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.

Every April, we recognize National Autism Awareness Month, which focuses on spreading awareness, improving understanding and promoting acceptance of autism spectrum disorder (ASD). Most of us are aware of the challenges families impacted by ASD may face throughout their lives. Research studies, media reports, social media and events help us keep up to date. But do we really think about the many amazing positive qualities people with ASD possess?

Traits that make people with Autism Spectrum Disorder awesome people, friends and coworkers

• Creative—People on the spectrum look at the world differently and process information in a unique way, making them independent and creative thinkers who can visualize solutions to problems that others may not see.
• Detail-oriented—People on the spectrum are highly attuned to detail. Little things that most of us might overlook, such as spelling or punctuation, stand out to individuals on the spectrum. They take note of specific details such as colors and names and remember directions.
• Honest—Many people with ASD are often black-and-white thinkers, so it makes no sense to them to lie. They are not afraid to tell us what they really think, but they tell the truth quite openly and accurately reflect their feelings, whether positive or negative.
• Non-judgmental—Because of their black-and-white thinking, people with ASD rarely compare others to any set of standards or expectations. Therefore, they are more likely to accept differences, see us as we are and not expect us to change.
• Passionate—Many people with ASD have a wide range of interests and are extremely impassioned about the things, ideas and people in their lives. They pursue interests with 100% of their energy and research obsessively until they have a deep understanding of the subject. They spend the time, energy and imagination needed to really master their interests and stick with things through difficulties and frustration.
• Reliable—People with ASD appreciate routines. Once a routine or rule is set, you can rely on them to follow it precisely. If it is on the calendar, you can be sure they will be there and arrive on time.

Keeping an eye on the positive characteristics of people with ASD is key to promoting wider acceptance. Help your family, friends and others learn why they are amazing and special by sharing this blog post.

To learn more about Magellan Healthcare’s work with Autism Spectrum Disorder, click here. 

Sources:            

• https://www.appliedbehavioranalysisedu.org/top-10-awesome-things-about-being-on-the-autism-spectrum/
• https://autismawarenesscentre.com/the-positives-of-autism/

When it comes to healthcare, it is all about the individual, not their condition. Healthcare organizations endeavor to help patients achieve better health, and this goes beyond reducing symptoms and healing injuries.

Behavioral economics—a science that was founded on the idea that “humans are irrational beings, but in highly predictable ways”—is empowering individuals to live healthier lives through programs that guide better decision making and create long-term healthy habits with the following three key principles:

Principle One: Understanding the human element of healthcare with the intent-behavior gap

Have you ever set your alarm to get up early, and then pressed the snooze button… multiple times… missing your morning workout?

If so, you know that achieving better health is easier said than done.

The disconnect between the healthy choices we want to make, and the instantly-gratifying choices we actually make, is called the intent-behavior gap, and it’s one of the key principles driving the science of behavioral economics.

Recognizing that we do not always follow through with our intentions, behavioral economics works to effect change through healthy habit formation. As the right choices become routine habits, it gets easier to match intentions with behaviors for better long-term health.

Principle Two: Overcoming present bias through financial incentives

Behavioral economics explains that we are all subject to present bias, the instant, tangible gratification that often drives basic human motivation. This bias leads us to prioritize immediate desires over things that will be best for us in the long run. As such, present bias is what causes us to order that dessert when we eat out with friends or lures us to stay seated on the couch, binge-watching a sub-standard reality television show when we told ourselves we were going to read.

Because what we want now often overshadows our ultimate goals, offering immediate rewards for making long-term healthy choices can motivate individuals in overcoming present bias and do what is required to be healthy, whether that’s checking glucometer readings regularly, exercising, or taking medication as prescribed.

Principle Three: Leveraging loss aversion to maximize results

If you have ever owned stocks or investments, chances are you are familiar with loss aversion, even if the term sounds unfamiliar. Imagine, your investment portfolio shows significant 15-20% growth across investments over the past year, but one of your investments dropped 10%. Are you focused on all the money you made, or walking away wondering when you could have sold that last stock to avoid a loss?

Loss aversion describes the human tendency to prefer avoiding loss, rather than gaining an equivalent amount. In other words—losing $100 feels worse than gaining $100 feels good. This means that, while traditionally structured incentives programs can be effective in changing patient behavior, they leave significant room for improvement.

Combining these three key principles of behavioral economics, with expert clinical pharmacy solutions, we can support and empower patients to better health, resulting in positive, lasting impacts and outcomes.

Taking your medications exactly as prescribed (improving medication adherence) is one of the most important things you can do to enhance your health and prevent medical complications.

For many Americans, medication adherence can be difficult to maintain. There are a number of barriers that we face every day, from social determinants of health (like medication cost, the ability to get your medication, etc.) to simply remembering when and how often to take your prescription.

As part of your pharmacy care team, we are dedicated to helping you manage your medications so you can live a healthy life. Here are 5 tips for improving medication adherence:

1. Set a reminder: Forgetfulness is the leading cause of non-adherence. Set an alarm on your phone or use a weekly pill organizer to remember when to take your medication, and include a note on how to take your medication (on an empty stomach, with water, with food, etc.)
2. Understand your medication: Understand how your medication works and why it is important to take it as prescribed. Ask your physician or pharmacist follow-up questions about anything you don’t understand. The more you know, the more likely you are to stay on track.
3. Know what happens if you miss a dose: What happens when you don’t take your medication as prescribed? Sometimes it sets back your treatment or can cause adverse effects or symptoms. If you do miss a dose, reach out to your pharmacist! Follow up with them as soon as you remember to minimize negative effects and get back on track.
4. Know your options: We understand that medication can be expensive, but there are things you can do to help reduce the cost to you. Call your health plan to make sure you are using a preferred pharmacy or to find out what medication alternatives are covered and available. If applicable, talk to your pharmacist about filling a 90-day supply, sometimes this can cost less than a monthly refill.
5. Plan ahead for refills:Get into the habit of checking your bottle for the number of remaining refills. Most pharmacies will call your doctor for you when refills run out, but it’s always a good idea for you to know when your prescription is coming to an end.

Anxiety is a normal response to a constant barrage of bad news. Headlines and notifications related to recent events are taking their toll on mental health in what some call “headline stress disorder.”

While this is not a medical diagnosis, the continued anxiety or stress from headlines may cause things like heart palpitations and chest tightness or insomnia. Further progression may lead to physical and mental conditions such as anxiety disorders, depression, endocrine disorders or hypertension.¹ The combination of civil unrest, political instability and COVID-19, and the resulting economic uncertainty, has led to an increase in stress and anxiety in society. Both adults and children may struggle to process their feelings and maintain a sense of normalcy.

Here are some tips to help you understand and manage your fears, how to help children deal with traumatic events and how to know when you or someone close might need help.

Understanding the emotional and physical reactions to traumatic events

Emotional reactions

When the initial shock of a traumatic event subsides, normal emotional responses in the hours and days that follow may come in waves and at unpredictable times. These responses include:

• Fear and anxiety
• Sadness and depression
• Guilt, shame or despair
• Anger and irritability
• Emotional numbness
• Feelings of separation from others

Physical reactions

Physical reactions are the result of stress hormones flooding the nervous system. Common physical symptoms include:

• Difficulty sleeping
• Fatigue
• Headache, abdominal pain or other physical pain
• Racing heart
• Dizziness or fainting
• Change of appetite

How to help yourself

• Take care of yourself first. Eat healthy foods, get enough rest and exercise regularly. Physical activity can reduce anxiety and promote well-being.
• Talk to people you trust about your concerns. A supportive network is important for emotional health.
• Take time for hobbies and fun activities or find interesting volunteer activities. This can be a healthy distraction from everyday stress.
• Limit your exposure to disruptive TV, radio and social media coverage.
• Practice mindfulness and relaxation techniques such as deep breathing and meditation.

How to help children cope with traumatic events

• Be aware of your own reactions to the event and manage your own stress. Stay calm and offer hugs and reassurance to restore your child’s sense of safety and security.
• Share information about the event and answer your child’s questions honestly. Listen to your child’s fears and let them know that it is okay to share their feelings at any time.
• Restrict or prevent contact with disturbing news and social media coverage of the event. Children who see graphic images or hear disturbing news can be re-traumatized.
• Maintain as many stable routines as possible, including regular meals, bedtimes and exercise.
• Engage in fun activities to help the children relax and get the feeling that life is back to normal.
• Watch for signs of trauma, even after weeks have passed. Children, like adults, cope with trauma in different ways, and may show signs of sadness, anxiety or disruptive behavior weeks or months after the event.

Know when to get help

• Common signs that you or your child may need professional help can include: excessive worrying or fear, extreme mood swings, avoidance of friends, difficulty understanding or relating to other people, changes in eating and sleeping habits and inability to engage in daily activities or deal with daily problems and stress.
• If you are suffering from stress reactions that affect your ability to lead a normal life for six weeks or more, you may need help from a mental health professional. While everyone is different and heals at their own pace, some people develop Post-Traumatic Stress Disorder (PTSD) after a traumatic event.
• Signs of PTSD include: disturbing memories, nightmares or flashbacks, suicidal thoughts or feelings, disconnection from others, and trouble functioning at home and work. It is important to seek help if you think you might have symptoms of PTSD.

¹https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104635/

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.