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Working from home during COVID-19

As more people are working from home to limit the spread of the novel coronavirus (COVID-19), what was once a perk may now seem like a punishment. It can be hard just to find and set up a workspace and connect with work, let alone deal with the isolation.

If you are used to going into work, you may miss opportunities for regular social interaction and connection with co-workers. Regardless of which life stage you’re in, working from home may cause feelings of isolation, frustration or stress that can impact your mental health.1 Here are some tips to help you manage your new work-life balance:

Set yourself up for success

Find the most quiet place you can to set up your home work area. Make sure you have good lighting, a comfortable chair and plenty of outlets to plug in your computer, monitor, phone charger, etc. Put everything you need nearby so that you don’t need to constantly hop up to find a report, get supplies, etc. Maintain as much of an office-like demeanor as you can. If you are using video for meetings, remember, you’re on camera too.

Establish your routine

When you’re away from the workplace, it’s important to set specific hours—and stick to them. It’s easy to work more hours than normal, but that may cut into your family time and affect your sleep schedule. You may also feel pressure to prove that you are spending your time productively, and this can result in increased anxiety and stress. Set your boundaries and develop a routine: wake up at the same time every day, take a shower, get dressed, etc. Keep as much of your non-work life as it was before the pandemic: eat well, exercise and get fresh air—just remember to maintain a 6-foot distance from others.

Practice self-care

Self-care is any proactive activity that we do to take care of our mental, emotional and physical health. Good self-care is the key to improved mood, reduced anxiety and a good relationship with yourself and others. While so many normal activities are disrupted, take some time to practice gratitude, eat healthy, get enough sleep and maintain or start an exercise program. You will feel better for it.2

Increase communication

You might find it easier to be productive without your most chatty coworkers constantly buzzing in your ear. But social interactions—even with coworkers—can alleviate feelings of isolation and loneliness. Try to maintain normalcy by setting up regular check-ins with your team or manager that allow you to provide progress updates, sort through problems or brainstorm ideas.

Cherish children

If you have children at home due to school closings, helping them make sense of what is happening in the world will help you process the situation too. Kids of all ages are as vulnerable as adults to feelings of anxiety, stress and sadness. Do the best you can to manage childcare, plan for different age groups and ask for help from those near to you, while staying mindful about social distancing. Be flexible to accommodate your children’s needs and those of your employer. This is a unique moment in history. Move through it as gracefully as you can and create good memories for your family.

Take breaks

In the office, there’s usually time for coffee breaks, lunch walks and chats with colleagues that give some breathing room from work. Just because you are working from home doesn’t mean you aren’t entitled to the same breaks. Hitting the pause button throughout the workday can be good for productivity. Get up and stretch, take deep breaths and look up from the computer at regular intervals. Remember to eat, and check with your supervisor for permission to take a break for a quick walk.

For more information and tips, 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/

 

1Smith, P. (2020, March 10). How To Deal If Working From Home Is Hurting Your Mental Health. Retrieved from https://www.huffpost.com/entry/working-from-home-mental-health_n_5afd88e2e4b0a59b4e014602?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAALPysx5taWAnltmdXV9uEcuIXzXyRxgs3xGUH0ztFrzmyZfyFKQUQo1BetFTXXoiY1lnEVcXeQbFXLffHW2baI7Yr9eG5nDkYyB5iecH6hx8iRFumbBwpzRVhn1H7uRr-3ZngjIoto2Ctd1o-7Sl4sEDdIr-GAyVlgsNUEul-5MM

2Michael, R. (2018, July 8). What Self-Care Is – and What It Isn’t. Retrieved from https://psychcentral.com/blog/what-self-care-is-and-what-it-isnt-2/




School is canceled. Now what?

Coronavirus (COVID-19) concerns are growing, and school closures are happening in most states. While grown-ups are anxiously figuring out how to handle the impacts of these decisions, kids are observing everything and may feel just as scared and confused as adults.

Talking with children about COVID-19

Children look to parents, guardians, caregivers and other trusted adults to help them make sense of what is happening in the world. COVID-19 is the topic of conversations everywhere on social media, web news outlets and TV. Everyone is being exposed to the fear and uncertainty of this global pandemic.

Children might find it difficult to understand what they are seeing or hearing about COVID-19, so they can be particularly vulnerable to feelings of anxiety, stress and sadness. As an adult, it’s important to make yourself available to listen to children’s thoughts and communicate in an age-appropriate way that addresses children’s questions without stoking anxiety. Children react, in part, on what they see from the adults around them. When parents and caregivers deal with a stressful situation calmly and confidently, they can provide the best support for their children.

The Substance Abuse and Mental Health Services Administration provides Tips for Caregivers, Parents and Teachers During Infectious Disease Outbreaks that includes information on possible reactions and tips for talking with children and youth of different age groups.

Tips for staying at home with children during the outbreak

  • Focus on the uniqueness of the moment. This situation has never happened before. How can you make the best of it? Yes, it is stressful on many levels, but for your children, it is a time they will never forget and there is an opportunity in forced togetherness to reinforce your family bonds.
  • Plan for different age groups. Younger children will love being home. Young teenagers may not be as thrilled by not being able to hang out with their friends on a daily basis. High schoolers can handle themselves and may be able to help with the younger kids if you have to work.
  • Bend with the wind. Meaning: be flexible with the schedule. Let children play, do a fun project together (make cookies or do a craft), eat breakfast for lunch and make room for downtime to read and hang out. Your kids may have quite a bit of time at home, so try to maintain your patience and perspective.

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/

 

Adapted from: Stockwell, A. (2020, March 13). What to do with your kids when schools are canceled. Retrieved from https://www.vox.com/the-highlight/2020/3/13/21178234/coronavirus-covid-19-school-closures-kids-home




Coping with isolation during COVID-19

Humans are social beings, and the social distancing that is necessary to flatten the coronavirus curve is hard on everyone. The forced change in social behavior and the resulting isolation can affect people’s mental health in many ways. Whether you are home alone, with a sick family member or with kids out of school, isolation can increase stress and anxiety.

Depending on your situation, isolation can impact you in different ways. From loneliness to feeling cramped, dealing with these feelings on top of worrying about the COVID-19 outbreak can be overwhelming.

General tips
• Keep in touch with your social support groups virtually through social media, FaceTime, Skype, online games and other digital platforms.
• If the weather is nice, go outside and get some fresh air. Maintain a 6-foot distance from others.
• Stay busy. Read, play games or work on a project.
• Decrease the time you spend watching or listening to upsetting media coverage.
• Draw on skills that you have used during difficult times in the past to manage your emotions. That may include deep breathing, meditation, positive self-talk, etc.
• Maintain a healthy lifestyle. Stay hydrated, eat nutritious meals, exercise and get enough sleep.
• Avoid using tobacco, alcohol or other drugs to cope with your emotions.
• Access information that can help you cope with stress, worry and confusion during the pandemic. Visit Magellan Healthcare’s COVID-19 response website for information and links to self-assessments, videos and other resources.
• Get the facts about your risk and how to take precautions. Use trusted national and international resources including the World Health Organization, Centers for Disease Control & Prevention and State Departments of Health.

For people living with children
• Remember that during times of stress, it is common for children to seek more attachment and be more demanding on parents.
• Be honest when discussing COVID-19, but do so in an age-appropriate way. If your children have concerns, help them ease their anxiety.
• Make sure you model good behavior. Children will observe adults for cues on how to manage their own emotions during difficult times.
• Help children find positive ways to express their fears about the situation. Every child has their own way to express emotions. Sometimes engaging in a creative activity such as drawing can help this process.
• Maintain a safe and supportive environment and practice familiar routines in daily life as much as possible, especially if children are confined to home.
• Provide children with engaging activities

For caretakers of older adults
• Provide practical and emotional support by sharing simple facts about what is going on.
• Give clear information about how to reduce risk of infection in words older people with/without cognitive impairment can understand. Repeat the information whenever necessary.
• Engage their family and other support networks in providing information and helping them practice prevention measures (handwashing, proper sneezing and coughing techniques, etc.).
• Be aware that older adults in isolation and/or those with cognitive decline/dementia may become more anxious, angry, stressed, agitated or withdrawn during this time.
• Encourage older adults with experience and special skills to help others by providing virtual peer support, reading to children over the phone, and the like.

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/

Adapted from Miller, H. (2020, March 10). WHO gives advice on handling mental health toll from the coronavirus. Retrieved from https://www.cnbc.com/2020/03/10/who-gives-advice-on-handling-mental-health-toll-caused-by-coronavirus.html. March 13, 2020.




Anxiety and COVID-19

It is midnight and I’m feeling anxious. I am hearing my daughter cough—she and I returned from New York City four days ago. I’m highly aware of what is known about the incubation and symptom development of the coronavirus. What if she, I, and all the others flying home from NYC last week became the latest vectors of this disease? I have a feeling of dread that I can’t shake, and it’s fueled by the fact that I can’t protect her from any illness, let alone coronavirus.

Anxiety is natural. It’s to be expected in times like these. The news cycle keeps us up to date on every change in the number of infected persons, or the number likely to die. There is a sense of foreboding about whether oneself will get sick, or whether our children or parents will fall ill. We rightly worry about what will happen to the economy and our financial well-being. And, it’s not as if anything else goes away—there is still work, financial obligations, an impending presidential election, countries at unease, and climate change. It is easy to reach the point of feeling on edge, irritable, anxious, or overwhelmed. I would be lying if I said I didn’t feel some of those feelings tonight.

Turning the Anxiety Around

Here are some helpful tips to consider as you grapple with the uneasy feelings associated with the coronavirus:

  1. Accept It – It’s important to accept that this is happening; it’s real. Don’t pretend that it’s not. Look for the middle ground here—avoid the Armageddon predictions, as well as the pundits who say this will be over in a week. Accept that your partner, your children, your friends, your parents likely have some level of anxiety—some more than others. Be willing to share those feelings—sharing does not mean that one is weak. That honesty may make one feel less isolated in learning that others feel the same way. Talk to your kids to understand their feelings. My daughter asked me why I was buying extra groceries when I had told her that I wasn’t scared. Her question opened up a wonderful conversation; I am so glad she asked.
  2.  Be Informed – Keep yourself informed, but, don’t fall for the endless news cycle and the counting of the numbers of people who have become infected, or what the politicians are saying. Use legitimate sources such as the World Health Organization or the Centers for Disease Control websites. Listen to the science. Know what your public health authorities are saying so that closures don’t come as a surprise, and you are aware of mitigation efforts.
  3. Recognize our Burdened System – Try to understand that the healthcare system is under strain right now. The coronavirus is additive—none of the other needs for healthcare have gone away. This means that triaging is critically important and because for the vast majority of cases—those with mild and moderate symptoms—the care is symptomatic, there is no cure. Demanding to be seen because of cold or flu symptoms doesn’t serve anyone. Those with documented fevers, and with shortness of breath or labored breathing, need to be prioritized and seen first.
  4. Take Advantage of the Time – If you are now working at home, embrace some of the time you’ve saved in not commuting. Use this time to go for an outdoor walk, or to do yoga in the house. Start journaling. Engage in self-care, and care for those who live with you. Read your child an extra story, cook a hot breakfast, watch something that will make you laugh. All of this will support your ability to focus while you are at working from home. And if you are still needed in the office, use this time to focus on the task at hand. Remember to engage in handwashing, and social distancing. Use your commute to focus on something other than the coronavirus. Listen to a book or find new music. While at work, think about starting a desk exercise routine.
  5. Recognize the Challenges – Realize that working from home and social distancing can be hard, especially in our tech-enabled world. If you are someone who travels a great deal for work, and those travels have been placed on hold, understand that you might become antsy at being grounded for weeks on end. Your routine, and the routine of your family has been upset. Talk about it. Understand that while it may be hard for you to stay home, it may be hard for your family to change their usual routine that takes place in your absence. It will take time to adjust and that’s okay. That’s the reality.
  6. Maintain a Routine – Do your best to keep your usual schedule, and keep your kids on their schedule, too. This isn’t a holiday. It’s a time to be productive at home during the usual work and school hours. It’s a time to get a full night’s sleep. Print worksheets for your kids. Read. Keep screen time limited to educational activities. If going outdoors is an option, stay active outside. If it’s not, access an exercise program online. Checkout online books from your local library. Play a game. Do a puzzle. Watch television or stream some of the content you’ve been wanting to watch—but not for endless hours. I have ordered a PSAT prep book, and downloaded DuoLingo for my daughter. While she’s not so happy about that, those unpopular choices are the right thing to do.
  7. Seek Help – Finally, if the anxiety is affecting your ability to carry out your roles, seek counseling. While face-to-face visits may not be possible, look for telemedicine or tele-behavioral health providers. If these are not an option, seek support through app-based services. Apps that focus on cognitive behavioral therapy or problem-focused therapy may be helpful. Look for apps that support relaxation, medication, and techniques to deal with insomnia.

As our country engages in mitigation, and promotes self-isolation and quarantine, realize that none of this is easy. But it is necessary. You aren’t in it alone—the whole community, even most of the world’s population is adjusting to this new state of life. By participating in what is best for the community, you are taking control of the anxiety by doing something to fight the spread of coronavirus. It’s important to recognize the critical role you are playing in this fight. Thank you.

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/




Compassion Fatigue and COVID-19

The COVID-19 global pandemic is taking a physical, mental and emotional toll on doctors, nurses, healthcare workers and caregivers. The long work hours and limited resources are causing overwork, exhaustion and in some cases, compassion fatigue. Not to mention balancing your work with the concerns for your own family and loved ones.

What is compassion fatigue?

Compassion fatigue is a state of chronic physical and mental distress and exhaustion. People with this fatigue often describe a negative shift in their world view and a preoccupation with the illness of others. They may experience stress and burnout, affecting their ability to be effective in their jobs and relate to their loved ones and friends.

Tips for preventing compassion fatigue:

  • Make self-care a priority. Despite your workload, do your best to practice healthy habits. Focus on making sure you are staying hydrated, sleeping as much as possible, eating nutritious meals and getting exercise when you can. Follow the COVID-19 CDC guidelines on keeping yourself and your family’s risk low.
  • Boost your emotional resilience. Deep breathing, meditation, being grateful and allowing yourself some down time are ways to keep your life in balance, so you are better able to handle stress, setbacks and crises.
  • Get social support. Reaching out over the phone or through a text message to supportive loved ones, friends and colleagues can be a calming influence and shift your perspective on what you are dealing with every day.
  • Be proud of your profession. Your work is important. You are caring for people during the first-ever pandemic caused by a coronavirus and giving them hope and strength.
  • Seek professional help. If you are experiencing distress and/or symptoms of burnout, take advantage of your healthcare and employee assistance benefits and meet with a behavioral health professional who can help.

We wholeheartedly thank you for all you are doing to care for others and combat this outbreak.

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




Mitigation and COVID-19

When I was a child visiting my grandparent’s Iowa farm, I would often hear stories of how my mom and her eight brothers and sisters lived during the war efforts of the 1940’s. My grandma described a common purpose—that sense of pride that the family rationed and repurposed. Their singular focus was that the good of the individual was less important than the whole of the country, even the world.

Watching the coronavirus make its way across the world and rapidly grow in the United States, I can’t help but think of those stories. As the shelves of Costco and Sam’s Club stores emptied this weekend, and school closures were announced community by community, it made me realize that our time to step up is now. Our singular, collective focus needs to be mitigation and in order to be successful, mitigation efforts need to be embraced and enacted on by us as individuals.

What is Mitigation?

Mitigation is a strategy to reduce the seriousness or impact of a natural disaster, such as a pandemic. The goals of mitigation include minimizing morbidity and associated mortality, avoiding an epidemic peak that overwhelms healthcare services, keeping the effects on the economy within manageable levels, flattening the epidemic curve to wait for vaccine development and manufacturing to reach populations, and actively pursuing the development of antiviral drug therapies. Practically, mitigation relies on social distancing—measures that are taken to restrict when and where people can gather to stop or slow the spread of infectious diseases such as the coronavirus.  Social distancing measures include limiting large group gatherings, closing buildings and canceling events. However, for mitigation to be successful, individuals, even those who are asymptomatic, must be willing to self-isolate.

Self-Isolation Challenges

In a society as mobile as ours, and where high degrees of social contact is the norm, self-isolation is challenging. For instance, if one has become accustomed to eating meals outside the home, the transition to grocery buying and cooking may seem formidable. If one is used to getting together with friends to play cards, go running, have a beer after work, the loss of those types of activities will create holes in one’s social network.

We are fortunate to have an infrastructure in which many people can work from home and education can be delivered virtually. Workers who cannot isolate because the nature of their work cannot be done virtually, must take precautions. While in the workplace, distancing at least six feet, maintaining high levels of handwashing and the use of hand sanitizers is a must.   When returning home, it is best to avoid being in the presence of those most vulnerable to coronavirus—elders and persons with underlying comorbidities. It is also important to acknowledge that one may feel anxious and may not have all the answers that our members or clients are seeking. Maintain lines of communication with co-workers and supervisors. For those who are new to work at home, talk to coworkers for whom this has been the norm to get some advice on structuring the workplace and the day. And don’t forget that you can use technology to connect with friends. Facetime, Skype and other video conference capabilities are a great way foster your relationships during social isolation.

Mitigation is a critically important strategy to quell the spread of the virus. It has been beneficial in China as new cases are now falling. In areas where community spread is mild, targeted isolation of high-risk people, or those who may have come in contact with the virus, can be implemented. Even inside households, those with symptoms should keep distance from the healthy. And, even if you are asymptomatic, but have been in a high-risk area or where there is growing or wide community spread, it is important to maintain social distancing and self-isolation.

Social distancing and isolation are not easy—but I am trying to look at them as the Victory Gardens of my mother’s childhood. I hope that 50 years from now, my grandchildren will hear stories of how the United States and the world beat back the coronavirus, and I hope that my children who are on this journey with me now will reflect and recognize the importance of a global community, productively working together for the common good.




Addressing anxiety about the coronavirus (COVID-19): Healthcare workers

The novel coronavirus (COVID-19) outbreak in the United States continues to evolve, with more cases and quarantines popping up on news feeds everywhere. The closer it gets to their homes, the more people are worrying. In our last post, “Addressing anxiety about the coronavirus,” we talked about the things people can do to help feel less anxious and more in control. But what about the people on the front lines? Nurses, doctors, healthcare workers and other medical professionals who are testing for and treating patients with COVID-19 are at a higher risk of contracting it than the general public. What can they do to take care of themselves, physically and emotionally?

As Kushal, Gupta and Mehta stated in Study of Stress among Health Care Professionals: A Systemic Review, “Work related stress is a potential cause of concern in healthcare workers and is associated with decreased job satisfaction, days off work, anxiety, depression, sleeplessness , medical errors and near misses.” Long shifts and working with sick people—some of whom are gravely ill—can lead to burnout and anxiety from their normal jobs. These already-struggling healthcare workers are now faced with COVID-19 unknowns and demands, including taking care of people with confirmed cases of the virus.

While some people may feel they are at the whims of the virus, there are things healthcare workers can do to take some control over their work environment and manage their fear or anxiety.

  • Know what your organization’s plans are. Read the business continuity plan and know your role. Talk to your team members about cross-training and covering for each other if one of you gets sick. In addition, ensure you are following proper protocols for cleaning and preventing spread. Visit cdc.gov for helpful information. This is particularly important for behavioral health providers who may not always think about universal precautions.
  • Surround yourself with green. If your facility permits, bring in a few plants to liven up your surroundings. Being around plants has a calming effect on people. Employees who work in offices with plants tend to feel better about their jobs, worry less and take fewer sick days.1 If you can’t have plants in your space, take time to look out the window and find some green. You may find that is enough for a quick mental break and perspective.
  • Use small tools to create a calming environment. A small water feature, a sand garden or hourglass, stress balls and other items can provide a quick way to refresh your mind. Or just step back, take deep breaths, stretch and/or meditate.
  • Find someone to talk to. Some hospitals have on-site or on-call chaplains; take advantage of them. Don’t be afraid to talk to your coworkers about how you are feeling. Chances are, they are feeling the same way and would welcome a discussion. Many medical settings offer a form of rounds that addresses the emotional impact of caring for a particular patient or theme. Similar semi-structured discussion groups with peers can be very helpful in handling stress and preventing the development of PTSD.2
  • Get professional help. Be open to contacting your organization’s EAP, if you have one, or reach out to a therapist if you find yourself developing “compassion fatigue,” where your desire to help others erodes.
  • Limit exposure to media. Media outlets have a tendency to sensationalize stories, so it’s important to consume news thoughtfully and with a critical eye.

In addition, do all the normal things to take care of yourself: try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs. Doing these things can have a positive impact on your mental health and help you manage anxiety.

For more information and tips, visit MagellanHealthcare.com/COVID-19. We wholeheartedly thank you for all you are doing to combat this outbreak.

1: https://www.webmd.com/a-to-z-guides/ss/slideshow-health-benefits-houseplants.

2: See Schwartz rounds.

Disclaimer: The content in this blog article is not a substitute for professional medical advice. For questions regarding any medical condition or if you need medical advice, please contact your healthcare provider.




Addressing anxiety about the coronavirus (COVID-19)

As the coronavirus disease (COVID-19) continues to evolve with ongoing media coverage, many people are experiencing anxiety due to the uncertainty about how this will impact them. They are worried about the impact to their communities, how they can protect themselves and their families, and how to be prepared if the situation disrupts the normal course of daily life.

It is normal to feel anxious, unsettled, distracted, scared and/or overwhelmed by COVID-19 and the uncertainty surrounding its impact to communities. Some people may be more vulnerable due to pre-existing physical and mental health conditions, including generalized anxiety disorder.

Feeling stressed can affect the immune system and increase the risk of getting ill in general. That is why it is important to take steps to manage anxiety and reactions to this evolving situation. The following suggestions can help people manage anxiety and stress for themselves and their families:

  1. Seek health information from trusted resources like the U.S. Centers for Disease Control & Prevention (CDC), The World Health Organization and state health department websites.
  2. Plan ahead to feel more in control. Make contingency plans for work, childcare or travel if it becomes necessary.
  3. Wash hands often, get plenty of rest, exercise, eat well, don’t smoke and limit alcohol consumption.
  4. Put things into perspective:
    1. Of the 80,000 confirmed coronavirus cases reported in China, “more than 70% have recovered and been discharged,” according to the World Health Organization (WHO) in a news conference on Monday.1
    2. Per the CDC, only certain groups, such as older adults and people with serious chronic medical conditions, are at higher risk of getting very sick from COVID-19.2
    3. Public health officials are working to mitigate the virus’ spread.
  5. Limit exposure to media. Media outlets have a tendency to sensationalize stories, so it’s important to consume news thoughtfully and with a critical eye.

Magellan Healthcare has resources to help people during crises and difficult times. Our Crisis Communications website provides topical information and connects people with U.S. resources, and our Mind Your Mental Health site addresses many topics related to emotional well-being.

1: https://www.cnn.com/asia/live-news/coronavirus-outbreak-03-09-20-intl-hnk/index.html, “More than 70% of coronavirus cases in China have recovered, WHO says,” posted 3/9/20, 7:25 p.m. EDT, Jacqueline Howard, accessed from site 3/10/20, 12:57 p.m. EDT.

2: https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html#who-is-higher-risk, accessed 3/10/20, 12:34 p.m. EDT.

Disclaimer: The content in this blog article is not a substitute for professional medical advice. For questions regarding any medical condition or if you need medical advice, please contact your healthcare provider.