusions, including the belief that the U.S. government is responsible for the terrorist attacks that took place on 9/11. Loughner perseverates on numerous other conspiracy theories such as the belief of a new currency that will result from a New World Order, the idea that the government brainwashes individuals by controlling their grammar, and a belief that NASA conducts fraudulent spaceflights. The individual was also reportedly obsessed with lucid dreams, mostly because of his ability to transfix his mind in an alternative state where he could live a different reality. These obsessions and delusions allude to a possible thought or psychotic disorder. 

Additionally, Loughner has a history of drug abuse, as evidenced by an alcohol poisoning incident that led to his withdrawal from high school in 2006, and a drug paraphernalia possession charge in 2007. The U.S. military also rejected Loughner's application in 2008, due to his admitted use of marijuana. His drug history potentially points to a drug induced psychosis. 

Loughner's rants on various internet sights also reveal that he was antisemitic and anti-religious. Loughner's deteriorating mental state was exacerbated by social isolation. 

In hindsight, it is clear that Loughner needed to enter treatment long before he committed the horrific events that took place on January 8th, 2011. However, it is important for mental health professionals and those training to be, take the time to evaluate the warning signs that Loughner exhibited. I believe it is a lesson to all of us that we not only pay greater attention to those we interact with, but also encourage family and friends to look for these same warning signs.

Photo Credit: Getty Images

Ego Boost

Today was a rough day to say the least. Due to some shuffling around of interns' and residents' schedules, the caseload of my team nearly doubled. I felt like I was a chicken running around with my head cutoff. Here is a breakdown of exactly what my day looked like today:

8:30 - 9:00      Reviewed patient census sheet
9:00 - 10:30    Attended medical rounds with entire treatment team
10:30 - 11:30  Bio-psychosocial interview, patient note, contacted patient collateral
11:30 - 11:45  Attempted to engage difficult patient; retrieved bible per patient's request
11:45 - 12:30  Bio-psychosocial interview; supervised while patient contacted collateral
12:30 - 1:00   Assisted with patient discharge
1:00 - 1:30     Lunch
1:30 - 2:30     Touch base with supervisor/review caseload
2:30 - 3:00     Wrote patient note for second bio-psychosocial interview
3:00 - 3:30     Prepped for family meeting
3:30 - 4:45     Attended family meeting to discuss patient's discharge

Once I arrived home, I felt exhausted from a busy but productive day. As I was trying to muster up the energy to begin my reading assignments, I decided to procrastinate for a few minutes and check out some of my blog stats. I noticed a lot of new traffic coming from MastersofSocialWork.org, and decided to see if this website posted a link to my blog.

To my surprise, the blog on MastersofSocialWork.org named The Nudge Patrol as one of the Top 50 Social Work Blogs. I'm listed as #4 under the "academic" category.

I am thrilled about this recognition, and it was definitely welcomed after a tough day at placement.

Patrolling the Web this Week

Below are some of my favorite articles and websites I've come across in the past two weeks. I hope readers find them just as insightful and/or entertaining as I do.

A slam dunk for mental health: via Zev Yaroslavsky. As some of you might know, Ron Artest, famous NBA basketball player infamous for his erratic behavior and anger outbursts, has recently sold his 2009 Lakers Championship ring to raise money for The Los Angeles Department of Mental Health. Below is a great in depth interview where Artest explains why he feels so close to this cause.


Ron Artest speaks to Los Angeles County Department of Mental Health from Alysa Solomon on Vimeo.

People Problems Masquerading as Business Problems: By Dan Pallota. Rarely do business and social work collide on the Harvard Business Blog, but the author of the article manages to do so just beautifully. Company founder of Pallotta TeamWorks and president of Springboard, Pallotta talks about the importance of deciphering between work-related problems and life-related problems in employees' lives. He believes that the ability to recognize this difference is the key to increasing worker productivity. His advice? "Make psychological and spiritual well-being as much a priority in your company as all of your other key operating indicators." America could really use more CEOs like Dan Pallota.

Isabelle Caro, Anorexic Model, Dies at 28: By William Grimes. This is truly a tragic story. Isabelle, widely known for her anti-anorexia campaign, lost her life to complications from Anorexia Nervosa in November of last year. It is unforgivable that women die from this completely preventable disorder.

Operation Beautiful: By Caitlyn Boyle. I stumbled across this blogger's website two weeks ago and have loved it ever since. Operation Beautiful is a way for complete strangers to communicate inspiring messages to each other, by means of sticky notes left in public places (bathroom stalls, drug stores, supermarkets, schools, etc.). I really liked today's phrase of the day: “When you get to the end of your rope, tie a knot and hang on.” I have yet to discover an Operation Beautiful sticky note in Los Angeles, but perhaps I will create one this week.

Simple guide to speaking foreign languages: By zenhabits. This article could not have been more timely for me. Zenhabits, a blog I consistently follow, has some really great tips on how to become fluent in a language (in three months!). While my expectations for learning a second language are not quite as bold, I believe his philosophy of speaking the language for at least an hour a day is crucial to the success of mastering another language. Looks like I'll have to find a way to start speaking outside of my Spanish class on Fridays.

Newer antipsychotics overused: By Julie Steenhuysen. According to a recent study, newer antipsychotic medications are being dolled out to patients without hard, scientific evidence to justify the prescription. Originally created to treat psychoses, these medications are now being used by doctors to treat depression, bipolar disorder and even autism. Among the drugs are Risperdal, Zyprexa, Abilify, and Seroquel.

UCLA MSW Program: Pre-Licensure Coursework

Last year, UCLA MSW students felt one consequence of California's budget crisis in a big way; tuition costs nearly doubled, increasing tuition to nearly $18,000 and $30,000 for California residents and non-residents respectfully. As expected, students became outraged and demanded faculty to find ways to mitigate enormous fee hikes.

This past fall, MSW faculty announced a few ways they were going to offset professional fee increases, including the decision to offer pre-licensure courses for students planning to become Licensed Clinical Social Workers (LCSWs). The following is a list of the five required pre-licensure exams (UCLA will provide condensed versions of each class that will still qualify students to sit for licensing exams):

1. Child Abuse Assessment and Reporting (seven hours)
2. Human Sexuality (ten hours)
3. Substance Abuse Dependency (fifteen hours)
4. Spousal/Partner Abuse Assessment, Detection and Intervention (fifteen hours)
5. Aging and Long-Term Care (ten hours)

Although faculty and administration have just started moving in the right direction, I do believe this promise is a great first step in appeasing valid concerns and frustrations over tuition hikes. Pre-licensure courses are extremely practical for micro students, as it will help students save time and money.

Unfortunately, field faculty recently informed one of my classmates that the pre-licensure classes will not be available to 1st year MSW students, the reason being twofold: (1) Faculty wants to ensure that 2nd year MSW students will have a spot in the class. (2) Topics covered in the pre-licensure courses are more advanced than the 1st year curriculum.

To be frank, I feel it is unfortunate that 1st year students are not allowed to participate in the pre-licensure courses. It's inevitable that some students will not be able to complete all five courses (scheduling conflicts always seem to get in the way!). It would be nice to have the opportunity to make up for a missed class. Graduates will then be forced to pay for and find the time to take one of these courses later.

Dare I ask what faculty has in mind to appease macro students?