LA County Invests Big in Free Virtual Mental Health Therapy for K-12 Students - California Healthline

 Los Angeles County public schools are rolling out an ambitious effort to offer free mental health services to their 1.3 million K-12 students, a key test of California Gov. Gavin Newsom’s sweeping, $4.7 billion program to address a youth mental health crisis.

Spearheaded by the county’s Medi-Cal plans — which provide health insurance to low-income residents — in collaboration with its Office of Education and Department of Mental Health, the LA school program relies on teletherapy services provided by Hazel Health, one of a clutch of companies that have sprung up to address a nationwide shortage of mental health services that grew much worse during the covid-19 pandemic.

The teletherapy effort is one of four LA County projects that will collectively receive up to $83 million from the state’s Student Behavioral Health Incentive Program, one component of the Democratic governor’s “master plan” to address gaps in youth mental health care access.

LA’s Hazel Health contract is aimed at helping overburdened schools cope with a surge in demand for mental health services. It promises to be a telling case study in both the efficacy of virtual therapy for students and the ability of educators and administrators to effectively manage a sprawling and sensitive program in partnership with a for-profit company.

For some Los Angeles County educators and families, the initial results are promising.

Anjelah Salazar, 10, said her Hazel clinician has helped her feel a lot better. After the fifth grader switched to a new school this year, Stanton Elementary in Glendora, she started having panic attacks every day.

Her mom, Rosanna Chavira, said she didn’t know what to do — even though she’s a clinical coordinator for a company that treats mental health conditions — and worried she wouldn’t be able to find an affordable therapist who accepted their insurance. Once Chavira learned about Hazel, she jumped at the opportunity.

“This being free and having a licensed professional teaching her coping skills, it just means the world,” Chavira said. “You can already see changes.”

Salazar said she’s met with her virtual therapist five times so far. One coping technique that she especially appreciates is a tapping exercise: Every night before bed, she taps her eyes, her cheeks, her chest, and her knees. With each tap, she recites the same affirmation: “I am brave.”
Christine Crone, parent of seventh grader Brady, said she has yet to see if the sessions have been effective for her son, who attends Arroyo Seco Junior High in Santa Clarita, but she knows he enjoys them.
“He struggles normally with being on time and prepared, but with these sessions, he always stops what he is doing and makes sure he is logged in on time,” Crone said. “He says that his therapist is nice, fun, and easy to talk to.”
Jennifer Moya, a mental health counselor at Martha Baldwin Elementary in Alhambra, a city east of Los Angeles, said her students like the flexibility of teletherapy, which allows them to meet with clinicians anytime between 7 a.m. and 7 p.m.
“This generation of kids has grown up digital,” said Moya, who is in charge of referring students to Hazel at her school. “They love that this is easy.”
Pablo Isais, a mental health counselor at Alhambra’s Granada Elementary School, said the services can also be a stopgap while a student waits for an in-person appointment, which can take six to eight weeks.
“To be able to let them know that there are services available that they can access within the next week is amazing,” Moya said.
Thus far, early in the rollout, only 607 Los Angeles County students have participated in Hazel sessions since they were first offered, in Compton, in December 2022, said Alicia Garoupa, chief of well-being and support services for the Office of Education. She acknowledged some bumps in the rollout but said Hazel is “another tool in our toolbox.”
 

LA County Invests Big in Free Virtual Mental Health Therapy for K-12 Students - California Healthline

BP check challenge: Only 1 in 159 med students gets perfect score | American Medical Association

This Fact is astonishing.   The only saving grace is that usually it is an aide or nurse that measures your blood pressure.

Check out your doctor !

Position is everything.  Sit in chair legs on ground, uncrossed, relax...

At a recent medical conference, 159 medical students volunteered to take part in a blood-pressure check challenge. Individually, students went into a mock exam room where a patient actor sat, legs crossed, on an elevated stool with no arm, back or foot support. An empty chair with support for the patient’s back and arms was next to the stool. A table that could support the patient’s arm properly was adjacent to the stool and an automated BP monitor, a tape measure and small, medium, large and extra-large BP cuffs sat on the table.

The students were told the patient actor was 50 years old, new to the practice and had not seen a doctor in several years, a scenario that calls for health professionals to check blood pressure in both arms. Researchers asked the students to measure the patient’s BP and write down the results. Professional observers evaluated the students in action and passed or failed them on 11 skills.

The results were “disappointing,” study authors said in an article published in The Journal of Clinical Hypertension. Just one student scored 100 percent. On average, students performed 4.1 of the 11 skills correctly. The “Blood Pressure Check Challenge” was held at the 2015 AMA Annual Meeting.

“Given these students represented schools in 37 states, the results suggest it is unlikely that current U.S. medical students are able to perform reliably the skills necessary to measure BP accurately,” the study authors wrote.

Most often, students did not have the patient rest in the chair for five minutes before taking a measurement, with just 6.9 percent of students remembering to do this. There were five other areas where fewer than 20 percent of students performed the skill correctly: deciding which arm should be used for future readings (13.2 percent); ensuring the patient placed his or her feet on the floor (15.1 percent) not allowing the patient to use a mobile phone or read during the measurment (17 percent); checking blood pressure in both arms (18.2 percent); and when asked, identifying the arm with the higher reading as being more clinically appropriate (15.1 percent).

Students were best at placing the cuff over a bare arm (83 percent) and selecting the correct cuff size (73.6 percent). In three areas, about half of students did well: ensuring a patient’s legs were uncrossed (52.2 percent); not allowing the patient to talk during the measurement (57.2 percent) and supporting the patient’s arm at heart level (61.0 percent).

Students in their second through fourth years of medical school scored higher than medical students in their first year of school, but the numbers still showed a need for more training. The older students performed about five of the 11 tasks correctly versus the younger students nearly four out of 11 tasks being properly performed.

“We believe the use of automated devices will reduce some common errors in measuring BP, but our study confirms that automated device use alone will not eliminate many common errors in BP measurement,” the study authors concluded. “Medical school training in these skills should be revised and studied to ensure it is effective.”

BP check challenge: Only 1 in 159 med students gets perfect score | American Medical Association

Clinician burnout in the US: New data, surprising insights

A new insight about physician burnout. Some factors such as increased patient volume, administrative bureaucracy, profit driven coroporate medicine are now only a part of a worldwide increase in chronic diseases.

The increase in chronic disease can be attributed to the elimination of diseases which end life in young, or middle-age.  

The Paradox Of Clinician Burnout In America

Doctors and nurses today are the beneficiaries of groundbreaking advancements in science, technology and disease treatments. With so many sophisticated tools available to diagnose and cure patient problems, you’d think this would be the golden era of clinician fulfillment. And yet, this period of radical advancement is marked by growing dissatisfaction and an exodus of physicians. Last year alone, 71,309 doctors quit the profession.

At a press briefing last month, Dr. Debra Houry, Chief Medical Officer at the Centers for Disease Control and Prevention, highlighted this growing threat to healthcare professionals.

“Burnout among these workers has reached crisis levels,” she said, noting that the COVID-19 pandemic had intensified long-standing challenges within the workforce. Fatigue, depression, anxiety, substance use disorders and suicidal thoughts are on the rise, according to the CDC.

In self-reported surveys about the causes of burnout, medical professionals point to the profit-centric American healthcare system that burdens them with countless bureaucratic tasks, endless prior authorization requirements, and a revolving door of patient visits.

All these complaints are valid, but new data on burnout from the nonprofit Commonwealth Fund raise another possibility and shed light on a potential solution.

Burnout: A Distinctly American Problem?

If the main drivers of burnout were indeed greedy insurance execs and a for-profit healthcare system, then you would expect that the Western nations with universal healthcare (which is paid for and provided by the government) would have dramatically lower physician burnout rates than in the United States.

But the Commonwealth Fund report tells a different story. Surprisingly, primary care physicians in the U.S. are in the middle of the pack when it comes to burnout. They report higher rates of satisfaction than their peers in the UK, Germany, Australia, New Zealand and Canada (but trail the Netherlands, Sweden, France and Switzerland in satisfaction).

If physician burnout isn’t a distinctly American phenomenon, deriving from unique aspects of the U.S. healthcare system, then what is causing doctor dissatisfaction around the world?

If we look at the biggest change to global medical practice in the 21st century, it’s not the corporatization of care or the administrative burdens heaped on clinicians. It’s the evolution of illness, itself.

Clinician burnout in the US: New data, surprising insights | LinkedIn

Cardiovascular Health of Middle-Aged US Adults by Income Level: From 1999 to March 2020 or Social Determinants of Healt (SDOH)

TAKE-HOME MESSAGE

Your risks depend upon your income.  

Low income persons are at higher risk of hypertension, while high income persons are more at risk for diabetes and obesity

In this serial cross-sectional analysis of NHANES data from middle-aged US adults between 1999 and 2020, the prevalence of hypertension increased among low-income adults, whereas the prevalence of obesity and diabetes increased among high-income adults. 

Cigarette use decreased only among high-income adults. Overall, the prevalence of modifiable risk factors was substantial, irrespective of the income category.

These findings highlight the persistent and increasing income-based disparities in the prevalence of major cardiovascular risk factors among adults in the US. Public health efforts targeting the diagnosis and control of these modifiable risk factors are critically needed in all populations.

Cardiovascular Health of Middle-Aged US Adults by Income Level: From 1999 to March 2020 | PracticeUpdate

Evaluating Plastic Syringes Made in China for Potential Device Failures: FDA Safety Communication

Date Issued: November 30, 2023

The U.S. Food and Drug Administration (FDA) is informing consumers, health care providers, and health care facilities that the FDA is evaluating the potential for device failures (such as leaks, breakage, and other problems) with plastic syringes manufactured in China. The FDA is collecting and analyzing data to evaluate plastic syringes made in China used for injecting fluids into, or withdrawing fluids from, the body. At this time, the issue does not include glass syringes, pre-filled syringes, or syringes used for oral or topical purposes.

The FDA received information about quality issues associated with several Chinese manufacturers of syringes. We are concerned that certain syringes manufactured in China may not provide consistent and adequate quality or performance.

Potential Syringe Failures

To date, the FDA is aware of quality issues from recent syringe recalls, Medical Device Reports (MDRs), and additional complaints about syringes made at various manufacturing sites in China. Quality issues reported have included leaks, breakage, and other problems after manufacturers made changes to the syringe dimensions. These quality issues may affect the performance and safety of the syringes including their ability to deliver the correct dose of medication when used alone or with other medical devices such as infusion pumps.  

Report any issues with syringes to the FDA