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

Health Care Systems - Four Basic Models | Which would you like?

Health Care Systems - Four Basic Models

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An excerpt from correspondent T.R. Reid’s upcoming book on international health care, titled “We’re Number 37!,” referring to the U.S.’s ranking in the World Health Organization 2000 World Health Report. The book is scheduled to be published by Penguin Press in early 2009.

There are about 200 countries on our planet, and each country devises its own set of arrangements for meeting the three basic goals of a health care system: keeping people healthy, treating the sick, and protecting families against financial ruin from medical bills.

But we don’t have to study 200 different systems to get a picture of how other countries manage health care. For all the local variations, health care systems tend to follow general patterns. There are four basic systems:

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The Beveridge Model

Named after William Beveridge, the daring social reformer who designed Britain’s National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.

Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.

Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world’s purest example of total government control.

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The Bismarck Model

Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system — the insurers are called “sickness funds” — usually financed jointly by employers and employees through payroll deduction.

Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don’t make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model — Germany has about 240 different funds — tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.

The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

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The National Health Insurance Model

This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there’s no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.

The single payer tends to have considerable market power to negotiate for lower prices; Canada’s system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.

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The Out-of-Pocket Model

Only the developed, industrialized countries — perhaps 40 of the world’s 200 countries — have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.

In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease.

In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat’s milk or child care or whatever else they may have to give. If they have nothing, they don’t get medical care.

These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we’re Britain or Cuba. For Americans over the age of 65 on Medicare, we’re Canada. For working Americans who get insurance on the job, we’re Germany.

For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you’re sick enough to be admitted to the emergency ward at the public hospital.

The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it’s fairer and cheaper, too.

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Note - Reid’s “Beveridge” model corresponds to what PNHP would call a single payer national health service (UK); “Bismark” model refers to countries that PNHP would say use non-profit “sickness funds” or a “social insurance model” (Germany); and “National health insurance” corresponds to single payer national health insurance (Canada, Taiwan). Reid’s “out-of-pocket” model is what PNHP would call “market driven” health care. Some countries have mixed models (e.g. Sweden has some features of a national health service such as hospitals run by county government; but other features of national health insurance such as physicians being paid on a FFS basis). This explains why Reid might classify the Scandinavian systems as “Beveridge” while PNHP classifies them as “single payer national health insurance.”

Health Care Systems - Four Basic Models | Physicians for a National Health Program

When am I going to see the doctor? ”Nurse: “Oh, you don’t see the doctor anymore.

A man sits in an exam room.  His appointment is with a specialist to help with his serious and chronic condition.  After a few minutes a nurse walks into the room.  The nurse asks him the standard list of intake questions and puts the information into a laptop.  When she is finished, she leaves the room and tells the man she will be right back.  Ten minutes later the nurse returns to the room.

Nurse: “Mr. Johnson, here is your prescription and an order for an MRI.  You can schedule your MRI when you check out as well as another follow up visit in the next 6 weeks.  Do you have any questions?”

The man is a bit confused and says, “Well yes.  When am I going to see the doctor?”

Nurse: “Oh, you don’t see the doctor anymore.  You see we found it to be much more efficient and profitable if we just put your information into our new care delivery algorithm.  The computer will tell us what you need.  But don’t worry, a doctor signs off on every chart.  This is so much more efficient.  Why yesterday one of our doctors signed off on over 25,000 charts in one day!”

Patient: “But wait.  That means the doctor only spent about 1 second reviewing each chart before signing off.”

Nurse: “I didn’t say he “reviewed” the charts.  I said he signed off on them.  You see, this is much more efficient than spending the time to review the charts.  But don’t worry, we have the utmost faith in the new computer algorithm.”

Patient: “So a computer is actually practicing medicine now and telling me what care I can get?”

Nurse: “Oh no. Of course not.  That would expose us to liability.  You can get whatever care you want.  We are not limiting the care you can get.  We are only telling you what our computer recommends.  It’s up to you if you want to follow that recommendation or not.   The other interesting thing is right after we got our new MRI and started making money on MRIs the computer started ordering them on every patient.  It’s almost like the computer is programed to do what is good for our bottom line and not necessarily what the patient needs.   You have a great day Mr. Johnson, and I will see you again in 6 weeks.”

So, I ask you, how is this different than what the payers are doing when denying care?  I will tell you how it’s different.  One is immoral and illegal and the other is just immoral.

Sound therapy may ease concussion symptoms - ScienceBlog.com

New research indicates that acoustic stimulation of the brain may ease persistent symptoms in individuals who experienced mild traumatic brain injury (concussion) in the past.

The study, which is published in Annals of Clinical and Translational Neurology, included 106 military service members, veterans, or their spouses with persistent symptoms after mild traumatic brain injury 3 months to 10 years ago. Participants were randomized 1:1 to receive 10 sessions of engineered tones linked to brainwaves (intervention), or random engineered tones not linked to brainwaves (sham control). All participants rested comfortably in a zero-gravity chair in the dark with eyes closed and listened to the computer-generated tones via earbud-style headphones. The primary outcome was change in symptom scores, with secondary outcomes of heart rate variability and self-reported measures of sleep, mood, and anxiety.   The results indicate that although acoustic stimulation is associated with marked improvement in postconcussive symptoms, listening to acoustic stimulation based on brain electrical activity, as it was delivered in this study, may not improve symptoms, brain function, or heart rate variability more than randomly generated, computer engineered acoustic stimulation.Among all study participants, symptom scores clinically and statistically improved compared with baseline, with benefits largely sustained at 3 months and 6 months; however, there were no significant differences between the intervention and control groups. Similar patterns were observed for secondary outcomes.

Conclusions

Participating in a study involving approximately 10 cumulative hours of resting comfortably in a zero-gravity chair in the dark with eyes closed and listening to computer-generated acoustic stimulation is well tolerated and is associated with clinically and statistically significant improvement in postconcussive symptoms. However, the results of this study do not suggest that in a primarily active duty group with postconcussive symptoms listening to acoustic stimulation based on one's own brain electrical activity reduces symptoms, or improves brain function or heart rate variability, more than randomly generated, computer engineered acoustic stimulation. In addition, ongoing work indicates that the combination of acoustic stimulation and microelectrical stimulation of the scalp, also based on brain electrical activity, may have greater power to improve postconcussive symptoms. Future studies will determine if the gains seen in this study can be improved (i.e., greater symptom improvement with fewer treatment sessions) using the combination of acoustic and microelectrical stimulation in a similar noninvasive neurotechnology intervention.

“Postconcussive symptoms have proven very difficult to treat, and the degree of improvement seen in this study is virtually unheard of, though further research is needed to identify what elements are key to its success,” said corresponding author Michael J. Roy, MD, MPH, of Uniformed Services University and the Walter Reed National Military Medical Center, in Bethesda.

Most Common Concussion Symptoms

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Sound therapy may ease concussion symptoms - ScienceBlog.com

Neuroplasticity in Stroke Recovery

What is Neuroplasticity?

Neuroplasticity, also known as neural plasticity or brain plasticity, refers to the brain’s ability to adapt or change (1). Neuro refers to the neurons, the nerve cells that are the building blocks of the brain and nervous system, while plasticity refers to change

The brain rewires itself through neuroplasticity. Brain cells send messages, which are the neural connections around the brain. However, when an individual experiences a stroke, the stroke damages some of the connections inside the brain in addition to the connection between the brain and the rest of the body (4). Rehabilitation activities help the brain in making new neural connections in the healthy parts of your brain. More neural connections can improve your brain’s ability to control your body and perform daily activities. Every time you take an extra step, say a new word or do an exercise, it helps the brain make new connections (4).
The brain rewires itself through neuroplasticity. Brain cells send messages, which are the neural connections around the brain. However, when an individual experiences a stroke, the stroke damages some of the connections inside the brain in addition to the connection between the brain and the rest of the body (4). Rehabilitation activities help the brain in making new neural connections in the healthy parts of your brain. More neural connections can improve your brain’s ability to control your body and perform daily activities. Every time you take an extra step, say a new word or do an exercise, it helps the brain make new connections (4).

Physical Benefits:

• Speeds up all-around stroke recovery

• Recovers strength

• Improves balance

• Increases walking speed

• Boosts the ability to perform daily routine activities

• Prevents the recurrence of strokes

Mental Benefits:

• Reduces depression and enhances mood

• Boosts brain health

• Relieves stress

• Helps in increasing a sense of self-worth and self-reliance that can decrease after a stroke

• Gives patients a sense of purpose and a goal to work towards

• What is the Ipsihand?

References:

https://positivepsychology.com/neuroplasticity/#stroke-neuroplasticity (1)

https://www.ncbi.nlm.nih.gov/books/NBK557811/ (2)

https://www.verywellmind.com/what-is-brain-plasticity-2794886 (3)

https://www.stroke.org.uk/effects-of-stroke/neuroplasticity-rewiring-the-brain (4)

https://www.flintrehab.com/neuroplasticity-after-stroke/ (5)

https://tactustherapy.com/neuroplasticity-stroke-survivors/ (6)

https://www.stroke.org.nz/sites/default/files/inline-files/Your%20Guide%20to%20Exercise%20after%20a%20Stroke%202017%20%281%29.pdf (7)

https://www.scielo.br/j/anp/a/JL9mMt9QKWp8g85shXndnWs/ (8)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266302/ (9)

https://www.neofect.com/us/blog/the-ultimate-guide-to-stroke-exercises (10)

https://strokerecoverybc.ca/wp-content/uploads/2011/11/GRASP_All_3_levels11490.pdf (11)

https://ninkatec.com/nutrition-and-fitness-for-stroke-recovery/ (12)
Seek out a qualified rehabilitation counselor.
Is Ipsihand covered by insurance? Not yet
How much is Ipsihand? The Neurolutions IpsiHand system is a qualified medical expense under a heath savings account (HSA) or flexible spending account (FSA). Please verify youreligibility by checking with your individual physicianNeuroplasticity in Stroke Recovery