Behavioral Health Education

Substance Use Disorders (SUD) are a type of mental health disorder that impacts a person’s thinking and behavior. These disorders are marked by an individual’s inability to manage or control their substance use. Other mental health disorders, like depression, anxiety, or ADHD, can often occur at the same time as the substance use disorder, making treatment complex. Treatment often involves a combination of behavioral therapy, medication, and community support.

Buckeye’s Initiatives To Address SUD
Buckeye supports the use of evidenced-based, best practice treatment for SUD. Below are ways Buckeye is addressing SUD.

• Opioid Action Council
  Buckeye’s Opioid Action Council was created to establish evidence-based, multi-disciplinary interventions that Buckeye will engage in to address Ohio’s opioid epidemic. There are 4 subcommittees: pharmacy, provider, member, and community. Each subcommittee is developing interventions that will impact the multiple facets of this challenging issue. Some of our goals are to reduce residential treatment readmissions, contract with high quality substance use disorder providers, and increase the percentage of members with opioid use disorder being treated with medication assisted therapy.
  
  
• Wayspring
  Buckeye has newly partnered with Wayspring to enhance existing SUD services for members, address care gaps, provide holistic support early on in treatment, and address social determinants of health. Wayspring will work in conjunction with Buckeye’s care management team in addition to outpatient and inpatient providers. Representatives from Wayspring may contact you as a provider of these services to discuss how you will work together to support members in your care. You can learn more about Wayspring on our website.
  
  
• Peer Recovery Services
  Peer supporters are individuals who have a personal history of mental health or substance use disorder and have been successful in managing symptoms and maintaining health stability. These individuals serve as non-judgmental supports to others with a mental health or substance use disorder and help them along their recovery path. Peers can be essential to building a support network, implementing effective coping strategies, finding resources, advocacy, and relapse prevention. Over the past couple years, Buckeye has increased member referrals to Peer Support Services and have tracked improvement in member engagement and maintenance in treatment when a member has linked to a peer.

How to Refer Buckeye Members

If you are working with a Buckeye member who you believe may benefit from support for a substance use disorder, please call Buckeye Provider Services at 866-296-8731. Our Provider Services team will help with facilitating the referrals to our Behavioral Health care management team to assist with getting services established for Buckeye members.  

References:

“Substance Use and Co-Occurring Mental Disorders” March 2023. National Institute of Mental Health.

“Peer Support Recovery is the Future of Behavioral Health” October 28, 2021. Substance Abuse and Mental Health Services Administration.

For most of us, the holidays give us the expectation of warmth, peace and celebration with family and friends. Our thoughts go to enjoying gatherings and sharing our love and happiness. However, the reality is that the time leading up to the holidays is often stressful for many reasons, to name a few:

• Trying to create the ideal holiday for those around us.
• Staying on budget while finding gifts for everyone.
• Wanting present a fabulous spread of food and share goodies with family, coworkers, and friends add hours of extra work in cooking and baking.
• Hours of decorating, shopping, and gift wrapping can leave us tired and irritable as we try spending time with loved ones. 

Holiday stress is real, so how can we turn things around to have a good holiday without giving in to all of the stress that can come along with it? Find ways to prevent falling into stress-inducing behaviors.

1. If finances are a stressor, consider a gift exchange or a white elephant exchange. Some groups agree to create homemade gifts for each other, as well. Having to only come up with one gift and have fun with the actual gift exchange on the day of the holiday. 
2. Be realistic about our time and resource availability for completing holiday activities. Time at work, after-work activities involving family, household tasks and more, consider prior planning.
   • Scale down activities and leave time for rest.
   • Consider making a meal collaborative or pot luck. The host creates the main dish and other attendees bring appetizers, sides, or desserts.
   • Don't sacrifice healthful activities for holiday preparation. Prioritize time for enough rest, exercise, and proper daily nutrition.
   • Take breaks to breathe deeply and allow the body to relax. A focus on self-care can contribute to a relaxed, fun, and successful holiday with family and friends.
3. Finally, it is important to monitor for worry over how the holidays will play out. If someone knows they experience stress or anxiety-related health, ensure counseling sessions are kept and medication regimens are followed. If new stress or worries arise that feel difficult to cope with, it is important to consult with a mental health professional to have some support in dealing with those feelings. 

The holidays can be a stressful time for everyone. When a few adjustments are made, the holidays can be a relaxed and happy time for all.    

Senior Mental Health

Mental illness impacts individuals throughout their lifespan but there are unique factors impacting mental health and the senior population. These factors include increase risk of isolation, feelings one doesn’t belong, chronic medical conditions and pain, loss of self-sufficiency, feeling like a burden, grief over lost loved ones, cognitive impairment, and financial troubles. The most common mental illness seen with the elderly is depression.

In addition to depression, suicide is a significant concern because while older adults include just 12% of the population, they make up approximately 18% of suicides according to the National Institute of Mental Health.  Men 75 and older face the highest overall rate of suicide.

Providing support and linking to resources are ways to help older adults at risk of suicide. Advocacy is also needed to ensure older adults have access to needed services. One is example is need for Medicare to recognize licensed mental health counselors and licensed family therapists to increase older adult access to mental health care.

Substance use disorders impact nearly 1 million adults age 65 and over as reported in 2018 data from SAMSHA. The number of older adults admitted to Substance Use Disorder treatment facilities between 2000 and 2012 increased from 3.4% to 7% during this time per the National Institute on Drug Abuse. Due to increase chromic health conditions with aging, older adults are more likely to be precribed potentially addictive medications. Older adults also may metabolize medications differently. Many behavioral therapies and medications have proven effective  in treating substance use disorders, including in the older adult population.  (Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.)

Resources:

Suicide & Crisis Hotline- Call or text 988 or chat available on 988 Life Line website

Buckeye Health Plan has contracted with an array of behavioral health and substance abuse providers. Members can access Behavioral Health Providers, including metal health professionals and inpatient and outpatient treatment for mental health and addictions, using the Find a Doctor or Pharmacy feature on the For Members page of our website.

References:

National Council on Aging - 988 answering the call lfor stronger suicide prevention efforts

National Council on Aging - how to respond to suicide risk in older adults.  

SUD Support and Services

Many individuals struggle with alcohol and other substance abuse disorders (SUD) that may lead to, or cause, barriers to continuity of care. There is said to be a higher emergency department (ED) rate in those over age 12, that use substances compared to those who do not use substances. Seven and 30-day follow up for ED visits for SUD has shown effective in reducing the frequency of future ED visits, substance use, and inpatient hospitalizations (IP).

Here at Buckeye Health Plan, we offer Behavioral Health support to assist members with struggling with SUD through behavioral health case management, health care benefits that offer SUD interventions and coverage for treatment, and various programs. Buckeye case management is a great way to get the member engaged and assist the member with the necessary resources and tools to be successful in their care. Case managers can collaborate with IP facilities, community case managers, providers, family, etc. to ensure that member has supports in place. Buckeye benefits for SUD provides our members with the assurance that their follow up care and behavioral health providers will be covered. A few programs aside from case management that may support members with barriers to care are the cell phone program where members are provided a cell phone to be able to communicate with their providers and free transportation to assist members with traveling to their scheduled care, and follow up care, appointments. 

Resources:

NCQA HEDIS Measures

June is PRIDE month

The tobacco industry has a well-documented history of targeting the LGBTQ+ community, and research has shown that lesbian, gay, and bisexual youth use tobacco products at higher rates than their heterosexual peers. Quitting vaping is hard and it’s important to understand how to help those who might want to quit, but don’t know how or where to start. Take action this PRIDE Month: reach out to a young person in your life and talk to them about vaping.  As a parent or caregiver to a teen or young adult, you can access free support with advice for talking with a young person quitting nicotine and a community of adults experiencing the same thing. Register for free at BecomeAnEX.org. 

If you know a young person who is trying to quit vaping nicotine, there are free resources for them, too! This is Quitting is a free and anonymous text message quit program – anyone can text BUCKEYE to 88709 for daily messages and science-backed tools for quitting and staying quit. The program is already helping more than 580,000 young people on their journey to quit.

Summer break brings a lot of changes for young children and teens. While some children will want to spend that time at home others may need that structure and engagement throughout the summer. While summer creates additional opportunities for engagement with kids it can also create additional strain for children requiring structure in their day. There are many low-cost programs available to help support engagement for school age children during the summer months. Below are programs within Ohio offering summer programs and resources such as food programs.

YMCA

Boys and Girls Club of America

Ohio summer food service program

Cap for kids resources

May is Mental Health Awareness Month and Buckeye Health is aiming to raise the collective mental health IQ in our communities to help reduce fear, shame and stigma that is often associated with mental illness.

The Centers for Disease Control and Prevention defines mental health as our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood (2021).

The National Alliance for Mental Illness (NAMI) finds that mental health issues can be caused by a variety of factors, including:

• Family history of mental illnesses
• Traumatic life experiences
• Brain chemistry and functioning
• Genetic factors
• Social factors such as economic depression     

Nearly 21% U.S. adults and 17% of youth experience a mental illness each year yet less than half of those actually get treatment (NAMI, 2023).  Even more so, the average delay between symptom onset and treatment is 11 years.  The annual prevalence rates for the most common mental illnesses are as follows:

• 19% Anxiety Disorders
• 8% Depression
• 8% Co-occurring Substance Use Disorder and Mental Illness
• 4% Post-traumatic Stress Disorder
• 3% Bipolar Disorder
• 1% Borderline Personality Disorder
• 1% Obsessive Compulsive Disorder
• 1% Schizophrenia

Sadly, despite technical and medical advances in health care, mental health disorders remain largely stigmatized and socially taboo (Rean Foundation, 2022).  A study by NAMI (2023) found that only 47% of adults and 51% of youth seek care each year for their mental health conditions, despite various treatment options being available.  Increased mental health awareness is key to breaking stigma and assisting with getting people connected to care.  Some efforts we can take as health care professionals to improve mental health awareness include:

• Openly discussing mental health and sharing your own experiences and encouraging others to speak out will help them get needed care.
• Shedding light on the signs and symptoms of mental illness and how to assist others if they are diagnosed.  Some of the warning signs may include:
  • Unexplained mood swings
  • Changes in eating or sleeping patterns
  • Inexplicable feelings of sadness
• Checking in with your mental health and getting routine screenings with your health care provider.
• Volunteering at local mental health awareness programs and promoting events to help raise awareness.
• Adopting a holistic approach to helping and informing others on the importance of self-love and self-care.

To learn more about mental health and what you can do to support, please check out the following organizational websites:

NAMI

SAMHSA

NIMH

Ohio MHAS

Buckeye Partners with 'This Is Quitting' to Combat Teen Vaping

E-cigarettes have become the most common form of tobacco products for middle and high school students in Ohio. A recent study found that 11.9% of middle school and 29.0% of high school students use e-cigarettes. To combat the growing trend, Buckeye has partnered with This is Quitting to provide a free, app-based support tool for youth to quit.

Vaping nicotine can amplify feelings of depression and anxiety and increase stress. Nicotine also harms developing brains, and can make young people more susceptible to addiction. Quitting is hard and it’s important to understand how to help those who might want to quit, but don’t know how or where to start.  As a parent or caregiver to a teen or young adult, you can access free support with advice for talking with a young person quitting vaping and a community of adults experiencing the same thing. Register for free at BecomeAnEX.org.

If you have a young person patient who could use some extra help in quitting vaping, there are free resources for them, too! This is Quitting is a free and anonymous text message quit program –anyone can text BUCKEYE to 88709 for daily messages and science-backed tools for quitting and staying quit. The program is already helping more than 580,000 young people on their journey to quit. 

April is National Stress Awareness Month, an observance that has been in place since 1992. Stress can be thought of as physical, emotional, or mental strain or tension. Often all three of these types of strain occur simultaneously.

Recently, stress has been a focus when considering the well-being of individuals. People are reporting increased stress due to changing workplaces, evolving work practices, changes in the world related to our climate, the recent pandemic, and unrest across the globe. It is important to be aware of stressors in our daily lives, as stress, over time, can affect our health. For instance, you may experience stress if you have things going on in your life, such as being under lots of pressure, facing big changes, or not having much or any control over the outcome of a situation. You may also be experiencing having responsibilities that you find overwhelming, or not having enough work to make ends meet and provide you with a sense of purpose.

Another definite stressor is experiencing discrimination, hate, or abuse, which is on the rise for many groups of people at this time. All people respond differently to stress, and this can be due to each person’s body reacting differently to stressful situations. Factors to consider include genetic background, personality or temperament, biological age and the capacity to cope with stress.

The good news is that people can learn strategies for managing stress in a healthy way. The National Institute of Mental Health suggests techniques such as keeping and writing in a journal, learning to be mindful and stay “in the here and now”, making sure to get healthy nutrition each day, get exercise, and get enough sleep each night.  For more information on and tips for managing stress, visit the NIMH tip sheet, “I’m So Stressed Out!”:

A Brief on HEDIS measure FUH: Follow-up after Hospitalization for Mental Illness

Healthcare Effectiveness Data and Information Set (HEDIS) is one of healthcare’s most widely used performance improvement tools. These measures help set a benchmark for American healthcare consumers to review when choosing providers. Follow-Up After Hospitalization for Mental Illness (FUH) assesses the percentage of inpatient discharges for a diagnosis of mental illness or intentional self-harm among patients aged 6 years and older that resulted in follow-up care with a mental health provider within 7 and 30 days.

In 2019, nearly one in five adults aged 18 and older in the U.S. had a diagnosed mental health disorder.¹ Despite this, individuals hospitalized for mental health disorders often do not receive adequate follow-up care. Providing follow-up care to patients after psychiatric hospitalization can improve patient outcomes, decrease the likelihood of re-hospitalization and the overall cost of outpatient care.^2,3,4

HEDIS® Improvement Tips:

• Schedule member’s 7-day or 30-day follow-up appointment prior to the member being discharged from the hospital.
• Maintain appointment availability in your office for patients with recent hospital discharges.
• Complete appointment reminder calls 24-hours prior to the scheduled follow-up appointment.

References

1. Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (NSDUH). 
2. Barekatain M, Maracy MR, Rajabi F, Baratian H. (2014). Aftercare services for patients with severe mental disorder: A randomized controlled trial. J Res Med Sci. 19(3):240-5.
3. Luxton DD, June JD, Comtois KA. (2013). Can post-discharge follow-up contacts prevent suicide and suicidal behavior? A review of the evidence. Crisis. 34(1):32-41. doi: 10.1027/0227-5910/a000158.
4. Glazer, W. (2010). Tackling adherence in the real world. Behavioral Healthcare, 30(3), 28-30.

What Do Social Isolation and Loneliness Mean?

According to the ​​English Longitudinal Study of Ageing, social isolation and loneliness have specific definitions. 

Social isolation: refers to the general and often broad absence of contact with other people.

Loneliness: the perceived subjective feeling of being lonely. 

In the study, researchers coined a helpful phrase for understanding these two concepts: 

“Isolation is being by yourself. Loneliness is not liking it.” 

You can read more at Science of People.com

How to Recognize If Your Loved One is Feeling Lonely

• Withdrawal from daily activities
• Decreased participation in ADL’s/hygiene
• Unexplained tiredness/over sleeping
• Avoidance of meals/over eating
• Irritability
• Change in mood or affect
• Lack of motivation
• Apathetic attitude

Health Risks of Loneliness

Although it’s hard to measure social isolation and loneliness precisely, there is strong evidence that many adults aged 50 and older are socially isolated or lonely in ways that put their health at risk. Recent studies found that:

• Social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.
• Social isolation was associated with about a 50% increased risk of dementia.
• Poor social relationships (characterized by social isolation or loneliness) was associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.
• Loneliness was associated with higher rates of depression, anxiety, and suicide.
• Loneliness among heart failure patients was associated with a nearly 4 times increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits.

Immigrant, LGBT People Are at Higher Risk

A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) highlights loneliness among vulnerable older adults, including immigrants; lesbian, gay, bisexual, and transgender (LGBT) populations; minorities; and victims of elder abuse. It also points out that the literature base for these populations is sparse and more research is needed to determine risks, impacts, and appropriate actions needed.

Current research suggests that immigrant and lesbian, gay, bisexual populations experience loneliness more often than other groups. Latino immigrants, for example, “have fewer social ties and lower levels of social integration than US-born Latinos.” First-generation immigrants experience stressors that can increase their social isolation, such as language barriers, differences in community, family dynamics, and new relationships that lack depth or history, the report states. Similarly, gay, lesbian, and bisexual populations tend to have more loneliness than their heterosexual peers because of stigma, discrimination, and barriers to care.

How to Improve Loneliness: Questions to Ask

• Talk through the concerns with your loved one/yourself
• Do you feel like you are not getting out enough? 
• Are you worried/anxious about leaving the house? 
• Is there something that you can identify that is causing you to feel lonely?
• Do you feel connected to the people you interact with? 
• Are you feeling fulfilled with your daily life?

Source: CDC.Gov

Learn about Buckeye Peer Recovery Services 

Peer Supporters

Peer supporters are individuals who have a personal history of mental health or substance use disorder and have been successful in managing their symptoms and maintaining health stability. These individuals serve as non-judgmental supports to others with a mental health or substance use diagnosis and help them along their recovery path. A key element to peer work is the relationship formed between the two peers who share lived experience.

Peer Recovery Services

Peer Support is a Medicaid covered service in the state of Ohio. Peer Recovery Services are provided in many ways and settings including telephonic, face to face, individual and group contexts. Peers often meet in the community and can be essential to building a support network, implementing effective coping strategies, finding resources, advocacy, and relapse prevention. Peer led, peer run organizations known as Recovery Community Organizations (RCO’s) and Clubhouses are common. These locations provide safe environments free of judgment yet full of support and resources.

Benefits for Buckeye Members

Because Peer Specialists focus on individual strengths and assets, they can help Buckeye members view their challenges as opportunities rather than defeats or failures. Empathy is at the core of this service, and it embodies the Buckeye way of “leading with heart.” The Buckeye Behavioral Health team has a recovery practitioner on staff, David Nalls. He is an integral part of the recovery community in Ohio and is part of the team currently writing the Ohio Peer Recovery Support Manual. He is an incredible asset to our team and can provide additional information and answer questions.

How to Refer

If you are working with a Buckeye member who you believe may benefit from peer recovery services, we would be happy to help with linking the member to services. Please call Buckeye Provider Services at 1-866-296-8731. Our Provider Services team will assist with facilitating the referrals to our Behavioral Health care management team to assist with getting services established for Buckeye Members.  

References:

“Peers” April 26, 2022. Substance Abuse and Mental Health Services Administration. Retrieved electronically on July 15, 2022. 

“Peer Support Recovery is the Future of Behavioral Health” October 28, 2021. Substance Abuse and Mental Health Services Administration. Retrieved electronically on July 24, 2022. 

Thrive Peer Recovery Services

"I am so happy that Buckeye connected me with you so I can have support from someone that has been there." "I couldn't believe that you remembered to call me this week now that I am in treatment, thank you Debra, Thrive and Buckeye. I need this right now." – H.R.

As part of Buckeye’s vision to transform the health of our community, one person at a time, Buckeye Health Plan aims to manage the most complex, vulnerable members which include members with chronic mental health and substance use disorders. Annually, this subset of our population accounts for nearly 36% of the membership. According to the National Alliance on Mental Illness, nationally, nearly 40% of the population that has a mental health or substance use disorder does not seek care due to fear, shame and stigma (2021). To help combat this trend, Buckeye has partnered with Thrive Peer Recovery Services (Thrive) to better serve our most vulnerable members. The partnership utilizes mental health and substance use disorder peer support specialists to function as care extenders and engage members into treatment. Peer supports are individuals that have experienced success in their own recovery and serve to help others, through “lived with” experience.  The peer supporters participate in key activities designed to initiate and maintain recovery with our members, including advocacy, resource sharing, skill building, mentoring, and engaging community partners.  The peer supporters assist with decreasing stigma through shared understanding, mutual respect, and empowering members.

Buckeye’s partnership with Thrive provides a centralized dedicated peer support specialist that connects to our members through referrals and real-time warm transfers from Buckeye’s Care Management Team. Through the dedicated peer supporter, the program has realized nearly three times the successful engagement rate with the population at 38% compared to traditional care management outreach efforts. Since the program launched in 2022, over 300 members have been referred to Thrive with over 500 face-t- face visits completed.  Successful outcomes with the program include attaining the 95^th percentile for the National Committee for Quality Assurance (NCQA) Health Education Data Information Set (HEDIS) rates for the Initiation and Engagement (IET) of Treatment for Substance Use Disorder measures.  Additionally, the program has closed over 300 critical social determinant of health gaps for the members enrolled, with top 5 including mental health services, financial instability, food insecurity, housing, and employment.  Buckeye plans to expand the Thrive program and partner with local emergency departments and psychiatric hospitals to establish onsite presence in the facilities and engage with members in acute care settings.  After receiving peer support services through Thrive, one member shared "I am so happy that Buckeye connected me with you so I can have support from someone that has been there." "I couldn't believe that you remembered to call me this week now that I am in treatment, thank you Debra, Thrive and Buckeye. I need this right now." – H.R.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common behavioral health conditions diagnosed in childhood. A key component of effective treatment for ADHD is medication management.

The ADD HEDIS measure includes children ages 6-12 years and addresses 2 aspects of medication treatment – initiation and maintenance of a prescription. The focus of the initiation phase is follow up with a practitioner with prescribing authority to monitor the child’s response to a newly prescribed medication within 30 days of that initial prescription and assessing for potential side effects or adverse effects as well as supporting the adjustment to adherence to a new medication. Maintenance is continuing to monitor the child’s response to the medication with 2 follow up visits with any practitioner over the next 9 months after the initiation phase visit. There are several factors that could affect a child’s response and adherence to the medication including the child’s growth and development, daily routines (school year vs. summer break), and nutrition and activity levels. Additionally, routine monitoring of the child’s response to prescribed medications can help a provider to determine if other interventions and services need to be added or adjusted in the child’s treatment plan to reach most optimal outcomes.

Buckeye wants to support you in being successful with working with our members. Please review the following resources for helpful tips for the ADD HEDIS Measure.  

Strategies to Improve Psychosocial Care for Children and Adolescents on Antipsychotics and Follow-Up Care for Children Prescribed ADHD Medications: Optimizing the Impact of APP and ADD HEDIS Measures

NCQA HEDIS Measures

Metabolic monitoring for children and adolescents on antipsychotics

Antipsychotic medications can elevate a child’s risk of developing metabolic health complications and are associated with poor cardiometabolic outcomes in adulthood, these can include:

• Weight gain
• Insulin resistance
• Hypertension
• Increased risk of type 2 diabetes
• Heart disease
• Lipid and glucose abnormalities

Metabolic monitoring is needed to establish a baseline and annual monitoring to ensure appropriate management of side effects.

Children and adolescents aged 1 -17 prescribed 2 or more antipsychotic medications should receive testing for HbA1c or blood glucose and cholesterol (LCL-C) testing 4 months after a new medication is started and annually thereafter. Care coordination with providers is important to ensure metabolic testing is completed and monitored. Care managers can support members by providing education and support to parents and guardians on the side effects of these medications and encouraging physical activity, healthy sleep, and diet.

Sources:

NCQA HEDIS Measures

Heart disease and diabetes are among the top 10 leading causes of death in the United States. Because individuals with serious mental illness who take antipsychotics are at increased risk of cardiovascular diseases and diabetes, screening and monitoring of these conditions is important. Lack of appropriate care for diabetes and cardiovascular disease for people with Schizophrenia or Bipolar Disorder who take antipsychotic medications can lead to worsening health and death. Addressing these physical health needs is essential in improving health, quality of life and economic outcomes in the future.

Below are the different metabolic screening used to screen and monitor cardiovascular disease and diabetes:

What is the SMC measure looking at?

The percentage of members aged 18 – 64 with Schizophrenia or Schizoaffective disorder AND cardiovascular disease, who had an LDL-C test during the calendar year.

What can providers do to help improve HEDIS SMC rates?

• Order labs prior to patient appointments
• Ensure lipid levels, blood pressure and glucose are monitored at every appointment
• For patients that do not have regular contact with their PCP, coordinate medical management – including communication of lab results - with PCP
• Educate patient (and caregiver) about the risks associated with antipsychotic medications and cardiovascular disease and the importance of a healthy lifestyle.
• Assess the need for Case Management and refer if necessary

What is the SMD measure looking at?  

The percentage of members aged 18 – 64 with Schizophrenia or Schizoaffective Disorder AND diabetes who had both an LDL-C and an HbA1c test during the calendar year.

What can providers do to help improve HEDIS SMD rates?

• Document all elements of the exam, including response to medication and test results
• For patients that do not have regular contact with their PCP, coordinate medical management – including communication of lab results - with PCP
• Adjust therapy to improve HbA1c, LDL, and BP levels; follow-up with patients to monitor changes
• Give any patient caregiver instructions on the course of treatment, labs or future appointments
• Consider additional monitoring of associated factors (e.g. BMI, plasma glucose level, lipid profile)

What is the SSD screening?

A diabetes screening for people with Schizophrenia or Bipolar Disorder who are using antipsychotic medications

What can providers do to help improve HEDIS SSD rates?

• Document all elements of exam, including medications, diagnosis, and results of HbA1c.
• Ensure patient schedules appropriate lab screenings.
• Ensure patient (and/or caregiver) is aware of the risk of diabetes and have awareness of the symptoms of new onset diabetes while taking antipsychotic medication.
• Educate patient (and caregiver) about the risks associated with antipsychotic medications and cardiovascular disease and the importance of a healthy lifestyle.
• Assess the need for case management and refer if necessary

NCQA HEDIS Measures for Diabetes and Cardiovascular Disease for People with schizophrenia or bipolar disorder

Buckeye HEDIS Provider Reference Guide

Suicide is more than a preventable tragedy—it is a major public health problem affecting men and women of all ages. According to the National Institute of Mental Health, it was the 10th leading cause of death in the U.S. in 2019.  Among older adults in particular, suicide is a significant concern because while older adults include just 12% of the population, they make up approximately 18% of suicides.  Among people who attempt suicide, one in four seniors will succeed, compared to 1 in 200 youths.  In addition, men 65 and older face the highest overall rate of suicide.

Risk Factors

Suicidal behavior is common in older adults for several reasons, with loneliness at the top of the list.  As we know, many seniors are homebound and live on their own. If their spouse has recently passed on and there are no family members or friends nearby, they may lack the social connections they need to thrive. Other reasons for suicidal intent in older adults include:

• Grief over lost loved ones: Adults who live long enough may begin to lose cherished family members and friends to old age and illness. They may wrestle with their own mortality and experience anxiety about dying. For some, this “age of loss” is overwhelming and can intensify feelings of loneliness and hopelessness.
• Loss of self-sufficiency: Seniors who were once able to dress themselves, drive, read, and lead an active life may grapple with a loss of identity. They may mourn the independent, vibrant person they once were.
• Chronic illness and pain: Older adults are more likely to face illnesses and chronic disease such as arthritis, heart problems, high blood pressure, and diabetes. These conditions can bring on pain and mobility issues that compromise quality of life. Seniors may also experience loss of vision and other senses, such as hearing, making it harder to do the things they love.
• Cognitive impairment: In a recent study, researchers found that older adults with mild cognitive impairment and dementia had a higher risk for suicide. Declines in cognitive function can affect a person's decision-making abilities and increase impulsivity.
• Financial troubles: Older adults living on a fixed income may struggle to pay their bills or keep food on the table. For someone who is already struggling with health issues or grief, financial stress can be a trigger for suicidal thoughts.
• The physical, emotional, and cognitive struggles faced by older adults can lead to feelings of depression, which over time can evolve into clinical depression. Clinical depression is a mood disorder characterized by prolonged feelings of sadness, hopelessness, and loss of interest in activities. While most people with clinical depression do not commit suicide, having major depression does increase the risk.

Warning Signs

An important first step in preventing suicide is knowing the warning signs. In addition to an explicit expression of suicidal intent, there are certain behaviors that can indicate an older adult is thinking about self-harm. These include:

• Loss of interest in activities they used to enjoy
• Giving away beloved items or changing their will
• Avoiding social activities
• Neglecting self-care, medical regimens, and grooming
• Exhibiting a preoccupation with death
• Lacking concern for personal safety

How to Help

If you think someone may be at risk for a suicide attempt, it is important to know that your support is critical to that person.  The National Suicide Prevention Lifeline has outlined five action steps you can take if you know an older adult who has expressed or is exhibiting warning signs about suicide.

1. Ask. Don’t be afraid to be direct with the person at risk. Ask questions like, “Are you thinking about suicide?” and “How can I help you?” to initiate a conversation in a supportive and unbiased way. Be sure to listen carefully to their answers and acknowledge their emotional pain. Help the person stay focused on all the reasons why they should want to keep living.
2. Be there. If you’re able to, be physically present for the person to ease feelings of isolation and provide a sense of connectedness. If a face-to-face visit is not possible, be there for them via phone or video calls. Work with the individual to identify others who may be willing to lend their help. Be sure not to make any promises that you are unable to keep.
3. Keep them safe. Find out if the person has already made any attempts on their life. Do they have a specific plan or timing in mind? Do they have access to their planned method of self-harm? Learning the answers to these questions can help you understand whether this individual is in immediate danger. In general, the more detailed a person’s suicide plan is, the higher their risk. Someone who is at imminent risk for suicide may require more intensive intervention. The National Suicide Prevention Lifeline (1-800-273-8255) can serve as a valuable resource for helping you determine the next steps.
4. Help them connect. If a senior in your life is thinking about suicide, it’s important for them to establish support systems they can rely on now and in future moments of crisis. This includes suicide prevention hotlines such as the Lifeline, as well as resources available in their local community. Find out if the at-risk person is currently seeing a mental health counselor. If not, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a searchable, confidential directory of mental health providers across the U.S.
5. Follow up. Studies have shown that following up can reduce suicide-related deaths in high-risk populations. Once you've had an initial conversation with the vulnerable person and helped them establish a support network, make sure to check in. This can be done with a quick phone call, text message, or even a card. Ask if there is anything else you can do to help them get through this difficult time. The simple act of reaching out and showing you care can truly mean the difference between life and death.

    Resource: National Council on Aging

Ohio Choose Tomorrow

In addition to resources such as a crisis line, Buckeye has partnered with a Zero Suicide program called Ohio Choose Tomorrow™: A Zero Suicide Program to build a comprehensive suicide prevention culture within Centene that saves lives through early risk identification and collaborative member centric interventions.  The foundational belief of Zero Suicide is that suicide deaths for individuals under the care of health and behavioral health systems are preventable.

When it comes to member safety, the most fundamental responsibility of health care, the only acceptable number of losses due to errors in quality of care is zero. Zero Suicide applies that life-saving mindset to preventing suicide.  Studies have shown most people who died by suicide saw a health care provider in the year prior to their deaths. There is an opportunity for health care systems to make a real difference by transforming how patients are screened and the care they receive.

For more information on how to access resources for the Ohio Choose Tomorrow, please connect with one of our trained Behavioral Health Care Managers.

September is dedicated to raising awareness of suicide and shifting public perception, spreading hope and sharing vital information to people affected by suicide. The goal is to ensure individuals, friends and families have access to the resources they need to discuss suicide prevention and to seek help.

Suicidal thoughts and suicidality, like mental illness affects individuals regardless of age, race, gender or socio-economic status.  Suicide is the second leading cause of death among individuals aged 10–34 and the 12th leading cause of death in the U.S.

What is suicide?

Suicide is when an individual harms themselves with the goal of ending their life, and they die as a result.  A suicide attempt is when an individual harms themselves with the goal of ending their life, but does not die.

Warning signs that an individual may be at immediate risk for attempting suicide:

• Talking about:
  •  Wanting to die or wanting to kill themselves
  • Being a burden to others,
  • Feeling empty or hopeless or having no reason to live,
• Withdrawing from friends and family, giving away possessions,
• Saying goodbye to friends and family, putting affairs in order, acting impulsively or talking or thinking about death often.

If you or someone you know is suffering from suicidal thoughts or an untreated mental health issue, seek treatment immediately.  Treatment for mental illness varies by diagnosis and individual.  Treatment options can include medication, counseling, social support and education.

After years of advocacy and preparation, 988 is now available nationwide as the new number to contact for mental health, substance use and suicide crises.

988 is a simple, easy-to-remember way for people to get help. This new number will allow people to quickly connect with support during a crisis, 24/7, no matter where they live.  When people call, text, or chat 988, they will be connected to trained counselors that are part of the existing Lifeline network. These trained counselors will listen, understand how their problems are affecting them, provide support, and connect them to resources if necessary.  The previous Lifeline phone number (1-800-273-8255) will always remain available to people in emotional distress or suicidal crisis.

For more information on suicide, support or how to find treatment, visit National Alliance for Mental Illness (NAMI)’s website.  Don’t be afraid to reach out if you or someone you know needs help. Learning all you can about mental health is an important first step.

In America, the disease of addiction was given the opportunity to hide in the shadows of moral responsibility, in a chasm of debate concerning its pathology. As the debate narrowed and the science exposed the medical nature of addiction and alcoholism; the next frontier of the healthcare system has appeared. This transformation is one that views the chronicity of the disease as a “hijacking” of the brain. Now that we have that information, our approaches reflect compassion concerning moral insight during the brains executive healing process.   

It has been more than 275 years since the support of peers has been engaging in aiding families and individuals recover. In the 18th century the idea to have a recovered patient to stay and aid with care, sparked a revolution in healthcare. Today in America Peer Support has appeared in the healthcare system as a complement to services provided.  The professionalization of Peer Recovery Specialist has supplied hope for many individuals and families. Recovery Management insight and networks are what Peer Recovery Specialist offer. The Recovery Capital Scale or the BARC-10 (Brief Assessment of Recovery Capital-10 questions), is a tool used by Recovery Community Organizations (RCO) to aid in building the long-term recovered life people are hoping for.  

Source:

White, W. (2009). Executive summary. Peer-based addiction recovery support: History, theory, practice, and scientific evaluation. Counselor

The impact of exercise on health and wellbeing has been a topic of interest in public health for many years. According to the John W. Brick Mental Health Foundation’s June 2021 report, “routinely moving our bodies is a key element in the ecosystem of factors that help us to build our mental and emotional well-being” and “motion is indisputably associated with mental health benefits.”

Benefits of routine exercise include:

Physical: Improves sleep; weight management; strengthens bones and muscles; can help prevent illnesses such as cancer, diabetes, and heart disease

Mental: Improves cognitive functions like memory and recall; reduces depressive and anxiety symptoms; improves overall mood

Quality of Life: Increases life satisfaction; reduces feelings of stress; increases self esteem

Top 3 exercise types: General physical activity; Aerobic; Mindfulness activities like yoga. The greatest benefits of physical activity have been found to be moderate to intense activity performed 3-5 days per week.

How does Buckeye Health Plan support physical activity with our members?

Buckeye values the benefits that exercise can have for our members and offers different tools to support members in starting and maintaining an exercise regimen. 

• Buckeye Community Connect: Via this search portal, providers and members can search and connect to various programs, including exercise and fitness resources, by simply entering any zip code. 
• Wellframe: This free app allows adult Buckeye members to engage digitally with a Buckeye care manager and participate in wellness programs. 
  • Physical Activity Program: a 67-day program providing education and support, including information on nutrition and the benefits of exercise. Daily tasks and reminders are sent to members to engage them towards their personal movement goals.
  • Stress Management Program: a 25-day program that focuses on the development of new skills to manage stress. Topics include basic stress education, mindfulness, and deep breathing. This program also reviews the role of nutrition and exercise in improving stress levels.
  • Weight Loss Program: a 90-day program focusing on education and support for improving eating habits, nutrition, and physical activity. Encourages users to set regular goals for diet and exercise. The app can be downloaded through the App Store or Google Play or via Buckeye’s website.
• MyStrength: Free app provides members with access to education and information on many health and wellness topics. The app is available via the Apple or Google stores or myStrength.com.

We hope you find these resources helpful and that you will encourage your Buckeye patients to explore these and find tools to help them incorporate exercise as a regular part of their routine. Buckeye Member Services can provide additional information on any of the above resources. Member Services Representatives can be reached at 1-866-246-4358 Monday-Friday from 8am-5pm.

----------------
Source: New Report: Exercise Plays Key Role in Mental Health & Well-being. (July 14, 2021). Retrieved on 2/8/2022
Source: Move Your Mental Health Report. Retrieved on 2/8/2022
Source: CDC Physical Activity. Retrieved on 2/8/20222
Source: Neuroscience of Exercise: From Neurobiology Mechanisms to Mental Health. (July 2013). Retrieved on 2/8/2022
Source: 5 Facts About Mental Health & Exercise During COVID-19. (April 1, 2021). Retrieved on 2/8/2022

In celebration of May Mental Health Awareness Month, we want to introduce you to: Ohio Systems of Care Project ECHO for Multi-System Youth.

Project ECHO (Extension for Community Healthcare Outcomes) is a popular model for improving patient outcomes through provider education and collaboration.

Inspired by the way clinicians learn from medical rounds during residencies, the ECHO Model has evolved into a learning framework that applies across disciplines for sustainable and profound change. They call it “all teach, all learn.”

ECHO participants engage in a virtual community with their peers where they share support, guidance, and feedback. As a result, our collective understanding of how to disseminate and implement best practices across diverse disciplines continuously improves and expands

Project ECHO uses a 'learning loop' approach; specialist teams and local providers learn from each other by collaboratively problem-solving real-time experiences and sharing best practice via video-conferencing. ECHO's aim is to enhance decision making and transform service delivery.

Using a trademarked technological platform and methodology developed at the University of New Mexico, Ohio Systems of Care Project ECHO for Multi-System Youth program offers participants:

• Opportunities to present complex cases and to receive written recommendations from multidisciplinary experts
• Opportunities to develop the knowledge and skills to manage complex needs in their own communities and to be part of a community of practice
• Brief lectures and case-based learning on topics of special interest

Multi-System Youth Toolkit

Our team at Ohio Colleges of Medicine Government Resource Center has compiled a Multi-System Youth Toolkit

Systems of Care Project ECHO for Multi-System Youth - Case Referral, Presentation and Recommendations Process

Family and Children First Council (FCFC) coordinators may refer a case for consultation during a Systems of Care Project ECHO for Multi-System Youth session to the Family and Children First Regional Liaisons, Aimee.Matusik@jfs.ohio.gov 
and Jennie.Horner@jfs.ohio.gov)

Evaluation Summary

The FCF Regional Liaison will triage referrals and request that the FCF coordinator complete an ECHO case presentation form for the case selected for presentation. The FCF coordinator contacts SystemofCareECHO@neomed.edu for information about a secure pathway for sharing the case information with the SOC ECHO experts. Individuals are welcome and encouraged to attend all ECHO sessions, not just those at which they are presenting a case.

For more details and current/archived Program Schedules see Ohio System of Care Project ECHO Schedule.

On July 1, OhioRISE will begin to provide coordination and specialized services to help children and youth with behavioral health needs who receive care across multiple systems.

Mental Health Awareness 

Each year, millions of Americans face the reality of living with a mental health condition. However, mental illness affects everyone directly or indirectly through family, friends or coworkers. Despite mental illnesses’ reach and prevalence, stigma and misunderstanding are also, unfortunately, widespread (NAMI, 2020). 

The Impact of Stigma on Substance Use Disorders

David L. Nalls, ASB, CDCA, QMHS, CPI, PRS
Community Health Worker, MED-Connections
Buckeye Health Plan

The social stigma that houses fear and reluctance for people with substance use disorders, has been rooted in the lack of individual, organizational, judicial, medical, social and civil institutions knowledge of the condition.  Many of them continued to enforce rhetoric and or business functional protocol that challenges moral systems and not address the medical condition that substance use disorders produces.

To really get serious about stigma is to become serious about discrimination.  There is a prejudice that looms in the undertone of words used to define a person with an SUD. Stigma hinders the progress of individual growth in the sight of society and is the backdrop of some treatment agencies.  The policies created by governmental agencies to help individuals with SUDs are hindered in their efforts to build policies that assist with reintegration and recovery.  Polices that support individuals moving from benefits into work, from stagnation to flourishing.

Substance Use Disorder is largely coupled with criminal activity, however not all people living with this disease engage in criminal activity. The vacuum of stigma has created a stereotype that keeps people entrenched in the problem by tagging a host of slanderous labels that dehumanizes character.  Addict alcoholic, junkie, crack head, meth head and dope fiend have caused considerable damage in communities abroad. These labels can cause a great fear and that fear prevents people from seeking help.  The following settings have unwittingly perpetuated the promotion of stigma:

• Drug and Alcohol Treatment Centers
• Pharmacies
• Hospitals –(staff)
• Dentists
• Social Services
• Employment
• Housing
• Criminal Justice Systems.

Stigma has a broad base, it has had a major impact in treatment and the labels reinforce the negative views of the masses.  It is evident, without reconstruction of social education concerning SUD individuals will continue to be treated as a problem with a person and not a person with a problem.  Any suggestion that drug users deserve compassion and care rather than punishment and control threatens to undermine system of social acceptance created at the expense of individuality.

We have scientific evidence today that SUD is not a moral problem but a medical condition that cannot be managed simply with a moral compasses.  Although choices have an impact on individual growth and change, the process is different in everyone.  Words matter, if you what to help someone grown in life treat them as a person and not a problem; speak with care, compassion and let it all come from the heart.

“Today, I am challenging those of us who work within this special ministry to be more assertive in sharing the transformative power of recovery with all those we encounter socially and professionally and to share the privilege we have experienced as a guide and witness to such transformations. The public is constantly bombarded with addiction’s bad news; it’s time we shared with them the good news of recovery. Each time we introduce ourselves and what we do to a new acquaintance stands as a potential community and cultural intervention. We too are the faces and voices of recovery–regardless of our recovery status.” William L. White

References:

William L. White – Blog & New Postings

UK Drug Policy Commission (PDF)

Suicide prevention has been named a national priority and much work has been done to review existing evidence and to identify gaps in how our nation’s mental health and health care systems address this public health challenge. However, less attention has been paid to the integration of suicide prevention into primary care settings. The Association of Clinicians for the Underserved (ACU) worked with partners to develop and deliver training to prepare primary care teams to better meet the needs of patients at elevated risk for suicide.

The Suicide Safer Care program was created to train primary care providers and their teams on basic principles of suicide prevention and skills for integration into practice. The trainings provided a comprehensive, skills-based learning opportunity that offered “hands on” strategies that could be used with patients during a primary care visit. Skills developed through the training included identification of patients at risk, conducting risk assessments using a standardized tool, and brief evidence-based interventions including strategies for reducing access to lethal means, and safety planning.

Suicide Prevention in Primary Care Report(PDF)