Many of us can now say we have experienced the trials and tribulations of parenting during a pandemic. We have attempted to juggle full-time work and regular household duties, along with being a full-time teacher or daycare worker and entertainer for our kids. While we’re all doing the best we can in taking on these new and challenging roles, some parents and caregivers may be wondering about their child’s mental health after they have missed out on so much and dealt with new stress and uncertainty – certainly as many of us know that our own mental health has been affected.

If you’re worried about your child’s mental health or noticing any issues, read on for tips and knowledge shared by Magellan’s Linda Y. Evans, MD, FAPA, child psychiatrist and medical director, and Greg Dicharry, CPRP, youth empowerment director.

Children behavior changes

Changes in your child’s behavior may be a sign of mental health difficulties that should be closely monitored. Depending on the age of your child, stress can manifest in different ways. Toddlers and young children aged 2-6, may show signs of regression and lose the ability to do things previously learned, like toilet training. School-aged children and teenagers may show a disinterest in going to school and/or begin to see falling grades. The most common symptom in teenagers is irritable mood. Kids of all ages may experience vague body complaints, like a headache or belly ache, changes in sleep or appetite, difficulty concentrating, loss of pleasure in activities previously enjoyed, and withdrawal from social interactions.

Often, even the child may not recognize these symptoms as the result of mental health issues. It is important for parents and caregivers to be a barometer for behavioral or other changes in their children – as they may be the first to notice – to be able to identify if their mental health may be suffering. When parents keep the lines of communication open, allowing their kids to share their thoughts and feelings, they are better equipped to identify any troubling signs of childhood depression, anxiety or other mental health conditions.

The child’s primary care physician (PCP) also plays a role in screening for mental health concerns and can be a good first point of contact if parents are seeking additional help. With the shortage of child psychiatrists and mental health professionals trained to work with children in our country, PCPs are increasingly adopting a model of collaborative, or whole-person, care to screen and treat children for mental health issues before they get worse because of potentially waiting long periods to see a specialist.

Interrupted school and family routines

While there’s not much we can do about changing work, school and social arrangements due to the pandemic, it’s important to consider the stability of our kids’ environment and instill predictability in their lives to the extent that’s possible.

Additionally, there are many things that parents and caregivers can do to keep their kids content and engaged amid the chaos and unprecedented change we’re all experiencing. To make up for lost in-person social time with friends and family, virtual meetups can be scheduled. That could be a fifteen-minute Facetime call with grandma and grandpa every Wednesday night at 7:00, or a periodic Zoom/interactive video game gathering with friends. Parents can also take time with their kids away from the screens to play a board game or do a project to make home-time more fun. Exploring and supporting your kids’ passions is a way to get them involved in activities that will bridge the gaps of interrupted routines and help prevent negative mental health outcomes.

Family stress affecting children

We have all been affected by the drastic changes, uncertainty, loss and isolation caused by COVID-19. And it’s not hard for our own stress and worry to be noticed or even absorbed to some extent by our kids. While we’re focusing on our family’s well-being, it’s important to practice self-care and recognize that our own mental health is of paramount importance. Having healthy caregivers is an essential component in the normal development of kids.

When parents are navigating divorce and co-parenting arrangements during COVID-19, it can be even more difficult to filter out the negativity for our kids, especially when parents have different points of view about things like in-person vs. virtual learning, the vaccine and mask wearing. Although it can be difficult to share your kids with an ex-spouse, it’s important to remember they need both of their parents. When parents work together for the benefit of their children and keep the focus on them, the impacts of divorce can be mitigated. Implementing a flexible custody arrangement during COVID-19 is also encouraged; for example, if the child wants to see a parent when it’s not their day for visitation, it might be beneficial to the child to honor their request.

To alleviate stress and some of the burden, parents and caregivers can consider connecting with others who understand the struggles and support each other. They can look for parent support groups in their communities.

Back to school and bullying

For kids who experience any level of social anxiety, the transition back to school, or even a new school, from the comfort of home may be more difficult. While some kids may be happy to get right back to the in-person learning environment, a gradual adjustment may work better for others.

Teachers can be especially helpful in ensuring that children are adjusting well and that a child withdrawing from the group is noticed. When the teacher has a trusting relationship with students, they can initiate conversations to try to understand how a child is doing and if their emotional needs are being met. The teacher’s insights are critical for parents and caregivers who cannot be with their kids at school.

Parents and teachers should be especially sensitive to look for bullying and have a zero-tolerance policy for kids being cruel to one another. Children must understand that bullying is unacceptable, as it can lead to serious and disastrous consequences for those who are targeted.

In general, what kids need for healthy development is a stable routine, predictability, a safe environment and healthy parents or caregivers. COVID-19 has disrupted all of these conditions, leading to increased mental health disorders and interrupted development. There are many things that parents and caregivers can do to nurture their child’s mental health and address what they need for healthy development. We encourage you to explore Magellan’s following resources for additional information and support:

• Mental Health Month website for comprehensive tips and resources to support yours and your family’s mental health.
  • Be sure to check out the recording of our webinar, How are your kids doing? under “Previous events”
• Understanding and Meeting the Needs of Children and Adolescents at High Risk: Foundations of a Model clinical monograph highlighting evidence-based research on the prevention and treatment of problematic behaviors and various types of behavioral health challenges in children and adolescents.
• Stay Home for MY LIFE virtual youth fest, featuring inspirational speakers, uplifting entertainment, fun activities and more, taking place on the 4^th Thursday of each month, from 6:00 – 7:30 p.m. ET, for youth and young adults who have experience with mental health, substance use, juvenile justice and foster-care-related issues, as well as professionals and caregivers across the country.

In January 2021, the United States (US) Food and Drug Administration’s (FDA) Center for Drug Evaluation and Research (CDER) published Advancing Health through Innovation: New Drug Therapy Approvals 2020. This report provides a summary of a number of approvals and highlights the novel therapies approved in 2020, continuing the generally upward trend in approval volume seen over the past decade, despite the impact of coronavirus disease 2019 (COVID-19). Compared to 2018 and 2019, in which CDER approved 59 and 48 new drugs, respectively, 53 novel agents were approved in 2020. This number does not include new and expanded uses of already approved drugs, new formulations, new dosage forms, vaccines, blood products, cellular or gene therapy, or biosimilar approvals. Once again, the number of approvals exceeded the average of 41 novel approvals per year in the past 10 years. Figure 1 outlines approvals over the past 10 years.

Despite the ongoing pandemic the FDA continued their strategic initiatives to expedite the safe review of treatments in 2020. With the unprecedented challenges incurred in 2020, the FDA acknowledged that maintaining their commitment to bringing forth innovative therapies was difficult. Remarkably, the numbers reported by the FDA do not include the several emergency use authorizations (EUAs) issued by the FDA for COVID-19.

Last year, all 53 novel drug approvals again met their Prescription Drug User Fee Act (PDUFA) goal dates, cementing this as a priority for the Agency. In 2020, 40% were considered first-in-class, and 58% were approved for rare diseases (Orphan Drugs), the latter of which increased from 44% in 2019. Priority Review was granted to 57% of novel drugs, 23% received Accelerated Approval, 42% were designated as Breakthrough Therapy (up from 27% in 2019), and 32% garnered Fast Track designation. Overall, 68% of all drug approvals in 2020 used expedited development and review methods. In addition, 92% were approved in the first review cycle, and 75% were approved in the US prior to receiving approval in other countries. A breakdown of the types of drugs approved in 2020 is illustrated in Figure 2, with agents within the oncology spectrum representing over one-third of 2020’s novel approvals.

The notable 2020 approvals encompassed new advances for the treatment of infectious diseases, including a new medication class for the treatment of human immunodeficiency virus-1 (HIV-1). Garnering perhaps the most attention, the FDA also approved the first medication for hospitalized patients with COVID-19. Unique infectious diseases in the US also received attention, with a new drug for malaria, two new options for the Ebola virus, and a new treatment for Chagas disease approved in 2020. In the neurology arena, there were multiple approvals of agents for more common conditions, such as migraine or Parkinson’s disease. Moreover, there were significant advances for rare neurological conditions, including the first oral agent for spinal muscular atrophy and new treatments for rare seizure disorders. In addition, two immunological agents were approved for the treatment of neuromyelitis optica spectrum disorder. Additional treatment options emerged for several autoimmune conditions in 2020 as well. Not surprisingly, numerous advances were made within the oncology umbrella, including both novel approvals and new or expanded indications for several existing agents. With over half of the novel approvals being classified as Orphan Drugs, in 2020, the FDA has fortified their dedication to providing innovative and often targeted treatment options for all individuals.

Mental health is an important part of our overall health and well-being. While mental illness is incredibly common, two-thirds of Americans do not actively seek help or receive the proper treatment¹.

Plenty of treatment options are available to help patients with mental illnesses, but navigating care can be difficult. It is also important to consider the social and physical factors rather than focus only on mental health symptoms because mental health and physical health are directly related. This is why a behavioral health care manager’s role is essential. They provide care for the whole patient and ensure that treatment plans focus on health, wellness, and preventive care.

Here are five key ways care managers are helping guide patients to better mental health:

Coordinating Care
Care managers are typically nurses, clinical social workers, or licensed counselors who take a holistic approach to mental health. They work collaboratively and alongside physicians, nurses, providers, and other medical staff to ensure more continuity of care for patients. “Getting people to the right place is really our number one goal,” says Michael Adamson, LCSW, manager of clinical care services at Magellan Rx.

Preventing Escalation
If not treated properly, mental illnesses can lead to emergency room visits, hospitalization, or suicide. Care managers can help mitigate this risk by helping patients maximize their existing benefits for mental health and medical care. “If we can intervene before they think of suicide or before they need the hospital, that benefits everybody,” states Jordan Johnson, LMFT, senior care manager for Magellan Rx.

Checking In and Following Up
After a doctor visit or being discharged from a hospital, a patient may be feeling overwhelmed. Care managers check in on patients, make sure they understand their treatment plan, and eliminate gaps in care. “If I have a member who is discharged without a care plan, the member says, ‘I’m so glad you called, what do I do now?’” discloses Silvia Pantoja, senior care manager.

Supporting Parents and Caregivers
Depression and mental illness have increased over time in children and teens. Care managers not only help individual patients, but they can also support and provide resources for parents or their caregivers.

Education and Resources
Care managers help patients learn about all the resources and educational materials available to them. Especially during the COVID-19 outbreak, members need to rely on resources they are not normally used to. Care managers help find virtual care, online support groups, mail-order pharmacies, online resources, and more.

¹ National Network of Depression Centers. Get the Facts. Retrieved July 21, 2020 from https://nndc.org/facts/

In light of recent events, Yagnesh Vadgama, BCBA, vice president, clinical care services, autism, Magellan Health, shared his perspective about how COVID-19 and racial and ethnic disparities may be combining to delay diagnosis and important early treatment for autism spectrum disorder in children.

 Magellan Health Insights: Yagnesh, thank you for chatting with us today. In the past there have been marked differences in the rates in which Black and Hispanic children are diagnosed with autism spectrum disorder (ASD). Why was that?

 Yagnesh Vadgama: For years, there was a disparity in the rates of ASD diagnosis of Black children versus White children – as recently as 2014 White children were 1.1 times more likely to be diagnosed with ASD by age 8. And in the 1990s, Black children were identified as having ASD later and were more likely to be diagnosed with conduct disorder or adjustment disorder than were White children. For the first time, the CDC has reported that this gap has closed as of 2016 for Black children, which is encouraging news, but was not the case in every state studied.

And, a gap still exists for Hispanic children. White and Black children were 1.2 times more likely to be identified with ASD than Hispanic children. Reasons for this difference include lack of access to healthcare services, differences in Medicaid vs. commercial insurance coverage of ASD services, parents and children speaking a primary language other than English, and potentially fear of seeking out care because of one’s immigration status. It’s still the case that Hispanic and Black children receive evaluations at a later age than White children. Often, children with Medicaid don’t get diagnosed until they begin attending school.

Magellan Health Insights: Why does age of evaluation and diagnosis matter?

 Yagnesh Vadgama: With ASD, time is of the essence. The earlier we get kids into services, the better the health outcomes are going to be. If an individual gets treatment early, there is less risk of developmental delays becoming permanent. A recent University of California San Diego study indicates children should receive ASD services as early as 18 months. During this time, the brain is able to acquire new skills at an earlier age. Also, as individuals get older, they are more likely to develop a comorbid diagnosis, so it’s important to begin services prior to the onset of other comorbidities.

 Magellan Health Insights: How might COVID-19 be affecting the age at which children are being evaluated?

 Yagnesh Vadgama: People are avoiding nonurgent care. Utilization rates of elective services have plummeted. Also, since school is the first place many children get evaluated for ASD, that may not happen with schools closed or moving to remote learning. And since many individuals’ health insurance is provided by their employers, many newly unemployed individuals may not be able to afford COBRA premiums and may lose coverage. Time is of the essence, and delays may have long-term or permanent effects.

 Magellan Health Insights: What can healthcare providers do to help ensure early, accurate diagnosis?

Yagnesh Vadgama: Healthcare providers should conduct early and frequent screenings as recommended by the American Association of Pediatrics. But, as important, providers should make appropriate recommendations for follow-up care and really help parents understand the next steps. They need to create a sense of urgency for follow-up care – encourage parents to act now, not to sit on it, see someone now. Then follow up with additional testing and screening on subsequent visits, because ASD can evolve over time. But never use a “just wait and see” approach, because time is of the essence.

Magellan Health Insights: What can parents do to help ensure a correct, early diagnosis if they have concerns?

Yagnesh Vadgama: Understand developmental milestones for your child’s age and the signs of ASD. Speak up about your concerns, especially where a child has a hearing impairment or an intellectual disability – because both situations could lead to a later ASD diagnosis. Be your child’s biggest advocate and ask about concerns and next steps.

One of the beautiful things is that in all 50 states, there is a mandate that commercial insurance carriers provide autism coverage. Covered members now have access to screenings, psychologists, developmental pediatricians and services that weren’t available when I began practicing over 16 years ago. And keep pushing until you get the care that best meets your child’s needs. Don’t wait!

Magellan Health Insights: We couldn’t agree more! Thank you, Yagnesh!

Edith Calamia, DO, MPH, CMD, was a teenager when she saw the impact that lack of access to clean water, food insecurities, and unreliable access to care could have on vulnerable populations.

As a young woman Dr. Calamia traveled to the Philippines during summer vacations. There, she would assist her brother, a dentist, in small dental clinics in towns outside Manila. In the Philippines, where eight out of 10 people face dental health issues, millions of people have never seen a dentist due to absence of transportation and limited education. Without proper care, dental decay can lead to chronic disease, premature births, low birth weight, and more.

“As a young person growing up in the ‘70s, I remember thinking that sections of extreme poverty like those I had seen in the Philippines and also in Africa would no longer exist by the time I was in my 30s or 40s,” she says. “I thought we would solve those issues. Now, as the mother of a small child, I’m very passionate about addressing social determinants of health in the United States and abroad so that our children don’t have to find solutions to these problems in their 30s and 40s.”

Dr. Calamia, who joined Magellan Complete Care as chief medical officer in December 2019, sat down to discuss the role of healthcare organizations in addressing social determinants of health (SDOH)—the conditions in which people live, learn, work, and play that can affect health risks and outcomes—and ways that organizations can strengthen their approach.

Magellan: Could you tell us what sparked your passion for caring for vulnerable populations?

Dr. Calamia: My dad was a pilot for Pan American, and from an early age, my three siblings and I traveled internationally, including to Africa, the Philippines, and other countries. We became very cognizant of the impact that social determinants of health—from socio-economic factors to an individual’s physical environment—have on vulnerable populations, from the ability to access basic healthcare services to the ways in which barriers to basic necessities affect health and health outcomes. These experiences prompted each of my siblings and I to enter the medical field.

Early in my healthcare career I did work in Miami and was inspired to go into public health. I completed a fellowship in geriatrics, which enabled me to go into the homes of the seniors I was treating, which underscored for me the difference in health and health outcomes that can be achieved when individuals have reliable access to basic necessities as well as skilled care.

Magellan: What are some of the lessons you learned early in your career about ways to leverage federally funded programs to improve outcomes for the most vulnerable populations?

Dr. Calamia: When I was in private practice, my organization treated people who were on Medicare and Medicaid as well as those who were uninsured, but it was very difficult to support the care of these populations, financially. So, I got together with a group of providers on Staten Island [New York] to open a federally qualified health center (FQHC). This was a journey: It required us to form a community board to guide us through this process. I served as chief medical officer for the FQHC, and I worked with people who had been in the FQHC space for years and years. Through this experience, I learned how to be a good fiscal steward of the federal dollars we received by thinking about our programs strategically, with an eye toward which initiatives would make the biggest difference in members’ health. We concentrated on providing services for the most vulnerable mothers and infants in our community—for example, mothers who smoked or showed signs of substance use disorder; babies with low birth weights or whose first days or weeks were spent in the NICU. We were able to start the FQHC, and open two more centers. I’m really proud of that work.

Later, I joined a managed care company (MCO) and began to view social determinants of health initiatives from that organization’s point of view—which in some instances is a steward of both state and federal dollars.  Here, I began to look at the types of relationships that were necessary to ensure value. For example, how do MCOs find centers of excellence—the organizations that really move the needle on quality and value—to send their members? How do they make sure the programs these organizations provide meet the needs of their members and improve health outcomes?

As a result, we developed a partnership with Camden Coalition to determine how a very intense care management model could keep members out of the emergency department and keep them healthy. At that time, the managed care space incorporated more of a disease management model that wasn’t a face-to-face, in-home visit, hands-on model of care. After running a pilot program, we partnered with Camden Coalition to develop, test, and scale new models of care for members with complex health, behavioral, and social needs.

Magellan: What are some of the biggest challenges healthcare organizations face in addressing social determinants of health?

Dr. Calamia: I think we’ve been challenged as organizations to really measure the effectiveness of our interventions around the social determinants of health. We know that addressing social determinants of health is the right thing to do, and anecdotally, we have many stories about the ways in which addressing social determinants of health can change individual members’ lives. We need to aggregate, on a national level, the data we have and dig deep into the information we can glean from that—exploring where we can build relationships on a local level to change a few lives at a time and then using the lessons learned to scale our approach on a national level for specific populations.

Gaining access to this data may be a challenge for providers’ organizations as well because of limited resources and bandwidth. That’s why it’s so important that MCOs lean in and help them with the data piece—aggregating the data and providing the insight that can help providers dig deeper at the point of care.

When we think about social determinants of health, we have to look at the long game when it comes to understanding the results of our efforts. It’s also critical that we examine the potential for technology and digital apps, in combination with personalized care management, to help meet the needs of our most vulnerable populations in a holistic way. In doing so, we can more effectively help members live healthy, vibrant lives.

Magellan: How are SDOH coming into play during the COVID-19 pandemic?

Dr. Calamia: In so many ways. People are stuck in their homes. If they live in a crowded apartment building, it’s hard for them to distance themselves from others. Home may not be a safe place for victims of domestic violence. In certain urban areas, it’s already hard to get fresh food; with the pandemic limiting distribution, people are eating more processed foods. People who rely on home care services and home-delivered meals aren’t getting the services and sustenance they need. We’re seeing problems with meal distribution and have ordered restaurant take-out meals to ensure our members are fed. The health conditions many people have as a result of SDOH make them more likely to get very sick from the virus. That’s why it’s becoming more important than ever to address these issues.

 Magellan: What attracted you to Magellan?

Dr. Calamia: One of the biggest barriers I’ve seen in my career is helping patients and members determine where they are in their health journey and understanding their mental health needs. Magellan has a rich history of understanding mental health as a key social determinant of health. Frankly, the behavioral health community really understands social determinants of health. They have explored issues such as: Where do members live? Do they have food insecurities? Have they experienced childhood trauma that makes them more comfortable receiving care in an emergency department versus an office? Things of that nature. I believe there’s a chance to create something at Magellan that is really unique, leveraging Magellan’s behavioral health and pharmacy expertise as well as its depth of experience in working with MCOs to make a deep impact on social determinants of health.

We’re going to change the way in which people can access their healthcare, and we’re going to change the way that people feel about their MCO as a partner.

Edith Calamia, D.O., M.P.H., C.M.D., is national chief medical officer for Magellan Complete Care (MCC). Dr. Calamia joined Magellan in March 2020 and oversees all clinical programs within MCC. She also leads the development and delivery of health plan-specific clinical programs targeted to complex populations such as those needing Long-Term Services and Supports, those who are dually eligible for Medicaid and Medicare, people with Serious Mental Illness, and recipients of Temporary Assistance for Needy Families (TANF) and Children’s Health Insurance Program (CHIP) benefits.

There’s no denying that for many of us, our pets hold a special place in our hearts. They’re our loyal companions, can make a bad day better, and love us just the way we are. The First Week of May is National Pet Week. In honor of this, we wanted to take a moment to celebrate some truly amazing animals that have a profound effect on the lives of their owners: service dogs.

Humans and dogs have had a special bond since the early days of our history. So, it’s no wonder we looked to them as a potential resource for people with disabilities who need some extra assistance. Whether it’s retrieving things for their owner, helping them get dressed, acting as their eyes, or alerting their owner of an oncoming seizure or drop in blood sugar, service dogs perform the necessary tasks that make their owners’ lives easier and give them more independence.

In 1929, we were introduced to the first official service dogs in this country – then called seeing eye dogs – who helped people who were blind navigate their surroundings. By the 1960s, people realized that service dogs had the potential to take on other tasks beyond guiding their owners around. By the 1970s, we had created a more formalized set of guidelines and methods for what service dogs could be used for and how to properly train them. In 1990, the Americans with Disabilities Act (ADA) defined a service dog as “any guide dog, signal dog, or other animal individually trained to provide assistance to an individual with a disability.” Service dogs also became protected under the ADA, giving people with disabilities the right to take their service dog with them wherever they go.

Getting a service dog ready to serve their owner takes serious work. According to Aaron Backer, Executive Director of the Wisconsin Academy for Graduate Service Dogs (WAGS), it takes their dogs around two years of intensive training before they can go home with their owner. WAGS dogs begin their training at 8 weeks old so that all they know is how to be a service dog. During the first two years, the puppies are trained by and live with volunteer trainers, who work closely with WAGS staff to ensure the animals have what it takes to be a service dog. The WAGS dogs will not only need to learn 50 to 60 commands, but also to prove that they are capable of being on-call at all times.

“You need a dog that wants to work,” says Aaron. “If you want them to work, you expect them to jump up and say ‘Yep, I’m ready to go!’ It doesn’t mean the dog should be doing something every second of every day. It means when you ask the dog to do something, they’re going to jump up and do it. That’s the kind of dog that enjoys being a service dog.”

               Aaron & Ian

After the puppies have completed their training with the volunteers, the new owners work with the WAGS Program and Training Director to match them with the right service dog. Owners then train with their dogs at the WAGS office in Madison, WI, over the course of several weekly visits before the dog is finally ready to be taken to its new home.

WAGS primarily provides dogs to people with physical disabilities, and they work exclusively with Golden Retrievers and Labrador Retrievers. These larger breeds tend to have a friendly temperament and are motivated to work, making them a particularly good fit for people with physical disabilities and limited mobility. Kinsley Tarr of Appleton, WI, was paired up with Teal, a Golden Lab who was trained by WAGS, in 2016. Teal helps Kinsley, who uses a power wheelchair, by giving Kinsley her paper and pens, helping her put on her jacket, closing doors for her, and carrying her wallet, among other tasks. The two have formed a deep bond, and Teal has become one of Kinsley’s best friends.

“Teal is very smart and fun to be with. Playful and energetic,” says Kinsley. “She’s always a lot of fun.”

Teal isn’t Kinsley’s first service dog. When Kinsley was in high school, she was paired with Hawk, and then after he retired, Kinsley had Shelby until she retired, too. All three of Kinsley’s dogs were trained at WAGS. Kinsley, who is enrolled in the TMG IRIS Consultant Agency, was able to use her IRIS funds to purchase Teal. IRIS (Include, Respect, I Self-Direct) is a Wisconsin long-term care Medicaid waiver option that allows people with disabilities and those who are aging to self-direct their long-term care supports and services.

                             Kinsley & Teal

Kinsley’s mom, Jane Tarr, says that having Teal and the other service dogs has led to a richer life for Kinsley. Not only does Kinsley have more independence since she doesn’t have to rely as much on caregivers, but having Teal has opened up Kinsley’s world.

“Before Kinsley got her first service dog, we found she was struggling with friendship. Having a service dog, it brings people to her and gave Kinsley her own presence in her social environment in school, and it helped her in the community,” says Jane. “The service dog helped Kinsley expand her outlet for communication with friends and family and people she doesn’t know.”

Taking service dogs out in public so that people with disabilities have more opportunities to be involved in their community is an important benefit of having a service dog.  Organizations like WAGS have a deep understanding of all the things that go into creating and maintaining a good service dog – knowing what breed will best fit the person’s needs, having professional trainers to help the volunteers train the puppies, and being available to the owners to help with any issues that may come up with the service dog down the road.

Emotional support animals are different than service dogs. Many people find great comfort and joy in their pets, which is wonderful and why we have pets in the first place. However, there is no certification needed to deem that a dog is an emotional support animal. There are ways, however, to tell if a dog is a properly trained service dog or is simply a pet, says Aaron. When service dogs are working, they will be perfectly behaved. Also, most service dogs will be wearing a vest with text indicating that people shouldn’t try to pet or distract them.

Kinsley’s mom Jane knows that properly trained service dogs do more than simply help people with disabilities go about their day-to-day lives. These dogs show the world that with a little extra help from their canine companions, people with disabilities can live more independent lives. They also give their owners the opportunity  to talk to curious strangers about what work their service dog does for them, and why it’s so important for people with disabilities to continue having the right to use their service dogs wherever they go.

“A service dog can be an ambassador for people with disabilities,” says Jane.

For those lucky enough to have a service dog, they find themselves richly rewarded. It’s no small undertaking to commit to having a service dog, and Jane says she’s so proud of all the hard work that Kinsley has put into training and caring for Teal. Kinsley, in turn, is grateful that Teal is there to help her whenever she needs, and that she’ll always be by Kinsley’s side. Kinsley and Teal have a deep, unconditional love for one another and an unbreakable bond.

“I think Kinsley and Teal are mirrors to each other,” says Jane. “They both have an internal spirit of happiness and they make each other fulfilled.”

Perhaps, though, Kinsley best sums up this special relationship:

“A person with a service dog has a heart that’s full!”

Article submitted by TMG Wisconsin 

Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. The Social Distancing concept, which is intended to reduce disease transmission and currently being practiced by communities at large, can be very isolating and lead to increase in stress levels. How you respond to the outbreak can depend on your background, the things that make you different from other people, and the community you live in.

People who might have more difficulty responding effectively to the stress of a crisis include:

• Those who have mental health conditions including problems with substance use
• Children and teens

If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, and feel like you want to harm yourself or others please call 911.

In general, health impacts from stress during an infectious disease outbreak can include:

• Fear and worry about your own health and the health of your loved ones
• Changes in sleep or eating patterns
• Difficulty sleeping or concentrating
• Worsening of chronic health problems
• Increased use of alcohol, tobacco, or other drugs

People with physical and mental health conditions should continue with their treatment and be aware of new or worsening symptoms. Make sure you continue to take your medications as prescribed and contact your healthcare provider if you find you are starting to feel worse.

Taking care of yourself, your friends, and your family can help you cope with stress. You can do this remotely through phone or video.

Things you can do to support yourself

• Take breaks from watching, reading, or listening to news stories, including social media.
• Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
• Make time to unwind. Try to do some other activities you enjoy.
• Connect with others over phone or video. Talk with people you trust about your concerns and how you are feeling.

Look out for these common signs of distress:

• Feelings of numbness, disbelief, anxiety or fear.
• Changes in appetite, energy, and activity levels.
• Difficulty concentrating.
• Difficulty sleeping or nightmares and upsetting thoughts and images.
• Physical reactions, such as headaches, body pains, stomach problems, and skin rashes.
• Worsening of chronic health problems.
• Anger or short-temper.
• Increased use of alcohol, tobacco, or other drugs.

Reduce stress in yourself and others

1. Take breaks from watching, reading, or listening to news stories, including social media.
2. Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
3. Make time to unwind. Try to do some other activities you enjoy.
4. Connect with others over phone or video. Talk with people you trust about your concerns and how you are feeling.
5. Use trusted sources for information such as the U.S. Centers for Disease Control & Prevention (CDC), The World Health Organization and state health department websites and encourage others to do the same.

For Parents

Not all children and teens respond to stress in the same way. Some common changes to watch for include

• Excessive crying or irritation in younger children
• Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting)
• Excessive worry or sadness
• Unhealthy eating or sleeping habits
• Irritability and “acting out” behaviors in teens
• Difficulty with attention and concentration
• Avoidance of activities enjoyed in the past
• Unexplained headaches or body pain
• Use of alcohol, tobacco, or other drugs

There are many things you can do to support your child, including:

• Take time to talk with your child or teen about the COVID-19 outbreak. Answer questions and share factual information about COVID-19 from the aforementioned trusted sources in a way that your child or teen can understand.
• Reassure your child or teen it is ok if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.
• Limit your family’s exposure to news coverage of the event, including social media. Children may misinterpret what they hear and can be frightened about something they do not understand.
• Try to keep up with regular routines. If schools are closed, create a schedule for learning activities and relaxing or fun activities.
• Be a role model.  Take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members over the phone or through video.

Call your healthcare provider if stress gets in the way of your daily activities for several days in a row.

To learn more about what Magellan Healthcare is doing to support clients during the COVID-19 pandemic, visit MagellanHealthcare.com/COVID-19.

To learn more about Magellan Health’s corporate response to the COVID-19 pandemic and to view Magellan’s available resources click here: https://www.magellanhealth.com/news/covid-19/

Teen dating violence is just as serious as adult domestic violence. And it’s common. About 2 in 10 teen girls say they have been physically or sexually abused by a dating partner. About 1 in 10 teen boys reports abuse in dating relationships.

Teen dating abuse is a pattern of abusive behavior used to control another person. It can be:
•Any kind of physical violence or threat of physical violence to get control.
•Emotional or mental abuse, such as playing mind games, making you feel crazy, constantly texting you, or constantly putting you down or criticizing you.
•Sexual abuse, including making you do anything you don’t want to do, refusing to have safer sex, or making you feel bad about yourself sexually.

Who’s at risk?

Like adult domestic violence, teen relationship abuse affects all types of teens, regardless of how much money your parents make, what your grades are, how you look or dress, your religion, or your race. Teen relationship abuse occurs in straight, gay, and lesbian relationships.
Relationship abuse is not just dangerous for you physically and emotionally. It can also put you at risk for other health problems, such as:
•Eating disorders.
•Depression.
•Low self-esteem.

Teens in abusive relationships are also more likely to take sexual risks, do poorly in school, and use drugs, alcohol, and tobacco. Girls are at higher risk for pregnancy and sexually transmitted infections (STIs).

Is it abuse?
Abusive relationships can have good times and bad times. Part of what makes dating violence so confusing is that there is loved mixed with the abuse. This can make it hard to tell if you are really being abused. But you deserve to be treated in a loving, respectful way by your boyfriend or girlfriend.

Does your boyfriend or girlfriend:
•Act bossy and make all the decisions?
•Put you down in front of friends?
•Try to control who you see and talk to?
•Threaten to hurt or kill himself or herself?
•Blame you for “making” him or her treat you badly?
•Pressure you to have or force you to have unprotected sex?
•Stalk you? This can include constantly texting or calling you to find out where you are and who you’re with. You might think that’s about caring, but it’s really about controlling the relationship.

Do you:
•Feel less confident about yourself when you’re with him or her?
•Feel scared or worried about doing or saying “the wrong thing”?
•Find yourself changing your behavior out of fear or to avoid a fight?

If you answered “yes” to any of these questions, you might be in an abusive relationship. There are people who can help you. You’re not alone. Talk to your parents or another adult family member, a school counselor, a teacher, or someone else you trust. Call a help center or hotline to get help.

How parents can help

Teens may not have the experience or maturity to know if their relationships are abusive. A teen may think of dating violence as only physical violence—pinching, slapping, hitting, or shoving. Teens may not realize that any relationship involving physical violence, sexual violence, emotional abuse, or the threat of violence is an unhealthy relationship.

For example, a teen may think his or her partner cares when he or she calls, texts, emails, or checks in all the time. But that kind of behavior is about controlling the relationship.

Talk with your teen about what makes a healthy relationship. Explain that a caring partner wouldn’t do something that causes fear, lowers self-esteem, or causes injury. Let teens know that they deserve respect in all of their relationships. Think about values and messages that you want to pass on.

You might start by asking your teen:
•Is your boyfriend or girlfriend easy to talk to when there are problems?
•Does he or she give you space to spend time with other people?
•Is he or she kind and supportive?

Hotlines for help
These national hotlines can help you find resources in your area.
•National Domestic Violence Hotline toll-free: 1-800-799-SAFE (1-800-799-7233), or see the website at www.ndvh.org.
•National Teen Dating Abuse Hotline toll-free: 1-866-331-9474 or (1-866-331-8453 TTY) or see the website at www.loveisrespect.org.

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