Mental Health Crisis Created by the Coronavirus

Mental Health Crisis Created by the Coronavirus

We have a major mental health crisis coming our way and we are not prepared. Before the Coronavirus pandemic one out of five teenagers met the criteria for a mental health diagnosis and needed psychotherapy (CDC). In addition depression, anxiety and cutting were at epidemic rates for teenagers (CDC). To make matters worse, suicide had been the third leading cause of death for teenagers prior to the pandemic and has been moved from the third to the second leading cause of death for teenagers (CDC). Additionally, African-American teenagers were committing suicide at five times the rate of Caucasian teenagers (CDC). This means prior to the pandemic, we had many teenagers dying due to suicide and the rate has been increasing every year for the past ten years (CDC). In 2018 over 6200 teenagers between 10-18 committed suicide (CDC). If the number of teenagers committing suicide is increasing every year significantly, then how many teenagers committed suicide last year? How many teenagers will attempt or commit suicide this year?

Here are the statistics for teenage mental health prior to the pandemic. We know since the pandemic the number of teenagers reporting depression and anxiety have significantly increased and so have the number of teenage suicides and death due to drug overdoses have increased since the pandemic. I have seen a significant increase in patients calling my office for psychotherapy for their teenagers and children. How are we going to provide all these children and teenagers with psychotherapy? Additionally, many parents are having to stop their child’s psychotherapy because they can no longer afford the copayments. Many parents have lost their jobs or have had their hours cut which reduces their monthly income. Therefore, many parents are having to choose between paying rent and buying food or their child’s therapy. I am willing to make accommodations so the children and teenagers I treat can stay in therapy, however many therapists will not make accommodations. So what happens to all these children who need therapy because the pandemic has exacerbated their mental health issues? Why should parents have to decide between food on the table or therapy for their depressed teenager?

Another fact we cannot overlook is that this week we reached the point where 200,000 Americans have died due to the Coronavirus. This means there are 200,000 families who are grieving. Many children have lost parents and grandparents. Many parents have lost their parents and have lost their child too. The Coronavirus does and has killed children. How do we provide grief counseling to all of the grieving families and friends? With a record number of people out of work order besides finding therapists to help all these family members, how do you provide therapy at an affordable price? If you have a family of four that needs therapy, the monthly cost for therapy will be very expensive. Again people are having to choose between food for the family or therapy for the family.

Another factor impacting the mental health of children and parents is school. Because the President refuses to issue a national mandate regarding masks, children and teenagers are having to attend school remotely. Fourth percent of the parents in our Country have had to adjust their work schedules so there is someone at home to help the children. This has resulted in many parents having to reduce their pay. Again making it difficult to pay the rent and afford food. Additionally, many children and teenagers are becoming very frustrated because the remote learning is not well coordinated and they want to give up on school. This is adding more stress to families who are already over stressed. They are needing psychotherapy to help them, but they cannot afford therapy. Again what are we going to do to help these families?

One final point for this article, we hear that people have and do recover after being diagnosed with the Coronavirus. This is true, however, we have now learned something new about this new virus. A number of people who recover go on to develop what is being to referred to as “long haul syndrome.” People who develop this syndrome have heart palpitations, neurological problems, losing their hair and a condition referred to a brain fog. At this point no one knows how long it will last and who will develop it. It also is creating mental health issues such as depression. These people and their families will require therapy too. Again, how do we provide affordable therapy to these people? Since there is a negative stigma about mental health, we do not have enough therapists in the United States to treat all these people. Right now of course we are looking for a cure to the virus but we have not been paying attention to the collateral damage this virus has caused and how are we going to cope with it. Mental health is a major area, but we have not been paying attention to the mental health issues created by this virus and how are we going to address the mental health needs of the United States.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information about his work or private practice visit his website at www.RubinoCounseling.com or his Facebook page at www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

IEPs and 504 plans Exist with Remote Schooling Too

IEPs and 504 plans Exist with Remote Schooling Too

While most of the schools in California are using remote learning, it does not mean that Individual Educational Plans (IEP) and 504 plans are obsolete. In fact, due to remote learning and the pandemic many students are experiencing increased problems with learning and need IEPS and 504 plans as a result. Unfortunately I have been contacted by many families who were in the process of having their IEP meetings when the schools shut down suddenly due to the Coronavirus. These families have been contacting the school to finish their child’s IEP, but the district continues to postpone. Additionally, some children who didn’t have difficulties when they were in class are having difficulties with remote learning and increased anxiety due to the Coronavirus. Therefore, parents you are correct when you are asking to have your child’s IEP completed. Legally the school districts must complete a student’s IEP. The pandemic does not allow them to legally abandon IEPs and 504 plans. Also until they finalize the new IEP, the district legally must comply with the existing IEP on file. Furthermore, for parents who have children who need an IEP due to the remote learning or anxiety due to the pandemic, you can still legally request an IEP for your child. Additionally, school districts must comply with the existing IEP guidelines and laws. The pandemic does not allow a school district not to comply with the IEP and 504 laws.

It should be a straight forward process if your child needs an IEP, but many school districts play games with the process because it cost them money. However, they have enough money for IEPs. It comes down to a school districts priorities and how they choose to spend their money. Therefore, don’t be afraid to demand what your child is entitled to.

In order to help you understand how severe the schools play games with the process, here is one family’s experience trying to get their child an IEP and how the school district abused the family. The names have been changed for the family’s privacy. However, this same story happens daily to many families and children. In fact, I have three other families I am currently working with where the school district is doing similar things. Instead of decreasing, it appears the abusive behavior by the school districts is increasing every year. Therefore, parents please read carefully because you never know when you may be facing the same issues.

The story of Tara and her daughter Payton is a common story I have heard many times from families who have children who need an IEP. Prior to the age of 4 years old Payton was diagnosed with a speech and auditory processing difficulties. Payton was behind in her speech developmental milestones and attending preschool to address these issues. However, no one explained to Tara, Payton’s mother, what this diagnosis meant or the prognosis. Neither did anyone explain to Tara about the special education services she was entitled to.

Payton started kindergarten and do to her difficulties she needed to repeat kindergarten. Again, no one explained to Tara, Payton’s mother, how this may impact Payton and they also did not explain any other options, Tara agreed. She was not alarmed because Tara had to repeat kindergarten herself.

However, this started a never ending cycle, where Payton was not meeting the standards for her grade level even when she was receiving Resource Assistance. Tara stated some Resource Teachers were great and others knew very little about auditory processing issues so her daughter received no help.

Tara, watching her daughter struggle, decided to do her own research. She found out more about her daughter’s learning disability and that there was a private school which specialized in this learning disability. Mount Diablo School District continued to lie to Tara as she asked more questions. Also the District went to Payton’s father and lied to him. They told him if Payton’s mother was successfully in getting Payton into the private school, he would have to pay upfront. The District said they would reimburse him later. This is a lie. Also it is not uncommon for the school district to take advantage of a divorce situation and play the parents against each other.

This resulted in a long fight with the school district and in the family court. Payton is in 6th grade and after many years and a great deal of time and money, the fight continues. Mount Diablo School District never looked at the price Payton was paying not receiving the education she is entitled to and having to endure her parents fighting each other in the courts.

This could have been handled very easily if someone was honest with Tara and told her what her daughter was entitled to and if the District followed the legal guidelines. However, they lie to parents all the time hoping parents will give up. If they do, then the District doesn’t need to pay anything and can use the money how they want. Tara was a prime target. A single parent who does not have a lot of time or money. Mount Diablo misjudged Tara, she would not give up on her daughter.

Tara also found out something else parents need to be aware of when dealing with the IEP process. The parent liaisons provided by the district are not there to help the parent or the student. They serve as another way to confuse parents by providing incorrect information to parents. Most parents trust these people believing they are on the student’s side, but they really are there to support the District.

As I said, Tara and Payton’s story is not uncommon. I have worked with many other families who have very similar stories. Also as I stated above, the number of families in these situations are increasing not decreasing. Parents tend to believe school districts have the students best interest at heart. This is how it is suppose to be. However, I have worked with families across the United States and what I have seen is that school districts have their best interest at heart not the students. Tara had a very good way of stating the problem, “the child is the one who struggles for not having their needs met academically”.  How many more parents are out there with struggling students who have been given the same bad information?  I don’t know.  But we need to help them help their child, or these children will be at risk of dropping out and struggling the rest of their lives.  The school district is actually helping create children who are unable to get jobs and will be unable to afford decent housing when they become adults.  And that is a very very scary reality, no one wants to talk about it because it’s not their child who is at risk. However, it could very easily be your child. What do you do then?

Parents need to come together and demand that their children be provided the accommodations they are entitled to. Look up the educational law so you are aware of the appropriate procedure and accommodations. Also do not be embarrassed for standing up for your child’s rights. You are just being a good parent. The school districts need to look at how they are treating children. Also when it comes time to elect the school board, research the candidates and elect those who have a history which demonstrates they truly care about children.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers and children. In addition he has over 20 years experience serving as an IEP advocate for families. For more information about Dr. Rubino’s work or private practice visit his websites www.RubinoCounseling.com or www.LucasCenter.org or listen to my podcast Understanding Today’s Teenagers on Spotify and Apple.

How Many People Need to Die?

How Many People Need to Die?

Schools and colleges are back in session and in college towns we are seeing an increase in the number of college students and people with the Coronavirus. As of today we also have over 500,000 children diagnosed with the Coronavirus. A 16% increase since schools have resumed (CDC). The White House said children could return to school and colleges could open safely. Obviously this is not the truth. The White House also say we are turning a corner with the Coronavirus and we are getting it under control. However, over 6 million Americans have the Coronavirus and over 190,000 have died and we have a thousand people dying daily (CDC). According to the University of Washington if we continue on our current course over 400,000 Americans by the end of the year will die. Also the White House states we will have a vaccine by the end of the year or even maybe by November 3, 2020. Neither one is realistic. Even if by magic we have a vaccine by the end of the year, we need to find a way of storing a vaccine that requires sub zero temperatures and who gets the vaccine? In addition to these facts, what about the long haul syndrome many people are developing after they had the Coronavirus? We are just learning about it so we still don’t totally understand the Coronavirus.

Let’s turn back to the College students. When an 18 year old goes away to College they are finally on their own and can make their own decisions. They want to have fun with their friends. Let’s examine what College students experience. They are away from home and friends. Therefore, their lives consist of going to class and doing their homework. Besides that they have nothing els to do. They are feeling lonely and craving interaction with other people. Therefore, they develop friends and they want to and need to spend time with their friends and roommates. They need the social activity. Without the social interaction, they feel lonely, isolated and depressed. Therefore, sending 18 year old students to college and expecting them not to socialize is crazy. Also remember their brains are not fully developed and able to make mature, rational decisions until they are 25 years old. These students are already feeling lonely and bored and many college towns are allowing bars to stay open. We are encouraging these students to party and spread the Coronavirus. With all the temptations in college towns, why are we surprised that they are not following guidelines and not socializing?

Another option for College students would be for them to stay at home and go to school remotely. Many colleges are having students live in the dorms and going to class remotely. Therefore, why can’t they stay at home and attend remotely? They would have the support system of their families and close friends. Their parents could help encourage them to not go to parties and wear masks when they leave the house. Yes the college losing the money they earn on the dorms and the White House feels it looks bad for them. However, are we more concerned about saving lives or making money for colleges and making the White House look good?

Another factor we need to consider is that we are entering the flu season. We already have 500,000 elementary students with the Coronavirus and we have an increase in the rates in the Coronavirus in College towns. How are physicians supposed to determine the difference between the flu and the Coronavirus? We don’t have a rapid Coronavirus test. People who take the current Coronavirus tests often don’t get their results for 10 days which is too late. This generation of children and teenagers are aware of the news and what is occurring in the world. Due to their smartphones and instant access to the internet, they know they virus is not under control. They are afraid of dying from the virus. I have very few children and teenagers that I provide psychotherapy for who like remote learning. However, they prefer remote learning than being exposed to the virus. They see how many people are dying and they are afraid that they will catch the virus. They ask me over and over, why won’t people wear masks? School children are looking at adults and the White House pretend that the virus is under control and refuse to address it. So they ask, why? It is a valid question, why won’t the White House admit how serious the Coronavirus is and why do some adults ignore the fact that we are living in the middle of a pandemic?

Therefore, I am asking the question for all the children, teenagers and college students that I treat? How many people have to die before the President starts to seriously address the Coronavirus? Why do we have to wear a mask and miss parties, when the President doesn’t? Remember the party he had on the lawn of the White House when he accepted the Republican Nomination. The President didn’t miss his party, but children have had to miss their birthday parties this year and many have seen grandparents die. So how do we answer the children? How many people have to die before our President provides a national prevention program for the Coronavirus?

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information about Dr. Rubino visit his website at www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

I Have A Dream but I Am Afraid

I Have A Dream but I Am Afraid

Today was the 57th year anniversary of Dr. Martin Luther King, Jr’s, “I have a dream” speech. In Washington D.C. protestors had a protest today to honor the anniversary and to look at how close we have come to meeting the goals that Dr. Martin Luther King set 57 years ago. Unfortunately, it appears we have not made a great deal of progress when it comes time to racial equality. Statistics show this fact and I hear it every day in my office from the teenagers that I work with who come from minority backgrounds. Many of these teens and children are telling me that they do not feel safe in the United States.

One thing that many people ignore is that this generation of teenagers are actively involved in politics and very aware of what is occurring politically in our Country. Teenagers today have smartphones which give them access to everything that is going on in the world and our Country and they are paying attention. They are also very concerned about the possibility that Trump could be re-elected President. They feel if he is re-elected the progress which has been made regarding racism will be erased by Trump. They have a right to feel this way. Trump criticizes sport stars for not standing during the national anthem. He claims they are disrespectful to the United States. However, Trump wants to protect statues of Confederate soldiers. These soldiers did away with the United States Flag and were committing treason against the United States and wanted to keep slavery. Trump wants to honor these soldiers. If I was a black teenager, I would be worried about what Trump might do to my rights if he is elected for a second term. Teenagers are telling me about these fears.

Looking back after Trump was elected it became apparent to me how Trump was making teens and kids anxious and afraid. I had many children who were Hispanic and from other minority backgrounds asking me if they were safe in the U.S. They had heard what the President had been saying about deporting people, they were very afraid that their families would be deported. However, all the kids and their families were American citizens so they could not be deported. However, due to what they were hearing and seeing the President do, they were very afraid for their safety.

This past week provides another example to children and teenagers to worry about their safety. A few weeks ago we witnessed George Floyd, a black man, being murdered by the police. Many of us hoped that this incident would be the trigger for all of us to look at the institutional racism in our Country. However, we were wrong about this being the trigger to make changes in our Country. This last week Jacob Blake was shot seven times in his back and the police officer had the gun in Jacob’s back as he shot. The President never addressed the shooting and we have heard little from the police. However, a white, 17 year old male from Illinois felt it was his duty to go to Wisconsin to protect people. He shot and killed two people and walked down the middle of the street with his gun and the police did nothing. In fact, we are hearing he may have done nothing wrong because he was acting in self defense. However, he doesn’t live in the city and had no reason to take a gun, a gun he had no legal right to own, and go to Wisconsin to protect people. I may be wrong, but I thought that was the job of the police not a 17 year old Caucasian boy. It seems like the two men were treated differently due to their color.

The black adolescent boys all tell me they need to be careful when they are out so they don’t get arrested. Looking at the above example and the statistic that black teenagers are 15 times more likely to be arrested than Caucasian teenagers (DOJ, 2018) helps me to understand why they are so concerned. Also from my own experience working with teenagers on probation, I see the discrimination. I have had white teenage boys violate their probation numerous times and nothing is done. However, a black teen I was working with who was on home arrest had to go back to Juvenile Hall for a month for a probation violation. The reason was there was a power outage on the way home from his appointment with me. Because there was no power the monitor turned off and he was unable to call in because the phones were down. Probation decided he violated probation because the monitor went off and he did not call probation. The probation officer knew the power was off, but charged him with a violation anyway. Why? I also had some black teenagers tell me that at there high school students were using the “N” word and someone left and hanging noose on campus. The black students were assured that the incident would be addressed, but it never was addressed.

I have mentioned before that suicide is now at an epidemic rate and has been increasing every year for the past 20 years now so now it is the second leading cause of death for teenagers (CDC). However, Black teenagers are five times more likely than Caucasian teenagers to commit or attempt suicide. The reasons why the rate is higher for black teenagers seem to be racism and feeling like no matter how hard they try they feel they cannot succeed due to institutional racism (CDC). When I hear how many of the black teenagers I work with are being followed when they go to stores or if they say they want to be a physician or get their doctorate degree that their high school counselors discuss being plumbers or electricians with them instead. These teens are very bright and this must be very discouraging. I was told the same thing in college because I have a neurological disability. I share my story with these teenagers and encourage them to go for their dreams.

57 years ago today Dr. Martin Luther King, Jr disgust a dream where racism was not an issue and we were all treated equally. However, if we look at our society, we are very far from Dr. King’s dream. The teenagers who are speaking out and protesting are telling the truth and we need to listen to them. Many people criticize them for protesting during a pandemic, however no one says anything to President Trump about not wearing a mask and holding campaign rallies that violate all the safety guidelines regarding the pandemic. Again a white man is getting a way with exposing thousands of us to the pandemic, yet the protestors who wear masks and try to social distance are criticize. Stop and think about that point.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information regarding Dr. Rubino’s work or private practice visit his website at www.RubinoCounseling.com or his Facebook page at www.Facebook.com/drrubino3. or listen to his podcasts on Apple or Spotify.

Seeing No End to the Pandemic more Teenagers are Thinking about Suicide

Seeing No End to the Pandemic more Teenagers are Thinking about Suicide

Many parents ask me, if their child could be suicidal and what to do if their child is suicidal? I have been getting this question even more now that the pandemic has lasted so long. As a result of teenagers and children having to stay in the house for so long and not being able to return to school, many teenagers are feeling isolated and lonely. Suicidal feeling have been increasing for teenagers for several years. As a result, the CDC has moved suicide from the the third leading cause of death to the second leading cause of death for kids 10 to 18 years old. Furthermore, since the quarantine and pandemic have occurred, there has been an increase in suicides and deaths from drug overdoses in teenagers. A recent study by the CDC has found that during the pandemic, the idea of suicide for teenagers has increased. Currently, 1 out of 4 teenagers have been having suicidal thoughts (CDC). Also for adults, the suicidal ideation has increased by 11%. As a result, parents are worrying more about if their teenager may be feeling suicidal. Additionally, before the quarantine and pandemic, parents were worrying more about their teenager being suicidal because a study by the CDC indicated that survivors of mass shootings were more likely to attempt suicide. The issue of suicide is very scary especially because we do not discuss mental health issues in our society. As a result, parents are not sure what signs they should be looking for or what to do if they think their teen is suicidal. This creates a great deal of anxiety for parents because we were discussing the teenage suicide epidemic, but since the pandemic has lasted so long, the number of teenagers thinking about suicide has increased suicide significantly (CDC). Parents have been isolated to due to the pandemic so besides the fact they are dealing with their own feelings of isolation and fatigue, they are faced with trying to decide what is the best thing to do for their teenager.

A successful suicide attempt is definitely a tragedy for the entire family. However, an unsuccessful attempt can be a major tragedy for the teen and the family too. Depending on the method used, a child who has an unsuccessful attempt may have to live their entire life with major medical complications. They can cause brain damage which may cause them to lose the ability to speak or the ability to breath on their own. Therefore, they may spend the rest of their life on a ventilator. Guns are one of the top three ways teenagers attempt suicide. However, teenagers are not aware that guns jump when fired. Many teens who use a gun do not kill themselves, but they do shoot off their face. The result is they have to have numerous surgeries to reconstruct their face, but their face and life are never the same. Some teenagers may need a face transplant which is a new technique surgeons have as an option.

I read this very good article describing what to do if you think your child is suicidal. It provides the steps you need to take in a non-threatening manner. It also addresses issues parents often may not think about, if they are concerned about their child being suicidal. The most important step is don’t be afraid to ask your child if they are feeling suicidal. It is a myth that if you ask someone if they are suicidal that you will cause them to become suicidal. In fact, you may save their life by asking them if they are suicidal. By asking you let them know it’s ok to talk about their feelings. Also by asking you reassure them there is nothing wrong with them and that you are emotionally strong enough to cope with the situation. Therefore, you may save their life by asking, if they are feeling suicidal.

Another reason many parents do not ask their teenager about suicide is the negative stigma associated with suicide. Often when someone dies of suicide the family will give another reason. Many families also request suicide not be listed as the cause of death. The Lighthouse Project conducted at Columbia University is attempting to remove this stigma. The Project has also developed questions that family members, friends and first responders can ask a person who they think might be suicidal. The questions have shown to be very effective at identifying someone who is suicidal and having the person to get help. I am including the link to the Lighthouse Project so you can learn more about it and download the questions that are most appreciated for you, if you feel someone in your life maybe suicidal. http://cssrs.columbia.edu/. It is a very good list of questions and the research shows that the questions are very effective at identifying someone who is suicidal. I have looked at the study and questions and I highly recommend the Lighthouse Project.

I have included the link to this article and I encourage parents to read it and to save it. What to Do if You’re Worried About Suicide |. https://childmind.org/article/youre-worried-suicide/#.W9PRyfwKel8.twitter. It provides you with symptoms and signs to watch for in teenagers. It also helps you talk to your teen about their feelings and opinions you can use for help. The bottom line, if you feel your teenager is suicidal do not be embarrassed. Remember today’s teenagers have had to deal with a lot over the past couple of years. They had to worry about being shot at school by a mass shooter, bullying has significantly increased so has the pressure to succeed and now they have had to cope with 4 months of being quarantined, their school was abruptly closed and now many are having to return to school remotely. They are all saying the same thing to me, when do I get to see me friends and when will life return to normal. Since many are now feeling life will never be normal, they are feeling suicidal. We need to be there for them and help them through these very confusing times. These times are confusing for adults imagine how they are for teenagers and children. So if you teen or child seem depressed or are talking an suicide make an appointment to have your teen evaluated by a psychotherapist who specializes in suicidal teenagers. If you walk in on a teenager attempting suicide, call 911 immediately.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating suicidal children and teenagers. For more information on his work or private practice visit his website www.RubinoCounseling.com or Facebook page www.facebook.com/drrubino3 or his podcast Understanding Today’s Teenagers on Spotify or Apple.

Helping Kids Return to School During A Pandemic

Helping Kids Return to School During A Pandemic

Well it has taken some time, but finally most school districts have decided when school will be starting and how students will be resuming school. This decision has been made fairly late for most students. Many schools will be resuming school in two weeks and several schools that have tried returning to the classrooms have already started, but several are already having to interrupt classes because students and teachers have already tested positive for the Coronavirus, such as in Georgia. The children and teenagers I have spoken with are angry and upset about school resuming. However, most of them are also happy too, but don’t like to admit it. This article will explore how parents can help their children and teenagers resume school in the middle of a global pandemic.

Starting back to school in the middle of a pandemic can create anxiety and fear for some students, since they still are hearing about people contracting and dying from the Coronavirus. Also since most students have been through a great deal of stress prior to the pandemic such as dealing with daily mass shootings last year, schools closing suddenly due to the quarantine and now they are resuming school but have no idea what to expect. Many students are tired of dealing with the unknown and many kids are losing interest in school too. They want their lives to be somewhat normal again. Since most the children and teenagers that I deal with will be returning to school remotely, I will be looking at the issue from that perspective, however you can use many of the same suggestions for children returning to their classrooms for school. In my opinion, remote learning is the best option for this semester, but there are various opinions and parents need to do what they feel is best for their family.

The first thing parents can do before their child or teenager returns to school is explain what to expect at school. Children’s imagination can be very active and often their imagination is worse than reality. By explaining how remote schooling will work you are preparing your child what to expect and they don’t have to imagine what remote school will be like. Also because you are explaining all the details you are telling your child and teenager that you have inspected the plan for school and you are feeling safe enough to allow them to participate. Children know that if their parents felt the situation was not appropriate for them that you would not allow them to be involved in the situation.

The next step for parents is to listen to your child and teenager. Allow them to vent their frustration, their fears and their disappointment and any other feelings they may have about the plan for school. It’s important for them to express all their feelings and concerns so you can address them. Also if they are not allowed to express how they are feeling most likely they will start to feel resentful because they feel like no one cares about their feelings. If this occurs, they could resist participating in the remote schooling. The most common feeling you will probably hear is anger and frustration about not being able to see their friends daily at school and hang out with their friends. Remember, due to schools closing early and quarantine restrictions many children and teenagers have not been able to see their friends for several months now. Yes they understand the need to be careful due to the Coronavirus, but they are also tired of it especially when they see adults not wearing masks and disobeying the guidelines. A good example is the motorcycle rally they are having in South Dakota.

In addition to listening to their feelings, validate their feelings. Let them know they are entitled to whatever feelings they are having and this is not an easy situation for anybody. Empathize with their feelings too. Explain while it’s not easy for anyone it is more difficult for them because they are young and they want to enjoy life. You can understand how frustrating it is with no one being able to give them definite answers about when their lives may return to normal. Reassure them that you have heard all their feelings and concerns and you are going to do your best to help them through this situation.

Another important thing parents can do with their children is to brainstorm. Now that you know their feelings and concerns, you and your child or teenager can brainstorm about how you can address the various issues and concerns they have about the remote schooling. If at the end of last school year the remote schooling was slightly chaotic you can agree to work with them until you figure out the system for this year. If they are missing friends, maybe there is away they can see friends in person but still adhere to the guidelines of wearing masks and keeping appropriate distance from each other. If they are missing working out at the gym or practicing with their team, there maybe a way they can do workouts at home or there maybe coaches offering private lessons. You can also see if the school has developed an answers to these situations. Most importantly let them know you will look at all the options and you may have to consider options outside of the box because of the unique situation with the pandemic. The main point is you will work with them as hard as you can to address their concerns and make their lives feel as normal as you can given the pandemic.

Finally schedule regular check-ins with your children and teenagers. The above steps are a good beginning, however things can change. Therefore, what was working at the beginning of the school year may not be working two months later. If you have regular check-ins and something changes you can catch it before it becomes a big issue. In addition to checking-in with your child, remember to check-in with your child’s school. Ask about how your child is doing and also ask if there are any proposed changes scheduled for the remote learning. Again if there are changes being proposed, you can prepare your child so you can hopefully make the transition any easy one rather than a stressful one.

Finally, remember the children and teenagers of today have been under a great deal of stress due to the mass school shootings which were occurring daily before the pandemic and quarantine. The pandemic has only added to their stress levels. Since the beginning of the pandemic depression and anxiety disorders have increased significantly for children and teenagers (CDC). Anxiety and depression were already at epidemic levels for children and teenagers before the pandemic. Therefore, anything we can do to help reduce anxiety and depression for children and teenagers will help them adjust to the remote schooling. Remember we are all in this together and need to all work together and we will survive the pandemic. If you do notice that your child or teenager is acting more anxious than normal or appear several depressed, make an appointment for them to see a psychotherapist experienced with treating children and teenagers. There is nothing to be embarrassed about if your child needs therapy during this time.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information about his work or private practice visit his website http://www.RubinoCounseling.com or his Facebook page at http://www.Facebook.com/drrubino3 or his podcast Understanding Today’s Teenagers on Apple or Spotify.

Teenagers May Need more Access to Electronics during the Pandemic

Teenagers May Need more Access to Electronics during the Pandemic

Most middle school and high school students have grown up with smart phones and computers for gaming and texting their friends. This brings up the common argument about how much time teens are spending on line. Many parents have concerns that their teenager is addicted to their smart phones and gaming. Teenagers feel that their parents are over reacting and they can’t become addicted to their devices.

However, due to the pandemic gaming is now one of the few safe activities teenagers can do. Most places such as movie theaters and malls are closed so gamine provides a safe way to hang out with friends. This is very important to their social development at their age. Additionally, research is showing that teenagers who have little access to normal social activities are becoming depressed during the pandemic (CDC). Therefore, we need to re-evaluate the issue of gaming during the pandemic.

While the truth is teenagers can become addicted to their computer devices and gaming. The World Health Organization (WHO) took a step this year and classified “Gaming Disorder” as a formal diagnosis. As I stated, many parents have been concerned about this for years. Also it does not just impact teenagers, as many may think. I have had couples come in for marriage counseling because Gaming was destroying a marriage. For several years the American Psychological Association has said it would be adding Gaming addiction as a formal diagnosis to the Diagnostic and Statistical Manual, however, so far the APA has not been able to decide on the specific criteria for this diagnosis. What the WHO has done is they have acknowledged what many parents have been reporting for years and helping us to take a step so it is acknowledged as a diagnosis. While it is a diagnosis according to the WHO, gaming again is one of the safe activities teenagers can engage in during the pandemic. This does create a difficult situation.

The United States appears to be behind other countries in identifying that video game addiction does exist and does create problems for individuals and families. Seoul, South Korea and Tokyo, Japan have inpatient treatment centers for gaming addiction. These rehabilitation centers have been open for years and have treated thousands of people over the years. Therefore, other countries have acknowledged Gaming addiction that United States parents have been reporting for years.

As a psychotherapist who treats teenagers, I would have to agree with the parents and I say Gaming addiction is real. I have seen teenagers become violent, punching holes in walls or physically threatening their parents, if there video games or cellphones are taken away as a punishment. Teenagers have told me they cannot function without their video games or cellphones and will do anything to get them back. This sounds like and look like a problem to me. A cellphone or PlayStation should not be a teenager’s life line.

However, as I stated above, the pandemic does create a different situation regarding teenagers gaming online with friends. Since this is a safe way for teenagers to maintain social contacts, I think we need to create new guidelines for the pandemic. Parents are aware that teenagers can become addicted, but they can monitor how their teenagers are acting before and after using electronics. Also maybe have a day without electronics, while allowing some extra time on other days. So try to balance out how much time they are on electronics along with doing other things such as going outside for walks to get exercise.

The statement from the WHO states that the Gaming must be interfering with activities of daily life, such as homework, and be present for at least a year. These guidelines seem sensible to me. Also the WHO cautions that issues such as depression and anxiety need to be ruled out before assigning the diagnosis of Gaming Addiction. Many teenagers who are depressed or dealing with severe anxiety do self-medicate with video games. Finally, the WHO states your child needs to be evaluated by a mental health clinician who specializes in treating and assessing children and teenagers. This is very important because typically children and teenagers do not always have the typical symptoms we associate with depression or anxiety. A clinician experienced in assessing children and teenagers can make the appropriate diagnosis. Given these guidelines it appears to me that parents can allow teenagers to use their electronics more during this time of the pandemic. Parents can make sure to balance electronic time with other activities such as exercise. Furthermore, parents need to be observing their teenagers mood on a daily basis. If the teen is looking depressed or acting anxious then the parents need to schedule a time to have their teenager evaluated by a mental health professional who specializes in treating children and teenagers.

I have included a link to a segment on Good Morning America which discusses the diagnosis and other issues I have discussed to assist you in understanding what the WHO is referring to with Gaming Addiction, https://youtu.be/axG1tLdutmY.

The World Health Organization has taken an important step in helping us understand and define a problem many parents have been reporting for years. This is not a bad thing. I view it as a positive step. Technology is moving very fast. In fact, it is moving so fast we cannot keep up with all the new issues we need to deal with as a result of new technology. The more we understand this technology the more we all can benefit and avoid potential serious problems.

With that be stated, the Coronavirus pandemic does present parents and teenagers with a entirely new set of issues. If we stay calm and flexible, we should be able to address these new issues without a great deal of stress for parents or teenagers. Remember this is a new situation for everyone and no one has experienced this type of health situation before. Therefore, if we all work together, we should be able to find solutions to the new issues we continue to face on a daily basis.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating and assessing children and teenagers. For more information about his work visit his website http://www.RubinoCounseling.com or Facebook page http://www.Facebook.com/drrubino3.

Should Schools Reopen in the Middle of a Pandemic?

Should Schools Reopen in the Middle of a Pandemic?

Are we thinking about the safety of our children, school personnel and family members, when we are debating should we or should we not reopen schools in two to four weeks? Currently, the Coronavirus is out of control in Florida, Georgia, Alabama, Texas, Arizona and California. Florida has used all of their ICU beds, in Georgia surgeons don’t have enough masks for surgeons and State officials in Texas, Arizona and California are requesting that their states be shut down and return to shelter in place (CDC, CNN, ABC News). Furthermore, the latest results indicate that people under 40 are the ones who are currently being infected (CDC). In addition to this fact, research does indicate that children can contract the Coronavirus and can die from the Coronavirus. A couple of weeks ago an 11 year old boy, in Florida, died due to the Coronavirus (CDC, CNN).

If the virus is out of control and children can contradict it and die, why are we pushing them to go to the school site, where social distancing is impossible? Additionally, many of these children have parents and grandparents living with them who are at high risks. Therefore, by going to school, they are exposing their families to the Coronavirus. How would a 10 year old boy feel if he brought the virus home and his grandparents caught it and died? It would be devastating to the child. The child could also transmit the virus to his teacher or his teacher’s parents who live with her. Again, if any of them died the little boy would be devastated and emotionally scared for life.

Chris Cuomo interviewed a wife, on his show Prime Time, whose husband was on a ventilator due to the Coronavirus. She had the virus too. They were not sure if her husband would survive. The family contracted the virus because their 21 year old son went to a party. The mother reported that emotionally her son was devastated. He was worrying that by going to his friend’s party, his father might die and he was blaming himself. If a 21 year old young man is having severe emotional difficulties dealing with this situation, how would an eight or 10 year old child handle it?

As a psychotherapist who specializes in treating children and teenagers, I have been asking my patients about how they feel about returning to their classrooms this semester or doing remote learning like they were doing at the end of last year? All the children and teenagers have discussed how it would be nice to return to school so they can see their friends. However, they all are also worried about contracting the Coronavirus and they are concerned about pacing the Coronavirus on to someone in their family. As a result of this fear, all the kids want to do remote learning. Additionally, all the children and teenagers that I work with do not trust the White House to protect them. We forget this is the generation that has grown up with Smartphones. As a result, they have access to news reports and are aware of what is happening in our Country. They also have opinions about the Coronavirus and how it has been handled. They also have opinions about the Black Lives Matter movement and the recent protests that have occurred across the Country.

When the physicians who are experts regarding this virus and public health experts all agree that returning to the classrooms at this time is not safe for the students, their families or for teachers or other school personnel, I think we should listen to them. They said we were reopening the government too fast and look at the mess we are in at this time. As of July 25, 2020, over 145,000 Americans have died and the state of California reported the highest number of people dying in the state today and Florida now has more reported cases than New York at its peak (CDC). This is for today. The numbers in Florida, Texas, Arizona and California continue to rise which means more people will be dying.

Besides medical professionals and educational professionals recommending that we have children do school by remote learning, children and teenagers are requesting remote learning. They are afraid of catching the Coronavirus. Again, the research indicates that children and teenagers do contradict the Coronavirus. When they do they are more at risk to develop a unique complication which is similar to Kawasaki‘s disease. As a result of this fact and other things we do not know about the Coronavirus, children and teenagers can and do die from the Coronavirus (CDC).

The only reason I can see to rush children and teenagers back into classrooms is so President Trump looks like he is doing something about the Coronavirus and being President. If he was serious about protecting our children, he could have started developing a plan to return children to school back in April instead of waiting until two weeks before schools start and then just ordering the children back to school with no safety plans. He also could have urged the public to wear face masks in April and May when that was the recommendation of the medical professionals. Instead, he waited until his poll numbers were so low, he had to do something. Having children return to classrooms is a very serious issue considering how this virus acts and the lack of information we have about the Coronavirus. We would need safety plans for teachers, school staff members, students and families of the students and teachers, if we were serious about children and teenagers returning to the school site safely. With all this happening, what is President Trump doing today? He is playing golf. He is not addressing this serious issue about the schools or any issues associated with the pandemic. Additionally, when the press asked KellyAnn Conway what the President was gong to do about his son Barron, Ms. Conway said it was a private matter between the First Lady and the President and they would be making the decision they felt was in their son’s best interest (ABC, CBS, Fox News, CNN). She never said Barron would be returning to the classroom. Therefore, if the President is not rushing his son back to school, why should your child go back with no firmly established safety procedures.

Given the fact that the White House has failed to take the pandemic seriously and the medical experts are recommending that remote learning is the safest option at this time, I would recommend listening to the medical experts. Additionally, many teachers are stating that it is not safe to return to the classrooms under the current conditions. Finally, the students are saying that they do not feel safe returning to the classrooms and instead they prefer remote learning because it’s safer. I think we owe it to the children and teenagers to listen their concerns and resume this semester via remote learning. In the meantime we need the government to seriously address the pandemic so we can return to normal lives like other countries.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information regarding Dr. Rubino’s work visit his website at http://www.RubinoCounseling.com, his Facebook page at http://www.Facebook.com/drrubino3 or his podcasts, Understanding Today’s Teenagers.

Outside Family Activities during the Pandemic

Outside Family Activities during the Pandemic

Since the Coronavirus has hit, we have had to change our work lives and family lives. Change the family life has been a challenge for many parents. It has become more of a challenge since summer has started and the kids want to go outside. They are tired of being inside. I found some good recommendations on Lori Lite’s blog regarding reducing stress for children. All of these activities can be done wearing a mask and keeping the social distancing requirements. These are perfect activities during the pandemic and with the State being closed down. Also getting outside in the fresh air and sunshine is great for the whole family since we have been locked down for several months. It’s a great family bonding experience and a great way to reduce everyone’s stress. Here are some fun outdoor activities to do as a family:

Go For a Walk:
Not only is this a completely free activity, but it is also an excellent opportunity to talk more with your family. However, remember you need to wear your masks, keep appropriate social distance from others and use your sunscreen. Take the time to ask them about they are feeling about the situation with school, friends, or anything else that interests them. You can take a walk around the block or head to a trail nearby. This is also a great way to get in more exercise as a family and can encourage a healthier lifestyle. You can easily take a walk after dinner or make a day out of it as well. It’s amazing the topics of conversation that come up with kids when there aren’t the distractions of being inside, screens, phones, or chores.

Go For a Ride:
Riding with family, like walking, is great bonding activity. Again, remember your helmets, masks, sunscreen and to social distance from others. At first, it’s good to do it on footpaths and then get to cycle-paths to build up each of your skills and also to bit by bit learn how you ride together and communicate with each other. Like walking, it’s amazing the conversations that will arise with your family. The beauty of cycling with your family is the different places you can see. You can do an off-road trail and explore the bush. You can ride around a harbor, lake, river or parkland – chatting about the wildlife, views, houses and architecture. As long as you remember to social distance from others and to wear your masks. Of course, you don’t have to ride all the time, there will be plenty of playgrounds to stop at and explore and many times there are great trees which are just beckoning your kids to stop, get off their bikes and climb. Consider making cycling a regular family adventure and build lifetime memories with your kids!

Have a Picnic
Enjoy the next sunny day with your family by having a picnic. You and your kids can prepare the food together in the morning. Choose foods you all love and have them help pack everything you need for the picnic. Then you all can spend the day in the park or even your backyard enjoying each other’s company. If you are at a park, remember your masks and to keep appropriate social distance from others. Picnics can also be an opportunity to play games, try out new recipes, and find new parks around your neighborhood. 

Water Balloon Fight:
You and your kids can do this in the backyard or even at the nearby park. Grab a large bucket and a bunch of balloons to fill with water. You can make your own rules with this kind of activity or even make it into a hide-and-seek game. This will also get your family moving and exercising without even realizing it. Again, remember you still need your masks and to social distance from others at a park. You can change it up by using raw eggs at times. This may be a good idea if it’s a little too cold for water balloons.

These are a few ideas. Now that we have started the ball rolling, you can also ask your kids about activities or games they may want to play. You may be amazed at their creativity and again it’s a great way to keep the communication flowing between you and your kids.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information about his work with teenagers or his private practice visit his website at http://www.RubinoCounseling.com or his Facebook page at http://www.Facebook.com/drrubino3.

Dealing with Visitation Issues during A Pandemic

Dealing with Visitation Issues during A Pandemic

After a divorce there are still issues to address. One of the major issues is child custody and visitation, especially exchanges for visitations. The issues usually are addressed in the divorce settlement and the Court Mediation report. However, even though the Mediation Agreement attempts to address these issues, there are usually still issues.

I have parents who are divorced come in very often arguing about issues that occur during visitation exchanges. A majority of times these issues are addressed by the Mediation Agreement. However, many parents are still fighting with each other after their divorce is final. Typically I see this when one or both parents are not ready to let go of each other yet. Arguing over the visitation exchanges is a way to still keep them in contact with each other. However, parents do not pay attention to the price the children are paying. By focusing on visitation exchanges this puts the children in the middle of the divorce.

By focusing on visitation and putting the children in the middle of the divorce, I see children who become depressed and anxious. Often these children start acting out at school and home and their grades start to decline. Also many of these children often start drinking or using marijuana so they can numb themselves out and ignore their parents’ arguments. Most of these children ask me, why can’t they just stop fighting? They are already divorced, what else do they want?

Goldberg Jones is a very good divorce attorney who writes articles regarding issues related to divorce and how these issues impact the children and the family. He wrote a very good article regarding visitation exchange issues. I found the suggestions very good and helpful. I would recommend that divorced parents read these ideas and try them. Therefore, I have included them in this article for you to review and try. You have nothing to lose by trying and you could help reduce the stress your children experience with visitation. You may also reduce your stress and frustration and allow yourself to let go of the marriage and move on with your life.

How often visitation issues occur often depends on the custody agreement, parenting plan, and the visitation schedule. Visitation may be a couple of times a week, once a month, or only around major holidays, but it’s likely going to be a repeating event. Also how well the parents work together as co-parents and allow the divorce issues to be past issues plays a major role in determining if visitation goes easily or is a source of ongoing arguments.

In the best of times, even if both parents can be civil, custody exchanges will probably still be a little awkward. In less amicable scenarios, prepare for outward hostility that resembles the opening scene in Saving Private Ryan. Pack a helmet and prepare to duck.

In more combative circumstances, it helps to have a strategy in place to keep things civil. That’s easier on everyone, especially the kids. There are ways to cut down the amount of face time and limit the friction. It may never be easy or ideal, but it helps with stress level and peace of mind, for both the parents and the children—no kid wants to watch mom and dad fight.

  1. CUSTODY EXCHANGES AT THE BABYSITTER’S
    In contentious situations, the more you see your ex, the more potential there is for friction and conflict. Sometimes it’s simply best not to see each other if you can avoid it. There are practical ways to circumvent this. One common approach is to make custody exchanges at a babysitter’s house or at daycare.

One parent drops the kids off and the other parent picks them up. If you schedule it right, the two of you may almost never come face-to-face. Because there are other people involved, you may encounter scheduling hurdles. Clear communication about who is picking up the kids and when is key. But once you iron out the kinks, this strategy helps limit contact and potential fights.

  1. CUSTODY EXCHANGES AT SCHOOL
    Similar to using daycare to facilitate custody exchanges, you can use your child’s education to the same end. Again, one parent drops the kids off at school in the morning while the other picks them up after. This has the desired effect of not having to see your ex more than is absolutely necessary. It can be useful in situations where parents are prone to fighting.

Like with the child care, you’ll need to arrange this with school administrators. Schools like to know they’re handing kids over to right people. But if there is clear communication between all the involved parties, it’s possible to make these arrangements work.

  1. CUSTODY EXCHANGES IN PUBLIC
    Many people want to avoid causing a scene in public. If you and your ex can’t handle custody exchanges without fighting, consider meeting in a public place. Choose a neutral spot where neither parent is likely to start a ruckus. If such a place exists. In some situations, nowhere is off limits, but being exposed often encourages both parties to be on their best behavior.

Where depends a great deal on the people involved. Pick a centrally located park. The mall, a restaurant, or a coffee shop where you know the regulars are all options. Extreme cases may call for supervised visitation centers or even a police station. Then again, if you just kind of rub each other the wrong way from time to time, a supermarket parking lot may work fine.

  1. INVITE A THIRD PARTY WITNESS
    While people are reluctant to fight in public, they’re also often hesitant to start trouble in front of friends or acquaintances. One strategy that can smooth over problematic custody exchanges is bringing along a third party. A mutual friend or even authority figure can help keep the peace, especially if it’s someone who knows both parents.

If there are individuals both of you maintain a relationship with, that might be the ideal fit. This approach often serves to calm down heated emotions. And if things do escalate, having a witness never hurts.

If you do go this route, it’s important to give some thought to who you bring along. If you have a new spouse or significant other, consider the ramifications of their presence. Is that going to touch on a sore spot and ignite lingering resentment? In some situations, it might be best to ride solo instead of risking a potential fight.

  1. COMMUNICATE VIA ALTERNATE MEANS
    Visitation, overnights, and custody exchanges often become logistical tangles. With football games, school plays, robot camp, and the many other activities children participate in, scheduling gets complicated. Pulling it off requires regular communication. If there are problems in this area, conflict often arises. When it involved kids, some level of contact must exist. Fortunately, there are alternative means of communication.

You may have mutual friends or family members willing to serve as go-betweens. Though it tends to get expensive fast, enlisting a lawyer or mediator is another potential strategy.

Thanks to modern technology, you have more outlets than ever before. If you can’t talk on the phone or in-person, email, texting, instant messaging, and other online options exist. Websites like Our Family Wizard provide shared scheduling services and online tools for co-parenting. There are even numerous smartphone apps for tracking parenting schedules and children’s activities. 6.

  1. PREPARE FOR CUSTODY EXCHANGES AHEAD OF TIME
    Preparation in advance of custody exchanges is key. The more prepared you are, the faster and smoother they’ll go. Before your ex picks up the kids, take the time to gather everything they need for this particular stay. Whether it’s a quick overnight or a two-week vacation, make sure to gather the essentials.

Did you pack all of the regular medications they take? Do they have all the school books they need to get their homework done? That report on the solar system isn’t going to write itself. If your daughter has a baseball game, pack the mitt and cleats. If your son can’t sleep without his special stuffed zebra, it needs to make the trip. Knowing you have everything set reduces the amount of time you have to interact with someone you’d rather not see.

Think about what the kids can’t live without and send it with them. Otherwise, you risk a middle-of-the-night call or visit from your ex. If the goal is to limit the amount of contact, that defeats the purpose, doesn’t it?

After a divorce, it may be quite some time before you want to see your ex again, if ever. But when you have kids, that’s not really an option. Custody exchanges can be tough, but it’s something you have to deal with.

For the sake of the kids, for their well-being—as well as your own—it’s important to try to make these encounters as smooth and painless as possible. Have a plan, be efficient, and keep your seething emotions in check for a few minutes. Hopefully, that’s all you’ll need. Taking steps to limit conflict in a custody exchange is healthier for everyone involved.

Also remember children have been through more stress than they can tolerate. Besides the divorce, children have been dealing with mass shootings and mass shooting drills at schools for several years. In 2019, there was a mass shooting everyday (CDC). As a result children and teenagers reporting anxiety and depression disorders have reached epidemic levels (CDC). Furthermore, cutting in teenagers has reached epidemic levels and suicide is now the second leading cause of death for children 10 to 18 years old (CDC).

In addition to dealing with mass shootings, now children are dealing with the Coronavirus. No one has any answers and children have had their worlds shrink. They have had to shelter in place, schools were closed early so they have had little to no contact with their friends. Finally, they have no idea about the upcoming school year and are hearing conflicting reports. Therefore, children and teenagers have had more stress than they can handle. They need you, their parents, to put divorce issues aside and make visitation civil and for the two of you to make decisions about the upcoming school year without arguing and drama. They do not need anymore stress. Finally, if you are noticing symptoms of anxiety or depression in your children and it appears they may need professional help, please do not argue about it. Have your child evaluated by a psychotherapist who specializes in treating children and teenagers are after the examination, calmly decide what is best for your child. Please do not make it into a contest between the two of you. Put your issues aside and just focus on your child.

If you have questions about child custody or parenting plans, feel free to contact Goldberg Jones at his San Diego office.

I think these are all very valid points and important issues to consider and feeling that often occur during and after a divorce. I often recommend the same approach and encourage parents to consider the same issues in regards to their children and themselves. Divorce is a very painful experience even when it is handled well and with respect for each other. However, the truth is most children I see for divorce issues are because their parents are still hurting so they children sense it and take on the family pain trying to solve it. So please try these ideas especially during this time of uncertainty.

Dr. Michael Rubino has over 20 years experience treating children and teenagers. He is an expert in treating children who are involved in a high conflict divorce. For more information regarding Dr. Michael Rubino or his practice visit his website at http://www.rcs-ca.com or http://www.rubinocounseling.com or Facebook page at http://www.facebook.com/drrubino3.