Fire Away


I began writing this post in February of 2017 with the idea that I would post it during national suicide prevention awareness month in September of 2017. Then 13 Reasons Why happened.

This is what I wrote back in February of 2017 when this topic was foremost in my mind:

Suicide is the second leading cause of death among teenagers. Ahead of homicide and behind accidents, suicide accounts for approximately 8.7 deaths per 100,000 as of 2014. As of this writing, suicide remains the 10th leading cause of death in the United States.

This is unacceptable. And we all know it.

This sickens and angers me beyond all recognition because we could prevent and detect it better with more well-integrated physical and mental health care. Specific segments of society are at even greater risk for suicide: Native AmericansLGBTQ, and individuals with disabilities.

This is what I write now after having watched 13 Reasons Why all the way through three times.

I am going to write this as a consumer of art, as a father, and as a mental health provider.

Things I thought the series did well in the service of addressing suicide risk factors:

  • Portraying slut-shaming and sexual assault as risk factors for suicide

  • Elaboration of the "bro-code" dynamic that encourages the bystander effect

  • Pro-social presentation of consent (during Hannah's interaction with Clay)

  • Range of issues that can lead to adolescents being bullied or ostracized

  • Hyper-acceleration of comparison and degradation via social media platforms

Things I thought the series insinuated but did not do well to follow through on:

Things I thought the series failed at articulating in a coherent manner:

  • Presentation of topics without trigger warnings and access to resources

    • I recognize that they added these later. A day late and a dollar short. I am a staunch proponent of free speech, but the creators of this show owed the viewers (particularly younger ones) access to content to support their reaction to it.

  • Presentation of conflicting roles for the school counselor as normative

    • I recognize that mental health providers are fallible and human. However, the lack of skill and empathy as described here in Mr. Porter’s Mistake is inexcusable.

  • Woefully inadequate and inept suicide risk assessment on multiple levels

After the show received quite a bit of critical acclaim and consternation, they added in some of the things I referenced here in my thinking and writing back when 13 Reasons Why was originally released.

The best defense is a good offense.

We need to go on the offensive by doing everything we can to prevent suicide today. There are so many direct and immediate ways that people can involved with suicide prevention efforts:

  • Reading and Sharing Resources:

  • Joining or Supporting a Walk Team:

  • Learning and Knowing the Signs:

  • Connecting with Professionals:

At the end of the day, there is no good reason for how or why someone takes their own life.


This song and music video by Chris Stapleton radically captures the experience of suicide.

Know the Five Signs of emotional suffering. Visit

Back to School

Summer sizzled into September and hastened with heat the beginning of the new school year.

Many families worked with their loved ones over the Labor Day weekend to ready themselves for new classes and fresh faces in places both familiar and entirely new. Some boarded a bus, some shared a van, some saw their home return to a school setting, and some left their home.

There are so many moments in life where the next level feels so unclear, but not with school.

You start a new grade that's a higher number or greater distinction. You literally "level up" in the video game of your educational and vocational life. But even still, the grade level tells only a small portion of the story.

Are you ready for what comes next? Have I prepared them well?

The bus comes, the van pulls away, the kitchen is now class, and the class is in another state.

Students of every age and ability likely approach the school year with anticipation, but this feeling careens between the boundaries of hope and doubt as the first day dawns anew here. 

Will I feel safe? Will I learn something new? Will I make friends? Will I be included in this?

They arrive in bunches and in droves of a diverse beautiful sort on the threshold of their school. Their teachers greet and guide them down a path they have worked so hard to prepare, and the thankless endeavor of raising our children's minds and hearts begins anew for them. These teachers and their tandem forces work silently to set the occasion for learning and growing.

How can I reach her? How can I help him? How do I talk with their parents? How can I do this?

Upon teachers and their teams are foisted the blessing and burden of educating our children. They ready their classrooms and unpack their belongings and beliefs in less than one week and they do so with a smile and a scientific method to their presentation for our general benefit.

Whether you are a student or a teacher, a parent or administrator, I would encourage folks to hold fast to the belief that we are quite literally all doing it "for the kids" as we start out now. Even if we don't see eye to eye on every moment between meetings and miscommunications, I believe we are playing for the same team that is our children and their future as it unfolds.


Six Months Later

It's been roughly six months since last I posted here, and I wanted to fill folks in on my world.

I seriously can't believe that the last time I wrote was before spring started, and now the fall is moving in a serpentine, but certain manner toward the winter holiday season. Tempus fugit.

Waiting for the bus on the first day of school.

Waiting for the bus on the first day of school.

The biggest and best explanation for this writing interlude is Life itself. In May, My Better Half gave birth to our third child. Life has been a whirlwind tour of emotions and activities since our newest bundle of joy arrived, and our older children have embraced the chaos and noise with a youthful exuberance that either sustains or exhausts us (sometimes both!). Our older children have also experienced transitions (new schools, different teachers, more activities and friends) during this time period, which has made the process of keeping up challenging and rewarding.


As of this weren't enough, My Better Half managed a variety of home improvement projects during her maternity leave. The range of things that "got done" or "came up" are too numerous to mention, but my personal favorite was removing the towering trees in the back of our house that I have been complaining about since we moved in. It was an entertainment value for us.

On a professional level, I've had the opportunity to partner with both the Rochester City School District and the University of Rochester Medical Center around similar projects. The initiative with the university involves providing guidance around family-centered practices for providers of early intervention services, while the city school project focuses on partnering with educators and parents to support preschool students with more complex areas of need.

While my involvement with both projects is in its early stages, I am incredibly energized by the possibility of working with different service systems to support young children and families. 

At AutismUp's Kite Flite on August 20.

At AutismUp's Kite Flite on August 20.

I also joined the Board of Directors at AutismUp. I feel so deeply honored to be invited to work with this organization, and I hope that I can contribute to the next steps in AutismUp's story.

In early October, I presented on intelligence and adaptive behavior to a group of graduate students at Nazareth College's Interdisciplinary Specialty Program in Autism. I encourage families and providers to learn more about this amazing collaborative training program.

I recently worked with colleagues with the Genesee Valley Psychological Association to plan and host a convention on trauma-informed care at St. John Fisher College Wegman's School of Nursing. The presenters were excellent and represented a range of disciplinary perspectives.

I hope to post more often, but am mindful that the holiday season fast approaches for many of us. I welcome those who read this blog to send questions and ideas my way. I'd appreciate it!



To end National Autism Awareness Month (April 2017), I wanted to share some exciting news about my increased involvement with the autism community here in the Rochester metropolitan area.

I was recently added to the Board of Directors at AutismUp, and My Better Half and I celebrated by attending the AutismUp Gala "Hope Lights the Night" on Saturday, April 29. I am excited to take on this leadership role and hope that I can be an asset to individuals with autism and their families. Plus we had a great time on our last planned date night before the baby arrives, dressed to the 1920's theme, 36 weeks (and counting) baby bump and all.

Autism Evaluation Process

April is National Autism Awareness Month, so I wanted to post about topics that relate to the autism aspects of my professional training and practice. One piece that is often not discussed is what actually goes into an autism diagnostic evaluation - for patient and practitioner alike.

I take the process of conducting an autism diagnostic evaluation very seriously. I try to give as much of myself as I can intellectually and emotionally in order to provide patients and families with guidance. My goal is to offer an evaluation that is compassionate, informative, and useful.

These are the measures I routinely use as part of an autism diagnostic evaluation:

  • Autism Diagnostic Observation Schedule - Second Edition (ADOS-2) - clinician-administered
  • Social Communication Questionnaire (SCQ) - caregiver report
  • Social Responsiveness Scale - Second Edition (SRS-2) - caregiver & self-report
  • Detailed Developmental History - caregiver report
  • Chart Review - pediatric medical records and educational services & assessment history

As outlined above, the diagnostic evaluation is not just me and the patient taking a prescribed set of tests. It is often what I learn in the life narrative that gives me the confidence to proceed with a clear diagnosis and treatment plan. In order to get this information and an accurate health history, I need to talk to caregivers and review pediatric records. This is true for my adult patients seeking a diagnosis as well. While it may seem like a long time ago, childhood behaviors as reported by caregivers give me a fuller picture of the patient's life. 

Beyond the ADOS, I provide anxiety, ADHD, and mood screening Instruments when applicable. An evaluation is so much more than a "Yes" or "No" stamp for a single diagnosis, as it represents a person and a plan to improve their lives based on the challenges they have had and face today.

The inspiration for my wanting to be Ever Better at conducting autism diagnostic evaluations comes from the families I've met along the way. Those who've talked with me about what went well and what they wished could've been different on the day they learned the diagnosis.

I've also found new inspiration and room for growth in working with adults who are seeking a diagnosis later in life. The feelings and dynamics of obtaining a first diagnosis as an adult are something I am learning to navigate with my clients, and I am honored to learn with them.

I am starting to get into a rhythm with scheduling diagnostic evaluations, and I hope to keep receiving referrals for individuals across the lifespan who wonder if they're on the spectrum. In private practice, I am afforded more flexibility in scheduling and administering tests. What this has meant is that patients can get an appointment more quickly and often during "outside of typical office hours" so they can get the answers and help they are seeking more smoothly. 

This April, I'm providing autism diagnostic evaluations on Saturday mornings. So far, I have enjoyed serving new patients in a timely manner - it is very fulfilling for me to get a call from a new referral and be able to serve them within a week or two of their inquiry. Providing answers and helping families better understand their loved ones is one of the most satisfying parts of my work, and I am grateful for the opportunity to serve patients and families in this way.