Anyone who has gone through a traumatic event can develop symptoms of stress disorders such as post-traumatic stress disorder (PTSD).  Although the COVID-19 pandemic in general would not meet the criteria for formally causing a stress disorder, many of the same issues can result from such a widespread and overwhelming event.

The pandemic could be viewed as a long-term stress event.  It has become life-changing for the whole world.  As COVID-19 spreads across the globe, people may experience increased anxiety and fear triggered by the pandemic and constant news. In addition, the pandemic can be traumatizing for others: healthcare workers, people who have lost friends and loved ones, and people whose lives have drastically changed.

What are stress-related disorders?

Stress-related disorders can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening. These symptoms can change your behavior and how you live your life.

How can reaction to the COVID pandemic be similar to a stress disorder?

When you struggle with a stress disorder, it can be hard to anticipate when anxiety or depressive symptoms may flare up. Although it may appear that symptoms come out of nowhere, in most cases they are cued by factors called triggers. Internal triggers are the feelings, thoughts, memories, emotions, and bodily sensations that you feel or experience. External triggers are the people, places, and situations that can bring back memories of the traumatic event.  In the current environment this could be caused by news reports, social media or discussion with friends or family.

The first thing to realize is that many fears are unwarranted; anxiety may arise when you are in a completely safe environment. When you begin to despair or your fears consumer you, try to remember that your worries and fears may be extreme because of previous experiences and not current facts. Once you’ve realized what may trigger these fears and anxiety, you can begin to try to deal with them.

How to cope with stress-related symptoms amid COVID-19

• Cultivate ways to be calmer. It’s understandable to feel anxious and worried about what may happen. While circumstances may be stressful and beyond your control, you can try to offset them with positive, calming activities. Practice slow, steady breathing and muscle relaxation, as well as any other actions that are calming for you (yoga, exercise, music, keeping the mind occupied).
• Understand what is within your control. Accept circumstances that cannot be changed and focus on what you can do. Evaluate your risk of contracting the virus, practice social distancing and follow clinical guidance on other practices. If you are in quarantine or isolation, do things that can support your mental health.¹ Focusing on what you can control and do can help you deal with the unknown.
• Remain hopeful. Keep a long-term perspective. Look for opportunities to practice being more patient or kind with yourself, or to see the situation as an opportunity to learn or build strengths. Celebrate successes, find things to be grateful about, and take satisfaction in completing tasks, even small ones. Remember that this will not last forever.
• Lean on your network. Make the most of technology and stay in touch with colleagues, friends and family via phone calls, texts, social media and video conferencing. Consider joining a free support group online to stay connected.² If you have a therapist, try to continue your treatment by phone or online.
• Focus on the potential positives. Try and focus on the things that can be viewed positively such as spending more time with family and a experiencing a potential to grow. Many times, going through a stressful time like this can lead to post-traumatic growth. This growth can be seen as though the stressful event was a trial or challenge that you conquered, something you learned from and became more resilient through. Sometimes stress can stimulate personal growth and improved overall coping.

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

More people are being exposed to infection as the number of COVID-19 cases continue to grow, resulting in an increased need for quarantines. The fear, stress and stigma associated with being quarantined can be damaging to one’s mental health.

The differences between isolation, quarantine and social distancing

The U.S. Centers for Disease Control and Prevention (CDC) defines medical isolation, quarantine and social distancing as follows:

Isolation – The separation of a person or group of people confirmed or suspected to be infected with COVID-19, and potentially infectious, from those who are not infected. This can prevent spread of the virus. Isolation for public health purposes may be voluntary or compelled by federal, state, or local public health order.

Quarantine – The separation of individuals who have had close contact with a COVID-19 case, but are not showing symptoms, to determine whether they develop symptoms of the disease. This keeps the person from potentially spreading the virus in the community. Quarantine for COVID-19 should last for a period of 14 days in a room with a door. If symptoms develop during the 14-day period, the individual should be placed under isolation and evaluated for COVID-19.

Social Distancing – The act of remaining out of congregate settings, avoiding mass gatherings and maintaining distance (approximately 6 feet, or 2 meters) from others when possible. Social distancing strategies can be applied on an individual level (e.g., avoiding physical contact), a group level (e.g., canceling group activities where individuals will be in close contact), and an operational level (e.g., rearranging desks in an office to increase distance between workers).

 Emotional impact of quarantine

The simple act of being quarantined can be distressing. When people are quarantined, they:

• Can be completely separated from loved ones
• Lose their freedom of movement
• Don’t know if they will show symptoms or not
• Don’t know how the disease may affect them
• Have no understanding of how long they will be separated
• Experience boredom and have too much time to worry about the situation

People who have been quarantined have reported or shown a high prevalence of symptoms of psychological distress and disorder. Symptoms reported include emotional disturbance, confusion, depression, stress, irritability, insomnia and post-traumatic stress symptoms. In addition, the stigma surrounding those in quarantine can lead people to feel rejected and/or avoid seeking help.

How to reduce the negative effects on mental health

• Seek trusted information sources. COVID-19 information and news is everywhere, and it’s hard to know what’s true. Follow news from the World Health Organization, the CDC and your state health department. Stay away from suspect information that well-intentioned people may share on social media. If you have specific questions about your situation, call your doctor.
• Make sure you have adequate supplies. Make your experience as tolerable as possible. Make sure you have basic supplies such as food, water and medicine for the duration of the quarantine period. Many communities have stores or services that will deliver essential items to your door, so keep a list in case you need anything.
• Make the most of your downtime. As noted above, isolation, boredom and stigma negatively impact mental health. Call old friends you haven’t talked to. Catch up on your reading, do crossword puzzles or play electronic games. Listen to music. Organize those piles of paper you haven’t gotten to. If you can, work remotely.
• Keep a journal, blog or vlog about your experience. Writing down your feelings and experiences, or talking about them, can be cathartic for some people. And if you are comfortable sharing it, your journal can be helpful for other people in the same situation.
• Don’t be afraid to reach out. Talk to a neighbor or two and let them know of your situation so they can help. Find others who are going through the same thing or have been in your shoes before. Talking to someone who knows what you’re going through can help you feel less alone.
• Focus on how you are helping. Remind yourself that your isolation, while difficult to bear, is truly helping contain the spread of disease and potentially saving lives.

If you find yourself feeling overly sad, angry or anxious, contact a behavioral health professional. They can conduct appointments over the phone and provide helpful advice.

After the quarantine

You’ve stayed away from everyone for 14 days, and you’re still healthy. When you are released from quarantine, remember that social distancing may still be in force.

You might have some residual stress from being alone for so long, or you might be angry that you had to stay separated from loved ones when you weren’t contagious. It’s OK to have those feelings. If they don’t subside after a few months, talk to a behavioral health provider.

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

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.

While the pandemic may be causing you and your loved one feelings of anxiety and apprehension, now is a good time to look for reasons to be happy. Practice these tips to nurture yourself, improve your mood and help others.

1. Be kind. Call your friends and neighbors. Maintain social distancing, but smile to all the grocery workers who are keeping the shelves stocked. Ask an elderly neighbor if they need anything. An act of kindness boosts serotonin, a natural antidepressant in your brain, in both you and others.

2. Be thankful. Don’t rush through your daily interactions on autopilot. Slow down and notice when someone is kind to you, even in the smallest way, and show them your appreciation. When you practice thankfulness, you become more positive; that helps others feel good too.

3. Deepen your connections: Share your feelings about this experience with those closest to you. Encourage each other to make the best of this moment in time, and come up with a game plan to support each other moving forward.

4. Move your body. Exercise is vital to maintaining physical and mental health. Get your heart pumping by taking a walk in your neighborhood, going on a hike in nature or using an app for a guided training or yoga session. If you do go outside for a walk, maintain social distancing.

5. Write down your thoughts. Keeping a journal is a powerful way to get perspective. Clarifying your thoughts and feelings on paper helps you get to know yourself better and release the stresses of daily life.

6. Meditate. All you need to do is sit quietly for a few minutes, breathe deeply and let your mind relax. Meditation alleviates anxiety and helps you get in touch with your inner self, helping you face the world in a centered and focused way. Find free guided meditation sessions online.

7. Determine what is really bothering you. Vague worries are harder to manage because they are all jumbled together. Try to get clear on what you are specifically concerned about. Finding the root of the worry helps you figure out what to do about it.

8. Play games. Engaging in a game with others online, or even by yourself on your phone, helps you take your mind off other things. Give yourself permission to have some fun.

9. Dine Well. Have fun with food. Make your favorite recipes. Set the table with your finest dishes. Cook a meal with others. If you live alone, share pictures with friends for fun.

10. Remind yourself that this will pass. Try and come to terms with what you can’t control, and focus on what you can do to move through this time in a positive way. Draw on skills you have used during other difficult times, and remember how those times eventually passed by.

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

May is Mental Health Awareness Month. This is an opportunity to increase public awareness of mental health conditions.  We can break down the stigma by ending the silence. About 1 in 5 Americans experience mental illness. It is important to be able to talk openly about it to get people the help they need. It is particularly timely this year, as we are seeing stigma associated with COVID-19, and we must do what we can to stamp out stigma in all its forms.

Understanding mental illness

According to the National Alliance on Mental Illness (NAMI), a mental illness is a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis. If you have — or think you might have — a mental illness, the first thing you must know is that you are not alone. Mental health conditions are far more common than you think, mainly because people don’t like to, or are afraid to, talk about them.

Mental illness can affect anyone regardless of age, gender, income, social status, religion or race/ethnicity.

• 1 in 5 U.S. adults experience mental illness each year
• 1 in 25 U.S. adults experience serious mental illness each year
• 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
• 50% of all lifetime mental illness begins by age 14, and 75% by age 24

Depression and anxiety disorders are the most common mental health disorders worldwide.

The exact causes of mental illness are not fully understood. However, factors that can contribute to mental health problems include:

• Genes and family history
• Biological factors such as brain chemistry and brain injury
• Serious medical conditions
• The use of alcohol or other drugs
• Traumatic life experiences
• Isolation and other social factors

Mental illness is not a character flaw or something that a person can just “snap out of.” For many people, recovery — including meaningful roles in social life, school and work — is possible, especially when you start treatment early and play a strong role in your own recovery process.

Sadly, many people never seek treatment out of fear and shame. The stigma of having a mental illness or substance use disorder is two-fold: people suffer needlessly even though effective treatments are available, and they’re also at higher risk of premature death. For example, people with depression have a higher risk of heart disease and cancer. Studies also show that people with severe mental illness have a higher incidence of chronic diseases and tend to die 10 – 25 years earlier than the general population.¹

Stamping Out Stigma

Everyone experiences the ups and downs of mental health. Many people have a mental illness or know a friend or family member who has struggled with one. To stamp out stigma and get people the help they need NAMI offers these practical tips:

• Talk openly and honestly about your own experiences with mental illness and addiction.
• Educate yourself and others about the facts of mental illness. Mental disorders are treatable just as physical diseases are, and people with mental illness are not to blame for their condition.
• Recognize the signs of mental illness and seek professional help when needed.
• Show empathy for those living with mental health and substance use disorders.
• Be aware of your attitudes and language used to describe mental illness and people with mental illness. Jokes and name-calling are hurtful and perpetuate demeaning stereotypes.

Let’s work together to Stamp Out Stigma!

Sources:

[1] Management Information Sheet. (n.d.). Retrieved from https://www.who.int/mental_health

²Social Stigma associated with COVID-19. (2020, February). Retrieved April 10, 2020, from https://www.unicef.org/media/65931/file/Social%20stigma%20associated%20with%20the%20coronavirus%20disease%202019%20(COVID-19).pdf

The stress of COVID-19 can present many challenges to those who are in recovery. In particular, social distancing is limiting people’s ability to get support from friends, family, and support groups.

Connection to others in recovery is a big part of the solution for many in recovery. Meetings make people feel supported and understood in ways nothing or no one else can. With much of the world under orders to quarantine or shelter in place, people in recovery can struggle to maintain a connection to their support groups. The good news is many recovery groups are scheduling virtual meetings, and that number is increasing each day.

Below are links to information about virtual 12-step and non-12-step meetings. These meetings take place in a variety of ways: over the phone, in online community posting forums, in social media groups, and through video.

Also, if you have a sponsor, peer specialist, or other special relationship, maintain that connection through text, email, phone, and FaceTime, or Skype.

12-Step Programs 

• Alcoholics Anonymous (AA; aa.org): For regularly scheduled virtual meetings, visit aa-intergroup.org and click on Online Meetings.

• Narcotics Anonymous (NA; na.org): For regularly scheduled virtual meetings, visit www.na.org/meetingsearch. In the NA Meeting Search box on the right, select “Phone” or “Web” in the Country field drop-down list.

• Al-Anon (for families and friends of alcoholics; al-anon.org): For regularly scheduled virtual meetings, visit al-anon.org/al-anon-meetings/electronic-meetings.

• Nar-Anon (for families and friends of addicts; nar-anon.org): For regularly scheduled virtual meetings, visit www.naranon.com/forum.

Other Programs

Some in recovery prefer non-12 step programs. Listed below are a few organizations who provide virtual support.

• SMART Recovery (for people with addictive problems; smartrecovery.org): To find online forums and meetings, visit www.smartrecovery.org/smart-recovery-toolbox/smart-recovery-online.

• LifeRing (for people addicted to alcohol or drugs; lifering.org): To find online video meetings via Zoom, visit www.lifering.org/online-meetings.

• Women for Sobriety (for women facing issues of alcohol or drug addiction; org): For information on the online community, visit wfsonline.org.

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

COVID-19 has disrupted our lives in many ways. The stress of social distancing and loss of routine, compounded with health and job concerns, has caused grief and anxiety levels to increase. What we thought of as “normal” is in transition, and we need to redefine how to cope with these changes.

Reasons people feel grief

Grief is a natural feeling accompanying any kind of loss. Typically, grief is associated with losing a loved one to death. With COVID-19, people are experiencing grief related to the loss of routines, livelihoods and relationships. While it is always good advice to be thankful for what we have, it is also important not to minimize the pandemic or its associated losses. Also challenging is that we do not know how long we’ll be impacted by COVID-19. With no clear end in sight, feelings of grief can intensify and make people feel less in control.

Grief shows itself in different ways

It’s perfectly normal to grieve when you can’t celebrate your child’s birthday, your friend’s graduation, your honeymoon or other important life events. It’s important to know that we all grieve differently. Some people may experience feelings more intensely than other people. We shouldn’t make judgments about how someone grieves. There is nothing wrong with having emotions; it is a common response to loss. When we don’t express our feelings, they can get stuck in our bodies, causing physical illness and/or depression.

Listed below are some of the common emotions people experience when grieving, and they may be heightened because of the pandemic.

• Shock, disbelief and denial
• Anger
• Fear
• Guilt
• Helplessness
• Anxiety and depression
• Acceptance and hope
• Relief

Complicated grief

In the current environment, any losses experienced now have additional layers of complexity and depth. Likewise, if we’ve had previous traumas from earlier stages in our lives, the stress of the pandemic might bring up past life experiences that were painful. It’s important to be sensitive to those potential triggers.

COVID-19 has brought on many situations: not being able to say goodbye, to have a funeral service, to grieve because of taking care of others, dreams put on hold, etc. We don’t have the same levels of support due to the quarantine, such as being able to see loved ones and friends. For these reasons and others, it is important to develop coping skills to help get us through this difficult time.

Understanding grief

Part of what gives comfort during challenging times is understanding the healing process.

• Grief can be an ongoing process. It can take on different forms and meanings and with time; the intensity and feelings of grief do change.
• Grief doesn’t mean you obsessively think about what has happened. It is important to allow yourself to deal with the feelings, but obsessively thinking about the pain and fear will only make the feelings worse and can trigger anxiety.
• Grief does not mean “forgetting.” If you have experienced a significant loss or you have missed out on a long-planned event, it is okay to think about who or what you will miss. Part of the grieving process involves keeping your loved ones and/or cherished dreams with you emotionally, as they are still a part of you even if they are no longer a physical reality.
• Grief involves growth. Whether it is coping with the death of a loved one, going through a traumatic event or dealing with the loss of a job, no one chooses these experiences. Working through grief and sorting through intense emotions can help you learn new things about yourself and discover new strengths that can result in emotional growth and maturity. In this way, loss sometimes yields gifts.

How to help yourself

• Build a virtual support system. In the era of social distancing, be creative about how to give and receive support. It’s important to turn to friends, co-workers or family members for support. People like to be of service. Giving and receiving are part of the same equation and benefit all.
• Focus on hope. We all have times when we feel hopeless. Being hopeful helps you realize that we all have tough times and that those times will pass, as will the feelings associated with them.
• Take care of yourself. The mind and body are connected. When you feel good physically, you also feel better emotionally. When you feel sad, do not be influenced by how others think you should grieve. It’s important to feel whatever you feel without embarrassment or judgment. It’s okay to be angry, cry or not cry. It’s also okay to laugh, find moments of joy and let go when we’re ready.
• Practice gratitude. Sometimes when people are in the midst of loss, they have deep moments of gratitude for what they once had. Practicing gratitude trains our minds to change our thinking and to see the glass as half full.

How to help others

• What to say. It can feel awkward when conversing with someone going through grief. You may wonder what to say ornot say; however, don’t avoid the topic or be afraid to bring it up. Open the door for the grieving person to talk about their feelings. It’s not helpful to say things like, “There’s a reason for everything,” or ” “I know how you feel.” Instead, you can offer a simple expression of sorrow, such as “I’m sorry you’re going through this,” or “I don’t know how you feel, but I’d like to help in any way I can.”
• Sometimes the best thing to say is nothing. Or very little. A grieving person may need to tell their story again and again as part of the process. Be willing to listen without judgment. A good rule to follow is to listen 80 percent of the time and talk the other 20 percent. Your presence can be comforting to a grieving loved one, and you don’t have to do anything special. Often, grieving people just don’t want to be alone.
• Avoid giving advice. Unless someone specifically asks for your advice, it isn’t your place to give it. Grieving people need to do things in their own unique way.
• Don’t take things personally. When people are in profound emotional pain, they can cycle through a whole range of feelings, including irritability and anger. If a grieving person snaps at you, or doesn’t feel like engaging, don’t take it personally. It’s not about you.
• Offer to help. Grieving can make the demands of daily living feel overwhelming. Many times, the grieving person does not want to burden others by asking for help. Don’t wait for them to ask. Instead, offer to help by bringing over dinner, shopping, gardening, etc. During the quarantine, there might be a limit to what you can physically do to help, but you can still take on tasks for the individual to relieve some burdens.

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

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