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ADHD Diagnosis and Treatment Through Behavioral Telehealth

Attention deficit hyperactivity disorder (ADHD) is a common mental health disorder that can cause increased levels of hyperactive, impulsive behavior. Individuals with ADHD may find it difficult to sit still or focus on a task for extended periods.

ADHD is commonly diagnosed in children, with about 9.4 percent of U.S. children diagnosed. ADHD affects about 4.4 percent of U.S. adults, as well.

Though demand for behavioral health services has increased, including treatment for ADHD, fewer adults with ADHD receive a diagnosis and treatment for their condition. Many adults with symptoms of ADHD have to wait weeks or even months for an assessment, diagnosis, and help. However, assessment is a vital step in getting an individual with ADHD the help they need.

Examples of ADHD Assessments

Online assessments play an important role in helping behavioral health providers diagnose ADHD through telehealth. Some examples of these assessments include:

ASRS for Adults

Primary care and mental health providers can use the Adult Self-Report Scale (ASRS) for quickly screening patients over age 18 who show symptoms of ADHD. This assessment can help determine an individual’s symptom severity. The ASRS can also be used for individuals diagnosed with ADHD to monitor their symptom changes and the effectiveness of treatment.

Vanderbilt Assessments for the Youth

The Vanderbilt Assessment Scales (VAS) were developed by the American Academy of Pediatrics and the National Initiative for Children’s Healthcare Quality. VAS is completed by parents and teachers, assessing a child’s ADHD symptoms of inattention and hyperactivity. This scale also assesses academic performance, conduct disorder, and anxiety/depression. VAS is intended to assess ADHD symptoms in children aged 6-12 years.

Treating ADHD Remotely

As more jobs, classes, and health services move online in response to the COVID-19 public health emergency, many individuals with ADHD have struggled to keep up. Children and adults with ADHD have difficulty adjusting to disruptions to their routines. Many have found online classrooms and workspaces more distracting.

Though children and adults with ADHD may struggle with online work, however, telehealth may still be a viable option for addressing ADHD.

Behavioral health providers may offer videoconferencing options for counseling sessions. Some providers may continue to offer in-person therapy sessions, while using remote, telehealth options to conduct initial assessments, prescribe or monitor medications, or make follow-up visits.

Telehealth can be used effectively to provide education to ADHD clients and caregivers. Parents can receive online training in interventions that help them deal with their child’s ADHD symptoms.

Individual or group online sessions can offer support for children or adults with ADHD. Remote behavioral health services also can address comorbidities, such as anxiety and depression.

The disruptions resulting from the COVID-19 public health emergency remains challenging for behavioral health providers and caregivers of individuals with ADHD. Despite these challenges, providers must continue to follow best practices for ADHD. This includes offering appropriate treatment, medication and treatment monitoring, symptom and medication assessments, and routine screening.

In times like these, your EHR software should make your job easier, not more complicated. Contact the BestNotes EHR team to schedule a free demo and find out how our customized behavioral health solutions can help you streamline your business to improve profitability and patient outcomes.

date:  Sep 18, 2020
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Natural Disasters, Mental Health Parity, and Other California Behavioral Health News

California is taking steps to address a range of behavioral health issues. From mental health insurance coverage to depression research to addiction treatment, here is the major behavioral health news making headlines in California.

California Legislature Passes Bill to Mandate Mental Health Parity
Insurance companies are required to cover mental and physical health equally, but this has been easier said than done. The California Legislature recently passed a new mental health parity law to bring such coverage closer to a reality.

The proposal must be signed into law by California Governor Gavin Newsom. Supporters say that the new law would close loopholes used to deny many mental health claims, expand mental health coverage for private insurance, and expand the illnesses covered, including addiction. Insurance companies argue that the new law is unnecessary under current requirements and could increase administrative costs.

Natural Disasters Take Toll on Mental Health

Many survivors of natural disasters, such as wildfires and floods, can experience emotional distress for months and even years after the event. This could be devastating for places like California, where firefighters have been struggling to control multiple fires.

Early research out of UC Davis found that about one in five people who survived the North Bay wildfires in 2017 reported significant symptoms of anxiety and post-traumatic stress up to 10 months later. California state law requires counties to provide mental health services after an emergency event, but only as much as county resources allow. Many poorer, rural counties lack resources to provide sufficient mental health assistance, although the needs are increasing among persistent wildfires and the ongoing COVID-19 public health emergency.

Mental Health Study Launches at UCLA

UCLA has launched a new, three-year study, sponsored by and in collaboration with Apple, to help improve how mental health providers diagnose and treat depression. This study will measure objective factors such as sleep, physical activity, heart rate, and daily routines, and analyze how they relate to depression and anxiety.

The study will include the use of Apple technology, including iPhone, Apple Watch, and a Beddit sleep-monitoring device. Researchers hope results will help inform healthcare providers and patients of the warning signs of depression and better identify causes and treatments. The study is part of UCLA’s Depression Grand Challenge, an initiative that aims to better understand, identify, and treat depression

California State Funding Goes to Harm Reduction Programs

California is partnering with the nonprofit Harm Reduction Coalition on the new California Harm Reduction Initiative (CHRI) to provide syringe service programs in the state. The state’s 2019 budget included more than $126 million of funding for syringe service providers in different counties.

The National Harm Reduction Coalition is working with the California Department of Public Health, Office of AIDS to help determine how the money is allocated. Funding will go to increased staffing for syringe service programs, as well as technical assistance and training from the coalition.

Behavioral health providers in California are juggling complications like increased demand for services, COVID-19 lockdown restrictions, and other issues. In times like these, your EHR software should make your job easier, not more complicated. Contact the BestNotes EHR team to schedule a free demo and find out how our customized behavioral health solutions can help you streamline your business to improve profitability and patient outcomes.

date:  Sep 14, 2020
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How Working Remotely Affects You – And What to Do About It

Telecommuting was already increasing when the COVID-19 pandemic gave it a big, sudden push forward. How does remote work affect individuals and relationships? Let’s take a look.

Remote Work: Pros and Cons

The benefits of remote work are easy to see. Workers have more time and flexibility for daily life, whether that means just being home for deliveries or spending more time with family. The lack of commute also saves time and gas money, can reduce your carbon footprint, and reduces your risk getting involved in a traffic collision.

Work itself often benefits from telecommuting. Fewer interruptions from coworkers or distractions in the office means increased productivity and engagement. It also reduces your exposure to people who may be ill.

Remote work also has different disadvantages compared to traditional commuting. Organizations may have more difficulty onboarding and training new employees. Individuals may struggle to manage their own time with less oversight.

Personal difficulties associated with telecommuting may include loneliness due to isolation and distance from colleagues, especially for remote workers who live alone. Separating work from a personal life is also harder to accomplish.

Loneliness and Working From Home

Loneliness is an obvious drawback of working from home. It can also have some of the worst side effects. One study found that social loneliness can increase health risks as much as alcoholism or smoking 15 cigarettes a day. Loneliness may be twice as harmful to physical and mental health as obesity.

In older adults, social isolation is associated with a 50-percent increase in dementia risk. It can increase depression, anxiety, and suicidal ideation.

Try these tips to reduce loneliness:

Early in the week, schedule face-to-face social interactions; plan a safe activity or setting that everyone is comfortable with.
Use videoconferencing software when possible; this not only allows you to see a friendly face, but can minimize miscommunication and thus save time.
Join a digital community, such as a local or national HIMSS group, an online conference, or a hobby-related forum.
Make time for family and friends before you feel too lonely.

Managing Stress While Working Remotely

The challenges of remote work can increase stress levels, which causes adverse effects for 43 percent of U.S. adults. In fact, some estimates say that 75-90 percent of all doctor visits are stress-related. Such conditions include:

Headaches
High blood pressure
Sleep issues
Diabetes
Skin conditions
Asthma
Arthritis
Depression/anxiety

The best way to deal with stress is to identify and address underlying causes. If your work situation is creating stress, try to:

Discuss possible changes with your organization, manager, or teammates.
Look for ways to manage your time more effectively.
Create a workspace with few distractions.
Keep to a morning and evening routine.

Your physical health may affect stress levels. Try to:

Exercise regularly.
Get enough sleep at night.
Make and eat healthy meals.
Learn and practice relaxation techniques, such as meditation or yoga. Accept that there are always things you cannot control.

Practice being assertive, not aggressive or passive-aggressive, in your interactions with others. Assert your feelings, opinions, or beliefs in a respectful way. Set boundaries with housemates, family members, and colleagues.

Working remotely can be a big change for many people, but many of the challenges can be overcome. If you’re a behavioral health or addiction treatment organization, BestNotes EHR has features that leverage low-cost telehealth solutions, such as Zoom or GoToMeeting.

Contact our team to learn more, or schedule a free demo!

date:  Sep 04, 2020
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Depression, Anxiety, and Mood Disorder Assessments That Can Be Delivered Remotely

During the ongoing COVID-19 Public Health Emergency, more behavioral health providers are delivering services by using a variety of telehealth solutions. These services often include assessments for depression, anxiety, and mood disorders.

For new behavioral health clients, most providers conduct an assessment to help determine the extent of their symptoms and possible treatment options. Providers also may give assessments to current clients to monitor their progress.

Here’s an overview of assessment tools that can be delivered through telehealth. Each of these surveys can be found in BestNotes’ Questionnaire Library, along with links to additional information.

Depression, Anxiety, and Stress Scale (DASS21)

The DASS21 is a 21-item, self-report questionnaire that provides three scores, one each for depression, anxiety, and tension/stress. Individuals read each statement and circle the number 0, 1, 2, or 3, depending on how much the statement applies to him or her in the past week. This is a shorter version of the 42-item DASS, which is in the public domain.

Research suggests that the DASS-21 may be suitable for depression screening in substance use disorder clients, when administered soon after detoxification, although additional research is needed.

Generalized Anxiety Disorder-7 (GAD-7)

GAD-7 is a self-administered patient questionnaire used by both mental health and primary care providers to screen for, and measure the symptom severity of, the four most common anxiety disorders. This includes Generalized Anxiety Disorder, Panic Disorder, Social Phobia, and Post-Traumatic Stress Disorder.

Clients who receive the assessment are asked to write or circle the number 0, 1, 2, or 3 to indicate how often they have been bothered by seven problems in the last two weeks. The total score can range from 0 to 21. Cut-off scores for mild, moderate, and severe anxiety symptoms are 5, 10, and 15, respectively.

Major Depression Inventory (MDI)

The World Health Organization developed the MDI, a self-report mood questionnaire, to be able to generate an ICD-10 or DSM-IV diagnosis of clinical depression. It also helps measure the severity of depression symptoms. Similar to the GAD-7, it asks the client how he or she has been feeling over the last two weeks.

Zung Anxiety Self-Assessment Scale (SAS)

The SAS is a 20-item, self-report assessment designed to quantify an individual’s anxiety level. The scoring is based on four types of manifestations: cognitive, autonomic, motor, and central nervous system symptoms. The scores range from 20-80, with Normal Range, Mild to Moderate Anxiety Levels, Marked to Severe Anxiety Levels, and Extreme Anxiety Levels.

Zung Self-Rating Depression Scale (SDS)

The Zung SDS is a 20-item, self-report questionnaire used to screen for depression. This tool includes affective, psychological, and somatic symptoms. Most people with depression score between 50 and 69, while a score of 70 and above indicates severe depression.

The Patient Health Questionnaire (PHQ)-9

The PHQ-9 is a single, depression-focused module of the full Patient Health Questionnaire. The PHQ-9 is used in primary and mental health settings to screen for and diagnose depression, as well as determine the severity of symptoms. This self-administered questionnaire scores the frequency of each of the nine DSM-IV depression criteria, from 0-3.

These standardized questionnaires are also used with OutcomeTools, which helps behavioral health organizations track their effectiveness and client outcomes. With BestNotes EHR solutions, you can also develop and use your own custom questionnaires. Contact us today to learn more.

date:  Aug 31, 2020
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Why Don’t More Residential Substance Abuse Programs Offer MAT?

Although the use of opioids has declined in recent years, substance abuse and addiction remains a persistent problem. Every day, 128 people in the United States die after overdosing on opioids, according to 2018 data. While nearly 21 million Americans have at least one type of addiction, only about 10 percent of them receive treatment.

Addiction and substance abuse treatment remains a critical need for Americans, especially in the wake of the COVID-19 public health emergency. Widespread anxiety about the novel coronavirus and social isolation due to stay-at-home orders has contributed to an increase in the use of drugs and alcohol as a coping mechanism. This could have serious, long-term effects on behavioral health in the United States.

Medication-Assisted Treatment Shows Effectiveness

One of the most successful types of treatment for opioid addiction is medication-assisted treatment (MAT), also known as medications for opioid use disorder (MOUD). In fact, it has been called the “gold standard” for treating opioid addiction.

The FDA has approved naltrexone, buprenorphine, and methadone for use in MAT for opioid use disorder. These drugs help reduce cravings or block the effects of opiates.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT has been shown to:

Improve addiction treatment client survival
Help keep individuals in treatment
Help reduce criminal activity
Increase ability to get and keep a job
Improve birth outcomes in pregnant women with SUD

Despite its effectiveness, however, it remains largely underused in most U.S. addiction treatment programs.

New Research on MAT Underutilization

Most U.S. residential treatment facilities for opioid use disorder (OUD) do not use MAT, a new study shows
Researchers looked at data from 2,863 residential treatment centers and 232,414 patient admissions for OUD in 2017. Only 15 percent of all patients included in the study had MAT as part of their treatment plan.

Some key findings of the study:

60 percent of facilities in the study did not offer any MAT.
Only 1.3 percent offered all three FDA-approved MOUDs.
Buprenorphine was the most common MOUD, used by one-third of facilities.
Only 2.1 percent of facilities offered methadone.

“There was no appreciable difference in MOUD availability in residential facilities in states that did or did not expand Medicaid,” the researchers noted. However, more treatment plans for patients admitted in Medicaid expansion states included MOUDs than plans for patients in non-expansion states.

The researchers note that addiction treatment providers face numerous barriers when it comes to offering MATs. These restrictions include:

Prior authorization to prescribe buprenorphine or extended-release naltrexone
Requiring buprenorphine to be distributed by an opioid treatment program
Lifetime limits on buprenorphine doses larger than 8 mg
Assigned levels of care and reimbursement, often determined by insurance coverage, do not always match what the provider or client think are appropriate for treatment

Get the full study from JAMA Network Open.

Treating OUD and other forms of addiction is a complex issue that requires different plans for different clients. BestNotes EHR solutions allow you to customize your experience so your behavioral health or addiction treatment organization can treat clients as individuals, improving outcomes and revenue. Contact us today to learn more.

date:  Aug 20, 2020
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