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MGH Community News |
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MGH Community News |
| March 2014 | Volume 18 • Issue 3 |
Highlights
Sections
Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
State to Distribute $20 Million in Heating Aid Massachusetts lawmakers recently approved the release of $20 million in heating aid for low-income households the long, cold winter drags on — the first time in three years that the state has provided such assistance. The money was included in a supplemental spending bill. The money is crucial for tens of thousands of poor households that have struggled to keep the heat on since about mid-January, when the state exhausted $140 million in federal heating aid. About 200,000 Massachusetts households rely on the government to help them keep their homes warm each winter. The Department of Housing and Community Development increased the maximum benefits than can be provided to each household. Depending on the household's income and the fuel used (gas, electricity, oil, etc.; or if heat is included in the rent), benefits increased approximately $50 to $100. See the revised benefits chart (benefits appear below income eligibility). The added benefits will help offset some of the highest heating bills in years. New England residents are projected to pay an average of $1,700 to heat their homes, up nearly $300, or about 20 percent, from last winter. The federal fuel assistance program has been cut by one-third in recent years, to $3.4 billion this year from $5.1 billion in 2010. In the past, Congress supplemented the program with additional money during the winter, but the last time that happened was in 2010. Still, John Drew, the president of Action for Boston Community Development, an organization that helps funnel heating aid to families in Boston, Brookline, and Newton said that he is worried about natural gas and electric customers who have wracked up enormous heating bills this winter and will soon be receiving shutoff notices from their utility companies. State law prevents utilities from shutting off service to customers between Nov. 15 and March 15, even if they fall behind on payments. End of Winter Moratorium The state’s investor-owned utilities have already agreed to extend the moratorium until April 1, at the request of state regulators. National Grid spokeswoman Deborah Drew said her company also agreed to use the April deadline in future years. So has Northeast Utilities. It will start sending out shutoff notices after April 1 to affected customers of its Massachusetts subsidiaries, NStar and Western Massachusetts Electric Co., said spokeswoman Caroline Pretyman. They won’t be disconnected from service until May 4 at the earliest. -See the full Boston Globe article... |
Governor Declares an Opiate Abuse Emergency- Makes Narcan Available to First Responders Governor Deval Patrick declared a public health emergency Thursday to combat the growing abuse of opiates, directing that all the state’s police, firefighters, and other emergency personnel be equipped with a drug that can quickly reverse heroin overdoses. Using his emergency powers, Patrick told the Department of Public Health to make Narcan available immediately to all first responders, as well as more accessible to families and friends of drug abusers. Narcan, the brand name for naloxone, halts overdoses almost instantly. Many first responders have been barred from administering the drug by state regulations written before the opiate crisis. The state also will work with medical directors of large pharmacies to write standing orders that will allow Narcan to be purchased by individuals, Bartlett said. The governor also pledged to spend $20 million more to increase treatment and recovery services for the public, state prisons, and county jails. Another component of the state’s action will be a mandate that physicians and pharmacies monitor prescriptions of narcotic painkillers and other drugs linked to abuse. Such checks had been voluntary, the governor’s office said. “We must have more rigor over the overprescription of pain medication,” Patrick said. Opiate overdoses in Massachusetts rose 90 percent from 2000 to 2012, the governor said. -See the full Boston Globe article...
Newborn Addiction is Soaring and Ensuring Safety is Difficult Some 1,300 babies in Massachusetts — about three to four each day — were born in 2012 with “neonatal abstinence syndrome,” suffering withdrawal pains as a result of exposure to illegal opiates such as heroin or prescription drugs such as Oxycontin or methadone, according to a first of its kind survey of local hospitals. There is no statewide data from earlier years for comparison, but anecdotal evidence suggests the number of cases is exploding. At South Shore Hospital in Weymouth the number of drug-dependent babies rose from 33 in 2008 to 115 in 2013, according to hospital data. UMass Memorial Medical Center in Worcester treated about 60 drug-exposed babies last year, double the number in 2008, a hospital official said. And doctors from Boston and Lowell also say the number of drug exposed-babies has soared. They are the tiniest victims of the region’s growing opiate epidemic. The increase in drug dependent babies has hospitals scrambling to care for them. Physicians say there are no federally approved medications or standard procedures to follow, so hospitals care for vulnerable patients as best they can with a variety of treatments. But a potentially bigger danger awaits the children when they leave the hospital. Most drug-exposed children return to their families, said Robert Sege, medical director of the Child Protection Team at Boston Medical Center. At Boston Medical Center, which treated 106 children last year who suffered drug withdrawal, about 85 percent return to their parents, he said. Most of them were exposed in utero to methadone or buprenorphine, drugs commonly prescribed for those in treatment for addiction. Many parents work hard to fight their addictions and get better, he said. Unfortunately, Sege’s own hospital data shows that a large portion — more than a third of parents — end up relapsing. Within a year, their children are often sent to foster care. Sege said state social workers need to continuously monitor these troubled families because when parents relapse, children are more likely to be neglected, found wandering alone, unclean, or hurt. Sege said families need more support when they leave the hospital. Social workers investigate the home life of each child identified as born drug-exposed, but Sege said too often they close cases for these fragile children and families quickly. “I don’t think the answer is to take all the babies and put them up for adoption,” he said. “Our feeling is that DCF should have a policy that they should keep these cases open for six months of life.’’ DCF officials said they are trying to do a better job managing the “explosion” of drug-addicted babies statewide. In January, the agency launched a new training program to teach managers how to identify addiction in adults and recognize when the children of substance abusers are at risk, according to Kim Bishop-Stevens, DCF’s substance abuse manager. Before letting a drug-exposed child go home with drug-using parents, state officials say they review the home situation, including housing, family supports, and whether a parent is getting help. Social workers also have started gathering more information about what happens to substance-exposed newborns after they get home in an attempt to provide better services, which the state’s child advocate, Gail Garinger, called a good start. In cases involving drug-exposed babies, Laurie Myers, founder of Community Voices, a Chelmsford-based advocacy group for child abuse victims, said DCF should have distinct and more detailed guidelines to address the children’s specific long-term needs and determine when to pull them out of a precarious situation. Representative Sheila C. Harrington, a Republican from Groton, recently filed legislation to make the child’s best interest — not family reunification — the top priority of the child welfare law. Peter MacKinnon, a long-time social worker and president of the DCF chapter of the Service Employees International Union, said protecting children from opiate-abusing parents is challenging. Adults can hide their drug use, he said, and social workers can only pull children from their home if they can prove that parents are being abusive or neglectful to such an extent that a child is in immediate danger. -See the full Boston Globe article... Veterans’ Treatment Court Opens in Boston Judge Eleanor C. Sinnott, a former Navy intelligence officer attached to Special Operations Command Korea Unit, presides over Boston’s new Veterans Treatment Court session. It is the first veterans court in Suffolk County and the second in the state, and is designed to help treat military veterans arrested for crimes linked to trauma caused by their service. “When veterans end up on the wrong side of the law, we shouldn’t and don’t turn our backs on them,” said Boston Mayor Martin J. Walsh. “Instead, we use it as an engagement to get them the services they need and they deserve. We don’t set laws aside, we bring the administration of justice in line with our values.” The veterans court began holding sessions at the end of January, and currently has three people in the program and another 12 in the pipeline. It is staffed with specially trained judges, clinicians, probation officers, and attorneys, many of whom are veterans themselves. Program participants receive rehabilitation and treatment for substance abuse issues, alcoholism, mental health issues, and emotional disabilities, as well as academic and vocational training and placement services. “We cannot arrest and incarcerate our way out of the many problems that we face,” said Suffolk District Attorney Daniel F. Conley. “Accountability takes many forms, and what justice and the public safety require is not always a jail cell.” Across the country, there are about 130 veterans courts, and around 200 more in the planning stages, said Christopher Deutsch, director of communications at Justice for Vets, a nonprofit that implements veterans courts nationwide. Not every veteran accused of a crime is eligible for the Boston treatment court session, said Sinnott. Applicants must persuade the court that their crime is linked to some trauma — such as post traumatic stress disorder or substance abuse — caused by their military service. The first veterans court in the state opened in Dedham in 2012, and graduated its first class of five in November. All veterans in the Boston program are expected to remain drug and alcohol free. The program takes one to two years to complete. -See the full Boston Globe article... The Department of Children and Families (DCF) Crisis Two reports were released this month that investigated operations at Massachusetts Department of Children and Families (DCF). Also this month DCF front-line social workers, investigators and supervisors circulated a critical open letter as a petition to demand changes within their agency. While last month, a Boston Globe columnist reported on a dramatic increase in DCF petitions to remove children from their homes and suggests that there is “an air of panic in the numbers coming out of DCF.” Child Welfare League of America’s Preliminary Report An independent agency hired to review the practices of the Massachusetts Department of Children and Families has made a preliminary series of recommendations including increasing staffing; upgrading technology; enhancing background checks for foster families; providing earlier medical examinations for foster children; and increasing efforts to reduce runaways. Specific recommendations include:
Secretary of Health and Human Services John Polanowicz said the state has already started implementing some of the recommendations of the Child Welfare League of America, including adding staff and buying new technology. “We were very clear with them that if they were to identify anything as a part of their process, we didn’t want to wait until there was a progress report or a final report, particularly if it was something that would have a direct impact on the safety of the children,” Polanowicz said. The report provided general recommendations as an interim “progress report” to address concerns about the agency that were raised by the Jeremiah Oliver case and by recent media reports. A final report is expected in May. State Auditor’s Report In a separate report, an audit of DCF services, conducted by state Auditor Suzanne M. Bump, revealed a host of management problems in the period between July 2010 and September 2012. State Auditor Suzanne Bump said her investigation discovered that:
DCF Worker’s Charge “Drive-By Social Work” In their open letter, the DCF employees say under-fire Commissioner Olga Roche has implemented major changes in the agency without backing them up with sufficient resources. "We are concerned that the Commissioner’s Office does not know or understand what is really going on in the field," said the letter, which was provided to news organizations. The DCF workers praised some of the steps the agency has taken recently. The letter said "notable progress has been made in the allotment of resources for new hires and technology upgrades." But, the letter warns that a lack of support from DCF administration, a dramatic spike in caseloads and low morale have led to "the kind of 'drive-by social work' that could place children at risk.'" The DCF employees said that, above all else, they need "additional boots on the ground to alleviate the caseload crisis." In response to the letter, a DCF spokesperson pointed to a letter from Roche to her employees, touting a recent productive meeting with union officials and the hiring of 91 new workers since January. Patrick's budget calls for 175 new social workers and staff, Roche said in an emailed statement. "As a social worker myself, I recognize how hard the Department's staff in the field is working to protect the children and support the families in our care, and I deeply appreciate their commitment," Roche said. "We are continuing to take steps that will improve the Department and positively impact their work." Dramatic Increase in Removal Requests Reported In a February column, Boston Globe columnist Yvonne Abraham charges that in response to the negative publicity surrounding the Jeremiah Oliver case, DCF has dramatically increased their requests to remove children from their homes. She writes: The figures, from the juvenile courts where DCF lawyers request custody of the children, paint a picture of a state agency no longer willing to take chances. Weighing the good of keeping families intact against the possibility of harm coming to children, they are erring on the side of caution, again and again. Against the backdrop of an unthinkable tragedy, this may sound like the smart, obvious, compassionate choice. But in the real word of fragile families and vulnerable children, it can be anything but. There is, in fact, an air of panic in the numbers coming out of DCF. She reports that in December, DCF made 52 percent more removal requests than it did the previous December. In January, the number jumped by 86 percent over 2013. The 77 removal requests filed in Worcester County that month more than doubled the 31 filed at the same time last year. It’s a familiar pattern, repeated all over the country whenever a child in state care goes missing or dies. Agencies like DCF come under fire — and the fire this time, from the media and the Legislature, has been brutal — and they react by becoming way more risk-averse, removing more children from their homes, pushing decisions into the hands of judges. If every one of these removals is a clear-cut case of children in imminent danger, that’s pretty troubling: It means we have been overlooking hundreds of endangered kids before now. That’s possible, but not likely. These numbers are so high that at least part of the increase is panic-driven. It means some at DCF are more concerned with protecting their own behinds, instead of the kids they’re supposed to be serving. That’s troubling, too. Peter MacKinnon, DCF chapter president of the social workers’ union, said that in some offices, the jump in removals stems from an appropriate abundance of caution. In others, he said, “managers are really putting the pressure on, saying the only way to keep a kid safe is to take custody.” Some judges are alarmed at the surge of requests, though none of them would be interviewed. Removing a child from her home is an immensely traumatic event, with lasting consequences. Research by Joseph Doyle, a professor of economics at the Sloan School of Management at MIT, has shown that, when it comes to marginal cases of kids being considered for removal, those who are taken from their families face far worse outcomes down the line than those who are kept in their homes: higher rates of teen pregnancy, unemployment, and delinquency. That’s why DCF worked so hard under previous head Angelo McClain to keep families together, shifting resources to provide better home support. Removals had been climbing since his departure, fueled partly by rising abuse reports. But with Oliver’s disappearance, the pendulum has swung back with greater, and potentially destructive, force. “The incentives are lined up so we are overly aggressive,” Doyle said. “People get penalized if they make the wrong decision and leave the child in the home. And they don’t if they remove the kid from the home and there are bad consequences later.” Sources and For More Information Child Welfare League of America Preliminary Report State Auditor’s Report DCF Staff Open Letter Dramatic Increase in Removal Requests
State Stepping Up Efforts to Reduce EBT Fraud After widespread complaints about welfare fraud, Governor Deval Patrick’s administration appears to be stepping up efforts to reduce abuses of state food benefits, typically distributed through electronic benefit transfer cards, or EBTs. Staff members at the Department of Transitional Assistance reported 14,431 cases of potential fraud or abuse of food benefits to investigators through the first 10 months of 2013, an 87 percent increase over the same period in 2012, according to a new report by Inspector General Glenn A. Cunha. The Supplemental Nutrition Assistance Program (formerly known as food stamps) serves about 880,000 individuals. Department officials attributed most of the increase to a streamlined system to report potential fraud. Transitional Assistance Commissioner Stacey Monahan said her office more than quadrupled the number of investigators last year to root out fraud and tweaked the computer system to make it much easier for staff to file a report when they find something amiss. In addition, the department now requires case managers to flag cases in which people make suspicious requests for replacement benefit cards, such as asking for four replacement cards in a year, suggesting that they may be selling the cards. Department of Transitional Assistance employees referred 966 cases to investigators after recipients requested a replacement card under circumstances that raised flags. Thousands more cases were referred to investigators because a database search suggested that they might be earning too much money to qualify for benefits, were currently in state prison, or were receiving benefits in other states. The increase in potential fraud reports came after the agency took heavy fire for not doing enough to make sure that benefits were only going to those who truly needed them. The former head of the agency, Daniel J. Curley, resigned in early 2013 after Cunha reported that the agency failed to verify recipients’ eligibility, potentially costing the state $25 million a year in unwarranted payments. A separate 2013 report by State Auditor Suzanne Bump found evidence that the state handed out $18 million in “questionable public assistance benefits” over the past few years, including to more than 1,160 people using a dead person’s Social Security number. Agency officials later said Bump’s number was inflated, because it included duplicates, people who had already been dropped from the welfare rolls, or other cases in which recipients were still alive. Starting in June, when people apply for benefits for one program, case workers will check to ensure that applicants are not already receiving benefits from another program. They will also be required to check 20 other databases, as well, including a list of prison inmates. -See the full Boston Globe article... Child Poverty Increased in Mass. A growing percentage of Massachusetts children are living in poverty, with more than a quarter of youngsters in Suffolk County and nearly a third in Hampden County coming from families with incomes below the federal poverty line in 2012, according to a new report that concludes that where residents live significantly affects their health and their longevity. Even as the economy has rebounded, the data show that children in poor households have not enjoyed a similar recovery. In 2007, before the recession hit, 13 percent of the state’s children were living in poverty. By 2012 that had grown to 15 percent, and the rates remain higher now than in 2007 in every county except Suffolk, which includes Boston. Nationally, the percentages jumped from 18 percent to 23 percent during that span, the report found. Childhood poverty is one of the key indicators of later health problems, concludes the report from the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. It’s their fifth annual examination of data for nearly all counties in the United States. While Massachusetts fares well in some health indicators, such as having relatively low rates of teen births, and fewer residents who lack health insurance, the report shows that in many other critical areas, including the percentage of children living in poverty and those in single-parent households, the state lags behind the top-performing counties in the United States. Even in areas where Massachusetts receives high marks nationally, the data show the numbers vary widely across the state, with teen birth rates more than five times higher in Hampden County in Western Massachusetts than they were in Hampshire and Norfolk counties. Hampden residents were the least fit in the state on several health measures, while Hampshire and Norfolk residents tended to be much healthier. Physicians and researchers who care for and study poor children said the report jibes with what they have been seeing and worrying about. “Families with young children are working harder and harder, but are falling farther behind,” said Dr. Megan Sandel, an associate professor of pediatrics and public health at Boston Medical Center. Sandel tracks the number of young children treated in the hospital’s emergency room who are hungry and dangerously thin. She said recent cuts to the federal program that helps the poor afford food are forcing many of the families she treats to choose among rent, food, and heat, even as many reports suggest the economy is improving. “We see these play out on the bodies of our patients,” Sandel said. The Robert Wood Johnson Foundation report encourages community, business, government, and health leaders to pool dollars across counties for more cost-effective programs to battle childhood poverty and other problems. But Julie Wilson, a faculty member at the Harvard Kennedy School of Government who specializes in family policy and poverty, said Massachusetts has historically resisted a countywide approach to solving community problems. -See the full Boston Globe article... Also see: Interactive Graphic: Choose a health category to see how Massachusetts counties rank. (Note: at this writing consider an internet browser other than Internet Explorer for optimum viewing.) Heirs of Reverse Mortgage Holders May Inherit Pitfalls A growing number of baby boomers are confronting a bitter inheritance. The same loans that were supposed to help their elderly parents stay in their houses are now pushing their children out. Reverse mortgages allow homeowners 62 and older to borrow money against the value of their homes — money that need not be paid back until they move out or die. Under federal rules, survivors are supposed to be offered the option to settle the loan for a percentage of the full amount. Instead, reverse mortgage companies are increasingly threatening to foreclose unless heirs pay the mortgages in full, according to interviews with more than four dozen housing counselors, state regulators, and 25 families whose elderly parents took out reverse mortgages. Some lenders are moving to foreclose just weeks after the borrower dies, many families say. The complaints are echoed by borrowers across the country, according to a review of federal and state court lawsuits against reverse mortgage lenders. Others say that they don’t get that far. Soon after their parents die, the heirs say, they are plunged into a bureaucratic maze as they try to get lenders to provide them with details about how to keep their family homes. Reverse mortgage lenders say that they abide by the federal rules, noting that their goal is to avert foreclosures, which can be costly and time-consuming. Under federal regulations administered by the Department of Housing and Urban Development, reverse mortgages that are insured by the Federal Housing Administration (which is virtually all of the market) must offer heirs up to 30 days from when the loan becomes due to determine what they want to do with the property, and up to six months to arrange financing. Most important, housing counselors say, is a rule that allows heirs to pay 95 percent of the current fair market value of the property — a price that is determined by an appraiser hired by the lenders. The difference offered by the 95 percent rule can be critical. Since the financial crisis, when housing prices tumbled, the disparity between the current value of the home and the total balance on the mortgage has often meant the difference between keeping a home and losing it to foreclosure. -See the full Boston Globe article...
Health Care for All Announces OneCare Ombudsman Health Care for All’s (HCFA) Massachusetts office recently announced that they are hosting the new OneCare program’s Ombudsman. The OneCare program is the state’s Integrated Care Organization, a demonstration project that provides patient-centered medical homes that integrate primary care and behavioral health services, care coordination, and clinical care management for those under age 65 who are dually eligible for Medicare and MassHealth. While MGH is not participating in this program for primary care, we may see these patients in other situations. The OneCare Ombudsman is part of Health Care For All’s HelpLine team, and will provide information, education, and advocacy to individuals participating in a OneCare plan. There are three Integrated Care Organizations contracting with OneCare. Network Health’s Unify Program, Fallon Total Care, and Commonwealth Care Alliance plans are available to approximately 90,000 individuals located in nine Massachusetts counties. OneCare members can contact the Ombudsman with any questions or concerns by phone at 1-855-781-9898 or email at help@onecareombuds.org More at: http://www.hcfama.org/blog/hcfa-announces-one-care-ombudsman
National Association of Home Builders’ Certified Aging in Place Specialists According to AARP, older home owners overwhelmingly prefer to age-in-place, which means living in their home safely, independently and comfortably, regardless of age or ability level. The NAHB Remodelers of the National Association of Home Builders (NAHB) in collaboration with Home Innovation Research Labs, NAHB 50+ Housing Council, and AARP developed the Certified Aging-In-Place Specialist (CAPS) program to address the growing number of consumers that require home modifications to make aging in place possible. While most CAPS professionals are remodelers, an increasing number are general contractors, designers, architects, and health care professionals. Modifications may range from the installation of bathroom grab bars and adjusting countertop height to the creation of first floor bedrooms and the installation of private elevators. CAPS professionals have been taught the strategies and techniques for designing and building aesthetically pleasing, barrier-free living environments. CAPS graduates pledge to uphold a code of ethics and are required to maintain their designation by attending continuing education programs and participating in community service.
CHECKLIST: Choosing a remodeler for aging-in-place and universal design improvements
Find a local Certified Aging-in-Place Specialist Related/Also See: The National Directory of Home Modification and Repair Resource: http://www.homemods.org/directory/index.shtml (From the National Resource Center on Supportive Housing and Home Modification. The Center does not endorse nor qualify any of these home modification and repair providers.) -Adapted from and more information at: http://www.nahb.org/generic.aspx?sectionID=126&genericContentID=8484 "Transitions to Work" – Job Training for Young Adults with Disabilities Transitions to Work, a program of Jewish Vocational Services, program, offers assistance to individuals with disabilities to help launch their careers through skills training, internships and employment opportunities. To participate in this program participants must:
More information at https://www.cjp.org/our-work/our-caring-programs/transitions-to-work or call Madeline Wenzel from JVS at 617.399.3241 or e-mail her at mwenzel@jvs-boston.org. -Adapted from Frequently Asked Questions About Your Health Care Proxy and More, e-mail correspondence, Margolis & Bloom, Tuesday, March 25, 2014.
Medicare Reminder: How Do I Appeal a Medicare D Coverage Decision? Medicare D plans may place coverage restrictions on certain covered drugs to limit use of those drugs. There are three types of coverage restrictions:
If coverage is denied at the point of service, the pharmacist should give the patient a notice called Medicare Prescription Drug Coverage and Your Rights. This is a notice that explains the process to contact the Part D plan to request coverage of the needed drug. This is not a formal denial notice, rather it is an educational notice that provides general information on the first steps of the appeal process. One generally needs a written, formal denial notice from the Part D plan to begin the appeal process. There are a couple of steps to take before filing an appeal. First the patient should contact their Part D plan directly to find out why the plan is not covering the drug. If the denial is due to an administrative error, it should be resolved with this call. Patients should be advised to write down the date and time of the call, who they spoke with, and what they were told. If the issue is not due to an administrative error, patients should contact the health care provider to see if an alternate drug covered by the Part D plan can be substituted. If there is not an appropriate covered substitute, the patient should ask the provider to help file an exception request, also known as a coverage determination. An exception request is a formal, written request asking the plan to cover the drug that is not on its formulary, or asking it to lower the price of a formulary drug (moving it to a lower tier). One must file an exception request before filing an appeal. Plans generally provide decisions on exception requests within 72 hours. The provider can request an expedited decision within 24 hours if the patient’s health would be harmed by waiting the standard 72 hours for a plan decision. If the exception request is denied by the Part D plan, the plan should then send a written, formal denial notice that includes instructions on how to file an appeal. Keep in mind that one can file an exception request with a Medicare Part D plan, whether it is a stand-alone Medicare Part D plan that works with Original Medicare or a Medicare Advantage Prescription Drug Plan, also known as a Medicare private health plan. Click here to use a Medicare Interactive Roadmap that can help walk you through the necessary steps of appealing a Part D drug denial. Learn more about the Medicare Part D appeal process. Contracted Health Plans Reminder It can be challenging to understand MGH/Partners insurance contracts and whether a patient’s health coverage is contracted or non contracted. Recent changes related to the Affordable Care Act have added to the confusion. Here’s an explanation and reference materials. Products vs. Health Plans The PRODUCT is the type of state program that covers a low-income patient. The HEALTH PLAN is the health insurance company that administers the PRODUCT. Products
MassHealth patients also have a CATEGORY (or “coverage type”), depending on their situation (income, immigration status, etc). Categories include MassHealth Standard, Family Assistance, CommonHealth, Limited, and the new category CarePlus. Health Plans Most patients on state coverage also have a HEALTH PLAN: MassHealth PCC Plan, Neighborhood Health Plan (NHP), Network Health, BMC HealthNet, CeltiCare, Health New England, or Fallon. Some of these HEALTH PLANS are contracted and some are non contracted.
Frequently Asked Questions Question: What if someone has one of these PRODUCTS but no HEALTH PLAN? Question: We keep hearing that the state has extended coverage. Does this mean our contract with Network Health MassHealth has been extended? Question: What if a patient has a HEALTH PLAN that is non contracted (like Network Health CarePlus)? This information is all available on a Sharepoint site that is maintained by our Partners’ Public Payer Patient Access department. Here’s the homepage: -Adapted from AFFORDABLE CARE ACT: reminders about products and health plans, e-mail, Kim Simonian, MPH, Director for Public Payer Patient Access, Partners HealthCare - Community Health, March 12, 2014. Open Enrollment Extended for Some No Open Enrollment Limit for Most Heavily Subsidized MA Plans A version of this article was e-mailed to Social Service staff on March 27, 2014. The federal government this week announced a special enrollment period for consumers using the Federal Marketplace (Healthcare.gov) who have had trouble signing up for health insurance. Following suit, the Health Connector has announced that it will grant people who have had problems completing an application with additional time to complete an application and select a plan. The current open enrollment period closes on March 31st. However, if a consumer has tried to apply for health insurance without help paying for costs through the Health Connector during open enrollment and were unable to complete enrollment because of IT systems issues, these consumers will now have until April 15th to select a plan that starts either May 1st or June 1st. Payments for coverage effective May 1st must be submitted by April 23rd to complete enrollment. Those seeking coverage effective June 1st will have until May 22nd to pay their first premium in order to complete their enrollment. Applications can be completed online at MAhealthconnector.org. If you have any questions, please call Health Connector Customer Service at 1-877-MA ENROLL (1-877-623-6765) or TTY: 1-877-623-7773 or contact Patient Financial Services. Key Open Enrollment Updates for Individuals NOT seeking Help Paying for Insurance
Open Enrollment for Individuals Seeking Help Paying for their Insurance As a reminder, if a person is applying for coverage and is looking for help paying for their health insurance, they can apply at any time during the year at MAhealthconnector.org. If a person is determined eligible for ConnectorCare, MassHealth, the Children's Medical Security Program, or Health Safety Net, they will be able to enroll in that coverage at any time during the year. If they are only determined eligible for tax credits or are determined not to be eligible for any help paying for the cost of their health insurance, however, they must have a qualifying event that allows them to shop before the next open enrollment period. It is important to note that loss of Minimum Essential Coverage is a qualifying event, so for those individuals that are enrolled in the temporary coverage program, their disenrollment from that program is considered a qualifying event that will allow them to shop before the next open enrollment period. A version of this update is also available online at https://bettermahealthconnector.org/update-for-people-who-applied-for-insurance-coverage-without-help-paying-for-costs/. Correction/Clarification: ConnectorCare and QHPs will use 2013 FPLs Until Next Open Enrollment We reported last month that new Federal Poverty Guidelines/Levels went into effect on March 1, 2014. The article continued to list some of the programs that use these figures in eligibility determination calculations. While it is accurate that ConnectorCare and Qualified Health Plans (QHPs health plans with state and/or federal subsidy) use FPLs in determining eligibility, they will in fact continue to use the 2013 FPLs until the next open enrollment period- starting November 15, 2014. This alternate 2014 FPL chart includes the applicable health coverage program(s) in the column headings: http://www.masslegalservices.org/system/files/library/2014%20FPL%20Table%203-18-14%20Final.pdf. See page 2 for 2013 FPLs for ConnectorCare and QHP eligibility. Connector Enrollment: Progress But Still Ways to Go The state has been working furiously to improve the state’s Health Connector website (mahealthconnector.org/) and to facilitate health insurance enrollment. One tip for those trying to apply online: Google Chrome is the best web browser for MAhealthconnector.org. Firefox, Opera, and Safari are other web browsers that also work well. The website is currently not compatible with Internet Explorer 11 (nor does it seem to be compatible with IE 8 which is the version many at MGH run). As noted in an accompanying story (Open Enrollment Extended for Some) the state has just announced a two week Open Enrollment extension for those hampered by the website’s failings. One recent website fix closed the limited program determination functionality for Health Connector subsidized aid categories. Prior to this closure, a small group of subsidized applicants that met certain criteria were being determined eligible for Premium Tax Credits or wrap plans, but they then did not have a path forward to select and enroll in a health plan. Now, until full and complete program determination functionality is available, anyone that applies for subsidized coverage and receives a Health Connector aid category determination (other than MassHealth) will be moved directly into temporary coverage. The Massachusetts Health Connector officials also recently announced some good news: A backlog of 72,000 paper applications for health insurance coverage, many submitted by low-income residents, has been completely eliminated. The backlog had piled up after officials encouraged residents to file paper applications because of the website problems. The applications were expected to take months to process but were done in about six weeks after officials hired additional staff and developed a data-entry system that cut the time it took to enter each application into a database from two hours to 27 minutes. Those residents have now been given temporary health insurance coverage through the state Medicaid program. Now that the backlog has been eliminated, the recently hired Optum staff will transition from application data entry to other operational tasks, including:
The state is facing a deadline of June 30 to move the 125,000 residents enrolled in temporary Medicaid coverage to plans that comply with the federal health care law. But because the website is not expected to be fully functioning by that date, officials have previously said they plan to ask the Obama administration to extend that deadline to Sept. 30. Sources and for More Information
ACA Requires Medicaid Spousal Impoverishment Protections for Medicaid-Funded Home and Community Based Services (Waivers) While Massachusetts already does so, now all states must extend impoverishment protections to spouses of home and community-based services (HCBS) waiver participants. Spousal impoverishment protections prevent one spouse from experiencing severe poverty when the other spouse has qualified for certain kinds of Medicaid coverage. The Affordable Care Act (ACA) requires that the spouse of any person who is receiving Medicaid-funded long-term services and supports, either in a nursing facility or at home, be allowed to keep a minimum amount of income and assets. Prior to the ACA, states were only required to extend the protections to spouses of nursing facility residents. Many states (including Massachusetts) voluntarily chose to give impoverishment protections to spouses of HCBS waiver participants, and as of January 1, 2014 all states must comply. The ACA does not change the spousal impoverishment protections themselves. The spouse who is not using Medicaid HCBS or nursing facility services is not required to use his or her income to pay for the care. The non-Medicaid spouse has the right to a minimum monthly allowance in order to ensure a basic standard of living. Additionally, the non-Medicaid spouse is permitted to keep a larger amount of assets than would otherwise be allowed absent the impoverishment protections. -Adapted from Spousal Impoverishment Changes, e-mail, National Senior Citizens Law Center, March 5, 2014. Full text available at: http://salsa4.salsalabs.com/o/50849/t/0/blastContent.jsp?email_blast_KEY=1237303. The Health Insurance Subsidy Gap Some people seeking to buy health insurance are finding themselves falling into a subsidy gap that leaves them ineligible for financial assistance under the Affordable Care Act. Subsidies in the health law were designed to lower insurance costs for people who make around $11,000 to $46,000 a year. But for those earning toward the higher end of that range, it's more complicated than that. A new study shows that in major cities, some fall in that salary range but don't actually qualify for government help to pay their insurance premiums. That's because subsidies kick in only when a baseline health plan exceeds a certain percentage of a person's income. The higher a person's income, the more expensive premiums must be before subsidies kick in. That's the subsidy gap. "What we found is that on average, once you were above $31,744 you probably were not going to qualify for a subsidy," says Kev Coleman, with the health information technology company Healthpocket. He looked at plans for young adults in eight major cities, and all of them had these subsidy gaps. -See the full NPR story...
Invisibility Survival Tactic Blocks Progress for Homeless Youth Boston’s last homeless census counted 7,255 men, women, and children living in shelters, on the street, or in transitional or residential treatment programs–a 3.8 percent increase from the 2012 census. The way the homeless census is conducted, the mayor, city officials, community leaders, and 350 volunteers spend one night every year counting every homeless person they can find, in and out of shelters. In the process, the commission also passes out a survey targeting unaccompanied youth, with questions about age, sexuality, and where people sleep. Each year, the homeless census generates vital information and statistics, and informs state officials about what resources are needed for these at-risk populations. But Cambridge drop-in program Youth On Fire staffer, and former homeless teen, Diamond MacMillion, like other advocates interviewed for this story, says asking young folks to come forward can threaten their camouflaged way of life. In 2012, for example, the Boston Emergency Shelter Commission conducted a homeless youth count for the first time ever, attempting to identify unaccompanied young people across different service sites. Those wielding the clipboards found 191 individuals under 24 years old–a number advocates and legislators say seems drastically inaccurate. “You’re not going to be able to seek them out,” MacMillion says. “They survive by being invisible. That’s one of the biggest complaints, that they’re so invisible on the street, but it’s the only reason they survive so long.” Bed Shortage Before working at Youth on Fire, in the basement of the Harvard-Epworth United Methodist Church, MacMillion spent her nights with friends, in non-working elevators near Kenmore Square, or in laundry rooms at MIT. “It’s all about appearances, and when you’re out here, you learn that quick,” says MacMillion. “If you were to ask me when I was out here if I was homeless, nine out of ten times I would deny it.” Though harrowing by all means, the situation around youth homelessness in Massachusetts is also complicated. Statewide, there is not only a lack of housing opportunities, but also a lack of emergency options. In all of Greater Boston, there are only 12 beds for young people–at Bridge Over Troubled Waters, a transitional housing program in Downtown Crossing. There are also adult shelters, but according to advocates, regardless of how well maintained those facilities are, they’re still unfit for anyone below the age of 24. “We just throw our 18-24 year-olds into the adult shelter system,” says Ayala Livny, the program manager of Youth On Fire. “We set them up to be victimized, and exploited, and violated. It is unconscionable that we can’t do better by them.” Livny says youth caught in the shelter system are often preyed upon by older homeless people. As a result, when many under the age of 25 feel unsafe, they avoid shelters altogether. By avoiding shelters for safety reasons, young people can slip through the cracks and escape the state’s radar. “It’s not uncommon for young people to report having to be involved in trading sex–not only for a roof over their head, but to meet other basic needs” says Kelly Turley, the Director of Legislative Advocacy of the Massachusetts Coalition for the Homeless. MacMillion says the problem is exacerbated by prejudice against LGBTQ youth, who deal with a limited set of options. Catholic shelters, for one, often won’t take them in. A Continuum Of Options This year, the Massachusetts House Committee on Ways and Means will consider a $5 million bill to provide funding for housing and services for unaccompanied homeless youth. The text of the House bill calls for “a continuum of housing options,” to be delivered in conjunction with “wraparound support services.” The proposal also pegs various training programs and health services that could be of help. Bill 135 isn’t meant to provide more short-term shelter solutions, or hotel rooms, but rather structured long-term support. Before becoming a legislator, Rep. Jim O’Day of Worcester, one of the bill’s drafters, spent years advocating for homeless youth through social work. “How do you study if you’re bouncing from couch to couch to couch?” he asks. “If your biggest challenge is keeping yourself alive, all those other things are secondary.” When it comes to requesting funds for Bill 135, legislators and advocates are faced with an invisibility paradox–homeless youth are difficult or even impossible to identify, and that’s what keeps them alive. In other words, lawmakers must essentially ask their colleagues to help a population that is, statistically speaking, almost nonexistent. “As a state, Massachusetts has a very comprehensive response to homelessness,” Turley says. “But for this particular population of young people, there isn’t a safety net.” In addition to her position on the commonwealth homeless coalition, Turley is the co-chair of a working group on connection and identification–ways to make up for the troubling but inevitable visibility gap. In that work, Turley says young people are reluctant to participate since they doubt their input will amount to anything. “Because the state right now doesn’t have a comprehensive response to homelessness, even if a young person were to come forward and share their story, there may not be resources,” Turley says. “Once young people know that there may not be resources, there’s less and less motivation to come forward, and to come out of the shadows and share their story.” -See the full Dig Boston article... Cited in/linked from: MassterList, Mike Deehan, March 07, 2014 IOM to Military: Raise the Bar on Mental Health Programs The US Department of Defense (DoD) must conduct more rigorous evaluation of programs aimed at improving the psychological health and well-being of members of the military and their families, according to the Institute of Medicine (IOM). In a new report, the IOM states that many of the programs developed and instituted by the DoD to prevent negative psychiatric outcomes in military members lack a solid evidence base and are evaluated infrequently. "Increasing rates of mental health problems among service members and the related toll on families point to an urgent need to prevent and mitigate these conditions," Kenneth Warren, chair of the committee that wrote the report, said in a release. "DoD should rigorously evaluate any new programs that are developed to do so, because we remain uncertain about which approaches work and which ones are ineffective," he added. In examining the quality and evidence-base of programs in DoD designed to prevent negative psychological health outcomes among service member and their families and to identify appropriate performance measures for such programs, the IOM committee made the following 5 recommendations:
The full report can be viewed on the IOM Web site. -See the full Medscape article... Possible DTA Staffing Shortage Looming House Minority Leader Bradley H. Jones is questioning whether the Patrick administration is ignoring what he called a “potential ticking time bomb” at the Department of Transitional Assistance after a Boston Herald report of an internal audit showing 55 percent of the agency’s 1,100 caseworkers are retirement age. “I would like to think someone is saying, ‘What’s the plan? What’s the recruitment plan to fill some of these slots, and what are we going to have to do, if all these people retire?’” Jones said. “I’m not one who wants to say, ‘Let’s see state employment go through the roof,’ but there needs to be certain areas where there needs to be ... an appropriate level of staffing.” The Herald reported recently that the DTA is bracing for a possible flood of retiring staffers, with some caseworkers already handling as many as 1,500 EBT recipients. The stunning state-ordered audit by Ernst & Young, obtained by the Herald, also raised questions among management experts about whether the agency can follow through on reforms. DTA Commissioner Stacey Monahan said the agency brought on 157 workers last year, and another 55 hires are in the works. But union officials questioned DTA’s ability to keep pace, noting that since September, just 38 new hires have been made at a time when 100 have been lost to retirement. “The tremendous caseload that some of these people are carrying only serves as incentive for some to say, ‘I am going to retire when I can,’” Jones said. -See the full Boston Herald article... Cited in/linked from: MassterList , Mike Deehan, March 12, 2014.
Medscape recently interviewed Dr. David Perlmutter, Associate Professor at the University of Miami School of Medicine, about his theory that carbohydrate and gluten consumption may cause or contribute to dementia (Summarized in the January 2014 MGH Community News). Dr. Neal D. Barnard, Adjunct Associate Professor of Internal Medicine at the George Washington University School of Medicine, doesn't agree. Here's why. Grain and the Brain: A Lesson From Japan It seems that many people are looking for a whipping boy on whom to blame our expanding waistlines, our diabetes epidemic, and our continuing need for cholesterol and blood pressure medications. Some clinicians and writers are going a step further. They are now flogging that whole-wheat whipping boy for triggering Alzheimer disease. Grain-blaming started with the observation that high blood sugar levels are linked with Alzheimer disease. That's true enough. People with diabetes are at elevated risk of developing dementia. So some have reasoned that because carbohydrates release natural sugars during digestion, the way to lower blood sugar must be to avoid carbs. They assumed that might protect the brain, too. But here they have stepped on a scientific landmine. Avoiding healthy carbohydrate-containing foods turns out to be the last thing you would want to do for diabetes, obesity, or Alzheimer disease. It is not bread, rice, or grains in general that have caused blood sugars to rise or diabetes to become an epidemic. Just the opposite: The transition to a diet heavily based on animal products, especially meat and cheese, aided and abetted by fryer grease and sugar, is the real culprit in the current epidemics of obesity; diabetes; and Alzheimer disease. How Bad Fats Harm the Brain But how could fatty foods increase blood sugar? The answer appears to lie in the accumulation of fats inside muscle and liver cells. The metabolism of these intracellular lipids appears to disrupt insulin signaling, causing insulin resistance. While these mechanisms are still under investigation, our research group, with the support of the National Institutes of Health, tested the theory that getting these fats out of the diet would help. And it clearly does. In people with type 2 diabetes, a low-fat, plant-based diet causes significant weight loss and dramatic improvements in blood sugar control, not to mention reductions in plasma lipids and blood pressure. All this occurs in the absence of any limits on carbohydrates, calories, or portion sizes. As our diabetes study was bearing fruit, researchers at the Chicago Health and Aging Project published ground breaking findings showing that fatty foods were linked to Alzheimer disease. After 4 years of observation, saturated and trans fats were associated with increased Alzheimer risk. Other studies have examined the same relationship, and although the data vary somewhat from study to study, the overall picture is that saturated and trans fats increase Alzheimer risk, just as they increase the risk for many other health problems. Bottom line -- avoiding "bad" fats is a good idea. -See the full Medscape article... Binge Drinking Boosts Mortality Risk in Older Adults Episodes of binge drinking are risky for anyone, but they are particularly so for aging adults who are moderate drinkers, new research suggests. Compared with moderate-drinking older adults who do not binge, those that do have a 2-fold increased risk of dying during a 20-year period. "These findings demonstrate that among older adults, drinking patterns need to be addressed along with overall consumption in order to understand alcohol's health effects," Charles J. Holahan, PhD, professor of psychology at the University of Texas at Austin, who worked on the study, said in a statement. "This is a crucial point since approximately a quarter of 'moderate' drinkers report binge drinking, and most folks in the US don't typically drink in an 'average' way or on a daily basis," added "Clinicians should understand that even among those with apparently modest average consumption, a number of these folks may be drinking in risky ways," said Timothy S. Naimi, MD, MPH, associate professor at Boston University Schools of Medicine and Public Health, who was not involved in the study. The study was published online March 3 in Alcoholism: Clinical and Experimental Research. -See the full Medscape summary article...
Doctor Debunks 12-Step Recovery Since its founding in the 1930s, Alcoholics Anonymous has become part of the fabric of American society. AA and the many 12-step groups it inspired have become the country's go-to solution for addiction in all of its forms. These recovery programs are mandated by drug courts, prescribed by doctors and widely praised by reformed addicts. Dr. Lance Dodes sees a big problem with that. The psychiatrist has spent more than 20 years studying and treating addiction. His latest book on the subject is The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. Dodes tells NPR's Arun Rath that 12-step recovery simply doesn't work, despite anecdotes about success. "We hear from the people who do well; we don't hear from the people who don't do well," he says. On Alcoholics Anonymous' Success Rate There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don't seem to know that because it's not widely publicized. There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine. It's not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we'd say OK. But it's harmful to the 90 percent who don't do well. And it's harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it's you that's failed. On Why 12-Step Programs Can Work The reason that the 5 to 10 percent do well in AA actually doesn't have to do with the 12 steps themselves; it has to do with the camaraderie. It's a supportive organization with people who are on the whole kind to you, and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood rather than a treatment. So as you can imagine, a few people given that kind of setting are able to change their behavior at least temporarily, maybe permanently. But most people can't deal with their addiction, which is deeply driven, by just being in a brotherhood. On a Psychological Approach to Addiction When people are confronted with a feeling of being trapped, of being overwhelmingly helpless, they have to do something. It isn't necessarily the "something" that actually deals with the problem. Using substances is the "something" that they do. In psychology we call it a displacement; you could call it a substitute.
When people can understand their addiction and what drives it, not only are they able to manage it but they can predict the next time the addictive urge will come up, because they know the kind of things that will make them feel overwhelmingly helpless. Given that forewarning, they can manage it much better. Read the full article summary or listen to the full interview at: http://www.npr.org/2014/03/23/291405829/with-sobering-science-doctor-debunks-12-step-recovery Also see following story. Mindfulness Approach Reduces Substance Use Disorder Relapse Risk Mindfulness-based aftercare significantly reduces relapse risk in patients with substance use disorders (SUDs) in the long-term compared with 2 other standard treatment approaches, new research shows. Results from a small randomized clinical trial show that after initial treatment for drug and alcohol abuse, patients assigned to receive mindfulness-based relapse prevention (MBRP) were significantly less likely to relapse at 12 months compared with their counterparts who received usual 12-step programming. "These findings suggest that MBRP may support longer term sustainability of treatment gains for individuals with substance-use disorders," the investigators, led by Sarah Bowen, PhD, Addictive Behaviors Research Center, Seattle, Washington, write. The study was published online March 19 in JAMA Psychiatry. -See the full Medscape summary article...
Caregiver Burden Often Overlooked A recent report published in JAMA finds that many physicians overlook caregiver burden. “Most physicians haven’t been trained to ask patients about it, and it’s a new clinical habit that you have to consciously adopt and work on,” says geriatrician Dr. Anne Fabiny, medical editor of Caregiver’s Handbook, a Special Health Report from Harvard Medical School. The authors of the JAMA study found that caregivers are typically women who spend about 20 to 40 hours a week providing care. They also found that most caregivers feel abandoned and unrecognized by the health care system. Spousal caregivers face greater challenges than caregivers helping a parent for a variety of reasons, one of which is that they tend to be older. Of these caregivers, 32% have a high caregiver burden. There is no medical classification for “caregiver burden.” But it’s generally known as the toll that caregiving takes on a person. It can manifest in many ways, including physical ailments, mental illness, social isolation, and financial problems. “Caregivers get depressed. Then they neglect their own health or they miss doctor appointments because they can’t extract themselves from their caregiving role. They just don’t have support, so things like exercising, getting enough sleep, or engaging in a social life all fall away,” says Dr. Fabiny.
The JAMA study cites cases of elderly caregivers who are so distraught that they try to commit suicide just to get out of the situation. The authors of the JAMA report and others are urging physicians to help prevent or reduce mounting desperation among caregivers by playing a part in assessing the caregiver’s health during regular clinic visits for the person who is chronically ill.
The answers can help physicians direct caregivers to various services and support systems. These include:
-See the full Harvard Health Blog entry...
Gun-Ownership and Suicide Risk Overlooked in Dementia Patients The risk for violence in elderly dementia patients, including homicide and suicide, is often overlooked and highlights the need to allow clinicians to ask about gun access and ownership in this population. Paul Kirwin, MD, immediate past president of the American Association for Geriatric Psychiatry (AAGP), told meeting delegates attending the AAGP 2014 Annual Meeting that older white males are 5 times more likely to die by suicide than their younger counterparts and that there have also been serious reports of elder violence toward others. "In 2004, the VA found that 40% of veterans with mild to moderate dementia had guns in their homes. Deferring to a patient's autonomous choices only makes sense when that patient is capable of making logical decisions," he said. "Guns, like cars, signify independence and individualism. And the right to own a gun is not in dispute. But one's ability to handle a deadly weapon when physical or mental acuity begins to deteriorate is an issue of public safety." He noted that according to a 2004 national survey, more than 25% of those older than 65 years own guns. Other recent studies have shown that firearms are the most common method used in suicides by both men and women in later life. "Elderly men used a gun 79% of the time to end their life. And every day, an estimated 22 veterans kill themselves in the United States, according to the VA." In an attempt to prevent such events, the VA recently launched a public awareness campaign about gun access and dementia patients. Its brochure, Firearms & Dementia, encourages to families take appropriate action to unload, secure or remove firearms in the home regardless of the severity of dementia or whether the loved-one is suffering from a behavioral problem or depression, and gives specific recommendations as to how to do so. -See the full Mescape article... Few Teens Referred for Mental Health Treatment Go Through With It Less than half of teenagers who test positive for mental disorders and receive a referral for care actually undergo treatment, a new study has found. Out of 117 youth who tested positive in a primary care mental health screen, 63, or 54%, were referred for treatment. But only 29, representing 46% of those referred, had some contact with a professional within 180 days of referral, the study found. And only 18% of them saw a mental health professional face to face. The low rate of contact came as a surprise, researchers say, but at the same time it is not an uncommon problem. "Unfortunately, completion of referral to mental health services from primary care is still a challenge," Dr. Karen Hacker, who led the study at the Cambridge Health Alliance's Institute for Community Health in Cambridge, Massachusetts, told Reuters Health by email. "I would suggest that physicians should schedule a return visit for anyone that they refer to mental health. That way they can see how the teen is doing and determine if further services are necessary. If they are, they can encourage the teen and family to engage in care," Dr. Hacker says. Dr. Hacker and her team published their results February 12 online ahead of print in the Journal of Adolescent Health. The study aimed to test the efficacy of the Pediatric Symptom Checklist or Youth-Pediatric Symptom Checklist mental health screen at a well-child check-up. -See the full Medscape article....
Best Therapy for Sexual Abuse-Related PTSD in Adolescent Girls Evidence-based treatments for posttraumatic stress disorder (PTSD) have not yet been established for adolescents, despite the high prevalence of PTSD in this population. Now a team of investigators from the University of Pennsylvania has conducted a small single-blind randomized trial to examine the effects of 14 sessions of counselor-delivered prolonged exposure therapy compared with the same dose of supportive counseling for adolescents with PTSD. The investigators reported that participants demonstrated greater improvement with exposure therapy on the primary outcome measure (PTSD symptom severity), which was assessed by the Child PTSD Symptom Scale-Interview, and on all secondary outcomes, such as depression and global functioning, and that these treatment differences were maintained at 12-month follow-up. This conclusion has potentially substantial implications which may require many clinicians to review their clinical practices and skills. -See the Medscape Psychiatry Minute... |