Expanding our Horizons

To be able

The Touchpoints Approach: Value Disorganization

TBBT. Berry Brazelton, renowned pediatrician and author, developed the Neonatal Behavioral Assessment Scale. The scale assesses newborns’ physical and neurological responses as well as their emotional well-being and individual differences. Brazelton’s greatest achievement, however, has been to raise awareness for the ways that children’s behavior, activity states, and emotional expressions affect their parents, and the ways that parents’ reactions and behaviors, in turn, affect their children.

At birth, babies are ready to build relationships with parents. Their early emotional experiences are powerful enough to become embedded like architecture in their brains. To capitalize on this, Brazelton created the Touchpoints Approach.

Touchpoints are predictable periods of regression and disorganization that occur before bursts in development. What happens between children and their parents at these times? Often, it’s parental frustration and self-doubt, exacerbated by disruption in family relationships. If parents could be warned about these developmental transitions, Brazelton believed they could better understand their children’s behavior, feel more competent, and react positively.

The most critical step in this approach is accepting that development is not linear. The succession of touchpoints in a child’s development is like a map that can be identified and anticipated by parents and providers. Regression, while natural, can cause disorganization. Parents and providers need to embrace the disorganization and value it is a stepping stone—it’s likely a precursor to success. This perspective can change the way parents react to their child, which, in turn, can change the child’s outcome.

Many families of children with delays or disabilities can feel isolated or unsupported. The Touchpoints Approach reinforces providers’ desire to join parents as allies interested in empathetic, not objective, involvement. The approach presents a paradigm shift. It asks us to move from a linear model of development to a multidimensional one. It asks us to focus on parents’ strengths, acknowledging them as the experts on their children. It asks us to see parenting as an ambivalent process built on trial and error. In this way, providers who work with children and families collaborate rather than prescribe, support rather than fix.

quote-T.-Berry-Brazelton

The Touchpoints Approach is an evidenced-based way of understanding and being with families. Providers join the family’s system of care rather than the family joining the providers’ system of care. The child focuses on learning new skills, the parent focuses on developing competencies, and the provider focuses on supporting parents, developing skills, and overcoming assumptions. Goals are optimal child development, healthy and functional families, competent professionals, and strong communities.

While all children develop at their own pace, these Touchpoints typically precede a burst in development and can cause disorganization for the child and family:

  • The Ideal Baby – Pregnancy  TP book
  • The Real Baby – Newborn
  • The Energy Sink – 3 wks
  • The Rewarding Baby – 6-8 wks
  • Looking Outward – 4 mos
  • Up at Night – 7 mos
  • The Pointer – 9 mos
  • The Walker – 12 mos
  • The Clinger – 15 mos
  • Rebel with a Cause – 18 mos
  • Getting to “No!” – 2 yrs
  • “Why?” – 3 yrs
  • What I Do Matters – 4 yrs
  • Who I Am Matters – 5 yrs
  • Entering the Real World – 6 yrs

Excellence: DSPs at Work

All of us

The Capitol Gang: Michael Toothaker, Brittany Smale, Jana Hoffman, Representative Diane Mitsch Bush, Susan Mizen, Heather Gibbon, Yvonne Truelove

At Horizons, we envision a world where people with IDD live community-based lives of their choice supported by highly qualified DSPs. Alliance Colorado celebrated Awareness Day at the Capitol on February 17th, highlighting issues people with IDD face and the work DSPs do. From across the state, 30 DSPs were nominated for the 2016 DSP of the Year Award—all of whom have the knowledge, skills, and values needed to support people with IDD in achieving their life goals.

From Horizons, Jana Hoffman and Brittany Smale were recognized. Jana has worked at Horizons for eight years and Brittany for three. Both Jana and Brittany share a respect for the dignity and completeness of the people in Horizons’ programs.

In the dome

Horizons’ 2016 DSP nominees!

In her worldview, Jana is inherently person centered. She embraces person centered values and employs person centered techniques. When interacting with the people she supports, Jana recognizes their unique attributes and potential. She has exceptional skills and stealth approaches to working with people with IDD, along with the intuitive capacity to understand the person beneath the label.

Jana is respected and admired, quiet and confident, assertive and charismatic. She leads by example and compels others to be their best. Watching her work is like reading a “How To” book—she seamlessly incorporates ideas, strategies, and values to help people achieve their personal goals and greater autonomy. She does this with a gentle spirit and sense of ease: you don’t notice what she’s done until you see the end result. When the people she supports accomplish something you didn’t know they could, that’s when you realize: Jana made this happen.

Jana works well with people who have significant behavioral challenges, people who have extremely high needs, and people who struggle physically or socially. She treats people as individuals without categorizing them, and it works. She makes people feel good about themselves, and it works. Her positivity is contagious, infecting the people she supports and helping them succeed.

Jana with Alliance staff

Jana accepts her nomination as a DSP finalist from Alliance Colorado staff, Ellen Jensby and Josh Rael.

To come up with new ideas to improve people’s lives, Jana taps into her creativity. She discovers new recipes for dinner and unexplored areas of the community for activities. She presents new topics of conversation, unusual games, and unfamiliar faces. In her creativity, Jana is patient and generous. She leads people to new places and waits for them to adapt, accept, decline, or succeed. She wants people to experience life on their own terms, with their own perspective.

Brittany Smale, our other nominee, works weekend shifts at two of our most challenging homes. Residents have high medical and behavioral needs and, at times, Brittany is the only staff for the entire shift. She takes this in stride and no one misses a beat.

Working independently and efficiently, Brittany takes extraordinary care of the people in our programs, paying particular attention to their health. As an LPN, she comes into the office on her time off to talk to her supervisor or agency nurse, following up on health concerns experienced over the weekend. Brittany’s medical knowledge and expertise surpass what’s expected of a DSP and this brings comfort and relief.

Michael, Bob and Brittany

Michael Toothaker, Representative Bob Rankin, Brittany Smale

As a strong natural advocate, Brittany sees people’s strengths rather than their limitations. Her work is predicated on the belief that all people can learn, improve, succeed, and flourish. Her language is person centered and spoken without a trace of negativity, making her a solid support and a consistent leader.

Brittany and Michael

A good team.

Brittany’s actions and words are always a variation on the theme: what can we do to help the people we serve? Her gentle, calm demeanor puts people at ease. Her ability to manage everyone’s needs—the daily details and the big picture—keeps her in high regard among coworkers. She is reliable, dependable, and willing to excel.

When quality is defined at the point of interaction between the DSP and the person with a disability, we feel fortunate to have both Jana and Brittany to fulfill Horizons’ mission.

Real Food: Deciphering Diet Trends

Based on Integrated Health‘s presentation by Cara Marrs, Laura Stout and Charlie Petersen at YVMC.

90% of the cases medical professionals treat in the hospital today are driven by lifestyle diseases—those associated with the way a person lives. That means that while 10% of our health is dictated by genetics, we still have control over the other 90%.

We’ve learned over the years that when we focus on weight, things fall apart. Moving from a definition of diet as a means to lose weight to diet as the kind of food a person continually eats can help us reduce the number and severity of lifestyle diseases.

what causes obesity

Looking back, American diet trends have been intriguing. In the 1930s and 40s, smoking was marketed as a means for weight loss. In the 1950s, there was the cabbage soup diet. It was fast acting and easy to follow: seven days of broth and vegetables. We’ve seen drugs like Fenphedra and Apidren and additives likes Olestra, but these aren’t necessarily safe or sustainable. Diet pills help you lose weight quickly but are intended for short term use only. Diet pills and additives often have undesirable and/or serious medical side effects.

diet-pillszero calories

In the 1980s and 90s, we moved to a low fat trend. Shunning fats, we consumed too many carbs by eating increased amounts of processed fat free foods (which are also high in salt and sugar). The low fat trend gets much of the blame for America’s obesity epidemic.

fat tieIn response, the Atkins Diet removed carbs in favor of high proteins. People lost weight fast, but the Atkins Diet also proved unsustainable. Carbohydrates are essential to our health; along with proteins and fats, they’re one of the macro-nutrients we need to function. Our muscles are fueled by carbs and our brains run on sugar or ketones. A lot of cancers track with a higher consumption of red meat. Those who followed the Atkins Diet experienced higher cholesterol levels and consumed little to no fiber, resulting in a lack of much needed prebiotics. And as soon as they stopped Atkins, their weight returned.

Meal replacement systems like Nutrisystem and Jenny Craig offer prepackaged foods delivered to your house. Portions are controlled and meals provide a balance of macro nutrients. Weight Watchers adds the accountability of a group setting. Drawbacks to these systems include their cost and their use of processed ingredients with lots of chemicals. They provide convenience to consumers but don’t establish a relationship between consumers and food. Once the program is finished, people often don’t know how to shop for and prepare their own meals.

Nutrisystem3

Then came the Master Cleanse (or Lemonade Diet). It consists of salt water each morning, water with fresh lemon juice, maple syrup and cayenne pepper throughout the day, and an herbal laxative tea at night. With virtually no calories, weight loss is guaranteed. But you’ll be losing water weight and lean muscle mass—not fat. Fasting can negatively affect your metabolism, increasing the likelihood that you’ll regain weight once you resume a normal diet. Additionally, the Master Cleanse can set you up for nutrient deficiencies, a weakened immune system, and heart and kidney problems.

Juicing is a similar cleanse promoting detoxification and offering more calories (with little to no protein and fat). It can be a good reset for your body but not a healthy, sustainable weight loss program.

More recently, we’ve begun to see lifestyles marketed more so than diets. We hear people identifying themselves as Paleo or Vegan and proclaiming that they “eat clean.” These lifestyles are on the right track, but it’s important to remember that you can take the good parts from each plan to make your own healthy, sustainable lifestyle. We’re more likely to see people focus on real foods and stay away from processed foods. Mainstream messaging informs us about the harmful effects of sugar, a disease-causing “recreational drug.” More people understand the benefits of eating plant-based food rather than man-made food (aka, “the anti-nutrient”).

apple v cookieAmerican diet trends are continuing in their transition from the determination to lose weight to the appreciation for whole body health. People are accepting that food can be functional and medicinal, tasty and fun. Mindfulness is moving into the kitchen with an intent to nurture a healthy relationship between food, eating, mental health and physical health. We’re considering nutrient density instead of counting calories. We even recognize that cultures exist—Blue Zones—where people don’t diet.

Because of their lifestyles, activities, eating habits and values, people in Blue Zones live long lives free of heart disease, obesity, cancer and diabetes. Blue Zone cultures tend to value mindless movement and/or exercise; community, friends and family; plant-based diets (with meat as an accent); sunshine; a sense of purpose or religion; wine; herbal teas; and goat milk. We can look to these cultures and see that food is more than what we eat.

bluezonestills-3_slide-357c69e87e12bc33f1f95f28fae1deae39ebea09-s800-c85

Real Food: Gut Health

Hippocrates, the Father of Western Medicine, believed that all diseases begin in the gut. The digestive system is directly linked to the immune, nervous and endocrine systems. It’s the avenue through which nutrition is taken in, broken down, absorbed, assimilated and incorporated into our bodies. If your gut is healthy, chances are you’re healthy.

Our modern western lifestyle, however, is far different than Hippocrates’ was in 460 BC. We exist in a culture of stress (which exacerbates digestive issues). We’ve strayed from the daily organic farm to table tradition. And we cohabitate with countless manufactured toxins. From the way we live to the way we feel, our bodies suffer from pervasive threats to our digestive health.

Stress can cause and exacerbate digestive ailments.

Stress can cause and exacerbate digestive ailments.

In their presentation, “Real Food: Gut Health,” Laura Stout, R.D., and Phaedra Fegley, M.D. and Director of Integrated Health, discussed our most common gastrointestinal diseases, their symptoms and some dietary suggestions. Over and over, they extolled the virtues of a plant based diet for keeping the digestive fire strong and healthy. A plant based diet reduces inflammation, increases absorption of nutrients and excretion of toxins, and fuels our bodies for optimal health.

A plant based diet offers lots of fiber. Fiber is what gives plants their structure and is indigestible by humans. Fiber does not add calories to your diet, but it does play a critical role in maintaining gastrointestinal health. The fibrous portion of a vegetable is a prebiotic and can alter the composition of organisms within the gut. Prebiotic food sources include asparagus, garlic, onions, leeks and bananas.

Fibrous, fermented foods optimize gut health.

Fibrous, fermented foods optimize gut health.

The intestinal wall is made up of probiotics, or strains of naturally occurring bacteria which are fed by prebiotics. Probiotics aid digestion, provide nutrients, synthesize vitamins and boost immunity. They rely on prebiotics for nourishment, so buying supplemental probiotics without consuming prebiotics is ineffective. Probiotic food sources include yogurt, kefir, miso, tempeh, kombucha and fermented foods. The pasteurization process kills probiotics.

Understanding and balancing prebiotics and probiotics is essential to cultivating a healthy gut microbiome so that your body can break down your food. But even so, there are foods in our modern western diet that are universally difficult to digest. FODMAP is an acronym of these carbohydrates and their restriction (the FODMAP diet) has been beneficial for people who suffer from gastrointestinal disorders. The carbs are: fructose (fruits with more fructose than glucose, honey, agave nectar); lactose (dairy); fructans (wheat, barley, rye, onion, garlic); galactans (beans, lentils); and polyols (sweeteners such as sorbitol, xylitol).

gut flora

Another seemingly trivial part of our culture that affects our digestive health is drinking cold liquids. Restaurants set tables with plates, utensils, napkins and ice water; it’s how we dine. But, drinking cold water is akin to squelching a fire—you’re literally throwing ice water onto a fire (your digestive system). It’s best to consume liquids that are warm or room temperature, and it’s better to drink liquids between rather than with meals.

The fire of life.

Your gut: the fire of life.

Gastroesophageal Reflux Disease (GERD) is chronic damage caused by stomach acid coming up from the stomach into the esophagus. Symptoms include heartburn, regurgitation, chest pain, feeling like food is stuck in your throat and difficulty or pain when swallowing. Contributing factors can be pregnancy, obesity, alcohol, smoking and certain medications. Lifestyle changes to alleviate the symptoms of GERD include raising the head of your bed 6-8”, not lying down after eating, wearing loose clothing, and drinking liquids between meals rather than with meals. Problematic foods include coffee, tea, cola, citrus, mint flavoring, high fat processed foods, tomato based foods and spicy foods.

A Peptic Ulcer is a break in the lining of the stomach, first part of the small intestine, or lower esophagus. Symptoms include pain (usually worse at night), feelings of fullness, belching, vomiting, poor appetite and weight loss. Treatment options include: antibiotics to get rid of any existing H-pylori bacteria; acid blockers; and stopping the use of NSAIDS and tobacco. Dietary suggestions include limiting the use of alcohol and caffeine as well as fatty, acidic and spicy foods.

Small Intestine Bacterial Overgrowth (SIBO) is a chronic bacterial infection of the small intestine. It’s caused by bacteria that normally live in the gastrointestinal tract that have abnormally overgrown into the small intestine (and are similar to the bacteria found in the colon). The bacteria interfere with the normal digestion and absorption of food that occurs within the small intestine and cause damage to its lining. Common symptoms include abdominal gas, cramps and/or pain as well as constipation and/or diarrhea. Treatment includes antibiotics and probiotics.

Celiac Disease is an immune reaction to eating gluten, a protein found in wheat, barley and rye. Over time, this reaction produces inflammation that damages the small intestine’s lining and prevents absorption of some nutrients (malabsorption). The intestinal damage can cause weight loss, bloating and diarrhea. Eventually, your brain, nervous system, bones, liver and other organs can be deprived of nourishment.

Celiac_disease

The truncating of the villi lining of the small intestine is called villous atrophy.

Irritable Bowel Syndrome (IBS) is the umbrella term used for all of these digestive issues. Stress, diet, medications and hormonal imbalances can play a role.

Inflammatory Bowel Disease (IBD) is an autoimmune disease of the colon and small intestine. Crohn’s Disease and Ulcerative Colitis are the most common types. Currently, there is no medical cure for IBD but prebiotics and probiotics are becoming increasingly effective treatments.

Leaky Gut Syndrome is the condition of increased intestinal permeability which allows food and toxins to leave the intestines and enter the bloodstream. Because these particles aren’t supposed to be in the bloodstream, the immune system identifies them as dangerous and creates an immune response, attacking them along with other healthy cells. Leaky Gut can cause allergies, fatigue, skin conditions, depression, anxiety, insomnia, migraines, and more. It’s important to remember that intestinal impermeability is not fixed—we all have it to some degree and it can change over time.

leakyGut_largeIntegrated Health’s mission is to promote self-healing through interaction of mind, body and spirit and enhance traditional medicine practices.

Horizons Annual Plan Update: Executive Summary, April 2015

When I look back on 2014, I will think of it as a year of growth. We opened a new, seven person apartment building in the spring. By the end of the calendar year, 17 additional people were offered Supported Living (SLS) resources. By March 2015, eleven new people were enrolled in our SLS program with three more in process. In the Children’s Extensive Support Waiver, we have enrolled two new children for a total of four. While these numbers are relatively small, they represent significant growth in our program.

We have achieved many important things:

  1. Seventy-two employees have been trained in Person Centered Thinking.
  2. We are maintaining financial sustainability by limiting growth in agency expenses and increasing revenue.
  3. We developed systems to maximize our use of the funding hierarchy for Early Intervention services.
  4. Individuals are being served in an SLS model using Routt County mill levy funds.
  5. Three individuals were enrolled in our Medicaid comprehensive services program.
  6. Four individuals are enrolled in CES. Three more are approved and one in process. This represents 300% growth for us.
  7. We have 20 one to one mentors for the adults in our programs. These partnerships do a variety of things: attend fundraisers for other non-profits, go skiing, go out for coffee, go for walks, go out for meals, attend social media classes, play billiards, attend local sporting events, go to community concerts, and go to local restaurants for Happy Hour.
  8. We held our third annual Pick a Dish event in Moffat County in April. Interested individuals in Horizons’ adult programs were paired with chefs from local restaurants. Together they prepared a dish to share at the event. About 200 people attended and voted on their favorites. The primary goal of the event was to develop relationships between our chefs and the restaurant chefs that would result in employment. No job offers yet…
  9. Tommy Larson and Sylvia McFeaters were two of the five finalists for the Direct Support Professional of the Year award by Alliance at Awareness Day at the Capitol.
  10. All Adult Service Coordinators have been trained by the Labor Relations Board to conduct investigations.
Jamie Ogden and Ashleigh Santistevan partner with Castle Ranch at this year's Pick a Dish fundraiser in Craig.

Jamie Ogden and Ashleigh Santistevan partner with chefs from Castle Ranch at this year’s Pick a Dish fundraiser in Craig.

Sylvia McFeaters and Tommy Larson were finalists for the 2015 Alliance DSP award. Matt Troeger led the pledge on the House floor on Disability Awareness Day at the Capitol.

Sylvia McFeaters and Tommy Larson were finalists for the 2015 Alliance DSP award. Matt Troeger led the pledge on the House floor on Disability Awareness Day at the Capitol.

We have maintained many important things:

  1. The president of the board of directors is a liaison between the Grand County Advisory Board and Horizons’ board.
  2. We are maintaining our collaborations with Aging Well, the Northwest Colorado Center for Independence, the Yampa Valley Autism Program, Steamboat Adaptive Recreation Services (STARS), and the Council on Aging.
  3. We work closely with Behavior Services of the Rockies and with Mindsprings Health.
  4. We have maintained a high level of supported employment in Routt County.

Our priorities for 2015 include:

  1. Identifying needed growth in infrastructure in response to an additional 15 SLS resources, and growth in CES and comprehensive programs.
  2. Identifying staff to become Person Centered thinking trainers.
  3. Upgrading our vehicles with $81,400 in funding from the Colorado Department of Transportation.
  4. Updating and/or creating policies and procedures.
  5. Improving our system for monitoring agency performance.
  6. Defining our relationship with the local autism program.
  7. Continuing to monitor our budget to ensure that we are limiting growth in expenses and maximizing revenue.
  8. Advocating for choice in Case Management to include Horizons CMs.
  9. Advocating for a solution to CFCM that preserves our mill levy.
  10. Celebrating our 40th anniversary! We are planning 1970’s dance parties in Steamboat and in Craig.

Susan Mizen, Executive Director

I Can Do Better

The R word. The H word. And now the C words: consumers, clients. When can we stop using words to differentiate “us” from “them”? People with disabilities, people in our programs, individuals—do these work? How do we maintain compliance within the current system but still move forward to change it? It was Maya Angelou who said, “I knew then what I knew how to do. Now that I know better, I can do better.”

If language is how we activate our values, what do these words and phrases reveal about us, our perspectives, our intentions and our services? And how do we take buzz words like person first (a good first step) or person centered and transform them into valid change agents for our practices?

At our Person Center Thinking (PCT) Training by Bob Sattler from The Learning Community, we learned that PCT is an ongoing search for effective ways to deal with challenging barriers and conflicting demands. It’s a way to assist people in defining and pursuing desirable futures. PCT takes clarity, commitment and courage. It’s based on respect for the dignity and completeness of every person. To be person centered, we need to ask why (a lot) and consider others’ perspectives. It’s not us versus them; it’s simply us.

Bob Sattler leads the grip of Horizons support professionals through discussion on person centeredness.

Bob Sattler leads a group of Horizons employees through a discussion on person centeredness.

The goal of PCT is to move from a service life to a community life. Bob reminded us that we are not trying to make people independent, but autonomous. After all, how many of us are actually, truly independent? Maybe independence too is a buzz word—one that was well intentioned but not quite accurate?

One focus of the training was the importance of environment. Environment is not a disability issue; everyone is affected by it. Environments can be toxic, tolerated, supportive or healing. A toxic environment can cause depression, aggression or withdrawal. A tolerated environment can lead to feelings of helplessness or powerlessness. Many people live in toxic or tolerated environments and they result in one person (the paid counselor) having power over the other.

Environment is powerful and complex.

Environment is powerful and complex; it can be positive and/or negative.

A supportive environment allows people to grow and blossom. This should be the accepted minimum standard for everyone. A healing environment is needed by those who’ve been hurt in toxic or tolerated environments, and the focus is on restoration and wellness. Both supportive and healing environments foster a sense of empowerment.

While there are distinctions between the kinds of environments we live, work and play in, we can be in multiple environments at the same time. Environments are powerful and multidimensional. They can often be the cause of a symptom we treat; what we see and hear depends on what we’re looking and listening for. This is a reminder to be self-reflective, to continuously look at what’s working and what’s not working, and to address issues effectively.

When we talk about creating person centered lives, we can’t prioritize what’s important to people over what’s important for them. PCT doesn’t mean giving up on health and safety issues for the sake of pure joy and constant happiness. A person centered life is one where a desirable lifestyle has been purposely crafted—it’s full of engaging experiences and rewarding possibilities. It emphasizes dreams and hopes. It fulfills who the person is rather than meeting the needs of the person’s diagnosis.

PCT tells us not to fix people but to support them. Bob’s playful phrase “Don’t should on people!” helps instill this value. And because PCT is part of a process of improving how we support people, it’s important to remember that we’re doing the best with what we know. While Maya Angelou’s words are eloquent and poetic, we can also refer to Bob’s wise words: “My name is [counselor’s name] and it’s been [X] days since I’ve tried to fix someone.”

Adult Program Director Tatum Heath follows up with a work session on implementing PCT tools and strategies.

Horizons Adult Program Director Tatum Heath follows up on Bob’s training with a work session to implement PCT tools and strategies.

Stop Stress!

Children and adults with intellectual or developmental disabilities often experience stressful events and interactions and then use maladaptive strategies to manage these situations. In addition, the presence of behavior challenges in children is linked to elevated stress in parents. Stress is an epidemic in our western world. It’s implicated in 7-10 of the leading causes of death (heart disease, cancer, stroke, suicide, homicide) and indirectly linked to cancer, liver disease and emphysema. 75-90% of visits to primary health care doctors are for stress related concerns. Stress negatively impacts our physical, emotional and psychological wellbeing.

jim-porter_smallHaving recently attended Dr. James Porter’s presentation, “Stop Stress This Minute,” at the Yampa Valley Medical Center, we learned about the causes and effects of stress as well as effective management strategies to reduce its powerful impact.

What causes stress? Is it your job, finances, relationships, responsibilities? No, Dr. Porter says; it’s you! Stress is the result of you, or more specifically, your thinking. Stress is a word that stands for problems. But stress is your problem to solve. Taking responsibility for solving your problems doesn’t mean that you are to blame. It means that you are the one to solve the problem.

Stress is related to feelings of control (a concept so important for people within the I/DD world). People who feel in control of their lives are invigorated and challenged by busy schedules. They believe there’s a solution to every problem. People who don’t feel in control of their lives are overwhelmed. They tend to see problems as unsolvable. In order to feel in control, we need to believe we’re in control. Control begins in our minds.

Stress is the body’s response to demands placed on it. It’s different for everyone; what stresses you out is different than what stresses your coworker or roommate out. Your signs and symptoms are specific to you. Stress is not what happens to you, but how you respond to it.

While today’s stressors have evolved from those of the caveman 25,000 years ago, the physiological reaction is the same. We inherited the Fight or Flight response from our ancestors. When we feel threatened and can’t escape (a predator attacking its prey), our bodies activate a supercharged, high octane response. The hypothalamus sends a message to the adrenal glands. The heart pumps 2-3 times faster, sending nutrient rich blood to major muscles. Capillaries close down and blood pressure rises. Eyes dilate and bodily functions associated with long term survival shut down (digestion and sexual function stop, the immune system shuts down, and excess waste is eliminated). Fight or Flight is short term for survival.

Physical signs of stress can include a pounding heart, upset stomach, dry mouth, rapid pulse, skin rash, perspiration, sleeplessness, diarrhea, recurrent colds, headache, fatigue, weight loss or gain, frequent urination, unexplained or frequent “allergy” attacks, gritting or grinding teeth, neck ache, back pain and muscle spasms. Emotional signs can include anger, frustration, worry, fear, panic, anxiety, feelings of loneliness or worthlessness, and overreaction to petty annoyances. Psychological signs can include crying spells or suicidal thoughts, depression, frequent or wild mood swings, obsessive or compulsive behavior, lies or excuses to cover up poor work, and difficulty in making decisions.

Today, most people manage stress by smoking, eating, drinking, spending money or using drugs. Stress is a ubiquitous and dominating lifestyle factor. So why don’t we manage it? Dr. Porter suggests that our culture promotes stress like a badge of honor—it’s synonymous with the American work ethic. We’ve cultivated a mindset against managing stress. Doctors receive little or no training about its impact on health. As a result, we don’t know how stressed out we are.

Stress is cumulative and our levels vary throughout the day. If something small bothers you, your stress levels have accumulated and you need to hit the reset button. It takes 1-2 hours for stress chemicals (adrenaline and cortisol) to come down to baseline. Dr. Porter encourages us to know our stress number: 0 = no stress and 10 = a panic attack. If we’re at 5 or above, we need to use a strategy to bring it down.

One strategy is Cognitive Restructuring. It’s based on the equation: A (activating event) + B (belief) = C (consequence). Cognitive Restructuring means changing your thinking and it requires a commitment to transformation. It challenges us to get rid of negative self-talk. For example, when we get a flat tire on the way to work (A), we tend to get stressed (C). Most people believe that A = C, when it’s actually our beliefs about the flat tire (B) that determine the consequence. Cognitive Restructuring implies that if we change our thinking (B), we can change the outcome of a stressful event. Instead of responding to A by thinking, “Why does this kind of stuff always happen to me?!”, choose to accept what can’t be changed and stop passing judgment. We can’t change events, but we can change the way we view them. The only thing standing between us and our new behavior is a single thought (B).

Another strategy is to Self-Regulate. This includes deep breathing, progressive muscle relaxation, mindfulness and meditation. Deep breathing opens the capillaries that close during fight or flight. Progressive muscle relaxation relaxes the muscles and lowers blood pressure, heart rate, and respiration. It’s simply the tensing and then relaxing of each muscle group of the body, one group at a time. Mindfulness is all about being in the present moment. In today’s society, we tend to do things mindlessly, or we let our minds wander into the future and feel anxiety or reflect into the past and feel anger. In meditation, we notice the in breath, the out breath and the gap in between. Meditation trains the mind to identify thoughts without judging them or becoming them. Meditation allows us to notice what goes on in the present (where life happens) and breathing is how we bring ourselves into the present.

We’re all somewhat addicted to stress. It’s a buzz; it makes us efficient! It can be the spice of life, but it can also be the kiss of death. So when you decide what it is you want to change—which events or situations cause toxic stress—start small. Make one change at a time and practice it for weeks, if not months, before adding in additional layers of change. First, become aware of the need to change, learn why you should change and consider how you want to change. Once you take action, focus on maintaining your healthy behaviors.

A Time Management Matrix can help you decide which behaviors you want to change.

A Time Management Matrix can help you decide which behaviors you want to change.

And for those of us who know, work or live with people with I/DD or children with behavioral challenges, Dr. Porter’s work reminds us to be curious about how stress presents itself and knowledgeable about strategies to manage it. While stress is a natural human state calling us to pay attention, it can also be identified and nurtured to work for us rather than against us.

There's a relationship between increasing levels of stress and optimal performance--but only to a certain point.

There’s a relationship between increasing levels of stress and optimal performance–but only to a certain point.

Dr. James Porter has presented seminars on stress management at West Point and for The FBI, The Navy, The Department of Homeland Security, The American Heart Association, The International Stress Management Association and at Time Life Headquarters in NYC. His work has been reported on in a wide variety of national media including Good Morning America, PM Magazine, Ladies Home Journal, The Daily News, The Dallas Morning News and in such medical Journals as The Journal of Bio-communication and the Journal of Cardiopulmonary Rehabilitation and The Journal of Family Practice. He is currently a fellow of The American Institute of Stress.

See more at: http://www.youtube.com/watch?v=qAqoKGy9zHM

The Steamboat Pentathlon: The Place to Race and Volunteer

It’s a calling for world-class athletes, seasoned ironman triathletes, adventure racing juggernauts and outdoor warriors. People say it’s not for the faint of heart.

The first Steamboat Pentathlon was held in 1992. It was an effort to invigorate late winter crowds and boost out of town visits. Since then, the one-of-a-kind Pentathlon has brought athletes from all around the state and all stretches of our local competitive landscape. Hardcore and quirky, the Pentathlon epitomizes what Steamboat’s all about.

The race features two courses. The standard course is a combination of a 500 vertical foot climb up Emerald followed by a ski down, a 2.4 mile snowshoe, a 5.6 mile Nordic ski, a 12.8 mile mountain bike ride and a 3.2 mile run. The short course is a 300 vertical foot climb up and ski down, 1.6 mile snowshoe, 1.9 mile Nordic ski, 7.4 mile mountain bike ride and 2 mile run.

But more and more, people are calling the Steamboat Pentathlon a community event. Even with its tangible intensity, competitive zeal, three month training schedules, transition area perfectionism, VO2 max calculations, electrolyte monitoring and carb consuming, it truly is about community. It’s about family and fun. It’s a day in the winter snow (hard ice pack or sugary slush) or spring sun (cloudless, boundless bluebird skies) where people show up to cheer, laugh, breathe and enjoy.

The Steamboat Pentathlon 2015 was a Coloradan bluebird day.

The Steamboat Pentathlon 2015 was a mild and sunny Coloradan bluebird day.

This year’s Pentathlon was the 24th annual. It was also the 4th consecutive year that Horizons has volunteered for the event. Led by Vocational Specialist Mike Dwire and Volunteer Coordinator Tommy Larson, people who work at Horizons and people who participate in the programs have come out to help.

Three of this year's volunteers: Jaimee, Tommy and Paula.

Three of this year’s volunteers: Jaimee, Tommy and Paula.

This year, their station was the midway point of the event’s first leg, the climb up, ski down. A quick ride on the Snowcat to the top of Emerald and the Horizons volunteer team was ready to monitor the station, point racers in the right direction, collect athletes’ clothing and bring it down to the bottom once the leg was finished. Back at the transition site, the team separated clothes and shoes, helping to restore order in an event made as much of gear as it is of grit.

Race coordinators attest to the fact that the Pentathlon cannot be done without volunteers. With Adult, Team, Duo, Youth, Standard and Short course categories, plus a new Adult Chariot Division, race numbers have swelled in recent years to 270 participants. Volunteers help racers on the course—handing out water and energy replacements, cheering them on, and perhaps most importantly, keeping them on the right course amidst the dynamic, spirited buzz of the energized, determined and charismatic racers.

Three-time volunteer Jaimee Purcell Sexton has a blast at the event. Tommy Larson calls her an old pro. “It’s a great opportunity to meet people you’ve never met before,” Jaimee says. “You get to cheer people on. It’s so much fun, I would recommend it to anyone.”

Having fun is just one of the perks of volunteering at the Pentathlon. Supported Living Services and Day Program counselor Paula Lotz helped out this year and says, “Most of the time at Horizons, we’re on the receiving end of giving. It was cool to be on the giving end this time.” It’s great to be able to give—that’s what the volunteer program is all about. It’s also about being part of a community, getting out into it and having a presence. According to Tommy, “Wherever we go, we try to be visible. We knew so many of the racers and we got to show them our support. There was a lot of clapping and a lot of enthusiasm. This year, it was sunscreen, lip balm and laughing.”

The Pentathlon has evolved into a harmonious balance of the red zone, adrenalin craving ultra athletes with family oriented and fun loving, (borderline) ridiculous mountain town fanatics (with team names like “The Heavy Equipment Operators,” “The Frozen Chosen,” “Miller Time,” and “Wizzpoppers”). It’s a community event for all, where people get to show their true colors, push to new limits, create adventurous memories and redefine typical.

The view from the climb up, ski down volunteer station on Emerald (before the mad rush of racers).

The view from the climb up, ski down volunteer station on Emerald (before the mad rush of racers).

2015 DSP Finalist: Sylvia McFeaters

Anyone who knows her will say that Sylvia McFeaters is a ROCK. She has anchored the entire Supported Living Services program in Moffat County for years. She is hardworking and adaptable. She has the ability to step in and out of roles effortlessly. She knows how to see the bright side of people and situations.

Sylvia has been with Horizons for 17 years. She was a Team Coordinator at Duke House, a group home for three people. In 2004, she took over the Supported Living Services and Vocational programs in Moffat. She has been our only staff member agency wide trained as a SIS interviewer. This specific and critical skill gets overshadowed by all the other things she does once someone is assessed. After a recent SIS interview, an individual couldn’t stop talking about her plans once she started receiving support through Horizons. Sylvia really knows how to make a good first impression!

Sylvia and Susan Mizen at our Pick a Dish cooking contest fundraiser.

Sylvia and Susan Mizen at our Pick a Dish cooking contest fundraiser.

Sylvia works with the most challenging behavioral issues in our agency. She can figure out how to work with people so they can function and be part of our programs. She is successful with people with whom it is difficult to build a rapport. Sylvia inspires trust. She is consistent, has clear expectations, validates concerns and needs, and lets others know she is there to help. She is articulate about the plan–no energy is wasted in confusion.

Sylvia never thinks working with challenging behavior is too hard. She only comes to her supervisor with a problem if she has a solution as well. She is a can-do person willing to take on any challenge. “If there were anyone in this agency I had to lean on,” her supervisor said, “it would be Sylvia.” She tackles things head on with a positive attitude and produces amazing results.

In her work, Sylvia is professional. In addition to providing great services and supports, her reports on done on time. She is respectful of everyone and she interacts well with other agencies. Everything she does is with a sense of equality.

In Sylvia’s world, every opportunity is a great opportunity to meet the needs of the people she supports. We’re so excited that Sylvia was recognized for her skills, strengths and value at Alliance Colorado’s Awareness Day at the Capitol.

Sylvia and Service Coordinator Pauline Godfrey working the door at Pick a Dish.

Sylvia and Service Coordinator Pauline Godfrey working the door at Pick a Dish.

2015 DSP Finalist: Tommy Larson

Alliance Colorado held their annual Awareness Day at the Capitol on February 18th, 2015. Awareness Day helps state level elected officials understand the significance of supporting individuals with intellectual and developmental delays and disabilities. Alliance hosts a luncheon for its Community Centered Board and Program Approved Service Agency members and honors the top Direct Support Professionals from around the state. This year, Horizons was proud and excited to have two employees chosen as finalists for the award.

2015 DSP finalists Sylvia McFeaters and Tommy Larson. Matt Troeger led the Pledge.

2015 Alliance DSP Finalists Sylvia McFeaters and Tommy Larson. Matt Troeger led the pledge.

Tommy Larson, our Volunteer Coordinator and a Supported Living Services Counselor, has been with Horizons for eight years. He is one of those people every organization needs. On any given day, he goes above and beyond. Even when you tell him not to go above and beyond, he can’t help himself. That’s his natural state. He volunteers his time to create social opportunities for clients—whether it’s Guys’ Brunch, Spaghetti Night, 4th of July Fireworks, trips to Denver, Labor Day Air Show, or a Pie in the Sky party.

Guys' brunch at CMC

Guys’ Brunch at Colorado Mountain College. That’s a crew!

Tommy consistently addresses needs; the needs of the people he supports come first. When someone he works with injured himself at 9pm on a Sunday night, he called Tommy. Tommy stayed with him until he felt comfortable. This person had never wanted to reach out before, and he might not have called anyone else if Tommy wasn’t part of his life.

When it comes to teaching new skills, Tommy is creative. To work on reading comprehension, Tommy asked the family of a woman he works with to write notes to her. This way, her learning was integrated into her personal relationships and daily living. For individuals who are working on social skills, Tommy brainstorms fun activities in the community and actively encourages participation. Tommy helped Matt host a Midsummer Mixer for friends at a local brewery; the brewery has since offered Matt a job!

Tommy is a connector. He and Matt volunteer at Casey’s Pond retirement community. He involves Horizons in student activities at Colorado Mountain College. Tommy weaves together social circles and makes real, personal, deep connections for himself and others. He doesn’t just go through the motions or follow a program. Tommy lives in the moment and the moment belongs to him and the people with whom he’s working.

Tommy knows that finding natural supports is critical to helping people thrive. He goes the extra mile to connect with existing businesses and organizations to make ordinary days and events extraordinary. He put together a holiday party at Lake Catamount, coaxing a fellow counselor into wearing an elf costume! He organizes road trips to Hahn’s Peak Café to experience the live music of bands. When bands play at Carl’s Tavern, he’s there, too, for camaraderie and fun.

Tommy and his wife Sarah with Peter at a concert in Gondola Square

Tommy and his wife Sarah take in a concert at Gondola Square with Peter.

Tommy is a regular in almost all community events, from Steamboat’s Merry Main Street parade, the Pro Rodeo Series and the circus to the free summer concerts and Steamboat Springs Running Series. On holidays, Tommy invites the people he supports out so they don’t have to be alone. He improves people’s quality of life and he perfectly combines his two roles—advocating for people and advocating for volunteering. Ultimately, he makes the community better.

Merry Main Street parade

Merry Main Street Parade: it’s cold but full of holiday spirit!

Tommy’s humor makes people feel at ease and comfortable. He genuinely listens to people and he genuinely supports people. He is truly person centered. He is selfless but not a martyr. Tommy makes things happen.

Amanda Barnett, Tommy’s supervisor, sees clear program related results after Tommy is done working. She sees an improvement in individuals’ cooking skills, their ability to navigate the kitchen efficiently and use knives. “It’s the person who does the job and how he does it,” Amanda noted.

Professionally, Tommy is always willing to learn. He wants to improve and is open to feedback. He is humble enough to assume he’ll do better next time. Tommy enrolled in the Leadership Steamboat program and consequently expanded his network of community contacts. His participation in Leadership Steamboat led to his involvement with Colorado Gives Day. He created his own donor page and spent hours of time promoting Yampa Valley Gives. His band, Badunkafunk, played at a McKnight’s Irish Pub to promote Colorado Gives/Yampa Valley Gives Day. Badunkafunk never turns down an opportunity to play free for local nonprofits with worthy causes.

Matt easily sums up Tommy: “Tommy is really fun to hang out with. He totally cares about people.” And the mother of a woman in Horizons’ program likes to say: “When my daughter hears special needs, all she hears is special.” Tommy makes this true by providing her with so many opportunities to be special.

Tommy and Mark at Fish Creek Falls

Tommy and Mark enjoying Fish Creek Falls.

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