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Bullying in the Digital Age I thought that with this being my first blog I wanted to share about something that I not only have experienced myself, but also worked on with clients and their families. Bullying is a horrible experience for children but also family members who see how devastating it can be and feel helpless to protect their child. Throughout elementary and high school, I was teased about many things such as my looks, reading a lot, not being good at sports, and who I was friends with. I remember being told “it’s just kids being kids'' or “if they see it bugs you, they will keep it up.” For a kid to hear this, and feel like it won’t change and this is horrible. Types of Bullying There are three main types of bullying, Direct, Indirect, and Cyber. Social or Relational Bullying is increasing with our digital age, and will soon be a fourth main type. Although bullying has been around for ages, it has gotten more sophisticated and cruel since the age of Facebook, Snapchat, and the Internet. Direct Bullying takes place when the target individual is physically or verbally attacked by the bully. This is how most parents think about bullying, such as being punched, tripped or name calling. Indirect Bullying takes place when the bully spreads rumors or false information about the target individual. Some parents might have also experienced this type also, examples could be spreading rumors about the target or telling private information such as crushes or embarrassing accidents. Cyber bullying has been in many news articles as of late. This is where a target is being bullied not only on school grounds or classroom chat rooms, but also when they go home. This is a big reason why it is so hard to hold individuals accountable because, where does the school authority end and the law enforcement begin? Cyber bullying can be spreading rumors, telling private information, telling others not to be friends with the target, or sending inappropriate pictures or memes about the target to thousands of people. And as we tell our children, once it is on the internet, it is not able to come off so easily. This is also where the fourth up-and coming type has emerged, Social or Relational Bullying. Social or Relational bullying can be spreading rumors or by using social media as a control mechanism for dating violence. What is more scary for parents is that these bullies put private information, such as School, address, and possibly pictures on the internet for not only the school and world to see, but also sexual predators. Causes Bullying can be about anything and unfortunately students that are just a little different are targets. Most bullies are one person who themselves have witnessed bullying at home or their community. They have learned that bullying makes you powerful and holds this power over others who are afraid of them. These other students will follow along because they are not the ones that are the target. Effects Bullying not only affects the target, but other peers, family members, and younger siblings of the targets. As you would expect, targeted individuals have increased anxiety about their looks, or insecurities that has made them a target, but also depression of constantly being battered with peers’ negative comments. These comments then become negative self talk, and with that goes their self esteem. With a decrease in self esteem, this is when suicidal ideation and self injury become a concern. This is usually when parents start to notice changes in their children. Even if parents have a great open communication relationship with their children, many children want to hide this from parents. And even if they are able to mention things to their parents, how are the parents supposed to protect their children from this invisible thing, again where does the responsibility fall and what if the Bully's parents are unresponsive to the gravity of the situation? Do you go further with legal action? These questions are hard to give a solid answer about. Laws have changed a lot about violence dealing with minors, and this is a positive step for Students, Schools, and States to understand that this is becoming a larger problem. Bullying Policies Many schools have a “No Bullying” Policy, below is an excerpt of my local High School’s bullying policy from the Student Handbook. As a Social Worker who deals with the effects of bullying with students, parents, and adults that experienced it years ago, I feel that this is a great policy, I also feel that the consequences for these actions are also fair. “All students at Worthington High School are entitled to a safe school environment. Therefore, all types of bullying, including cyber bullying, are unacceptable. Cyber bullying is sending or posting harmful or cruel text and/or images using the internet or other digital communication devices. This generally occurs through the use of computers, cellular telephones and/or internet and social media sites. Cyber bullying often occurs outside normal school hours, however, it is detrimental to school climate and can adversely affect student learning. Anyone who engages in Cyber Bullying is considered to be in violation of this policy and shall be subject to appropriate disciplinary actions. This could include, but is not limited to, the loss of Internet/computer privileges.” Consequences: Many school have the consequence that the first time the individual who is bullying will get an In School Suspension (ISS) or an Out of School Suspension (OSS). Many schools are also looking at another consequence of losing internet or computer privileges if the individual is caught participating in Cyber bullying. After the first time, depending on the severity could be expelled or might have legal consequences. If you have questions about your school’s policy, please contact them with any questions. Common Questions: I was bullied growing up, how do I recognize it in my child? This is a great question, as you know how alone you felt when you were bullied, keep an eye out for changes in your child’s mood, activities, and friend circle. If you notice them isolating, not being as excited about activities, not talking about specific friends or not having social dates as usual. I see these changes, but my child does not want to talk to me. What should I do? I completely understand the feeling of feeling lost and unable to protect your child. Start by reaching out to the school, many schools have a staff member that either is a Guidance Counselor or the School contracts with someone that does school based services. This agency might be your local Community Mental Health Agency, or an Agency that specializes in Children in the School age group. What should I say to my child if I think they are being bullied? First and foremost do NOT blame your child for being bullied. They did not ask to have this happen and more than likely, they did not tell you because they were embarrassed that this happened. Work with your child to not retaliate or answer the bullies and keep all materials such as screenshots, emails, or messages to give to the authorities. If you feel that your child is physically in danger, call Law Enforcement right away with your concerns. Are there other resources that could help us understand this? You bet, here are three great websites that deal with bullying specifically. www.bullying.org http://cyberbullying.us http://www.bullybust.org/resources/key_resources I hope that this overview of bullying in our present time has been informational. The more parents, teens, and children who fight against bullies appropriately, the less we will have of this horrible experience for future generations. References: 518 High School Student Handbook 22-23. (2022). 518 Worthington School District. Retrieved September 6, 2022, from https://www.isd518.net/wp-content/uploads/2022/07/WHS-Student-Handbook-2022-2023.pdf Klein, J. (2013, August 1). The Bully Society: School Shootings and the Crisis of Bullying in America’s Schools (Intersections, 6) (Reprint). NYU Press. Disclaimer Last updated: September 06, 2022 Interpretation and Definitions Interpretation The words of which the initial letter is capitalized have meanings defined under the following conditions. 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FAQ's What is with your business name? Tough the years of practice, the one consistent thing I hear is that my clients feel broken. So with every new client, we discuss what feels broken and work together to fix that feeling. Why Private Practice now? When I was working with some clients that were not able to continue when the program's grant ended and they had no services nearby, then I knew it was time to start really researching it. What ages do you see? We currently see only adults at this time, we are wanting to expand to 12 and up soon. We unfortunately are unable to see children under 12 due to the nature of telehealth. What Should I expect? After you send a request for services, we will work together to figure out a day and time to have our Intake Assessment. I will then email you a link to access our client portal so you are able to complete the necessary paperwork before your appointment. Please understand that this paperwork needs to be completed before the session to proceed. This paperwork will include a HIPPA Privacy Policy, a client history, insurance verification, client contacts, payment verification and clinic policies that will include late cancellations, how your information is stored, and more. If you have any questions about the paperwork, feel free to contact me. At your first appointment, we will review any additional information or question you may have and then we will develop goals for a treatment plan that we will work towards each session. At the end of each session we will review our progress and make any necessary changes to the goals and schedule another appointment. Depending on how you learn best, I might ask you to track thoughts or symptoms through the week or maybe complete a worksheet to help you think in a different perspective. These worksheets can be reviewed in session, or just discussed briefly if needed. Important Policies HIPPA Policy: Client’s Rights and Responsibilities: Receive Information. Dignity and Privacy. Each Member is guaranteed the right to be treated with respect and with due consideration for his or her dignity and privacy. Receive information on available treatment options. Each Client is guaranteed the right to receive information on medically necessary available treatment options and alternatives, presented in a manner appropriate to the Client’s condition and ability to understand. Participate in decisions. Each Client is guaranteed the right to participate in decisions regarding his or her health care, including the right to refuse treatment. Free from restraint or seclusion. Each Client is guaranteed the right to be free of any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation. Copy of medical records. Each Client is guaranteed the right to request and receive a copy of his or her medical records, and to request they be amended or corrected as specified in 45 CFR part 164. Free exercise of rights. Each Client is free to exercise his or her rights, and that the exercise of those rights do not adversely affect the way the Client is treated by the provider. Freedom to Change Provider. No More Brokenness, LLC shall not impose any limitation on the Client’s freedom to change mental health providers. Clients have the additional rights and responsibilities: To choose his/her provider To ask for a therapist who understands his/her language and culture To receive needed services at convenient times and places To obtain access to services within the specified access standards To treat others with consideration and respect To be at appointments on time To call if he/she must cancel To be part of the treatment team by telling your doctor or therapist about symptoms and to ask questions To tell the doctor or therapist if you do not agree with recommendations To tell the doctor or therapist when/if you want to end treatment To take medication as prescribed and to tell the doctor if there is a problem To carry his/her insurance cards To tell the Provider if they have other insurance To follow plans and instructions for care that they have agreed on with providers Your therapist may use a cell phone. Please utilize email for complete confidentiality. Second Opinions: Another important right Clients need to know about is the right to request a second opinion. Clients can request a second opinion from a licensed mental health professional. Compliance with the Americans with Disabilities Act: Providers have a responsibility to remove “non-physical” barriers to service and will make available at the request of its clients the following: Assisted listening devices Large print/Braille forms Sign language services Telecommunications devices for the deaf Section 504 of the Rehabilitation Act of 1973 and Title II and III of the Americans with Disabilities Act of 1990 (ADA) set forth requirements for Providers in serving persons who are deaf and hard of hearing or have other disabilities. This manual strives to alert Providers to their responsibilities. Providers should consult their legal counsel with questions or concerns. A person with a disability cannot be denied or excluded from services or treated differently. Auxiliary aids and services must be available at no additional cost to ensure effective communication. Section 504 at 45 CFR Part 84 of the Rehabilitation Act of 1973 prohibitions against discrimination applying to service availability, accessibility, delivery, employment and the administrative activities and responsibilities of organizations receiving Federal financial assistance. Relative to Health Care and Human Services settings, a recipient of Federal financial assistance may not, on the basis of disability: Deny qualified individuals the opportunity to participate in or benefit from federally funded programs, services, or other benefits. Deny access to programs, services, benefits or opportunities to participate as a result of physical barriers. The ADA states that Public Entities must: Provide services, programs and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities. Make reasonable modifications in their policies, practices and procedures to avoid discrimination on the basis of disability, unless they can demonstrate that a modification would fundamentally alter the nature of their service, program or activity. Ensure that individuals with disabilities are not excluded from services, programs and activities because buildings are inaccessible Provide auxiliary aids to individuals with disabilities, at no additional cost, where necessary to ensure effective communication with individuals with hearing, vision or speech impairments. Auxiliary aids include but are not limited to qualified interpreters, assistive listening headsets, television captioning and decoders, telecommunications devices for the deaf (TDDs), videotext displays, readers, taped texts, brailed materials and large print materials. The material presented above in section 2 comes from the OCR Fact Sheet U.S. Department of Health and Human Services Office for Civil Rights Washington DC 20201. Copies can be obtained by calling: 1-800-368-1019 (voice); 1-800-537-7697 (TDD); or e-mail ocr@os.dhhs.gov It is the policy of No More Brokenness, LLC, to provide treatment services to all person without regard to race, color, national origin, religion, sex, age, or disability. No person shall be excluded from participation in, or be denied the benefits of any service, or be subject to discrimination because of race, color, national origin, religion, sex, age, or disability. Complaint Procedures: In the event that you believe that you have been denied services because of your ace, color, national origin, religion, sex, age, or disability, you may file your complaint verbally or in writing. If you should choose to file your complaint in writing, please include your name, address, telephone number and a brief description of what occurred which led you to believe that you were discriminated against. You will not be intimidated, harassed, threatened, or suffer any penalty because you file a complaint. Any penalty or reprisal against you or any other involved person(s) is prohibited by law. Your complaint will be addressed within ten (10) working days to: No More Brokenness, LLC 3800 American Blvd. West Suite 1500 #300-030 Bloomington, MN 55431 Informed Consent for Telehealth Policy: This policy contains important information concerning engaging in electronic psychotherapy or teletherapy. Please read this carefully and let me know if you have any questions. This consent shall only apply to clients physically within the States of Iowa, Maine, Minnesota, Nebraska, North Dakota, and South Dakota seeking therapeutic treatment within the State of IA, ME, MN, NE, ND, and SD. Descriptions of Practice: No More Brokenness provides short and long-term psychotherapy via regular, scheduled appointments. You can expect your first session to be an initial evaluation to determine if No More Brokenness is the right fit to meet your clinical needs. If it is determined that another provider/form of treatment is more appropriate to meet your needs for treatment, resources and potential referrals will be discussed with you. Therapy sessions will be 50 minutes in length, unless scheduled otherwise. You are welcome to contact me by email at sheila@nomorebrokenness.com for scheduling purposes. Although I will make every effort to reply to your messages in a timely fashion, please note that this is generally only possible during regular business hours. No guarantees can be made regarding the promptness of replies during the evening, on weekends, or over vacations/holidays. Every effort will be made to schedule therapy appointments at a mutually agreeable time. Please remember that your appointment time is reserved for you and cannot be used by anyone else. If you need to cancel or reschedule your appointment, I ask that you please provide 48 hours notice when possible. Any cancellations received with less than 24 hours notice will be subject to a no-show fee (see fees section for further details). If a client fails to show up for an appointment, then the clinician will reach out to them via phone. Due to the nature of scheduling, it is usually not possible for appointments to run over. Therefore, sessions of clients who arrive late will still end at the agreed upon time discussed at the client’s previous session. If a client is more than fifteen minutes late for a session without contacting the clinician, the appointment will be considered a no-show and is subject to a no-show fee. Should a client no-show or cancel late two appointments in a row, the therapist will reach out to the client to discuss interest in continued treatment. If the client does not return this therapist’s attempt at contact, the client will be considered to have effectively terminated treatment and the client’s case will be closed within two weeks of the last missed appointment. Client Responsibilities: During the therapy process, I expect you to actively participate. This means that I want to have meaningful and explorative conversations during each session. This also means that you will participate in the educational portions of our therapy, practice skills learned, and utilize your best effort to completing “homework” recommended for upcoming sessions. Punctuality is important for me to be on time for all of my scheduled clients. If you are unable to arrive on time, or must miss a session, please do your best to notify me ahead of time as early as possible. Referrals: Should you or I, at any time, decide that a referral for another service provider would be required or appropriate, I will help provide you with the best and most appropriate resources needed and it will be your duty to contact those resources. Should your new service provider or therapist wish to talk with me, please have them work with you to sign a disclosure agreement and have it emailed to me so we can discuss your needs. Benefits and Risks of Therapy: Therapy can lead to all sorts of new discoveries about yourself and those around you. Many changes may begin to occur, and sometimes they can feel stressful or uncomfortable. I welcome you to address this with me during therapy. Please note that therapy is not meant to fix or cure any problems you may have. Therapy is meant to provide you with skills, coping strategies, and new perspectives on the problems you are experiencing so that you can make positive changes in your life. Teletherapy refers to the remote provision of psychotherapy services using telecommunications technologies such as video conferencing or telephone. A benefit of teletherapy is that the client and therapist can engage in services without being in the same physical location. There are fundamental differences between in-person psychotherapy and teletherapy, as well as some inherent risks, which may include: - Risks to confidentiality - There is potential for third parties to overhear sessions if they are not conducted in a secure environment. I will take reasonable steps to ensure the privacy and security of your information, and it is important for you to review your own security measures and ensure that they are adequate to protect information on your end. You should participate in therapy only while in a room or area where other people are not present and cannot overhear the conversation. - Issues related to technology - There are risks inherent in the use of technology for therapy that are important to understand, such as: potential for technology to fail during a session, potential that transmission of confidential information could be interrupted by unauthorized parties, or potential for electronically stored information to be accessed by unauthorized parties. - Crisis management and intervention - As a general rule, I will not engage in teletherapy with patients who are in a crisis situation. Before engaging in teletherapy, we will develop an emergency response plan to address potential crisis situations that may arise during the course of our teletherapy work. - Efficacy - While most research has failed to demonstrate that teletherapy is less effective than in person psychotherapy, some experienced mental health professionals believe that something is lost by not being in the same room. For example, there is debate about one’s ability when doing remote work to fully process non-verbal information. If you ever have concerns about misunderstandings between us related to our use of technology, please bring up such concerns immediately and we will address the potential misunderstanding together. Electronic Communications: You may be required to have certain system requirements to access electronic psychotherapy via the method we choose. You are solely responsible for any cost to you to obtain any additional/ necessary system requirements, accessories, or software to use electronic psychotherapy. For communication between sessions, I use email communication only with your permission and only for administrative purposes unless we have made another agreement. That means that email exchanges with my office should be limited to things like setting and changing appointments, billing matters, and other related issues. You should be aware that I cannot guarantee the confidentiality of any information communicated by email. Therefore, I will not include any clinical material by email and prefer that you do not as well. Treatment is most effective when clinical discussions occur at your regularly scheduled sessions, however if an urgent issue arises, you should feel free to attempt to reach me by phone. I will make every effort to return your call on the same day you make it, with the exception of weekends and holidays. If you are unable to reach me and feel that you cannot wait for me to return your call, contact your family physician or the nearest emergency room and ask for the psychologist or psychiatrist on call. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact, if necessary. Appropriateness of Teletherapy: If at any time while we are engaging in teletherapy, I determine that teletherapy is no longer the most appropriate form of treatment for you, we will discuss options of engaging in face-to-face in-person counseling or referrals to another professional in your location who can provide appropriate services. Privacy and Confidentiality: Privacy and confidentiality are respected and prioritized with my therapy clients. Some exceptions may occur in extraneous circumstances. All clinicians in Iowa, Maine, Minnesota, Nebraska, North Dakota, and South Dakota are required by law to disclose and report any real threats that a client makes toward themselves, others, or in the suspicion of abuse or neglect of a child or vulnerable person. If you decide that you would like your information disclosed to a specific entity, we will discuss what information will be shared, with whom, and fill out required forms to verify explicit written consent to provide that information. When billing insurance, I might be required to disclose dates of our sessions and diagnoses. Please consider this when thinking about how service fees will be paid. In any situation where legal entities provide a court order for your information, I will personally address this and discuss what will be disclosed before submitting any information to the court. Should this information be requested through legal processes, only required information will be disclosed to best protect both you and our client/clinician relationship. This information also applies to minors seeking therapy within the state approved guidelines. Additionally, this includes information that will be disclosed in joint custodial situations. Your personal information or anything discussed in therapy will not be shared with anyone outside of the needs of professional consultation. In this case, your personal identity will be protected and only some details of your situation will be shared to assist your therapist in providing the best therapy possible. I have a legal and ethical responsibility to make my best efforts to protect all communications, electric and otherwise, that are a part of our teletherapy. However, the nature of electronic communications technologies is such that I cannot guarantee that our communications will be kept confidential and/or that a third party may not gain access to our communications. Even though I may utilize state of the art encryption methods, firewalls, and back-up systems to help secure our communication, there is a risk that our electronic communications may be compromised, unsecured, and/or accessed by a third party. The extent of confidentiality and the exceptions to confidentiality that I outlined in my Disclosure Statement and Informed Consent for Services still apply in teletherapy. Please let me know if you have any questions about exceptions to confidentiality. Emergencies & Technology: Assessing and evaluating threats and other emergencies can be more difficult when conducting teletherapy than in traditional in-person therapy. In order to address some of these difficulties, I will ask you where you are located at the beginning of each session. I will also ask that you identify an emergency contact person who is near your location and who I will contact in the event of a crisis or emergency to assist in addressing the situation. I will ask that you sign a separate authorization form allowing me to contact your emergency contact person as needed during such a crisis or emergency. If the session cuts out, meaning the technological connection fails, and you are having an emergency, do not call me back, but call 911 or go to your nearest emergency room. Call me after you have called or obtained emergency services. If the session cuts out and you are not having an emergency, disconnect from the session and I will wait two minutes and then re-contact you via the teletherapy platform on which we agreed to conduct therapy. If you do not receive a call back within two minutes then call me on the phone number I provided you. If there is a technological failure and we are unable to resume the connection, you will only be charged the prorated amount of actual session time. Fees: The same fee rates shall apply for teletherapy as apply for in-person psychotherapy. However, insurance or other managed care providers may not cover sessions that are conducted using electronic psychotherapy. If your insurance, HMO, third-party payer, or other managed care provider does not cover electronic psychotherapy sessions, you will be solely responsible for the entire fee of the session. Please contact your insurance company prior to our engaging in teletherapy sessions in order to determine whether these sessions will be covered. The no-show/late cancellation fee is $75.00. This charge will not be submitted to your insurance carrier, and it is your sole responsibility to pay. Additionally, if you fail to show for your appointment and do not contact your therapist, any previously scheduled appointments will be cancelled until you contact the therapist to discuss scheduling. In order to establish a realistic plan for professional services, it is important to evaluate what resources are available to pay for such services. If you have a health benefits policy, it will usually provide some coverage for mental health services. I will provide you with assistance in facilitating your use of any insurance benefits to which you are entitled. However, you, and not your insurance company, are responsible for full payment of the fee for services. Therefore, please familiarize yourself thoroughly with your insurance coverage for psychotherapy services. The extent of coverage, yearly deductibles, coinsurance payments, or copayments vary significantly depending on your insurance plan. No More Brokenness cannot be responsible for knowing the specifics of your personal policy. Responsibility for paying any deductibles, co-insurance payments, or copayments associated with your plan remain with the client. Clients are expected to pay the therapy fee at the time of service by cashiers check, check or charge; payments processed by card are subject to a nominal processing fee of 3%. Checks should be made payable to No More Brokenness LLC. Complaints: I am well educated on and adhere to a strict code of ethical standards as proposed by the National Association of Social Work. Should any issues arise that you feel needs to be addressed, please contact me with any questions and we can discuss them appropriately to a resolution. You and I each have the right to end our professional relationship at any time. I will conduct therapy in a professional manner and expect that my clients do the same. The States of Iowa, Maine, Minnesota, Nebraska, North Dakota, and South Dakota requires Social Workers to adhere to a specific Code of Ethics that is determined by the NASW. Should you feel dissatisfied and wish to file a complaint, you may do so through your state's specific office for complaints: Bureau of Professional Licensure Iowa Board of Social Work 321 E. 12th St. Des Moins, IA 503319 515-281-3121 Office of Professional & Occupational Regulation Maine Board of Social Work 35 State House Station Augusta ME 04333-0035 207-624-8660 Minnesota Board of Social Work 335 Randolph Ave Suite 245 Saint Paul, MN 55102-5502 612-617-2100 Nebraska Board of Social Work DHHS Division of Public Health Investigations Attn: POL Investigation Unit P.O. Box 98933 Lincoln, NE 68509 North Dakota Board of Social Work Examiners P.O. Box 914 Bismarck, ND 58502-0914 701-222-0255 South Dakota Board of Social Work Examiners 810 North Main St. Suite 298 Spearfish, SD 57783 605-642-1600 Emergencies: In the case of an emergency in which you feel the need to include me, please contact me and I will do my best to support the needs that you may have. If you do find yourself in an eminent emergency, please contact 911, report to the nearest emergency room, or contact the following mental health crisis hotline: 1-800-273-8255 For veterans, press 1 at the menu after dialing