Transitioning from military to civilian life can be challenging, but with the right mindset and preparation, it can also be a fulfilling experience. With May being Military Appreciation Month, we spoke to three veterans, Amber Rodgers (Maj.), Angela Burd (MSG), and Jerome Simmons (SGM), about their experiences transitioning to civilian life and how their military background has helped them in their current roles at Magellan Federal.

They each offer valuable insights on overcoming challenges and making the most of the transition, including setting attainable goals, building new habits, and staying connected with the military community. Whether you’re a veteran, caregiver, or spouse, their advice can help you navigate this exciting but daunting time in your life.

Q: Are you a veteran, caregiver, or spouse?

Amber Rodgers: Veteran and spouse
Angela Burd: Veteran
Jerome Simmons: Veteran

Q: What’s your branch of service?

Amber Rodgers: Air Force
Angela Burd: U.S. Army
Jerome Simmons: U.S. Army

Q: How many years of service do you have?

Amber Rodgers: 10
Angela Burd: 27
Jerome Simmons: 30

Q: What was your experience transitioning from military to civilian life leading up to your role at Magellan Federal?

Amber Rodgers: It was a quick 3-week transition from active duty to civilian life and my Magellan role!

Angela Burd: I retired in 2021, and the transition was smooth. I had a lot of time to prepare. The military sets you up for success through the transition assistance program. I researched employment in the civilian sector because I believed I wanted a drastic change from the military in my second career. But after a few months as a civilian, I realized I greatly missed the military community. I knew I still had a desire to “serve” in some capacity. Then I came across the job posting for MFLC recruiting, and it felt like an amazing opportunity to put my military experience to great use!

Jerome Simmons: My transition has been tough to the point that I’m still up at 04:00 a.m. every day. I took a break for the first 90 days, which did not last because I ran out of things to do. I started working a contract job at Fort Bliss, TX, to stay active and still give back to the Soldiers. The job that I currently have is a true blessing allowing me to give back once again.

Q: What challenges did you face during your transition, and how did you overcome them?

Amber Rodgers: I initially struggled with not feeling busy enough, I was overwhelmed during active duty and trying to be present for my family, and then it all stopped when I got out. I couldn’t remember when I’d only worked an 8hr day. I focused on spending that “extra” time with my family, being outside, and finding hobbies.

Angela Burd: My greatest challenge was transitioning from being a leader and expert in my field to starting over and learning civilian aspects of the workforce. I needed to recognize that I would not initially come into the workforce at the “rank” I previously held; that I needed to establish myself as a valuable employee and learn, grow, and challenge myself to work toward new goals.

Jerome Simmons: The first challenge I faced was not being in charge anymore. I did a lot of cycling and CrossFit to take my mind off the pressure of not leading Soldiers!

Q: How do you think your military experience has prepared you for your role at Magellan Federal?

Amber Rodgers: The military prepared me to lead people, problem-solve, and think strategically.

Angela Burd: I can appreciate the mission and recognize the value of Magellan Federal from the angle of the service member. Additionally, I recruit Military and Family Life Counselors. I feel that my prior service lends to the credibility of who we are and what we do. I appreciate the counselors because so many times throughout my years of service, I now recognize that I could have used an MFLC!

Jerome Simmons: My experience with the Army has made it easy for me to network with Green Suiters (Army) and other organizations on the installation.

Q: What skills did you learn in the military that you feel are particularly valuable in your current position?

Amber Rodgers: Time management, setting goals, communicating expectations, giving and receiving feedback, and accountability.

Angela Burd: Adaptability. I have learned to make the best of plans but be ready at any time for a change in mission. All candidates are different and the ability to adapt can assist in keeping great candidates interested in our roles and ultimately filling our ranks with the right employees to serve our service members and their families.

Jerome Simmons: Leading and patience are two great skills that I’ve learned.

Q7: How do you stay connected with the military community while working in a civilian role?

Amber Rodgers: I serve in the Air National Guard.

Angela Burd: I had a great bond with my team of Soldiers, my leadership, and their families. Many have become lifelong friends who still come to me for advice from when I was in their positions. It is a great feeling to know that my work remains valued and worthy of recognition even after being gone for two years.

Jerome Simmons: I have a ton of old Soldiers, civilians, and leaders that stay in touch with me monthly for mentorship and mentee.

Q8: What advice would you give to someone who is currently transitioning from military to civilian life?

Amber Rodgers: Acknowledge that “it’s different,” normalize the transition of old habits, and explore how to build new habits. Find the similarities and find excitement in the differences. Take time for yourself and recognize that this is a transition for your family, too, don’t forget them!

Angela Burd: Start planning early. Set attainable goals for yourself with realistic timelines. Include your family in your plans. Ask questions, build connections, and network! Be realistic about what you want in a role. You may fail a time or two and need to reassess your goals, but that’s OK! The military community is always there to pick you up, and your training taught you to be resilient so you will eventually succeed!

Jerome Simmons: Please, please establish some type of support channel, whether it be military or civilian, that would push and motivate you!

Military Caregiver Month is a time to recognize and honor more than 5.5 million spouses, parents, children, relatives, friends, coworkers, and neighbors who provide care and assistance while warriors heal from their injuries. The caregiver’s dedication can lead to swifter recovery times for their loved one, a better quality of life, and saves the United States billions of dollars in health care costs.

The month of May is when the nation formally recognizes a caregiver’s dedication. It’s an understanding and appreciation that caregiving can sometimes come at a cost to their emotional, physical, and financial well-being. One of the goals of Military Caregiver Month is to get the word out regarding the life-changing work that caregivers are doing every day to support our nation’s wounded warriors, but also to take the time to spotlight resources that are available for Military Caregivers and advocate for additional resources to fill any gaps that have been identified.

Available Resources for Military Caregivers

Veterans’ Affairs

These caregiver support programs within Veterans’ Affairs (VA) are open to all caregivers regardless of the warrior’s years of service.

• VA Caregiver Support Program—based out of local VA Medical Centers, this program supports military caregivers with one-on-one and group coaching, mobile/telephone support, skills training, information regarding online programs, and referrals to available VA and community resources.
• Caregiver Support Line (1-855-260-3274)—Military caregivers can call to learn more about navigating barriers to accessing care and community resources available to help the veteran and receive supportive counseling for themselves from licensed social workers. Caregivers can also use the Support Line to network and obtain advice by participating in monthly telephone education groups where they can ask questions and learn additional skills regarding their own self-care.
• VA Peer Support Mentoring Program—New military caregivers are matched with more experienced caregivers to obtain ongoing monthly support and consultation with the National Peer Mentoring Support Program Managers. Through this supportive program, the military caregiver can socialize and create supportive friendships with individuals who understand the issues faced by caregivers and can provide support and advice.
• VA Comprehensive Assistance for Family Caregivers—This program is specifically geared towards those providing care for veterans with serious injuries who have served on or after 9/11. It provides approved caregivers support options, including a monthly stipend, respite care, payment of approved travel expenses, health insurance, and mental health services.

The Department of Defense

The Department of Defense (DoD) provides resources and information exclusively for military caregivers who assist wounded, ill, or injured Service members with activities of daily living.

• Military Caregiver PEER (Personalized Experiences, Engagement, and Resources) Forum Initiative—This initiative utilizes Military Family Life Counselors to organize and conduct forums that provide non-medical counseling opportunities for military caregivers. At these forums, attendees discuss topics they would like to focus on, such as managing stress, nutrition, financial wellness, and employment, among other issues. The Military Caregiver PEER Forums aim to reduce stress, provide emotional support, and be a resource for valuable information through guided discussion among military caregivers, allowing them to share practical, accurate, and thorough information based on their personal experiences.
  
• Caregiver Resource Directory (CRD)—The CRD is designed to help empower military caregivers with information about national and local resources and programs specifically for them. Topics include helplines, advocacy and benefits information, career transitions and employment, military caregiver support, children’s needs, education and training, financial support, rest and relaxation, and more.

You can access the 2022 CRD online or request a CRD at OSD.Caregiver@mail.mil.

• National Resource Directory – The NRD is an online database containing thousands of validated Federal, State, and local level resources that support recovery, rehabilitation, and reintegration for service members, veterans, family members, and caregivers.
• Virtual PEER Forums—Military caregivers may join their peers through virtual teleconference lines during forums scheduled on the first Thursday of every month at 11 a.m. ET and the fourth Thursday at 2 p.m. ET. Virtual Peer Forums allow caregivers to share their expertise and network with others who are experiencing similar challenges. Click here to RSVP.
• Warrior Care Recovery Coordination Program – A Defense Health Agency program where caregivers can learn more about navigating the various DoD programs developed for Wounded Warriors.
• Military Caregiver webinars, events, and specialized resources.

While caregiving is rewarding, it can also be challenging and overwhelming. That’s why spending awareness about the resources available to military caregivers is essential.

For National Nurses Week, we are honoring the contributions and sacrifices made by all nurses in the medical community who are instrumental in enhancing the health of their patients. Nurses are the healthcare professionals who perform some of the most challenging and essential healthcare tasks and serve as the first and last point of contact for most patients as well as being a crucial link between patients and doctors. Nurses have a versatile career with dozens of specialties that require extreme focus and dedication. We’re spotlighting two of Magellan Health’s nurses who each explain why they chose to become nurses, and who describe what are some of the most rewarding and challenging aspects of working in this field:

• Tracy McClain, RN, BSN, Care Coordinator, Employer Center of Excellence
• Jacqueline Rigby Siomos, RN, senior care manager, Cambria County Clinical

Continue reading to learn more from Jacqueline and Tracy on their experience as nurses:

Why did you become a nurse and what are the most rewarding aspects of working in this field?

Jacqueline: I really wanted to help people and becoming a nurse was the best fit for me. I knew nursing had a lot of different opportunities available and I would always be guaranteed to have a fulfilling career. I enjoy that I learn something new each day, whether it’s a new medication, a new treatment modality, or a new data system.

Tracy: I always knew since a very young age that I wanted to work in a career that allows me to help people. Helping and supporting people in their time of need by bringing them care, comfort, and compassion does as much for me as it does the people I help.

What are some challenges you face being a nurse? How do you overcome those challenges?

Jacqueline: One of the biggest challenges is stress and burnout. It is very important to have healthy self-care rituals to be refreshed and rejuvenated for the next workday. You must commit to be a lifelong learner if you want to be a nurse since healthcare is an ever-changing field. 

Tracy: Not being able to help or make a positive difference in someone’s life, but I just always remind myself that I can’t save the whole world, so I stay focused on the people I can impact and never give up on anyone.

Is there anything you’d like to highlight about working in this field and National Nurses Week?

Jacqueline: Nursing is a challenging field, but the rewards of helping others outweigh all the challenges. I have always been blessed to work with a wonderful group of nurses and other professionals who always make the workday go smoothly. The nursing profession offers tremendous amounts of flexibility in scheduling, clinical specialties, and employment locations. Celebrating National Nurses Week is a great way to recognize the hard work and dedication of all my colleagues in the field. We are all in this together.

Tracy: Working in this field and with my team at Magellan has helped me gain knowledge and grow as a person. I have worked here for 25 years and can honestly say I am a more patient, compassionate, and educated nurse. It’s nice to know that nurses are being recognized for what they do and made to feel proud of being a nurse, especially when burn out tends to be high in this field.

Hard work, dedication, love, and resilience weave together an extraordinary tapestry that is the military spouse. We are strong, independent women and men fiercely supportive of each other. We care wholeheartedly about all associated with the military and work tirelessly to support those who support us through serving our country.

Military Spouse Appreciation Month recognizes the spouse’s contributions to the military and the community. Those in the military took an oath to serve our country and receive medals, salutes, and commendations for their commitment. The sacrifices of the families, while not as evident, should also be applauded and recognized for their commitment to the service of our country through their support of the service member. Often these sacrifices go unnoticed and can create challenges, such as maintaining a job or career.

The Struggle of Finding Employment as a Military Spouse

On many military installations, spouses volunteer thousands of hours for the cause of the community and the military services. One can find a spouse volunteering at thrift stores, schools, Community Action Centers, Military Spouse Clubs, and the American Red Cross, to name a few. The spouse’s work is visible and needed. When the service member knows that the family is stable and receiving the required support within the community, they can focus on serving their mission without hesitation.

Along with the usual marital stresses, most non-military spouses are near support systems of family, lifelong friends, and resources known to them. We learn to make friends quickly, and those people become our family. The resentment and loneliness this lifestyle brings can be hard to understand. The sacrifice, commitment, and the stress of many domestic roles can be lonely and isolating at times. We can sometimes lose our identity – known only as someone’s spouse or someone’s parent. Many opportunities present themselves, such as worldwide travel, educational benefits, and excellent schools, but with these opportunities there can be just as many, if not more, sacrifices.

So much of our military lifestyle is beyond our control. Affordable childcare options are a major concern for military spouses. It is a primary family expense and the main reason many spouses choose not to work outside the home. At one point in my career, I worked 40 hours a week and cleared less than $600 monthly after childcare expenses, transportation, lunch, hair, nails, etc. I was exhausted and felt enormous guilt for allowing my children to be cared for by strangers while I earned a mere pittance.

Military spouses sometimes “Suffer in Silence,” fearing that speaking up may impact our service member’s career.

Qualities of a Military Spouse

We cover family milestones, holidays, and events alone, often finding ways to make up for the missing service member. In many cases, giving birth is a prime example. Thanks to my husband’s battalion chaplain (and his wife who made him do it), Gary was able to sneak away for a couple of hours (in full camouflage paint and an odor to match!) from field exercises to visit our newborn son and me in the neonatal intensive care unit in Fayetteville, NC.

Charlene Austin, the wife of Secretary of Defense General Lloyd Austin, has always been a working military spouse. She gave me this advice years ago when I became despondent during my job search. “This [military] experience is guaranteed to be like no other. Remain open to options and alternatives. Grow to be happy with yourself and work to realize your needs and goals.” That is good advice, but so much easier said than done.

Military spouses often sacrifice a stable career with their active-duty partner. The constant moving makes it hard to have career progression since you are not in any position long enough to have forward momentum. For example, my dear friend, Ivy, has multiple graduate degrees. Yet, she decided not to work for nearly twenty years because it was difficult to secure positions with growth and one that would work with her schedule of raising children and supporting her military service member.

Military spouses are adaptable, flexible, punctual finance managers, organizational managers, schedule managers, and residential physician assistants. They serve as Girl Scout leaders, Boy Scout leaders, piano teachers, sports coaches, and tutors. We are located in an area for 12-36 months. Within the first two weeks of arrival, the spouse has unpacked and arranged the house, registered students in new schools (who is my emergency contact when I don’t know anyone?!), obtained new doctors and a dentist, scheduled sporting activities and other extra-curriculum activities, and planned the summer vacation with fun activities.

Why Companies Should Hire Military Spouses

Securing positions and establishing a career have changed within the last 10 years for military spouses; however, it can sometimes still be difficult for a spouse to secure a position if they are not a teacher or working within the medical field. Many employers hesitate to hire a military spouse because they focused on the spouse leaving and not the skills the person was contributing to the overall mission.

An organization would benefit from having a military spouse who can work independently and collaboratively to complete tasks without supervision. A military spouse has likely managed a household and children and settled conflicts—from submitting damage claims to advocating for the best classes for their child. Military spouses are often highly educated and experienced; therefore, they meet the requirements for many positions. They should not be discounted simply because they may be at a temporary station. There are a lot of remote work options these days that may result in continuity beyond service location.

Carolyn Shelton, the spouse of General Hugh Shelton, former Chairman of the Joint Chiefs of Staff, shared an interesting story concerning her job search in the Washington, DC, area. She was submitting applications but had very little previous employment. She added her volunteer experience as a military spouse instead. A hiring manager reviewed her application and said, “Anyone who would volunteer this much at no pay has to be reliable. You’re hired!” Never discount the strength of your volunteer experience. You gain marketable skills needed in the business community.

When I met Carolyn, she had moved 24 times in 29 years. She humorously described her first experience as a military spouse (although I am sure humorously was not how she would have described it then).  They arrived at Ft. Benning, Georgia, where her husband was to attend Ranger School. He told her, “I’m going to sign in with the unit, then I’ll be back.” He didn’t make it back for two days! This happens more often than we care to admit.

It is past time that companies provide childcare assistance or subsidies. A flexible spending account should be one of many benefits companies offer employees. I hope the future holds affordable options for all companies that will foster a healthier work-life balance.

Companies like Magellan Federal have already taken giant steps in supporting military spouses in the workplace. Our Talent Acquisition team is superb at keeping the company recognized as a Military Friendly Top 10 Spouse Employer. Our President and CEO, Anna Sever, is the spouse of an active-duty military service member. I do not doubt that under her leadership, we will continue to build on the foundation the company was founded on – care for surviving spouses of the fallen. I applaud Magellan Federal for the emphasis placed on mental health and access to resources.

I encourage other corporations to provide more opportunities for military spouses. Hire them because they get the job done and allow them to manage at the highest positions!

On May 3, the U.S. Surgeon General issued an advisory calling attention to the public health crisis of loneliness, isolation, and lack of connection, calling it an “Epidemic of Loneliness and Isolation.”

Loneliness is the feeling of being isolated, or alone. It isn’t always tied to the amount of time you spend with other people but can come from a gap between the relationships you have and the ones you need or want.

There may not be a magic cure for loneliness, but there are healthy ways to cope and reconnect socially and regain a sense of belonging. Here are five steps to reduce loneliness:

1. Try helping someone else – Helping just one person at one time is a way to connect that improves the life of another, makes you feel better about yourself, and can be a great way to help people and meet others who share your interests. You can smile and be friendly, stop to help a neighbor, volunteer your time or donate food.
2. Think about getting a pet or finding a way to interact with animals – A pet can be a great companion, and source of comfort and may also lower stress and blood pressure. If you can’t have a pet, there are many volunteer opportunities to help animals in every community.
3. Take care of the relationships you already have – Reaching out to friends and family can help strengthen your sense of belonging. Set aside a few hours a week to connect. There doesn’t have to be a specific reason to call, and the call doesn’t have to be that long. A familiar look or a loving smile can change our experience instantly, even if we are far away or unable to see each other. You never know how reaching out to just one person may connect you to others.
4. Find new connections through activities you enjoy – Start or restart a hobby. Take a class to learn something new. Check out programs at the library or community center. You can invite friends or acquaintances you want to get to know better. Alternatively, you can go alone and meet people who share at least one interest of yours.
5. Talk with a counselor – It can be hard to make changes on your own and scary to think about being in social situations. If loneliness makes it hard for you to go about your day, a counselor can help.

As you think about taking small steps, remember the importance of self-care to help you feel better from the inside out. Exercise, healthy eating, proper sleep, sunshine and meditation are good ways to improve your emotional health.

Sources:

• Healthwise
• Surgeon General’s Advisory on Our Epidemic of Loneliness and Isolation – PDF

Evidence-based or evidence-informed treatment? Confused? You are not alone. Often used interchangeably, the terms “evidence-based” and “evidence-informed” in healthcare are two very different things. So, what do they really mean?

What is evidence-based treatment?

Evidence-based care is considered the gold standard in treating behavioral health conditions. Typically, “evidence-based” refers to an individual intervention that is based on quantitative research studies conducted in controlled, blinded settings and proven to be effective across a wide range of environments and people. Medications and other treatments that receive U.S. Food and Drug Administration (FDA) approval for a certain indication are also considered evidence-based.

What is evidence-informed treatment?  

 Evidence-informed care is an approach that shows promise but lacks enough proof of success to be viewed as a gold standard. Practitioners take bits and pieces from a variety of research, including evidence-based interventions and apply them to a condition. This produces something uniquely tailored to a certain need. Unlike evidence-based treatments, evidence-informed treatments don’t have results from research in controlled settings that demonstrate their effectiveness across a wide range of settings and people. When considering medication and other drug-like treatments, evidence-informed interventions have not received FDA approval for the condition they are treating. This is called “off-label” use.

Examples of evidence-based treatments

• Cognitive behavioral therapy (CBT) is a type of talk therapy that has proved effective in the treatment of anxiety, depression, addictions, phobias and certain physical health conditions. CBT focuses on changing automatic negative thoughts that can contribute to and worsen mental health and substance use symptoms. CBT has more evidence supporting it than any other psychological therapy.
• Acceptance and commitment therapy (ACT) is a type of mindful talk therapy that helps individuals stay focused on the present moment and accept thoughts and feelings without judgment. Over 200 randomized controlled trials have proven ACT is an effective treatment for depression, psychosis, chronic pain, substance use disorder, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder and social phobia.
• Dialectical behavior therapy (DBT) is a type of talk therapy based on CBT and specially adapted for people who experience emotions very intensely. Nine published randomized controlled trials and five controlled trials of DBT have proven its effectiveness for treating borderline personality disorder, including in highly suicidal women.
• Exposure and response prevention (ERP) therapy is a form of CBT that encourages individuals to engage with their obsessive thoughts without carrying out their associated compulsions. Treatment begins with placing individuals in situations which cause a tolerable level of anxiety and gradually build up to settings they find more difficult. ERP has been proven effective for treating obsessive-compulsive disorder in numerous clinical trials.
• Eye movement desensitization and reprocessing (EMDR) therapy is a mental health treatment technique that involves moving your eyes a specific way while you process traumatic memories. The goal of EMDR is to help individuals heal from trauma or other distressing life experiences. Since the first EMDR clinical trial in 1989, dozens of other clinical trials have proven this technique is effective and faster for the treatment of post-traumatic stress disorder.
• Transcranial magnetic stimulation (TMS) is a noninvasive treatment that was first used to treat depression in individuals who were nonresponsive to other treatments. TMS involves using a magnetic coil to influence the brain’s natural electrical activity and has full FDA approval for the treatment of major depressive disorder, obsessive-compulsive disorder, migraines and smoking cessation.
• Esketamine is an FDA-approved nasal spray used to treat severe treatment-resistant depression. Esketamine was found effective in a phase 3, double-blind, active-controlled study conducted at 39 outpatient centers from August 2015 to June 2017. The study involved nearly 200 adults with moderate to severe depression and a history of not responding to at least two antidepressants.
• Fluoextine is an antidepressant medication that is approved by the FDA to treat depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder and panic disorder. It belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs) and works by increasing the activity of serotonin in the brain. Data based on a group of 9,087 patients who were included in 87 different randomized clinical trials confirms that fluoxetine is safe and effective in the treatment of depression from the first week of therapy.

 Examples of evidence-informed treatments   

Response Disequilibrium Therapy (RDx)—Based on the response disequilibrium model, RDx puts patients in charge of implementing their own treatment procedure outside of therapy sessions in the same environments that trigger their symptoms so they can learn new behaviors to replace and control their previous responses to distressing situations.

While preliminary findings from case studies involving 19 participants with OCD suggest RDx may be a promising alternative to traditional OCD treatments, future research is needed to determine its effectiveness across a wide range of settings, people and problems to classify it as an evidence-based intervention.

• Pregabalin (an FDA-approved anticonvulsant medication and fibromyalgia treatment) has been used off-label to treat generalized anxiety disorder, social anxiety disorder, bipolar disorder, insomnia and chronic pain conditions other than fibromyalgia. For pregabalin to be used for these conditions in an evidence-based manner, the FDA would have to approve their use for each specific condition.
• Risperidone (an atypical antipsychotic medication approved by the FDA for the treatment of schizophrenia, bipolar disorder and autism-associated irritability) has been used in a variety of off-label ways, including to treat borderline personality disorder, post-traumatic stress disorder (PTSD) and bipolar disorder. To date, the FDA has not approved risperidone to treat these three conditions.

Are mental health and wellness apps evidence-based or evidence-informed?

These days, you can’t browse the web or use most apps on your phone without seeing an ad for a wellbeing or therapy program or app. Used alone or to supplement traditional treatment and promote wellbeing, not all mental health, substance use and wellbeing apps use evidence-based practices, nor have they been extensively researched in treating specific conditions. Wellbeing and therapy apps are typically considered:

• Evidence-based when evidence-based interventions are fully implemented on the platform and followed by users in the same manner they would be if they were being delivered during face-to-face treatment. For example, the original evidence-based model below is used in a wellbeing app that delivers CBT digitally and all steps are followed as listed.
  1. Identify troubling situations or conditions in your life.
  2. Become aware of your thoughts, emotions and beliefs about these problems.
  3. Identify negative or inaccurate thinking.
  4. Reshape negative or inaccurate thinking.
• Evidence-informed when only certain components of evidence-based interventions are implemented on the platform, and/or the app only fully implements or uses components of evidence-informed interventions. For instance, if a wellbeing app provides CBT and only asks users to identify troubling thoughts and become aware of their thoughts, emotions and beliefs about these problems, it is evidence-informed because it does not ask users to identify and reshape negative or inaccurate thinking.

When considering using an app for yourself, your patients, your employees or your members, ask yourself these questions:

• Are the treatments used in the app based on quantitative research?
  • Were the studies conducted in controlled, blinded settings?
  • Are the treatments proven to be effective across a wide range of environments and people?
• Are all treatment steps included in the process, or has the process been watered down?
• Have the treatments used in the app received FDA approval for a certain indication, if FDA approval is possible?

Magellan’s approach to evidence-based versus evidence-informed treatments and mental health, wellbeing and substance use apps

The American Psychiatric Association and the American Psychological Association both consider evidence-based interventions preferred approaches for the treatment of psychological conditions.

At Magellan, we are leading the way in providing innovative, impactful behavioral healthcare solutions. When developing new and enhancing existing offerings , like our digital cognitive behavioral therapy (DCBT) programs, we always start with evidence-based treatments and adhere fully to all tenets. Magellan Healthcare’s DCBTs have been heavily researched in the studies below:

• FearFighter® for anxiety, panic and phobia (now available online in Spanish)
  • Computer-aided CBT self-help for anxiety and depressive disorders: Experience of a London clinic and future directions. L. Gega, I. Marks, D. Mataix-Cols. Journal of Clinical Psychology: In Session (2004), Vol. 60 (2), 147-157.
  • Computer-aided vs. tutor-delivered teaching of exposure therapy for phobia/panic: Randomized controlled trial with pre-registration nursing students. L. Gega, I.J. Norman and I.M. Marks. International Journal of Nursing Studies 44 (2007) 397-405.
  • The feasibility and effectiveness of computer-guided (CBT) (FearFighter) in a rural area. L. Hayward, A.D. MacGregor, D.F. Peck, P. Wilkes. Behavioural and Cognitive Psychotherapy (2007) 35, 409-419.
• MoodCalmer for depression (now available online in Spanish)
  • Saving clinician’s time by delegating routine aspects of therapy to a computer: A randomized controlled trial in phobia/panic. I.M. Marks, M. Kenwright, M. McDonough, M. Whitaker and D. Mataix-Cols (2004).
  • Technology-based advances in the management of depression: Focus on the COPE program. Disease Management and Health Outcomes. J.H. Greist, D.J. Osgood-Hynes, L. Baer and I.M. Marks (2000) 7, 4.
• RESTORE® for insomnia and other sleep difficulties (now available online in Spanish)
  • Implementing computer-based psychotherapy among veterans in outpatient treatment for substance use disorders. E.D.A. Hermes and R.A. Rosenheck. Psychiatric Services 67:2, February 2016, 176-183.
  • Cognitive behavioral therapy for insomnia enhances depression outcomes in patients with comorbid major depressive disorder and insomnia. R. Manber, J.D. Edinger, J.L. Gress, M.G. San Pedro-Salcedo, T.F. Kuo, T. Kalista. SLEEP, Vol. 31, No. 4, 2008, 489-495.
  • Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. N. Vincent and S. Lewycky. SLEEP, Vol. 32, No. 6, 2009, 807-815.
  • Sleep locus of control and computerized cognitive-behavioral therapy (cCBT). N. Vincent, K. Walsh, and S. Lewycky. Behaviour Research and Therapy, 48 (2010), 779-783.
• SHADE for substance use disorder
  • Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems: Short-term outcome. A.L. Baker, D.J. Kavanagh, F.J. Kay-Lambkin, S.A. Hunt, T.J. Lewin, V.J. Carr and J. Connolly. Addiction, 105, (2009) 87-99.
  • Clinician-assisted computerised versus therapist-delivered treatment for depressive and addictive disorders: A randomised controlled trial. F.J. Kay-Lambkin, A.L. Baker, B. Kelly and T.J. Lewin. Medical Journal Australia, 195, 3, 1 August 2011.
  • Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: A randomized controlled trial of clinical efficacy. F.J. Kay-Lambkin, A.L. Baker, T.J. Lewin and V.J. Carr. Addiction, 104, 278-388 (2009).
• ComfortAble® for chronic pain
  • Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. D.M. Ehde, T.M. Dillworth and J.A. Turner. American Psychologist (2014), Vol. 69, No. 2, 153-166.

We further validate this research with outcomes from practical application of our solutions. By doing this, we ensure our clients and members receive only high-quality products and services that work in the real world—where it really matters.

SOURCES:

• ACT is an Empirically-Supported Therapy: Background and Clinical Evidence
• Act Theory: Acceptance and Commitment Therapy Explained
• CBT Explained: An Overview & Summary of CBT
• Dialectical Behavior Therapy
• EDMR Therapy
• Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives – PMC
• The Evidence for Cognitive Behavioural Therapy in any Condition, Population or Context: A Meta-review of Systematic Reviews and Panoramic Meta-analysis
• Fluoxetine: a review on evidence-based medicine
• National Library of Medicine: Pregabalin
• National Library of Medicine: Risperidone
• New Therapy Shows Promise for Swift Treatment of Obsessive Compulsive Disorder – Association for Psychological Science – APS
• Psychiatry.org – Study Supports Effectiveness of New Fast-Acting Antidepressant, Esketamine Nasal Spray
• Transcranial Magnetic Stimulation
• VR therapy for OCD Can Enhance the Delivery of Exposure Response Prevention
• What is Evidence-Based Therapy: 3 EBT Interventions

Since joining Magellan Behavioral Health of Pennsylvania (Magellan) two years ago, Stephanie Cassanese, stays busy in Cambria County supporting many different aspects of Magellan’s business in the Pennsylvania counties served by Magellan. In her role as supervisor of Recovery and Resiliency Services, Cassanese first and foremost leads the recovery and resiliency team and leads MY LIFE for Pennsylvania, where she oversees all aspects of the youth and young adult program for all Magellan counties.

“I do many things and every day here is different which is one of the reasons I love the job. It’s never the same day twice,” said Cassanese. Continue reading to learn more about the many innovative initiatives Cassanese and her team are working on at Magellan:

What project have you recently worked on that is impactful?

My team completed a project at the end of 2022 called the Peer Professional Employment Guide. It’s a workbook that we provide to new certified peer support (CPS) professionals with the goal of providing a source of advice and inspiration. This was a part of our Workforce Development Project that we’re continuing into 2023 post-COVID. There have been staffing shortages in every industry, but particularly in mental health. We’ve struggled to find and retain workers, so this is a part of our hope to retain newly trained peer professionals. There are a lot of individuals that get into peer support and don’t know what they’re getting into. The workbook shares information on everything from getting hired, interviewing, ethics, boundaries, and self-care. We also include testimonials from working peer professionals, so that individuals coming into peer support know what to expect.

Why is Magellan Behavioral Health of Pennsylvania the best place to work on creative projects?

Magellan is more than just a managed care organization; we really want to collaborate with the counties that we serve. I think Magellan encourages relationship building and that’s really the core tenet of my job, just building relationships with our county and provider partners and reassuring them that if they have questions or need any peer support related information, they can come to me. That’s something that Magellan really promotes collaboration and the idea of going above and beyond.

What are your thoughts on the culture at Magellan Behavioral Health of Pennsylvania? How has that culture impacted your team?

The culture here is really to be collaborators with our counties and providers. I think what differentiates us from other managed care organizations is that we’re not just the people that pay the claims. More than that, we try to be present at different events together with other stakeholders. Leadership is supportive; they want us to be out there in Pennsylvania communities, and leadership is always looking to help make that happen. We always strive to do better than we did the day before, that’s the culture here.

What exciting trends in the healthcare industry have you noticed? In what direction do you see healthcare going in? What lessons are there to learn from other industries that can be applied to healthcare?

The biggest one that comes to mind is the focus that the state and federal government is putting on suicide prevention and education. Since COVID, suicide rates have skyrocketed, and people are feeling more isolated and lonelier than they ever have before. This can also be related to another research push I’ve seen recently, which is on the impact of social media on youth and young adults on FOMO (the fear of missing out), self-esteem, and body image issues. I think that focusing on both, post-COVID, is going to be important.  Self-care has become common, and I think it is important that we encourage people to focus on caring for themselves, both physically and mentally. Magellan has also implemented a suicide risk assessment plan to identify members who may need additional support or treatment.

The healthcare industry also continues to conduct research focusing on things that are significantly impacting mental health, post-COVID. This is also more of a focus because our physical health and our mental health are one. When you’re struggling with your mental health, then your physical health will suffer and vice versa. I hope we continue with that direction because they are not two separate things. We’re one body, soul, spirit, and mind and it’s all connected.

A certain amount of ambiguity surrounds the term autism and often suggests a stereotypical image, but autism affects individuals uniquely. Over the years, professional theories about autism and other childhood disorders shifted to try to better capture what is now known as Autism Spectrum Disorders (ASD). Causes and treatments continue to be put forth to capture pieces of the mysterious puzzle. Though commonalities persist, each person with ASD experiences a unique level of impact on skills, intelligence, and capability and even the characteristics of siblings with ASD can vary widely. A few unique thinkers and accomplished artists that fall into this population are Albert Einstein, Thomas Edison, Emily Dickinson, Sir Isaac Newton, Beethoven, Mozart, de Vinci, Anthony Hopkins, and Jerry Seinfeld.

Early Warning Signs

Currently, one in forty-four children are diagnosed with ASD, with over 1 million reported to be in active-duty military families, according to 2021 CDC data (7) and Operation Autism (11). The American Autism Association offers some early signs and symptoms to be aware of for parents raising young children. (1):

Communication

• Delays in language development.
• Quirky repetitive language or sounds.
• Inability to initiate or maintain speech.
• Responds by repeating a question, rather than answering it.
• Difficulty communicating needs or desires.

Social Interactions

• Lack of appropriate verbal and nonverbal behavior.
• Lack of ability to develop peer friendships.
• Social and emotional exchange challenges, including maintaining eye contract.
• Minimal tolerance to being touched, held, or cuddled.
• Trouble perceiving or talking about feelings.
• Trouble sharing interests or successes with others (art, playthings).

Patterns of Behavior

• Restricted, repetitive and stereotyped behaviors.
• Difficulty in motor control
• Peculiar connection to objects.
• Distress with change in routine.
• Lining up toys.
• Head banging or rocking back and forth.

Looking Closer

Concerned parents are encouraged to speak to their child’s medical provider. Most communities offer free screenings to assess developmental progress and check for school readiness. The earlier an ASD screening occurs, the better, as this is the first step toward diagnoses which leads to important early interventions. Siblings of children with ASD screened, since ASD can present families. Military treatment facilities can assist through Educational and Developmental Intervention Services (EDIS). Once a screening determines risk factors and signs of ASD, a formal diagnostic evaluation is conducted to identify areas that may be addressed in treatment, such as challenges in social communication, behaviors, sensory issues, and the level of impact on daily functioning is assessed. (1)

Children on the autism disorder spectrum experience a unique combination of impacts on brain functions (i.e., thinking, memory) that may reflect some strong skills in one functioning area and low abilities in other areas. For example, a strong math aptitude may be coupled with a slow processing speed that appears as laziness to observers. Social issues may surface as peer conflict and loss of friends due to errors in interpreting social cues and sensory discomfort felt when looking others in the eye. A perceived lack of empathy may result from a child experiencing intense feelings of empathy, but not knowing how to identify or act on them, and then responding inappropriately. Inadequate verbal skills and meltdowns may occur when emotional or sensory stimulation floods the child, maxing their coping skills (as with loud noises or unexpected changes).

Easily knocked out of balance, these children struggle to identify and communicate their needs. Sensory sensitivity, such as the feel or fit of clothing fabric, food texture or taste, odors, certain sounds, temperature variations, and light levels can flood the brain at unbearable levels. Food refusals can make it difficult for them to receive adequate nutrition, complicating healthy development. Nearly half will run or wander off without warning and many struggle with physical tasks like writing or riding a bike. With 40% of ASD children lacking verbal skills, it can be stressful for both caregivers and child to understand each other despite access to communication assistance devices. (4)

Diving Deep

The five major types of disorders falling under the ASD umbrella are Asperger’s, Rett’s, Kanner’s syndrome, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder. It is very common to see other disorders accompanying ASD like Attention Deficit Hyperactivity Disorder (ADHD), Dyslexia, and Dysgraphia which can complicate the individual’s learning processes. Other concerns affecting this population in higher numbers are bullying, self-injurious behavior, anxiety, depression, schizophrenia, various health issues and physical disabilities.

Boys are four times more likely to be diagnosed with ASD than girls. (7) Professional theories have asserted that girls may be more likely to compensate by masking their symptoms resulting in a missed diagnosis or being misdiagnosed. (11). Girls may have subtle symptoms or higher functioning and do not always exhibit characteristics according to traditional ASD testing markers.

High functioning autism, (Asperger’s, ‘Aspie’), is seen in individuals with high levels of intelligence in some areas and deficits in others. The terms ‘camouflaging’ or ‘masking’ refer to sophisticated compensation skills where one notices, studies, and mimics the social skills of others, to compensate for natural tendencies. This can trigger remarks about them being too outgoing to have autism and undermine their self-awareness and identity. (5) ‘The invisible edge’ coined by Autism specialist Tony Attwood, describes these persons as flying under the radar resulting in either a late diagnosis or a missed diagnosis. (2) Delays in confirming the diagnosis hinder crucial access to early services and lead to the child facing expectations outside their abilities.

Compassionate Responding

Caring for a child with ASD can be quite physically and emotionally exhausting. Finding support can make a big difference. When a parent is stressed, it can be hard to be their best self for their special needs child and the rest of the family. Self-care for the caregiver is a necessary survival skill. Military installations offer respite care to help the caregivers and some states will offer pay for respite caregivers.

Emotional outbursts are common for children with ASD and challenging for parents to handle. It is helpful if the caregiver remains calm and models good coping skills from which the child can then draw to self-soothe. Using a distraction or special interest of the child (reading or playing with cars) can help calm the child. Raising voices and increasing tension can inadvertently prolong periods of challenging behaviors. Attuning regularly to the nuances of the child offers a parent greater ability to notice and appropriately respond to symptom escalation.

The American Autism Association identifies common interventions to include speech and language therapy; occupational therapy to address motor skills, sensory issues, and functional living; play therapy and floor time to aid in emotional and cognitive development; and social skills/ communication therapy to assist with socialization and emotional management. (1) Building a team of professionals around the child supports growth. It is vital to keep in mind that individuals with ASD can be quite gifted in areas of aptitude, enjoy life, and lead productive careers.

Military Families

Military lifestyle challenges are already difficult for the average family but for the family dealing with autism, essential care can be complicated. The process of confirming an ASD diagnosis can take up to 18 months to complete due to long wait times for testing. For the military family, duties, and permanent changes of station (PCS) moves can not only complicate this timeline but also delay the feedback process from providers and teachers who may have less opportunity to consistently observe and work with a child. Additionally, remote installations may not be able to offer access to all the necessary services, making participation in the Exceptional Family Member Program (EFMP), a significant benefit to the military child, less feasible. Operation Autism offers an in-depth resource Guide for Military Families and an interactive geographical map of resources. (11)

Many ASD symptoms can be intensified by stress and frequent changes that come with the military lifestyle as these children benefit most from a predictable routine and steady environment. Frequent relocations, changing homes, schools/ teachers, and making new friends, are especially difficult for children on the spectrum. With social skills already elusive, the ASD child may find these changes unbearable. Frequent social rejections and bullying can further frustrate attempts at making even a single real friend. Higher stress can lead to more health issues with these children who do not read their body cues well and even a loss of previously gained skills.

Magellan Federal Solutions

Magellan Federal provides counselors for many programs like the Military Family Life Counseling Program (MFLC) located on many installations within the US and overseas. The MFLC program is available to service members and their families for non-medical support. Although the medical nature of the ASD diagnosis causes the child to be out of scope for direct MFLC services, family members can be supported with counseling, resources, and referrals. The MFLC program offers a variety of including Healthy Steps Specialists working with parents of children 0-3 in pediatric clinics; Child and Youth Behavior Counselors working in the Child and Youth Program in CDCs/ school age services, and schools; and Adult MFLCs located in the family readiness centers. Other resources an MFLC might make referral to are Exceptional Family Member Program (EFMP), New Parent Support Program (NPSP), Tricare, and Military OneSource. Each of these assist parents with specific concerns related to their children.

EFMP is an installation-based program (offered by the Magellan Federal family in some locations) serving the military family with special needs members and is the best first stop for the family with a child newly diagnosed; offering support, resources, and information on assistance like respite care for parents. NPSP, also provided by Magellan Federal family at some locations, offers military families in home support to assist families with children under age five with visits by a nurse or social worker.

Regardless of when in the journey an ASD diagnosis is received, the military family does not have to travel the road alone. Magellan Federal is committed to providing support and guidance along the way.

This article was originally published on MFed Inform.

Resources and Bibliography

1. American Autism Association: myautism.org, https://www.myautism.org/information-kits https://www.myautism.org/informational-kits/general-therapies-for-individuals-with-autism
2. Attwood, Tony. Asperger’s Syndrome: A Guide for Parents and Professionals. Jessica Kinglsey Publishers 1998.
3. Autism Society: https://autismsociety.org/
4. Autism Speaks: autismspeaks.org
5. Abilities Workshop: https://special.abilitiesworkshop.com/autism-resources?gclid=EAIaIQobChMIiPj53OG9_QIVGXxvBB3CQg1tEAAYASAAEgJgTPD_BwE
6. Bargiela, S., Steward, R. and Mandy, W. (2016) ‘The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of Autism and Developmental Disorders 46, 3281-3294
7. Center for Disease Control https://www.cdc.gov/ncbddd/autism/index.html
8. Exceptional Family Member Program (EFMP), an installation-based program offered by the Magellan Federal family in some locations, serving the military family with special needs children, including autism and is the best first stop for the family with a child newly diagnosed with ASD; offering support, resources, and information on assistance opportunities like respite care for parents.
9. Military OneSource offers a special needs consultant at 888-342-9647, articles and information. militaryonesource.mil
10. National Professional Development Center on Autism Spectrum Disorder. (NPDC). https://autismpdc.fpg.unc.edu/national-professional-development-center-autism-spectrumdisorder. Develops free professional resources for teachers, therapists, and technical assistance Focused Intervention Resources and Modules (AFIRM), a series of free online modules.
11. Operation Autism website offers a resource Guide for Military Families including an interactive geographic guide to local resources at https://operationautism.org/autism-101/causes-and-prevalence-rates/. https://operationautism.org/resources/bases-map/.
12. Organization for Autism Research (OAR). https://researchautism.org/ Non-profit organization responsible for creating Operation Autism and guide and offers free resources either as a digital download or hard copy.
13. Tricare offers special needs liaisons and autism specific resources and information including providers and programs like Echo and Autism Care Demonstration.
14. Extended Health Care Option (ECHO) supplemental benefit for Active Military families with special needs. More information provided through Tricare.org
15. Autism Care Demonstration. https://www.tricare.mil/Plans/SpecialPrograms/ACD