For our kids, disruptions caused by the COVID-19 pandemic are likely more than just that – temporary inconveniences, varying in severity, until life goes back to “normal.” Besides missing out on once-in-a-lifetime events, like graduations, birthdays and other milestones – at least in a way they would traditionally be observed – regular human interactions, part of social and emotional development, have changed. While adults may be experiencing a serious blip on the radar, children may be experiencing an interruption in brain development and/or lack the ability to fully cope in this unchartered territory.

In this post, we will contemplate these issues and draw on knowledge from Magellan Healthcare’s recently updated clinical monograph, Understanding and Meeting the Needs of Children and Adolescents at High Risk, which highlights evidence-based prevention and treatment approaches for problematic behaviors and various types of behavioral health challenges in children and adolescents.

As we think about the significance of childhood development, the following points from Magellan’s monograph provide insights:

A growing body of scientific information has confirmed the importance of the first five years of life, when the ongoing construction of brain architecture impacts youth social and emotional development, the ability to learn new behavior and skills, and how the youth evolves into adolescence.

Advances in neuroscience have contributed new understanding of adolescent development. During adolescence, the brain experiences a period of major development comparable to that of early childhood.

With much changing in our kids’ lives and environment – virtual schooling, modified in-person play arrangements with friends and reduced time with extended family – the responsibility falls on parents and caregivers, as it always does, to ensure their child’s wellbeing and adjustment. Magellan’s monograph offers the following to ponder:

While genes determine when specific brain circuits are formed, experiences actually shape their formation and are fueled by a self-initiated, inborn drive toward competence. This phenomenon depends on appropriate sensory input and stable, responsive relationships whereby adults respond to a child’s natural reaching out for interaction.

However, when parents are under unprecedented stress and often just trying to make ends meet, attending to their child’s increasing needs can understandably be overwhelming. In addition to the role of parent and full-time employee, many adults have taken on the additional roles of teacher, daycare worker and entertainer, to name a few. In some cases, however, a parent’s struggles may lead to neglect of their children. Magellan’s monograph highlights the following of child neglect:

While child abuse is more widely acknowledged and publicized, child neglect is, in fact, the most common type of child maltreatment, which frequently goes underreported. Expanding on the earlier discussion of impaired brain development, it is now understood that lack of stimulation and necessary care early in life may cause children to remain in a state of “hyperarousal” (i.e., constantly anticipating threats and/or experiencing dissociation) rather than a normal state of attentive calm. This phenomenon leads to a decreased ability to benefit from social, emotional and cognitive experiences and results in other psychosocial consequences. Together with insecure attachments, this state of hyperarousal can significantly affect normal growth and development.

Many parents are also managing their own mental health conditions and substance use disorder during the pandemic, which adds to the impact of what children and adolescents are experiencing themselves. The monograph outlines the risks for children of these parents:

There are many serious risks to children and adolescents who have a parent or both parents with mental illness. The American Academy of Child and Adolescent Psychiatry (AACAP) calls attention to the strong genetic predisposition in children for inheriting bipolar disorder, an anxiety disorder, attention deficit-hyperactivity disorder (ADHD), schizophrenia, alcoholism or other SUD, or depression. Recent studies have also demonstrated delayed brain development in young children of depressed mothers. Further, the AACAP notes the additional stress that mental illness places on a marriage and parenting abilities of the couple, and the risks that stem from an inconsistent, unpredictable family environment that can contribute to psychiatric illness and developmental delays in children.

It’s also appropriate to consider the older children and young adults who may lack the ability to cope with increased stress and instability. Magellan’s monograph calls attention to recent research:

A CDC report on mental health, substance use and suicidal ideation during the COVID-19 pandemic shows that while 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%).

During these difficult times, we’re all doing the best we can. And we know that brighter days are on the horizon. Until then, and always, as we’re helping ourselves and our children through, let’s remember that “information is power,” as they say. To that effect, we encourage you to learn more in our full children’s clinical monograph here.

Anxiety is a normal response to a constant barrage of bad news. Headlines and notifications related to recent events are taking their toll on mental health in what some call “headline stress disorder.”

While this is not a medical diagnosis, the continued anxiety or stress from headlines may cause things like heart palpitations and chest tightness or insomnia. Further progression may lead to physical and mental conditions such as anxiety disorders, depression, endocrine disorders or hypertension.¹ The combination of civil unrest, political instability and COVID-19, and the resulting economic uncertainty, has led to an increase in stress and anxiety in society. Both adults and children may struggle to process their feelings and maintain a sense of normalcy.

Here are some tips to help you understand and manage your fears, how to help children deal with traumatic events and how to know when you or someone close might need help.

Understanding the emotional and physical reactions to traumatic events

Emotional reactions

When the initial shock of a traumatic event subsides, normal emotional responses in the hours and days that follow may come in waves and at unpredictable times. These responses include:

• Fear and anxiety
• Sadness and depression
• Guilt, shame or despair
• Anger and irritability
• Emotional numbness
• Feelings of separation from others

Physical reactions

Physical reactions are the result of stress hormones flooding the nervous system. Common physical symptoms include:

• Difficulty sleeping
• Fatigue
• Headache, abdominal pain or other physical pain
• Racing heart
• Dizziness or fainting
• Change of appetite

How to help yourself

• Take care of yourself first. Eat healthy foods, get enough rest and exercise regularly. Physical activity can reduce anxiety and promote well-being.
• Talk to people you trust about your concerns. A supportive network is important for emotional health.
• Take time for hobbies and fun activities or find interesting volunteer activities. This can be a healthy distraction from everyday stress.
• Limit your exposure to disruptive TV, radio and social media coverage.
• Practice mindfulness and relaxation techniques such as deep breathing and meditation.

How to help children cope with traumatic events

• Be aware of your own reactions to the event and manage your own stress. Stay calm and offer hugs and reassurance to 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 them know that it is okay to share their feelings at any time.
• Restrict or prevent contact with disturbing news and social media coverage of the event. Children who see graphic images or hear disturbing news can be re-traumatized.
• Maintain as many stable routines as possible, including regular meals, bedtimes and exercise.
• Engage in fun activities to help the children relax and get the feeling that life is back to normal.
• Watch for signs of trauma, even after weeks have passed. Children, like adults, cope with trauma in different ways, and may show signs of sadness, anxiety or disruptive behavior weeks or months after the event.

Know when to get help

• Common signs that you or your child may need professional help can include: excessive worrying or fear, extreme mood swings, avoidance of friends, difficulty understanding or relating to other people, changes in eating and sleeping habits and inability to engage in daily activities or deal with daily problems and stress.
• If you are suffering from stress reactions that affect your ability to lead a normal life for six weeks or more, you may need help from a mental health professional. While everyone is different and heals at their own pace, some people develop Post-Traumatic Stress Disorder (PTSD) after a traumatic event.
• Signs of PTSD include: disturbing memories, nightmares or flashbacks, suicidal thoughts or feelings, disconnection from others, and trouble functioning at home and work. It is important to seek help if you think you might have symptoms of PTSD.

¹https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104635/

As the new COVID-19 vaccine is being administered across the country, many people are feeling a mix of emotions. There is hope that the vaccine will normalize life and relief that the vaccine will save lives.  There is also anxiety about its potential side effects, long-term effectiveness and availability. For some, the stress and uncertainty caused by the pandemic are being exacerbated by vaccine concerns.

Vaccine safety

Although the two vaccines currently available were rapidly developed, they meet the safety and efficacy standards of the U.S. Food and Drug Administration (FDA). The data from the manufacturers and research from large clinical trials show that the benefits of the COVID-19 vaccines outweigh the risks of side effects and coronavirus infection. There are also other COVID-19 vaccines in development that must meet stringent safety standards before they can be released.

In addition, the Centers for Disease Control (CDC) and FDA have expanded safety monitoring systems to continue to track possible side effects of vaccines. A new easy-to-use, smartphone-based tool called V-safe enables vaccinated individuals to notify the CDC about any side effects. V-safe also texts reminders to get the second vaccine dose.

Anxiety about the COVID-19 vaccine

Anxiety can stem from fears about the vaccine’s safety, getting a shot or not having control over when it will be available.

Here are tips to help manage it:

• Stay informed and research credible sources. There is a lot of misinformation online about vaccinations in general. Follow credible news and information sources. Up-to-date information about the COVID-19 vaccines, side effects and benefits, and answers to frequently asked questions, are available on the CDC website.
• Follow recommended guidelines to keep yourself safe. It will likely take months for the COVID-19 vaccine to be available to anyone who wants it. In the meantime, take precautions to protect yourself and your family by wearing masks, maintaining social distance and washing your hands frequently. Minimize your risk of contracting the virus by following CDC guidelines on travel, gatherings and other activities that can spread the virus.
• Make self-care a priority and consistently practice ways to cope with stress. Anxiety can result from a feeling of lack of control and uncertainty, and the pandemic was the perfect storm of both. Get enough sleep, eat nutritious foods, exercise and take time every day for an activity you enjoy.

Finally, remember that feelings of stress and anxiety during difficult times are normal and will pass. If you find that anxiety continually affects your quality of life and you feel overwhelmed, consider talking to a mental health professional.

To learn more about Magellan Healthcare’s mental and behavioral health resources, click here. 

Source: Centers for Disease Control and Prevention

How we can comfort and support each other when grieving

Grieving the loss of a family member, friend or colleague is difficult. The pandemic has made it even harder for many people to cope. Those who have lost loved ones to COVID-19 or other illnesses may face additional grief and sadness. Infection control restrictions have left them unable to visit or say goodbye. Moreover, traditional wakes and funeral services have been modified or eliminated due to social distancing and limits on the size of gatherings, changing the way people can comfort and support each other.

Many people have experienced multiple losses. For example, the loss of a loved one at the same time as unemployment and social isolation.  The resulting grief may be prolonged and complicated with delays in the ability to heal and move forward.

Common Grief Reactions

Pain associated with grief is a normal response to loss and can be felt on emotional, physical and spiritual levels. Common reactions to grief are:

• Initial feelings of shock, denial, and disbelief, which can be heightened when the death is sudden and unexpected
• Feelings of worry, fear, frustration, anger or guilt
• Physical reactions such as headaches, fatigue, difficulty sleeping, loss of appetite, pain and other stress-related symptoms
• Spiritual expressions of grief, such as questioning the meaning and purpose of life, pain and suffering

There is no normal and expected time for mourning to end. Depending on the relationship with the individual and the circumstances of the loss, grief can last for weeks to years. Grief can ebb and flow at unexpected times, triggered by memories of the deceased person, holidays and anniversaries of loss.

Coping with Loss

It is important to find ways to express grief.

• Connect with other people, such as friends, relatives, support groups, and faith-based organizations if applicable, even if the contact must be virtual or by phone. Sharing your feelings with people who understand what you are going through is comforting and eases loneliness.
• Participate in an activity, such as planting a tree or creating a memory book, to honor the person you lost. Ask family and friends to contribute their memories and stories.
• Take good care of yourself. Maintain a balanced diet, moderate exercise and adequate sleep. Treat yourself to something you enjoy, such as a massage or a walk in nature.
• Avoid the use of alcohol, tobacco or other drugs to escape emotional pain.
• Don’t be afraid to ask others for help. Allow other people to assume some of your responsibilities when you are feeling overwhelmed.

When time has passed, if you are still having difficulty functioning, seek support through grief counseling, your EAP, support groups or hotlines. As writer Vicki Harrison said, “Grief is like the ocean; it comes in waves ebbing and flowing. Sometimes the water is calm and sometimes it’s overwhelming. All we can do is learn to swim.”

Find ways to deal with negative emotions

There is no question that the pandemic has affected the mental and emotional health of Americans of all ages. We have experienced months of social isolation, job changes and unemployment, school closures, and other disruptions. This has led to a surge in the number of people reporting high levels of stress, anxiety and depression. Given the uncertainty of when life will return to normal, finding ways to manage negative emotions and strengthen your mental health is important.

Building and exercising resilience skills can help protect your mental and emotional health. Try these tips:

• Stay in touch with positive and supportive people, even if you can’t see them in person. Strong social connections can reduce stress and help you feel happier and more energetic. If you haven’t already, learn to use video platforms like FaceTime and Zoom to stay in touch with friends and family.
• Practice ways to manage everyday stress. For some people, a daily walk eases the pressure of the day. Try meditation, reading, yoga, working on a hobby, listening to music or any other activity that you enjoy. Practice finding something you can be grateful for every day. You will feel more positive and recharged.
• Find what motivates you. Research shows that people who feel they have a purpose in life tend to be happier and live longer. For some, being creative, helping other people or devoting their time and energy to a cause can be the best motivators.
• Make self-care a priority. Physical and mental health are closely intertwined. In difficult times, it is important to get enough sleep, eat a healthy diet and exercise. Avoid using alcohol, tobacco or other drugs to cope with negative emotions; they can make sadness, depression and anxiety worse.
• Limit the amount of time you spend on social media and the news. If you are constantly frustrated and upset over what you see in the news or on social media, limit or take a break from both.
• Maintain your sense of humor and practice reframing negative thoughts. If you become aware that negative thoughts and images are invading your mind, draw your attention to your surroundings. Being present in the moment, or mindful, is one way to break a pattern of negative thinking. Humor is another way to defuse negative emotions.
• Give others the benefit of the doubt. Everyone is affected by the pandemic in one way or another, and others’ emotions may not be obvious. Be kind in any interaction with others.

If you find that your mental health symptoms are negatively impacting your quality of life, consider talking to a professional.

To learn more about Magellan Healthcare’s behavioral health resources, click here.

Normal holiday stressors can be compounded when we miss someone we have lost or are impacted by other hardships. This year, the sense of loss – of a loved one, financial security and a sense of “normal” – has touched many of us due to the COVID-19 pandemic. As we’re making plans to celebrate the holidays in unprecedented times, let’s take a break with Magellan’s Dr. Shareh Ghani as he discusses ways to address feelings of loss, practice self-care and make the most of this holiday season.

Magellan: Dr. Ghani, thank you so much for being here with us to share your many years of expertise in helping patients with behavioral health needs. Our first question: Is it possible to enjoy the holidays when we are experiencing the pain of losing a loved one to COVID-19 or something else?

Dr. Ghani: Thank you for having me. The pandemic has taken a toll on our community as we have lost loved ones prematurely, and we continue to experience sustained emotional pressure as COVID continues to spread. It is vitally important that we celebrate the holidays, exchange gifts and cards, gather virtually, and celebrate life. Spreading love and joy in these trying times will bring much-needed respite to the brain and body and boost our immune systems.

Magellan: How can we overcome feelings of worry and anxiety due to a job loss or other financial insecurity during this holiday season?

Dr. Ghani: Losing a job obviously leads to worry, anxiety and even questioning one’s own competence. The pandemic has helped many people shift focus to the “must haves” and not worry about the “nice-to-have” luxuries in life. Some are paying more attention to their health and fitness, minimizing spend, and planning for the future. Having a good strategy will help reduce the anxiety of uncertainty. If need be, talk to a therapist.

Magellan: Do you have any tips for people experiencing distress over not being able to celebrate the holidays in the way they may have in the past?

Dr. Ghani: One needs to evaluate the reason why we are changing our lifestyle. Social distancing helps stop the spread of the virus. Those who take this threat to our lives lightly may experience distress. Understanding the gravity of the situation alleviates it. We are celebrating in smaller groups so we can defeat the virus and return to our old ways of celebrating holidays safely. Think of it as a form of delaying gratification for better outcomes.

Magellan: What is your general advice for anyone who is experiencing loss to feel better and be able to experience joy this holiday season?

Dr. Ghani: Losing loved ones is a part of our life cycle. Human beings are resilient beings. Remember – those that we have lost would have wanted us to be happy. We should think about the happy moments we shared with those that are not here today and celebrate life.

Magellan: Why is it important to practice self-care and be an advocate for one’s own mental health?

Dr. Ghani: Good eating habits and physical exercise are key to physical and emotional wellness. Sleeping at least eight hours a day, hydrating well and experiencing joy and happiness are also important. All these things help with mental health. Relationships, family, helping others and being grateful add to a joyous life experience.

As winter approaches, efforts in many states across the country to control a second rise in COVID-19 infections also mean continued social isolation and hardship for millions of people. High, chronic levels of stress resulting from unemployment and economic insecurity, school closures, disruption to normal routines, illness, and loss have a negative impact on mental and physical health. In addition to the burden of the pandemic, simmering political and social tensions have left many people feeling distressed and threatened.[1]

As a nation, we face a challenging winter even as coronavirus vaccination news looks promising. It will be months before a vaccine can be widely distributed across the population, and even then, life may not be back to normal. In the meantime, it is important to monitor and care for your mental health as we move through this next phase.

People at Risk

A significant number of Americans report feeling depressed and anxious as a result of the pandemic. People who are already prone to mental health problems, people with low incomes, minorities, young people and isolated older adults (especially those living in facilities) are at higher risk of depression.

If you or a loved one are struggling with persistent feelings of sadness and hopelessness that last for two weeks or more, have lost interest in things you used to enjoy, have thoughts of self-harm and/or experience sleep disturbances and changes in appetite, it is important to see a doctor for an evaluation and possible treatment of your symptoms. There are effective treatments for depression, including medication and various therapies.

Building Resilience

There are several ways to build resilience and prepare emotionally for winter shutdowns. Research shows that resilience skills can be learned and include the following:

• Social connections. A strong social support network is one of the most important parts of building resilience. If face-to-face contact is not possible, stay in touch with family and friends by phone or video. Check in on friends and neighbors who are having a hard time.
• Pay attention to negative thoughts and practice gratitude. Resilient people tend to be optimistic and flexible in their thinking. If the constant negative bombardment of news and social media makes you anxious and unhappy, limit or take a break from your screen time.
• Assess what you can and cannot change. Focus on positive actions that you can take, even if the possibilities seem limited. Tap into your talents: revisit an old hobby or try something you’ve always wanted to do.
• Take care of yourself. Maintain routines, get enough sleep and exercise and eat a healthy diet. Avoid using alcohol or other drugs to combat sadness or boredom.

Having goals and a purpose can also increase resilience. The pandemic has led many to rediscover a new appreciation for their gifts, relationships and the values that give meaning to their lives. If you are doing all the right things to build your resilience and still feeling down, make an appointment with your doctor. You will get through this.

For more information and tips, visit MagellanHealthcare.com/COVID-19.

[1] Nancy Schimelpfening,“This COVID-19 Spike Will Also Hit our Mental Health with a ‘Second Wave,’” September 23, 2020, Healthline, https://www.healthline.com/health-news/this-covid-19-spike-will-also-hit-our-mental-health-with-a-second-wave#Why-is-the-pandemic-putting-our-mental-health-at-risk?

The Child and Adolescent Needs and Strengths (CANS) assessment is a multi-purpose tool developed for children’s services to support decision making, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. It is one of the tools in the Transformational Collaborative Outcomes Management (TCOM) framework, developed by Dr. John S. Lyons, consisting of a set of Guiding Values and Core Principles, all centered on how to provide the best and most support to all those in need.

I am often asked “How does managed care use the CANS?” Managed care organizations, like Magellan, are increasingly using clinical decision support tools and implementing value-based programs; the CANS offers a common language to look at resource needs and make the balancing of resources more transparent.

John Lyons frames the use of the CANS as part of “Five Key Decisions”: access, engagement, appropriateness, effectiveness and transitions. This framework on CANS use may be helpful for understanding how managed care uses decision support tools, and the CANS in particular, as the CANS has bonus options beyond the usual clinical decision support tools.

In this post, I provide an overview of each of the Five Key Decisions to shed light on how managed care uses the CANS. I invite you to explore the topics below and follow the links to learn more in my series on the TCOM Conversations blog.

Access

Access refers to screening for a target population, such as using CANS algorithms for matching needs to services. This identifies youth who will benefit from a certain level of care or service, as well as those who will not.

MCOs, with their advanced analytics capabilities, can provide valuable insights to state and local agencies to inform ongoing adjustments to algorithms to ensure that youth have access to the appropriate level of care.

Learn more

Engagement

Key Decision 2, Engagement, is about bringing people from access — opening the door — to becoming equal partners in the helping system. Engagement is built on respect and understanding that youth and family are experts in their own lives and need to captain their own ships. Engagement uses a fully person-centered discovery and planning process.

MCOs are tasked with operationalizing engagement, often taking the form of a checklist with time-frames and standards for everything from forms, consents, plans, child and family meetings, authorization, and even how often helpers and family are required to meet.

Proper operationalizing of engagement allows for family and youth to participate as fully as possible in using the CANS for reflection, self-advocacy and self-direction.

Learn more

Appropriateness and Effectiveness

An appropriate service should be effective. These two Key Decisions are inextricably linked and are often the basis of medical necessity. Evidence-based practices assign a defined appropriate population and a set of measures demonstrating effectiveness and provide a good example of how the community at large and managed care can agree.

Standardized assessment is an established best practice for measuring appropriateness and effectiveness. The CANS in practice excels at both. When the practice is done well, youth and families flourish and successfully complete their programs.

Learn more

Transitions

Using CANS algorithms for access and transition decision support is particularly helpful when celebrating successes. In behavioral healthcare, a discharge from a program can be seen as a success, but “success” may only be based on utilization or length of stay, and not on quality outcomes for the youth and family. The CANS is a functional outcomes measure, i.e., it measures how a youth and family is functioning in real life. As value-based programming expands, the CANS will be used for evidence of discharge success.

Learn more

Barbara Dunn, LCSW, ACSW, is director of program innovation and outcomes for Magellan Healthcare. She is the Conference Program Chair for the 16th annual TCOM Conference, A TCOM Cloud Gathering. Meeting Each Other Where We Are: Collaboration in a COVID-19 World. Learn more about the event here.