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U.S Health Officials Lift Some Barriers to Opioid Addiction Treatment

New guidelines from the U.S. Health and Human Services Department (HHS) will make it easier for health providers to prescribe buprenorphine to treat opioid use disorder (OUD). As the U.S. faces an increase in drug overdose-related deaths during the COVID-19 pandemic, this change will help more patients gain access to necessary treatment, and expand the number of providers available to prescribe buprenorphine.

As of April 28, 2021, eligible healthcare providers will not need extra hours of training to prescribe buprenorphine, and they will no longer be required to refer patients to counseling services. The providers can also treat up to 30 patients at a time with buprenorphine. Prescribers who want to treat more than 30 patients at a time must continue to follow the stricter requirements.

Addiction treatment providers should be aware that the exemption applies only to the prescription of Schedule III, IV, and V drugs, and does not apply to Schedule II medications, such as methadone.
Before prescribing buprenorphine for OUD, providers must first obtain a waiver under the Controlled Substances Act and submit a Notice of Intent to the Substance Abuse and Mental Health Services Administration (SAMHSA), following current protocols. Providers must be state licensed and registered by the U.S. Drug Enforcement Administration to prescribe controlled substances. For the full list of eligible prescribers, see the official HHS notice.

Although the American Medical Association has praised the change, it has called for Congress to further loosen restrictions to buprenorphine prescriptions. Few providers have been willing to fulfill the requirements for prescribing the drug, restricting the number of prescribers available and limiting treatment access for patients struggling with OUD.

Buprenorphine (also known by the brand name Suboxone) has been approved by the FDA as a medication-assisted treatment (MAT). It is the first medication to treat OUD that can be prescribed or dispensed in physician offices, which can make it more available to those who need it most.

Buprenorphine is available as a pill or a sublingual film for about $100 a month. It helps reduce opioid withdrawal symptoms and cravings. As an opioid partial agonist, buprenorphine produces effects such as euphoria or respiratory depression. These effects are weaker compared to stronger drugs, such as methadone and heroin, making it less likely to be misused. This helps a patient taper from powerful drugs to lower doses of more mild opioids.

SAMHSA offers numerous resources for prescribers interested in MAT, and buprenorphine specifically. Recommendations for prescribing buprenorphine for OUD include:

Patient must abstain from opioid use 12-24 hours and be in the early stages of withdrawal.
The prescriber should adjust the buprenorphine dose once the patient is seeing fewer (or no) side effects or cravings, and has significantly reduced other opioid use.
Depending on the patient’s individual needs, OUD treatment with buprenorphine may go on indefinitely.
Besides buprenorphine, providers treating OUD should prescribe additional behavioral therapies, such as counseling, for the best treatment outcomes.

Do you treat patients for OUD and other substance misuse disorders? Your EHR should support every type of addiction treatment, from counseling to MAT. Learn how BestNotes can save you time and money with an EHR solution that offers eprescribing, medication monitoring, outcome tracking, and compliance with state and federal EPCS mandates. Contact BestNotes today to schedule a free demo.

date:  May 18, 2021
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Social Determinants of Health: What Behavioral Health Providers Should Know

Physical and mental health depends on a lot of different factors. Behaviors like diet and smoking status can affect our health, as well as uncontrollable factors, like genetics.

Even our environments and income levels can affect health outcomes. That’s the idea behind social determinants of health (SDOH), which include conditions related to where we live and work.

What are social determinants of health (SDOH)?

Healthy People 2030, an initiative by the U.S. Department of Health and Human Services, groups SDOH into five general areas:

Economic Stability
Education Access and Quality
Health Care Access and Quality
Neighborhood and Built Environment
Social and Community Context

These SDOH include factors such as:

Access to safe housing
Experiences of violence or discrimination
Job opportunities and income level
Opportunities for physical activity
Exposure to pollution

These factors can have a significant impact on health and quality of life. For example, lack of access to healthy foods and few opportunities to exercise can increase a person’s risk of cardiovascular disease. Individuals who live in urban areas with high levels of air pollution tend to have higher rates of asthma.

And those are just physical health concerns. SDOH can also affect mental health.

How do social determinants affect mental health?

For example, a person who experiences frequent violence in their neighborhood or home can experience chronic stress and anxiety. This, in turn, can affect physical health in ways that may include disturbed sleep and increased inflammation. When these negative experiences occur in childhood, they can also impact mental health in adulthood.

Certain neighborhood details can also influence mental health. A team of British researchers found statistically significant associations between the prevalence of depression and residential characteristics, such as “abundant graffiti” and lack of private outdoor space.

Research from the World Health Organization in 2014 found that certain populations around the globe are at higher risk of mental disorders due to exposure to unfavorable circumstances. These include war and other armed conflict, neglect in early childhood, and lack of access to clean water. (Download a PDF of the full report here.)

In the United States, researchers examined the health effects of the severe drought in California in 2015. Many affected households reported that the drought negatively affected their peace of mind. Those households who reported that the drought affected their finances or property were more likely to report that it impacted their peace of mind and stress levels.

By understanding how these factors impact a person’s health, behavioral health providers can gain a more complete picture of their clients’ needs and concerns. This can help guide treatment and may lead to better client outcomes. Social workers and other types of behavioral health providers also will be better prepared to advocate for their clients, when necessary.

To get started, consider learning which SDOH most affect your practice’s client population or geographic location. You may be working with local, county, or state health departments in this area. If your clients mention particular SDOH concerns, document it in their health record, if appropriate. When possible, work with your client to take action or point them toward specific resources to help mitigate some SDOH.

At BestNotes, we’re big fans of helping behavioral health providers and their clients achieve the best outcomes. Our OutcomeTools feature helps you gather, track, and report outcome data, saving you time and reducing frustration. Whether you’re following one client or many, it’s never been easier to gather outcome data. Contact BestNotes today to learn more.

date:  May 12, 2021
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Medicaid Waivers, Magic Mushrooms, and Other Texas Behavioral Health News

There are a lot of changes happening in Texas that could have significant implications for behavioral health. Here are some of the big mental-health stories impacting the Lone Star State.

Biden Administration Rescinds Changes to Texas 1115 Waiver

The Centers for Medicare and Medicaid Services (CMS) announced that it has rescinded an approval to extend a federal funding agreement, known as a 1115 waiver, with the state of Texas. Under the 1115 waiver, hospitals are reimbursed for “uncompensated care” provided to patients without health insurance. Texas has used it to pay for certain healthcare projects, including mental health services that serve low-income Texans.

The extension, originally granted late in the Trump administration, would have continued those hospital reimbursements until September 2030. The waiver now expires September 30, 2022. Reversing that decision pushes Texas toward expanding Medicaid, according to two federal health officials cited by the Washington Post.

Psychedelic Drugs for Veteran PTSD?

A proposed Texas House bill would order a study of the use of psilocybin, also known as “magic mushrooms,” to treat post-traumatic stress disorder (PTSD) in veterans. Texas Rep. Alex Dominguez authored the proposal, House Bill 1802, which is scheduled for public hearing.

The bill would direct the state’s Health and Human Services Commission (HHSC) to conduct the study with a health sciences university and a Veterans Affairs hospital. HHSC would also be asked to do a review of prior studies on the use of psilocybin, MDMA, and ketamine.

Lack of Maternal Mental Health Treatment Costs Texas Billions, Report Says

Mothers and children with untreated mental health needs cost Texas about $2.2 billion during the child’s first five years of life, new research says. The study, found that about 13.2 percent of pregnant or postpartum women had a maternal mental health condition in 2019. For each mother with untreated maternal mental health conditions, the average cost was $24,796 the first year after their child’s birth and $44,460 through the child’s fifth birthday.

Researchers calculated the cost by examining the cost of care for women with untreated mental health conditions, such as anxiety and depression, and the loss of income from work absenteeism. Cost of care tended to increase for children due to preterm birth, low birth weight, reduced breastfeeding, behavioral or developmental disorders, and other childhood heath issues.

A few of the recommendations from the report authors include:

Expanded funding for healthcare
Connecting pediatricians to psychiatrists for patient phone consultations
Increased access to group-based prenatal care and pediatric care programs

Harris Co. Sheriff’s Office Expands Mental Health Program

The Harris County, Texas, sheriff’s office is expanding a telepsychiatry program that allows law enforcement officers to respond more appropriately to mental health incidents. Under the program, a deputy uses an iPad to connect a person in distress with a mental health professional to help deescalate the situation.

In 2017, the Harris County, Texas, sheriff’s office became the first in the nation to invest in telepsychiatry. The program has grown from three deputies in 2017 to nearly 150 deputies in 2021. Sergeant Jose Gomez says the program is expanding to the office’s constable agencies.

Treating behavioral health and substance use clients in Texas? Make sure your EHR solution accounts for both state and federal documentation requirements. Contact BestNotes today to find out how our documentation features can help save you time and reduce frustration.

date:  Apr 29, 2021
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Five Common Trauma Therapies to Offer at Your Behavioral Health Practice

Mental health symptoms associated with the novel coronavirus pandemic could last months or years longer than the pandemic itself. Specifically, many individuals and families may seek out therapy to help with post-traumatic stress disorder (PTSD).

Symptoms of PTSD include nightmares, severe anxiety, flashbacks, or uncontrolled thoughts about a traumatic incident. If the symptoms get worse, affect daily life, or persist for months or years, it could indicate PTSD.

Who may need trauma therapy?

Trauma therapy may be helpful for individuals who have experienced a variety of situations associated with COVID-19:

Recovering from severe cases of COVID-19
Losing loved ones to the disease
Working directly with patients diagnosed with COVID-19
Disruptions due to school closures
Social isolation associated with stay-at-home orders, including experiences of domestic abuse
Job loss and other financial difficulties
Loss of or limitations to support services for mental health or substance use disorders
Increased consumption of negative news stories and social media, which can increase anxiety and fear

What can help individuals who have experienced trauma?

Here’s an overview of different types of evidence-based therapies often used for individuals who have experienced trauma.

1. Cognitive Behavioral Therapy (CBT)

A type of talk therapy, CBT examines a client’s thought patterns and how they influence behavior and choices. CBT helps clients pinpoint how some of their thoughts and behaviors have been incorrect or unhelpful.

Over time, clients can use CBT to develop more helpful, accurate thinking patterns and coping behaviors that can reduce symptoms and improve quality of life. For more details, check out our previous CBT post on the BestNotes blog.

2. Exposure Therapy

Exposure therapy can help clients confront and overcome their fears. Exposure therapy helps clients break patterns of avoidance by creating a safe environment in which he or she can face what they fear.

The BestNotes blog has a detailed post that provides a closer look at exposure therapy.

3. Narrative Exposure Therapy (NET)

A person’s life experiences and wellbeing heavily depend on the “story” that each individual tells himself or herself. With NET, a client can develop a fuller, more positive life story that appropriately contextualizes the traumatic event and how it has influenced him or her.

NET may help clients who have experienced complex and multiple trauma. One common use is among refugees, who have experienced trauma from “political, cultural or social forces.”

4. Eye Movement Desensitization and Reprocessing (EMDR) Therapy

EMDR is an evidence-based treatment for PTSD that helps clients process their trauma to aid healing. During EMDR sessions, the client focuses on a back-and-forth movement or sound while remembering an upsetting memory. The clinician also helps the client talk about and process their traumatic memories until PTSD symptoms decline.

5. Psychodynamic Trauma Therapy

Psychodynamic trauma therapy focuses on different factors that may affect or cause a client’s PTSD symptoms, such as experiences and coping mechanisms. This type of therapy focuses mostly on the client’s unconscious mind and how it influences behavior. Here, the therapist helps a client recognize and process painful, unconscious feelings so they can be released instead of being avoided.

Behavioral health clinicians may see a rise in demand for trauma-related therapies in the wake of COVID-19. Make sure you’re taking care of yourself as much as your clients with a customized EHR solution that helps you save time and reduce frustration. Contact BestNotes today to learn more.

date:  Apr 21, 2021
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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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