Family members can play an important role in helping a loved one with co-occurring mental health and substance use disorders get on the road to recovery. Support a loved one’s recovery by:

• Helping a loved one remember to take all prescribed medications for one or both disorders
• Listening to any concerns about medications – such as their purpose, benefits, and side effects – and helping address those concerns
• Making sure appointments with treatment providers are kept
• Working with the treatment team to stay informed and help address any issues related to medication

To learn more, visit Mind Your Mental Health.

Source: Behavioral Health Evolution

What is depression in children and teens?

Depression is a serious mood disorder that can take the joy from a child’s life. It is normal for a child to be moody or sad from time to time. You can expect these feelings after the death of a pet or a move to a new city. But if these feelings last for weeks or months, they may be a sign of depression.

Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve. As many as 2 out of 100 young children and 8 out of 100 teens have serious depression.

Still, many children don’t get the treatment they need. This is partly because it can be hard to tell the difference between depression and normal moodiness. Also, depression may not look the same in a child as in an adult.

If you are worried about your child, learn more about the symptoms in children. Talk to your child to see how he or she is feeling. If you think your child is depressed, talk to your doctor or a counselor. The sooner a child gets treatment, the sooner he or she will start to feel better.

What are the symptoms?

A child may be depressed if he or she:

• Is irritable, sad, withdrawn, or bored most of the time.
• Does not take pleasure in things he or she used to enjoy.

A child who is depressed may also:

• Lose or gain weight.
• Sleep too much or too little.
• Feel hopeless, worthless, or guilty.
• Have trouble concentrating, thinking, or making decisions.
• Think about death or suicide a lot.

The symptoms of depression are often overlooked at first. It can be hard to see that symptoms are all part of the same problem.

Also, the symptoms may be different depending on how old the child is.

• Both very young children and grade-school children may lack energy and become withdrawn. They may show little emotion, seem to feel hopeless, and have trouble sleeping. Often they will lose interest in friends and activities they liked before. They may complain of headaches or stomachaches. A child may be more anxious or clingy with caregivers.
• Teens may sleep a lot or move or speak more slowly than usual. Some teens and children with severe depression may see or hear things that aren’t there (hallucinate) or have false beliefs (delusions).

Depression can range from mild to severe. A child who feels a little “down” most of the time for a year or more may have a milder, ongoing form of depression called dysthymia (say “dis-THY-mee-uh”). In its most severe form, depression can cause a child to lose hope and want to die.

Whether depression is mild or severe, there are treatments that can help.

What causes depression?

Just what causes depression is not well understood. But it is linked to a problem with activity levels in certain parts of the brain as well as an imbalance of brain chemicals that affect mood. Things that may cause these problems include:

• Stressful events, such as changing schools, going through a divorce, or losing a close family member or friend.
• Some medicines, such as steroidsor opioids for pain relief.
• Family history. In some children, depression seems to be inherited.

How is depression diagnosed?

To diagnose depression, a doctor may do a physical exam and ask questions about your child’s past health. You and your child may be asked to fill out a form about your child’s symptoms. The doctor may ask your child questions to learn more about how he or she thinks, acts, and feels.

Some diseases can cause symptoms that look like depression. So the child may have tests to help rule out physical problems, such as a low thyroid level or anemia.

It is common for children with depression to have other problems too, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems to help your child get the right diagnosis and treatment.

How is it treated?

Usually one of the first steps in treating depression is education for the child and his or her family. Teaching both the child and the family about depression can be a big help. It makes them less likely to blame themselves for the problem. Sometimes it can help other family members see that they are also depressed.

Counseling may help the child feel better. The type of counseling will depend on the age of the child. For young children, play therapy may be best. Older children and teens may benefit from cognitive-behavioral therapy. This type of counseling can help them change negative thoughts that make them feel bad.

Medicine may be an option if the child is very depressed. Combining antidepressant medicine with counseling often works best. A child with severe depression may need to be treated in the hospital.

There are some things you can do at home to help your child start to feel better.

• Encourage your child to get regular exercise, spend time with supportive friends, eat healthy foods, and get enough sleep.
• See that your child takes any medicine as prescribed and goes to all follow-up appointments.
• Make time to talk and listen to your child. Ask how he or she is feeling. Express your love and support.
• Remind your child that things will get better in time.

What should you know about antidepressant medicines?

Antidepressant medicines often work well for children who are depressed. But there are some important things you should know about these medicines.

• Children who take antidepressants should be watched closely. These medicines may increase the risk that a child will think about or try suicide, especially in the first few weeks of use. If your child takes an antidepressant, learn the warning signs of suicide, and get help right away if you see any of them. Common warning signs include:
  • Talking, drawing, or writing about death.
  • Giving away belongings.
  • Withdrawing from family and friends.
  • Having a plan, such as a gun or pills.
• Your child may start to feel better after 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressants as prescribed and keeps taking them so they have time to work.
• A child may need to try several different antidepressants to find one that works. If you notice any warning signs or have concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child’s doctor.
• Do not let a child suddenly stop taking antidepressants. This could be dangerous. Your doctor can help you taper off the dose slowly to prevent problems

Help is available. For additional information, visit MagellanHealth.com/MYMH

©Healthwise

A child’s mental health affects nearly every aspect of their overall health. Their physical health and their ability to become successful, contributing members of society depends on the state of mind they bring to every situation. Children’s mental health issues are real, common and treatable. An estimated 15 million of our nation’s young people can currently be diagnosed with a mental health disorder. Many more are at risk of developing a disorder due to genetic and environmental risk factors. However, it is estimated that only about 7 percent of youth who need services receive appropriate help from mental health professionals (Department of Health and Human Services, 2001 — Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda).

1) What should I do if I am concerned about mental, behavioral, or emotional symptoms in my child? Keep in mind that every child is different. Even normal development, such as when children develop language, motor, and social skills, varies from child to child. If you are concerned about changes in behavior or other symptoms, talk to your child’s doctor or health care provider. If your child is in school ask the teacher about observed changes in behavior and see if the school system can provide an evaluation. Share this with your provider as well. Be prepared to seek further evaluation by a specialist with experience in child mental health issues. Specialists may include psychiatrists, psychologists, social workers, psychiatric nurses, and behavioral therapists.

2) How do I know if my child’s problems are serious? Many everyday stressors can cause changes in a child’s behavior, however, not every problem is serious. For example, the birth of a sibling may cause a child to temporarily act much younger than he or she is. Behavior patterns that may indicate a more serious issue include:

• Problems across a variety of settings, such as at school, at home, or with peers
• Changes in appetite or sleep
• Social withdrawal, or fearful behavior toward things your child normally is not afraid of
• Returning to behaviors more common in younger children, such as bed-wetting, for a long time
• Signs of being upset, such as sadness or tearfulness
• Signs of self-destructive behavior, such as head-banging, or a tendency to get hurt often
• Repeated thoughts of death.

3) How are mental illnesses diagnosed in young children? Just like adults, children with mental illness are diagnosed after a doctor or mental health specialist carefully observes signs and symptoms. Some primary care physicians can diagnose a child themselves, but many will refer to a specialist for diagnosis and treatment.

• Before diagnosing a mental illness, the doctor or specialist tries to rule out other possible causes for a child’s behavior. The doctor will:
• Review the child’s medical history
• Discuss the issues you have observed
• Review the child’s developmental level
• Ask about any family history of mental health disorders
• Ask if the child has experienced physical or psychological traumas, such as a natural disaster, or situations that may cause stress, such as a death in the family
• Consider reports caretakers and/or teachers

Children are constantly changing and growing and diagnosis and treatment must be viewed with this in mind. While some problems are short-lived and don’t need treatment, others are ongoing and may be very serious. In either case, it is important to see more information so you can understand treatment options and make informed decisions.

3) What are the treatment options for children? The specialist will recommend specific treatment based on the diagnosis. Treatment options may include psychotherapy and/or medication. Talk about the options with the specialist and ask questions. Some treatment choices are a part of standard health care practice while others may be in the experimental stage.

4) Will my child get better with time? Some children get better with time and others children may need ongoing professional help, it all depends on the diagnosis. That is why it is important to consult with a health care providers as soon as possible because treatment may produce better results if started early.

5) How can families of children with mental illness get support? Like other serious illnesses, taking care of a child with mental illness is hard on the parents, family, and other caregivers. Support groups are available for many different types of issues and age groups. By sharing experiences in a safe and confidential setting encourages empathy and a sense of community.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Sources: American Psychological Association, National Institute of Mental Health

If you’re raising children today, it can be easy to focus on the negative, especially with the constant media stream coming from all directions. Helping children see the positive in the world today is more important than ever. Research shows that optimists, who believe they can achieve success, are in fact more able to do so. They are less likely to get depressed, get fewer illnesses, have longer relationships, and live longer.

Here are 12 tips to help your children develop a positive outlook on life.

1. Quit complaining. Focusing on negative thoughts and frustrations is classic pessimism. The more you moan about troubles at work, money problems, etc. the more likely it is that your children will learn to do the same thing. Instead, try talking about things that go right.
2. Have high expectations. Kids won’t develop an optimistic, “can-do” attitude unless they have the opportunity to prove their worth.
3. Encourage reasonable risk-taking. Discouraging your children from doing activities because they might not be as skilled as other children can undermine their confidence.
4. Wait before reacting. Let your children try to solve things without your help. This will boost their sense of accomplishment and also make them more optimistic about what they can do in the future.
5. Be realistic and honest, even in difficult situations. For example, if your child is having a difficult time making friends at a new school, empathize with him/her, but explain that making friends takes time and he/she needs to take active steps to meet other kids and make friends.
6. Show your children you love them. Make time for them every day and use words and affection to show you care.
7. Be a positive role model. Your children will mimic your behaviors, so make sure you show them constructive ways of dealing with life’s challenges and misfortunes.
8. Allow your child to experience success. For example, give them age-appropriate tasks around the house and praise them for their efforts.
9. Teach practical skills with patience and humor. Help your child to keep up with peers – for example, tying shoelaces, using cutlery and managing the toilet.
10. Listen to their problems. Take concerns seriously and be supportive as they learn how to cope with life’s hurts and disappointments.
11. Point out the ‘silver lining’ in every cloud. Get your child into the habit of looking for the positives, even times where it may only seem like the chance to learn from a mistake.
12. Make happy events a regular part of your family life.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Sources: Parents.com, Better Health Channel

Traumatic events, such as a sudden death, natural disaster, motor vehicle accident, or terrorist attack can leave children and teens feeling stressed, frightened, and helpless. Whether they personally witness the event or are exposed to it on the news or social media, children may experience intense emotions and a heightened sense of insecurity. Children’s reactions to a traumatic event depend on their age and personality, the severity of the event, the availability of support, and previous experience of trauma

Tips for all ages

Traumatic events can disrupt children’s sense of safety and result in fears and worries, nightmares, and physical reactions such as headaches, stomachaches, problems sleeping, and loss of appetite. Here are suggestions to help children through the emotional and physical challenges they may face after trauma:

• Be aware of your own reactions to the event and manage your own stress. Stay calm and offer hugs and reassurance to help restore your child’s sense of safety and security.
• Share information about the event and answer your child’s questions honestly. Listen to your child’s fears and let him/her know it is okay to share his/her feelings at any time.
• Limit or prevent exposure to disturbing news and social media coverage of the event. Children who see graphic images or hear distressing news stories may become re-traumatized.
• Maintain stable routines as much as possible, including regular mealtimes, bedtimes, and exercise.
• Engage in fun activities to help children relax and feel that life is returning to normal.
• Watch for signs of trauma, even after weeks have passed. Children cope with trauma in different ways, and some may show signs of sadness, anxiety, and troubling behavior weeks or months after the event.

Tips by age group

Preschool age

After a traumatic event, children who are age five and under may display behavior from an earlier stage of their lives, such as bedwetting, thumb-sucking, clinginess to parents, and fearfulness of strangers. They may have tantrums or cry more than usual, or become withdrawn from others. Parents and other adults can help children by providing comfort and reassurance, maintaining routines as much as possible, encouraging them to express their feelings, and giving simple explanations to children’s questions about the event. Children look to their parents for cues as to how to feel and react, and will pick up on a parent’s distress or anxiety. It is best not to expose young children to the news on TV or the radio about the traumatic event. Involving toddlers and preschoolers in fun activities and playtime with others will provide a healthy distraction.

Early childhood

Children ages 6 to 11 may show some of the same reactions that younger children have, such as reverting to more childish behaviors. They may have nightmares or trouble sleeping, find it difficult to concentrate in school, become irritable, anxious or disruptive, or lose interest in family, friends, and fun activities. Parents should reassure children that they are safe and will be taken care of no matter what. Encourage family discussion about the event and answer questions, but be careful about exposing children to news and TV footage. Keep bedtime and meal routines as normal as possible, and involve children in activities that keep them busy. Identify the positives such as community recovery activities and the ways people help each other get through difficult times.

Adolescence

Older children ages 12 – 17 may have stress reactions such as nightmares and flashbacks of the event, lose interest in school, hobbies, and friends, feel angry, guilty, or depressed, withdraw from others, have physical symptoms such as headaches, or abuse alcohol or other drugs. As with younger children, parents can help teens rebuild a sense of trust and safety by listening to their concerns without judgment and providing them with peer support opportunities. Age-appropriate volunteer activities can help teens feel useful and productive.

When to get help

Be aware of signs that a child may need extra help coping with the trauma. If six weeks or more have passed since the traumatic event and your child is not feeling better, has trouble functioning at school or at home, is withdrawn from friends and family, or continues to have physical complaints such as headaches, stomach pains, and problems sleeping or eating, contact a mental health professional.

Mike* was dancing wildly to hip hop music before running up to me and confidently stating, “I’m a leader.” He told me about how he ran to be a class officer and lost but how he was not going to give up. He talked about his search for a life-long mentor and how he wanted to make the world a better place. Not the type of random conversation you would expect at an outdoor community event, but MY LIFE youth are not average.

Since 2007, Magellan Youth Leaders Inspiring Future Empowerment, or MY LIFE, has proactively sought to change the trajectory of young lives engaged in the foster care and juvenile justice systems, as well as youth with behavioral challenges. Led by Greg Dicharry, Magellan’s national director for youth empowerment, monthly MY LIFE groups and annual MY FEST events have provided thousands of youth an opportunity to connect to their community and hear stories of overcoming hardships and reaching for their full potential. In Florida alone, groups in Tallahassee, Orlando and West Palm Beach enable over 100 youth ages 13 to 23 to meet monthly in a safe environment where fun and inspiration are plentiful.

Getting to spend time with youth involved in MY LIFE underscores the impact. One young man who has been attending a Florida MY LIFE group for three years described how the motivational speaker’s life lessons inspired him to focus on his future instead of focusing on his past. He told me about the hard times he was going through now and how the stories of the speakers going through tragic times provided him with the feeling that “it’s not too late for me.” It was a tough thought to imagine that at only 16 years old, this young man felt like the cards had already been stacked against him. MY LIFE provides a consistent message that he and his peers have the power and support to create a future different from their current reality.

And then there was Mike with his boundless energy. He may never lose that energy, which could either lead him down a path that is damaging to himself and others, or one that honors his strengths and abilities as he contributes to society. MY LIFE has helped him set upon the latter path. His future can now be one where his energy is directed into developing his leadership skills, pursuing higher education and a meaningful career, despite the challenges he might face at home or at school.

MY LIFE is just one way Magellan is supporting young leaders to help make our communities stronger.

*Mike is not this individual’s real name.

Today, children and adolescents with behavioral health challenges are generally prescribed, and use, an alarming number of psychotropic medications. This excessive usage has raised concerns among families, practitioners and advocates amid questions about the appropriateness of the diagnoses that justify the drugs’ use – as well as the uncertainty surrounding the long-term effects of these drugs on a child’s neurological development.

Thinking ahead about the challenge

Magellan Health has had its eye on this issue for years, publishing a popular monograph, “Appropriate Use of Psychotropic Drugs in Children and Adolescents,” on the topic in 2013, which addressed the anxiety and confusion around the issue. Now – leveraging new data and research – we have released an updated monograph.

We know that appropriate use of psychotropic medications can play a role in helping children and youth with behavioral health conditions successfully live at home, achieve in school and experience positive engagement within their communities. But first parents, caregivers and practitioners need to fully understand the risks and monitor their use. When they’re used in the wrong way, these drugs can lead to a host of medical conditions and social problems that prevent youth and their families from achieving their goals.

10 questions to ask before starting treatment

To tackle this issue in the most practical way, we’ve developed a list of top 10 questions for caregivers, practitioners and the child/youth to discuss before beginning this type of treatment:

The treatment options

1. Are these medications needed?
2. Will the child benefit from therapy?
3. Did the child get a full evaluation from a behavioral health practitioner?

The medication

4. Has the medication been tested and approved for children? What are the risks, benefits and side effects?

The treatment plan

5. How will we know the child is making progress?
6. How often will the child be checked after starting the medications? What happens if we don’t see progress?
7. What warning signs should we look for and when should the doctor be called?
8. Will the treatment be noted in the child’s health care records?
9. Will the practitioner talk to the child’s other health care providers?
10. Does the practitioner know of other medications the child is taking and are there risks in combining them?

Implications

We know practitioners strive to do the right thing for the individuals they serve. With our monograph, we aim to support them in their decision-making process. Our approach is to help primary and behavioral health practitioners – as well as parents, youth and advocacy organizations – make informed decisions that most effectively meet each child’s needs. When the right medications are prescribed and monitored, they can have positive results in a child’s life.

Magellan Behavioral Health of Pennsylvania, Inc., a Medicaid managed care organization (MCO), started as the new HealthChoices behavioral health exclusive contractor for the Cambria County Behavioral Health Services Program on July 1, 2017. Magellan currently administers behavioral health benefits for Medicaid members through HealthChoices contracts with Bucks, Delaware, Lehigh, Montgomery and Northampton counties.

Magellan has over two decades of experience managing behavioral health benefits for HealthChoices members through close collaboration with members, providers and community organizations. Through this collaborative mindset, Magellan has succeeded in producing innovative efforts in the following areas:

• increases in access to care
• improved service use rates
• expansion of the continuum of services in alignment with evidence-based models
• maximization of clinical appropriateness
• nationally recognized level of quality services

Read more about Magellan’s collaboration with Cambria County, local providers, community organizations and members in the Tribune Democrat: New Behavioral Health Provider Brings Options, Jobs to Cambria County.