Improve Your Child’s Life and Future Using Positive Behavior Interventions and Supports

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This 12-minute online captioned module is 1 of 5 from the Utah Parent Center.

6 Ways to Deal With Your Child’s Aggressive Behavior

If you’re a parent, you’ve probably dealt with your fair share of tantrums, meltdowns and freak-outs. Emotional regulation is a skill we all have to learn, and some kids take longer to master self-control than others. But how do you know when your child’s aggressive or violent behavior is not just part of their learning curve, but is getting out of hand? And what can you do to help? 

Do most kids act out like this?

It’s all about knowing what’s developmentally appropriate. “We generally expect toddlers to experience some aggressive behaviors,” says pediatric psychologist Emily Mudd, PhD.

“At this stage, kids tend to resort to physical expressions of their frustration, simply because they don’t yet have the language skills to express themselves. For example, pushing a peer on the playground could be considered typical. We wouldn’t necessarily call that aggression unless it was part of a pattern.”

How do you recognize true aggression?

By the time a child is old enough to have the verbal skills to communicate his or her feelings — around age 7 — physical expressions of aggression should taper off, she says.

If that’s not happening, it’s time to be concerned, especially if your child is putting himself or others in danger, or is regularly damaging property.

Watch for warning signs that your child’s behavior is having a negative impact:

• Struggling academically.
• Having difficulty relating to peers.
• Frequently causing disruptions at home.

“These warning signs are cause for concern and should not be ignored,” she says.

Your child’s behavior may have an underlying cause that needs attention. ADHD, anxiety, undiagnosed learning disabilities and autism can all create problems with aggressive behavior.

“Whatever the cause, if aggressive behavior impacts your child’s day-to-day functioning, it’s time to seek help,” Dr. Mudd says.

Start by talking with your pediatrician. If necessary, he or she can refer you to a mental health professional to diagnose and treat problems that may cause aggression.

What can parents do to help their child?

Dr. Mudd recommends these strategies for helping your child tame his or her aggression:

1. Stay calm. “When a child is expressing a lot of emotion, and the parents meet that with more emotion, it can increase the child’s aggression,” she says. Instead, try to model emotional regulation for your child.
2. Don’t give in to tantrums or aggressive behavior. For example, if your child is having a tantrum at the grocery store because she wants a particular cereal, don’t give in and buy it. This is rewarding, and reinforces the inappropriate behavior.
3. Catch your child being good. Reward good behavior, even when your child isn’t doing anything out of the ordinary. If dinnertime is problem-free, say, “I really like how you acted at dinner.” Treats and prizes aren’t necessary. Recognition and praise are powerful all on their own.
4. Help kids learn to express themselves by naming emotions. For example, you may say “I can tell you’re really angry right now.” This validates what your child is feeling and encourages verbal, instead of physical, expression.
5. Know your child’s patterns and identify triggers. Do tantrums happen every morning before school? Work on structuring your morning routine. Break down tasks into simple steps, and give time warnings, such as “We’re leaving in 10 minutes.” Set goals, such as making it to school on time four days out of five. Then reward your child when he or she meets those goals.
6. Find appropriate rewards. Don’t focus on financial or material goals. Instead, try rewards like half an hour of special time with mom or dad, choosing what the family eats for dinner, or selecting what the family watches for movie night.

If your child is struggling with self-control, incorporating these strategies into your parenting should help you rein in those behaviors.

If the situation seems unmanageable, remember that you’re not the only one struggling with your child’s behavior. Pediatric psychologists are adept at helping children and families solve emotional and behavioral problems. Ask your pediatrician for the names of mental health professionals in your area.

November 14, 2018 / By Children's Health Team

originally posted here: https://health.clevelandclinic.org/6-ways-to-deal-with-your-childs-aggressive-behavior

Lawmakers Revive Plan To Curb Restraint, Seclusion In Schools

by Michelle Diament | November 15, 2018

Legislation establishing first-ever federal oversight of restraint and seclusion in the nation’s schools is back on the table.

Democrats in Congress introduced a bill known as the Keeping All Students Safe Act this week. The measure would bar seclusion at any school receiving federal tax dollars and significantly limit the use of restraint to situations where the safety of students and teachers is at risk.

“It’s barbaric for schools to confine students alone in locked rooms, or to use abusive methods to restrain little children. Treating school kids this way should not be tolerated in America. Period,” said U.S. Sen. Chris Murphy, D-Conn., a sponsor of the legislation. “Our bill would establish strong federal standards to keep students safe, while giving school staff alternatives to respond to challenging situations in the right way.”

The move comes little more than a week after Democrats secured control of the House of Representatives in the coming legislative session and signals that they will use their new majority status in the body to press for the legislation.

Data released earlier this year by the Department of Education indicates that 122,000 students were subject to restraint or seclusion in the nation’s schools during the 2015-2016 academic year. Children with disabilities accounted for 71 percent of those restrained and 66 percent of seclusion cases.

At present, rules governing the practices vary significantly from one state to the next.

Legislation to create federal standards on the use of restraint and seclusion in schools passed the House in 2010 but failed to secure support in the Senate.

The latest bill was introduced this week in the House by Reps. Don Beyer, D-Va., and Bobby Scott, D-Va., the top Democrat on the House education committee. A Senate version of the bill was introduced by Murphy and Sen. Patty Murray, D-Wash., the lead Democrat on the Senate education committee.

In addition to ending seclusion and curtailing the use of restraint, the measure would require training for any school staff members who restrain students, ensure that restraint could not be used as a planned intervention and mandate that parents be notified if their child is subject to the practice, among other changes.

originally posted here: https://www.disabilityscoop.com/2018/11/15/lawmakers-curb-restraint-seclusion/25733/

Join the call-in Day for Money Follows the Person on Thursday!

from Center for Public Representation: Facebook event As the holidays approach, urge Congress to pass the EMPOWER Care Actto reauthorize the Money Follows the Person (MFP) Program!  States are running out of money – and we are running out of time to get MFP funding during this Congress. MFP helps people with disabilities and older adults who want to move out of nursing homes or other institutions get back into their communities. MFP has assisted more than 88,000 individuals voluntarily move into a setting of their choice. MFP has improved the lives of older adults and people with disabilities, saved states money, and led to better outcomes. That’s why nearly every state has participated in the program!  But MFP expired September 30, 2016, and states are running out of funding. People with disabilities deserve the right to live in the community, rather than spending their lives segregated into institutions.   URGE CONGRESS TO SUPPORT COMMUNITY LIVING AND FUND MFP!    Call your Senators and Representatives on November 15th and ask them to cosponsor the EMPOWER Care Act! It's time to reauthorize the program and pass the bipartisan EMPOWER Care Act this year!    For more information: https://medicaid.publicrep.org/empower-care-act/.

2018 Election Update

from The Arc of Indiana:

2018 Election Update
Whose Leading Indiana

After all the campaigning, the 2018 elections are now over, and new leaders, as well as incumbents, will be leading Indiana. Here is an overview of the 2018 election results.

U.S. Senate
Republican Mike Braun beat out incumbent Democrat Joe Donnelly with a margin of 52-44. This leaves Republicans in control of the U.S. Senate.

Indiana’s Senate Delegation
Todd Young and Mike Braun

U.S. Congress
Not too much change up happened in Indiana’s Congressional races as Representatives Visclosky and Carson are the only Democrats representing Indiana in Washington, D.C. However, two rookies have joined their Republican colleagues to represent the Hoosier state in our nation’s capital - Jim Baird and Greg Pence. A blue splash was made in Congress as the Democrats have now taken control of the U.S. House of Representatives, winning the majority in the lower chamber.

Indiana’s Congressional Delegation:
District 1- Peter Visclosky
District 2- Jackie Walorski
District 3- Jim Banks
District 4- Jim Baird
District 5- Susan Brooks
District 6- Greg Pence
District 7- Andre Carson
District 8- Larry Bucshon
District 9- Trey Hollingsworth

Statewide Elected Officials
At the state level, Republican women swept the podium.

Secretary of State
Connie Lawson

Auditor
Tera Klutz

Treasurer
Kelly Mitchell

Also on the ballot was a key question asking voters if Indiana’s Constitution should require a balanced budget. More than 71% of Hoosiers supported the measure.

Indiana Senate
Indiana’s Senate Democrats gained a new senator and defeated a long-time Republican incumbent. Jon Ford beat Mike Delph to represent Senate District 38 at the Statehouse. Ford is the first openly gay lawmaker to be elected to serve in the General Assembly.
The Senate Republicans still maintain their Super Majority with 40 Republicans to 10 Democrats.

Indiana House of Representatives
House Democrats picked up at least two more seats, inching closer to breaking the Republicans Super Majority. With some delays in vote counting in Northwest Indiana the results are still out to see if Republican incumbents Julie Olthoff and Ed Soliday will remain in the Statehouse.

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Why Do Short-Term Health Insurance Plans Have Lower Premiums Than Plans That Comply with the ACA?

From Kaiser Family Foundation:

Larry Levitt Follow @larry_levitt on Twitter, Rachel Fehr, Gary Claxton, Cynthia Cox Follow @cynthiaccox on Twitter, and Karen Pollitz
Published: Oct 31, 2018

The Trump administration earlier this year issued a regulation that expands the availability of “short-term” health insurance plans that do not have to comply with any of the rules in the Affordable Care Act (ACA) for plans sold in the individual market. Specifically, the regulation allows short-term plans to be offered for up to 364 days and renewed at the discretion of the insurer for up to three years. Short-term plans are also expected to be more attractive now that ACA’s individual mandate penalty has been repealed, since people previously enrolling in these plans were liable for the penalty.

Short-term plans pose tradeoffs for consumers. On the one hand, they typically have substantially lower premiums than ACA plans. On the other hand, they exclude people with pre-existing conditions — an estimated 27% of all non-elderly adults — and offer more limited benefits than ACA plans.

In this analysis, we quantify the effects of the eligibility rules and more limited benefits generally found in short-term plans on the premiums in those plans. We estimate that by screening out people with pre-existing conditions and providing less comprehensive benefits, insurers may be able to offer short-term plans at premiums 54% lower than ACA-compliant plans.

Denial of Coverage to People with Pre-Existing Conditions

Short-term plans generally limit coverage of pre-existing conditions in two ways: by denying insurance altogether to people with pre-existing conditions, and by excluding coverage of pre-existing conditions for people who are offered a policy. By covering primarily people who are healthy at the time they apply, short-term plans have much lower claims costs than ACA-compliant plans and can charge substantially lower premiums.

We estimate conservatively that excluding coverage of pre-existing conditions results in 38% lower premiums relative to ACA-compliant plans.

Our estimate is derived by comparing average health care expenses paid by insurance for people with private health insurance overall – which includes a mix of both healthy and sick people in individual and employer-based plans – to average expenses for people who do not have a pre-existing condition that would have led to a denial of insurance before the ACA. The estimate is conservative because it assumes that the ACA’s risk pool includes a proportionate mix of healthy and sick enrollees, while it is likely that actual enrollment in ACA individual market plans are disproportionately sick. To the extent the current ACA risk pool is sicker than average, the potential reduction in premiums in short-term plans that exclude people with pre-existing conditions could be greater. If insurers start to offer guaranteed renewable short-term policies, the premium advantage would moderate as some enrollees develop health conditions over time. However, our review of products now on the market suggests that insurers are generally not yet offering a renewal option.

Limited Benefits

Short-term plans often exclude or severely limit benefits that ACA-compliant plans are required to cover, including prescription drugs, maternity care, mental health, and substance use treatment. Excluding people with pre-existing conditions eliminates a substantial amount of expenses in each of these benefit categories, but excluding the categories altogether further reduces spending and premiums.

Eliminating prescription drug coverage reduces premiums by an estimated 13%, after accounting for the reduction from excluding people with pre-existing conditions. This estimate is based on analysis of prescription drug expenses paid by private insurance for people without pre-existing conditions. Since the survey data on which this estimate is based do not account for rebates provided by drug manufacturers to insurance companies, it is likely slightly overstated.

Maternity expenses account for an estimated 3.4% of claims expenses in private insurance plans. However, because women who are pregnant at the time they apply for coverage would be excluded, the effect on premiums would be approximately one-quarter of that amount, or about 0.85%.

Mental health and substance abuse treatment account for 4.2% of claims expenses. It is difficult to estimate how much an insurance plan would pay for mental health and substance abuse, once people with pre-existing conditions (e.g., severe mental illness or a history of alcohol or substance abuse with recent treatment) are excluded. We assume half of the claims expenses for these services, or 2.1% total expenses, would be eliminated if plans did not cover mental health and substance abuse treatment.

In total, we estimate that the benefits often excluded or limited in short-term plans could reduce premiums by about 16%.

Other Factors Affecting Premiums

Short-term plans can be purchased with a variety of features, which will also affect the premiums they charge, including:

• Deductibles, coinsurance, and copays. Higher or lower levels of patient cost-sharing than in standard ACA-compliant plans (i.e., bronze, silver, and gold) will result in different premiums. Since short-term plans do not have to cap patient out-of-pocket costs like ACA-compliant plans, they can be purchased with very high deductibles and lower premiums.
• Dollar limits on coverage. Short-term plans can and generally do impose annual limits on benefits, which results in lower premiums. In some cases, an enrollee can choose the level of the limit. Short-term plans also in some cases cap what they will pay for a day in the hospital or a physician visit, which lowers premiums but could result in balance billing for patients.
• Age and gender rating. The ACA prohibits premiums from varying by gender and limits the variation in premiums due to age to a ratio of three to one. Short-term plans are not subject to those restrictions.
• Medical loss ratio. Individual market insurers must have a medical loss ratio of at least 80% — meaning 80% of premiums are spent on health care expenses – or pay rebates to consumers. Short-term plans can devote a larger share of premiums to overhead and profit, which may push premiums up.

Conclusion

Short-term health insurance plans present a tradeoff to consumers – lower premiums in exchange for more limited coverage and less protection than ACA-compliant plans. Overall, we estimate that short-term plans could provide coverage with fewer benefits at premiums 54% lower than ACA-compliant plans. However, the bulk of these premium savings result from exclusion of people with pre-existing conditions, for whom short-term plans are not an option.

The lower premiums will likely prove attractive to people who are healthy, especially those buying their own coverage now who have incomes too high to qualify for ACA premium subsidies. If such individuals opt for short-term plans and then become seriously ill or injured, however, they could face higher out-of-pocket costs.

To the extent short-term plans siphon off healthy enrollees attracted by lower premiums, ACA-compliant plans will be left with a sicker pool of enrollees, and individuals with pre-existing conditions not eligible for subsidies will face higher premiums.

Methods

Average total spending and prescription drug spending by private insurance come from the 2015 Medical Expenditure Panel Survey (MEPS). These spending averages are for people ages 18 to 64, with nine or more months of private insurance and zero months of Medicaid in 2015. For the purposes of this analysis, people with pre-existing conditions are those who have at least one declinable health condition, based on ICD9 codes, condition classification codes, and BMI data from MEPS.

originally posted here: https://www.kff.org/health-reform/issue-brief/why-do-short-term-health-insurance-plans-have-lower-premiums-than-plans-that-comply-with-the-aca/

Help for Mental Illnesses

If you or someone you know has a mental illness, there are ways to get help. Use these resources to find help for you, a friend, or a family member.

Please note that NIMH is a research funding agency. Resources on this page are provided for informational purposes only. The list is not comprehensive and does not constitute an endorsement by NIMH.

Get Immediate Help

If you are in crisis, and need immediate support or intervention, call, or go the website of the National Suicide Prevention Lifeline (1-800-273-8255). Trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals. If the situation is potentially life-threatening, call 911 or go to a hospital emergency room.

Find a Health Care Provider or Treatment

For general information on mental health and to locate treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). SAMHSA also has a Behavioral Health Treatment Locator on its website that can be searched by location.

National agencies and advocacy and professional organizations have information on finding a mental health professional and sometimes practitioner locators on their websites. Examples include but are not limited to:

• Anxiety and Depression Association of America
• Depression and Bipolar Support Alliance
• Mental Health America
• National Alliance on Mental Illness

University or medical school-affiliated programs may offer treatment options. Search on the website of local university health centers for their psychiatry or psychology departments.

You can also go to the website of your state or county government and search for the health services department.

Some federal agencies offer resources for identifying practitioners and assistance in finding low cost health services. These include:

• Health Resources and Services Administration (HRSA): HRSA works to improve access to health care. The website has information on finding affordable healthcare, including health centers that offer care on a sliding fee scale.
• Centers for Medicare & Medicaid Services (CMS): CMS has information on the website about benefits and eligibility for these programs and how to enroll.
• The National Library of Medicine’s MedlinePlus website also has lists of directories and organizations that can help in identifying a health practitioner.
• Practitioner lists in health care plans can provide mental health professionals that participate with your plan.
• Mental Health and Addiction Insurance Help: This website from the U.S. Department of Health and Human Services offers resources to help answer questions about insurance coverage for mental health care.

Participate in a Clinical Trial

Clinical trials are part of clinical research and at the heart of all medical advances.. People volunteer to participate in carefully conducted investigations that ultimately uncover better ways to treat, prevent, diagnose, and understand human disease. Clinical trials can also look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Learn more about clinical trials on the Clinical Trials — Participants page.

• Find a Clinical Trial at NIMH. Doctors at the NIMH in Bethesda, Maryland are trying to learn more about the causes of, treatments for, and genetic factors in mental disorders. To learn more, visit the NIMH Join a Study page.
• Find a Clinical Trial Near You. For information on clinical studies across the country, visit  www.clinicaltrials.gov. You can search by topic and location.

Help for Service Members and Their Families

Current and former service members may face different mental health issues than the general public. For resources for both service members and veterans, please visit https://www.mentalhealth.gov/get-help/veterans.

Learn More about Mental Disorders

NIMH offers health information and free easy-to-read publications on various mental disorders on its website in the Health & Education section. The website is mobile and print-friendly. Printed publications can be ordered for free and free eBooks are available for select publications. Many publications are also available in Spanish. To order free publications, order online (haga su pedido por el Internet en español) or call 1-866-615-6464 (TTY: 1-866-415-8051).