In the midst of a national children’s mental health crisis, families are doing the best they can to assess how well their children are coping with increased stressors from the pandemic and figure out what to do if it seems they are having difficulty. Psychotropic medication is among the options to consider when indicated. However, over the years, children and adolescents with behavioral health challenges have generally been prescribed an alarming number of medications. This high prescription rate, paired with questions about the appropriateness of the diagnoses used to justify the drugs’ use, has raised many concerns among families, practitioners, and youth advocates alike. Prescribing medication to treat children’s mental health conditions can be appropriate, but parents, caregivers, and practitioners need to fully understand the risks and monitor their use.

In this post, we will contemplate these issues and draw on knowledge from Magellan Healthcare’s recently updated clinical monograph, Appropriate Use of Psychotropic Drugs in Children and Adolescents, which highlights evidence-based research on the use of psychotherapeutic agents in children and principles for optimal children’s psychopharmacotherapy practice.

Considerations for treatment with medication for children’s mental health

When families consider medication as an option to treat a child’s mental health condition, Magellan’s monograph offers the following to contemplate:

The practice of evidence-based medicine for children and adolescents requires health professionals and child welfare advocates to engage in a careful assessment of the risks and benefits of using psychopharmacological treatments while addressing serious concerns of over-diagnosis and overtreatment in this vulnerable population. As attention to these issues has grown, a strong undercurrent of anxiety and confusion exists about whether the use of psychotropic agents to remove undesirable impulses and behaviors of children may affect their neurological development, personality, character, and temperament. Suspicions exist that over-diagnosis and overtreatment are driven by a supply-induced demand created by pharmaceutical companies and medical providers.

Addressing the shortage of children’s mental health professionals

Another consideration for parents and families is the shortage of professionals providing specialized mental healthcare services for children. Mental healthcare for children is often initiated at the pediatrician’s office, Magellan’s monograph provides the following insights:

Given the significant national shortage of child psychiatrists, there remains a realistic need to rely on primary care clinicians to perform screenings of children for mental health disorders and treat uncomplicated ADHD, anxiety, or depression. However, the problem of follow-up care and ongoing monitoring of mental health problems in pediatric primary care is a matter that must be addressed.

Principles for optimal use of medication to treat children’s mental health

The American Academy of Child and Adolescent Psychiatry published the Practice Parameter on the Use of Psychotropic Medication in Children and Adolescents to promote the appropriate and safe use of medication to treat children’s mental health by emphasizing the best practice principles that underlie medication prescribing. These principles, as highlighted in the monograph, are as follows:

Principle 1: Before initiating pharmacotherapy, a psychiatric evaluation is completed.

Principle 2: Before initiating pharmacotherapy, a medical history is obtained, and a medical evaluation is considered when appropriate.

Principle 3: The prescriber is advised to communicate with other professionals involved with the child to obtain collateral history and set the stage for monitoring outcomes and side effects during the medication trial.

Principle 4: The prescriber develops a psychosocial and psychopharmacological treatment plan based on the best available evidence.

Principle 5: The prescriber develops a plan to monitor the patient, short and long-term. Clinicians should use standardized, objective measures to measure the efficacy of pharmacologic interventions.

Principle 6: Prescribers should be cautious when implementing a treatment plan that cannot be appropriately monitored.

Principle 7: The prescriber provides feedback about the diagnosis and educates the patient and family regarding the child’s disorder and the treatment and monitoring plan.

Principle 8: The child’s assent and parent’s consent are completed and documented before initiating, and at important points during, medication treatment

Principle 9: The assent and consent discussion is focused on the risks and benefits of the proposed and alternative treatments.

Principle 10: Medication trials are implemented using an adequate dose and for an adequate duration of treatment.

Principle 11: The prescriber reassesses the patient if the child does not respond to the initial medication trial as expected.

Principle 12: The prescriber needs a clear rationale for using medication combinations.

Principle 13: Discontinuing medication in children requires a specific plan.

We encourage you to learn more about medication to treat children’s mental health in the full clinical monograph and Understanding and Meeting the Needs of Children and Adolescents at High Risk: Foundations of a Model, which highlights evidence-based prevention and treatment approaches for problematic behaviors and various types of behavioral health challenges in children and adolescents, here. Both provide valuable insights and information to support the critical behavioral health needs of our nation’s children.

This article is part two of our discussion about the impacts on mental health and the war in Ukraine. Click here to read our tips for adults. 

Information on the war is continually changing. The youngest viewers, children, are watching and may experience the fear and stress associated with images from the war in Ukraine.

To add to the stress and concern, this global crisis comes on the heels of being exhausted and socially isolated by the pandemic. The following are some tips to help children that are impacted or stressed by the Ukraine situation.

Listen to children. Children hear and see things. This can be especially frightening if they have a parent deployed. It is important not to force them to talk. Find alternative ways to communicate with children such as drawing or playing with toys.

Calm conversation. It is important for parents to be calm when talking to their children about Ukraine. Parents need to be careful not to be the source of a child’s anxiety. Parents are encouraged to check-in and ask their children how they are doing.

Answer children’s questions. Support and acknowledge what your child is saying and their potential fears. Reassure your child but do not make unrealistic promises. Answer questions and help in separating fact from fiction.

Provide support. Do not let children watch the images of violence on television. Children who have experienced trauma may need extra attention. Some children may not want to talk about the event. It is okay if they would rather play or be outside.

Limit exposure to media and social media. Limit the exposure to graphic violence on media. For older children, watch the news with the child and then talk about how the child is reacting to what they are seeing.

Maintain a normal routine. Encourage the daily routines such as homework, sports, activities to continue.

Watch for changes in mood. Some children show their reactions in nonverbal ways. Watch for anger, physical symptoms, mood changes, or withdrawing from usual activities and conversations.

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

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

Children behavior changes

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

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

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

Interrupted school and family routines

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

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

Family stress affecting children

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

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

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

Back to school and bullying

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

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

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

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

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

By: Linda Y. Evans and Greg Dicharry

Before the COVID-19 pandemic started wreaking havoc on various aspects of our “normal” lives, including our mental health, 1 in 6 children aged 2-8 years in the United States was diagnosed with a mental, behavioral or developmental disorder.[1] While these children have endured the impacts of drastic changes over the past year, so too have others who did not previously have a mental health diagnosis; some children have been newly diagnosed with a mental health condition as a result of COVID-19. When considering how to nurture the mental health of our children during a pandemic, we must understand their pre-pandemic mental state and monitor how they are coping.

Children diagnosed with a mental health condition before COVID-19

For children who experienced mental health challenges before COVID-19, the pandemic may have imposed new complications. In many cases, before COVID-19, families practiced a routine in their daily lives, which helped everyone manage their feelings and behaviors. When routines changed – kids were no longer going to school, adults were working from home, or not at all, and in-person interactions with friends, extended family, and even doctors were cut off – that familiarity and rhythm, and the associated therapeutic effects, were lost. Another part of the pre-pandemic routine for many children with a mental health diagnosis was the special help received by trained teachers and therapists in schools. While this support could be a vital lifeline, it was completely cut off for the kids who depended on it. Other treatment options, through primary care and other outpatient settings, also dwindled due to office closures caused by COVID-19. As a result, an increasing number of children were seen for mental health-related care in emergency departments (EDs). From mid-March to October 2020, the Centers for Disease Control and Prevention reported an increase in the proportion of mental health-related ED visits among children aged 5-11 years (24%) and 12-17 years (31%) compared with the same period in 2019.[2]

Serious mental health impacts for children as a result of COVID-19

Children and youth who started off 2020 without a mental health diagnosis may not have ended the year in the same way, as newly developed depression and other mental health conditions were caused by the pandemic. A CDC report on mental health, substance use, and suicidal ideation during the COVID-19 pandemic shows that while 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%).[3] The serious effects on younger children include delays in social and emotional development, as their brains are forming amidst irregular human activity. In some cases, when parents weren’t adjusting or handling the increased stress and uncertainty well, maltreatment in the form of child neglect or abuse has resulted.

Negative mental health consequences of COVID-19 for all children

Because of COVID-19, all children are coping with unprecedented change and loss. Children feel the family stress of economic hardships, health concerns, social isolation, exhaustion, bereavement, and worsening mental health and substance use. And children have stressors of their own. When healthy outlets, like school, sports, and social engagements, are lost, that energy may become more negative and unproductive. The impacts of missed once-in-a-lifetime childhood events, like birthdays, graduations, and family vacations, may not even be fully realized until later in life. Children and youth may also experience their own anxiety and stress about what the future looks like.

The state of mental healthcare for children

There have always been barriers for children to access mental healthcare. Among them are stigma, availability, misinformation, and lack of information. While these factors impact access to care for adults, as well, they may be more pronounced for children. Parents are afraid or do not want to accept that their child is affected by a mental illness. There is a shortage of child and adolescent psychiatrists and therapists trained to work with children in our country. In addition, many parents and caregivers are misinformed about child psychiatric services that are meant to improve a child’s mental state, and not necessarily their behavior, although the latter may be a secondary effect.

With the pandemic, parents may be so preoccupied that they cannot see potential conditions in their children. The advent of a pandemic has stretched an already thin system of specialized mental healthcare for children at a time when it may be needed the most. And misinformation continues to plague our news sources and social media.

Where to go from here

There are many things that parents and caregivers can do to support and nurture their child’s mental health. We encourage you to learn more in a recording of the webinar, “How are your kids doing?” where I was joined by Greg Dicharry, CPRP, youth empowerment director, to share knowledge and our years of experience working with children to improve mental health and wellness and answer audience questions.

[1] https://www.cdc.gov/childrensmentalhealth/data.html

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6945a3.htm

[3] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Access

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

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

Learn more

Engagement

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

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

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

Learn more

Appropriateness and Effectiveness

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

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

Learn more

Transitions

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

Learn more

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

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

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.