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What Should Behavioral Health Providers Know About Polyvagal Theory?

“Polyvagal Theory” describes a group of ideas related to the role of the vagus nerve in human psychology. According to this theory, the vagus nerve serves an important role in emotional regulation, social behavior, and fear response. Stephen Porges, director of the Brain-Body Center at the University of Illinois at Chicago, first introduced Polyvagal Theory in 1994.

What is the vagus nerve?

The vagus nerve, also called the pneumogastric nerve, is a cranial nerve made up of sensory and motor fibers. It is also the longest nerve of the human autonomic nervous system (ANS). The ANS controls and regulates many bodily functions, usually unconsciously. Such functions include heart rate, digestion, respiratory rate, and urination.

The ANS is important for the human body’s stress response and defense mechanisms. One branch of the ANS, the sympathetic nervous system, is connected to the “fight-or-flight” response. Another branch, the parasympathetic nervous system, controls what is sometimes called the “freeze-or-faint” response. In stressful situations, these systems may work together, or one may inhibit the other.

What is Polyvagal Theory?

Under Polyvagal Theory, human beings can immediately, even unconsciously decide if an environment is safe or threatening because of information sent via the vagus nerve.

When responding to their environment, Polyvagal Theory proposes that humans use not only the fight-or-flight and freeze-or-faint responses, but another division of the ANS. This third division includes a social communication and engagement system, which includes facial muscles, middle ear function, and vocalizing.

According to Polyvagal Theory, a person who, with the information sent via their vagus nerve, has determined that an environment is secure can feel safe in using their social engagement system. This includes a calm heart and respiratory rate, and the free use of vocal and facial expressions.

However, if the environment is not safe, it will trigger the fight-or-flight response. If that system somehow fails, then the freeze-or-faint response kicks in, and the affected person is less able to relate to the world socially. Porges also suggests that the body can remember a traumatic experience and become “stuck” in one of these trauma response states.

Polyvagal Theory in Mental Health

Psychologists and therapists who are interested in Polyvagal Theory often use it to inform decisions about anxiety, fear, and trauma.

According to Bessel van der Kolk, professor of psychiatry at the Boston University School of Medicine and author of The Body Keeps the Score, the Polyvagal Theory “makes us look beyond the effects of fight or flight and put social relationships front and centre in our understanding of trauma. It also suggested new approaches to healing that focus on strengthening the body’s system for regulating arousal.”

Because Polyvagal Theory is a relatively recent idea, supporting evidence remains limited. While it has been used to help inform trauma treatment, Polyvagal Theory has also been criticized for this lack of research. Additional research may be necessary before the theory is more widely incorporated into behavioral health clinical practice.

Trauma recovery is just one of many challenging areas for behavioral health providers. In particular, mental health and addiction treatment professionals can prepare to see an increased demand for services related to trauma connected to the COVID-19 pandemic.

You use different treatment approaches for different clients, so it’s important to make sure your EHR solution is just as flexible. BestNotes EHR solutions can be customized to your unique needs to help you save time, reduce frustration, improve profitability, and meet documentation and reporting requirements. Contact us today to learn more or schedule a demo.

date:  Apr 16, 2021
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This Spring, Consider the Link Between Green Space and Mental Health

Spring is finally here, bringing longer days, warmer temperatures, and new growth. As a behavioral health provider, this is the perfect time for you to encourage your clients to enjoy the benefits of green space.

Green Health Benefits

An increasing body of research shows that green spaces and nature can be a vital part of mental and physical health. For example, a World Health Organization report in 2016-17 noted that greenery and natural features can specifically help counteract the stress, lack of physical activity, and environmental hazards associated with urban living.

Experts have not yet determined exactly why we benefit from green space, but the effects are fairly obvious. Health benefits include:

Encouraging physical movement
Space to socialize (a notable benefit during the era of COVID-19, when people still need social interaction but many places have limited indoor gatherings)
Lower air and noise pollution
Exposure to beneficial microbes that can improve immune function
Reduced stimulation, leading to a more relaxed mind and increased ability to concentrate, remember, and learn

A Danish study published in 2019 suggests that, among those with behavioral health disorders, the benefits of green space may be greatest for individuals with mood disorders, depression, neurotic behavior, and stress-related concerns.

In fact, the study also found that children who grew up with the least exposure to green space had up to 55 percent higher risk of developing a psychiatric disorder. This was independent of other known risk factors.

Not Just Any Green Space

But are all green spaces created equal? Not necessarily, some research suggests.

One study in the United Kingdom, published in Frontiers in Psychology in 2018, found that biodiversity in urban green spaces was best for mental health. Study participants reported significantly more “psychological restoration” from urban parks with more biodiversity. Where mental health is concerned, parks with a variety of plants and other natural features are more beneficial than cultivated landscapes and modern amenities.

Different people also may respond to green space differently. One 2014 study found that the relationship between urban green space and health can vary by age and sex. Researchers report in the Journal of Epidemiology and Community Health that the benefit of more green space was most apparent in early to mid-adulthood for men. Among older women, those with moderate access to green space had better mental health.

Other research has found that green space access can have specific benefits for children. In the Journal of Pediatric Nursing in 2017, researchers reported that access to green space was associated with better health and cognitive development for children. Green space access was linked to attention and memory restoration, stress moderation, improved behaviors, and even higher standardized test scores.

Behavioral health clinicians can use these findings to encourage green space exposure and outdoor activities in clients of all ages. Consider discussing these benefits with your clients and working with them to determine the best outdoor locations and activities for their particular mental and physical health needs.

With behavioral health services in greater demand than ever, you need to strike the right balance between improving client outcomes, keeping your practice profitable, and staying compliant with regulatory bodies. BestNotes EHR solutions, built and customized specifically for behavioral health clinicians, helps you accomplish all three. Contact us to learn more about how our solutions can help your practice.

date:  Apr 12, 2021
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Lowering Suicide Rates, Reaching Rural Communities, and Other Utah Behavioral Health News

Each U.S. state is facing unique challenges in behavioral health, from substance abuse to the mental health effects of the pandemic response. Here’s a look at a few of the biggest behavioral health and addiction concerns in Utah, and how the state’s healthcare leaders are addressing them.

Expanding Mental Health Services in Rural Utah

The Huntsman Mental Health Institute (HMHI), part of University of Utah Health Hospitals & Clinics, is planning to increase access to mental health care services in rural communities throughout the state. To help fulfill its goals, HMHI has received $1 million from Oregon-based Cambia Health Solutions.

Mental Health America’s 2021 report (download the PDF here) found that Utah ranks last in the United States for adult mental healthcare access. Part of this is due to provider shortages, which particularly affects rural areas. HMHI plans to place psychiatry residents and fellows in rural communities, offer school-based psychiatric consultation, and partner with the university’s Department of Educational Psychology to provide mental health support and training in several community schools.

Addressing Suicide Rates in Utah

Utah lawmakers have passed several bills in an effort to address the state’s rising suicide rates. These include bills to:

Increase access to telehealth services, including raising Medicaid reimbursement rates for mental healthcare
Make nearly $16 million available to hire staff to implement 988 as a new phone line for mental health emergencies
Allow people who are experiencing a mental-health crisis to add their name to a “no-gun” registry and prevent firearm purchase for at least 30 days
Forbid police from shooting at people who are suicidal and a risk to only themselves
Provide about $1.6 million to educate care providers about mental health support for young children and fund family stabilization services

Utah to Receive Federal Behavioral Health Funding

Utah will receive almost $7.5 million for mental health services and $15.5 million for addiction treatment from the Substance Abuse and Mental Health Services Administration (SAMHSA). The agency is providing a total of $2.5 billion in block grants for states to address mental illness and drug addiction.

These block grant programs allow states to determine where they most need the money and how to address behavioral health issues, such as treating serious mental health conditions and preventing substance use disorder.

Utah Medical Clinic Now Offering On-Site Harm Reduction Services

The Odyssey House’s Martindale Clinic in Salt Lake City has become the first primary care clinic in the state to offer harm reduction services on its premises in addition to medical care. The clinic offers several different services related to substance misuse, including syringe exchange, prescriptions for medication-assisted treatment, and fentanyl test strips.

Such practices keep patients “coming back so that you can keep revisiting those notions of using drugs, less frequently, more safely, and not at all,” says Dr. Paula Cook, Chief Medical Officer for Odyssey House.

When you serve clients with substance use disorder, it’s important to know if your treatment plan is working. BestNotes EHR solutions, including our OutcomeTools system, were designed to address the needs of both your practice and your clients. Contact us today to learn how BestNotes can help your behavioral practice succeed.

date:  Apr 05, 2021
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Should You Discuss Nutritional Psychology With Your Behavioral Health Clients?

Do the foods we eat influence our mental health? That’s the idea behind nutritional psychology, also called nutritional psychiatry.

Support for Nutritional Psychology

Studies suggest there is, indeed, a connection between food and mental health. After all, our brains require food for fuel, just like any other organ. It makes sense that the kind of fuel is important.

Plus, the gastrointestinal tract is responsible for producing 95 percent of the body’s serotonin, a neurotransmitter involved in mood regulation. The condition of the gastrointestinal tract, including the presence of beneficial bacteria or harmful inflammation, could affect both digestion and emotions.

One systematic review, published in 2018 in Molecular Psychiatry, analyzed more than 40 studies that looked at the connection between following a healthy diet and depressive symptoms or clinical depression. Results indicated that a healthy diet may offer some protection against depression.

Stanford Medicine, the medical school at Stanford University, established the Metabolic Psychiatry Clinic, the first academic specialty clinic in the United States that evaluates and treats patients with psychiatric illness and metabolic abnormalities. Compared to the general population, people with psychiatric illness have a higher proportion of obesity, diabetes, and heart disease. Many patients also may experience metabolic abnormalities from taking certain medications for mental health conditions.

Behavioral health clinicians who encourage healthy lifestyle choices could help improve their clients’ outcomes. Positive lifestyle behaviors can also improve physical health, especially when encouraged in partnership with the rest of a client’s care team.

An Ideal Mental Health Diet?

There may not be a single, ideal diet that everyone should follow for their mental health. Each person is different, with different nutritional needs. However, some research offers insight that behavioral health providers and other clinicians might use to guide their clients’ nutritional decisions.

For example, the Molecular Psychiatry study found support for the use of a Mediterranean diet in treating depression. Generally, this diet includes relatively high consumption of olive oil, legumes, fruits and vegetables, and fish, with moderate consumption of dairy products and wine, and limited meat products.

Another 2018 study, published in the World Journal of Psychiatry, looked at the most nutrient-dense foods and how they might help prevent or mitigate depression. They found a connection between 12 “Antidepressant Nutrients” and the prevention and treatment of depressive disorders. These nutrients include:

Folate
Iron
Long-chain omega-3 fatty acids (EPA and DHA)
Magnesium
Potassium
Selenium
Thiamine
Vitamin A
Vitamins B6 and B12
Vitamin C
Zinc

Foods with the highest concentrations of these nutrients were found to be:

Various seafoods (including oysters and mussels)
Organ meats
Leafy greens and lettuces
Peppers
Cruciferous vegetables

The study authors recommended that further research examine these nutrients and foods, and that clinicians consider their dietary value in supporting clients with depression.

When you recommend a treatment for your client—whether that’s lifestyle changes, medications, or a type of psychotherapy—how do you know it’s working? Tracking outcomes is not only important for your clients, but is required in some form by various state and federal agencies. The right outcome tracking and documentation is vital for your practice’s success.

The OutcomeTools system by BestNotes helps reduce the hassle of recording and tracking outcome data. You can get OutcomeTools as a standalone tool, or as part of the BestNotes EHR solution. Contact us today to learn how OutcomeTools can help your behavioral health practice stay compliant, profitable, and effective.

date:  Mar 25, 2021
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How Will New Legislation Impact Addiction Treatment?

On March 11, 2021, President Biden signed the $1.9 trillion American Rescue Plan Act of 2021 into law. Much of the funding in this act is related to COVID-19 relief, such as vaccine distribution, unemployment assistance, lending to small businesses and organizations, and expanded testing.

However, a portion of the spending bill is also related to substance use disorder (SUD) treatment. Most of the SUD funding involves publicly funded treatment, but there is also funding available for all SUD treatment providers through the previously approved Healthcare Provider Fund.

Under the latest spending bill:

Each of the Substance Use Prevention and Treatment and Community Mental Health programs administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) will receive $1.75 billion.

Another $80 million will go toward mental and behavioral health training for healthcare professionals and public safety officers.
$20 million will go toward evidence-based education and awareness for healthcare professionals and first responders.
$40 million will go toward the promotion of mental and behavioral health among healthcare professionals and first responders.

A new SAMHSA program, intended to provide prevention programs for overdose and other drug misuse, will receive $30 million.
The Health Resources and Services Administration will receive $100 million for its Behavioral Health Workforce Education and Training program, with the aim to promote focused training that will expand access to services.

Other funding will go toward a new grant program for community-based and behavioral health organizations throughout the nation. Organizations in each state can apply directly for the grants, which can be used for medication-assisted treatment and telehealth treatment services.

Over the past year, substance misuse and overdose fatalities have increased across the nation. The BestNotes blog has previously highlighted some of the findings around this trend.

Recently, analysis of nearly 190 million emergency department (ED) visits found higher rates of opioid overdoses between March and October 2020 compared to the same dates in 2019. From mid-April onward, the weekly rates of ED visits for drug overdoses rose by as much as 45 percent compared to the same period in 2019. That study was published in JAMA Psychiatry on Feb. 3.

States and communities that have struggled with increased behavioral health concerns are preparing to make use of their portions of the spending bill. For example, Hawaii is set to receive about $15 million to support mental health programs such as the Substance Abuse Prevention and Treatment Block Grant and the Community Mental Health Services Block Grant. Rhode Island will receive an estimated $3-4 million, for the state to distribute to local governments and community organizations to use in providing treatment and prevention services.

Check out the National Association of Addiction Treatment Providers for further analysis and public policy updates.

Expanding funding and access to SUD services means that addiction treatment providers could see greater demand. Make sure your practice software can keep up.

BestNotes EHR solutions, designed for behavioral health and addiction treatment providers, were designed to help you reduce frustration, save time, and boost profitability. From admission to eprescribing to outcome tracking to reporting, we cover the entire client experience and your business process. Contact us to schedule a free demo and see how we can help your practice succeed.

date:  Mar 15, 2021
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