Healers of young minds

“Mental illness is no different than a broken heart or a broken arm. It’s an illness of an organ (the brain), and it requires medical treatment and care.” — Dr. Jeffrey Lieberman, former president of the American Psychiatric Association

“We need to stop thinking about mental disorders as behavioral conditions and start recognizing them as brain disorders that deserve the same level of medical care as any other illness.” — Dr. Thomas Insel, former Director of the National Institute of Mental Health

People are often surprised to learn about the medical staff at Dakota Boys and Girls Ranch. Because mental illness is an illness of the brain, as Drs. Lieberman and Insel say above, we have full-time nurse’s aides, nurses, doctors, psychologists, and nurse practitioners who provide medical care to our kids. We thought it was time you heard their stories.

Dr. Wayne Martinsen, Psychiatrist/Medical Director

“A psychiatrist is a medical physician who has undergone four years of specialist behavioral health training after completing medical school. Psychiatrists can play a number of roles with mental health patients, but they typically specialize in medication management of mental health concerns like depression, anxiety, ADHD, bipolar disorder, schizophrenia, etc.” — Dr. Martinsen

Dr. Wayne Martinsen said the Ranch works with the most vulnerable, traumatized kids in the region.

“Our kids struggle with multiple mental health diagnoses and the resulting behavioral, educational, and interpersonal problems,” Martinsen said. “The work is complex, and the stakes are high in terms of helping relieve emotional suffering, and in assisting children in reintegrating into their families and communities. Our psychiatric and therapeutic goal is to improve quality of life and set a firm foundation for their adult lives.”

Martinsen didn’t intend to pursue a career in mental health. He was going to school for architectural drafting when he started working at a residential treatment facility in Minnesota to pay the bills.

“I enjoyed my work with adolescents, and liked trying to help them find ways to connect and solve problems,” Martinsen said.

He switched his degree to social work, went on for his master’s degree, and spent several years providing family and individual therapy, before going to medical school and completing a residency in psychiatry. More recently, he became board certified in Lifestyle Medicine so he could focus on a broader and more holistic approach to behavioral health.

In addition to his work at the Ranch, Martinsen teaches at the UND School of Medicine as clinical faculty for medical students as well as family practice and psychiatric residents.

Much of Martinsen’s work at the Ranch centers around psychiatric diagnoses. The purpose of a diagnosis is to understand the underlying reason for problematic behaviors so medical and behavioral health providers can implement effective treatments. The diagnosis process includes interviews of the child and family, a review of education and medical records, and often a referral for formal psychological testing.

“The most common symptom that brings children to the Ranch is anger,” Martinsen said. “But anger can come from any number of underlying problems such as trauma, depression, bipolar disorder, autism, and personality disorders. The treatment for each of these diagnoses is different, so the cause of the anger is vital to tailoring a treatment plan.”

While people are often concerned about labeling children, Martinsen said it is important to understand emotional and behavioral symptoms so children struggling with psychiatric problems are not simply labeled as “acting out” when they need professional help.

“I like to compare behavioral health to other medical specialties. If your primary care doctor diagnoses you with strep throat, it doesn’t mean you are a strep throat victim. It identifies a problem that can be treated to improve your quality of life,” he said. “Similarly, a mental health diagnosis directs treatment. Even our kids who have the most problematic emotional and behavioral symptoms have an identity far bigger than any diagnosis.”

Some people are also concerned about psychiatric medications.

“While psychiatric medications can have side effects and sometimes need to be discontinued,” Martinsen said, “it is important to look at them in a broader context. When effective, psychiatric medications relieve suffering and help our kids get back on track with their families, friends, education, and dreams.”

Medications are never used as a stand-alone treatment at the Ranch, and children and their parents or guardians are free to refuse or discontinue a medication at any time.

The role of psychiatric care at the Ranch is just one facet of care that includes individual, family, and group therapy; education support; spirituality; occupational therapy; and wellness.

Perhaps the greatest lesson Martinsen has learned from the kids at the Ranch is to value patience.

“We have a resident who recently returned to the Ranch after his initial discharge a couple years earlier,” Martinsen said. “During his first placement, he was very traumatized and sullen, refusing both therapy and medication. Now that he is back, he is engaging meaningfully in trauma therapy, started medication for ADHD and depression, and is actively engaged in school. He is thriving as he once again approaches discharge from our program, this time talking about going to tech school and being back with his family. He is a far cry from the young man who sullenly refused to talk to me two years earlier.”

Martinsen has been at the Ranch for 27 years. He stays because he loves what he does.

“I love the people. I love the complexity of the problems. I love maintaining connections with all parts of the treatment team including residential staff, supervisors, therapists, nursing, psychology, and administration,” Martinsen said. “I find it incredibly rewarding to make a difference by helping children and their families live the lives they want to live. I am also humbled by other professionals and our donors. None of what we do would be possible without the support of the incredible donors who make our work possible.”

In his off time, Martinsen and his wife enjoying traveling, spending time with their kids and grandkids, and enjoying the company of friends.

Dr. Hannah Baczynski, Psychologist

“A psychologist is a doctoral-level mental health professional. In addition to providing therapy, we order, administer, and interpret psychological assessments; develop and oversee mental health programming; diagnose mental health conditions; and supervise counseling interns working towards licensure.” — Dr. Baczynski

Dr. Hannah Baczynski likes to say she made it through her teenage years on anger and spite.

“I was a cranky, defiant child. I got myself into a lot of trouble because I was always moving around or being sassy, and I didn’t always get along with the teachers,” she said. “I did a lot of things that were impulsive and probably unwise. In some ways, I wasn’t so different from the kids we have at the Ranch.”

Baczynski credits her success to a couple of key factors. Being a fast learner allowed her to get by academically without much effort. And living in a small Illinois community with a large, well-known family meant she had a lot of support. These experiences help her connect and relate to kids.

At the Ranch, Baczynski conducts psychological assessments, leads therapy groups, and is involved in program development and staff training. While she doesn’t have a lot of time to provide individual therapy, she does like to have one or two kids on her caseload to keep her grounded.

Over the last year, Baczynski has been reworking the Ranch’s treatment programming to center around Dialectical Behavior Therapy (DBT). DBT is a type of therapy designed to help people change unhelpful patterns of behavior by learning new skills to manage their emotions and reduce conflict in relationships.

Baczynski believes in the ability of DBT skills to help everyone and said learning and practicing the skills changed her life.

“I’ve seen them transform kids’ lives and I think about them myself all the time,” Baczynski said. “I started teaching my children DBT skills when they were toddlers. We started with paced breathing activities to help them calm down and regulate their emotions.”

One of the more powerful DBT skills is opposite action, a skill that helps you manage intense emotions by doing the opposite of what your mind and body are telling you to do.

“I had a kid who dealt with his frustration by bolting from the room and punching the wall over and over,” Baczynski said. “At one point about 60% of the way through his treatment, he looked at me after punching the wall and said, ‘I have to stop doing this. It’s not working.’ I’m like, ‘That’s what I’ve been telling you!'”

They discussed ways he could recognize what he was feeling and then take opposite actions like pausing to take a deep breath, expressing his emotions in words, and asking for a moment to take a time-out.

“For kids with really severe trauma, seeing them use their DBT skills to get through trauma treatment, and then be a totally different kid on the other side is really magical to watch,” Baczynski said.

She tells the story of one young boy with a smile.

“At the end of therapy, I always have a termination session where I tell kids what I’ve learned from them. I worked with one kid who had pretty significant ADHD and required a lot of patience, which is not one of my strongest qualities,” she said. “When I told him the biggest thing I learned from him was patience, he looked at me as if to say, ‘I’m not quite sure you’ve mastered that.'”

Over the last year, Baczynski has been training the Ranch therapists and leading the charge to get everyone on the treatment team on a 16-week rotation of DBT skills training and practice. Groups provided by nurses, case managers, wellness staff, spiritual life staff, and therapists are all focused on learning and practicing the skills of the week.

She is now rolling i tout for the residential treatment specialists whoa re with the kids day and night. Understanding and learning about DBT enables them to help the kids practice the skills when they aren’t in therapy or group.

“The research shows that getting all staff involved will not only improve outcomes for the kids but also improve outcomes for the staff by improving retention and job satisfaction,” she said.

When asked what she wishes people knew about the kids, Baczynski said, “A lot of times people have this misconception that they can drop their kids off and we will fix them—like they exist in this vacuum where we can tinker with them a little bit and they’ll be fine. Kids are a product of their environment. Poverty, homelessness, domestic violence, or anything like that impacts the brain. The stuff that happens in the home is the pattern against which they do everything. We can’t ‘fix’ the kids by themselves. We have to make changes in their environment.”

To do that, the Ranch starts with families by encouraging them to be involved in their child’s treatment through family therapy and a weekly parent group.

“It’s not just about going to therapy once or twice a week,” Baczynski said. “If a kid struggles in school, how can we work with the school to create an environment where they can succeed in school? If they struggle at home, how can we impact how they interact with their parents and siblings? How do we impact friendships and free time? What kinds of hobbies can they do? The whole system needs to change to impact the child.”

Baczynski said the greatest misconception about kids and mental health is that kids have control over their behaviors.

“When a child is abused, it impacts the wiring of their brain. They might not remember the abuse or trauma, but it impacts how they react to everyone in their lives. The brain is very plastic and changeable so there are things we can do to mitigate the damage, but it is hard work,” she said.

Baczynski chooses to work at the Ranch because of the culture.

“The Ranch places such value on learning and improving and making things better. We bring people with unique strengths together to provide the best possible care for the kids. We can look at the things from different angles and problem solve together,” Baczynski said. “Working with an interdisciplinary team allows us to think through things in a more comprehensive way. And we are all here for the right reasons. We love the work we do. We all want to learn and improve and do the right thing for the kids.”

Baczynski attended the University of Illinois, Urbana-Champaign, IL, where she majored in psychology and statistics. She earned a master’s degree in forensic psychology and a doctorate in clinical psychology from the University of North Dakota, Grand Forks, ND. She and her husband live in Fargo with their two children. She enjoys painting, yoga, aerial workouts (with aerial silks and a metal hoop), and doing lots of fun things with her family.

Jadin Stromme, PMH, MP-BC, Psychiatric Mental Health Nurse Practitioner

“A psychiatric mental health nurse practitioner is a  mid-level provider, the same as any nurse practitioner but we specialize in mental health. We can prescribe medications, provide therapy, and diagnose mental health conditions for people across the lifespan. Nurse practitioners are different than a physician’s assistant in that we can practice on our own without a physician’s oversight.” — Jadin Stromme

Jadin Stromme got her bachelor’s degree in nursing from Concordia College, Moorhead, MN. She discovered her love for psychiatry while working in the Emergency Room at Sanford Health.

“When you work in the ER, a lot of psych is involved. There is such a stigma to mental health that not a lot of people in healthcare can break past,” Stromme said. “It hit me that you can really make a difference with mental health. I was able to therapeutically communicate with these patients when their mental illness symptoms were the most acute.”

So, when Stromme decided to go back to school, she enrolled in the Psychiatric Mental Health Nurse Practitioner Program at the University of North Dakota, Grand Forks, ND. Following graduation, she worked at an outpatient clinic, but quickly realized it wasn’t the right fit.

“I got a little bored doing outpatient therapy. I wasn’t being challenged, diagnostically or therapeutically,” Stromme said. “It’s very different at the Ranch because the kids have such complex issues. I like the challenge.”

Stromme enjoys getting to know the kids and build relationships with them during such a pivotal time in their life.

“Almost every kiddo here has depression and anxiety. Knowing how to communicate with them about that, telling them there is a reason they are feeling this way and that it’s not hopeless is very rewarding,” she said. “I want them to know there is light at the end of the tunnel—that they can do things that are going to make them feel better.”

“When you have a breakthrough moment with a kid, it’s unlike anything else,” she said.

A big breakthrough moment with one resident has taught Stromme a lot about how to relate to the kids.

“This young girl doesn’t think she is very smart of that anyone loves her. She was resistant to treatment, and often said things like, ‘No, I don’t like that,’ and ‘That’s not fair’,” Stromme said. “Over the past weeks, she has turned a corner and is a different kid in the way she carries herself. Being a good listener is what has really connected us. Like all of our kids, she needed to feel heard.”

The challenge of providing psychiatric care to kids in acute psychological distress has helped Stromme grow her diagnostic and therapeutic skills. She credits much of what she has learned in her short time at the Ranch to Dr. Wayne Martinsen, the Ranch’s psychiatrist and medical director.

“Dr. Martinsen is one of the reasons I’m at the Ranch. I’m learning so much from him. He make it a safe place to learn, to grow in my profession and knowledge, and to help these kids,” she said.

Stromme appreciates working with a cohesive team and has been surprised by all the teamwork and communication.

“Everyone is so involved with our morning updates with Dr. Martinsen,” she said. “We have therapists, case managers, cottage staff, and school staff. Everyone provides input in how the child is doing, including information and concerns from the residents and their parents. We’re seeing all aspects of what’s going on with the kids and are very well-rounded, which leads to really good holistic care.”

Stromme said the Ranch couldn’t do what it does for the kids without the support of the community and donors across the country.

“I hope they know how important their donations are and how they go a long way here,” Stromme said. “There aren’t a lot of other resources for these kids and the work we do is so important.”

Stromme lives in Fargo with her husband, their young son, and their two dogs. Spending time with her husband, son, and dogs is very important to her. They like to spend time outdoors, go to the lake, cook ethnic food, and get together with friends. She also enjoys traveling and has traveled all over the world including trips to Iceland, England, Africa, Greece, and Thailand.

Like Martinsen, Baczynski, and Stromme, the medical staff at the Ranch are all passionate about their work and the kids. Everything they do is based on the science and biology of the brain. At the same time, they are compassionate and kind and work together with everyone on the treatment team to do what is right for each child and their family. They are committed to healing young minds.