We have become more aware of depression, but awareness is only the first step. It’s also critical that we’re regularly screening individuals for depression, just like we do for other health conditions like heart disease or high cholesterol. When we catch depression symptoms early on, we can help people realize there is a health problem and get the treatment they need – often through employee assistance programs.

National Depression Screening Day is celebrated each year in the first week of October. In today’s blog, we’ll help you prepare for this important day by giving you tips and resources on how to conduct depression screenings in your workplace.

Understanding what depression looks like

Most people have a general idea of what a “depressed person” looks like; perhaps you imagine someone who is often sad and cries frequently. But in reality, this is only one presentation of depression. There are many types of depressive disorders, and it’s important to understand how each of them can present.

Common symptoms of depression

Sad or low mood and frequent crying often do come along with depression. Some other common symptoms that you may notice include:

• No longer seem to enjoy things they used to enjoy
• Suddenly being apathetic or indifferent to work
• Appearing lethargic or extremely fatigued, which can even lead them to physically move slower than normal
• Decreased productivity at work
• Eating more or less than usual, which can lead to weight gain or loss
• Mood swings or being irritable; snapping at colleagues over small things
• Difficulty concentrating or making decisions; seeming to have a hard time remembering things
• Withdrawing and isolating themselves from others, especially if you’ve known them to be social people
• Increased absenteeism and tardiness
• Frequently complaining of unexplained physical symptoms like headaches or stomachaches
• Being very self-critical or having low self-esteem
• Talking about death and suicide, even if it’s in a “joking” manner

Although not everyone who displays these signs is experiencing depression, it’s important to be aware of the signs so you know what to watch out for. If you notice these signs, consider employee assistance programs to help improve your mental health.

On top of that, there are several different depressive disorders.

Major depressive disorder

This is what we most often refer to when we talk about “clinical depression.” People with major depressive disorder show many of the above symptoms for a period of 2 weeks or more.

Persistent depressive disorder

Persistent depressive disorder is also called chronic depression, and is diagnosed when someone has symptoms of depression for 2 years or more. They may not seem as acutely depressed, but likely show at least some of the symptoms.

Bipolar disorder

People with bipolar disorder swing between mania/hypomania (an intensely euphoric or “high” mood that can cause impulsive and dangerous behaviors) and depression. People with bipolar disorder may not be immediately identified as having depression because they could be in a manic episode the majority of the time. Other people with bipolar disorder are depressed most of the time and only experience one manic episode in their lives.

Postpartum depression

Colleagues who have recently given birth may show signs of postpartum depression, which is when someone experiences depression symptoms after childbirth. Research shows that people who adopt, as well as non-birthing partners, can also experience postpartum depression.

Because of these variations, depression can present itself in many different ways. Regular depression screening can make sure no one falls through the cracks.

Why is it important to screen for depression?

National Depression Screening Day can be an opportunity to remind employees to self-reflect and check themselves for symptoms of depression. Just like they go to their doctor every year for an annual physical exam, they can complete depression screening tools to ensure that their mood and mental health are sound.

Often when we’re experiencing depression, especially if we’ve experienced it for a long time, we don’t realize that we need help. We may assume that certain feelings or experiences are “just a part of life.” This can prevent us from getting support when we need it.

Here are some other reasons why it’s important to regularly screen for depression:

• Regular screening allows for the early identification of depression symptoms, which enables timely intervention and support (employee assistance programs) for employees who may be struggling.
• Employees benefit from increased awareness of their mental health through routine screenings. This knowledge can empower them to take proactive steps in managing their mental well-being and seeking support when it’s needed.
• Routine screening can minimize the personal and professional consequences of untreated depression, like workplace conflicts, strained relationships, financial stress, or compromised work-life balance.
• When people regularly screen themselves for depression, they’re connected to appropriate resources and assistance.
• Screening initiatives play a crucial role in tailoring and targeting mental health support through employee assistance programs in terms of organizational support.
• A workplace that prioritizes regular depression screening experiences improved employee engagement and retention because they’re creating environments that are characterized by care and support.

Screening tools for depression

Here is a helpful list of screening tools and resources that your employees can use to screen themselves for depression. Make sure that employees know that their results will be confidential. The idea is to help them get access to treatment when they otherwise wouldn’t have.

It’s also important to note that depression screening tests are not a replacement for a professional evaluation and diagnosis. No screening tool can diagnose you with depression, but they can give you a better idea of the signs of depression you or your employees might be experiencing and whether or not they could benefit from professional support.

• Beck Depression Inventory (BDI)
• Center for Epidemiological Studies Depression Scale (CES-D)
• EQ-5D
• Hamilton Depression Rating Scale (HAM-D)
• Quick Inventory of Depressive Symptomatology – Self-Report (QIDS-SR)
• Beck Hopelessness Scale
• Patient Health Questionnaire (PHQ-9)

You can get access to most of these tools through the American Psychiatric Association. Mental Health America also offers a quick online depression test that you can take.

Your Employee Assistance Program may also be able to help. If you’re a MINES & Associates client, you and your family have access to free and confidential counseling services at any time, day or night. Our mental health therapists can help you figure out if you might be experiencing depression, and offer guidance and support.

Contact us today and let us know how we can support your organization.

To Your Wellbeing,

The MINES Team

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Happy National Foster Care Month

Several important subjects are tackled in the month of May. Two of them I will be addressing here. May marks National Foster Care Month and Mental Health Awareness Month. Those that work within the foster system are well aware of the issues and concerns around mental health in this subset. Between the abandonment that the majority of these kids feel, to the oversaturation of kids in the system and lack of foster families, all parties are susceptible lack of resources, energy, resilience, and understanding about how to handle the emotional situations that are bound to happen.

Personal Perspective on Foster Care

My husband and I have been working with foster families for five years. Since we do not have kids of our own, we have found a way to work with a group of kids that are severely in need of love, understanding, patience, and support. We work with those who have their own biological kids and yet have opened their home to others in need. We have found that these foster parents lack the support and sometimes understanding of how to give themselves self-care or how to support the emotional needs of the kids in their home. The first family we started working with had a set of siblings who brought forth a lot of complications, concerns, and opened their eyes to how little they really were prepared for this change in their lives. This brought into focus various ways how we can help families traverse this experience.

Examples of Mental Health Concerns within the Foster Family

Lack of Basic Emotional Intelligence

Emotional Intelligence comes in many forms and levels of understanding. Just type in that term and thousands of articles will come up on it and how you can improve your “emotional intelligence.” Most people have some level of understanding emotions and how to differentiate how between various emotions and can recognize those emotions in others. However, most children coming into the foster care system do not understand mad, sad, glad, and the variations that come from these basic feelings. They can’t describe how they feel, and the most can’t express their feelings without throwing a tantrum as that was the only way they could get attention at home.

Foster parents often are uncertain the best way to deal with the lack of emotional understanding of the foster kids. Another dynamic happens when the foster children leave the foster home to be reunited with their biological family. Foster families aren’t often shown how to express their feelings around this with their own kids or their foster children. Teaching families that grief is natural and it is ok to feel various emotions is vital and sorely lacking in my opinion. I think that the movie, InsideOut, was a blessing as we use those characters all the time when we are teaching parents and kids how to express different emotions and talk to each other about what they are feeling in a way that the whole family can understand.

Consequences around Lack of Information

We worked with a family who was fostering 3 kids between the ages of 7-11. The oldest witnessed horrible things his younger siblings went through with trusted family members. Due to this, this child’s emotional age was stunted at 5 years old. The 11-year-old also came from another family that had placed this child on psychotropic drugs to help control their mood swings and poor sleeping habits. This medication variant added another layer that the foster family was unprepared for and was unsure the best action-whether the child should stay in the home or not. The sibling group had an unspoken history and acted as a team against the foster family. These siblings struggled to share anything in therapy and since foster parents do not generally have the rights to hear about what happens in therapy, there was a wall between these kids and the foster family.

The foster family ended up making the hard decision to have the 11-year-old leave their home, but they kept the other two. Due to the lack of knowledge of what happened and the limited access to Medicare therapists, the whole family suffered. The remaining foster kids grieved losing their sibling, and the foster parents were unsure if they made the right decision or to remove the child.

The Effects of Extreme Emotional Turmoil

Another case we have seen revolves around a 12-year-old child went to a home with other kids in it. This child had been in the foster system for 10 years and had a history of being moved around the system, along with going through the adoption process.  This child was on ten different medications and labeled as ODD, RAD, and ADHD. Although the system readily accepted these medications and diagnoses, the foster system restricted access to therapy, support at school, and tools to help this child process their past. This began a 1.5-year cycle of the child threatening suicide, attempting suicide, and threatening the other kids in the home.

Once theft and continual lying was added to the mix, the foster parents had to make the difficult decision to remove this child from the home. The bio-children in the home were devastated, angry, confused, and totally unprepared on how to handle this turmoil. The foster parents struggled with guilt, grief, and burn out between the drawn-out hospital stays, the having to drop everything, and the effort to have this not affect the other children in the home. The relief they felt when the child wasn’t in the home made them feel guilty, the emotions of seeing what he put himself through strained their relationship about how to handle it, and the destruction and stealing of property put them in a difficult situation of deciding what was best for the child and the family. Again, lack of training by the foster system or support to the whole family system around resilience, becoming trauma-informed, and how to give yourself a break as parents was all very hard to witness.

The Need for Training in Foster Families

Although the foster system has access to legal, financial, medical, educational, and mental health services, generally foster parents aren’t told how to access these. In the age of focusing on emotional resilience and work/life balance, these foster families aren’t taught how to do this within the confines of having foster kids. We need to find ways to support our foster families better and give them better access to mental healthcare for the whole family. We need to find ways to give them access to training on emotional resilience and how to do self-care.

Emotional Resiliency

You don’t get to go home and escape the stressors when you are a foster family. You don’t get to take time off when you need it to restore your energy. It is a 24/7 job and unless you have others who tell you to pace yourself or offer you resources, you will burnout as a foster parent. We see this in all the horrible stories of the poor conditions of foster homes or the additional trauma and lack of supportive care the foster children receive in some foster homes. We need to teach those who are foster families (yes the bio-children and foster children too) about resiliency and how to thrive through whatever life throws at you. Here is a great resource around resilience strategies. Also, if you are a MINES client, you have access to a great online resilience program.

Compassion Fatigue/Secondary Trauma/Vicarious Trauma/Burnout

When a child is suicidal or has severe attachment issues, it can be draining to deal with the continual manipulation or the dynamics these mental health conditions can bring into a home and it is easy for families to experience compassion fatigue. When a child finally breaks down and expresses they don’t know how to read and that is why they ditch school or when they share their story of seeing their family die in a fire, foster families need to learn how to recognize secondary or vicarious trauma as they take these stories to heart and want to help these kids out. When the school system says the child doesn’t qualify for assistance or the medical system says the child has maxed out their allotted therapy sessions and hospital stays for the year, burnout can be high. By recognizing these terms and having others close to you keep an eye out for the symptoms, foster families can prepare themselves for the inevitable.

Self-Care

The biggest thing we see lacking is self-care amongst foster parents. Respite Care is an important option for all foster families to take advantage of. Some don’t want to use the respite system as it disrupts the schedule of the foster children and family in general. Some don’t use it as then they still have their bio-children who want their undivided attention while the other children are out of the house. Some use it but don’t know what to do with their time once the children are temporarily out of the home. The web has some great resources on ways to do self-care and there are plenty of articles on it. Two of the easiest things to do is to practice mindfulness and taking time to do things for yourself/loving yourself.

What can you do?

As an Outsider

If you know someone who is a foster parent, thank them. Offer to babysit the whole crew for an evening so they can go have a night out. Offer to make them dinner one night. See if they are connected to a foster support group, and if they aren’t, offer them a list of some, and even offer to go with them. We all need to talk to someone who understands what you are going through. Or help do laundry- extra kids means extra laundry and less time for family time.

And the same goes for the foster kids. Some of these kids have been through literal hell. Some have been abused in ways they don’t even recognize. Some struggle with why they are being removed and whether or not they are loved. The best thing you can do is find ways to connect and support these kids. It isn’t their fault their parents are unable to have them. Regardless of their behaviors or struggles, there is something you can do for them- show them unconditional kindness and love. If they are involved in sports, go see their games. If they are selling chocolate for school, buy some. Find ways to give foster kids a special experience or memory. One thing we do is take them to an ethnic grocery store and let them try various fruits and foods that they have never been exposed to. If all of us can share a bit of ourselves with these kids, then these kids have a better chance of thriving wherever they end up. This website is a great resource and there are plenty of other blogs and stories how you can help those who are in the foster care system. As an outsider, be that person foster kids can come to, feel loved, and help them find good outlets for their anger, frustration, and hurt.

As a Foster Care Provider

If you have time and can become a respite provider, do. If you become a foster parent, take time for self-care, take time to do training and prepare yourself, and consider all the things that can come along with a child before you make the commitment. If you are interested in being a CASA or a GAL, do the research and use your skills. Become a Big Brother or Big Sister or with another support type groups to help kids through the trauma and struggles of growing up without a bio-family or changing home situations. In whatever function you are in, find a support group, get connected with others, and give yourself a break when you falter or struggle. Be prepared to struggle and have a good support team that you see regularly to help you recognize when you start to show signs of secondary trauma or compassion fatigue as it will happen.

Personally, even though we do make sure that we take care of ourselves and our needs so that we don’t suffer from burnout/compassion fatigue, we have found at times to have certain memories burned into our brains and have experienced secondary trauma. We have seen a child draw a dead tree because trees don’t deserve to live and a house with a danger room. We have seen babies stagnate developmentally due to what their mother did while they were pregnant. We have been with families as they received the news of what happened in the biological home and watch it tear them apart. Through it all, we have had to come up with strategies to move past these tragic events and not let those traumatic memories affect our daily lives or interactions with kids.

Final Thoughts

Not all foster care agencies falter when it comes time to prepare foster families and not all foster kids suffer severe mental health conditions. Not all stories are tragic or heartbreaking. We have seen parents truly change their lifestyle or other relatives step up and bring the family back together. Some of these stories are wonderful and heart-warming. However, not all re-unifications result in a positive outcome. Regardless of what you do or how you choose to interact with the foster care system, resiliency, training, and self-care are important.

If you are financially able to support agencies or support groups, please do. There are some great agencies out there are trying to supply the resources needed for foster children and foster families. If you are able to provide free trainings or webinars, find a group to do that for.

MINES would be happy to talk to you more about how you can support your employees who may be foster parents and how EAP services can assist them through the journey they have decided to take. If you are interested in learning more about MINES EAP and PPO program, feel free to contact us at 1-800-873-7138 or at info@minesandassociates.com.

To Your Wellbeing,

Raena Chatwin

The MINES Team

References and Suggested Reading

Joanne Riebschleger, Angelique Day & Amy Damashek (2015) Foster Care Youth Share Stories of Trauma Before, During, and After Placement: Youth Voices for Building Trauma-Informed Systems of Care, Journal of Aggression, Maltreatment & Trauma, 24:4, 339-360, DOI: 10.1080/10926771.2015.1009603

Barbell, K., Wright, L. (2001). Family Foster Care in the Next Century. New York: Routledge. https://www.taylorfrancis.com/books/e/9781351320474

Erum Nadeem, PhD, Jill Waterman, PhD, Jared Foster, PhD, Emilie Paczkowski, PhD, Thomas R. Belin, PhD, and Jeanne Miranda, PhD. (2016) Long-Term Effects of Pre-Placement Risk Factors on Children’s Psychological Symptoms and Parenting Stress Among Families Adopting Children From Foster Care . Journal of Emotional and Behavioral Disorders 25:2, 67 – 81, https://doi.org/10.1177/1063426615621050

Moira A. Szilagyi, David S. Rosen, David Rubin, Sarah Zlotnik. Health Care Issues for Children and Adolescents in Foster Care and Kinship Care. The Council on Foster Care, Adoption, And Kinship Care, The Committee On Adolescence And The Council On Early Childhood Pediatrics, Oct 2015, 136 (4) e1142-e1166; DOI: 10.1542/peds.2015-2656 https://goo.gl/inDxcD

Great Websites to check out

http://www.ncsl.org/research/human-services/mental-health-and-foster-care.aspx

https://www.childwelfare.gov/fostercaremonth/resources/parents/

http://nfpaonline.org/foster

http://www.nationalfostercare.org/national-foster-care-month.html

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