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What’s the difference? Physician Assistant vs Nurse Practitioner

Health care delivery has undergone significant changes in the last few decades. The need for cost-effective care skyrocketed along with the number of people living with chronic illness demanding access to care. At times it has been said that individuals trained as a Nurse Practitioner or a Physician Assistant are interchangeable as medical providers. While many hospital systems may hire Nurse Practitioners or Physician Assistants to fill similar roles, the training and licensure of each program prepares the clinician to practice in a different way. 

The Physician Assistant profession was created in the mid 1960’s to meet the growing demand for access to health care, specifically access to primary care providers. Duke University Medical Center offered the first official program training individuals to provide medical care as a Physician Assistant based on the “fast track” programming for individuals trained to provide medical care during World War II.

Nursing pioneers were up to similar work across the country in Colorado, as the first Nurse Practitioner program was developed in 1965 at The University of Colorado to meet the growing demand for primary care providers in that region of the country. Many of the early Nurse Practitioner’s were trained in certificate programs through hospital systems and universities before formal Master’s Programs were developed.

The foundational training of a Registered Nurse, including hours of clinical experience, sets the Nurse Practitioner apart from the track Physician Assistants take.

The primary differences in training for a Physician Assistant and a Nurse Practitioner is found within the names of each. A Physician Assistant is trained similarly to a physician, under the medical model after completing the following requirements:

  • Bachelors Degree (GPA above 3.0)
  • Program Pre-requisite courses 
  • GRE or MCAT (program specific)
  • 1 year clinical experience in a healthcare setting.

Once admitted, PA programs focus on a comprehensive general medical education in addition to the clinical experiences. Most PA programs are over 100 credit hours completed in 2 years. The different Master of Health Sciences curriculums provides PA students with depth of knowledge in the basic medical sciences and clinical medicine, as well as skills in administration and research.

PA programs today are Master’s level programs with both didactic and clinical experiences that prepare individuals to take the Physician Assistant National Certification Exam or “PANCE” exam, achieving the certification designation of PA-C and opportunity to move on to state licensure. PA Certifications in subspecialty areas are available including in Mental Health/Psychiatry, this is achieved by completing the PA Certificate of Added Qualifications (PA-CAQ) clinical experience and passing the exam.

What is important to remember is that both PA and APRN programs support clinical care that is evidence based and held to standards at the state licensure and national certification levels.

Nurse Practitioners are first and foremost nurses. They are trained in the nursing model to practice the art and science that is nursing. They are licensed to practice as an RN prior to continuing their education in Nursing to become an Advanced Practice Registered Nurse (APRN). Graduate level nursing programs require the following:

  • Bachelor of Science in Nursing (BSN) from an accredited program (GPA 3.0-4.0)
  • RN license in good standing with the state
  • GRE entrance exam 
  • 1-2 years Nursing Experience (programs vary)

Nurse Practitioners are trained at Master’s or Doctoral levels (depending on the program or specialty) as well as must sit for their specialty’s board certification exam and meet the licensure requirements for their state. Nurse Practitioner’s can sit for the American Academy of Nurse Practitioners Certification Board (AANPCB) or the American Nurses Credentialing Center (ANCC) exam. Master of Science in Nursing programs can be completed in 18 months while Doctor of Nursing Programs and PhD Nursing programs are completed between 3 – 5 years depending on full or part time course work. These advanced nursing programs range from 70 – 100 credit hours. 

The Doctor of Nursing Practice is a Clinical Degree that prepares the Advance Practice Nurse to translate research evidence into nursing practice, understand and contribute to healthcare policy (including budgets, financial management, leadership theory), as well as cultivating practice expertise in their specialty. APRNs are independent licensed providers and required to sit for board certification in their specialty.

The role of the nurse practitioner can differ somewhat depending on the state in which the APRN is practicing. Certain states allow work to be completely independent, whereas others require them to work in a collaborative agreement with a Physician. The State of Florida requires APRN’s to practice with a collaborative agreement and general supervision from a physician or dentist. Nurse Practitioners are independent prescribers for non-controlled substances, after 2 years of practice experience in the State of FL APRN’s are eligible for their DEA License and prescriptive rights for both controlled and non-controlled substances.

 

Elizabeth Winings, DNP, APRN, PMHNP-BC

At the Retreat PVB we have Elizabeth Winings, DNP, APRN as our Director of Nursing. She is ANCC board certified as a Family Psychiatric Mental Health Nurse Practitioner. After completing her Bachelors of Science in Nursing at The University of Florida in 2011 and a 1-year surgical nurse residency program through the VA Hospital in Gainesville, FL she transitioned to community based care as an emergency room nurse for 2 years. These experiences inspired her to pursue advanced training in mental health and nutrition. She completed her Masters of Science in Nursing at the University of Florida in 2013 and began practicing as a Psychiatric Nurse Practitioner in Jacksonville in the spring of 2014, initially at The UF Health Department of Psychiatry in their outpatient adult, child and adolescent clinic. She transitioned to join the team at Nemours Specialty Clinic in the fall of 2015 where she was able further specialize in the care of children and adolescents in the outpatient setting as well as on the inpatient Behavioral Health Unit at Wolfson Children’s Hospital. While working as a Nurse Practitioner, Dr. Winings continued her education as well as specialized in Plant Based Nutrition through Cornell University and completed a 300 hour internship in Lifestyle Medicine at The True North Health Center in Santa Rosa, CA. She completed her Doctor of Nursing Practice through UF in 2016. Dr. Winings grew up in Jacksonville and is honored to bring her passion for nursing, wellness, and mental health to the community of Ponte Vedra Beach and surrounding areas. Come experience the personalized care of a Nurse Practitioner at The Retreat at Ponte Vedra Beach!

Psychiatric Direct Care Membership

We are so thankful for our clients and excited to offer Direct Psychiatric Care Membership Plans in 2019! Each plan outlined below is a different RPVB monthly membership option covering the costs Psychiatric of care at The Retreat at Ponte Vedra Beach. You can read more about the details of each plan as well as contact our office if you are interested in learning more!

1. Point of Care

Personalized psychiatric care in an inviting and comfortable environment is available right here in Ponte Vedra.  At The Retreat at PVB, psychiatric medication management services are accessible and affordable without compromising quality of care.  Medications recommendations and management is combined with supportive care, careful measurement of response, and consideration of alternative and integrative therapies.

What is the cost?  $147.00 per month

What is included?

  • 1-2 visits monthly.
  • Visits will last 15 to 30 minutes.  
  • Family support, coordination with other providers, discounted admission to Retreat sponsored events
  • You will receive a 50% discount on fitness and educational services (excludes personal fitness, individual academic coaching) in 2019!

How do I know if Point of Care is right for me?  You have been treatment responsive in the past. You are new to treatment and this frequency of care has been advised by your provider. You are in already in psychotherapy therapy with your own therapist or counselor for regularly recurring (not open ended) visits. You are not currently in therapy but are willing and able to begin counseling/therapy, if it is recommended as part of your treatment plan.

2. Enhanced Psychopharmacology

Medication management plays a role in treatment and recovery of many psychiatric and emotional conditions.  Evidence-based interventions are employed along with measurements to follow response to remission. We are committed to helping you feel confident that the medication you are taking is making a difference.  

What is the cost?  $297.00 per month

What is included?

  • 2 visits monthly.
  • Visits will last 30 to 45 minutes.  
  • Priority scheduling for early morning and afternoons.
  • Family support, coordination with other providers, discounted admission to Retreat sponsored events
  • You will receive a 50% discount on fitness and educational services (excludes personal fitness, individual academic coaching) in 2019!

How do I know if Enhanced Psychopharmacology is right for me?  You have complex or treatment refractory conditions or a preference for longer visits. You will benefit from additional supportive and brief Cognitive-Behavioral Therapy interventions.  You may or may not also be involved in therapy with a psychologist, counselor, or therapist outside RPVB.

3. Wellcare Advantage Counseling

Set your goals for wellness and chart your course with the support and strategies for success.  Discover the barriers to making the changes you desire. Find the motivation to achieve your vision of thriving.  Take a deep dive into the psychological factors impacting your Wellness goals. Attain the practical advice for your diet, exercise plan, and decisions making to surpass your expectations.  

What is the cost?  $497.00 per month

What is included?

  • 3 visits monthly.
  • The first visit of the month with last 60 minutes and include goal setting and planning.  The second 2 visits are 30 minutes and will examine progress and barriers and set short term goals.
  • Family support, coordination with other providers, discounted admission to Retreat sponsored events
  • You will receive a 50% discount on fitness and educational services (excludes personal fitness, individual academic coaching) in 2019!

How do I know if Wellcare Advantage Counseling is right for me?  You are looking for combination of positive psychology and wellness care.  You are interested in making some changes to your lifestyle. You want support setting and reaching goals related to diet, exercise, and health-seeking behaviors. You do not require management of medications.  

4. Comprehensive Psychiatric Care with Psychotherapy

The Retreat at PVB was founded with the determination to provide a level psychiatric of care that has nearly been eliminated by managed care.  We are dedicated to spending our time in the service of our patient. We are committed to a model of prevention and respect for the multidimensional factors leading to issues that bring people through our doors.  Optimal results cannot be obtained without consideration of normal development, relationships, past experiences and insight into the how, the why, and the now. When indicated, medication management should enhance the process of growth or recovery in therapy.  

What is the cost?  $997.00 per month

What is included?

  • 4 visits monthly.
  • Visits will last 60 minutes.  
  • Priority scheduling for early morning and afternoons.
  • Family support, coordination with other providers, discounted admission to Retreat sponsored events
  • You will receive a 50% discount on fitness and educational services (excludes personal fitness, individual academic coaching) in 2019!

How do I know if Comprehensive Psychiatric care with Psychotherapy is right for me?  You are curious about your internal life and you are looking for insight and answers to help you live a more peaceful or content life. You will benefit from Psychodynamic Psychotherapy or Cognitive-Behavioral Therapy and are ready to commit to regular sessions.  You may or may not be taking or considering taking psychiatric medications or alternative. You are not currently involved in therapy with a psychologist, counselor, or therapist outside RPVB, unless specialty referral is necessary.

5. *ADD ON* Concierge Care to Comprehensive Psychiatric Care with Psychotherapy

The addition of Concierge Level Care is available at the RPVB.  Weekday appointments though regularly scheduled with be adjusted to accommodate your schedule, including evening and weekends.  You will have access by email and phone to your doctor as questions or concerns arise. Coordination of subspecialist care will be completed by your doctor, as indicated.  You will receive expert psychopharmacology informed by psychological formulation, which will incorporate parents and family, in the case of children in care.

What is the cost?  $1197.00 (an addition of $200 per month)

What is included?

  • 4+ visits monthly.
  • Visits will last 60 minutes, family consultation and coordination up to 1 hour a month.  
  • Family support and feedback, comprehensive coordination of care with other provider
  • Priority scheduling for early morning and afternoons.
  • Admission for you and a guest to Retreat PVB sponsored events.
  • You may attend unlimited group fitness classes and educational services at the Retreat (excludes personal fitness, individual academic coaching) for a nominal charge ($10.00 a month) in 2019!  

How do I know if Comprehensive Psychiatric care with Psychotherapy Plus is right for me?  You are curious about your internal life and you are looking for insight and answers to help you live a more peaceful or content life. You will benefit from Psychodynamic Psychotherapy or Cognitive-Behavioral Therapy and are ready to commit to regular sessions.  You may or may not be taking or considering taking psychiatric medications or alternative. You are not currently involved in therapy with a psychologist, counselor, or therapist outside RPVB, unless specialty referral is necessary. You have a demanding schedule and require your provider to adapt to your schedule.  You prefer significant amount of family involvement and feedback. You benefit from time over the phone or by email with your provider.

 

2019 Direct Care Membership Plans

Psychology vs. Psychiatry

What type of healthcare professional should you seek when you have mental health concerns? Should you look for a psychiatrist or a psychologist? For many people, the answer to this question is a difficult one. Unless you are in the medical field or know someone who is, there’s a good chance you don’t know the difference between the two. We thought it would be great to highlight the differences between these two specialties for families looking for mental health care.

Before we compare and contrast the two professions, we should acknowledge the fact that you are seeking help, which is the most essential step in treating any issues you might have.

Psychologists and psychiatrists share a common goal to help people feel better.

Both are typically trained to practice psychotherapy — talking with patients about what is bothering them. The differences in background and training leads to various approaches to addressing mental health needs. Each clinician’s aim is to provide you with the means to manage the issues in your everyday life by talking through challenges and discovering solutions.

Here are the main differences between psychiatrists and psychologists:

  • Psychiatrists are Medical Doctors (MDs) who’ve graduated from a 4-year medical school after completing a 4-year-college degree. They complete an additional 4-years of Medical Specialty Residency. They are trained to diagnose and treat individuals with mental health disorders. This is a total 12 years of training. Psychiatrists who sub-specialize go on to complete 1 – 2 years of Fellowship Training in areas such as Child Psychiatry, Addiction, Geriatric Psychiatry, Consult-Liaison Psychiatry, and Forensic Psychiatry.
  • Psychologists, on the other hand, are not medical doctors. They’ve earned a doctoral degree such as a P.hD. in related areas or Psy.D. in a selected area of psychology, which focuses on the study of personality development, the history of psychological problems, and the science of psychological research.

Therefore, the two are prepared to diagnose and treat their patients differently.

Psychiatrists—being trained medical doctors—have the authority to write prescriptions for medication while psychologists, in most states, do not. Many Psychiatrists, in the era of managed care, spend the majority of their time on medication management. Traditionally, psychiatrist received training in psychotherapy, also. Psychologists spend most of their time either performing psychological testing or conducting psychotherapy to treat patients.

Psychotherapy—or “talk therapy,” as it is sometimes referred to—can “help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing,” according to the American Psychiatric Association.

Coming from the medical background, psychiatrists typically consider your genetic, biological, and medical history. Psychiatrists are uniquely trained to formulate a possible diagnoses and rule out causes of mental disorders due to other medical issues. People experiencing a significant impact on the body—and daily life activities from mental illness are well served by a psychiatrist. Psychiatrists are trained to listen for the signs and symptoms of particular neurochemical alterations, just the way a conductor can pick out the contribution of the violin amongst the symphony.

The field of mental health eliminates the division between the mind-body connection. So a person who is suffering can benefit from both a psychologist and/or a psychiatrist who often work together to treat patients.

At The Retreat at Ponte Vedra Beach, our psychiatrist is Theresa Randazzo-Burton, MD, who provides exceptional personalized psychiatric care.

Dr. Theresa Randazzo-Burton

Dr. Burton, is a Board-Certified Adult and Child and Adolescent Psychiatrist, who finished her training at UMASS in 2008. She completed years of supervision in individual, group, and family therapy. Her training and experience in cognitive behavioral therapy and psychodynamic psychotherapy sets her practice apart from most contemporary psychiatrists. While practicing from 2008 until 2014 at Presbyterian Hospital in Charlotte, NC on a 60-bed psychiatric unit (for ages 7 and up), she honed her psychopharmacology skills treating patients requiring the highest levels of care. Moving to the Jacksonville area in 2014, she joined the fantastic team of doctors at Nemours Specialty Clinic, most frequently overseeing the Psychiatric Care for Children on the Behavioral Health Unit at Wolfson Children’s Hospital. As a resident and a parent in Ponte Vedra Beach, Dr. Burton is dedicated to bringing her passion for psychiatric care to this community at The Retreat PVB.

Dr. Burton has created a welcoming office for her clients

The Retreat at Ponte Vedra Beach is a Child Psychiatry and Family Wellness Center for those looking for mental health care for themselves or their children in a comfortable and relaxed setting. We don’t look like any doctors office you have ever seen. Experience the difference individualized care in a stigma-free environment can make in your life. You can read more about our entire team on our website: click here

Mindful Eating

A Mindful Approach to Eating: Week 3

The Retreat at Ponte Vedra Beach is committed to helping individuals and families develop the tools for living every day more satisfied. We know that happiness is connected to finding a rhythm to life that makes sense and is sustainable.

Today, most people are focused on reducing or restricting their caloric intake in America. Americans are discontent with their health and their bodies. They eat on the go, eat food prepared by others, and they eat alone or while multitasking much more than they would like.  Most importantly, they’ve become disconnected from the ingredients in their food. When we put these factors together, they have put their bodies at a disadvantage and taken away its ability to auto regulate.

If you are generally unsatisfied with your relationship with food and eating, then developing a broader appreciation for how your food was grown, harvested, processed and packaged may be the next step. Being aware of how the food came to your plate is important.

These things sound simple, and much of it is common sense, but there are good reasons we ignore our relationship with food. 

Change is hard.

We are comfortable with our habits and anything new takes more time and energy, even when we are motivated. We settle into familiar patterns for which there are proven outcomes–we already know the results for how we have been living.  Happy or not with those results, living with the status quo seems easier than taking a chance on something unknown. Experimenting with something new opens up the possibility of failure. We are very motivated to avoid feeling like we have failed.

This brings me to my next point.

There is so much information about how you should eat, what you should eat, and when you should eat that it’s difficult to know what’s really useful. The potential for your investment into a plan that is not effective gives short-lived results or leaves you with consequences to your overall health, which is a fear everyone has. People are tired of food trends and buying supplements that, as a nation, have not made us healthier and happier.

Diets that eliminate food groups or strictly reduce calories leave people feeling resentful, unsatisfied, and generally do not lead to long-term health outcomes. Additionally, it can be counterproductive to move towards a category of eating that is judgmental or judged as extreme by others.

Mindfulness is an approach to eating that moves beyond a “diet plan” and offers opportunity to recalibrate our appetite. Here is a summary of the tips from this series including two new ones for this week:

      Try implementing the following tips this week:

      1. Let your body guide your eating.

      Hunger is an important cue.  So is satiety. It takes your body about 20 minutes to feel full during a meal.  If meal time is shorter, the signal will be missed and overeating will happen. When pressed for time, consider eating a replica (in size and content) of a healthful meal that fills you up and keeps you satisfied.  Eating calorie dense foods quickly tricks your mind into thinking you need much more of it than you do.  It may take some time for your stomach and your brain to start communicating effectively again, but it will happen if you keep up these tips.

      2. Make mealtime a sensory experience.

      Take time to really chew your food, breaking it down to a consistency where the flavor comes through.  This is also great for digestion! Food that is appealing to the eye and smells appetizing sets the tone for a fulfilling meal. The texture, temperature, combinations of flavors are pieces of information that help you feel more satisfied with the food you are eating.  The more senses used to take in the meal, the more meaningful it will be. We are less likely to eat too much and we are more likely to make wise choices.

      3. Share your meal with someone, someone you like, if possible.  

      Good conversation, stimulating ideas, shared enjoyment makes food more memorable and meets your need for sustenance in ways that can’t come for food.  Humans need connection: it fills us with positive emotions. Isolations is much more likely to lead to overeating.

      4. Choose nutritionally rich food that are sustainable.

      Eating a diet high in a variety of nutrients provides more energy, keeps away cravings, and supports health. There is a great deal of misinformation about where nutrients come from and how much we actually need. Dr. Fuhrman published a handy guide, “Nutritarian Handbook and ANDI Food Scoring Guide,” with rankings of the most nutritious foods.  You guessed it, the most nutritious foods are all green! When available, buy local and seasonal food. It will taste better and drastically reduce the carbon footprint.

      5. Eat and only eat at mealtimes.

      Other than good conversation, try not to multitask during meals.  When your attention is on something else, you are not registering what you eat.  Your getting the gist of it now, this leads to eating more food, eating less well, and disconnects your mind from your gut.  

      6. Eat at specific, scheduled meal times.  

      Help your body get on a schedule to manage hunger and regulate your digestion.  Setting aside a time to eat also sends you the message that nourishing yourself is a worthwhile effort.  Putting sometime and some thought into preparation or presentation will pay off. When you create something, you cherish it.  Your loved ones also get the message that you believe nourishing them is important. Not many more gestures help the parent-child relationship more than this one.  

      I cannot encourage this step more strongly as a physician and as a child-psychiatrist. If you are only able to implement one step, this is the one. This does not mean you must be a gourmet.  Many semi-prepared options or even take out options are healthful and if served on plates, even paper plates, at the table, this will do the trick.

      Theresa Randazzo-Burton, MD
      Child, Adolescent, and Adult Psychiatrist

      Mindful Eating

      A Mindful Approach to Eating: Week 2

      The Retreat at Ponte Vedra Beach is committed to helping individuals and families develop the tools for living every day more satisfied. We know that happiness is connected to finding a rhythm to life that makes sense and is sustainable.

      As we have come to associate what we eat with who we are, we have become more dissociated from how we are eating and the actual food by which we are nourished. It’s easy to understand how this could have happened when we think about how quickly food went from being scarce to being in overabundance. It’s pretty simple to fill a plate with calorie-dense foods for most Americans today, but this was not something most of our great grandparents could say.

      As a nation, we simply have not had time to adapt our relationship with food as our identity has shifted. Today, in a world where we can grow or import anything from anywhere (at least for the time being), it seems that what we are missing out on the practice of thinking about how we are feeding our appetites.

      So, let’s step back and take a look at process rather than content.

      This is mindful eating.

      Start to think about how you eat. 

      Take a moment to note what comes to mind when you ask yourself this question:

      “How do I eat?”

      Common answers are:

      “Whenever I can”

      “On the go”

      “Whatever’s in the lunch line”

      “Fast”

      “Alone”

      “Between shifts”

      “While watching TV”

      It’s likely that some of the above answers might resonate with you, these factors have a significant impact on your health and wellbeing and are key to the success of whatever approach to eating you take or strategy you have for nourishing your body. 

      Mindful eating, in its simplest form, is turning some (or all) of your attention to the meal at hand with the goal of fully understanding and engaging in the experience.

      Core Ideas of Mindful Eating:

      • Let your body rather than your emotions guide your eating
      • Stay aware of your sensory experiences while eating
      • Share the experience with others
      • Choose nutritionally rich and sustainable foods
      • Focus on eating only while you are actually eating
      • Carve out specific times for meals.

        Try implementing this tip this week:

        Make mealtime a sensory experience.

        Take time to really chew your food, breaking it down to a consistency where the flavor comes through.  This is also great for digestion!

        Food that is appealing to the eye and smells appetizing sets the tone for a fulfilling meal. The texture, temperature, combinations of flavors are pieces of information that help you feel more satisfied with the food you are eating.  

        The more senses used to take in the meal, the more meaningful it will be. We are less likely to eat too much and we are more likely to make wise choices.

        Share your meal with someone, someone you like, if possible.  

        Good conversation, stimulating ideas, shared enjoyment makes food more memorable and meets your need for sustenance in ways that can’t come for food.  Humans need connection: it fills us with positive emotions. Isolations is much more likely to lead to overeating.

        Theresa Randazzo-Burton, MD
        Child, Adolescent, and Adult Psychiatrist

        Mindful Eating

        A Mindful Approach to Eating: Week 1

        The Retreat at Ponte Vedra Beach is committed to helping individuals and families develop the tools for living every day more satisfied. We know that happiness is connected to finding a rhythm to life that makes sense and is sustainable.

        Despite the fact that a relationship with food is a part of both our daily routine and deeply ingrained individual and family traditions, it remains an aspect over which very few people feel that they have mastery. There are many reasons for this, but in my opinion, one of the major problems is that there is just too much advice available about what we should be eating that it’s impossible to make sense of it all. The importance of a healthy diet for physical and emotional wellbeing is not in dispute, but knowing what to do or who to believe is much less clear. The confusion created by all the information available is not to the advantage of the individual.

        This flood of information is in response to the demand and people’s willingness to allot a significant amount of resources in attempts to master how they nourish their body.  There are so many conversations going on about what to eat and how to eat: paleo versus vegan, low glycemic versus starch based, six small meals a day versus intermittent fasting, juices versus bowls, fish versus mercury. The list goes on and on. Sorting through all this is overwhelming and leaves people feeling like they are missing the key to achieving their goals.

        Mindfulness is an approach to eating that moves beyond a “diet plan” and offers opportunity to recalibrate our appetite.

        There is so much information about how you should eat, what you should eat, and when you should eat that it’s difficult to know what’s really useful. The potential for your investment into a plan that is not effective gives short-lived results or leaves you with consequences to your overall health, which is a fear everyone has. People are tired of food trends and buying supplements that, as a nation, have not made us healthier and happier.

        Diets that eliminate food groups or strictly reduce calories leave people feeling resentful, unsatisfied, and generally do not lead to long-term health outcomes. Additionally, it can be counterproductive to move towards a category of eating that is judgmental or judged as extreme by others.

          Try implementing this tip this week:

          -Let your body guide your eating.

          Hunger is an important cue.  So is satiety.

          It takes your body about 20 minutes to feel full during a meal. It meal time is shorter, the signal will be missed and overeating will happen.  

          When pressed for time, consider eating a replica (in size and content) of a healthful meal you like, that fills you up and keeps you satisfied.

          Eating calorie dense foods quickly tricks your mind into thinking you need much more of it than you do.  You also get a huge mental reward (similar to sex or winning) when you eat foods high in fat. This makes it a very seductive option at the moment you want a quick boost in mood.

          This is also what makes it risky to use food as a reward for children. It does not take long for this phenomenon to become a craving.  This pattern sets you up to repeatedly turn to food for emotional reasons rather than in response to hunger that comes from your belly.

          It may take some time for your stomach and your brain to start communicating effectively again, but it will happen if you keep up the tips discussed in this series! 

          Theresa Randazzo-Burton, MD
          Child, Adolescent, and Adult Psychiatrist

          Beach Tree - Sunset

          World Suicide Prevention Day

           

           

           

          Join me, today and everyday, in the fight to prevent suicide. The battle is here in our community and we all need to reach out to those who are suffering with life threatening emotional pain. Suicidal thoughts should never be dismissed or minimized. They always represent a treatable condition. Any emergency room in the country can direct someone to the care they need. If you are worried about someone, speak up, get help, don’t wait. Let’s get rid of stigma and become beacons of hope.

          Dr. Burton-Dr. Burton

          The American Academy of Child and Adolescent Psychiatry Suicide Resource Center has valuable information for families: ACCAP Family and Youth Resources

          Mother and Daughter on Beach

          Exercising For Two?

          We’ve all heard of the phrase “Eating for Two” while pregnant, but have you heard of the phrase “Exercising for Two”? If you haven’t, you’re in good company. 

          There are many benefits to staying active while your baby is growing. Exercise and fitness are important while you are pregnant, because in addition to caring for your physical and emotional health, you are giving your baby the healthiest start possible.

          Luckily, The American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) have provided some guidelines to help staying active during pregnancy safe and easy to understand. 

          The CDC recommends that pregnant women get at least 150 minutes of moderate-intensity aerobic activity every week.

          • Aerobic activity is one in which you move large muscles of the body
          • Moderate intensity means you are moving enough to raise your heart rate and start sweating
          • You still can talk normally, but you cannot sing.

          You can divide the 150 minutes into 30-minute workouts on five days of the week or into smaller 10-minute workouts throughout each day. If you are new to exercise, start out slowly and gradually increase your activity.  

          During your pregnancy you are certainly going to have times when your body is going to tell you that you need to relax, kick up your feet and take it easy. It makes sense. You’re growing a human after all! 

          For me, I had terrible morning sickness for the first 15 weeks of my pregnancy with my daughter. It was hard to get moving when spurts of nausea hit, but I found that getting out and going for a walk—or taking a barre class—would minimize my nausea and improve my mood.

          The ACOG is spreading the word that if you are healthy and your pregnancy is normal, it is safe to continue or start most types of exercise with a few modifications. 

          Now, if I haven’t convinced you yet, here are some facts to consider.

          Regular exercise during pregnancy benefits you and your fetus in these key ways:

          •  It reduces back pain. 
          •  It eases constipation.
          •  It can decrease your risk of gestational diabetes, preeclampsia and Cesarean delivery.
          •  It promotes healthy weight gain during pregnancy. 
          •  It improves your overall general fitness and strengthens your heart and blood vessels. 
          • It helps you lose that stubborn baby weight after your baby is born.

          Although every pregnancy is different and you need to discuss exercise with your obstetrician, for many women, physical activity does not increase their risk of miscarriage, low birth weight or early delivery.

          Here are four things you can do to make exercise during pregnancy as safe as possible: 

          1. Drink plenty of water before, during and after your workout to avoid dehydration. Signs of this include dizziness, a racing or pounding heart, and urinating only small amounts or having urine that is dark yellow.
          2. Wear a sports bra that gives lots of support. Later in pregnancy, a belly support belt may reduce discomfort while walking or running. Ask your doctor if this is right for you.
          3. Avoid becoming overheated, especially in the first trimester. Drink cool fluids, wear loose-fitting clothing, and exercise in a temperature-controlled room. Do not exercise outside when it is very hot or humid.
          4. Avoid standing still or lying flat on your back. When you lie on your back, your uterus presses on a large vein that returns blood to the heart. Standing motionless can cause blood to pool in your legs and feet. Both of these positions can decrease the amount of blood returning to your heart and may cause your blood pressure to decrease for a short time.

          If your OB-GYN gives you the green light to exercise, you can decide together on an exercise routine that fits your needs and is safe during pregnancy. There are prenatal barre, yoga and pilates classes designed for pregnant women that teach modified poses to accommodate a pregnant woman’s shifting balance.

          You should avoid poses that require you to be still or lie on your back for long periods. If you are an experienced runner, jogger, or racquet-sports player, you may be able to keep doing these activities during pregnancy.

          There are some women out there who, because of medical reasons, should not exercise during their pregnancy.  Specifically, the ACOG clearly warns women with the following conditions or pregnancy complications not to exercise during pregnancy:

          • Certain types of heart and lung diseases
          • Cervical insufficiency or cerclage
          • Being pregnant with twins or triplets (or more) with risk factors for preterm labor
          • Placenta previa after 26 weeks of pregnancy
          • Preterm labor or ruptured membranes (your water has broken) during this pregnancy
          • Preeclampsia or pregnancy-induced high blood pressure
          • Severe anemia

          As you can tell, I am passionate about this very real and current topic in my own life. I experienced a lot of benefits of staying active throughout my pregnancy and into the postpartum period, as well. And I want to lend support to other women as they strive to balance fitness, fatigue and body changes during their pregnancy. 

          So get after it!

          Talk to your doctor, and find the activity that best interests you. And although you may need to make modifications here and there, your body and your baby will benefit greatly.

          Let’s make this whole “Exercising for Two” phrase an actual thing!

           

          Amy-Katherine Ahrberg, RN, BSN

          Exercise Nurse Specialist 

          The Grove at The Retreat at Ponte Vedra Beach

          The Grove at Ponte Vendra Beach, Logo

          American Heritage and Psychiatry

          Common Messages to Help us Navigate the Crisis at the Border

          The ideals around which we have founded this nation and raised our families are dear to all of us.  We are fortunate to have been born in a nation where we can raise our children in relatively safe and secure communities and change our situation, station, or life when we choose.  When people around the world long for this freedom for their children they may make the choice to leave their land and journey to the United States of America. History has given us direction and psychiatry has given us understanding about how we can form and maintain a rich and diverse melting-pot as a nation.  


          “…Give me your tired, your poor,

          Your huddled masses yearning to breathe free,

          The wretched refuse of your teeming shore.

          Send these, the homeless, tempest-tossed to me.

          I lift my lamp beside the golden door.”

          Emma Lazarus 1883


          American Heritage

          In the 1860s, French anti-slavery activist Edouard de Laboulaye suggested that France gift of the
          statue, “Liberty Enlightening the World” to commemorate the alliance between the U.S. and France during the American Revolution and the end of slavery in the U.S. after the Civil War. In order to raise money to construct the monument’s base, the poet, Emma Lazarus wrote the famous sonnet “The New Colossus” for a Statue of Liberty fundraiser in 1883.  Concurrently, the “Great Wave of Immigration” had begun and between 1880 and  1920, 23.5 million persons immigrated to the U.S..  The poet was inspired by her experiences with Russian Jews detained by immigration officials on Ward Island and included a new facet of liberty in her interpretation of what the statue could mean. In the years since, though the statue would take on many additional layers of meaning, the link between it and immigration  solidified. 

          America is a nation of immigrants, but we have struggled with our identity.  My own  family came to the United States in 1966 from a small town in Italy, looking for a better life, hoping to find the “American dream”.  Many of you have stories of immigration, renewal, hope, and pride going back just a generation or so. We are the beneficiary of what freedom and opportunity has to offer.   This is the America where we are raising children together with the values we want to uphold. It is hopeful to believe in our commitment to liberty, justice, and freedom for all. It can be difficult to conceptualize that this same invitation is not extended to everyone.    

          We have always returned to the vision that the U.S. shall be a place of refuge in the World.  However, in May 2018, the U.S. began  enforcing a “zero-tolerance policy” to prosecute anyone crossing the border, including those who may seek asylum.  This policy determines that families apprehended at the border be separated, with parents being contained by the U.S. Department of Homeland Security (DHS) and children being sent to the U.S. Department of Health and Human Services’ Office of Refugee Resettlement. It is estimated that 658 children were separated from their parents in May.  

          We have misinterpreted fundamental concepts of helping others, building alliances, and protecting our future when we do harm to those least able to care for themselves.  Children coming to the United States from Northern Latin America are traumatized, depleted and most vulnerable. They are fleeing a degree of danger and violence that is difficult for U.S citizens to understand, because despite our struggles, most of us can access safety and justice when we need it. It is important to understand the meaning and impact of the policy separating children from their parents.

          The Consequences of Separating Children from Parents:

          Disrupted Attachments

          In psychiatry we use the term attachment to describe the secure structure of a relationship between a child and caregiver. It is the portal through which the child learns to experience him/her self, others, and the world around them. The quality of the attachment translates into how the child relates and reacts to everything in ways that both subtle and overt. When the attachment is disrupted, the ripples into the child’s development and future and significant.

          A healthy attachment is described as a reciprocal, enduring, emotional connection between a child and his/her primary caregiver(s). This develops from care that is attuned and responsive to the child’s physical and emotional needs. A secure attachment is an essential building block of cognitive, social, emotional, and physical development. Characteristics such as empathy, capacity to love, and inhibition of aggression are all related to a child’s sense of secure attachment in the world.

          When this attachment is disrupted through a variety of circumstances such as the abrupt loss of or extended separation from a parent, child abuse or neglect, the child is at risk of attachment related problems.

          Attachment Related Problems:

          Problems with Interpersonal Relationships:

          • lack of trust in caregivers or adults in positions of authority
          • resistance to nurturance or guidance
          • difficulty giving and receiving genuine affection or love

          Problems with Emotional Functioning:

          • minimal ability to recognize the emotions of others
          • poor emotional regulation (moodiness, extreme fluctuations in emotions, “falling apart” when faced with stress)
          • low self-esteem

          Behavior Problems:

          • demanding, clingy, and/or overt or covert over-controlling behavior
          • temper tantrums and poor self-control
          • regressed behavior, problems with speech, problems with eating
          • chronic lying and Stealing
          • property destruction and aggression
          • impulsivity

          Problems with Cognitive/Moral Development:

          • lack of understanding of cause and effect
          • decreased abstract thinking
          • limited compassion, empathy, and remorse
          • difficulty concentrating and attending to school related tasks

          Currently, The U.S. has enacted a policy with potentially devastating consequences to children.  The types of injuries that we are causing can be permanent, pervasive, and exceptionally difficult to treat.  Repair of early life trauma, particularly the abrupt severing of contact between child and parent, without understanding, without predictability, and without promise of reunion causes irrevocable damage.   The cost to these children and the future that unfolds along with them will be astronomical and beyond any justification for the current policy.

          It is important to remember that these children may not demonstrate full signs and symptoms of their injuries at this time.  It is not until they reach a place where safety is more certain that that they begin to demonstrate the full impact of the trauma.  As a nation, we have an opportunity to either begin to heal or to further deepen the psychological wounds this children bring with them across our border. The United States has the capacity to offer a restorative and corrective experience to our neighbors, community, and within this nation.  We can rebuild the trust of these children. We can offer security. We have the opportunity to demonstrate that the world can be more good than bad. 

          As we look for solutions for families at our border it becomes increasingly important that we remember the lessons from the past. In medicine and psychiatry, not all things are certain; however, there are concepts that are universally accepted and foundational to healthy development. Supporting attachments between parents and children honors who we are as a people and builds upon the original principals of our nation.

           

          Theresa Randazzo-Burton, MD
          Child, Adolescent, and Adult Psychiatrist

           

          Resources:

          American Academy of Child and Adolescent Psychiatry https://www.aacap.org/AACAP/Policy_Statements/2018/Separating_Immigrant_Children_From_Their_Families

          Quick Facts:Disrupted Attachment. An Information Booklet For Parents/Guardians and Child Serving Professionals in Chittenden County, Vermont http://studentsfirstproject.org/wp-content/uploads/attachment-booklet-for-parents-guardians-and-child-serving-professionals.pdf

          Posted. June 1, 2018. They Are (Still) Refugees: People Continue to Flee Violence in Latin American Countries.  

          PEW Research Center: http://www.pewresearch.org/fact-tank/2017/05/03/key-findings-about-u-s-immigrants/

          August 2, 2017. TIME Magazine. Author: OLIVIA B. WAXMAN:The Poem on the Statue of Liberty Was ‘Added Later’ But There’s More to That Story

          Family on Cliffside

          Listening to the Little Things

          Let’s Put an End to Bullying

          “How did I miss this?  Why didn’t he tell me what was happening?  If I had known sooner, I could have done something! “ As parents, we try hard to avoid getting out of sync with our family.  We have all found ourselves wondering how to encourage our kids to talk to us about the issues they face.  While we may feel helpless or even unwanted at times, the good news is children really do look to parents and caregivers for advice and help with tough decisions. Getting them to talk is probably easier than you think, it’s just a matter of creating some time and space to connect.  Spending 10-15 minutes a day talking with your kids reassures them that you are available and attentive. If you want to hear about the big things happening in your child’s life, you have to listen to the little things.  

          For some families, conversation about daily life, classes, activities, friends, and hobbies comes easily and the topics flow.  Other families may feel out of practice, uncomfortable, or artificial when they try to communicate. Breaking the ice, or getting back to face-to-face communication is worth trying.  Chances are your child (yes, even your teenager) has also been longing to connect with you.

          Here are some ideas to help start conversations about your child’s daily life and feelings: 

          • What was one good thing that happened today? Any bad things?
          • What is lunch time like at your school? Who do you sit with? What do you talk about?
          • What is it like to ride the school bus?
          • What are you good at? What would do you like best about yourself?
          • How does your teacher handle problems in the classroom?  Do you think those methods are effective?

          When It comes to bullying, having a foundation of good communication and a feeling of security at home can literally be life saving!  Talking about bullying directly is an important step in understanding how this issue might be affecting your child or the school your child attends. Even if your child is not directly involved in bullying, an environment where bullying thrives can put everyone at risk.  The solutions to bullying depend largely on the bystanders deciding their school should be a place where every student feels safe. We can teach our children this message both directly and indirectly when we talk with them. There are no right or wrong ways to address these topics, but it is important to encourage kids to speak honestly. Assure kids they are not alone in addressing any problems that arise.

          You can start having conversations at home with questions like these:

          • What does “bullying” mean to you?
          • Describe what kids who bully are like. Why do you think people bully?
          • Who are the adults you trust most when it comes to things like bullying?
          • Have you ever felt scared to go to school because you were afraid of bullying? What ways have you tried to change it?
          • What do you think parents can do to help stop bullying?
          • Have you or your friends left other kids out on purpose? Do you think that was bullying? Why or why not?
          • What do you usually do when you see bullying going on?
          • Do you ever see kids at your school being bullied by other kids? How does it make you feel?
          • Have you ever tried to help someone who is being bullied? What happened? What would you do if it happens again?

          Expert Tip: Try listening without planning a reply.  Instead, focus on trying to understand how your child is processing and feeling. If you don’t know how to reply, ask your child how you can help.  You may be surprised by the answer. Finding out what would feel helpful goes a long way towards encouraging them to continue talking.

          We tune into our children when we listen to answers from questions like the ones above.  We show our children that they have valuable thoughts in their mind and those thoughts can turn into words and actions, which have the power to impact others.  A child who believes in their own ability is not likely to bully others or tolerate bullying around them.

          We spend so much time away from our children that it’s important to continually learn about how teachers, friends, social media and other influences are shaping and changing who they are.  When we listen, we stay tuned into the person they are becoming and we send them the message that they are worth knowing. A child who believes that they are worth knowing, worth our time, worth out effort, worth our support is as bullyproof as can be.

          There are simple ways to keep up-to-date with kids’ lives.  This is especially important for parents who split time with another caregiver or who travel and are away from home often.

          Tips for staying up-to-date with your child’s life:

          • Read class newsletters and school flyers. Talk about them at home.
          • Check out the school website
          • Attend school events and parent nights
          • Greet the bus driver
          • Meet teachers and counselors or reach out by email

          When we take time to talk with our children, we provide an example of how to listen, solve problems, and consider others.  The antidote to bullying is building kids who feel capable, confident, and worthwhile. Kids who receive this message at home share it with others.  

          Theresa Randazzo-Burton, MD
          Child, Adolescent, and Adult Psychiatrist

          Follow our Blog for more on this series.  Dr. Burton will visit topics related to bullying in more detail in weeks to come.  She will tackle the topics of cyberbullying, helping your child form a peer group, identifying bullying at home, bully proofing, bouncing back from bullying, and more.  Check with the Retreat at Ponte Vedra Beach this fall to join our Bouncing Back Group for kids to have experienced bullying.  

          Additional Resources:

          stopbullying.gov logoNational Anti Bullying Logo Anti-Bullying Logo