VA providers are working together to provide culturally sensitive care to veterans of all backgrounds. Recently, two VA neuropsychologists teamed up to conduct a neuropsychological evaluation of a bilingual veteran through telemedicine. This successful meeting reflects VA’s national goals to improve VA health care services with telehealth.

It seemed like the veteran was really happy to talk to someone who could understand him, Dr. Ana Messler said. And there didn’t have to be that third party, an interpreter, stepping in in case things got lost in translation. It was really cool to see that happen.

A successful bilingual assessment using VA telehealth

Messler, a neuropsychologist at the VISN 20 Clinical Resource Hub, received a request for services for a veteran in a rural area. The referral provider was concerned about the safety of the veterans and whether they were developing dementia. The veteran required a neuropsychological evaluation.

Neuropsychological evaluations include a diagnostic interview and observations, as well as standardized cognitive tests to identify the cause of any cognitive, emotional, and behavioral changes. The neuropsychologist then recommends treatments. Tests vary based on the symptoms experienced by each veteran. They measure skills such as memory, attention, thinking speed, and problem solving. They can also predict veterans’ ability to manage independent living. Test performance can be easily influenced by language and culture.

The evaluation takes several hours. And it can be conducted in-person or via telehealth when the veteran can’t enter a facility. The assessment begins with a diagnostic interview followed by cognitive tests and discussion of the results with the Veteran.

During their first meeting, Messler discovered that the veteran spoke Spanish very well. He therefore decided that a culturally responsive assessment should be conducted in his preferred language. The veteran and his family welcomed him. Messler then contacted Dr. Yesenia Serrano to consult on the case. Serrano is a bilingual neuropsychologist at VISN 4’s Clinical Resource Hub and frequently works with Spanish-speaking veterans.

Traveling to a Spanish-speaking provider in another state was not an option for the veteran. Messler and Serrano then agreed to work together on telehealth assessment, collaborating on case planning. During the assessment, Serrano acted as an interpreter and administered tests involving language. Messler conducted the nonverbal portions of the tests.

Working with a Spanish-speaking provider made the assessment culturally relevant. It was more comfortable for the veteran. It allowed him to be more open with his responses everywhere. This has resulted in greater diagnostic clarity and more appropriate recommendations for treatment. Her caregiver also appreciated the culturally relevant recommendations provided by a provider with a similar cultural background. The veteran and his family were so grateful for the attention given during the evaluation process that, during the feedback session, the veteran exclaimed: Te amo !, in Spanish I love you!

The Power of Telemedicine VA

I think that’s just the power of being able to provide culturally appropriate assessments and having VA providers who have a variety of cultural backgrounds to help our veterans feel comfortable, Messler said. Because he was able to disclose this way, we were able to get the information we needed to help him.

The COVID-19 pandemic has provided opportunities to increase the availability and access of TeleNeuropsychology. VA neuropsychologists are empowered to better serve veterans across the country, regardless of distance from a VA facility. These adaptations allowed Messler and Serrano to help the veteran quickly and without traveling to a VA facility with a Spanish-speaking provider.

Telehealth removes the barriers we once had to reaching all veterans and especially veterans in rural areas, Messler said. And we can often connect with family members back home who may simply accompany them to visit or not attend. Thanks to this collaboration, the veteran was not only able to obtain language-compatible services, but also to be rapidly evaluated by qualified operators and provided with very important therapeutic options that truly represented a turning point in his care. We were able to offer the family ways they could support him.

I think telehealth has helped ensure equity and inclusion in terms of service quality and access to services, Serrano said. And it provides opportunities for VA facilities to work together.

Resources for VA neuropsychologists

Because of cases like this, Serrano and Dr. Julija Stelmokas, a neuropsychologist at the New York Harbor VA, Brooklyn Campus, have been working with other neuropsychologists to facilitate education and improve culturally sensitive neuropsychological care for veterans of all backgrounds.

Veterans should receive assistance in their preferred language, especially when it comes to mental health and neuropsychology, Serrano said.

Messler’s experience with the case sparked his interest in ensuring that veterans of all backgrounds can receive the care that is best suited to their needs. She recently published a literature review, co-authored by two other neuropsychologists, including Serrano, to show the benefits of using TeleNeuropsychology services for culturally and linguistically diverse populations in the United States and its territories.

I got really interested in learning more about TeleNeuropsychology with racially and ethnically diverse veterans groups. Messler said. I think a lot of times people have these questions, they have these cases and they don’t know where to go. We’re trying to encourage people to really want to know more, to develop this area of ​​expertise and to address it.

Serrano said he wants to motivate other VA providers to be culturally curious and to think outside the box to help veterans of all backgrounds.

I want suppliers from all over the world to not walk away from these kinds of cases, to approach and ask others to help and to keep in mind how much impact a little effort can have. It was a great effort on our part. But the result was a positive outcome for the Veteran and the creation of something greater.

According to AARP, which cites data from the US Department of Health and Human Services, about 70 percent of Americans over the age of 65 will need long-term care in their remaining years. AARP notes that along with aging, the possibility of physical or cognitive deterioration increases. Family and friends may not be able to provide adequate care, and it is estimated that more than a third of the aging population will need to pay for the care of trained health care professionals.

Long-term care insurance (LTCI) is one way to deal with this costly possibility.

Consumer advocate Clark Howard notes on his website that long-term care for women averages 3.7 years and 2.2 years for men. Without long-term care insurance, a family can deplete all of its financial resources to provide for themselves or elderly relatives.

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Gail Raab, owner and broker of Insurance Depot, has been advising families on LTCI options for decades. She tells the following story:

I sold a shared long-term care policy to a couple in their 50s. The wife was athletic, in good health, and she did not feel she needed long-term health care coverage. She wanted it for her husband who was seven years her senior, but I explained that she could buy a policy where she and her husband could share the total benefits. If one spouse needs more than 50% of the policy, the other spouses’ share of the policy may be used. Eventually she accepted and purchased the shared LTCI policy. In the first year, her wife had a serious illness that put her in intensive care for a month, in the hospital for another few weeks, and she needed a year of physical therapy and rehabilitation. During this time, she was unable to take care of herself and needed long-term care. She thanked me over and over again for getting her to buy the shared policy, thus saving their retirement funds.

While regular life insurance will pay out the nominal amount of a policy to beneficiaries after one’s death, it does not alleviate the financial burden of a physical or mental illness while the policyholder is still alive. LTCI, while expensive, fills that need and can be applied at home or in an assisted living facility or nursing home where the caregiver works in addition to the facility’s regular staff.

Gail Raab, owner and broker of Insurance Depot, has been advising families on long-term care insurance options for decades.

LTCI is customized to an individual’s desires and wealth. Options can include any daily allowance the buyer selects, starting at $100 per day or $3,000 per month. Other options include the waiting period or number of days before benefits start, including 30, 60, 90, or 180 days; the zero wait period for home health care that begins on the first day long-term care is needed, after which the days used for home care can be used to meet the waiting period in a facility; the number of years the policy will continue to provide benefits, including two to ten years or lifetime; and the inflationary factor of compound interest rates of 3% or 5% simple interest; or no inflation pilot. In addition, couples have the option of receiving separate benefits or shared benefits, so they can take money from each other if needed for long-term care. In general, premiums are not guaranteed and can increase, and the many options affect the cost of the policy.

Medical care for an illness or injury is covered by health insurance policies, Medicare, or Medicare supplements. LTCI, however, only pays healthcare professionals and does not provide any treatment. A long-term care policyholder becomes eligible for benefits when they are unable to perform at least two forms of self-care, such as dressing, eating, bathing, moving in and out of bed, and moving independently. Cognitive impairment automatically qualifies a policyholder for long-term care benefits.

Is long-term care advisable for everyone? Sheldon Berch, an insurance broker for Siegel Insurance, suggests that it’s not imperative that the very wealthy who have sizable insurance policies leave to heirs and still be able to afford skilled care without LTCI. He adds that LTCI is not for the poor who can’t afford LTCI premiums. Georgia’s Medicaid Community Assisted Services program operates under the Aged and Disabled Waiver to help frail older adults stay in their homes or communities and receive services there as an alternative to nursing homes. Those who fall between the two extremes of rich and poor are strongly encouraged to buy LTCI.

Sheldon Berch, insurance broker at Siegel Insurance

Because LTCI is expensive and premiums rise periodically, the decision about when to buy isn’t fixed. Raab believes the best age to purchase long-term care is between 50 and 60. Howard and Berch agree. Berch says this age group often looks to their aging parents, who are in their 70s or 80s and who often don’t have LTCI. The younger group wants to plan for future needs without becoming a financial burden on their children. If purchased at an older age, in the late 60s and 70s, the premiums are much higher even though it is likely that fewer years would be required.

Applicants with serious health problems, such as diabetes, cancer, kidney or heart disease, may be denied LTCI or may be accepted for coverage at higher premiums.

Raab mentions a new long-term care product that Howard calls a hybrid policy. For a total lump sum, an individual can purchase a paid life insurance policy with long-term care benefits. For example, the individual may invest $100,000 with no further premiums and the proceeds will be paid to the insured’s beneficiaries upon her death. If the policyholder needs long-term care, the entire $100,000 can be used for caregivers, leaving no money with the beneficiaries.

However, the insurance company provides another sum corresponding to the nominal amount of the original life insurance policy, to be used if necessary for further long-term care. In this example, the sum would be another $100,000. This insurance product is available to older policyholders in their late 70s who can afford to put a large lump sum into this special insurance plan.

Howard praises the hybrid policy that combines life insurance with long-term care, pointing out that the policyholder gets long-term care coverage along with designated heir life insurance if LTCI is not used. If only a portion of the life insurance is used for long-term care, the balance of the life insurance goes to the beneficiaries upon the death of the policyholder. Hybrid policies replace traditional long-term care policies for the elderly, whose premiums would be prohibitively expensive and would have hikes. It is worth noting that premiums are not required when the insured receives benefits following a claim.

Raab suggests another option. Long-term care policyholders can buy LTCI with benefits that will increase with inflation over the years and wait on them when needed. Gives an example: If a policy is purchased with an annual compound inflation increase of 3% with an initial monthly benefit of $3,750 ($125 per day), that monthly benefit the second year will increase to $3,863, then $3,979 the second year. third year and up to $4,893 in year ten. The inflation factor and the number of years to add to the benefits (20 years or lifetime) are determined at the time the policy is purchased.

Raab shares this caveat: Long-term care policies are indeed worth gold and can prevent financial ruin. A friend’s affluent parents, who lived in an assisted living facility, both developed dementia that required around-the-clock care at the same time. Because they didn’t have long-term care coverage, the exorbitant expenses were paid out of pocket. Both parents have needed care for almost four years. After one parent died, the other parent needed care for another three years. My friend and her siblings have seen their legacy disappear.

The cost of long-term care insurance depends on your age, health status, gender, amount of coverage, how long you wait before starting treatment, and marital status.

Howard candidly states on his website: Getting old is a part of life. At some point, most of us will need treatment. Maybe in a nursing home. Assisted living. Qualified care in our homes. Are you prepared?

Berch adds this solemn advice: Don’t become a financial burden on your children. Do your financial planning now!

Raab is practical about long-term care insurance. When it comes to insurance, something is always better than nothing!

When Jessica Kennedy was five years old, she was diagnosed with bipolar disorder. Her mother told FRONTLINE in the 2008 documentary The medicated child that he couldn’t go a day without taking medication to stabilize his mood.

As long as I’m on medication, I’ll be fine, Kennedy told FRONTLINE when she was 12. It’s the only way to keep me settled. Taking my meds makes me calmer, more like I should be.

Now 28, Kennedy has been off psychiatric drugs for a decade. He said that although they seemed to solve his behavioral problems because he was more compliant, his performance in school suffered and his ideas about him became more lucid once he stopped taking them. Therapy now helps Kennedy deal with what her therapist thinks are symptoms of autism.

The meds were literally dulling all my emotions to the point where they didn’t solve the problem, she told FRONTLINE in a recent interview. I still had them, but I couldn’t express them.

The medicated child documented the increase in diagnoses of bipolar disorder among children from the mid-1990s to the late 2000s. This occurred in tandem with an increase in the prescription of antipsychotic drugs to treat them, despite the lack of independent research at the time on the their safety and efficacy in children. Since then, studies have found that children’s prescriptions for these powerful drugs have decreased, and fewer children are taking them for bipolar disorder. However, experts remain concerned about the lack of access to care beyond medicines amid a worsening mental health crisis for young people.

Diagnosis change and antipsychotic prescriptions decrease

By the mid-2000s, increasing numbers of children were being diagnosed with bipolar disorder, a controversial trend since the disorder was previously thought to exist only in adults.

That increase followed a series of studies at Massachusetts General Hospital led by Dr. Joseph Biederman. In a landmark 1996 paper, Biedermans’ group theorized that many children diagnosed with attention-deficit/hyperactivity disorder (ADHD) also met the criteria for bipolar disorder.

The documentary showed that the rapid increase in bipolar diagnoses was accompanied by an increase in prescriptions of antipsychotic drugs and mood stabilizers, used to quell disruptive behaviors and mood swings in children.

An image of Jessica Kennedy riding a bicycle in the 2008 FRONTLINE documentary “The Medicated Child.”

In the years following 2008, when the documentary premiered, concerns grew that bipolar was not the appropriate diagnosis for all the behavioral patterns practitioners saw. Researchers tried to address this problem in 2013, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the guide doctors use to diagnose mental illnesses. They added a new diagnostic category for children who exhibit strong emotional outbursts and frequent irritability called disruptive mood dysregulation disorder.

The new diagnosis appeared in the depression chapter of the textbook, which may mean that antidepressants often become the first line of treatment, said Dr. Eric Youngstrom, a clinical psychologist who co-chairs the Childhood Diagnosis Working Group on Depression. International Society for Bipolar Disorders. But Youngstrom also said there are numerous studies and analyzes showing that antidepressants aren’t very effective at treating disruptive behavior problems.

So there’s this group of kids that the book is trying to decide, do we look at it as a behavior problem or do we look at it as a depressive problem? he said.

The World Health Organization went with the former, choosing to add a new subdiagnosis to an existing behavioral disorder, instead of adding disruptive mood dysregulation disorder to its diagnostic manual.

From The medicated child on air, studies have shown a decline in antipsychotics prescribed to children. Two recent studies found that antipsychotic prescriptions decreased from the late 2000s to the late 2010s in both privately insured and Medicaid-insured children.

Dr Stephen Crystal and Dr Greta Bushnell, two of the study’s authors, said the decline in antipsychotic prescriptions for children was driven by new safety guidelines, as well as stricter requirements for prescribing such drugs for children. children with Medicaid. Several states require providers to receive approval from the state Medicaid agency before prescribing antipsychotics to children, another hurdle related to declining prescribing. Bushnell and Crystal concluded that this also had spillover effects on privately insured children.

The researchers also observed a decline in the number of children taking antipsychotics specifically for the treatment of bipolar in both the privately insured and Medicaid groups.

That tendency to attribute mood problems, mood swings, challenging behaviors [to] Bipolarity has been somewhat debunked, said Crystal, director of the Center for Health Services Research at the Rutgers Institute for Health, Health Care Policy and Aging Research.

But medications can still be an effective treatment for some children. For children dealing with mood dysregulation disorders, including bipolar, caregivers’ and families’ decisions about whether to take medications must factor in the risk of not treating, said Dr. Janet Wozniak , director of the pediatric bipolar disorder research and clinical program at Massachusetts General. Hospital, in a hospital presentation in January 2020. Delaying treatment, she said, can worsen outcomes in adulthood.

It is terrifying to write these prescriptions; it is terrifying to receive these prescriptions. But what’s more terrifying [is] not treating, he said. Because there are suicide attempts, there is poor judgment, there is reckless behavior, there are criminal arrests, abuse and addiction.

The growing need for therapy outstrips resources

Jacob Solomon was diagnosed with bipolar disorder, ADHD and autism and later Asberger syndrome when he was a child. At one point, he was taking eight different drugs at the same time.

Solomon was 16 when he arrived The medicated child. At 32, she still identifies with each of these disorders and, after years of trial and error and constant healing, she has said she feels like she’s found what works for him.

I really think that being where I am now, having been through all of this, is what matters, she said in a recent interview with FRONTLINE. I passed it.

Jacob Solomon, now 32, is a DJ in Denver, Colorado. (SOLODOME PRODUCTIONS)

Solomon works for United Airlines as a flight training planner and DJ in Denver. He produces and records his own music and has just finished his first album. Now he takes four drugs that he thinks help, but he has found maximum clarity by going to the gym every day. Solomon is not in therapy at the moment, he is currently using ChatGPT as a replacement counselor but has said he wants to get back to therapy soon.

Clinical guidelines recommend that children be counseled with or before using psychiatric drugs. However, Bushnell and Crystals’ study of privately insured children from 2007 to 2017 found that only half of the children prescribed antipsychotics had visited a psychiatrist or received treatment.

Dr. Laura Chavez, a researcher at Nationwide Childrens Hospital in Ohio who has studied the use of antipsychotics and anxiety medications in children, observed a similar dynamic in a 2023 study she co-authored: While diagnoses of anxiety increased from 2006 to 2018, outpatient visits for therapy decreased.

And in recent years, the number of children and adolescents reporting symptoms of anxiety and depression has grown. Diagnoses of ADHD are also on the rise.

Chavez said that despite growing mental health needs, resource shortages have contributed to a decline in therapy visits for children and adolescents.

Primary health care providers are indeed facing an onslaught of patients who really need help but have perhaps the least resources at their disposal to provide mental health, Chavez told FRONTLINE. Not a problem, we will be able to prescribe our way out.

Jessica Kennedy, 28, is now managing her mental health off medication. (Courtesy of Jessica Kennedy)

Kennedy and Solomon grew up with drugs as their primary form of treatment, and both said they’ve now found ways to manage their mental health that aren’t entirely dependent on them. They live alone, something they think others didn’t think was possible when they were children. Kennedy is planning on pursuing a career working with children, working towards a degree in early childhood education.

Looking back on her childhood, Kennedy said: Even though I didn’t have the vocabulary to articulate many things, which made things much more difficult, I feel like paying more attention to the child, and asking the child, and therapy would be big help.

Julia Ingram, Abrams Journalism Fellowship, FRONTLINE/Columbia Journalism School Fellowship

Whitmer’s speech was low on detail and he did not answer reporters’ questions.

Related:

A spokesman said the governor has been sticking to broad goals to make room for negotiations with the legislature, where Democrats’ lead of two House seats could soon disappear if two members win mayoral elections in November and step down.

Republicans interpreted the speech as a “leftist and progressive” wish list from a second-term Democrat, who earlier this year worked with legislative Democrats to enact sweeping policy changes, including repeal and codification of the right to work in favor of trade unions. of LGBTQ rights.

Here’s what Whitmer hopes to work on:

A mandate for paid leave

Whitmer backed the push to provide paid family and medical leave for all Michigan workers, granting time off for childbirth or ill health, but did not propose specific details or approve the legislation.

Whitmer called the matter “personal,” noting that when she had her first child, she was also caring for a mother who was dying of brain cancer. “I was sandwiched between them,” she said. “That time shaped me and showed me the challenges so many Michigan residents experience every single day.”

House Minority Leader Matt Hall, of R-Richland Township, slammed the proposal, arguing it would create a “payroll tax” for both small businesses and workers.

He pointed to a recently introduced Democratic bill for up to 15 weeks of paid annual leave that would require employers to pay into a state fund and allow them to deduct up to 50% of the cost from employees’ paychecks.

Business groups wary of a broad government mandate have also criticized the idea.

“Most small business owners already go to great lengths to provide paid time off and flexibility for their employees. This mandate could lead small business owners to downsize or go out of business altogether,” said Amanda Fisher, state director of the National Federation of Independent Businesses . she said in a statement.

Proponents argue that a robust paid leave law would help employers fill job vacancies while encouraging more people to re-enter the workforce.

Leave is critical to ensuring full labor participation, Monique Stanton, CEO of the Michigan League for Public Policy, a nonprofit that advocates for the poor, told Bridge Michigan.

Michigan has seen a pretty significant drop in the number of women in the workforce, and things like paid family leave help with that.

A 100% clean energy standard.

Whitmer offered broad support in a legislative push to require Michigan utility companies to produce 100 percent of their energy from clean, renewable sources, but the governor stopped short of proposing a deadline by which companies of public services would have satisfied this requirement.

Democrats in the Michigan Legislature have proposed requiring 100 percent clean energy generation by 2035, a timeline that would require, among other things, an aggressive phase-out of several newly built natural gas plants.

Whitmer has not yet committed to that timeline. Its previously published climate change plan calls for a zero-carbon energy standard by 2050.

But the governor said she and the House agree on ensuring that all of Michigan’s energy production comes from wind, solar or what she calls other common-sense sources, including nuclear.

We can achieve 100 percent clean energy by balancing reliability and affordability, Whitmer said.

State Representative Phil Green of Millington, who appeared to be the only Republican lawmaker to attend Whitmer’s speech, criticized the proposed clean energy mandate and suggested it would make Michigan a Third World country.

We already know this will drive up prices, Green said.

It puts us at a competitive disadvantage compared to manufacturing plants being built in China (and powered by coal-fired power plants). I see no way that this will improve Michigan’s economic position.

Solar and wind permits move into the state

Whitmer supported pending Democratic legislation that would move permits for larger wind and solar projects to the Michigan Public Service Commission, rather than city councils, where local opposition has delayed or derailed several developments.

Critics argue that the Democratic plan would divest control of local officials who know their communities best.

But Whitmer said the proposed state process would ensure that local perspectives are reflected in the planning process, while allowing us to move forward faster with the installation.

it should be easier to create jobs and build wind and solar projects. We enable clean energy projects through the MPSC just like all other sources of energy, the governor said.

Repeal the antiquated abortion law, expand insurance

Whitmer confirmed support for what advocates are calling a reproductive health law that would repeal several existing abortion laws, including a 24-hour waiting period law that requires women to be informed a full day before proceeding with a abortion.

We protect the freedom to make one’s own decisions without interference from politicians, Whitmer said, suggesting the state establish the right to abortion added to the state constitution last year through Proposition 3 approved by voters.

In a policy outline, the governor’s office also said Whitmer wants to ensure everyone has access to an abortion, regardless of where they live, work or what type of insurance they have.

Among other things, Democrats want to repeal a 2014 Michigan law that bars private insurers from automatically including abortion coverage in their policies, instead requiring customers to purchase a separate clause.

Abortion rights groups also want Michigan to become the 18th state to allow government-funded Medicaid insurance for low-income residents to pay for abortions. This would require state funds because federal funding can only be used to cover abortions in life-threatening cases, rape or incest.

Right to Life of Michigan, which helped enact many of the state’s existing abortion laws, accused the governor of using the passage of Proposition 3 as a Trojan horse to remove common-sense provisions meant to protect women and children who seek or undergo an abortion, as well as basic parental rights.

Codify the Affordable Care Act

With the federal Affordable Care Health Act facing legal challenges a decade after becoming law, Whitmer proposed codifying at the state level what she called the common-sense and cost-saving measures of the Affordable Care Health Act. it was Obama.

This includes: protections for residents with pre-existing medical conditions, the ability to remain with parental insurance until age 26, a ban on annual or lifetime coverage limits, and requiring insurance plans to cover essential services such as travel in ambulances, maternity care, mental health care and birth control.

Every Michigander deserves quality, affordable care, Whitmer said.

Prescription Drug Panel

Whitmer proposed creating what he called an independent, nonpartisan Prescription Drug Affordability Board, made up of leaders in business, healthcare, supply chain and academia, which would use data and evidence-based research evidence to address the cost of prescription drugs.

The governor did not provide further details about the board, how members would be selected or what authority they would have.

But he cited recommendations from a previously named task force that called for drug liability review committees that would have the authority to penalize and regulate certain entities in the prescription drug supply chain.

We need to hold bad actors along the supply chain accountable for rising prices while encouraging research and development for new treatments and cures made right here in Michigan, Whitmer said Wednesday.

Simplify business permits

Whitmer called on the Legislature to work with her to improve the state’s permitting process for construction projects, but offered few details about what she would like to accomplish on that front.

The governor said he wants to “streamline” permits for advanced manufacturing, infrastructure and construction projects, among others.

“I’ve heard from business leaders, especially from people in other states, that no state has gotten the permits right yet,” Whitmer said. “Michigan should be first. This is a bipartisan priority and I know we can get it done.”

Protect democracy

Whitmer said he wants to help protect democracy by, among other things, increasing election security and protecting election workers from intimidation.

“We cannot allow the will of the people to be sidelined or overturned, and we cannot allow politicians to remain in office despite being ousted,” Whitmer said, referring to former President Donald Trump.

As a third mom who is breastfeeding a 12-week-old baby, I respectfully ask that CMS enforce the legislation and policy established in 2012. As the Kaiser Family Foundation report on Medicaid coverage of pregnancy-related services points out, many states are currently not compliant to ACA requirements.

Right now, the United States is woefully behind our peers in all things maternal health. Our maternal mortality rates are worse than those of our parents’ generation, women’s and maternal health is understudied and underinvested in, and women’s pain during pregnancy and postpartum is continually ignored.

The failure of the US health care system to support women is incredibly short-sighted. Economists Henry Paulson and Timothy Geithner have published a report on economic uncertainty in the United States and one of their main recommendations is that the country needs population growth, even starting with new births. Some members of Congress are even calling on US women to focus on thriving families, but they don’t support investing in maternal and child health.

Today, most states do not allow breastfeeding support providers to enroll as Medicaid providers, which severely limits access. In some cases, it’s because there is no provider-type designation for lactation consultants. States may require credentials such as MD, NP, PA, or RN, as well as certification as an International Board Certified Lactation Consultant (IBCLC). Many states integrate breastfeeding support services into the overall maternity care payment rather than reimburse them separately, which creates a disincentive to providing care and is time-limited, while many parents require support beyond the postpartum care visit. The universal payment for maternity care is already too low, so there is no longer any room for breastfeeding and infant feeding support, which are a clinical specialty. However, as in the case of women’s health, these specialties are rejected and devalued, despite their enormous health benefits.

Breastfeeding the infant is deeply connected to the maternal health experience, including the physical and mental health of the mother and the health of the infant. Those first hours, days and months are critical to your baby’s well-being.

We know that breastfeeding support helps improve breastfeeding rates for those who choose to breastfeed (and it’s their choice!). Society does not support those who want to breastfeed despite the obvious public health benefits that come with it. Research shows that families in maternal health deserts lack access to support services, and this is especially true for Black women.

Support for breastfeeding initiated during pregnancy reaches patients before the baby is born to help address other maternal health issues. Early mental health screenings can detect the risks of postpartum depression and anxiety. Postpartum lactation support appointments are also a good way to remind patients to show up for the six-week postpartum visit, which historically has been attended by only 60 percent of patients. The six-week postpartum appointment is essential to check the mothers health, including blood pressure to prevent preeclampsia and control diabetes problems or anemia problems.

The ACA’s CMS Medicaid Breastfeeding Services coverage must apply. Women have been waiting for 11 years.

Andrea Ippolito is a health technology expert and founder of SimpliFed, a maternal health company that provides support for infant feeding and breastfeeding.

Opinions expressed in Fortune.com comments represent the views of the respective authors only and do not necessarily reflect the views or beliefs ofFortune.

WESTFIELD, Indiana — During their visit to Westfield High School Wednesday, First Lady Jill Biden, along with general surgeon Dr. Vivek Murthy, spoke with students and staff about the importance of mental health services within schools.

According to previous reports, the first lady arrived in the Indianapolis area on Wednesday as part of a series of back-to-school events around the country. Biden, along with Dr. Murthy, highlighted the importance of mental health resources for schools and how federal programs have supported mental health resources across Indiana and across the country.

When they arrived, Biden and Dr. Murthy met with a group of students from the Westfield High School chapter of the Robbie’s Hope organization, a student organization focused on suicide prevention. The students talked to them about the group’s mission and what they are doing to spread mental health awareness among students at Westfield High School.

During the visit, the first lady and the surgeon general also participated in a panel discussion with school officials to hear how the school, district, state and federal government work together to support students’ mental health needs. The roundtable was hosted by Biden and Dr. Murthy to learn more about how to improve mental health services federally for students and the wider community.

During his speech, Biden said in his class, there are still some students who struggle with anxiety and feel isolated. Biden teaches English and writing at Northern Virginia Community College.

As a teacher, she said she has worked with students to build community within the classroom, expressing the importance of sharing their stories and experiences.

Biden praised the Robbie’s Hope organization, saying that when she learned what they were doing in Westfield, she had to come and see them. He also praised the work done by President Joe Biden and the current administration to invest in the mental health of young people.

The first lady said Indiana has been a great partner in federal efforts to help young people through this mental health crisis.

“It’s not the political details or the legislative victories,” he said. “…It’s okay to not feel good and you’re not alone. You shouldn’t have to tackle the corners of the world alone.”

As Surgeon General, Dr. Murthy said the goal is to break down the “terrible stigma” surrounding mental health, especially for young people, which he says is a significant public health emergency in the United States.

As he traveled across the country, Dr Murthy said he listened to the concerns of students, who spoke to him about what’s causing mental health problems, including social media, bullying and “incessant pressure” within of the country’s culture. He said there is a lot weighing on young people, which has helped him issue numerous mental health advisories over the past two years.

Dr. Murthy spoke about the investment the administration has made in mental health in schools and communities through the Bipartisan Safer Communities Act. He also spoke about implementing 988 as a hotline for people to call or text as a resource to talk to qualified behavioral health counselors.

I believe this anxiety reflects the nature of something called “choice overload,” a research-backed theory that in certain situations, when people are presented with too many options, it can be more difficult to make or maintain a choice – and are less satisfied with it. it. that choice. Barry Schwartz, PhD, American psychologist and author of The paradox of choicesaid The Guardian that this happens because it is easier to imagine that there is something (or someone) better when there are so many viable alternatives. In terms of dating, if there are many other potential partners within walking distance, it’s easy to wonder if the person you’re with is really right for you.

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To be clear, it’s completely normal to experience relationship anxiety every once in a while. Committing to a person can raise doubts and insecurities even if you’ve never opened a dating app. But while these feelings are worth investigating, they aren’t necessarily indicative of a problem in the relationship. The problem is not asking any of these questions, but linking them to the belief that relationship doubt spells relationship doom. Sometimes doubt is simply a reaction to the hard work it takes to maintain a meaningful connection.

So how can we know if the relationship anxiety we’re experiencing suggests problems in your current relationship or is it simply a natural response to living in a world with many options? Here are some questions to ask yourself to help you figure out if what you’re feeling is legitimate self-doubt or simply the product of relationship anxiety.

5 questions to ask to help you deal with relationship anxiety

1. Am I emotionally safe with this person?

To be emotionally secure, you need to feel accepted for who you are and what you need. Your partner may not Pleases all aspects of your identity or being able to meet each of your needs, but to feel secure in a relationship it is necessary that these parts are recognized, known and received. (Important disclaimer: Emotional safety does not apply to abusive behavior. If you are being abused, that is always reason to end the relationship and seek personal safety.)

Don’t confuse feeling safe with always feeling good. But emotional security does it means that you have the space to explore what doesn’t feel good for you and come up with a shared strategy to feel more accepted (and therefore connected) in the relationship.

2. What is the frequency, duration and intensity of my anxiety?

Start tracking when anxiety arises and how it manifests itself. Anxiety often appears when we perceive that we are threatened, such as the threat of being hurt, abandoned, used, exploited, judged, or criticized. If you notice that your anxiety causes you to place meaning on an emotion, such as “he’s not paying attention to me, so I can find someone better out there,” it may be your attempt to seek relief in stressful times, not an attempt. a sign that your relationship should end.

Instead, become aware of the feeling you experience first (such as sadness, anger, fear) that leads you to draw a conclusion (for example, “this is the wrong person for me”). Now try to know that feeling: How long has it been here? When did it first appear? What is your earliest memory of experiencing this emotion? Then consider whether the conclusion you’ve drawn is a response to the current relationship or mirrors how you’ve reacted to big emotions from the past to stay safe in your previous formative relationships.

We don’t want to make decisions in a time of fight, flight, or freeze, as these ways of survival are indicators that we are seeking safety, they don’t indicate when we can connect to our inner wisdom and what is ultimately right for ourselves. Instead ask yourself how you feel about the relationship when you are not in an anxious state? My clients often describe their insights as unresponsive, but rather subtle, calm, and quiet; while anxiety drives us to focus on avoiding a threat or insecurity.

3. Are your doubts or insecurities really about you?

Sometimes we project our worries or negative emotions onto others, because we don’t want to own them. Projection can take the form of avoiding a feeling, belief, or judgment we have about ourselves by transferring it to someone else. It allows others to be “owners” of our personal flaws, thus removing us from having to acknowledge the things we don’t like or that don’t make us feel good.

Consider whether you have negative beliefs about your sufficiency that may be preventing you from accepting yourself and your partner. Can you be honest about these personal insecurities with your partner? Notice whether taking responsibility for your difficulties changes the dynamic and therefore your feelings about your partnership. The more we are able to accept ourselves, the more we accept the faults of others.

4. What are my beliefs about conflict and struggle in relationships?

There is a misconception that “we should be happy” all the time in relationships and that it is your partner’s job to make us happy. If you stay true to the belief that you would have no difficulty if you were with another person, you may be trying to free yourself from taking responsibility for your role in the challenges of the relationship.

A person is unable to satisfy each of our needs. In fact, in all relationships there are always three sets of needs that may not be met at the same time: your needs, your partner’s needs, and the needs of the relationship. The most successful couples aren’t necessarily the ones who have the most in common or who see things the same way, but the ones who mediate their differences with respect.

It can be helpful to ask yourself, “Can my wants and needs be seen and recognized by my partner, while still being satisfied outside the partnership?” This question allows you to contemplate strengthening and nurturing other pre-existing relationships in your life (including the one with yourself!), rather than trying to meet them with a new romantic partner.

5. Have I sufficiently explored my worries and fears?

Often, when we feel worried about being with the wrong person, we rush to make sense of our fears instead of knowing them. It may seem counterintuitive, but the more we know what scares us, the less suffocating it will have on our lives.

Consider writing down everything you know about your relationship anxiety: what it looks like, what it fears will happen, what it doesn’t like about your partner, what it hopes to find in another person, etc. Move towards fear instead of planning a relationship anxiety. run away from it.

Sometimes relationship anxiety is rooted in fear of the unknown, fear of being hurt, or fear of losing ourselves. Know your particular shade of fear and stare it in the face. Ask him what he wants you to know, sit down with him, and then once he’s explored enough, decide what you want to do about it (if nothing else). We want fear to remain present because it protects us, but we don’t want it to take the driver’s seat in our lives.

More than a decade after Democrats first tabled the proposal, Medicare is finally ready to begin negotiating prices for some prescription drugs.

This week, the federal government announced the 10 drugs that will be included in the first round of negotiations. The new prices will take effect in 2026.

The 10 drugs on the list make up a diverse set. Some are taken from millions of people with a price tag of a few thousand dollars a year. Others cost more than six figures a year and are taken from far fewer patients. Taken together, the list represents the many ways high drug prices put pressure on both patients and insurers and increase the risk that people won’t have access to the drugs they need.

Even if you don’t take one of these drugs, negotiations should help you if you’re on Medicare. Congress used estimated savings of $99 billion over 10 years to limit annual out-of-pocket costs to $2,000 for all Medicare beneficiaries.

Everyone will benefit, Stacie Dusetzina, a professor of health policy at Vanderbilt University who sits on the program’s congressional advisory committee, told me. You have the security of a $2,000 limit.

The negotiating program represents a major milestone for the US healthcare system: The federal government’s largest healthcare program (in terms of spending) is using its enormous financial leverage to try to stem high prices set by drugmakers for their products. The United States pays more for prescription drugs than any other country in the world and yet, compared to other nations’ health systems, the American government has had limited power in trying to lower prices. This new program, created by the Inflation Reduction Act, gives Medicare a powerful new tool.

Now that the top 10 drugs have been selected, the process can begin. Here’s how it will play out:

1. Drugmakers have one month to sign an agreement to participate in negotiations and submit data for Medicare to consider them for the negotiated price
2. By February 1, 2024, Medicare will offer its upfront pricing on select drugs; the producers then have one month to accept or submit a counter offer
3. There will be an opportunity to negotiate during the spring and summer of next year. Then, in September 2024, Medicare will announce final pricing. The program will start paying those prices in 2026.

The process will begin anew when Medicare announces 15 more drugs that it will be open to negotiation in February 2025, with pricing going into effect in 2027. In each subsequent year, additional drugs will be added to the negotiable program.

That is, if the courts will allow negotiations to proceed. The pharmaceutical industry has already filed a series of lawsuits, each with its own legal rationale, to stop the program before it starts. Many legal experts believe that this litigation will fail, how can the government run a sustainable program if it has no discretion over the prices to pay for drugs? but the rulings in these cases will ultimately determine whether Medicare drug negotiations can test their potential to save money for U.S. patients and their government.

Meanwhile, the drugs Medicare plans to negotiate on can be divided into two groups.

1) The rather expensive drugs for chronic diseases taken by hundreds of thousands or even millions of people

Seven of the 10 drugs announced for trading fall into this category:

• Eliquis, which treats and prevents blood clots (list price $561 for a one-month supply)
• Jardiance, which treats diabetes and heart failure (list price $570)
• Xarelto, which treats and prevents blood clots and reduces related risks for people with heart disease (list price $542)
• Januvia, which cures diabetes (list price $586)
• Farxiga, which treats diabetes, heart disease and chronic kidney disease (list price $549)
• Entresto, which treats heart failure (list price $545)
• A class of insulin injectors and related refill products: Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen and NovoLog PenFill

What these drugs have in common is that many Americans take them—perhaps because diabetes and heart disease are among the most common chronic health conditions in the United States—and must take them on a regular basis. More than 580,000 people on Medicare took Entresto from June 2022 to May 2023; more than 1 million have been prescribed Xarelto and Jardiance. Eliquis was the most commonly used drug on the list, being taken by more than 3.7 million people. At that time, the cost of Medicare was approximately $16.5 billion.

Even though most people who get Medicare do not pay list price, prescription drug coverage may still affect the prices you pay. Patients may have a deductible to meet before their benefits take effect or they may be responsible for paying coinsurance, which is calculated based on the list price.

These drugs also help people manage chronic health conditions to avoid more costly health problems in the future. The consequences can be severe if people are forced to give up medications due to cost. Insulin in particular has been subjected to rationing, which in the long term can reduce its effectiveness and, in some individual cases, has led to serious emergencies and even death of patients. (The IRA also included a provision to cap monthly insulin costs to $35 for Medicare patients.) Research has found that even an extra $10 cost can lead to people taking fewer medications than they need.

Medicare negotiations won’t solve all of these problems. But they will save patients and the program, and under the IRA, these government savings are used to limit drug costs for seniors participating in the program.

2) Super expensive drugs for people with serious and life-threatening illnesses

The second group of drugs under Medicare talks are being taken by a much smaller group of people, but for people who need them, their ability to afford them could determine in the very near future whether they live or die:

• Enbrel, which treats rheumatoid arthritis, psoriasis, and psoriatic arthritis (list price $1,762 for a one-week dosage)
• Imbruvica, which treats various blood cancers (list price $13,546 for about one month of tablets)
• Stelara, which treats psoriasis, psoriatic arthritis, Crohn’s disease, and inflammatory bowel disease (list price $25,497 for an 8-week supply)

The number of affected Medicare patients ranges from about 20,000 for Stelara and Imbruvica to nearly 50,000 for Enbrel. However, these drugs cost the Medicare program more than $2.6 billion each from June 2022 to May 2023.

These patients in particular will benefit from the negotiated pricing and the new cap established by Congress, Dusetzina said. Under the old Medicare subsidy model, they would have had to spend up to $10,000 a year on their drugs. Now their costs will not exceed $2,000 a year.

This is the tragedy of America’s drug price crisis. The pharmaceutical industry has developed and produced amazing treatments that can stop cancer or help people live with otherwise debilitating illnesses.

But too often these treatments come at a price that patients can’t afford or require health insurers to raise premiums so that everyone can cover the costs, or both. Our notoriously ungenerous health insurance made the affordability crisis worse, but so did the carte blanche granted to pharmaceutical companies under the current political regime: they can set whatever list price they like while their products are protected by a patent . Dusetzina told me she wouldn’t be surprised if the next rounds of drugs target more expensive drugs for severe acute illnesses like cancer, given that the initial list is more skewed toward (relatively) low-cost drugs for chronic illnesses. .

Historically, drug makers have argued that health insurance companies would negotiate these prices down, so no one would have to pay them. They would even say that, for Medicare, the different private Part D plans were already negotiating prices on behalf of their patients.

It was true. But it prevented Medicare from using all of its leverage to try to cut prices for everyone because each Part D plan represented fewer people than Medicare as a whole. (There are more than 800 Part D plans.) Now, things are finally about to change.

If you’ve ever had problems with your patients’ insurance company when it came to getting the prescription, you’re not alone. For patients with chronic conditions, including inflammatory bowel disease (IBD), newer medicines such as biologics can be very effective but also very expensive. As a result, many insurance companies have limited access to these drugs and doctors and families are forced to jump through hoops to get coverage. According to a recent ProPublica article, insurance companies sometimes make their doctors reject claims without even reading them.

To address these challenges, Athos Bousvaros, MD, MPH, vice president of clinical operations at Boston’s Division of Gastroenterology, Hepatology and Children’s Nutrition, is calling for change and equipping specialists with the tools they need to navigate an ever-changing approval process. harder.

A snapshot of what is happening

In a recent article, Bousvaros and his colleague Stacy Kahn, MD, detail how complicated the approval and rejection process for some drugs has become. They point out that the market is largely dominated by three specialty pharmaceutical companies and these three companies hold about 80% of the entire insurance industry market. Therefore, if a doctor files paperwork for one of these big three insurance companies but doesn’t prescribe the drug exactly according to FDA guidelines, they are immediately denied. (It’s unclear whether the drug benefits manager is withholding drugs after proper medical review or if the withholding is done through software.) These denials present a particular challenge in pediatric medicine because many of the drugs used to treat the same diseases in adults are not yet approved by the FDA for use in children and are prescribed off-label.

Two immediate problems arise here, Bousvaros explains. The first is that your patient will not receive the drugs he needs to treat his disease. The second is that there is now a lot more provider paperwork, which means less time to spend with patients.

So, what can you do if the prescription you write for your patient is denied?

What can you do now

While these challenges show no signs of disappearing, Bousvaros recommends three ways pediatric specialists can help patients access the medicines they need.

1. Tap into resources. If you work within a hospital or larger healthcare system, you may have access to insurance waste resources. For example, Boston Childrens has a dedicated team that assists physicians with pre-approvals, limiting the amount of time spent away from patient care.

2. Perfect your letter writing. In another article by Bousvaros and Kahn, they share the details of how to write a medical necessity letter. The goal of a medical necessity letter is to demonstrate why a patient will benefit from the prescribed medication. It can be really emotionally taxing writing these letters, but they’re absolutely crucial to being right when you’re fighting for your patient, says Bousvaros.

3. Take a stand. Bousvaros encourages doctors to stand up for their patients. At Boston Childrens, for example, great success has been achieved in supporting patient access to rare services by treating payers as partners. We also encourage specialists to work with professional and patient organizations to launch further advocacy efforts so our patients get the treatments they need, she says. Advocacy is incredibly important if we are to make improvements to this process in the future.

Find out more about our Division of Gastroenterology, Hepatology and Nutrition.

By CRISTINA JANNEY
Hays Post

The 988 Suicide and Crisis Lifeline has been in operation for a little over a year.

Last week a group gathered in Dodge City for a summit “Standing in the Gap: Rural and Frontier Access to Mental Health Care” and discussed the role played by the 988 crisis line in providing crisis intervention in rural Kansas .

The event was sponsored by the National Alliance on Mental Illness of Kansas, also known as NAMI.

According to 988 resource materials, 988 offers 24/7 access anywhere in the United States to qualified crisis counselors who can help people experiencing mental health-related distress.

Anyone can call or text 988 or chat on the 988 website at 988lifeline.org. You can call for yourself or for a loved one you have concerns about.

According to the Associated Press, 988 received more than 2 million calls, texts and chat messages in its first year of operation.

The new line, which was modeled to look like the 911 emergency line, has seen an increase over the previous national suicide and seizure line.

According to the Associated Press, the 988 helpline logged 154,585 more calls, texts and chat messages in November 2022 than the old national lifeline in November 2021.

According to the Associated Press, the Substance Abuse and Mental Health Services Administration saw a 1,227 percent increase in texting, while Veterans Crisis Services, which can be accessed via 988, reported a 10% increase.

“It’s early days,” said Clayton Levret, pharmacologist and PsychU speaker, speaking of the hotline. “I want to draw attention to how important it is to bring people together not only around 988, but also with today’s summit and around the community. rural and all the other challenges you face.”

65% of non-metro counties have no psychiatrists, Levret 60% of rural Americans live in areas with a shortage of mental health services.

Levret said through his research he found that suicide occurs within 11 minutes. If intervention can be achieved within that time, the thought process can be stopped.

988 differs from 911 in that it is a crisis response line and not a dispatch line. If you need medical or police assistance, you still need to call 911.

However, Brooks Robertson of the Kansas 988 system, which is based in Lawrence, said people don’t need to be suicidal to get in touch.

“One thing we found is that people knew they were in a crisis, but they didn’t necessarily know if they could call it a suicidal crisis. They didn’t know if 988 was an appropriate space and an appropriate path for them,” Robertson said.

“We really want to encourage people experiencing crises of all shapes, all sizes, whether it’s a substance use crisis, whether it’s a general suicidal crisis or a mental health crisis.” .

“If you are concerned about someone else, someone you love, someone you know and want to know the best way to connect them to the best support path, the crisis counselor on the other end of these three numbers will work with you as well.”

988 is available regardless of age, which means that the resources are available for young people. Spanish-speaking crisis counselors are available. Those who are deaf or hard of hearing can use the chat or text options or use a relay service by dialing 711 and then 988.

Many people use 988 completely anonymously without giving their name, Robertson said.

As for the telephone line, 80% of calls come from people aged 20 and over. On the other hand, 80% of SMS contacts come from people under the age of 20.

“There are so many different reasons why someone chooses one avenue of communication over another, whether it be skill or preference, but it really demonstrates how having these different methods of people preference can really drive engagement and provide one most comfortable space for that person,” Robertson said.

Calling 988 is not a panacea, Robertson said.

“We want to reserve space for people to call and not have the pressure to get better today. Many people use 988 as a temporary service between therapy appointments or other appointments they may have,” Robertson said.

However, 988 has limitations.

988 routes calls by area code. In a community like Hays, which is home to students from out of state, calls may be routed out of state.

If you have an Ohio area code, your call will route to Ohio. This could make it difficult to connect the caller to community resources for follow-up, Robertson said.

This is why it’s also important to raise awareness of local hotlines through community mental health centers, Robertson said.

“If you’re in a crisis, call 988,” Robertson said. “You have a direct connection to a compassionate support person who will be able to work with you during stress relief, assess your safety at the time, work with you on a collaborative safety plan, and hopefully lead that conversation in a neighbor place the connection can be established with whatever resource is needed.

“We also want to share that if you’re looking for that direct connection and that local support, reach out to that local crisis line. This will be the best path to that local asset.”

High Plains Mental Health Center is the community mental health center for Ellis County and most of northwestern Kansas. The 24/7 emergency number is 1-800-432-0333.

Robertson said 988 advisors will try to connect with local emergency services if they believe callers are in immediate danger. However, if someone is being routed out of state, making those connections can be much more difficult.

Despite its limitations, Levret said the 988 is an important tool.

“The most important thing I can say today is that 988 save lives,” he said.

Other resources

National Alliance on Mental Illnesses (NAMI)

NAMI Golden plainsserving Ellis, Graham, Lane, Ness, Rooks, Rush and Trego counties, can be reached at Namigol[email protected] or 785-214-4538 or follow them on Facebook at facebook.com/NAMIGoldenPlains

A combined NAMI Golden Plains Connection and Family Support Group, aimed at individuals with a mental illness or who have family members with a mental illness, meets on the second and fourth Wednesday of each month from 7-8:30pm at Oak Plaza , 103C E. 27th St., Hays.

NOTE: The NAMI Golden Plains Connect Support Group is now offered as a hybrid/in-person meeting, depending on your needs. Contact [email protected] if you wish to participate via Zoom.

FHSU of the NAMI campus meets at 3.30pm every other Wednesday in Rarick Hall, Room 107. Next meeting is 6th September.

American Society for Suicide Prevention

National Institute of Mental Health

Substance Abuse and Mental Health Services Administration

Independence of the High PlainsSocial and Peer Support, 1200 Canterbury, Hays, KS, 785-621-4188