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Is it ADHD or Exposure to Toxins?

In my December 20, 2010 blog  I asked if mental health therapists are asking about Housing Quality.  The CDC has linked housing quality to health.  There are ranges of issues that therapists could be asking but today I will focus on Indoor Pollution.  But first, lets explore the issue.  

The Environmental Protection Agency (EPA) has reported that people from Industrialized Nations spend up to 90% of their time indoors.  This number makes sense when we think about the time we spend at work, socializing, buying (i.e., groceries, mall), and hanging out in our homes.  When we think about small children and the elderly, this number may be even higher.  Because of this time spent indoors, people are more likely to be exposed to pollution and toxins in their homes rather than from the outside.  The EPA, CDC, and Physicians for Social Responsibility (PSR) list a number of indoor pollutants that are of concern.  They include; second hand smoke, lead, radon, biological contaminants (e.g., bacteria, molds, mildew, animal dander, house dust mites, cockroaches, pollen), carbon monoxide, nitrogen dioxide, organic chemicals (e.g., paints, aerosol sprays, pesticides, disinfectants, air fresheners, hobby supplies, dry-cleaned clothing), and asbestos.  This list is overwhelming!!

And while we might be concerned with these issues, we might think that someone else should explore these issues.  There are a number of reasons why a therapist should ask about Indoor Pollution.  First, children and the elderly are highly susceptible to toxins.  Children like to crawl around, put things in their mouth, and have increased metabolisms.  The Elderly are more likely to stay inside thus increasing their expose to molds, mildew, radon, and pesticides.  Reactions to indoor pollution can mimic psychological issues.  For example, children exposed to lead attention deficits, increased impulsiveness, reduced school performance, aggression, and delinquent behavior.  These exposures may also mimic cognitive deficits like memory loss.  As therapists we might be missing a key contextual factor that plays a significant role in the issue that brought a client to us.  Next, exposure to a range of indoor pollutants is harmful to expectant mothers.  Exposure to lead, mercury, alcohol, second hand smoke, and pesticides can adversely affect fetus development.  Lastly, parents are concerned about these issues but their primary care providers are not addressing environmental health issues.  Physicians for Social Responsibility highlight a report in Environment Health Perspective that despite the perceived importance of doing an environmental assessment, pediatricians are not trained to do one and thus lack confidence to ask the questions.

Hopefully you agree that therapists could play a pivotal role and one that does not take time too much time. So here is what you can do: 

• Ask about the occupation of all people in the household that work?  What do they do?  Do they think they might be exposed to chemicals on the job?  Employers are required by federal law to keep a list of all chemicals that are harmful to employees.  This is important because workers can bring chemicals back into their homes.  This information could be collected during the intake.  
• Ask about if they have any hobbies that include solvents (e.g., glue, paints, paint thinners, art materials)?  Where are they stored?  Do kids have access to them?  
• Ask about their diet.  Do they eat a lot of fish?  Where do they get their fish?  Fish can contain high levels of mercury.  
• Is there lead paint in the home? Homes built prior to 1978 used lead paint.  Older apartments can have lead paint.  
• Any hazardous sites near their homes?  Click HERE for an EPA website.  
• Where do they get their drinking water?  This is especially important for your rural clients.  
• When was the last time they had their heating system serviced?  Does not matter the type of heating?  This is also related to my previous post on Home Fires.  
• Have they talked to your Primary Care Provider about environmental health issues?

I know there is a lot of information above but the conversation you have with a client might only take a few minutes.  If you or your clients are curious or have more questions, you can check out the website below.  Leave a comment, questions, or concern below and thanks for following.

John

RESOURCES (Click on the links) 

• Center for Disease Control and Prevention's Environmental Health site.  
• Environmental Protection Agency has many resources.  Here are just a few: 
• The Indoor Quality site is a good start.
•  If you are interested in the science of environmental issues and children's health the Toxicity and Exposure Assessment for Children's Health is all you need.   
• Here is an Introduction to Air Pollution for Health Professionals 
• The International Labour Organization has useful page for Chemicals in the Workplace.  
• Physicians for Social Responsibility has great resources as well. 
• Here is a Pediatric Toolkit to help health care providers   
• Here is a wonderful publication called, In Harm's Way, that you can download.  
• Lastly, you can Continuing Education Course on Pediatric Environmental Health thats FREE.

Do Family Therapists ask about Fire Safety?

In my previous post I wondered how many family therapists ask questions about the quality of their clients' housing.  One particular topic in the area of housing quality is fire safety.  This is an important topic to ask families around this time of year.  Home fires increase during the holiday season and due to the financial difficulties families might have this year, public health officials are concerned of an increased risk of home fires.  It goes without saying that home fires are devastating and traumatic for those who experience it, even if everyone escapes safely.  But home fires can be deadly for a number of populations.  According to the Fire Safety.gov website:

• Children younger than 5 have a higher risk of fire injury and death than older children.
• Adults 65 and older are twice as likely as any other age group to die in a home fire. The death rate for those 85 and older is five times the national average.
• African Americans are twice as likely to die in a fire than the general population. For American Indians, the risk of fire death is 30% higher than the general population.
• Income level is inversely related to fire death risk, with the highest risk among the poorest population groups.
• Death rates in rural communities are more than twice the rates in large cities and more than three times higher than rates in large towns and small cities.

An important point to remember is that house fires are preventable.  Family therapists have a unique opportunity to help prevent house fires by simply asking some questions.  Here are some questions you can ask ALL of your clients:

• Do you have any smoke alarms in the house? For those who can’t afford them, check you local firehouse for programs that install free smoke alarms.
• When was the last time you tested your smoke alarms?
• If there was a fire in the house, does everyone know what to do? Ask about evacuation plans.  Help your families create an escape plan and ask them to practice it for homework.  Click here for escape plan information.
• Do you  know where they can get reliable information on how to keep your house safe from fires? Here are some great consumer friendly websites:

• Smoke Alarm Information
• Cooking Safety
• Home Heating Safety
• For Smokers
• Miscellaneous Information for Fire Safety

Asking these simple questions and sharing information is all that is needed to help your clients prevent a house fire.  If you need further information, please check out the CDC’s website.  Let me know if you have additional questions that are important and please leave a comment.  Take care.

Asking About Housing Quality

Family therapists ask many questions about family composition (blood and fictive kin) and the quality of these familial relationships.  One significant question that gets overlooked during intake or throughout therapy sessions is the quality of a family's housing.  This might be related to some of the social taboos of asking people about the quality of their living quarters but this should not deter family therapists about asking about the quality of a family's housing.  According the Center for Disease Control and Prevention healthy housing is key in understanding the health status of family members (CDC Healthy Housing Executive Summary).  This makes a lot of sense when you think about the variety of environmental issues that can affect the quality of housing.  Some of these issues include toxic chemicals, pests, waterborn diseases, noise, crowding, and indoor pollution.  And this is just a partial list of how housing could affect a person's health.

To begin the conversation about housing, family therapists should directly state why this information is important.  The quality of one's housing is directly tied to one's health, physical and mental Thus it is important to understand where the family lives.  You are not there to judge them but to help them and understanding the context of their lives, which includes housing.  There are a number of areas that should be explored (e.g., Housing Structure, Indoor Pollution and Toxic Materials, Water Quality, Environmental/Neighborhood Pollution, Housing Safety).  These different areas with questions will be explored in future posts.

If you include Housing Quality as part of your therapy, let me know how you do it.  If you do not, what prevents you from exploring this issue?  For further information, please visit the CDC and the Health Housing Manual at CDC Health Housing Manual

The Beginning

The field of public health focuses on population health while the field of family therapy focuses on systemic change in small systems (e.g., couples, families).  While the two fields seem to operating at different levels, it is my belief that these two fields can collaborate together to help individuals, couples, families, and communities create the healthy environments they desire. 

I have been working with individuals, couples, families, and communities as a family therapist for over 15 years.  An important part of my work has been to provide culturally sensitive care to those I serve.  In my quest to educate myself I came across public health literature that proposed a connection between the behavior of health providers and health disparities.  I went back to school to obtain my M.P.H. from Drexel University to better understand the world of public health.

During this time in school I become increasingly aware of how family therapists have an unique opportunity to let their clients know of important public health issues that affect their social, emotional, psychological, and physical health.  Equally important is how family therapy theories can help public health officials understand community behaviors that could influence public health policy.

Family Therapy IS Public Health blog will be a place in which the literature of public health and family therapy is examined, explored, and elaborated upon.