The holidays are a fun and joyous time but also a very busy one, and holiday stress and anxiety in children can and does happen. During the holidays, there are lots of fun activities and events going on, both at home and at school. And while that can be a good thing, the constant hustle and bustle can be just as overwhelming and nerve-wracking for children as it is for adults.

Recognize the signs that your child is stressed out. These signs may include:

• increased irritability or anger
• clinginess
• more crying, whining, or complaining
• sleep troubles (or sleeping too much)
• physical symptoms like headaches and stomachaches
• more or less eating
• isolation and/or refusal to participate in activities
• regressive behavior such as bedwetting or thumb- sucking

Try these tips to help alleviate your child’s stress and make the holiday season a merrier time for everyone:

Set a Calm Example

The most important way parents can help ease anxiety in children during the holidays is by trying to keep things relaxed as much as possible. As with so many situations, the way parents handle an issue can set the tone for how their kids will behave. If you let holiday stress get to you, your kids will definitely pick up on it, and child anxiety is more likely to be a problem in your house. To minimize anxiety in children during the holidays, take steps to handle your own stress and anxiety.

Set Up Conditions for Good Behavior

Avoid taking your child to places such as the mall or holiday gatherings when he is hungry or tired. It’s hard even for grown-ups to deal with noise and lots of stimulation when they’re not feeling their best; kids get hungry more often and become tired more easily, and may understandably have a tough time being on their best behavior and are more likely to experience holiday stress when they’re exhausted or hungry.

Remember the Importance of Routines

The holidays can throw a big wrench into household routines, and that can play a role in anxiety in children.  To minimize holiday stress in your kids, try to get routines back on track once an event or party is over. For instance, if a school holiday concert or a church gathering goes past your child’s bedtime, try to stick to quiet, calm activities the next day and get your child to bed on time the next night.

Watch What They Are Eating

Another thing that can fall by the wayside amidst the holiday hubbub is healthy eating. Between all the extra sugary holiday snacks and the lack of time to sit down  to regular meals, it can be all too easy for kids to eat less healthy foods, which can contribute to holiday stress and anxiety in children. Try packing healthy snacks when you have to go shopping or run other holiday errands and try to minimize the number of sweet treats at home. Whenever possible, offer healthy snacks, such as air-popped popcorn or apple slices with cheese and crackers and limit cookies and candy to after-snack treats.

Get Your Child Moving

Fresh air and exercise are essential for boosting mood and re-setting the spirit, which can alleviate holiday stress and anxiety in children. Make sure you schedule some time to get your child outside to run around and play.

Avoid Overscheduling

As tempting as it may be to accept every invitation from friends and family, try to limit your holiday parties and activities so that you and your child are not overwhelmed. A couple of events a week may be fine, but having an obligation every day can lead to holiday stress and anxiety in children.

Have Your Grade-Schooler Help You

Big kids love to help mom and dad, especially if they get lots of praise for being responsible and helpful. If you have to shop, ask your child to help you look for an item at the store (fun stocking stuffers for cousins, for example). Giving your child a task will not only boost her self-esteem, it’ll distract her and help prevent any holiday stress and anxiety.

Schedule Some Quiet Time

Having some peace and quiet with your child is more important than ever during the busy holiday season. Find a quiet corner and read a book with your child or create holiday pictures for grandma and grandpa. Take a walk outside in nature, away from noise and crowds and obligations.

Remind Your Child and Yourself What the Holidays Are Really All About

A great antidote for holiday stress and the bloated commercialism of the season is helping others, whether it’s by shoveling an elderly neighbor’s sidewalk or by wrapping presents for needy kids at your local church. Helping your grade-schooler become a charitable child will help alleviate her holiday stress and anxiety.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Post-traumatic stress disorder (PTSD) can be a challenge for you and your family. Your family may find it hard to accept some of the changes PTSD can bring to your life. By talking and supporting one another, you and your family will be better prepared for these changes.

Family support

Your family is an important part of your recovery. They can be there to listen and to help you through rough times.

It’s also important that you help your family understand PTSD. They may not always know how to respond when they see you hurting. They may feel scared, sad, guilty, or even angry about your condition.

Talking about PTSD can help you and your family cope. Talk about your symptoms and what triggers them. Discuss different treatments and how they can help you recover. When you open up, your family can better understand what you’re going through.

Family therapy can help. This is a type of counseling that involves your whole family. A therapist can teach you how to work through problems and communicate better.

Talking with your kids about PTSD

Teaching your kids about PTSD is important. They may not understand why you’re feeling bad or why you get angry sometimes. This can be scary for kids at any age. They also may blame themselves for things that aren’t their fault. Make sure your kids understand that they aren’t to blame for your PTSD. When talking with your kids about PTSD:

• Be honest and listen to what they have to say.
• Tell them it’s okay to ask questions. Ask them how they’re feeling, and let them know that their concerns are important.
• Make sure they feel safe, secure, and loved. They may be afraid that something bad is going to happen.
• Provide information about PTSD. Let them know what it is, how you got it, and how you can recover.
• Encourage a good support system of friends outside your family. Get them involved in school activities or youth programs in the community.
• Don’t promise that your PTSD is going to go away soon. Instead, talk about how treatment can help you feel better. It’s okay if you don’t have all the answers.
• Be as positive as you can. Your kids will notice how you react in difficult situations, which can influence their reactions.

Triggers Things that suddenly remind you of your traumatic event are called triggers. Triggers can bring up stressful feelings or cause you to have flashbacks, which means you feel like you’re reliving the event all over again.

Trying to avoid triggers is a common reaction. It’s normal to stay away from things that cause you stress. Because of this, you may feel like you can’t do the things you used to enjoy. This may be hard on you and your family.

Talk with your family about your triggers. They need to know what causes you stress. By being aware of your triggers, your family can help you find ways to cope with them.

Some common triggers include:

• Places, social events, or even smells and sounds. For example, smoke may trigger memories in someone who was hurt in a fire. Or a car that backfires may remind a veteran of gunfire.
• Being around others who were involved in your traumatic event. This may happen when veterans have a reunion.
• The anniversary of your traumatic event. Try to plan enjoyable activities on and around the anniversary date. It may help to be with friends or family.

Coping with holidays

Big holidays like Christmas and New Years can be stressful. The holidays can be a painful reminder of past times when life seemed better. Big groups of family and friends are often part of the holidays.

This may be stressful because:

• Groups tire you out or make you feel overwhelmed.
• You feel pressure to join family activities when you’re not up for it.
• You feel like you have to act happy when you’re not.

Your loved ones also might ask you questions about your life or about PTSD. You may not feel comfortable answering these questions. Keep in mind that your family may feel some of the same pressures.

You can cope with holiday stress by:

• Setting limits. Don’t join activities for longer than you can handle. You can choose when you want to be a part of the group.
• Taking breaks. Go for walks, or set aside a place where you can be alone for a while. This can keep you from feeling overwhelmed.
• Getting plenty of rest. Take naps if you feel like you’re not getting enough sleep at night.
• Talking with your family about how you feel. Your family can help you. Be honest with them about your stress.
• Not drinking too much. Alcohol may make your symptoms worse or cause you to have problems with your family.

For family members If you are the spouse or family member of someone with PTSD, here are some tips for helping your loved one during the holidays:

• Accept the mixed feelings your loved one may have about the holiday.
• Respect and support your loved one’s choices about being involved in the celebration.
• Plan ahead of time how you will cope with stress. This may mean talking about how your loved one will answer questions about PTSD, or deciding how long you will stay at a party.
• Remember to take care of yourself. Do things for yourself to relieve stress.
• Keep your expectations realistic.

The holidays can be a joyful time, offering a chance to reconnect with friends and family. They can also be stressful and hectic. You may feel pressure to buy and give gifts, have concerns about money, or feel like there isn’t enough time to get everything done.

Think about the kinds of events that trigger stress for you during the holidays. Then, you can focus on one or two things you can do that will help the most to reduce stress.

Here are some ideas:

Preparing for the holidays 

1. Know your spending limit. Lack of money is one of the biggest causes of stress during the holiday season. This year, set a budget, and don’t spend more than you’ve planned. It’s okay to tell your child that a certain toy costs too much. Don’t buy gifts that you’ll spend the rest of the year trying to pay off.
2. Give something personal. You can show love and caring with any gift that is meaningful and personal. It doesn’t have to cost a lot. Or, use words instead of an expensive gift to let people know how important they are to you. Make a phone call or write a note and share your feelings.
3. Get organized. Make lists or use an appointment book to keep track of tasks to do and events to attend.
4. Share the tasks. You don’t have to do everything yourself. Share your “to do” list with others. Spend time with friends and family while you share tasks like decorating, wrapping gifts, and preparing the holiday meal.
5. Learn to say no. It’s okay to say “no” to events that aren’t important to you. This will give you more time to say “yes” to events that you do want to attend.
6. Be realistic. Try not to put pressure on yourself to create the perfect holiday for your family. Focus instead on the traditions that make holidays special for you. And remember that just because it’s a holiday, family problems don’t go away. If you have a hard time being around your relatives, it’s okay to set limits on your time at events.

During the holidays

You may not be able to avoid stressful situations during the holidays, but you can plan to respond to them in a healthy way.

1. Take breaks from group activities. Pay attention to your own needs and feelings. Spend a little time by yourself if you can. Meditate, or do some relaxation breathing. Go for a short walk.
2. Keep a regular sleep, meal, and exercise schedule. Limit your alcohol. Taking care of yourself will help you deal with stressful situations during the holidays.
3. Get support if you need it. Holidays can sometimes trigger depression. They can be especially hard if you are already dealing with the death of a loved one or the breakup of a relationship. You may feel embarrassed to ask for help, or you may think that you’ll get over “the blues” on your own. But most people need treatment to get better. Talk with your doctor about counseling and medicine for depression.

Help is available. For additional information, visit MagellanHealth.com/MYMH

By Sam Srivastava and Mostafa Kamal

This week, the federal government took a significant step forward in helping address the opioid epidemic with the signing of the nation’s first comprehensive opioid legislation.

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act addresses a broad range of Medicare, Medicaid, public health and law -enforcement issues and aims to advance the recovery landscape for individuals living with opioid use disorder (OUD) and other substance use disorders (SUDs).

As longstanding advocates for access to mental health and substance use disorder treatment and services, we’re deeply appreciative of the bicameral, bipartisan work of the Congress to successfully drive this critical effort forward. The legislation contains a number of impactful policies we at Magellan Health, and many others, have pushed for, including those recommended in our testimony to Congress this past spring. These critical policies promote clinically appropriate opioid prescribing, support opioid misuse prevention, and enhance access to evidence-based treatment and recovery services.

The signing of this law marks a significant milestone and step in the right direction, and we believe there are several ways it has the potential to address some of the day-to-day challenges of the nation’s opioid epidemic. Three key areas stand out.

Safer prescribing patterns. The SUPPORT for Patients and Communities Act encourages the use of safe and effective alternatives to opioids for pain management, which – in addition to clinically appropriate prescribing practices – are key in breaking the cycle of prescription opioid misuse. These include the establishment of grant programs incentivizing the use of non-pharmacological opioid alternatives, the required implementation of safety limits for opioid prescriptions, new electronic prescribing requirements in Medicare, and beneficiary screening requirements in initial Medicare prevention exams, to name a few.

Our experience demonstrates the power of these and other safe-prescribing interventions—such as the Centers for Disease Control and Prevention’s prescribing guidelines, which Magellan has already implemented—to reduce opioid misuse rates.

Americans consume 80 percent of all opioid painkillers produced worldwide—and the risk of addiction after just four or five days of treatment is high. Opioid prescribing rates have decreased in recent years thanks to nationwide efforts to ramp up provider education. Yet the supply of prescription opioids remains high – approximately 66.5 opioid prescriptions for every 100 Americans in 2016 – reflecting the work still needing to be done.

By exploring alternative therapies to pain management, including non-pharmacological digital therapies, we can eliminate the risk of opioid misuse and addiction, and also equip individuals living with chronic pain with the tools and resources needed to live healthier, more vibrant lives.

Boosted access to evidence-based treatment. One of the most effective, evidence-based treatments for OUD is medication-assisted treatment (MAT)—considered the gold standard for reducing the risk of overdose and death. When combined with psychosocial interventions, like cognitive behavioral therapy and contingency management, and recovery supports, including peer and family, MAT empowers the recovery journey while building resiliency.

Increasing access to MAT is critical to promoting recovery and preventing relapse. Today, while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction.  Even fewer of these actually participate in prescribing MAT and, as a result, access to care is often limited or stigmatized. The SUPPORT for Patients and Communities Act expands providers’ ability to prescribe MAT, including by expanding eligibility for certification to new provider types. With stigma also playing a role in the lack of widespread adoption of MAT, this provision is a solid and necessary step toward expanding access to treatment.

Reaching underserved communities. The SUPPORT for Patients and Communities Act facilitates telehealth options for OUD treatment. In communities with limited resources for one-on-one OUD recovery support, telehealth services or a combination of virtual and in-office services provide the basis for the most evidence-based, person-centered and well-rounded approach to treatment. The package also authorizes pilot programs to provide temporary housing services for individuals recovering from OUD. We believe this is crucial to supporting those living with OUD and other SUDs, especially in rural and underserved communities, return to healthy and vibrant lives.

 The SUPPORT for Patients and Communities Act provides practical policy solutions necessary for addressing this national crisis. From expanded treatment options, to more effective care coordination, to improved prescription drug monitoring programs used to enhance detection and prevention of opioid misuse in real time, this legislation is an important step in the right direction.

We applaud Congress and the Administration on this bipartisan effort and important law, which will have a deep and lasting impact on health for generations to come.

 About the authors:

Sam Srivastava is Chief Executive Officer of Magellan Healthcare, and Mostafa Kamal is Chief Executive Officer of Magellan Rx Management.

Family members can play an important role in helping a loved one with co-occurring mental health and substance use disorders get on the road to recovery. Support a loved one’s recovery by:

• Helping a loved one remember to take all prescribed medications for one or both disorders
• Listening to any concerns about medications – such as their purpose, benefits, and side effects – and helping address those concerns
• Making sure appointments with treatment providers are kept
• Working with the treatment team to stay informed and help address any issues related to medication

To learn more, visit Mind Your Mental Health.

Source: Behavioral Health Evolution

1. Those who abuse prescription opioids are 40% more likely to use heroin than those who don’t.
2. The United States consumes 80% of the world’s prescription painkiller supply, despite not even making up 5% of the world’s population.
3. It’s possible to die the first time you use cocaine, consumption quadruples the risk of sudden death.
4. An estimated 88,000 people die per year due to alcohol.
5. Only about 11% of those addicted to drugs or alcohol actually receive treatment for their substance abuse disorder.

Source: Drugabuse.com

On the 10^th anniversary of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), the Association for Behavioral Health and Wellness (ABHW), the national voice for payers that manage behavioral health insurance benefits for over 175 million people, and its member companies today declared continued support for, and further commitment to, creating parity in behavioral health treatment and coverage.

While MHPAEA was signed into law on Oct. 3, 2008, ABHW and its member companies’ efforts to address mental health and substance use disorder (MH/SUD) parity have a much longer history – decades. As an original member and Chair of the Coalition for Fairness in Mental Illness Coverage (Fairness Coalition), we worked with a diverse coalition of stakeholders to win equitable coverage of MH/SUD treatment, and were an avid advocate and supporter of the final bill that became law.

Mental health and substance use disorder parity is a right. Everyone deserves access to equitable, affordable, medically appropriate, high quality mental health and addiction services and treatment. ABHW member companies have diligently worked to drive consistent interpretation and enforcement of MHPAEA across the United States. We will continue our efforts through:

• Improved access to behavioral health treatment, services, and providers;
• Behavioral health co-payments that align with medical visit co-pays;
• Elimination of arbitrary treatment limitations on the number of days of coverage for a condition, as well as financial limits on annual and lifetime dollar caps;
• Adjustments to prior authorization requirements for mental health and substance use disorder services so that they are comparable to medical benefits; and
• Integration of medical, pharmacy, and behavioral health benefits to increase consumer engagement and reduce overall medical costs.

While great strides have been achieved, we acknowledge that more can be done to ensure that mental health and addiction parity is being implemented in the manner in which it was intended.

• Accreditation – Currently there is no parity accreditation standard that would deem a health plan parity compliant. Recognition of such an accreditation by consumers, federal and state governments, employers, and providers would support consistency of interpretation and assessment of parity compliance.
• Best Practice Examples – Additional illustrations from the federal regulatory agencies of health plans that are implementing MHPAEA correctly or states that are accurately enforcing MHPAEA would be very helpful in advancing parity compliance. If regulating agencies release de-identified information related to non-compliance issues it would provide interested parties with a thorough picture of the regulator’s intent related to MHPAEA and would lead to improved compliance.
• Substance Use Disorder – Currently, there is not parity in the way health care professionals access SUD records. This puts SUD patients at greater risk and inhibits integrated care for these individuals. Since SUD patients and their records are siloed from the rest of medicine, many individuals are receiving substandard, uncoordinated care.

ABHW and its member companies are committed to the full implementation and enforcement of the parity law. We will continue our efforts to work with consumers, employers, health plans, state Medicaid agencies, regulators, legislators, providers, behavioral health interest groups, and others to further parity compliance, educate consumers about the law, and provide the tools and resources needed to make informed decisions.

Signed,

Association for Behavioral Health and Wellness

Aetna Behavioral Health

Anthem

Beacon Health Options

Centene Corporation

Cigna

Magellan Health

New Directions Behavioral Health

Optum

PerformCare
ABHW is the leading health plan association working to improve access and quality of care for mental health and substance use disorders. ABHW’s members include national and regional health plans who care for more than 175 million people. Together we work to reduce stigma and advance federal policy on mental health and addiction care. Member companies – Aetna Behavioral Health, Anthem, Beacon Health Options, Centene Corporation, Cigna, Magellan Health, New Directions Behavioral Health, Optum, and PerformCare.

Parity Progress

Ten years ago today, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was passed into law. This ground-breaking legislation required health plans to treat mental health and substance use conditions like physical medical conditions without treatment or financial limitations. For more than 40 years, Magellan has wholeheartedly supported and actively advocated for parity. Every day, we work together with our customers — health plans, employers, state Medicaid and military and government clients — to innovate new solutions on behalf of those we serve, which continues to advance the law and helps to reduce the stigma around mental health and substance use issues. At Magellan, mental health is fundamentally as important as physical wellness, but it’s just a start.

Beyond equal to individualized and integrated

While our country has made positive strides in parity, we know achieving a healthy, vibrant life is tied to many factors beyond parity – namely social determinants, such as housing, poverty, education and access to transportation and healthy food. One way we are addressing and accounting for these social determinants is by focusing on providing individualized, integrated care.

Complete Care-Person-centered. Community-focused. Evidence-based.

A great example is Magellan Complete Care, which operates person-centered health plans that provide complete care coordination for recipients in Medicare and Medicaid. In the state of Florida, we developed the first-in-the-nation Medicaid specialty health plan to integrate physical and behavioral healthcare and address the social determinants of health for individuals living with serious mental illness and substance use disorders. In Arizona, Massachusetts, New York and Virginia, our Medicaid health plans integrate the full continuum of healthcare services – including mental health and substance use disorder services and treatments individualized to help each member live their healthiest, most vibrant life.

Integrated Health Neighborhoods

Magellan Complete Care plan participants include many individuals who contend with complex conditions that impact their physical health and mental well-being every single day. These individuals need to stay connected to their families, friends, neighbors and others in their communities to maintain independence and achieve optimal health and well-being. Doing so makes the difference between surviving and thriving. To these ends, we have pioneered a care coordination model called the Integrated Health Neighborhood (SM).

This model challenges the definition of what you might think a traditional health plan does for its members. Instead of just focusing on physical and behavioral health treatment, Integrated Health Neighborhoods work within existing community support agencies and local public health systems to strengthen and extend their reach. Our local teams help each member navigate these systems and supports based on their needs as well as their preferences for connecting in their own communities. This helps minimize member disruption through the use of familiar local provider networks and support from trusted community organizations.

Our Integrated Health Network teams are comprised of Magellan associates who live in the same communities as the members they serve. Our assigned teams personally know people at agencies, organizations and local resources across their neighborhood, whom they can call on, person to person, to find the right resources for each member. They work collaboratively to help each individual member find his/her path to independence and well-being.

Recovery Support Navigators

A unique part of the team are the Recovery Support Navigators. These are certified peer support specialists who have lived experiences with some of the same challenges our members face – they have experienced substance use disorders or psychiatric disabilities and may have personally been homeless, had their utilities turned off or experienced food insecurity. They can relate to the members they support, empathize, and then draw on real-world solutions to help them.

For the past 20 years, Magellan has been a leader in increasing access to peer support through partnerships with the recovery community and providers.  We have assisted state customers in developing robust certified peer specialist capabilities, driven in large part by our depth and breadth of experience.   We create shared learning opportunities for the peer workforce and others to improve and enhance the knowledge, skills, and competencies of the peer workforce across the continuum.  Our Recovery Support Navigators represent our best practice approach to tapping the power and potential of peer support.

We know people are more than just a diagnosis – or multiple diagnoses. Truly living healthy, vibrant lives means seeing more than parity for the pieces. It’s seeing and caring for the whole person and bringing together the right resources across the community to help. Integration and individualization are the next steps, and I am proud to say Magellan is out front and on the ground in neighborhoods around the country, taking these steps with our partners and members – together!