Let's take a moment to get real about the professionals trying to help our kids. The doctors, psychiatrists, nurses, therapists, hospitals, social workers, and counselors who touch my kids lives. There are very few resources for parents who have kids with mental illness and fewer still for those who have kids with severe mental illness based on childhood trauma. When you add in the faith-based nature of many organizations out there for adoption, foster care, and childhood mental illness, as a queer family your options become even more limiting.
I'm going to disclose some information that would be confidential if it weren't ridiculous. My child has been seen by 4 general physicians, 7 psychiatrists, 9 therapists, 3 psychiatric hospitals, 5 different ERs, 3 social workers, 4 counselors, and innumerable nurses. These numbers are likely underestimated since hospital visits spanning weeks surely have rotating staff. In total she has been diagnosed with RAD, ODD, ADHD, Anxiety, Depression, Bipolar, Borderline Personality Disorder, Mood Disorder, PTSD, Schizophrenia and Autism. That's an awful lot of "we don't have a fucking clue."
As a parent you have an obligation to ensure the health and well being of your child. Realistically, although their intention is to help, I really haven't met a professional who's been able to significantly help in any way. In one instance I had a therapist who was honest with me after completing an intensive program she told me two things: 1. It wasn't worth us continuing with her program because the problem was my child had some wiring in her brain get messed up when she was a baby. Group doesn't really help with that, not really. 2. That she thought we were doing a fantastic job, all things considered. I'm not sure I agree with #2, but I was grateful for the boost that week.
I still haul my kid to therapy (she osculates between demanding to go "I can't live without" to refusing to go "I'll jump out of the car on the way there"), to a psychiatrist, and, when we need to, an ER or psychiatric hospital. You have to keep your kid safe, and you have to show schools, social workers, your family and friends that you're trying. My parents still believe in a concept that I gave up on a long time ago. They believe that if we just find the right doctor, therapist, medicine combo that the kid will be "fixed". Sometimes my kid believes this.
Lean into your computer screen real close, because i'm about to get real honest. Sometimes our kids can't be fixed. Sometimes fixing takes decades. That rewiring may have to be done by parents, teachers, aunts, grandparents, coaches, friends and neighbors a hundred times each before it'll really stick. How many of us have that many folks interested in our kid? How many of us can honestly say that many folks stuck around when our kids mental illness exploded in some destructive ugliness?
We know our kids. We know what will trigger them, how to keep them calm, how to temper disappointment and curtail the mania. We know what our kids real Diagnosis is, how to help them, what medicines are likely to work and what aren't. We know what the manipulations are and why they had that nightmare tonight. We know why March is always a bad month, why birthdays are bittersweet, and what happens if they do sneak in that 6th cookie. We live our kids every day, no professional can replace that intimate knowledge.
Yes, we should take our kids to the doctors, therapists, and psychiatrists they need. No, we shouldn't always take their treatment and diagnosis as the word of God. No, you shouldn't exhaust yourself running from appointment to appointment. At the end of the day you are your child's best hope of carving out a fruitful and productive life. You're there and in it. If you've got good instincts, trust them. If you can find professionals that are willing to listen to you- keep them. Be wary of ceding too much control and power of your life and your child's to folks whose diagnosis and treatment plans look more like a throw of a dart then a careful examination of your perspective.
Tuesday, August 2, 2016
Top 10 Queer Parenting Differences
So far we haven't talked much about what it's like to be a queer parent. Which is funny, considering the name of the blog. For all of our straight readers and aspiring queer parent readers... I think the point is that the daily struggle of being a parent is exactly the same whom ever you are. The burden may be more or less if you're single, divorced, poly, but the nature of the every day work is the same. The struggles my kids and I go through every day may be more extreme then other parents, but the nature of the work is fairly similar.
But there has to be some difference? Right?? Being lesbian or queer has to make a difference? Here's my Top 10 list for how I see queer parenting different then straight parenting (in no particular order):
Top 10
1. We're famous! We don't live in San Francisco, we live in the good ol' Midwest of America. We're the famous lesbians with kids at school, at the grocery store, the bank, the post office and the local restaurants. No one knows our names, but everyone knows us. And for those Midwest-phobes... 95% of the folks who remember us, greet us with a smile.
2. Kids at school suck in a homophobic way. Before kids at school realized my kids had lesbian parents they'd make fun of them for their noses. Noses, right? How dumb is that? About as dumb as making fun of someone for their lesbian parents. My kids have been called lesbians, have been made fun of when stepping outside of their traditional gender roles, and have been nervous about bringing friends home to hang out. One kid made fun of my kids because I cried at their band concert (not because I'm gay, just because I cried). I look at what my kids have had to deal with, and what I dealt with as a closeted youth, and it's pretty similar. It doesn't seem to effect them as much, probably because they don't internalize it as someone struggling with their identity might (assuming they're straight).
3. Makeup. I haven't worn makeup in years. YEARS. So when my kids got to that age, I helped them pick out makeup and was kinda like "have at it"! You know what they did? They put it on horribly for a couple weeks (what Middle Schooler doesn't?), then had a couple makeup sessions with friends at school and figured it out.
4. Shaving, apparently that's still important? Not to be a stereotypical lesbian here- but I haven't shaved in 10 years. The annoying thing about shaving and makeup is that although this is a typical American tween/teen thing, as someone who's rejected these... it's hard to let go and let my kids explore their expression (have no fear Christian Right, my kids wear makeup when they want to... and shave their legs).
5. Lack of queer friends. I'm sure there's a bunch of baby toting lesbians out there, but there aren't gay folks with teens our age. Our friends consist of a number of friendly straight folks who live in our neighborhood that have kids our kids age (or younger). It's hard enough meeting gay people when it takes a month to arrange a date night then to meet folks who either you have nothing in common with or they get this repulsed look when you mention kids.
6. Family. For most LGBTQIATS folks family sucks anyway. Sadly, family tends to suck more with kids. When you've got kids with issues, family can really suck. Sadly, all that judgmental bullshit you put up with from family by being gay, x10 by adopting kids, and x20 by having kids with issues. No one at school, in a therapist office, at a doctor's office thinks my kids have issues because they have gay parents, but my homophobic relatives do. You see these lifetime movies where the family pulls together to support the struggling family. In our experience you get the exact opposite. This is one of the biggest challenges to being queer parents- we don't have the family support system to help our family.
7. Trauma. I don't know many queer folks of my generation who haven't experienced some sort of trauma. As much as some individuals experience the "post-gay" story where parents, friends, family, and society doesn't seem to care if you're gay, that wasn't and hasn't been my experience. Queer individuals are still committing suicide at alarming rates, getting kicked out of home, having bibles thrown in their face, being raped, murdered, and abused. The physical and emotional abuse take a toll on our psych. When you're parenting traumatized kids and in some ways dealing with the emotional and sometimes physical abuse they serve up on a daily basis. It can trigger you, can knock down your defenses and erode your self esteem.
8. Mom and Dad moments. As someone who doesn't follow gender norms, it's odd to find yourself forced into them sometimes. Whether it's a typical "mom" or "dad" moment, it's still a parenting moment that needs to happen. Although I'm a woman, I find the conversation about changing a tire a lot more comfortable then the conversation about the best approach to eye-liner. Both conversations happen. I hold my kid when she has a nightmare and read her a book to help her sleep. I bandage her finger when it gets cut chopping carrots. I dole out consequences when rules are broken. It's called parenting... I think "moms" and "dads" sell them self short when they task each other with gendered parent roles.
9. The biggest question I got when I first got the kids was "What do they call you guys." Just to be clear... the kids call me mom. They call my wife mom too. This is only confusing 2% of the time.
10. Figuring out who's wearing the pants. Oh wait.. this is a different top 10 list.
But there has to be some difference? Right?? Being lesbian or queer has to make a difference? Here's my Top 10 list for how I see queer parenting different then straight parenting (in no particular order):
Top 10
1. We're famous! We don't live in San Francisco, we live in the good ol' Midwest of America. We're the famous lesbians with kids at school, at the grocery store, the bank, the post office and the local restaurants. No one knows our names, but everyone knows us. And for those Midwest-phobes... 95% of the folks who remember us, greet us with a smile.
2. Kids at school suck in a homophobic way. Before kids at school realized my kids had lesbian parents they'd make fun of them for their noses. Noses, right? How dumb is that? About as dumb as making fun of someone for their lesbian parents. My kids have been called lesbians, have been made fun of when stepping outside of their traditional gender roles, and have been nervous about bringing friends home to hang out. One kid made fun of my kids because I cried at their band concert (not because I'm gay, just because I cried). I look at what my kids have had to deal with, and what I dealt with as a closeted youth, and it's pretty similar. It doesn't seem to effect them as much, probably because they don't internalize it as someone struggling with their identity might (assuming they're straight).
3. Makeup. I haven't worn makeup in years. YEARS. So when my kids got to that age, I helped them pick out makeup and was kinda like "have at it"! You know what they did? They put it on horribly for a couple weeks (what Middle Schooler doesn't?), then had a couple makeup sessions with friends at school and figured it out.
4. Shaving, apparently that's still important? Not to be a stereotypical lesbian here- but I haven't shaved in 10 years. The annoying thing about shaving and makeup is that although this is a typical American tween/teen thing, as someone who's rejected these... it's hard to let go and let my kids explore their expression (have no fear Christian Right, my kids wear makeup when they want to... and shave their legs).
5. Lack of queer friends. I'm sure there's a bunch of baby toting lesbians out there, but there aren't gay folks with teens our age. Our friends consist of a number of friendly straight folks who live in our neighborhood that have kids our kids age (or younger). It's hard enough meeting gay people when it takes a month to arrange a date night then to meet folks who either you have nothing in common with or they get this repulsed look when you mention kids.
6. Family. For most LGBTQIATS folks family sucks anyway. Sadly, family tends to suck more with kids. When you've got kids with issues, family can really suck. Sadly, all that judgmental bullshit you put up with from family by being gay, x10 by adopting kids, and x20 by having kids with issues. No one at school, in a therapist office, at a doctor's office thinks my kids have issues because they have gay parents, but my homophobic relatives do. You see these lifetime movies where the family pulls together to support the struggling family. In our experience you get the exact opposite. This is one of the biggest challenges to being queer parents- we don't have the family support system to help our family.
7. Trauma. I don't know many queer folks of my generation who haven't experienced some sort of trauma. As much as some individuals experience the "post-gay" story where parents, friends, family, and society doesn't seem to care if you're gay, that wasn't and hasn't been my experience. Queer individuals are still committing suicide at alarming rates, getting kicked out of home, having bibles thrown in their face, being raped, murdered, and abused. The physical and emotional abuse take a toll on our psych. When you're parenting traumatized kids and in some ways dealing with the emotional and sometimes physical abuse they serve up on a daily basis. It can trigger you, can knock down your defenses and erode your self esteem.
8. Mom and Dad moments. As someone who doesn't follow gender norms, it's odd to find yourself forced into them sometimes. Whether it's a typical "mom" or "dad" moment, it's still a parenting moment that needs to happen. Although I'm a woman, I find the conversation about changing a tire a lot more comfortable then the conversation about the best approach to eye-liner. Both conversations happen. I hold my kid when she has a nightmare and read her a book to help her sleep. I bandage her finger when it gets cut chopping carrots. I dole out consequences when rules are broken. It's called parenting... I think "moms" and "dads" sell them self short when they task each other with gendered parent roles.
9. The biggest question I got when I first got the kids was "What do they call you guys." Just to be clear... the kids call me mom. They call my wife mom too. This is only confusing 2% of the time.
10. Figuring out who's wearing the pants. Oh wait.. this is a different top 10 list.
Alternatives
Apologies for the absence. As you may guess, things have been rough this summer.
So I read a post by the ACLU the other day: https://www.aclu.org/blog/speak-freely/all-kids-nebraska-need-love . I sometimes think about how lucky my kids are to have been born in America in the 21st century. Even 100-200 years ago in early America they would have been regulated to homelessness, poorhouses, asylums, jail. Actually, they probably would have stayed with their birth mother. Did you know that the first child welfare laws were actually based on animal abuse laws?
Then I read this article about traumatized kids put in solitary, and I wonder if we've really come that far? When our legislative and voting bodies don't see the humanity in kids. I'll admit, in the daily grind of parenting I sometimes loose the compassion I need to have for my kid. Most of the time it's there, but not always. I can't imagine, even then, putting my kid in solitary confinement, locking her up and isolating her from people, family, and love.
Every kid deserves those things. Every kid.
Our government is responsible for kids when parents are deemed unfit. These are citizens, vessels of hope and should be receiving goodwill and compassion. Not simply be a budgetary number to be cut. A number to be confined.
Stand up and speak out.
So I read a post by the ACLU the other day: https://www.aclu.org/blog/speak-freely/all-kids-nebraska-need-love . I sometimes think about how lucky my kids are to have been born in America in the 21st century. Even 100-200 years ago in early America they would have been regulated to homelessness, poorhouses, asylums, jail. Actually, they probably would have stayed with their birth mother. Did you know that the first child welfare laws were actually based on animal abuse laws?
Then I read this article about traumatized kids put in solitary, and I wonder if we've really come that far? When our legislative and voting bodies don't see the humanity in kids. I'll admit, in the daily grind of parenting I sometimes loose the compassion I need to have for my kid. Most of the time it's there, but not always. I can't imagine, even then, putting my kid in solitary confinement, locking her up and isolating her from people, family, and love.
Every kid deserves those things. Every kid.
Our government is responsible for kids when parents are deemed unfit. These are citizens, vessels of hope and should be receiving goodwill and compassion. Not simply be a budgetary number to be cut. A number to be confined.
Stand up and speak out.
Monday, March 21, 2016
Goldfish Memory
(Apologies for the absence!)
There's this mildly terrible movie I watched 5-10 years ago about these couples that repeatedly make relationship mistakes. The only thing I really remember from the movie is the analogy draw to goldfish. Goldfish, the movie insists, have very limited memories. They basically swim to one side of their bowl and by the time they get there, they've forgotten what was on the other side of the bowl. So they swim in circles just to find out what their bowl looks like. The movie draws some parallels to to the characters and how they don't learn from their mistakes.
There's this mildly terrible movie I watched 5-10 years ago about these couples that repeatedly make relationship mistakes. The only thing I really remember from the movie is the analogy draw to goldfish. Goldfish, the movie insists, have very limited memories. They basically swim to one side of their bowl and by the time they get there, they've forgotten what was on the other side of the bowl. So they swim in circles just to find out what their bowl looks like. The movie draws some parallels to to the characters and how they don't learn from their mistakes.
Outside of the movie, I've used the idea of having a goldfish memory to my advantage a parent. There are two factors that create an unhealthy lack of memory. Stress has a negative effect on how our brains function in general. Moderate to severe stress over a long time period takes a toll on our memory. Extreme, traumatic stress can also effect our memory. This is why first person accounts of horrific events tend to be inaccurate and disagree with each other. Our brains try to forget trauma, make it fuzzy. RAD kids are masters at keeping parents under stress for long periods of time interrupted by extremely stressful events. All of this being said, what I really want to talk about is intentional forgetting, being the goldfish on purpose.
Philosophy and religion have different terms that get at the essence of what I'm talking about. Buddhists have this idea of living in the present, the moment. Christians version is of forgiveness. My version, goldfish. You have to intentionally leave all the hateful venom, the ugly acts, and the targeted destruction on the other side of the fishbowl. My kid needs me to hold her and tell her that I love her after she puts the hole in the wall, calls me a motherfucker, or tells me she'd rather live with her birth mother. Admittedly, I am not always able to be there for her. I'm human too. But as much as I can, I try to be the goldfish. This doesn't mean the consequences for her actions evaporate, but it does mean that the debt doesn't just pile up to infinity. I honestly don't think it's possible for my kid to make up to me all the emotional and physical destruction she's wrecked on my life. She's not capable of making it up nor does she, at this point in her life, have any desire to. I forgive her, and what I can't bring myself to forgive, I try to intentionally forget. To live in the moment, to recognize the trauma and hurt that originate her actions. I swim in a circle not because I'm dumb, but because it's the way to survive, to function, to continue the empathy and compassion I try to live my life by.
Be the goldfish... an adventure around every corner.
Friday, January 29, 2016
Diagnoses
Let's take a moment to get real about the professionals trying to help our kids. The doctors, psychiatrists, nurses, therapists, hospitals, social workers, and counselors who touch my kids lives. There are very few resources for parents who have kids with mental illness and fewer still for those who have kids with severe mental illness based on childhood trauma. When you add in the faith-based nature of many organizations out there for adoption, foster care, and childhood mental illness, as a queer family your options become even more limiting.
I'm going to disclose some information that would be confidential if it weren't ridiculous. My child has been seen by 4 general physicians, 7 psychiatrists, 9 therapists, 3 psychiatric hospitals, 5 different ERs, 3 social workers, 4 counselors, and innumerable nurses. These numbers are likely underestimated since hospital visits spanning weeks surely have rotating staff. In total she has been diagnosed with RAD, ODD, ADHD, Anxiety, Depression, Bipolar, Borderline Personality Disorder, Mood Disorder, PTSD, Schizophrenia and Autism. That's an awful lot of "we don't have a fucking clue."
As a parent you have an obligation to ensure the health and well being of your child. Realistically, although their intention is to help, I really haven't met a professional who's been able to significantly help in any way. In one instance I had a therapist who was honest with me after completing an intensive program she told me two things: 1. It wasn't worth us continuing with her program because the problem was my child had some wiring in her brain get messed up when she was a baby. Group doesn't really help with that, not really. 2. That she thought we were doing a fantastic job, all things considered. I'm not sure I agree with #2, but I was grateful for the boost that week.
I still haul my kid to therapy (she osculates between demanding to go "I can't live without" to refusing to go "I'll jump out of the car on the way there"), to a psychiatrist, and, when we need to, an ER or psychiatric hospital. You have to keep your kid safe, and you have to show schools, social workers, your family and friends that you're trying. My parents still believe in a concept that I gave up on a long time ago. They believe that if we just find the right doctor, therapist, medicine combo that the kid will be "fixed". Sometimes my kid believes this.
Lean into your computer screen real close, because i'm about to get real honest. Sometimes our kids can't be fixed. Sometimes fixing takes decades. That rewiring may have to be done by parents, teachers, aunts, grandparents, coaches, friends and neighbors a hundred times each before it'll really stick. How many of us have that many folks interested in our kid? How many of us can honestly say that many folks stuck around when our kids mental illness exploded in some destructive ugliness?
We know our kids. We know what will trigger them, how to keep them calm, how to temper disappointment and curtail the mania. We know what our kids real Diagnosis is, how to help them, what medicines are likely to work and what aren't. We know what the manipulations are and why they hadthat nightmare tonight. We know why March is always a bad month, why birthdays are bittersweet, and what happens if they do sneak in that 6th cookie. We live our kids every day, no professional can replace that intimate knowledge.
Yes, we should take our kids to the doctors, therapists, and psychiatrists they need. No, we shouldn't always take their treatment and diagnosis as the word of God. No, you shouldn't exhaust yourself running from appointment to appointment. At the end of the day you are your child's best hope of carving out a fruitful and productive life. You're there and in it. If you've got good instincts, trust them. If you can find professionals that are willing to listen to you- keep them. Be wary of ceding too much control and power of your life and your child's to folks whose diagnosis and treatment plans look more like a throw of a dart then a careful examination of your perspective.
Tuesday, January 19, 2016
Playing to strengths
It took us 3 years to get our youngest child to try an activity without self sabotaging. To stick with something long enough to get through the initial frustration. To do something that played to her strength and that she enjoyed enough to do at home, on her own. We haven't gotten there yet with our eldest. She still does the self esteem battles and gives up on all extra curricular activities after a quarter or two.
I read a Facebook post the other day that hit the nail on the head, "draw stick figures. sing off key. write bad poems. sew ugly clothes. run slowly. flirt clumsily. play video games on easy. you do not need to be good at something to enjoy the act. talent is overrated. do things you like doing. it's okay to suck."
Think about that for a second. How many times do you stop yourself from trying something new because you're afraid of sucking or it's not worth your time because you don't have talent for it? When we're young, really young, you don't have the fear of sucking. You suck at everything- walking, crawling, talking, reading, video gaming, painting, eating, heck we even suck at pooping. As a baby hopefully your happy world is all about sucking and getting the googly faces, giggles, and applause from your parents. We don't really learn to hate being terrible at things until we get older and go to school, or have parents that tell us we're terrible. The world has two messages for individuals growing up- you suck and it's not okay to suck. It's an act of bravery for anyone over the age of 8 to try something new.
This, sadly, seems to be a lesson my kids learned early and hard. For my eldest, I can't convince her she's good or talented at anything, even when she is. Think about that... she could be the next Mozart, I could fully believe she is the next Mozart, but she'd quit piano after 3 months because she's decided she sucks. "It's hard," she says. It's not so much that it's hard, it's that it takes effort and belief.
My youngest has finally started to learn the lesson. She's now an accomplished trumpet person (or whatever you call someone who does trumpet). She stuck with it, even though it was hard, and with lessons and effort has made it to first chair in her band. No small accomplishment. This from a girl who curled up in a ball during gymnastics because she messed up a cartwheel. Let me tell you, all the gymnastic cheerleading in the world couldn't convince her she was good at it.
Effort- work, putting in sweat equity for something you want.
My eldest is so afraid of wanting something and not getting it that she's given up wanting, and by consequence she's given up putting in effort into anything important.
Belief- if there is something most lacking, it's the belief in herself that she can do it. That a screw up or two doesn't define your total effort, worth, or talent.
I cried at my eldest's choir concert because, for the first time, I saw the belief and effort. She'd gotten a solo and had executed magnificently. I had belief that she'd turned a corner.
Within 6 months she'd quit choir.
My youngest, however is still first chair. She's earned it and it shows.
Monday, January 11, 2016
Coping Skills
A natural part of being human and growing up is developing coping skills. If you experience stress (we all do) and are breathing (hopefully no zombies reading this post) then you have coping skills. When I was a kid I did things for fun: played soccer, video games, and tv. When I was stressed out I'd disappear in a book (I'd do this for fun too), I'd Rollerblade for miles and miles, or sleep a lot. As an adult I'm still prone to reading, or watching tv, sports becomes a big distraction. The hilariousness of cleaning being my #1 coping mechanism is not lost on my sense of irony (A kid normally doesn't interrupt if you're doing the dishes or cooking dinner or raking leaves).
I've noticed a change in therapy over the last couple years as my kid has entered her teenage years. As a kid she would talk about her feelings, participate in art therapy and squeeze silly putty. As a teen she's been given a list of "coping skills" no less then 3 times in the last 6 months (hospital, group, and individual). I almost laughed out loud when her new individual/family therapist wrapped up her first session by handing her a list of 99 coping skills. (my thought: oh good we can put this next to the 150 and 200+! lists we've got in a drawer at home).
Is there something about having the word teen in your age that suddenly makes you able to look at a long list of "what you could be doing instead" and gives you the ability to pick a different choice? In the last 8 months I'd give that a big N-O.
(Side bar- some of my favorites on these lists: Shopping online, playing on your iphone, drawing on yourself, the list goes on... half of which my kid can't do because she doesn't have access to the internet).
So therapists: Stop giving out lists and help my kid practice. Talk to me about how to help my kid practice. Go through the list with the kid, pick some out and practice. Right now the last thing my kid wants is another list... and the last person she wants to "walk her through the choices" is me.
Coping skills in and of themselves are not bad, they're necessary mechanisms of dealing with life. Bad coping skills are all around: my Dr. Pepper addition, someone's food, cigarette, alcohol, drug, crappy behavior, etc. Developing good ones takes time, effort, and a lot more buy in then handing someone a list as they leave the hospital, group session and/or therapy session.
I've noticed a change in therapy over the last couple years as my kid has entered her teenage years. As a kid she would talk about her feelings, participate in art therapy and squeeze silly putty. As a teen she's been given a list of "coping skills" no less then 3 times in the last 6 months (hospital, group, and individual). I almost laughed out loud when her new individual/family therapist wrapped up her first session by handing her a list of 99 coping skills. (my thought: oh good we can put this next to the 150 and 200+! lists we've got in a drawer at home).
Is there something about having the word teen in your age that suddenly makes you able to look at a long list of "what you could be doing instead" and gives you the ability to pick a different choice? In the last 8 months I'd give that a big N-O.
(Side bar- some of my favorites on these lists: Shopping online, playing on your iphone, drawing on yourself, the list goes on... half of which my kid can't do because she doesn't have access to the internet).
So therapists: Stop giving out lists and help my kid practice. Talk to me about how to help my kid practice. Go through the list with the kid, pick some out and practice. Right now the last thing my kid wants is another list... and the last person she wants to "walk her through the choices" is me.
Coping skills in and of themselves are not bad, they're necessary mechanisms of dealing with life. Bad coping skills are all around: my Dr. Pepper addition, someone's food, cigarette, alcohol, drug, crappy behavior, etc. Developing good ones takes time, effort, and a lot more buy in then handing someone a list as they leave the hospital, group session and/or therapy session.
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