We’re Hiring! (Revised Job Posting)

After feedback from several interested parties, We have amended the positions we are offering to begin as part time independent contractor with the possibility of becoming a full time employee later. Here is the revised job posting:

JOB POSTING (Open until further notice):

Responsive Mental Health Services LLC (RMHS LLC) in Independence, Missouri, is looking for licensed clinicians (including provisionally licensed clinicians under supervision) who would like to work in a small office environment and/or providing in home therapy for a wide variety of therapy participants.

We offer much of the flexibility of self-employment along with the ability to focus on your therapy participants and clinical work that is offered by an employer. We use an electronic health record that makes creating your documentation faster and more accurate than most EHRs.

You will begin as a part time independent contractor with the potential for employment full time and advancement after six months based on performance. As an independent contractor, you will be paid a direct percentage of fees collected from your clients. Shared office space, EHR, billing services and Office apps will be included in the percentage allotted to RMHS LLC.

When you have built your case load to an average of at least fifteen sessions per week, you will have the option to be an employee paid hourly with a bonus structure based on your productivity and the company’s profits that is paid quarterly.

While we are a very small business and at this point offer few benefits, we do offer paid time whether full or part time, and offer a flexible schedule that works with your availability and is designed, even at full time, to minimize burnout. We are actively looking at providing short- and long- term disability plans and a group health plan as soon as we are large enough justify those benefits.

We are looking for the following in our clinicians:

  • A customer service based approach that isn’t based on buzzwords, but on compassion and a genuine heart for helping others
  •  An understanding of how people are impacted by the systems around them
  • Cultural competency regarding race, religion, sexual orientation, gender, and other cultural considerations
  • A current license (including provisional license) at the Master’s level or higher, that allows you to practice in the state of Missouri as a mental health therapist.

We are especially looking for clinicians that are interested in:

  • in-home therapy (pays at a higher rate)
  • working with children and families
  • wanting to develop and lead group therapy for the needs of the community
  • interested in training for an opportunity to supervise your own small branch office

Send your resume and cover letter to jliles@responsivellc.com today to reply to our job posting and join our small but growing business.

Photo by neetalparekh 1x1.trans - We're Hiring! (Revised Job Posting)

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Responsive Advice: My Adult Child and Her Significant Other Want To Move Back Home

home photoSince this comes from a situation I’m aware of and have permission to post, I’m going to make up the letter with some details changed to protect the person’s identity as requested:

Dear Responsive:

My eighteen-year-old daughter and her boyfriend have asked to move back home because they aren’t making enough to get by on their own, and they can’t stay with his parents because of some … issues … that I don’t want to go into here. I live on a set income and my younger child has severe ADHD that makes her challenging to take care of. On top of that, I have chronic mental health issues myself that cause me to have anxiety, anger, and depression on a regular basis. I don’t want to disrupt my household, but I do want to help my daughter and her boyfriend, who is a good kid. How should I do this?

Sincerely,

At My Wit’s End but Want to Help

Dear Want to Help:

We now live in a world where a lot of young people don’t have much choice but to move back home, and where the parents and other older adults are stretched to the breaking point themselves. And yet, somehow this form of blended family is going to have to find a way to survive if these families are to make ends meet. You have my sympathies, as this is likely to be tough.
Breaking down the letter, dear Letter Writer (hereafter known as LW), you have several different and important concerns:

  • Financial Concerns

  • Family Relationship Concerns

  • Mental Health Concerns

Taking them one at a time:

Financial concerns:

Two extra mouths to feed isn’t cheap.

Here’s some questions to ask yourself and them before they move back home:

  • Do they have incomes? If so, what would be a reasonable amount of their incomes to contribute toward the household? If not, how long can you support them without help? (be honest and realistic!)
  • Will your daughter and her boyfriend be expected to eat meals with you? Does their “rent” include some meals and/or snacks? What about laundry expenses? Gas or other transportation costs?
  • Even with their contributions, is that going to be enough? Can you re-negotiate a higher “rent”?

Along with the questions, here are some firm guidelines:

Get the amounts written down and have everyone sign that they agree to them.
Also agree to what “eviction” looks like, when eviction is for financial reasons.
Once their “rent” is established, don’t borrow money from them or lend money to them unless it’s life or death. The same goes for giving and taking money.

Now on to family management.

You need to set boundaries with them and with the rest of your family before they move back home. So here goes, questions and then guidelines like before:

  • Where will daughter and boyfriend be sleeping? Is it a public area? If so, will you be accommodating their need for private time somewhere in the home or will they have to go elsewhere?
  • Do they have transportation of their own? If not, can they use public transportation? How long would it take them, on their income, to afford to buy an inexpensive bicycle, motorcycle, or car?
  • If you have to transport them: How many trips a week is reasonable?
  • What will it take to minimize conflict between your older and younger children? Can you arrange for older and her boyfriend to have a bedroom with a key lock? If not, how will you enforce boundaries between the two, now that your older is not a child?

And some firm rules for you and them:

  • Your child is now an adult. You should only give advice when asked for it.
  • If your child and her boyfriend argue, so long as they do it in “their” space and it isn’t abusive, stay out of it. Feel free to ask them to argue more quietly, though.
  • You are not responsible for entertaining or accommodating everything your daughter wants. Shift your thinking from “mother” to “landlord” and try to act accordingly (with love).
  • All that privacy she needed as a teenager? She needs even more now. Unless she is making decisions that endanger you (such as illegal drug use or underaged drinking), stay out of her decisions.
  •  …Which doesn’t mean you can’t set house rules. Like rent, it should be in writing. Things like noise levels (and curfew times for loud music and voices), expectations for cleanliness of your daughter’s space and for her assistance in common areas of the house, and any expectations you might have for assistance with your younger child need to be in writing.

Mental Health Concerns:

Now on to your final concern, which in a lot of ways is the most important. You detail three mental health issues (without providing your diagnosis) that can make living in an overcrowded house more difficult. Anger, anxiety and depression all take their tolls in different ways. Rather than start with questions, I’m going to address the things you will need to keep in mind to maintain your mental health after they move back home. This will take a combination of healthy habits and attention to the medical aspects of your mental health:

  • If you don’t already have one, find a therapist you work well with and go to therapy regularly.
  • Get evaluated by a psychiatrist and discuss the pros and cons of medication. See if there is some combination that makes your symptoms go away without too many side effects.
  • Do something both mindful and enjoyable at least once a day, if you can manage it. This can include using adult coloring books, crafting, cooking or baking for enjoyment, going for a walk, gardening, or even just soaking in a bath and consciously giving each part of your body in turn a good wash.
  • If possible, get dressed and groom your hair every day to stave off the worst of the depression. Get out of bed. If you can’t do it for all day, do it for part of the day, even if just for a few minutes at a time.
  • Your anxiety is working against your anger to make it harder to manage – one of the best ways to manage anger is deal with things that trigger it as soon as it happens, calmly and patiently. Practice once a day with setting a small boundary (“Since you made that mess, please clean it up”) and enforcing it (“You didn’t clean up the mess, so I can’t start dinner. If you’re hungry, you’ll need to cook – and clean, since you still haven’t cleaned up”). It’s going to be hard, and you’ll get it wrong. That’s okay. Do your best to sound calm and confident.
  • The house is your house, and you have the right to make rules in it, with both of your children and with your oldest daughter’s boyfriend. Remember that when they resist (and they will!) If you have a supportive friend or significant other, ask them to simply back you up when you set rules, and to disagree with you privately if needed so you can change your rule as needed.
  • You have the right to change your mind. If you need to renegotiate the rules, do it, as often as necessary, so long it’s not every day. I can’t emphasize this enough. If you can’t handle having your daughter live with you as an adult, it’s okay to start the process of easing her out of the nest.

One final note: The “issues” your daughter’s boyfriend is having with his parents are none of your business unless they impact your family. Only give advice if asked (just like with your oldest daughter) and don’t hesitate to set boundaries with him and even his parents if they intrude on your household. At their age and circumstance, your daughter and her boyfriend are trying things out. Give them the room to make mistakes.

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Don’t Have Access to a Mental Health Therapist? Try These Ideas.

mental health

these alternatives to a mental health therapist are mostly Bandaids, but better than nothing

In an ideal world, everyone who needed a mental health therapist for someone to talk to would have one. We do not live in an ideal world. Money, travel, fear, and lots of other things can keep you from getting the help of a mental health therapist.

While not perfect, there are options you can explore. Feel free to add your own options in the comments. Note: these options are US-centric. Most other English speaking countries have universal healthcare and deal with these issues much less frequently. The options listed are “best-bad” options (the best of bad options) and are necessarily general and not geared to your county and state.

If you are feeling suicidal call 911 or the National Suicide Hotline at 1-800-273-8255, or text it at 741741. You are important and *totally worth the time of the person at the other end of that phone*.

Inpatient emergency mental health:

I’m mentioning this first because if you have a severe and persistent mental health issue, an inpatient stay alerts “the system” to your needs and you move up on a bunch of waiting lists and priority lists. This is not an invitation to pretend to have a mental illness to get help. The inpatient unit will figure that out anyhow. This is for people who have tried and failed to get into the systems designed to help them, whose symptoms have gotten bad enough that an inpatient stay makes sense.

Video sessions for people with Medicare:

If you have Medicare and can’t find a mental health therapist who takes Medicare, call Medicare’s customer service and ask if you’re eligible for telemedicine (a video conference therapy session). This is generally only possible if you live in a very rural area and have internet access at home. That extends your access to mental health therapists to your entire state. Only a few non Medicare providers offer this same service, so call your insurance company to check. If you can pay out of pocket, your choices improve.

Can the mental health therapist come to me?

Some mental health therapists make house calls (I do, but only very close to my office). Others offer video call therapy sessions (whether insurance can pay for these calls depends on your state and the insurance company). Call and ask around, and don’t forget to ask “Dr. Google”. It’s more common than you think to be able to find a therapist who makes house calls.

Ask your religious organization:

If you belong to a religious organization and feel comfortable with it, some pastors and religious counselors have mental health training.  If not, your church may work with a professional for free or reduced rate therapy. It’s worth asking.

Ask a friend:

Do you have supportive friends or family (supportive means: able and willing to go out of their way to help you even if it’s uncomfortable for them) who are not involved in the situation you need help with? If so, ask that person (those people). It doesn’t matter if the support person is an “online” or “in person” support person, if they are supportive, don’t encourage you to do things that don’t help you, and aren’t involved in whatever you need help with.

Are there support groups in your area or online?

Many of these are free and very helpful. Some examples include the various “Anonymous” organizations (for those that do well with 12 step programs). Searching for online support groups is easy using “Dr. Google”. Just use the search terms “online support group United States” plus whatever you’re seeking assistance for (depression, anxiety, anger, etc.) and pick your favorite(s) among the choices on the first few pages.

Online self-help resources:

If you need help building skills to help you cope with problems dealing with people, problems with managing anger, or problems with “having a better attitude”, there are a ton of free online resources for you. I’ll list just a few for you. Feel free to add more in the comments. Again, “Dr. Google” is a big help, and searching “online free resources for X” (with X being bipolar, depression, anger, or whatever issue you’re working with) should you give you lots of choices.

Among free online resources, some of my favorites are:

Captain Awkward: (really good guidance for saying the right thing at the right time in lots of different scenarios. She cusses a lot, so if that’s a problem for you, look elsewhere). Captain Awkward isn’t a mental health therapist, but she’s a really good advice columnist.

DBT Self Help: This is not only a resource hub with lots of downloadable stuff as well as good articles. It is also a community of people who have participated in DBT therapy and found it useful.

NAMI:  (National Alliance for the Mentally Ill) has a wonderful website with lots of local resources you can scroll through, especially in major cities. It also has discussion groups and a hotline. It is run by people with mental illnesses for people with mental illnesses.

Watch out for quacks and scams:

Along with good alternative to mental health therapists and mental health online resources out there, there are bound to be a few duds (and frauds, and jerks). If you discover one of these, please either drop a line or add a comment, and we’ll (my staff and I) will investigate and update as needed.

Get involved to change things:

Finally, as noted in my first paragraph, the United States has a much larger problem with access to health care than other English speaking countries, and this is largely due to political and health care policies. Be sure to advocate for ease of access to mental health therapists for yourself and those you care about. Call a congressman, speak to an employer, join community organizations.

Note: “Dr. Google” is my tongue in cheek way of asking you to do an internet search. Future articles will discuss this further.

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How To Create Resolutions that Work

goals are resolutions

goals are resolutions

Are Your Resolutions Reasonable?

It is an American tradition to charge out of the New Year in January with a long list of intentions and resolutions. You believe them to be achievable in a few months, at most a year, and you’ve read a couple articles or seen a YouTube video that explains how easy it is to achieve.

The second week of January rolls around and you’ve skipped a few days on your resolutions, but are enthusiastic.

Mid-February rolls around and you are trying still, every now and then, but enthusiastically lying to your friends about how it’s going.

Sometime around March or April, you stop even pretending to try.

Choosing Resolutions

Resolutions (goals) should:

  • Improve a situation rather than to keep it the same.
  • Be totally or mostly within your control versus something that others totally or mostly control
  • Reflect that “success” can come about multiple ways

Improving the Situation examples include better job, better health, better relationships, better housing, better attitude, etc.

Things that are mostly within your control include:

  • doing some sort of productive work
  • building relationship skills practicing and learning financial management skills
  • choosing to work on attitudes and beliefs that get in the way of your vision for yourself
  • choosing a cause to contribute time and effort to

Things that are not largely in your control include:

  • other peoples’ contributions to your goals
  • the course of chronic illness and mental illness (outside of following doctor’s orders and doing common sense health interventions)
  • the natural results of aging
  • larger societal forces such as war, economic recession, and climate change

How to Structure Resolutions:

Therapists and counselors and case managers work with “treatment plans”. These are plans that set one main goal, which is another word for resolution. The resolution is supported by three to five objectives, which are measurable ways to work toward the resolution.

Let’s take your resolutions and treat them like a treatment plan resolution. For example, “I want to have a job working in my chosen field this year”.

That looks like a good resolution. It’s probably achievable in a year, and it’s largely in your control if you have a broad definition of “working in publishing” that includes volunteering and web publication.

Let’s pretend your field is publishing, and you have just graduated from high school with good enough grades to get into at least a community college.

What sort of objectives should you set for your resolutions? Here are some guidelines:

  • They should be specific vs. vague. Numbers, dates, and percentages. “I will apply for three jobs per week” vs. “I will apply for jobs regularly”
  • They should be tailored to what you can do versus what you wish you could do. “I will move to New York and intern at a publishing company” might be an unreasonable resolution if you have to answer to a significant other, children, or a dependent elder, or if you won’t have any other source of income. Instead “I will volunteer to be a first reader for a friend who is an author” or “I will apply to work for a web based publishing company in an entry level position”.
  • They should address different aspects of your resolution versus going deeper on one aspect.
    • What if you must get over interview anxiety in order to be successful in your job search? “I will read one article about interviewing per week and/or practice interviewing in front of a friend or mirror once a week until hired”.
    • What if you need to have a paid job in another field and an unpaid internship that will benefit you? “I will look for a paid position making X amount per hour that is simple enough that I have energy left afterward for X number of hours per week in my internship”.
    • What if you need assistance or “sign on” with others to be successful? “I will develop three supportive friendships that encourage me in this resolution, in person or on line”.
  • There should be no more than five (three is better) objectives for each resolution. At any given time, you should have no more than three major resolutions, preferably ones that work well together.
  • Your objectives should address any major limitations you have. For instance, if a barrier to work in publishing is lack of education, you should have an objective for pursuing education. If a barrier is anger issues that result in regular problems with co-workers or supervisors, you should have an objective for seeking therapy or other means to find more effective ways to deal with anger.

Reviewing and Renewing Resolutions:

You should build your resolutions into daily, weekly, monthly and quarterly habits. For instance, using the above example:

Daily: Add an item to a To-Do list or app to research at least one publishing firm or one role in the publishing field every day. Subscribe to Facebook groups or email lists about publishing and read them daily. Write or read or edit daily.

Weekly: Apply for X number of jobs/internships per week, depending on your personal capacity. Work on networking through LinkedIn or Facebook or some other means (including in person if feasible) to meet and interact with people in the field. Set these goals on To-Do lists or calendars

Monthly and Quarterly: Review your actions for the month. Spend some time on this, again, putting it into a calendar as an appointment (your goals are important). Does any follow-up need to be added to your calendar? Do you need to re-assess tactics? Do you need to seek the help or advice of someone else? Begin thinking about ways to update your objectives. Have you met your goal or resolution? Is it time to set a new one?

What Sorts of Things Aren’t Good for Resolutions?

Resolutions stretch you out of your comfort zones. They are not for keeping things the same. Instead of setting resolutions for ongoing emotional, physical, financial and social maintenance of health and success that you already do, borrow a concept from Stephen Covey and consciously create habits that “sharpen the saw”. On a regular (daily, weekly, monthly, as appropriate) basis, do things that ensure you’re not backsliding on good practices you already have. These things tend to be done as soon as they are needed, take a short time unless you procrastinate and let them build up, and become “normal” as you repeat them.

Note: If any of these are not current regular habits, creating the habit is an appropriate resolution.

Examples include:

  • Regular religious or spiritual practice
  • Daily exercise (as simple as stretching in your wheelchair or as difficult as training for a marathon)
  • Regular creative expression
  • Regular social contact (in person or online, one-on-one or in groups as is your preference)
  • Setting a regular schedule of doctor, therapist, financial advisor, and other professional appointments as appropriate to your life
  • Building skills for employment or enjoyment to improve your experience of your life
  • Healthy, moderate eating and substance habits
  • Paying bills on the day they arrive (or setting up automatic bill pay for your bills)
  • Cleaning the house and taking care of the yard daily as needed
  • Auto or bicycle maintenance

Getting Help with Your Resolutions

We often set our resolutions in areas of our life where we have significant problems or imbalances. That means we often find that we need help to continue to be successful in working toward resolutions. Possibilities include:

  • Supportive friends and family (not the other kind)
  • Physicians
  • Mental Health specialists
  • Mentors (teachers, professors, co-workers or supervisors)
  • Attorneys, accountants, and other specialists
  • House care and lawn care specialists
  • Personal trainers
  • Self-help websites and books
  • Support groups

Go out and resolve to do the very best you can do. Check back often or sign up to receive regular updates for www.responsivellc.com for more helpful information.

Comment Policy: RMHS LLC and its owner, Jennifer Liles, are the sole arbiters of what is acceptable commentary on this page. As the primary function of this website is to provide information to therapy participants, therapists, and people looking for self-help resources, commenters who the intent or impact of causing harm to others will generally be warned to stop their behavior and given an opportunity to change it. If they refuse to do so, they will be blocked from commenting. Grossly inappropriate private messages designed to threaten, intimidate, or harass may be made public and/or reported to parents, employers, and the appropriate authorities.

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RMHS LLC Hiring Clinicians

hiring clinicians

By hiring clinicians to expand our reach, we sow the seeds of mental health.

Responsive Mental Health Services LLC (RMHS LLC) in Independence, Missouri, is hiring licensed clinicians (including provisionally licensed clinicians under supervision) who would like to work in a small office environment and/or providing in home therapy for a wide variety of therapy participants.

We offer much of the flexibility of self-employment along with the ability to focus on your therapy participants and clinical work that is offered by an employer. We use an electronic health record that makes creating your documentation faster and more accurate than most EHRs.

All positions are part time to begin with the potential for full time and advancement. You will be an employee paid hourly with a bonus structure based on your productivity and the company’s profits that is paid at every paycheck (productivity) and quarterly (profits).

While we are a very small business and at this point offer few benefits, we do offer paid time off starting at the beginning of employment, whether full or part time, and offer a flexible schedule that works with your availability and is designed, even at full time, to minimize burnout. We are actively looking at providing a group health plan at the beginning of 2017 along with short- and long- term disability.

We are looking for the following in our clinicians:

  • A customer service based approach that isn’t based on buzzwords, but on compassion and a genuine heart for helping others
  • An understanding of how people are impacted by the systems around them
  • Cultural competency regarding race, religion, sexual orientation, gender, and other cultural considerations
  • A current license (including provisional license) at the Master’s level or higher, that allows you to practice in the state of Missouri as a mental health therapist.

We are especially looking for clinicians that are interested in:

  • providing in-home therapy
  • working with children and families
  • wanting to develop and lead group therapy for the needs of the community
  • interested in training for an opportunity to supervise your own small branch office

Send your resume and cover letter to jliles@responsivellc.com today and join our small but growing business.

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Be Prepared: Your First Mental Health Therapy Appointment

your first mental health therapy appointment can be scary

What will your first mental health therapy appointment be like?

Your first mental health therapy appointment is a scary thing. You are going to be telling all of your deepest, darkest secrets to a stranger, or even more than one stranger, and you have no idea whether it will really help, or it’s all a bunch of smoke and mirrors. There are three basic categories of things to bring to your first appointment, and paying attention to all three — documentation, knowledge, and attitude — will help things go more smoothly. Continue reading

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Social Work Supervision

Jennifer Dowling Liles MSW, LCSW at Responsive Mental Health Services LLC (RMHSLLC) can now provide social work supervision for licensure for LMSWs and LBSWs in Missouri seeking LCSW and LBSW-IP licenses, respectively.

Requirements for Social Work Supervison at RMHS

Supervisees can pay for supervision in time, money, or a combination of the two. Group supervision is not yet available, but we expect it to be in the future, and we will strongly encourage supervisees to participate in group supervision at least once every two months. Supplementing individual supervision benefits supervisees by providing a forum in which discussion can flow freely. Continue reading

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On Grief: Caring for Yourself When Someone You Cared for Dies

Sometimes people assume that those of us who care for others professionally don’t go through grief when people we were providing care for die. It is part and parcel of the idea that we are a service (in our role as caretakers or care providers) and not people. And whether you cared for a person as a family member, a friend, or a trusted professional, when that person dies, you will go through grief.

On more than one occasion I have been blindsided by waves of grief days, weeks, or months after the death of someone I was a friend to, family member of, or provided professional services to. I am writing this post today not just as a service to you, but because as a friend and professional, I have had an exceptionally bad month for deaths ‘in my circle’, losing four people under the age of thirty – two to suicide, one to accident, and one to chronic disease. The youngest of these four were both sixteen. Continue reading

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Depression Workbook: Why Gratitude (or Appreciation)? My Life Sucks!

Appreciation can be the key for a door out of daily depression

Appreciation can be the key for a door out of daily depression

First, a disclaimer: I’m not a big fan of the positive psychology movement. From my perspective, and that of several researchers, it has a huge “blame the victim” mentality that goes something like this: If you think positive thoughts, you’ll be happy. If you’re still not happy, try harder. If you’re still not happy, it’s all your fault. While research demonstrates that positive thinking can improve motivation and have positive effects on mood, it’s not a cure-all. Depression is real, and the work that is needed for someone with depression to overcome it and improve her life is both real and difficult.

It’s not your fault if you’re not happy. Really. It’s not that you’re not good enough, or deserving enough, it’s that you have an illness that makes it difficult to see the good in life and nurture it. You deserve happiness and there are ways to make it more likely that you will find happiness, but they involve doing things that that lying liar, depression, makes it harder for you to do. These include exercising, eating right, setting up routines, and having an active social life. Continue reading

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Effective Parenting: Labeling vs. Ignoring vs. Educating

effective parenting photo

Photo by gorillakid4352012 creative commons no derivatives license

 

(The idea for this post on effective parenting was shamelessly stolen from a comment by newsoul11 (cool handle!) in this thread on Captain Awkward’s wonderful site.)

Effective Parenting: The Case of Captain Awkward and the Dirty, Rotten Little Milk Spiller:

The Scenario: Imagine if you will, three parents, all busy, all with totally normal, newly independent three year old children. Now imagine that each of those children has gone into the kitchen and poured herself a glass of milk. She has successfully gotten (most of) the milk in the cup, and might even have remembered to put the milk jug away. Finally, imagine that each of those children proudly toddles out to where Daddy is in the living room, chatting on the phone to a friend, and just as she is about to proudly demonstrate her ability to pour milk all by herself, she spills it, two feet in front of her father. Continue reading

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