#and I had to cancel therapy this week cause I have covid and my therapist wont be here for what was meant to be my appointment next week so

[muskpunk]

yooooooooo 5am ptsd flashback gacha pulls just dropped wooooooo yeah lets go gamers!!!!!

[teawiththeot]

First week of fieldwork. How does treating make me as OT student feel ?

First question people always ask me when I tell them that I am an OT student is ‘ huh what is OT and what do you guys do’ ? I love the concept of OT because we are involved in rehabilitation (regain of loss skills) and habilitation (gaining new skills) through a whole person approach. As OTs we support people in daily functional activity to improve lifestyles and live a more independent life. OT is a required service for patients especially if they are diagnosed with a illness, or had an injury, surgery or disability that may prevent them from being able to engage in daily activities such getting out bed, dressing, feeding, doing laundry, cooking and many more.

To be honest, first year I was not sure what OT really is either? I would usually say: “it’s like Physio but not really Physio” I had struggled to get a well-rounded idea of what OT is and what exactly we do. My second year (in 2020), I still was not sure, but I had an idea, because of COVID- our clinical work was cancelled, so most work had to be done online, I was not expose to real injured clients. We had to do assessment of the client with our families at home, which felt ineffective because “family patient” had no injury or diagnosis and was fully functioning. It is only now beginning of OT3, things are starting to fall into place. We are linking diagnoses, assessment and treatment method and clinical work has officially began for me. So, first week of fieldwork, how does treating make me feel?

To be honest I was nervous and excited at the same to learn more about the role of OT and the treatments we do. I was really looking forward to challenge myself and improve my skills and oh I really got the challenge I was looking for. My client Lauren is a 58-year-old left CVA and has expressive aphasia. Expressive aphasia, also known as Broca's aphasia, is a type of aphasia characterized by partial loss of the ability to produce language (spoken, manual, or written), although comprehension generally remains intact. A person with expressive aphasia will exhibit effortful speech. According to research, it can occur suddenly after a stroke or head injury or develop slowly from a growing brain tumour or disease and once the underlying cause is treated, the main treatment for aphasia is speech therapy. Lauren was admitted to my hospital only last week. She currently has not seen a speech therapist and communicating with her is a challenge. She cannot seem to have a way of saying ‘No’ even when I ask her to nod for yes and shake head for no. assessment such as Pain and sensation cannot be done with her because she can never answer my questions even after simplifying to yes and no., we currently cannot have a conversation, our sessions are filled with instructions from me telling her what do and providing physical assistance such as tapping her to move this leg and demonstrations. I had to look at more functional assessment and treating. Mostly this week, I was focused on assessments as assessments are important because they are focused on getting an understanding of what our patient’s current abilities are and which enablers may affect it. Treatment intervention I was able to do with my client was bed mobility, bed to wheelchair transfer and dressing, because the client has been recently admitted after falling at home, she had decreased strength and needs one person assisting her with ADLs but has some independence, however, she is not doing the methods correctly and could possibly hurt themselves. I had to teach her a correct and energy conservation method to easily transfer from the bed and dressing her gown using hemi-methods. I do not think she has grasped what I had taught her, we would have to repetitions and include the use of assistive devices. Her inpatient intervention is improving the areas of impairment to help her perform her ADLs more independently before returning home.

Therefore, I am excited, anxious, there is so much research that I will have to do about stroke patients, aphasia and handling it but I am looking forward to learning and growing more each and every day of my OT life as the opportunities present themselves and looking forward to helping Lauren improve her lifestyle.  

here are some references used in the blog and more to know research about stroke, stroke symptoms, stroke therapy, aphasia and types of aphasia

https://www.medicalnewstoday.com/articles/7624 -  This article explains why strokes occur and how to treat them. It also explains the different types of strokes

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589849/ - This article goes into depth about the pathophysiology of the stroke, just to understand more about stroke

https://www.mayoclinic.org/diseases-conditions/stroke/in-depth/stroke-rehabilitation/art-20045172 - What to expect as you recover 

https://www.physio-pedia.com/Stroke:_Physiotherapy_Treatment_Approaches -Physiotherapists also play an important role in stroke therapy, here are some of the treatment approaches from a member of the MDT

https://www.aphasia.org/aphasia-resources/brocas-aphasia/- To know about aphasia, types, causes and treatment

[anxious-acushla]

Alexa play Maggie Rogers’ Back in My Body...

I go to therapy every week but my therapist had an emergency and needed to cancel our appointment yesterday so today she called me on my lunch break just to check in. As usual, what was meant to be a very brief thing ended up being a very not brief thing. I told her about how bad my dissociation has been. And when I dissociate it’s like I’m an observer, watching this girl I don’t know, and don’t have particular interest in, live a very mundane (boring) and meaningless life. I didn’t know this wasn’t normal self reflection until I was about fifteen so today when I told my therapist about it she applauded me for being so self aware. We spent the rest of the time talking about my writing and why I’m not doing it. I think a lot of my aversion to writing is related to my dissociation habits which stems from my anxiety (GAD) which has been out of control since New York started opening back up after a strict COVID quarantine. I’d gotten very used to not having to leave my house. I didn’t have to spend most of my mental energy being the perfectionist workaholic. I didn’t have to get up every day and put on makeup and do my hair and look put together. I could do things I wanted to do: writing and yoga and napping. Then quarantine slowly ended and that rug was ripped out from underneath me; I was being thrust back into everything, and I really haven’t been able to find my balance since. What had become a very safe existence suddenly felt very unsafe - cue the trauma responses - cue the dissociation. Suddenly I was scared for all the immunocompromised people in my life and how the job I don’t really love (and most days don’t really like) put me in a position that could possibly cause them harm. A residual event at work (at the job that I left right before the pandemic hit) was gaining steam and then suddenly I was starting a new job, worried that I’d be dealing with the same workplace bullshit again. I was stuck in the past and being forced to live a future I really didn’t want - still don’t really want. I was just going through the motions, watching this stranger live her life, wondering how many more days I’d be forced to watch this god awful marathon of human nothingness. But the old work bullshit is just about done now. I’ve come to a realization with my job and my career that makes it all a bit more bearable. I’m more quiet now but I also care less and it’s honestly really nice. So I’m getting there. Things are a bit less foggy. For weeks the thought of writing made me nauseous. Then I didn’t think about it at all. Now I think about it almost everyday. I still don’t do it. I did put all of the dialogue I’d sketched out into a word doc. Almost 2K words of dialogue that once flowed out of me so easily. I loved CFDD and I want to love it again. I loved writing and I want to love it again. I just kind of need to get back in my body before that happens. And I hope that happens soon.

[technicolordeams]

June 7, 2020

“I'm the girl nobody knows until she commits suicide. Then suddenly everyone had a class with her.” -  Tom Leveen, Party

This has been my status on discord for about a month now. It just feels too relevant to me at these times.

I know I said I was going to update my blog back in May, but it’s taken me until now to get to doing it. Things have been hectic both with me and in the world. I am dealing with emotional trauma still (But I’m not going to talk about it on here. I do not feel safe enough to do so and I’m going to keep it to myself, my therapists, parents, and pastors at my church. Maybe two other people that I know too. Some people know that something went down with me recently but I won’t spread it around anymore. I’d rather not deal with anything... But it has caused me to have renewed trauma from when I was growing up. Surprisingly I don’t have an association with a girl I considered my best friend for seven years who turned out to be a pathological liar and manipulator. I guess I was able to get closure with that one and just be done with it. But the ones from before that... It just brings those back up. Anyways, I won’t go into any further detail about that in this blog.)

So I’ll try to summarize things a bit... But I’ve never been good at keeping things short. xD 

First off, in November of 2019 I started having really bad pains in my stomach. Just... horrific pain. (Before this started, I was working getting a job with the aid of a job coach.) I landed in the ER a total of 4 times, could have been 5 but that fit wasn’t as bad and went away after a couple hours. But in December after my 3rd ER visit to get pain relief and more testing... and some morphine (sorry but this stuff was good. But I know limitations and wasn’t going to the ER for it. It was strictly to ease the pain so I could rest) I had a couple tests done... I FINALLY got an x-ray of my stomach and it showed I had a slightly inflamed gallbladder. Before this, the nurse that was working with me and my parents just believed I was having constipation and I was being too sedentary. That miffed me big time. I remember coming home one day from shopping for groceries and such that my mom was just telling me off about how I need to exercise more... (I have a fear that is ingrained in my head over exercising. Thanks Children’s ED center.) I just went to my room, no lights, didn’t take my jacket off at all, just curled up on my bed and cried as quietly as I could even though I wanted to wail. I was sick of people not believing me when things aren’t going right with my body and I have been mistreated for many things. I didn’t want to hear this from my parents. There was something wrong and I needed help. I did end up getting a HIDA scan after meeting with a surgeon who said the x-ray wasn’t enough proof that there was something wrong and didn’t want to do anything drastic that possibly won’t help me. But I got the HIDA scan which confirmed that there was something wrong with my gallbladder and on my birthday (Horray horray. Legit though I was so happy) I was approved for surgery to get it removed. The surgeon cut my gallbladder open and found A LOT of small gallstones. He was kind of shocked. Over all of this... I lost probably 10lbs? max? Either way, enough to be concerning to me. Now I’m using this experience to get my parents to actually freaking listen to me when I say I’m having problems and that it needs addressed as quickly as possible and quit dragging your damn feet and believe ME.

Also from the surgery, they had to put a breathing tube down my throat. But something happened and has caused me to have chronic coughing fits where I couldn’t even breathe without coughing. And because of my phobia of throwing up, I didn’t want to eat so I started to restrict for a while. Lots of testing was done to figure out what was wrong there... I got an asthma test and it showed that I had a breathing abnormality but the ENT doctor the day before gave me steroids to help. Said it wouldn’t affect my asthma test the next day. It did. :) Had to wait until May to get retested and another test done. The steroids did help for a while... But getting to that point I had been seeing my regular doctor and he gave me a stronger cough medicine that gave me auditory hallucinations... That was terrifying. So I quit that. Was put on another cough medicine that had a controlled substance in it to suppress my cough. It helped... but not enough. In the end since I didn’t want to wait until May to get tested, my doctor got me an inhaler. It actually has helped a lot. I still cough, but it’s not to the gagging/can’t breathe point anymore. I was very scared and stressed and made my dad take me to get lots of tests. Even speech therapist. Due to the covid-19 threat though, I have been heavily isolating myself at home and my asthma test that I was supposed to get last month got canceled/put off to a later date. So I’m stuck paying for an inhaler at full price because insurance is a dick. Anyways that’s that...

In April, I got a puppy. I finally got a dog that I had been thinking about for months and praying for... His name is Echo and he is a yellow lab. The first couple weeks were absolute hell. He would get up at random hours of the night and needs constant supervision. He’s almost 4 months now, but he’s still very much a puppy. He knows sit, stand, down, looks at me if I call his name with a treat in my hand so he’s recognizing his name... And sometimes off when he will listen. I have plenty of bite marks on my hands and stuff xD I had to have an extreme learning curve on how to take care of him. He doesn’t have accidents in the house as much as before, he will usually indicate he needs to go potty by sniffing around and pacing or going to the door and looking at me like, ‘human. I must defecate.’ xD And he’s got quite the attitude. Which I don’t mind as long as he’s not ripping my clothes or biting me or jumping at me. Dad has stepped in to help me during the mornings take care of him since I’m not sleeping well. Which has helped me out a lot. He’s doubled in size already and I’m so happy with how he’s acting for the most part. The past couple days this past week we’ve learned how the hose works and how to have fun in it since it’s so hot outside. (Also learned I’m allergic to grass. Yay.) But there were several days where I was so stressed and scared that I couldn’t keep up with him and take care of him and I’d have to give him away... But I already invested so much money in him and time and have already fallen in love with him, I won’t give him up. Right now he’s sleeping under my desk as I write this post. Lots of the time though I have to force myself to pretend to be happy and praise him and play with him and teach him what to do and what not to... And it’s emotionally exhausting. Especially this past week.

I had a couple triggers the past two weeks. One was a possible fractured toe from jamming it super hard into the corner of my desk... Another I was woken to Echo making a horrific gagging noise that scared the shit out of me. Then I’ve been working with a grief counselor this past month in addition to regular therapy (obviously over video chat because of infection chances...) for extra support. Thankfully it’s pro bono so I don’t have to pay anything and neither does any of my insurances. But while working on a section in my WRAP plan (Wellness Recovery Action Plan) there was a part where I just started shutting down and falling apart. The Crisis Plan. “This is what I look like when I’m well:” That is where everything started falling apart. It has been like 7 months since I have felt well at all. I can identify what it looks like when things get too bad to handle on my own for the most part... but when I was asked about if my behavior endangers or has negative effects on me or others I want my supporters to... I locked up. I realized I do not really have anyone who I can go to for any sort of help. My therapist is the only one I can go to really about anything, but I can’t get the amount of help that I need from just her. She has told me that if there was no virus threat and that I was in a different city, she would recommend me to go to a mental health program there... That’s how bad I’ve gotten. 

In December my suicidal thoughts have sprung back up and I have withdrawn slowly and then faster from everyone. My parents don’t know how to handle me when I’m dealing with emotional distress... They are not very knowledgeable about mental illnesses and are pretty cold to emotional reactions. Sometimes mean. I love them very much yes and I know they would do whatever they could to help me... but when I need support from them specifically, things just go downhill. And I no longer have people I consider friends online anymore. I don’t feel safe to call anyone that right now. A girl from my church who was also in the Bible study I was attending before covid hit has been trying to reach out to me. Her and another lady at church are the only ones really actually reaching out to me. My pastor only stepped back into the picture after I posted asking for prayer for me since I called the suicide hotline the night before. And the things he has said to me already have been rather infuriating. Which makes me feel resentful towards the church I’m attending. That and the fact that nobody else actually reaches out to me at all. I know life has been thrown upside down and many have their own families with small children and such... It just feels very two-faced sometimes. I know that’s my distorted thinking kicking in as well... But it’s there and nobody’s around to disprove it. I am very grateful for the one girl who has been trying hard to reach out to me and encourage and just be there, but I know she knows little about the world and the crap in it and has experienced much if it first hand so far. But God bless her she really does try and care. My therapist has talked with my pastor after I signed a release form for her to do so and my parents have also talked to him about me last week. I have yet to hear from him since then though. They are busy though I know trying to figure out how to deal with this covid crap and how to manage the church so people who can’t go physically can still be sort of included...But I just don’t know if I want to go for a while. 

But yeah. While I have been dealing with the loss of my entire online friend group and then being harassed on facebook and only seeing horrible news about covid and people insulting different people and politicians and crap on there... I disabled it for a while. I posted that I was going to do that several hours before I did and told people to message me if they wanted to keep contact with me somehow... Maybe two people did. Granted I had only 69 people on my friends list and a good chunk were family members from the Philippines and don’t usually speak english... I do feel better about not being on it though. The first couple days when I woke up I’d automatically go to fb to look at my notifications and silly stories that I’d get recommended, but after that I felt complete relief. I did get into a bit of an argument about two weeks or so before I decided to do this with a childhood friend I had... She just irritated me... Making it sound like she shouldn’t be forced to stay in like people higher in risk of infection/death because she was healthy and yada yada... Not going to argue on here. I just realized fb is just a toxic social media outlet and I didn’t want to be a part of it. I’m especially glad I got off of it while I did before the rioting happened. I would rather not have my timeline flooded with it. 

Oh yeah, we did get rioting here where I live. Actually 10min away from where I live. That was scary the first couple nights. First night I was home alone with Echo when it started going down while my parents were at work. Thankfully though, our mayor put in a curfew and my parents’ work was closed down at exactly 5pm for EVERYONE. Including employees. Dad had to work on barricading one entrance way in case of looting. Sent me pictures of what he had to do... it was surreal. Not only do we need to be afraid of covid but now hostile people. (Note: I do NOT condone what those police officers did. They are getting punished heavily I assume. If anything, we shouldn’t have been rioting but instead having a vigil in honor for the man killed. Protesting is fine too. But when it becomes violent... I don’t agree with it. That’s just me though. Anyways enough political crap. I don’t want to discuss it on here.) The past two nights the mayor put up a curfew again for two days but two hours later than before (8pm) just to be on the safe side. My parents’ work has gone back to normal hours today. I did go out yesterday to get some groceries and medicine I needed. My car’s A/C has died. That was two hours of hell. 

But yeah...uhm... The depression has increased this past week. Actually... a couple weeks before that. I had a meltdown over Echo chewing through the wire of my drawing tablet... I had it still hooked up even though I can’t draw anymore (Long story... recent bunch of trauma related reasons) because of trauma and also lazy to get in the back of my computer to unplug it. And sort of hope that I might pick it back up again... But that destroyed me that night. I wasn’t mad at him for doing it. He’s a baby he doesn’t know anything. It was my fault for not paying attention and taking a bit more care with those wires. Dad was able to fix it though. But I can’t look at it. That same night I received a text from a friend I made in treatment that I love to death... Telling me that she had just got home from being hospitalized and then placed in a psych ward after trying to commit suicide. I think I broke then. Ever since then, I haven’t been able to process very much emotion... Sleep has become very bad... I fell asleep in my chair a few nights ago. Last week was the first time I’ve been able to have any sort of reaction to emotion aside from a heavy depression... I need a big trigger to happen so that I can finally release these emotions inside because it just won’t come, but I feel it waiting behind a thick glass wall in my head. I’ve even started watching movies and shows that would scare me normally and would avoid just from reading the premise or a trailer. I don’t really get much feeling from it (aside from the one night I watched the new Carrie movie and I had to take Echo out at night and it was foggy and very spooky). 

I think I’ll leave this here now and be done for a bit... I’ve written quite a lot and I’m sure very few people know of it’s existence and will look. But at least I’ve finally gotten some of it out... somewhere... Hopefully Echo will let me take a nap in a little bit. I would like to talk about my eating disorder at some point and how I’ve been since I got out of the treatment facilities in 2018 and maybe some other things. Been watching a bunch of videos of different mental illnesses because I’ve been running into a lot of people with them and I want to be able to at least know what’s it about and how to be a better person towards them and also not offend anyone so nobody goes off on me again.

[stephenmccull]

A Switch To Medicaid Managed Care Worries Some Illinois Foster Families

Rebecca and Bruce Austin in central Illinois have six kids — ranging in age from 4 to 22.

Five kids still live at home, and all of them came to the Austins through the foster care system. All told, they see 14 doctors.

Many states promise to provide health care to help foster and adoptive families keep kids healthy, but recently in Illinois, thousands of children temporarily lost coverage when the state switched their health plans. Some of Rebecca and Bruce’s children got caught in the coverage gap, which has the Austins wondering whether the state will fulfill its end of the bargain.

Three of the Austins’ children see psychiatrists. One has regular visits with specialists for epilepsy and other health conditions. Another has therapy four times a week for movement and speech delays.

“A typical day is pretty crazy,” Rebecca Austin said in an interview before the coronavirus shelter-in-place orders were issued. “I say I’m a stay-at-home mom, but with all the doctors’ appointments and therapies and appointments and stuff, I’m on the go all the time.”

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Their lives are full and busy already, and Austin is concerned Illinois’ health plan change will make juggling health care even more of a challenge.

The Austins live in Windsor, a rural town about 25 miles from the nearest hospital in Charleston, Illinois.

Since February, the state has been moving all current and former foster children covered by Medicaid into health plans provided by private insurers that contract with the state.

It’s a change to what’s known as Medicaid managed care. The shift has many families like the Austins concerned, because the initial phase of the rollout was rocky and because it’s not clear whether familiar, nearby health care providers will be designated as in-network.

More States Move To Managed Care 

Most states already use managed-care companies to run their Medicaid health plans, which means state agencies pay insurance companies to provide health care to people in the Medicaid program.

More From The Midwest Bureau

View More

Proponents of the managed-care model say it can lower costs while increasing access to care.

States that switch to managed care often find their budgets become more predictable, because they no longer pay providers for each service. Instead, they pay insurers a set amount per enrollee for all health care needs.

But Michael Sparer, a health policy professor at Columbia University in New York City, said evidence is both limited and mixed as to whether managed care lowers costs and increases access to care. Success depends on whether states hold insurers to their promises to maintain an adequate provider network, he said.

“Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to enough in-network primary care and specialty physicians, and all health care services included under the terms of the contract,” according to the National Association of Insurance Commissioners.

Sparer said success with Medicaid managed care also hinges on whether states “have the ability and have the oversight that’s required to make sure that the program works effectively.”

In recent years, Illinois switched most of the state’s Medicaid enrollees into managed care. Former foster children moved onto those plans on Feb. 1, and current foster children are set to eventually join them. The switch was initially planned for April 1, but the state has postponed the move for at least 30 days, citing the COVID-19 pandemic.

Some child advocates question whether the move is in the children’s best interests.

Many foster children have serious physical and mental health needs, and the switch could disrupt long-standing relationships with therapists and other providers, critics of managed care argue.

For thousands of families like the Austins, this means figuring out whether their children’s providers will still be in-network or whether they’ll have to use new doctors, who might be farther from home.

Austin said her family found a managed-care plan that allowed them to keep most of their children’s providers. But when the February switch was finalized, the Austin children were among the 2,500 former foster kids whose health coverage was interrupted.

Camdyn and Caydance Austin play in Camdyn’s bedroom at home in Windsor, Illinois.(Christine Herman/Illinois Public Media)

The “end date” for her kids’ coverage had been incorrectly listed in the computer system as Jan. 31 — one day prior to the coverage start date, Feb. 1, Rebecca said. This effectively left them without insurance. State officials blamed a glitch in the system for the error.

John Hoffman, a spokesman for the Illinois Department of Healthcare and Family Services, said in a statement that the agency worked with managed-care organizations “immediately to correct the error, resolving it within days.”

For the Austins, the error meant they had to cancel appointments and had problems getting prescriptions filled.

“My daughter who has epilepsy, her medicine was … a little over $1,000,” Austin said. “I didn’t have $1,045 to pay her for the medicine and, so, we were in a panic as to what to do because she had to have the medicine.”

Phone calls to pharmacies and insurers were onerous, she said, but she ultimately resolved the issue. Still, the Austins’ youngest, 4-year-old Camdyn, missed two weeks of therapy sessions, while they waited for the new insurer to approve them. Austin worries these delays will slow his progress.

Making Medicaid Managed Care Work

Heidi Dalenberg is an attorney with the ACLU of Illinois, which serves as a watchdog for the state’s child welfare agency. She said managed care can be beneficial, helping ensure all kids get regular well-checks and prevent doctors from overtreating or overmedicating children.

But those benefits will be realized only if the state has prepared for the transition and holds insurance companies to their contract requirements, she said. That includes ensuring managed-care organizations, or MCOs, have appropriate provider networks so children have access to doctors close to home.

“When it doesn’t work is when you have an MCO that is more worried about cutting costs and denying approvals for care than they are in making sure that kids get what they need,” Dalenberg said.

A retired federal judge is monitoring Illinois’ efforts to ensure foster children don’t lose access to care in the switch to Medicaid managed care, Dalenberg said.

Hoffman, the state DHS spokesman, said the switch to managed care, provided by the insurer YouthCare Illinois, will help improve health care for current and former foster children by coordinating and providing services.

“Right now, when a family needs a provider for their child, they’re left to navigate a complex system alone,” Hoffman said in a statement. “With YouthCare, families have a personal care coordinator who helps manage their overall care, researches providers and schedules appointments.”

He said the problems caused by February’s glitch have been resolved and will not resurface when 17,000 current foster children eventually get switched into managed-care plans as well.

The Austins’ foster daughter will be among them. And Austin worries her daughter will be forced to switch to a therapist an hour’s drive away, since the one she sees nearby is not in the managed-care network.

“She has established a relationship with that counselor. She’s been going there for almost two years and now we have to start all over again,” Austin said. “And that’s trauma. That’s a huge trauma.”

Illinois said even providers that are not in-network when the switch goes into effect can be paid for services during a six-month “continuity of care” period, and insurers will try to expand their networks during that time.

The Austins are trying to be optimistic, but the state’s track record doesn’t give them much assurance.

This story is part of a partnership that includes Side Effects Public Media, Illinois Public Media, NPR and Kaiser Health News.

A Switch To Medicaid Managed Care Worries Some Illinois Foster Families published first on https://smartdrinkingweb.weebly.com/

[gordonwilliamsweb]

A Switch To Medicaid Managed Care Worries Some Illinois Foster Families

Rebecca and Bruce Austin in central Illinois have six kids — ranging in age from 4 to 22.

Five kids still live at home, and all of them came to the Austins through the foster care system. All told, they see 14 doctors.

Many states promise to provide health care to help foster and adoptive families keep kids healthy, but recently in Illinois, thousands of children temporarily lost coverage when the state switched their health plans. Some of Rebecca and Bruce’s children got caught in the coverage gap, which has the Austins wondering whether the state will fulfill its end of the bargain.

Three of the Austins’ children see psychiatrists. One has regular visits with specialists for epilepsy and other health conditions. Another has therapy four times a week for movement and speech delays.

“A typical day is pretty crazy,” Rebecca Austin said in an interview before the coronavirus shelter-in-place orders were issued. “I say I’m a stay-at-home mom, but with all the doctors’ appointments and therapies and appointments and stuff, I’m on the go all the time.”

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

Sign Up

Their lives are full and busy already, and Austin is concerned Illinois’ health plan change will make juggling health care even more of a challenge.

The Austins live in Windsor, a rural town about 25 miles from the nearest hospital in Charleston, Illinois.

Since February, the state has been moving all current and former foster children covered by Medicaid into health plans provided by private insurers that contract with the state.

It’s a change to what’s known as Medicaid managed care. The shift has many families like the Austins concerned, because the initial phase of the rollout was rocky and because it’s not clear whether familiar, nearby health care providers will be designated as in-network.

More States Move To Managed Care 

Most states already use managed-care companies to run their Medicaid health plans, which means state agencies pay insurance companies to provide health care to people in the Medicaid program.

More From The Midwest Bureau

View More

Proponents of the managed-care model say it can lower costs while increasing access to care.

States that switch to managed care often find their budgets become more predictable, because they no longer pay providers for each service. Instead, they pay insurers a set amount per enrollee for all health care needs.

But Michael Sparer, a health policy professor at Columbia University in New York City, said evidence is both limited and mixed as to whether managed care lowers costs and increases access to care. Success depends on whether states hold insurers to their promises to maintain an adequate provider network, he said.

“Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to enough in-network primary care and specialty physicians, and all health care services included under the terms of the contract,” according to the National Association of Insurance Commissioners.

Sparer said success with Medicaid managed care also hinges on whether states “have the ability and have the oversight that’s required to make sure that the program works effectively.”

In recent years, Illinois switched most of the state’s Medicaid enrollees into managed care. Former foster children moved onto those plans on Feb. 1, and current foster children are set to eventually join them. The switch was initially planned for April 1, but the state has postponed the move for at least 30 days, citing the COVID-19 pandemic.

Some child advocates question whether the move is in the children’s best interests.

Many foster children have serious physical and mental health needs, and the switch could disrupt long-standing relationships with therapists and other providers, critics of managed care argue.

For thousands of families like the Austins, this means figuring out whether their children’s providers will still be in-network or whether they’ll have to use new doctors, who might be farther from home.

Austin said her family found a managed-care plan that allowed them to keep most of their children’s providers. But when the February switch was finalized, the Austin children were among the 2,500 former foster kids whose health coverage was interrupted.

Camdyn and Caydance Austin play in Camdyn’s bedroom at home in Windsor, Illinois.(Christine Herman/Illinois Public Media)

The “end date” for her kids’ coverage had been incorrectly listed in the computer system as Jan. 31 — one day prior to the coverage start date, Feb. 1, Rebecca said. This effectively left them without insurance. State officials blamed a glitch in the system for the error.

John Hoffman, a spokesman for the Illinois Department of Healthcare and Family Services, said in a statement that the agency worked with managed-care organizations “immediately to correct the error, resolving it within days.”

For the Austins, the error meant they had to cancel appointments and had problems getting prescriptions filled.

“My daughter who has epilepsy, her medicine was … a little over $1,000,” Austin said. “I didn’t have $1,045 to pay her for the medicine and, so, we were in a panic as to what to do because she had to have the medicine.”

Phone calls to pharmacies and insurers were onerous, she said, but she ultimately resolved the issue. Still, the Austins’ youngest, 4-year-old Camdyn, missed two weeks of therapy sessions, while they waited for the new insurer to approve them. Austin worries these delays will slow his progress.

Making Medicaid Managed Care Work

Heidi Dalenberg is an attorney with the ACLU of Illinois, which serves as a watchdog for the state’s child welfare agency. She said managed care can be beneficial, helping ensure all kids get regular well-checks and prevent doctors from overtreating or overmedicating children.

But those benefits will be realized only if the state has prepared for the transition and holds insurance companies to their contract requirements, she said. That includes ensuring managed-care organizations, or MCOs, have appropriate provider networks so children have access to doctors close to home.

“When it doesn’t work is when you have an MCO that is more worried about cutting costs and denying approvals for care than they are in making sure that kids get what they need,” Dalenberg said.

A retired federal judge is monitoring Illinois’ efforts to ensure foster children don’t lose access to care in the switch to Medicaid managed care, Dalenberg said.

Hoffman, the state DHS spokesman, said the switch to managed care, provided by the insurer YouthCare Illinois, will help improve health care for current and former foster children by coordinating and providing services.

“Right now, when a family needs a provider for their child, they’re left to navigate a complex system alone,” Hoffman said in a statement. “With YouthCare, families have a personal care coordinator who helps manage their overall care, researches providers and schedules appointments.”

He said the problems caused by February’s glitch have been resolved and will not resurface when 17,000 current foster children eventually get switched into managed-care plans as well.

The Austins’ foster daughter will be among them. And Austin worries her daughter will be forced to switch to a therapist an hour’s drive away, since the one she sees nearby is not in the managed-care network.

“She has established a relationship with that counselor. She’s been going there for almost two years and now we have to start all over again,” Austin said. “And that’s trauma. That’s a huge trauma.”

Illinois said even providers that are not in-network when the switch goes into effect can be paid for services during a six-month “continuity of care” period, and insurers will try to expand their networks during that time.

The Austins are trying to be optimistic, but the state’s track record doesn’t give them much assurance.

This story is part of a partnership that includes Side Effects Public Media, Illinois Public Media, NPR and Kaiser Health News.

A Switch To Medicaid Managed Care Worries Some Illinois Foster Families published first on https://nootropicspowdersupplier.tumblr.com/

[dinafbrownil]

A Switch To Medicaid Managed Care Worries Some Illinois Foster Families

Rebecca and Bruce Austin in central Illinois have six kids — ranging in age from 4 to 22.

Five kids still live at home, and all of them came to the Austins through the foster care system. All told, they see 14 doctors.

Many states promise to provide health care to help foster and adoptive families keep kids healthy, but recently in Illinois, thousands of children temporarily lost coverage when the state switched their health plans. Some of Rebecca and Bruce’s children got caught in the coverage gap, which has the Austins wondering whether the state will fulfill its end of the bargain.

Three of the Austins’ children see psychiatrists. One has regular visits with specialists for epilepsy and other health conditions. Another has therapy four times a week for movement and speech delays.

“A typical day is pretty crazy,” Rebecca Austin said in an interview before the coronavirus shelter-in-place orders were issued. “I say I’m a stay-at-home mom, but with all the doctors’ appointments and therapies and appointments and stuff, I’m on the go all the time.”

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Their lives are full and busy already, and Austin is concerned Illinois’ health plan change will make juggling health care even more of a challenge.

The Austins live in Windsor, a rural town about 25 miles from the nearest hospital in Charleston, Illinois.

Since February, the state has been moving all current and former foster children covered by Medicaid into health plans provided by private insurers that contract with the state.

It’s a change to what’s known as Medicaid managed care. The shift has many families like the Austins concerned, because the initial phase of the rollout was rocky and because it’s not clear whether familiar, nearby health care providers will be designated as in-network.

More States Move To Managed Care 

Most states already use managed-care companies to run their Medicaid health plans, which means state agencies pay insurance companies to provide health care to people in the Medicaid program.

More From The Midwest Bureau

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Proponents of the managed-care model say it can lower costs while increasing access to care.

States that switch to managed care often find their budgets become more predictable, because they no longer pay providers for each service. Instead, they pay insurers a set amount per enrollee for all health care needs.

But Michael Sparer, a health policy professor at Columbia University in New York City, said evidence is both limited and mixed as to whether managed care lowers costs and increases access to care. Success depends on whether states hold insurers to their promises to maintain an adequate provider network, he said.

“Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to enough in-network primary care and specialty physicians, and all health care services included under the terms of the contract,” according to the National Association of Insurance Commissioners.

Sparer said success with Medicaid managed care also hinges on whether states “have the ability and have the oversight that’s required to make sure that the program works effectively.”

In recent years, Illinois switched most of the state’s Medicaid enrollees into managed care. Former foster children moved onto those plans on Feb. 1, and current foster children are set to eventually join them. The switch was initially planned for April 1, but the state has postponed the move for at least 30 days, citing the COVID-19 pandemic.

Some child advocates question whether the move is in the children’s best interests.

Many foster children have serious physical and mental health needs, and the switch could disrupt long-standing relationships with therapists and other providers, critics of managed care argue.

For thousands of families like the Austins, this means figuring out whether their children’s providers will still be in-network or whether they’ll have to use new doctors, who might be farther from home.

Austin said her family found a managed-care plan that allowed them to keep most of their children’s providers. But when the February switch was finalized, the Austin children were among the 2,500 former foster kids whose health coverage was interrupted.

Camdyn and Caydance Austin play in Camdyn’s bedroom at home in Windsor, Illinois.(Christine Herman/Illinois Public Media)

The “end date” for her kids’ coverage had been incorrectly listed in the computer system as Jan. 31 — one day prior to the coverage start date, Feb. 1, Rebecca said. This effectively left them without insurance. State officials blamed a glitch in the system for the error.

John Hoffman, a spokesman for the Illinois Department of Healthcare and Family Services, said in a statement that the agency worked with managed-care organizations “immediately to correct the error, resolving it within days.”

For the Austins, the error meant they had to cancel appointments and had problems getting prescriptions filled.

“My daughter who has epilepsy, her medicine was … a little over $1,000,” Austin said. “I didn’t have $1,045 to pay her for the medicine and, so, we were in a panic as to what to do because she had to have the medicine.”

Phone calls to pharmacies and insurers were onerous, she said, but she ultimately resolved the issue. Still, the Austins’ youngest, 4-year-old Camdyn, missed two weeks of therapy sessions, while they waited for the new insurer to approve them. Austin worries these delays will slow his progress.

Making Medicaid Managed Care Work

Heidi Dalenberg is an attorney with the ACLU of Illinois, which serves as a watchdog for the state’s child welfare agency. She said managed care can be beneficial, helping ensure all kids get regular well-checks and prevent doctors from overtreating or overmedicating children.

But those benefits will be realized only if the state has prepared for the transition and holds insurance companies to their contract requirements, she said. That includes ensuring managed-care organizations, or MCOs, have appropriate provider networks so children have access to doctors close to home.

“When it doesn’t work is when you have an MCO that is more worried about cutting costs and denying approvals for care than they are in making sure that kids get what they need,” Dalenberg said.

A retired federal judge is monitoring Illinois’ efforts to ensure foster children don’t lose access to care in the switch to Medicaid managed care, Dalenberg said.

Hoffman, the state DHS spokesman, said the switch to managed care, provided by the insurer YouthCare Illinois, will help improve health care for current and former foster children by coordinating and providing services.

“Right now, when a family needs a provider for their child, they’re left to navigate a complex system alone,” Hoffman said in a statement. “With YouthCare, families have a personal care coordinator who helps manage their overall care, researches providers and schedules appointments.”

He said the problems caused by February’s glitch have been resolved and will not resurface when 17,000 current foster children eventually get switched into managed-care plans as well.

The Austins’ foster daughter will be among them. And Austin worries her daughter will be forced to switch to a therapist an hour’s drive away, since the one she sees nearby is not in the managed-care network.

“She has established a relationship with that counselor. She’s been going there for almost two years and now we have to start all over again,” Austin said. “And that’s trauma. That’s a huge trauma.”

Illinois said even providers that are not in-network when the switch goes into effect can be paid for services during a six-month “continuity of care” period, and insurers will try to expand their networks during that time.

The Austins are trying to be optimistic, but the state’s track record doesn’t give them much assurance.

This story is part of a partnership that includes Side Effects Public Media, Illinois Public Media, NPR and Kaiser Health News.

from Updates By Dina https://khn.org/news/a-switch-to-medicaid-managed-care-worries-some-illinois-foster-families/

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Is an 'echo pandemic' of mental illness coming after COVID-19?

New Post has been published on https://apzweb.com/is-an-echo-pandemic-of-mental-illness-coming-after-covid-19/

Is an 'echo pandemic' of mental illness coming after COVID-19?

TORONTO — The coronavirus that causes COVID-19 ravages the lungs in some who get infected, but it is certainly wreaking havoc with the mental health of virtually everyone, whether it touches them or not.

Whether you are on the front-lines in a hospital, nursing home or grocery store, or standing on the sidelines – doing your part by staying home – this pandemic is causing widespread anxiety, fear and dread.

People are afraid of the illness and what it could mean for them or their loved ones, but also about losing their jobs and paying their bills, and when, if ever, life will feel normal again.

Just like this virus, struggles with mental health affects people of all ages, education, income levels, and cultures all over the world.

Many Canadians, estimated at one in five in any given year, personally experience a mental health problem or illness. About 8 per cent of adults will experience major depression at some time in their lives.

Mark Henick is a mental health advocate, speaker and strategist who worries that once the virus emergency is brought under control, it could be followed by “a sort of echo pandemic of depression and anxiety and potentially even suicide” in the midst of “the carnage that this virus has left behind,” he told CTV News medical correspondent Avis Favaro.

Henick’s Why We Choose Suicide Tedx Talk is among the most watched in the world with more than 6 million views. And his successful search to find the man who saved him during a suicide attempt when Henick was a teen was a viral story.

But now the married father of three is living with the financial devastation of this pandemic, just like untold millions of others.

“Over the course of three days last week I had every single event that I was scheduled and contracted to do cancel for the next six months. So, you know, for me to have essentially my entire livelihood ripped out from under me within a few days has been very taxing on my own mental health as well.”

Michelle Garvey of Peterborough, Ont. overcame depression and anxiety to study to become an addiction counsellor and social services worker. But she worries that with her classes cancelled and her routine thrown into turmoil, that she could face a relapse of her symptoms.

“It’s shaken up a lot of things for me,” she said.

“Going back to school for me was something that provided the structure in my day and a new meaning to get out and get moving. So I need to continue having structure in my day so that I don’t fall back into the old ways.”

Garvey said she is reaching out to loved ones and practising mindfulness and gratitude to try to cope.

The rapid spread of this pandemic gave little chance to prepare for, or even process, all that has happened in terms of job losses and the complete upending of everyday life and relationships, says Dr. Roger McIntyre, a psychiatrist and professor at the University of Toronto.

“You lose your job overnight, you lose the security of your paycheque overnight. That is nothing short of an insult to your mental health and well-being,” he said.

“And we already know that being at work is not just a place that one takes away a paycheque, but it’s often a very important source of interpersonal connectedness.”

The immediate fallout can manifest in increased rates of addiction and depression, but McIntyre is particularly concerned about the long-term effects of this pandemic’s economic impact.

“Why I find this scary is that we know from a large body of scientific literature that there’s a close relationship between so-called macro-economic indicators, like unemployment and employment, and mental health and suicide.”

In fact, research out of the Great Depression and other economic downturns, found that a one-per-cent increase in the unemployment rate resulted in a one-per-cent uptick in the rate of suicides.

“This is not just a medical threat. This is an economic, financial threat that is going to have unbelievable effects on people’s mental health.”

The solutions have to be thought out while we are still running for cover against the virus itself, says McIntyre.

The priority must be on getting people back to work as soon as possible, and injecting resources into helping those in distress.

Henick also worries about the “downstream accumulated risk factors” if vulnerable people don’t get the long-term support they need from their landlords, employers, governments and banks.

“When this is all over, say six months from now, and they’re hit suddenly with large interest payments that have accrued on their debt, that’s going to put them in a worse-off position than they were before, and we know that financial struggles are one of the top stressors that negatively impact people’s mental health across Canada.”

Resources

The Centre for Addiction and Mental Health offers a range of FAQs, self-assessment tools, and tip sheets here.

The Canadian Mental Health Association (CAMH) offers some tips to stay mentally well through these difficult times.

Canada’s National Defence department also offers some helpful tips.

World Health Organization (WHO) on coping with stress during COVID-19.

WHO on helping children cope with stress during COVID-19.

List of Canadian Crisis Centre Numbers – National and Provincial

Mental Health Commission of Canada: Tips for managing COVID-19 anxiety

Provincial and territorial resources

BRITISH COLUMBIA

Managing COVID-19 Stress, Anxiety and Depression

BC Mental Health Services

HealthLink BC mental health resources

ALBERTA

COVID-19 and your mental health

Coping and connection for children and families during COVID-19

Alberta Health Services mental health resources

Alberta Health Services program Text4Hope: a free service providing three months of daily Cognitive Behavioural Therapy (CBT)-based text messages written by mental health therapists.

ONTARIO

Ontario mental health and addiction services

Ontario promotes free mental health portal during Coronavirus pandemic

Bounce Back: Free mental health phone line support with a coach and online videos

Big White Wall: Free 24/7 peer-to-peer online mental health support network for Ontarians aged 16+

Toronto professer creates free online course to manage mental health during covid crisis

Psychotherapist Karen Dougherty created Ontario COVID-1 Therapists to offer free therapy to frontline healthcare workers

QUEBEC

Stress, Anxiety and Depression Associated With the Coronavirus COVID-19 Disease

NEW BRUNSWICK

Mental health and coping during COVID-19

Addictions and mental health

SASKATCHEWAN

Saskatchewan Mental Health and Addiction Services

MANITOBA

Government of Manitoba – Mental health and addictions

The Manitoba government launches a free online counselling program to help people struggling with anxiety caused by the COVID-19 pandemic

NOVA SCOTIA

Nova Scotia Mental Health and Addictions

PRINCE EDWARD ISLAND

PEI Mental health and addictions supports

NEWFOUNDLAND AND LABRADOR

Mental health and addictions

NORTHWEST TERRITORIES

NWT Community Counselling Program

YUKON

Mental Wellness and Substance Use Services across Yukon

NUNAVUT

Government of Nunavut – Mental Health

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