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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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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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The Power of Outdoors for Mental Health Treatment

Health providers and clients everywhere are looking for different solutions to many behavioral health disorders and symptoms. While some potential mental health treatments may be untested or controversial, one approach has long shown significant promise, without high costs or side effects: Mother Nature and the great outdoors.

Many years of scientific research and anecdotal accounts demonstrate that outdoor, “green space” can reduce stress and anxiety, encourage mindfulness, and increase physical activity. These green environments include tiny urban parks, rural environments, or natural forests. Activities can range from peaceful meditation to casual hiking to heart-pounding white-water rafting.

What’s the Latest on Outdoor Activities and Mental Health?

Adventure Explorations, an outdoor adventure guiding company based in Pennsylvania, recently published a white paper on the link between outdoor activity and mental health. You can download the report here.

Although people can benefit from exercise and physical movement anywhere, the white paper notes that it’s even better if the activity takes place outside, rather than in a gym or indoor class. The authors cite previous research that found connections between outdoor activities and positive mental health outcomes.

Many types of mental health treatment, including pharmaceuticals, can be helpful, but may take weeks or months to show results. Clients also may experience medication side effects. In contrast, spending time in nature and outdoor activities may show faster improvements without serious side effects or high financial costs.

More Research Focuses on Great Outdoors and Behavioral Health

Additional research is needed to shed light on the best kinds of outdoor activities or green spaces, and who can benefit the most. Future studies can help guide behavioral health clinicians to the best type of activities for their clients.

For example, the University of New Hampshire’s Outdoor Behavioral Healthcare Center is planning a new, randomized study to examine the effectiveness of outdoor behavioral health (OBH). Specifically, the study will look at whether OBH can be used as a prescriptive treatment for adolescents struggling with depression, anxiety, or substance misuse.

OBH, also known as wilderness therapy, may help teens struggling with addiction, or emotional, behavioral, or relational difficulties. With wilderness therapy, adolescents participate in one or more outdoor experiences, such as hiking, camping, or climbing. This combines the advantages of physical activity with the benefits of green space exposure. OBH may also involve group living, group therapy, and one-on-one counseling.

A team led by Michael Gass, professor of outdoor education and director of UNH’s Outdoor Behavioral Healthcare Center, will compare treatment methods and outcomes among at least 100 teens. The study will also consider the role that socioeconomic factors may have in the treatment process.

Whatever treatment method you recommend for your clients, it’s more important than ever to know how well those treatments are working. However, client outcomes can be a hassle to measure, track, and report.

Fortunately, the OutcomeTools system by BestNotes makes it easy for you to use outcome data to track your clients and therapeutic effectiveness and meet or even surpass industry standards. OutcomeTools is available as a standalone tool or included in the BestNotes EHR solution. Contact us today to learn how OutcomeTools can help your behavioral health and addiction treatment practice.

date:  Mar 08, 2021
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How Behavioral Health Practices Can Prepare for Increased Demand

Demand for behavioral health services has skyrocketed during the COVID-19 pandemic. Besides fears of the virus itself, job losses and financial difficulties are increasing anxiety while social isolation from quarantine and stay-at-home orders are leading to a rise in depression symptoms. These difficulties are also leading to an increase in suicidal behaviors and substance misuse.

Additionally, behavioral health demand was already on the rise before COVID-19. PwC reported in February 2020 that a Health Care Cost Institute report on U.S. healthcare spending trends found that spending on psychiatry grew 43 percent between 2014 and 2018. Use of psychiatric services rose 32 percent between 2014 and 2018.

If you are an independent behavioral health provider, how can you prepare for and respond to this increased demand for your services? Here are a few things to consider.

Take a closer look at your practice’s infrastructure.

Are you practically able to add more clients to your practice? Not only should you consider your own limits of time and energy, but you also have the practice itself to consider. Make sure your practice’s infrastructure, such as your waiting room, office space, and any administrative staff, can handle more clients.

Will additional clients create more expenses or administrative burdens? Are your current solutions, such as billing, scheduling, and electronic health record (EHR) software, enough to help you manage these new clients? Make sure you understand how an increased client load will affect your practice.

Partner with other organizations.

For one reason or another, you may not have the availability to serve additional clients in your own practice. However, you may still be able to make a difference and help mitigate behavioral health demand through partnerships with other organizations in your community.

Reach out to other providers in both physical and behavioral health, as well as local health and social services agencies and community groups. Connecting with other professionals and related organizations can help you raise awareness of behavioral health issues, refer individuals in need to appropriate providers, and build your own professional network and knowledge.

If you don’t use telehealth, now is the time to start.

If you have not already added telehealth capabilities to your behavioral health practice, it is not too late. In fact, teletherapy use may be even higher now than in the early stages of the pandemic. Remote behavioral health options could allow you to see more clients in less time, whether you are conducting initial assessments or talk therapy appointments.

Although requirements have relaxed during COVID-19, it is still important to follow best telehealth practices. Make sure you take the appropriate steps to make sure you get reimbursed for telehealth, as well.

Consider adding a partner to your practice.

When you are the only behavioral health provider at your independent practice, there are greater limits to the services you provide and the number of clients you have. Hiring another therapist at your practice, or even bringing on a business partner, is one way to expand your capacity.

When you’re stressed and overworked, the right clinical tools are critical for helping you and your staff continue to serve clients and stay on top of your workload. BestNotes EHR solutions offer easy implementation, reduced clicks, and thorough technical support, as well as telehealth capabilities. Our software was created with clinicians in mind, helping you do what you do best. Contact us to learn more.

date:  Nov 24, 2020
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