As the new COVID-19 vaccine is being administered across the country, many people are feeling a mix of emotions. There is hope that the vaccine will normalize life and relief that the vaccine will save lives.  There is also anxiety about its potential side effects, long-term effectiveness and availability. For some, the stress and uncertainty caused by the pandemic are being exacerbated by vaccine concerns.

Vaccine safety

Although the two vaccines currently available were rapidly developed, they meet the safety and efficacy standards of the U.S. Food and Drug Administration (FDA). The data from the manufacturers and research from large clinical trials show that the benefits of the COVID-19 vaccines outweigh the risks of side effects and coronavirus infection. There are also other COVID-19 vaccines in development that must meet stringent safety standards before they can be released.

In addition, the Centers for Disease Control (CDC) and FDA have expanded safety monitoring systems to continue to track possible side effects of vaccines. A new easy-to-use, smartphone-based tool called V-safe enables vaccinated individuals to notify the CDC about any side effects. V-safe also texts reminders to get the second vaccine dose.

Anxiety about the COVID-19 vaccine

Anxiety can stem from fears about the vaccine’s safety, getting a shot or not having control over when it will be available.

Here are tips to help manage it:

• Stay informed and research credible sources. There is a lot of misinformation online about vaccinations in general. Follow credible news and information sources. Up-to-date information about the COVID-19 vaccines, side effects and benefits, and answers to frequently asked questions, are available on the CDC website.
• Follow recommended guidelines to keep yourself safe. It will likely take months for the COVID-19 vaccine to be available to anyone who wants it. In the meantime, take precautions to protect yourself and your family by wearing masks, maintaining social distance and washing your hands frequently. Minimize your risk of contracting the virus by following CDC guidelines on travel, gatherings and other activities that can spread the virus.
• Make self-care a priority and consistently practice ways to cope with stress. Anxiety can result from a feeling of lack of control and uncertainty, and the pandemic was the perfect storm of both. Get enough sleep, eat nutritious foods, exercise and take time every day for an activity you enjoy.

Finally, remember that feelings of stress and anxiety during difficult times are normal and will pass. If you find that anxiety continually affects your quality of life and you feel overwhelmed, consider talking to a mental health professional.

To learn more about Magellan Healthcare’s mental and behavioral health resources, click here. 

Source: Centers for Disease Control and Prevention

How we can comfort and support each other when grieving

Grieving the loss of a family member, friend or colleague is difficult. The pandemic has made it even harder for many people to cope. Those who have lost loved ones to COVID-19 or other illnesses may face additional grief and sadness. Infection control restrictions have left them unable to visit or say goodbye. Moreover, traditional wakes and funeral services have been modified or eliminated due to social distancing and limits on the size of gatherings, changing the way people can comfort and support each other.

Many people have experienced multiple losses. For example, the loss of a loved one at the same time as unemployment and social isolation.  The resulting grief may be prolonged and complicated with delays in the ability to heal and move forward.

Common Grief Reactions

Pain associated with grief is a normal response to loss and can be felt on emotional, physical and spiritual levels. Common reactions to grief are:

• Initial feelings of shock, denial, and disbelief, which can be heightened when the death is sudden and unexpected
• Feelings of worry, fear, frustration, anger or guilt
• Physical reactions such as headaches, fatigue, difficulty sleeping, loss of appetite, pain and other stress-related symptoms
• Spiritual expressions of grief, such as questioning the meaning and purpose of life, pain and suffering

There is no normal and expected time for mourning to end. Depending on the relationship with the individual and the circumstances of the loss, grief can last for weeks to years. Grief can ebb and flow at unexpected times, triggered by memories of the deceased person, holidays and anniversaries of loss.

Coping with Loss

It is important to find ways to express grief.

• Connect with other people, such as friends, relatives, support groups, and faith-based organizations if applicable, even if the contact must be virtual or by phone. Sharing your feelings with people who understand what you are going through is comforting and eases loneliness.
• Participate in an activity, such as planting a tree or creating a memory book, to honor the person you lost. Ask family and friends to contribute their memories and stories.
• Take good care of yourself. Maintain a balanced diet, moderate exercise and adequate sleep. Treat yourself to something you enjoy, such as a massage or a walk in nature.
• Avoid the use of alcohol, tobacco or other drugs to escape emotional pain.
• Don’t be afraid to ask others for help. Allow other people to assume some of your responsibilities when you are feeling overwhelmed.

When time has passed, if you are still having difficulty functioning, seek support through grief counseling, your EAP, support groups or hotlines. As writer Vicki Harrison said, “Grief is like the ocean; it comes in waves ebbing and flowing. Sometimes the water is calm and sometimes it’s overwhelming. All we can do is learn to swim.”

Find ways to deal with negative emotions

There is no question that the pandemic has affected the mental and emotional health of Americans of all ages. We have experienced months of social isolation, job changes and unemployment, school closures, and other disruptions. This has led to a surge in the number of people reporting high levels of stress, anxiety and depression. Given the uncertainty of when life will return to normal, finding ways to manage negative emotions and strengthen your mental health is important.

Building and exercising resilience skills can help protect your mental and emotional health. Try these tips:

• Stay in touch with positive and supportive people, even if you can’t see them in person. Strong social connections can reduce stress and help you feel happier and more energetic. If you haven’t already, learn to use video platforms like FaceTime and Zoom to stay in touch with friends and family.
• Practice ways to manage everyday stress. For some people, a daily walk eases the pressure of the day. Try meditation, reading, yoga, working on a hobby, listening to music or any other activity that you enjoy. Practice finding something you can be grateful for every day. You will feel more positive and recharged.
• Find what motivates you. Research shows that people who feel they have a purpose in life tend to be happier and live longer. For some, being creative, helping other people or devoting their time and energy to a cause can be the best motivators.
• Make self-care a priority. Physical and mental health are closely intertwined. In difficult times, it is important to get enough sleep, eat a healthy diet and exercise. Avoid using alcohol, tobacco or other drugs to cope with negative emotions; they can make sadness, depression and anxiety worse.
• Limit the amount of time you spend on social media and the news. If you are constantly frustrated and upset over what you see in the news or on social media, limit or take a break from both.
• Maintain your sense of humor and practice reframing negative thoughts. If you become aware that negative thoughts and images are invading your mind, draw your attention to your surroundings. Being present in the moment, or mindful, is one way to break a pattern of negative thinking. Humor is another way to defuse negative emotions.
• Give others the benefit of the doubt. Everyone is affected by the pandemic in one way or another, and others’ emotions may not be obvious. Be kind in any interaction with others.

If you find that your mental health symptoms are negatively impacting your quality of life, consider talking to a professional.

To learn more about Magellan Healthcare’s behavioral health resources, click here.

Normal holiday stressors can be compounded when we miss someone we have lost or are impacted by other hardships. This year, the sense of loss – of a loved one, financial security and a sense of “normal” – has touched many of us due to the COVID-19 pandemic. As we’re making plans to celebrate the holidays in unprecedented times, let’s take a break with Magellan’s Dr. Shareh Ghani as he discusses ways to address feelings of loss, practice self-care and make the most of this holiday season.

Magellan: Dr. Ghani, thank you so much for being here with us to share your many years of expertise in helping patients with behavioral health needs. Our first question: Is it possible to enjoy the holidays when we are experiencing the pain of losing a loved one to COVID-19 or something else?

Dr. Ghani: Thank you for having me. The pandemic has taken a toll on our community as we have lost loved ones prematurely, and we continue to experience sustained emotional pressure as COVID continues to spread. It is vitally important that we celebrate the holidays, exchange gifts and cards, gather virtually, and celebrate life. Spreading love and joy in these trying times will bring much-needed respite to the brain and body and boost our immune systems.

Magellan: How can we overcome feelings of worry and anxiety due to a job loss or other financial insecurity during this holiday season?

Dr. Ghani: Losing a job obviously leads to worry, anxiety and even questioning one’s own competence. The pandemic has helped many people shift focus to the “must haves” and not worry about the “nice-to-have” luxuries in life. Some are paying more attention to their health and fitness, minimizing spend, and planning for the future. Having a good strategy will help reduce the anxiety of uncertainty. If need be, talk to a therapist.

Magellan: Do you have any tips for people experiencing distress over not being able to celebrate the holidays in the way they may have in the past?

Dr. Ghani: One needs to evaluate the reason why we are changing our lifestyle. Social distancing helps stop the spread of the virus. Those who take this threat to our lives lightly may experience distress. Understanding the gravity of the situation alleviates it. We are celebrating in smaller groups so we can defeat the virus and return to our old ways of celebrating holidays safely. Think of it as a form of delaying gratification for better outcomes.

Magellan: What is your general advice for anyone who is experiencing loss to feel better and be able to experience joy this holiday season?

Dr. Ghani: Losing loved ones is a part of our life cycle. Human beings are resilient beings. Remember – those that we have lost would have wanted us to be happy. We should think about the happy moments we shared with those that are not here today and celebrate life.

Magellan: Why is it important to practice self-care and be an advocate for one’s own mental health?

Dr. Ghani: Good eating habits and physical exercise are key to physical and emotional wellness. Sleeping at least eight hours a day, hydrating well and experiencing joy and happiness are also important. All these things help with mental health. Relationships, family, helping others and being grateful add to a joyous life experience.

As winter approaches, efforts in many states across the country to control a second rise in COVID-19 infections also mean continued social isolation and hardship for millions of people. High, chronic levels of stress resulting from unemployment and economic insecurity, school closures, disruption to normal routines, illness, and loss have a negative impact on mental and physical health. In addition to the burden of the pandemic, simmering political and social tensions have left many people feeling distressed and threatened.[1]

As a nation, we face a challenging winter even as coronavirus vaccination news looks promising. It will be months before a vaccine can be widely distributed across the population, and even then, life may not be back to normal. In the meantime, it is important to monitor and care for your mental health as we move through this next phase.

People at Risk

A significant number of Americans report feeling depressed and anxious as a result of the pandemic. People who are already prone to mental health problems, people with low incomes, minorities, young people and isolated older adults (especially those living in facilities) are at higher risk of depression.

If you or a loved one are struggling with persistent feelings of sadness and hopelessness that last for two weeks or more, have lost interest in things you used to enjoy, have thoughts of self-harm and/or experience sleep disturbances and changes in appetite, it is important to see a doctor for an evaluation and possible treatment of your symptoms. There are effective treatments for depression, including medication and various therapies.

Building Resilience

There are several ways to build resilience and prepare emotionally for winter shutdowns. Research shows that resilience skills can be learned and include the following:

• Social connections. A strong social support network is one of the most important parts of building resilience. If face-to-face contact is not possible, stay in touch with family and friends by phone or video. Check in on friends and neighbors who are having a hard time.
• Pay attention to negative thoughts and practice gratitude. Resilient people tend to be optimistic and flexible in their thinking. If the constant negative bombardment of news and social media makes you anxious and unhappy, limit or take a break from your screen time.
• Assess what you can and cannot change. Focus on positive actions that you can take, even if the possibilities seem limited. Tap into your talents: revisit an old hobby or try something you’ve always wanted to do.
• Take care of yourself. Maintain routines, get enough sleep and exercise and eat a healthy diet. Avoid using alcohol or other drugs to combat sadness or boredom.

Having goals and a purpose can also increase resilience. The pandemic has led many to rediscover a new appreciation for their gifts, relationships and the values that give meaning to their lives. If you are doing all the right things to build your resilience and still feeling down, make an appointment with your doctor. You will get through this.

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

[1] Nancy Schimelpfening,“This COVID-19 Spike Will Also Hit our Mental Health with a ‘Second Wave,’” September 23, 2020, Healthline, https://www.healthline.com/health-news/this-covid-19-spike-will-also-hit-our-mental-health-with-a-second-wave#Why-is-the-pandemic-putting-our-mental-health-at-risk?

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.

For November National Family Caregivers Month, we are pleased to share our e-interview with Pat Hunt, executive director of the Family Run Executive Director Leadership Association FREDLA, on family support organizations and how they help families who are dealing with mental health issues.

Magellan: Pat, so glad to have you with us today. Tell us a little about how you came to the work of family leadership.

Pat Hunt: It’s always a pleasure to spend time with folks at Magellan. Like family leaders across the nation, my lived experience has continued to shape the pathway. As a parent, I didn’t want anyone else’s child to struggle the way mine did – or for other parents to have a similar experience as mine. I was so fortunate to have the benefit of allies in my state – other parents, people in state government, providers – all willing to be courageous and develop solutions together. I worked with 16 families across my state to develop a statewide family network with a vision toward positive change. As a family leader, I applied what I had learned from my experience as an advocate – which may be a misunderstood word today – to help other families understand the impact of policy on service array, practice, access, quality, etc. and to have the information, opportunities, skills and resources to effectively participate. This foundation took me to national organizations, such as the Federation of Families, Magellan and FREDLA.

Magellan: You became the executive director at FREDLA almost two years ago. What are you passionate about in your work at FREDLA?

Pat Hunt: Family-run organizations across the nation are the bloodline of the family experience – flowing from the heart of every family they serve. THEY touch lives in amazing ways. FREDLA is here to nourish and support their work – to ensure they have the tools and support they need to be successful, viable and sustainable. That means we also help states, counties, practitioners, health plans and management organizations by providing consultation and training – because they are interdependent in achieving the positive outcomes for children, youth and their families.

Magellan: What should we be looking forward to in the next year on developments in the family support field?

Pat Hunt: 2020 has taught us that the efforts of peer family support partners have been nothing short of herculean during the most challenging of times. They are innovative, dedicated and resilient. The results of FREDLA’s recent national survey will be released soon and used to inform workforce development, technical assistance, national advocacy efforts and research programs. In March, we will be hosting a national event to respond to the needs of parent peer support providers, their supervisors and the funders and management of their programs. Stay tuned, and we hope your audience will as well.

Pat Hunt is the executive director of FREDLA, the national Family Run Executive Director Leadership Association, a non-profit union of leaders of grassroots family-run organizations across the nation. Along with her lived experience as a parent, Pat brings over 25 years of experiences as an advocate for children with behavioral health needs and their caregivers. During this time, she had extensive experience overseeing both federal and state grants and served as the founding director of a family-run organization.

Pat’s experience includes over 10 years in a corporate leadership role at Magellan Healthcare to advance best practices for children, youth and their families, and to ensure that their experiences informed policies, practices and program development. She previously held a senior leadership position as a conduit for local grassroots experience to inform national policy decisions at the Federation of Families for Children’s Mental Health. She has served as a VISTA Volunteer, directed a federally funded rural substance abuse prevention project, managed a statewide family-run organization, served as president of the Maine’s mental health planning council, and was the only non-state employee member invited to the Governor’s Children’s Cabinet.

 This is an excerpt from the Magellan Healthcare eMpowered for Wellness November newsletter. To read the full article, go here.

Depression is a disease. It’s caused by changes in chemicals in the brain that are called neurotransmitters. Depression isn’t a character flaw, and it doesn’t mean you are bad or weak. It doesn’t mean you are going crazy.

People who are very depressed can feel so bad that they think about suicide. They may feel hopeless, helpless, and worthless. But most people who think about suicide don’t want to die. They may see suicide as a way to solve a problem or end their pain.

What to watch for

It is hard to know if someone is thinking about suicide. But past history or events may make suicide more likely.

Things that can make suicide more likely for those suffering from depression include:

• Being male
• Having had a family member attempt suicide or kill himself or herself
• Having access to a firearm
• Having been sexually abused
• Drinking a lot of alcohol or using drugs
• Having attempted suicide before
• Feeling hopeless
• Other mental health problems, such as bipolar disorder or schizophrenia

Warning signs of suicide include someone:

• Planning to or saying he or she wants to hurt or kill himself or herself or someone else
• Talking, writing, reading, or drawing about death, including writing suicide notes and speaking of items that can cause physical harm, such as pills, guns, or knives, especially if this behavior is new
• Saying he or she has no hope, feels trapped, or sees no point in “going on”

Find additional information and resources on suicide prevention here.

For information about Magellan events during National Depression and Mental Health Awareness and Screening Month, downloadable materials and more, visit our website here.

Adapted with permission from copyrighted materials here from Healthwise, Incorporated.  Healthwise, Incorporated and Magellan Health disclaim any warranty and all liability for your use of this information.