Children who are socially withdrawn, shy, and appear to lack self-esteem are more likely than other children to be targets for bullying. Children who appear confident and strong are better able to discourage children from harassing them.

Parents and other important adults in a child’s life can use these suggestions to help boost a child’s self-esteem:

• Encourage your child to participate in extracurricular activities such as sports or drama, which can raise a child’s confidence and sense of mastery. Sports, in particular, also help build strength, which can level the imbalance of physical power between children. Some children may prefer individual sports (such as karate, gymnastics, and swimming) over group sports (such as soccer or baseball). Drama classes can help children project strength and confidence, even if they don’t feel it at first.
• Help children become involved socially with other children through school, church, or community activities. This way, children will build social skills and learn to be at ease with others. Children who have friends and “hang out” with them at school are less likely to be targets for bullying than lonely children who have no social support.
• Role-play with children to show them how to appear confident and how to handle encounters with children who harass them. Help children learn to look people in the eye and to speak with a strong voice—but not shout—when talking to would-be bullies.

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Childhood isn’t all fun and games. Even young children can feel worried and stressed.

Stress can come from outside sources, such as family, friends, and school. It can also come from children themselves. Just like adults, children may expect too much of themselves and then feel stressed when they feel that they have failed.

How can you help your child with stress?

Adults can help children and teens with stress in many ways. Three important things you can do are to:

• Try to reduce the amount of stress in your lives.
• Help them build positive coping skills.
• Teach them to let stress out.

Reduce the amount of stress in your lives

• Acknowledge your child’s feelings. When children seem sad or scared, for example, tell them you notice they are sad or scared. If appropriate, reassure them that you can understand why they would feel sad or scared.
• Develop trust, and let your child know that mistakes are learning experiences.
• Be supportive, and listen to your child’s concerns. Allow your child to try to solve his or her own problems, if appropriate. But offer to help and be available to your child when he or she needs you.
• Show love, warmth, and care. Hug your child often.
• Have clear expectations without being too strict. Let your child know that cooperation is more important than competition.
• Don’t over-schedule your child with too many activities.
• Be aware of what your child wants (not just what you want).

Build positive coping skills

It is important to help children learn positive coping skills. These skills are often carried into adult life.

• Provide a good example. Keep calm, and express your anger in appropriate ways. Think through plans to reduce stress, and share them with your family.
• Teach them about consequences. Children need to learn about the consequences—good and bad—of their actions. For example, if they do all of their chores on time, they will get their allowance. If they break another child’s toy, they must find a way to replace it.
• Encourage rational thinking. Help your children understand what is fantasy and what is reality. For example, help them see that their behavior did not cause a divorce, or that they are not failures because they were not picked first for something.
• Provide them with some control. Allow your children to make choices within your family framework. For example, allow them to arrange their rooms, choose family activities, and help make family decisions.
• Encourage them to eat healthy foods, and emphasize the importance of a healthy lifestyle.

Get the stress out

Finding ways to get stress out of their systems will help children feel better. The best ways to relieve stress are different for each person. Try some of these ideas to see which ones work for your child:

• Exercise. Regular exercise is one of the best ways to manage stress. For children, this means activities like walking, bike-riding, outdoor play, and individual and group sports.
• Write or draw. Older children often find it helpful to write about the things that are bothering them. Younger children may be helped by drawing about those things.
• Let feelings out. Invite your child to talk, laugh, cry, and express anger when he or she needs to.
• Do something fun. A hobby can help your child relax. Volunteer work or work that helps others can be a great stress reliever for older children.
• Learn ways to relax. This can include breathing exercises, muscle relaxation exercises, massage, aromatherapy, meditating, praying, yoga, or relaxing exercises like tai chi and qi gong.
  • Stress Management: Relaxing Your Mind and Body
• Laugh. Laughter really can be the best medicine. You can be a good role model in this area by looking for the humor in life. Your child can learn this valuable skill by watching you.

©1997–2019, Healthwise, Incorporated

Read the full article here: https://www.healthwise.net/magellanhealth/Content/StdDocument.aspx?DOCHWID=aba5971#aba5972

This document is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Magellan Health does not endorse other resources that may be mentioned here.

“For a turtle to walk forward, it has to stick its neck out. Because Wraparound challenges systems to support families in unique and strength-based ways, staff must take chances when doing things differently than has been done in the past. Hence, they stick their necks out for change and work toward a better future for children, youth and their families.” – National Wraparound Implementation Center

Our challenge as wraparound providers is to stick our necks out for change! We are all working for a better future for the children, youth and families in Wyoming. Though our roles may differ, the objective is the same. Keep more youth at home, in school and out of trouble.

I have had High Fidelity Wraparound graduates tell me, “You saved our family.” The comments are heartfelt and genuine. But in wraparound, we don’t save their family. We do our duties with respect and fidelity. We show up for families, have hard conversations, reframe thoughts and ideas into action items and create tangible goals. We help them start to build a solid team of “go to” people and supports. We give a lot of suggestions and do a lot of work. But we alone, do not save their families.

They save their family. They do the hard stuff. They listen when they don’t yet understand how things could be different. They show up to their wraparound meetings and start to learn the process. They work to strengthen relationships needed for more natural supports. They are brave enough to question systems and processes that don’t work for them. They try new things, even though they are unsure of the outcome. They trust a stranger, like me, who shows up to help. They believe in me, and I believe in them. They keep on building trust in each other and confidence in their own abilities. They keep doing this work until one day they don’t need me anymore. It’s not as if everything is changed, fixed and all challenges solved. They did grab onto a life preserver when it was thrown. They did all the hard stuff to save themselves. That’s the true work. As wraparound providers, we share in the work load, but it is not all ours to do. Not even close.

Some families that I hear from I have worked with over 10 years ago. I believe this is because we built solid connections which are genuine. I stuck my neck out and let people know how to reach out if they ever need me, even after they transitioned from wraparound. What stands the test of fidelity to the model of wraparound is not how many youths are “saved”, but how many families and individuals we influence to create lasting and positive change in their lives. The relationships we build is what sets the stage for how well the process of wraparound gets incorporated into everyday life. We must be brave and risk our necks at times to build authentic relationships with people. We are all vulnerable. Sticking our necks out for the right reasons, at the right time and in right way, keeps Wyoming’s families moving forward.

Who’s with me? Turtles unite!

Magellan Health Insights: Dr. Ghani, thank you for chatting with us today. Why do you think it’s important to be aware of minority mental health?

 Dr. Shareh Ghani: Many psychological conditions have a connection to the individual’s perception of themselves. How comfortable do we feel in our environment? How well do we fit into what is seen as the norm? It’s human nature to want to fit in. Being a minority myself as an immigrant to the U.S. from Pakistan, I can see that there is extra pressure when you may be uncertain about fitting in or what is expected.

Seeking treatment for mental health unfortunately carries a degree of stigma for everyone and minorities are much less likely to seek or receive treatment for mental health conditions. For those who don’t speak the primary language or do not speak fluently, it can be even more difficult to seek these services and treatment. In addition, there may not be bilingual providers available or covered in the network, if the patient has insurance coverage – which is less likely for minority members. We are starting to see improvements, but for immigrants and members of other minority groups, it can be even more difficult to ask for help.

Magellan Health Insights: Why wouldn’t a minority member seek out care for mental health?

 Dr. Shareh Ghani: There are many reasons. Fundamentally, these members are often challenged by the complications of poverty and social determinants of health (SDOH). Language, i.e. communication and or comprehension, can be a barrier. Beyond language, it may not be culturally acceptable to ask for help. It may seem embarrassing. Which leads us to stigma. The person’s community at large, the clinicians and physicians providing care, and even the patients themselves may see it as stigma. People openly discuss their diabetes but not their depression.

 In addition, these patients are less likely to be routinely screened. They also may not be able to specify that their symptoms are symptoms of a behavioral health condition. In the U.S., patients come to me and say they think they may be depressed. In India, my patients would describe physical symptoms – like gastrointestinal problems. This means they may go through a battery of tests to eliminate physical diseases before behavioral health is addressed.

Magellan Health Insights: How can providers best support minority mental health?

Dr. Shareh Ghani: Paying extra attention and being aware of the cultural needs of every individual is key. In order to come up with a successful treatment plan, providers need to be knowledgeable about cultural factors. And they need to ask about what their patients preferences are related to care. Unless and until we talk to each person about their comfort level working with a provider of a particular gender, someone from their own culture or sexual orientation, or even age group, we can’t provide the best treatment. We, as patients, are most likely to speak openly when we feel comfortable. Being able to speak openly with a therapist or provider will make it more likely that the member will be accurately diagnosed and that treatment will be more successful.

Providing culturally competent care is critical – all care must be culturally competent care. What does that mean? We must be able to provide care to patients with diverse values, beliefs and behaviors and meet patients’ social, cultural and linguistic needs. We must acknowledge the importance of culture, recognize the potential impact of cultural differences, and adapt services to meet culturally unique needs. By taking training and educating ourselves on cultural competence we can reduce the racial and ethnic disparities in healthcare and give all of our members the best care. 

Magellan Health Insights: We couldn’t agree more! Thank you, Dr. Ghani!

Read more about Minority Mental Health Here

One suicide is too many. Yet more than 47,000 Americans die each year as a result of suicide. Because suicide is the 10th leading cause of death in our nation, we at Magellan Health believe it is nothing short of a public health crisis. Thankfully many experts and organizations agree.

Recently, Magellan had the privilege to host a suicide prevention conference in Boise, Idaho. The free conference brought almost 200 local and national leaders together to exchange ideas, share successes and discuss solutions around the challenges we face together in addressing this crisis in our communities. Suicide is a topic that’s difficult, but we must talk about it and deal with it by creating an environment for genuine caring for one another. To have the greatest impact possible, this should start by encouraging those who are struggling to ask for help, and we need to remind one another to watch for signs and signals with our family, friends and colleagues.

The suicide crisis is particularly impacting the state of Idaho. In 2017, Idaho’s suicide rate was 22.9 per 100,000 residents. The state’s suicide rate is 58 percent higher than the national rate and reflects a 44 percent increase over the past 10 years.

During the conference, Dr. Michael F. Hogan, principal, Hogan Health Solutions, LLC, gave one of three keynote addresses. He spoke about opportunities to prevent suicide in all healthcare settings. As I shared in my remarks at the conference, I wholeheartedly agree with his perspective. From the examination room to the boardroom, healthcare leaders and executives play a critical role in helping solve this crisis. We must lead the charge—drawing in other key stakeholders like providers, lawmakers, teachers and family members to support efforts to make this crisis visible, reduce stigma and drive solutions.

One important place to start is by ensuring people understand the signs of suicide. First, we must increase education and awareness and promote community and statewide educational programs. We should focus on an audacious goal, a path to zero suicides, to drive the sense of urgency needed to get community-wide buy-in. In addition, we should invest in suicide training for family members and peers of those with a mental health diagnosis. Such training fosters early detection and, in the case of peer support, provides a common frame of reference, making individuals more likely to engage.

Second, we must work to break the stigma around mental health issues — and normalize the need for care. As Dr. Thomas Joiner, The Robert O. Lawton Distinguished Professor of Psychology at Florida State University, said during his keynote address, “Reach out and tell someone when you see that someone is desperate. These person to person connections as we look out for each other can have such a significant impact in reducing suicides. It is important to keep in mind that all of us hold an important role in caring for one another.” Creating opportunities for open dialogue in the community, like the workshops during our Boise conference, helps shine a light on the problem and engages more people in helping others before it’s too late.

Finally, improved access to care and early screening will go a long way toward reducing the risk of suicide. Ensuring people of all economic status and backgrounds have access to behavioral healthcare is key. However, finding specialists who are skilled in suicidology isn’t easy. One study in Maricopa County, Ariz., determined that only 30 percent of behavioral health professionals in the county believed they had the necessary skills and support to treat at-risk patients. We need increased funding for suicide training among all medical professions.

As many as 38 percent of people making a suicide attempt did so within a week of a healthcare visit. Our healthcare system must look for ways to support early detection by making depression screenings part of every primary care visit. To help identify patients with mental health conditions, Magellan Healthcare has developed SmartScreener^SM. SmartScreener is a digital application that contains standard screening tools used by behavioral health professionals like counselors, psychologists and psychiatrists. While the patient waits to be seen by the physician, he/she completes the screener. Answers are confidential and only shared with the physician, who will discuss the patient’s results during the appointment and can help with next steps.

This routine screening is making a difference in identifying patients with behavioral health concerns. In a six-month primary care SmartScreener implementation, approximately half of the patients screened positive for a behavioral health concern. About 38 percent were deemed appropriate to be referred to digital cognitive behavioral therapy (DCBT). Fifty-four percent of these appropriate patients then enrolled in DCBT, getting help for which they may otherwise never have been referred.

The path to zero suicides requires that healthcare leaders—and the nation as a whole—treat suicide as a public health crisis and that we normalize discussions about mental health, suicide and treatment. I hope everyone who attended our Boise conference left as inspired about the urgency of this issue as I did. Let’s all commit to strategies that involve our communities in suicide prevention and draw upon multiple resources for continuing education and improved access to treatment.

 For more information about suicide prevention, read our other blog articles here.

Prior authorization (PA) goes by many names—preauthorization, preapproval, advance notification, precertification and preadmission, to name a few. All these terms refer to the utilization management (UM) process used by many U.S. health insurance companies to ensure patients receive the right services, equipment and prescriptions at the right time and place. PA requires healthcare providers to request and obtain approval before rendering certain services, equipment or prescriptions in order to receive insurance reimbursement for those services. Not everything requires PA. Typically, authorization is needed for more complex services such as hospital admissions, diagnostic tests, medical equipment and complex prescription medications.

The PA process is intended to act as a safety and cost-saving measure. It can lower costs to the patient, prevent unnecessary or invasive procedures, and reduce the use of unnecessary tests that may expose patients to potentially harmful radiation and/or undue stress. For example, up to half of advanced imaging procedures ordered fail to provide information that improves patients’ welfare.[i] In addition, despite studies demonstrating overuse, rates of advanced imaging procedures continue to rise—increasing costs and exposing consumers to excessive radiation.  Despite its benefits, the prior authorization process needs an upgrade.

According to the 2018 CAQH Index , manual prior authorizations (via fax or telephone) are the second most-costly medical administrative transaction, costing providers $6.61 per submission. Providers estimate their staff members spend up to 30 minutes completing one manual prior authorization. While manual prior authorization is a much-debated topic due to the time and cost it requires, many parties support standardizing and simplifying the process.

Technology can significantly  decrease the need for expensive manual processes.  According to the 2018 CAQH Index, the medical industry could save $417 million annually by transitioning to electronic prior authorizations, which includes $278 million in annual savings for providers and $139 million for health plans.

While many health plans offer web portals to process prior authorizations, this approach requires providers to use different online systems for each health plan. Instead, digital solutions should include automation within the electronic health record (EHR) and the physician’s workflow. Automation is essential to reducing inefficiencies for providers and health plans and enabling authorizations at the point of care while maintaining clinical integrity.

The goal is to make the right decision for each patient—quickly and easily so patients get the care they truly need. Automating prior authorizations will benefit everyone involved.

[i]Beachy, D. (2014, September 8). Defensive medicine driving up wasteful imaging. Retrieved from https://www.healthimaging.com/topics/healthcare-economics-policy/defensive-medicine-driving-wasteful-imaging.

As we observe National Minority Mental Health Awareness Month, we sat down with Dr. Rakel Beall-Wilkins, a former Magellan Healthcare medical director.

 Magellan Health Insights: Dr. Beall-Wilkins, thank you for speaking with us today. Of course, everyone’s mental health is critical, but why is it important to pay particular attention to the mental health of Black, Indigenous and People of Color (BIPOC)?

Dr. Rakel Beall-Wilkins: We know that mental health conditions can be successfully treated. However, BIPOC are significantly less likely to receive treatment for mental health conditions, including substance use. And it’s reaching crisis levels, especially among our young people. For example, suicide is now the third leading cause of death among African American males who are 15-24 years old.

Magellan Health Insights: What are the barriers to BIPOC receiving high quality mental health treatment?

Dr. Rakel Beall-Wilkins: BIPOC are less likely to seek treatment, both for their physical and mental health. However, when they do reach out for assistance, they are less likely to receive consistent, high-quality treatment.

There are many contributing factors to these barriers. The high costs of care can be a deterrent. Most BIPOC in the U.S. (with the exception of Asians) have higher than average rates of poverty. BIPOC are more likely to lack insurance coverage, and may only seek emergency care, which costs more and is less effective than sustained treatment. Medications or diagnostic procedures may be viewed as too expensive. Or reliable transportation for follow-up care may not be available.

There are also what are called the social determinants of health (SDoH). These include factors such as consistent transportation, the availability of healthy food, safe and affordable housing, access to education, public safety and working conditions. BIPOC are more frequently negatively impacted by the SDoH. For example, these members are more likely to be homeless or move frequently, which interferes with maintaining consistent treatment. They may lack adequate nutrition and are at greater risk for having associated medical conditions like hypertension or diabetes.

Further, the stigma around mental health conditions, while improving, is still a deterrent to seeking treatment—for everyone. Some cultures may see it as taboo to request help or be seen as someone who needs help.

When BIPOC patients do seek treatment, there may be no one available who speaks their language. In some clinical settings I’ve been in, it could take a week to arrange for an interpreter or a therapist who was proficient in the patient’s language. They may not have a primary care physician (PCP) to help with screening for mental health conditions or provide follow-up care. In addition, the community clinics where BIPOC are more likely to receive care may be understaffed, overcrowded and have long wait times. Understaffing may lead to inadequate screening or even misdiagnosis. And, frankly, the clinic also may not be in a place where the member feels safe traveling so, they may hesitate to go in the first place or return for continued treatment.

Magellan Health Insights: How can everyone, including healthcare professionals, best support minority mental health?

Dr. Rakel Beall-Wilkins: Everyone can help eliminate stigma. Be open to talking and hearing about mental health conditions, and make it clear that you know that having a mental health condition is nothing to be ashamed of. When someone you care about is going through a difficult time, encourage them to get help, and learn ways you can support someone who coping with a mental health challenge.

As healthcare providers, we personally can help by:

• Ensuring we are taking into account each person’s wishes when referring them to other providers: We should ask every patient whether they prefer to see someone of a specific race, ethnicity, gender or sexual orientation.
• Educating ourselves to be more culturally competent and making cultural training a priority for our staff.
• Expanding our workforces with staff from various backgrounds, sexual orientations, cultures and with varied linguistic skills particularly for the unique cultures that are most prevalent in the community.
• Screening for psychiatric conditions during routine visits. Many patients will report physical symptoms instead of talking about the underlying mental health concerns. PCPs and others see many cases of mild or moderate depression during routine care, and screening every patient can help prevent costly emergency visits and admissions. Self-screening tools can also help.

Beyond what we can personally do to educate and equip ourselves and our staff, I believe that the best solutions come from an integrated, collaborative approach. Everyone can help eliminate the disparities. If we work with leaders in the community, for example in churches and schools, we can raise awareness of mental health conditions, destigmatize treatment seeking, help address the social determinants, and improve the lives of everyone in our communities.

While there may be some debate as to who deserves credit for originally developing insulin in the 1920s, there is no doubt that its serendipitous discovery had a life-saving impact. In an attempt to provide affordable treatment to the public, the researchers opted to sell the patent for insulin to the University of Toronto for $1. The researchers later collaborated with a pharmaceutical company to develop insulin due to limited ability of the university to develop it on its own. Once made primarily from animal sources in limited selection, several insulin options are now available, and each product differs slightly in manufacturing and design to better mimic the lacking endogenous insulin in patients with diabetes. Today, insulin is marketed primarily by three manufacturers, and counterintuitive to its length of time on the market as a primary treatment, insulin costs continue to increase. One assessment reported that annual spending per person with type 1 diabetes nearly doubled between 2012 and 2016, and the reported cost of one specific brand of insulin increased by 668% from 2001 to 2015. There are several purported reasons for the high costs of insulin, even resulting in lawsuits and a push for legislative involvement.

The high cost of insulin is a hurdle for many patients and the entire healthcare system, especially considering a reported 1.2 million Americans have type 1 diabetes and a portion of the nearly 30 million Americans with type 2 diabetes are insulin-dependent. So, what happens when a medication necessary for life continues to increase in price? Patients may resort to acquiring insulin from less expensive resources outside of the United States (US). In addition, some patients will continue to use insulin vials beyond their stable use (i.e., beyond 28 days once opened) or share insulin pens. Patients may ration their insulin for their own use or sell the remaining insulin to others, as the temptation for potential income may be too enticing for those with limited financial means. One study reported that the rise in costs has resulted in nearly 25% of patients not taking insulin as directed. Lack of blood glucose control resulting from these measures could be life-threatening.

Taking insulin access to another level, one project aims to develop a protocol for insulin production that would circumvent intellectual property concerns, enabling manufacturers to produce more affordable insulin. Theoretically, an open protocol for manufacturing of insulin could result in community biolab production or somewhat “home-brewed” insulin, but there would still be several costly regulatory hurdles for each product. Even if crowdfunding could support these “biohacked” insulin barriers, would the resulting product be the best treatment for all patients? Would it still result in a high-cost product?

Historically, the US Food and Drug Administration (FDA) has regulated insulins as small molecule drugs; thus, the few generics available are actually branded competitors and considered “follow-on” insulins. The FDA has announced insulins will be transitioned from the small molecule pathway to the biologics pathway effective in March 2020 as part of their Biosimilars Action Plan. According to acting FDA Commissioner, Dr. Ned Sharpless, after this transition, the FDA will be able to license biosimilar and interchangeable insulin products that may be substituted at the pharmacy, potentially leading to increased access and lower costs for patients.

While the idea for “generic” (cheaper) insulin is becoming more of a reality, what will patients do in the meantime for a disease state in which the treatment is not optional? Will interchangeable biosimilar insulin finally be the solution for reversing the constant upward trajectory of insulin prices?