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How Does ADHD Affect Sleep in Adolescents?

Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), from childhood to adulthood, often experience sleep difficulties and disorders. These include shorter sleep time, difficulty falling or staying asleep, racing thoughts, and bursts of energy at night. Other issues include sleep apnea and restless leg syndrome.

Possible causes of sleep problems associated with ADHD include:

Disruptions to the parts of the brain involved in arousal, alertness, and regulation
Hormone dysfunction, including melatonin production, that may affect circadian rhythms
Side effects of ADHD medications
Co-occurring disorders, such as anxiety and depression, can cause sleep problems

Research has not yet fully explained the connection between sleep and ADHD, partly due to the nature of sleep itself. While it may seem simple on the surface, sleep is a complicated activity. Many factors go into a good night’s sleep: the timing of falling asleep and waking, sleep cycles (including dreaming), hormone levels, and the environment, to name a few.

New Research on Sleep and ADHD

Because sleep involves so many factors, it is difficult to pinpoint which ones are most influential on adolescents with ADHD. However, new research out of Duke University Medical Center suggests that two in particular—sleep timing and regularity—can have a big impact.

For their study, the researchers looked at sleep regularity and sleep timing in 90 adolescents, mean age of 14. They looked at possible connections between these factors and the severity of the adolescents’ ADHD symptoms, as well as their academic and social functioning.

The participants received seven days and nights of actigraphy, a type of monitoring that measures motor activity and rest/activity cycles. The participants and their parents or guardians also reported and commented on the severity of their ADHD symptoms and their academic and social functioning.

After controlling for factors such as sex and race, results indicate that the participants who experienced delayed sleep timing were more likely to report more ADHD symptoms and lower social functioning. Irregular sleep was associated with more ADHD symptoms and lower social and academic functioning, reported by both participants and their parents.

The study, “Sleep Regularity and Timing Associated With ADHD Severity and Academic/Social Performance in Adolescents,” was presented at The American Professional Society of ADHD and Related Disorders 2021 Annual Conference.

Importance of Sleep in ADHD

These new findings could provide a more specific target for improving the sleep of adolescents with ADHD. This is especially critical due to the negative effects of poor sleep quality on those with ADHD:

More severe ADHD symptoms
Lower quality of life
Negative impact on school or work performance
Increased risk of additional mental health concerns such as depression, anxiety, hyperactivity, inattention, and cognitive impairment
Physical health problems, such as a higher BMI and cardiovascular risks
Hazards caused by sleepiness while driving
Strained relationships and family life

Just as mental and physical health influence each other, sleep quality is closely linked to both. Addressing sleep problems in adolescents with ADHD could help decrease symptoms, increase social functioning, and improve quality of life.

Many families and adolescents now lack ADHD and other behavioral health resources due to various COVID-19-related restrictions. As a behavioral health provider, you can offer a variety of services, such as assessments and counseling, virtually with telehealth capabilities. Contact the BestNotes EHR team to schedule a free demo and learn how our customized behavioral health solutions can help you streamline your business and improve patient outcomes.

date:  Feb 05, 2021
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OxyContin Maker Pleads Guilty to Three Criminal Charges in Opioid Crisis

OxyContin maker Purdue Pharma pleaded guilty in November to three criminal charges, in a virtual hearing with a federal judge in Newark, N.J., as part of a criminal and civil settlement between Purdue and the Justice Department. Purdue made numerous admissions during the hearing, including that it hindered efforts by the U.S. Drug Enforcement Administration (DEA) to fight the addiction crisis.

The company has acknowledged that:

Purdue had told the DEA that it had a program to prevent diversion of prescription drugs to the black market, when it had not effectively maintained such a program.
It gave the DEA misleading information to encourage the company’s manufacturing quotas.
It has paid doctors through a speakers program to encourage them to write more painkiller prescriptions.
Purdue paid an electronic medical records company to send patient data to doctors to encourage them to prescribe opioids.

The settlement includes $8.3 billion in penalties and forfeitures. The company will pay a smaller amount of $225 million directly to the federal government as long as it executes a settlement pending in federal bankruptcy court with numerous entities. State and local governments have also sued the company for its role in the opioid epidemic.

As part of the bankruptcy settlement, Purdue has proposed that the company will become a public benefit corporation, using its proceeds to fight the opioid crisis. Members of the Sackler family, who own Purdue Pharma, have also agreed to pay $225 million to the federal government to settle civil claims.

Advocates, state attorneys general, and family members of individuals affected by opioids are dissatisfied with the company’s admission. Opponents to the federal settlement had hoped that company employees and members of the Sackler family would face individual penalties, including prison.

According to the CDC, 128 people a day die in the United States after overdosing on opioids. Prescription opioid misuse in the United States is estimated to have an economic burden of $78.5 billion a year, which includes not only healthcare costs, but also law enforcement, lost productivity, and addiction treatment.

The company has made its admissions at a time of renewed concern about opioid misuse and overdoses. Data from the CDC show that opioid deaths dropped 4.6 percent during a 12-month period in 2017 and 2018. (This did not include opioid deaths related to illegally made fentanyl, which increased 11.1 percent during that period.) In March 2020, CDC reported that prescription opioid-involved overdose death rates decreased by 13.5 percent.

During the COVID-19 public health emergency, however, addiction and mental illness rates have increased. U.S. lawmakers and healthcare providers have reported increases in overdoses and deaths associated with opioids and other drugs. In some locations, opioid misuse is still declining, but use of illicit drugs, such as fentanyl and heroin, have increased.

Research has found an increased rate of overdoses in areas where automotive assembly plants have closed. The ongoing financial difficulties during the pandemic could lead to further overdoses.

Is your behavioral health practice seeing an increased demand for addiction treatment services? Without the right tools, you may struggle to keep up, stay profitable, and take care of clients. BestNotes EHR and CRM tools offer online assessments, lead tracking, telehealth appointments, billing, outcomes tracking, and reporting in one easy, customizable solution to help you increase profits and make your life easier. Contact us today to learn more or request a live demo.

date:  Feb 05, 2021
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How to Approach Adolescents With Behavioral Health and Substance Misuse Needs

Substance use, including alcohol and illicit drugs, has increased during the COVID-19 pandemic. Many people who already struggled with substance use have faced social isolation, financial distress, limited healthcare access, and anxiety symptoms. This can increase their use of drugs or alcohol as a way to cope.

Addressing substance misuse in adolescents

Unfortunately, this trend has not only affected adults, but adolescents. Research published by Boston University found that, among adolescents who consumed drugs or alcohol, the use of alcohol and cannabis increased significantly after social distancing measures were implemented.

When it comes to addressing substance use among adolescents, many clinicians have taken an approach known as “screening, brief intervention, and referral to treatment (SBIRT)”. The SBIRT approach includes:

Screening the individual adolescent with validated surveys
Brief, patient-centered intervention, mainly with motivational interviewing
Referring the individual to behavioral treatment for more severe symptoms

Motivational interviewing is a type of counseling that helps individuals make necessary, healthy changes to their behavior. This method does not try to force clients to change or tell them specifically what to do. Instead, the counselor converses with their client to guide them through their feelings and consider how they may need to change. This method was originally developed for individuals struggling with alcohol problems, but may help others who need to make changes in their lives and struggle to do so.

What new research shows

The SBIRT approach has had a positive effect in the short term, but there’s been a lack of research on its longer-term effects. Now, a team of researchers report in Pediatrics that 185 adolescents who received SBIRT by a pediatrician or behavioral clinician showed better outcomes compared to 104 adolescents randomized to receive usual care.

Adolescents in the “usual care” group were assigned to pediatricians who had access to EHR screening tools but did not have formal SBIRT training.

The benefits included:

Lower risk of depression after one year and three years
Lower risk of being diagnosed with substance use three years later
Fewer emergency department visits

These findings are important because adolescents with co-occurring substance use and mood symptoms are more likely to develop other comorbidities. They may use more health resources, such as emergency departments, and their substance use may escalate. Evidence-based interventions can help reduce health costs as well as improve quality of life.

In a blog post about this study, the American Academy of Pediatrics noted that the study was limited because it was conducted in a health system that provides behavioral health, and the participants were insured. Most pediatric primary-care practices lack behavioral health providers. Many young people with substance use disorder may be uninsured or underinsured, which can make it more difficult for these clients to have access to SBIRT and its benefits. Because of these complicating factors, additional studies of the use of SBIRT in other settings are still needed.

Even after the COVID-19 pandemic has ended, it is likely that the behavioral health consequences will persist for months and even years afterward. As a behavioral health provider, you need the right tools to serve your clients and stay efficient. That’s why BestNotes EHR solutions offer many customization options to help you work more effectively, improve profitability, and get the results you and your clients want. Contact us today to learn more or schedule a demo!

date:  Jan 20, 2021
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Drug Decriminalization, Rising Overdose Deaths, and Other Addiction-Related News in Oregon

In November 2020, Oregon residents approved a measure to decriminalize all drugs. However, this was not the only drug and addiction-related story from Oregon. Here are the major substance use and addiction stories out of the state.

Oregon’s Drug Decriminalization Started in Portugal

Fifty-eight percent of Oregon voters in November 2020 approved Measure 110, which will decriminalize all drugs, including cocaine and heroin. Under the law, which will take effect on February 1, 2021, possession of controlled substances would be reclassified from a misdemeanor to a violation with a $100 fine. The measure will also move millions in marijuana tax revenue to support addiction recovery.

Oregon’s new approach aims to focus on diversion and harm reduction for drug use, saving the punitive measures for drug trafficking. This was based on Portugal’s model, which decriminalized hard drugs in 2001. Individuals caught using drugs recreationally are sent to a commission of health and legal experts who evaluate the person and may refer them to voluntary treatment. These changes helped reduce drug-related fatalities, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) reported.

Lane County, Oregon Sheriff’s Office Receives Grant for Inmate Substance Abuse Treatment

The Lane County Sheriff’s Office in Oregon has received a three-year Comprehensive Opioid, Stimulant, and Substance Use Site-based Program grant, distributed through the Bureau of Justice Assistance. The office plans to use these funds for the Lane County Jail Substance Abuse and Transition Program.

This program will provide medication-assisted treatment to 20 inmates per month, and education and counseling to another 100 inmates. The program especially targets those individuals with at least two substance use-related jail bookings annually. This may help “to increase their chances of sobriety and reduce their chances of returning to jail,” said Lane County Sheriff Cliff Harrold.

Overdose Fatalities Increase in Oregon

Following similar trends across the country, Oregon saw a nearly 40-percent increase in overdose fatalities in 2020. While most of these deaths involve opioids, other deaths involved methamphetamines and the synthetic opioid fentanyl. Health authorities note that many individuals who already struggle with substance misuse are struggling with social, financial, and health disruptions during the COVID-19 pandemic

To try to reduce overdose deaths, the state is distributing naloxone and using real-time surveillance data to make immediate responses to sudden death increases. The state is also providing methadone to patients through opioid treatment providers.

Grants Pass, Oregon Initiative Aims to Help With Addiction

Grants Pass, Oregon Lieutenant Dennis Ward has launched a new initiative, called “A New Way Home,” that aims to take on substance misuse, addiction, and drug-related fatalities. The initiative is based partly on a program started in Massachusetts called Police Assisted Addiction and Recovery Initiative (PARRI).

The nonprofit Options for Southern Oregon will work with the Grants Pass Department of Public Safety on the new initiative. Under this program, individuals who struggle with addiction and are in possession of a controlled substance are invited to come to the police department and ask for help. They can do so without the fear of getting arrested.

Legislative changes, increased substance misuse, and the rising demand for behavioral health services could create major challenges for addiction treatment providers in Oregon. Make sure your practice is prepared for the demands with the right clinical and business tools. BestNotes EHR software was designed with you in mind, tailored specifically for the needs of behavioral health practices. Contact us today to schedule a free demo or ask questions about our solutions.

date:  Jan 14, 2021
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New Bill for Audio-Only Telemedicine Could Further Encourage Telehealth Growth

U.S. Reps. Jason Smith (R-Mo.) and Tony Cardenas (D-Calif.) in December introduced the Permanency for Audio-Only Telehealth Act to permanently expand Medicare coverage for audio-only telehealth visits.

Until telehealth restrictions were relaxed during the COVID-19 public health emergency, it was difficult or even impossible for behavioral health clinicians to conduct telephone-only visits. Protecting client privacy could be tricky, and getting reimbursed for the telehealth visit was often in question.

Under the new bill, Medicare would reimburse providers for audio-only behavioral health evaluation and management services after the COVID-19 pandemic has ended and other emergency measures for telehealth expire. Geographic restrictions of Medicare also would be removed, so that a Medicare patient’s home could be designated as a delivery site for certain telehealth services.

This bill is one of several telehealth bills that have been introduced in Congress since the start of the COVID-19 pandemic. Opponents of this bill argue that phone calls cannot properly establish a doctor-patient relationship and should only be allowed after an in-person exam. However, groups like the American Psychological Association (APA) have voiced support for this latest bill, saying it can improve health equity for underserved populations. You can read more about the bill’s supporters in a press release issued by Smith’s team.

The Permanency for Audio-Only Telehealth Act, if passed, would have several potential advantages for both behavioral health providers and clients. These include:

Better reimbursement options for behavioral health providers in a period of financial difficulty for many practices
Making permanent many of the benefits of telehealth that providers have enjoyed under emergency provisions
Increased access to behavioral health services for low-income clients who may lack the technology necessary for video telehealth visits
Expanded care options for older clients who may be unable to use full-service telehealth technology or make in-person visits
Behavioral health access for individuals in rural areas who may not have reliable access to broadband

This last advantage could be especially important. Farmers and other workers in rural areas are at high risk of mental illness and even suicide, according to the Centers for Disease Control and Prevention. New research shows that farmers have benefited significantly from the recent growth of telehealth. Virtual behavioral health services have given rural workers better access to care that may otherwise be located too far away. It can also help reduce the stigma associated with mental healthcare in remote communities.

New research shows that mental health clinicians are pleased with telehealth services, as well. the COVID-19 Healthcare Coalition, a group of more than 1,000 health organizations, technology firms, and nonprofits, recently published a survey of more than 1,500 providers, including physicians, nurse practitioners, psychologists, and social workers. Overall, 60 percent of clinicians reported that telehealth has improved patient health and 55 percent reported that telehealth has improved their satisfaction with their work.

Are you adding or expanding telehealth options at your behavioral health practice? You need an EHR solution that will help meet your client, staff, and financial needs while balancing onsite and virtual care. Fortunately, adopting behavioral telehealth doesn’t have to be complicated. BestNotes EHR solutions were developed specifically for behavioral health and addiction treatment providers to help you stay compliant and profitable. Contact BestNotes today to learn more.

date:  Jan 07, 2021
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