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Whole-Person Care for Coping Well

Whole-Person Care for Coping Well

by | Dec 16, 2020 | Being Well

We’ve been sharing ways to #CopeWell during stressful and uncertain times. Because mental health is connected to our physical well-being, health care services are increasingly offering mental and behavioral health services in conjunction with primary care to effectively address root causes of health concerns. This Wellness Wednesday tribute goes to Adventist Health Tillamook and their providers who share information about these vital services.

What are some of the more common issues for which people are seeking help right now?                                                                       

We are definitely seeing an increase in individuals struggling with feelings of anxiety and depression, but anxiety seems to be the predominant emotion at this time. It is important to recognize that anxiety and depression affect children as well as adults. It is estimated that about 7.1% of children, ages 3-17 experience these conditions. There is also a lifetime prevalence of 28.8%, with the average age of onset around age 11.

What are common warning signs for this condition?

Common warning signs people should look for include excessive worry, restlessness, insomnia, racing thoughts and fear of the future. If any person is experiencing these symptoms, it is important to schedule a visit with their primary care provider who will work with their care team to support their mental and physical health needs.

What are some of the specific services your organization provides that help individuals with these concerns?             

As a first line of treatment, patients are provided counseling or behavioral health treatment. Typically, this is a form of talk therapy where a person gains insight into their thoughts and how they are affected by anxiety, and then develops an understanding of how to best cope with it. There are also more specialized approaches that some therapists utilize such as somatic experience, movement, or Eye-Movement Desensitization Reprocessing (EMDR) to name a few. There are also medications such as SSRI’s which can help reduce a person’s feelings of anxiety, which would be prescribed by their medical provider.

Are these services covered by insurance and/or do you offer a sliding scale for payment?           

Adventist Health Tillamook accepts insurance for behavioral health services, and if someone does not have insurance, the hospital has a financial assistance program to help those who otherwise might not be able to afford these services.

With multiple behavioral health providers working within the Adventist Health system, you can find one that fits your needs. And just like with medical care, if your provider does not suit your needs, it is your right to switch providers. Having a provider you feel shares a connection is vital within behavioral health care.

To schedule an appointment, call (503) 842-5546. You can also go to https://www.adventisthealth.org/tillamook/services/behavioral-health/ to learn more.

Para Seguir Adelante, Mantengamos La Fe (To Move Forward, We Must Have Faith)

Para Seguir Adelante, Mantengamos La Fe (To Move Forward, We Must Have Faith)

by | Dec 10, 2020 | Being Well

Para Sequir Adelante, Mantengamos La Fe

Cuando Marilu y yo nos pusimos en contacto la una con la otra para hablar sobre este momento “bien difícil que cambió la vida” para toda la comunidad, ella me admitió que no había pensado poder “hablar ni expresarme bien” a propósito de ser entrevistada sobre tal asunto. Yo espero que ella me estuviera platicando a tono de broma cuando menospreció sus consejos alrededor de cómo sobrellevar los días frente a la pandemia del coronavirus. Lo que me compartió fueron estrategias sumamente realistas que uno puede aplicar universal y duraderamente para seguir adelante.

Su actitud pragmática de que “tenemos que hacer todas las reglas que se requieren; si no obedecemos las reglas, sigue peor, sigue más contagio del virus,” aparentemente resuena con la realidad que recién hemos observado por la subida de infecciones esta temporada otoñal. Durante la última semana de noviembre, el estado de Oregón continuó estableciendo nuevos máximos semanales de casos y hospitalizaciones. Y el Condado de Tillamook, hasta el 2 de diciembre, tenía que contar a la gravedad de 148 casos confirmados y presuntos en total (La Autoridad de Salud de Oregón [OHA], actualizaciones y datos disponibles en https://govstatus.egov.com/OR-OHA-COVID-19.) Es probable que el tono directo de Marilu derive de su experiencia ya extensa bajo la pandemia de adaptar las cosas para protegerse a sí misma y a la familia. Trabaja en limpieza de casas y tempranamente se acostumbró a trabajar menos horas mientras tomaba las precauciones comprensivas para prevenir la propagación del virus, minuto por minuto. Entrar y arreglar los espacios vividos por otros cuyas interacciones e itinerarios diarios permanecen desconocidos desde el punto de vista de Marilu — este servicio ha pedido a ella que asuma bastante riesgo. Lo ha combatido por,entre otras medidas, mantener la puerta abierta, poner la mascarilla y los guantes, desinfectar más las superficies y las sábanas — cada momento trabajado ahora es estructurado por una regulación que higieniza el marco. Más que nada, enfatiza que “trato de limpiarme bien antes de entrar a la casa para sentirme segura de que no voy a traer infecciones al llegar [allí].”

Para Marilu, como para muchos, el hogar contiene a las razones, personificadas, por las que ella se compromete a hacer todas las medidas preventivas, bien en el lugar del trabajo o en los sitios públicos esenciales, minimizados que sean. Tiene el orgullo de ser madre de cuatro hijos, algunos de quienes todavía viven a su lado en casa. Con respecto a ellos que ya se han mudado fuera, como su hijo mayor, Marilu espera que, algún otro día, su hogar podría albergar a la familia que sigue creciendo: la niña de él justo cumplió los dos años. Pero debido a los aislamientos requisitos de casa a casa, Marilu no pudo hacerle una fiesta para ella, su primera nieta. En vez de poder tocarle a la muchacha con el cariño compartido por una abuela, se ha acostumbrado a “visitarla” a través del teléfono o la computadora. Asistir a reuniones electrónicas o digitales es algo que se ha convertido más común en su vida, en conjunto con otras en la comunidad hispana que vienen de los deseos de reunirse con la familia y de celebrar todos juntos. Pese a la imposibilidad de reconfortarse uno en la compañía de multitudes, especialmente cuando muchas personas hispanas se han enfrentado a “tantos casos” en sus comunidades, Marilu permanece una mujer de la fe. Les anima a los que tienen depresión y que sienten tristes que “tenemos que tener la fe, o si no, buscar ayuda.” Ya que “salían las emociones [de las personas en la comunidad] porque siempre van a andar con este miedo de que agarremos el virus,” Marilu subraya que “si pone uno al pensar o estresarse, es peor.” Por lo menos, tenemos que “parecer positivos y no negativos,” — tal vez fingir una emoción puede llegar creando la cosa auténtica. Dicho esto, Marilu no se conforma a pura ilusión. Nos aconseja que “sigan las reglas, tomen todas las precauciones, que no pierdan la fe.” Esta fe se mantiene con pasos prácticos en el camino hacia “una vida más normal” — que incluye quizás una reunión en persona — y que venga en el horizonte que creemos.

To Move Forward We Must Have Faith

When Marilu and I got in touch with each other to talk about this moment, one “so difficult that changed life for the whole community,” she admitted that she had thought she could not “talk or express myself well” in being interviewed on such a matter. I hope that she was joking when she diminished her advice on how to endure days facing the coronavirus pandemic. Because what she shared with me were extremely realistic strategies that one can apply universally and lastingly to keep moving forward.

Her pragmatic attitude that “we have to follow all the regulations that are required; if we don’t comply with them, things will get worse and there will be more infection from the virus,” seemingly resounds with the reality we are observing with the surge in infections this fall season. During the last week of November, the state of Oregon continued setting new weekly highs for cases and hospitalizations. And Tillamook County, on December 2nd, had to count up the seriousness of 148 confirmed and presumptive cases in total (source: Oregon Health Authority [OHA], updates and data available at https://govstatus.egov.com/OR-OHA-COVID-19). It’s likely that Marilu’s straightforward tone comes from her already extensive experience under the pandemic adapting things to protect herself and her family. She works in housekeeping and early on adjusted to working fewer hours, while taking many precautions to prevent the spread of the virus, minute to minute. To enter into and arrange the spaces lived in by others, whose daily interactions and itineraries remain unknown from Marilu’s point of view — this service has asked her to assume quite enough risk. She has combatted it by, among other measures, leaving the door open, wearing mask and gloves, further disinfecting surfaces and sheets — each moment worked now is structured by a routine that sanitizes the setting. More than anything, she emphasizes that she “[tries] to clean myself well before entering the house to feel certain I’m not bringing infection when I arrive.”

For Marilu, as for many, the home contains the reasons for which she commits to take all preventive measures, whether in the workplace or in the essential public places, minimized as they are. She carries the pride of being mother to four children, some of whom still live by her side in the house. As for those that have already moved out, like her eldest son, Marilu hopes that, some other day, her home could host the family that keeps growing: his little girl just turned two years old. Due to the isolations required household to household, Marilu couldn’t put on a party for her, her first granddaughter. Instead of being able to hold the girl with the care that a grandmother shares, she has become accustomed to “visiting her” through the phone or the computer. Attending virtual gatherings is something that has become more commonplace in her life, together with others in the Hispanic community that come from desires to reunite with family and celebrate altogether. Due to the impossibility of comforting oneself in the company of multitudes, especially when many Hispanic people are confronting “so many cases” in their communities, Marilu remains a woman of faith. She encourages those that are experiencing depression and that feel sadness that “we must keep the faith, and if not, seek help.” Given that “everyone’s emotions are coming out because we are always walking with the fear that we might catch the virus,” Marilu underlines that “if one gets to [over]thinking or stressing themselves, it is worse.” At the least, we’ve got to “seem positive, not negative,” — sometimes faking an emotion can end up creating the real thing. That said, Marilu doesn’t settle for wishful thinking. She advises “sticking to the rules, taking all precautions, not losing faith” — this faith is maintained in practical steps, on the path toward “a more normal life” — including perhaps an in-person reunion — and that comes on the horizon we create.

AUTHOR: Libby Kokes, Health Equity AmeriCorps VISTA at Tillamook County Community Health Center

For more local health and wellness information, follow Tillamook County Wellness on Facebook, Instagram and Twitter.

Navigating Holiday Travel

Navigating Holiday Travel

by | Dec 3, 2020 | Being Well

It’s that time of year again! The trees are changing colors, the weather is getting colder, and the days are getting shorter. While some things are expected and familiar to us all, other things are new – Holidays during a Pandemic.

After 8 months of lockdown and social distancing, many of us find ourselves eager to see loved ones. While spending time with loved ones can be a great stress-reliever, navigating the holidays during a pandemic can also be a source of stress. So that begs the question: to travel or not to travel?

The absolute safest way to celebrate this Holiday season is to stay home and celebrate with your household family members. Virtual gatherings, over Zoom or Facetime, are encouraged to stay connected and safe this season. Given the new statewide “Two-Week Freeze” announced by Governor Brown, limiting gatherings to no more than 6 people from no more than 2 households, now is the perfect time for virtual gatherings!

For those that are traveling and will be spending time with friends and family outside of their homes, here are some tips to enjoy the holidays safely:

  • Wear a face mask at all times (except for when eating)
  • Always maintain social distance of 6ft or more
  • Try to have gatherings in an outdoor location, but remember to dress warm and wear a face mask if social distancing cannot be maintained
  • When sharing a meal, consider individual plates of food versus buffet-style dining
  • Consider driving with household members to the gathering, versus flying when possible
  • Make a plan to quarantine before and after the gathering, to reduce transmission of COVID-19
  • Get your flu shot before traveling and meeting up with friends and family for holiday gatherings
    • While the flu shot will not directly protect against COVID-19, it has many other benefits to keep you safe and healthy, reducing illness
  • Stay home if you are feeling sick, have recently tested positive for COVID-19, or are a known contact to someone who recently tested positive for COVID-19
  • If flying, consider purchasing traveler’s insurance and pack for a two-week trip in the case you should have to quarantine at your destination

Deciding to cancel your trip is difficult, but also something to be on our minds. Traveling during a pandemic requires all of us to call on the power of our inner-planners! Check out this infographic below for tips on delaying or canceling trips:

Remember, you can still partake in the holidays and make it special, while still staying safe! Now’s the perfect chance to get the WHOLE family together (virtually) and finally take that large family photo you’ve been wanting. Is it the same? Of course not. But will it be a holiday season you’ll ever forget? Of course not- it will be one to remember!

AUTHOR: Morganne Skinner, RN, BSN, Public Health Nurse at Tillamook County Community Health Center

For more local health and wellness information, follow Tillamook County Wellness on Facebook, Instagram and Twitter.

Seeking Help in Times of Stress

Seeking Help in Times of Stress

by | Nov 25, 2020 | Being Well

We’ve been sharing ways to cope well during stressful and uncertain times. This Wellness Wednesday tribute goes out to another partner organization that provides vital services to those who are struggling to cope right now. Just like with other prevention measures, it is better to seek and get help early, even if we don’t think we are “that bad off.” This week’s shout out goes to the Rinehart Clinic in Wheeler.

What are common issues for which people are seeking help right now?

It is well-known that the pandemic has widely resulted in anxiety, depression, and an increased use of alcohol and drugs across the world. People may be seeking help for anxiety or depression, but they may also be seeking treatment for other symptoms related to stress, trauma, or anxiety that may masquerade as separate ailments. These symptoms could include increased irritability/anger, new or increased pain (migraines, new back pain, etc.), changes in sleep patterns (not sleeping or sleeping too much), increased distractibility, inability to stay on task. People may also be struggling ​more with relationship issues, prolonged isolation-related distress, feeling exhausted by parenting while working-from home, and feeling overwhelmed in general.

What are some of the specific services your organization provides that help individuals with these concerns?             

Rinehart Clinic offers a full scope of health services including: medication, acupuncture, individual psychotherapy, Mindfulness Meditation classes, SMART Recovery meetings, recovery groups, and a variety of online classes and programs that offer social connections to others in the community.

As part of our team-based care, we conduct regular screenings ​and interventions for depression and substance use, as well as a variety of social determinants that may impact the health of our patients. Interventions may include a brief meeting with a mental health or behavioral health provider, connection to needed resources, and sometimes a referral to an outside specialist.

What are some common outcomes for people who receive these services?   

Patients have experienced a reduction in symptoms,  increased coping ability, decreased sense of isolation, and an overall increased feeling of well-being.

Are these services covered by insurance and/or do you offer a sliding scale for payment?     

Rinehart Clinic accepts most major insurance plans, including Oregon Health Plan, and we offer a sliding fee scale based on income. Our community wellness classes and group meetings are held free of charge.

Rinehart Clinic takes a team-based approach to primary care, so providers work together to offer​ care for the whole person. Patients can access mental health or behavioral health services through their primary care provider, or if they prefer, they can access these services directly by contacting our behavioral health providers.

To learn more, contact us at 1-800-368-5182 or www.rinehartclinic.org.

Stress Coping Strategies During and After the Pandemic

Stress Coping Strategies During and After the Pandemic

by | Nov 25, 2020 | Being Well

You are not alone if you have been feeling more stressed than usual. This additional stress is likely a result of the COVID-19 pandemic. One way to cope with stress is to utilize stress coping strategies. These strategies can be used as a tool to manage current and future stress that you may encounter.

Here are five coping strategies that may help you manage stress:

Journal writing: Journal writing can help to reduce stress levels. This coping strategy can be done in many ways, such as: recording daily events, creative writing, gratitude journaling, goal tracking, or journal prompts. If you are looking to learn about other ways that you can document what you are experiencing during this time, I encourage you to read this New York Times article.

Physical activity: Physical activity helps your body release endorphins which can make you feel good. Individuals of all ages can benefit from physical activity. To ensure physical activity will be sustainable in your life, choose exercises that you enjoy. If you are looking for some ideas on how to be active, I would recommend visiting Tillamook County Wellness.

Breathing Exercises: Breathing exercises are a good way to lower stress. These exercises are great because you can do them almost anywhere. To learn more about breathing exercises, I recommend reading this Washington Post article.

Do something you enjoy: Take time each day to do something that you enjoy. Try scheduling enjoyable activities the same way as you would schedule an appointment. If you are interested in learning about hobbies that lower stress, I recommend starting with this list for inspiration.

Have a conversation: Having conversations with others can allow you to get emotional support. You can connect with anyone that you trust, such as family members, friends, or a faith leader. If you do not feel comfortable opening up to someone you know, you may want to consider speaking with a health professional. A health professional is trained to help a person improve physical or/and mental health. Examples of these professionals include: physician, nurse, and counselor. If you would like to learn more about health services in Tillamook County check out the Best of Health & Wellness Guide. Another way to get emotional support is through a support group. These groups are facilitated by either peers or health professionals. These groups allow participants to participate in whatever way they feel comfortable. Support groups are ideal for people who want to talk with individuals that have similar lived experiences. One support group that I would like to highlight is the Tillamook Family Counseling Center’s COVID-19 support group. If you would like to learn more about the group call (503)842-8201.

I hope you have found this article helpful. If you would like to learn more about stress coping strategies be sure to follow the Tillamook County Wellness’s #COPEWELL campaign by following Tillamook County Wellness on Facebook.

AUTHOR: Janeane Krongos, Prevention Specialist at Tillamook Family Counseling Center

For more local health and wellness information, follow Tillamook County Wellness on Facebook, Instagram and Twitter.

Getting the Help We Need

Getting the Help We Need

by | Nov 18, 2020 | Being Well

We’ve been sharing ways to cope well during stressful and uncertain times. For the next few weeks, our Wellness Wednesday tributes go out to partner organizations who provide vital services to those struggling to cope. It’s important to reach out and get help even if a person doesn’t think they are “that bad off,” as we so often hear. Just like with other prevention measures, it is better to seek and get help early. This week’s shout out goes to Tillamook County Community Health Centers (TCCHC) and their behavioral health providers who responded to our interview.

What are the more common issues for which people are seeking help right now?

We are noticing an increase in Depression, Anxiety, Mood disorders, PTSD, and Substance Use Disorders. There is also an increase in difficulty managing chronic conditions such as health conditions like hypertension and diabetes as well as insomnia and other sleep issues, fatigue, chronic pain, stress, migraines and headaches. People are also struggling with weight concerns and behavioral challenges for children which can include ADHD.

What are some common warning signs for these conditions and how common are they? 

Warning signs can include insomnia and other sleep issues, emotional dysregulation, difficulty concentrating, increased disassociation, difficulty with organization, no or low motivation, lack of interest in pleasurable activities, irritability, increased risky behaviors, increased use of alcohol, drugs, gambling, food, etc.

Statistics cited by the National Institute for Mental Health for these conditions include:

Anxiety: 19.1% of the US adult population (23.4% are female, and 14.3% are male).  31.9% of the US adolescent population ages 13-18 (38.0% female, and 26.1% male)

Depression: 7.1% of the US adult population (8.7% female, 5.3% male). 13.3% of the US adolescent population ages 12-17 (20.0% female, 6.8% male).

Suicide: 10th leading cause of death overall in the US in 2018.  2nd leading cause of death among individuals ages 10-34, and 4th among individuals ages 35-54.

Post-Traumatic Stress Disorder (PTSD): 3.6% of the US adult population (5.2% female, 1.8% male), 5.3% in ages 45-59.  5.0% of the US adolescent population (8.0% female, 2.3% male), 7.0% for ages 17-18.

Substance use: (2018) 60.2% of the US population ages 12 and older (this includes alcohol, drugs, and tobacco). Highest use is 39% among ages 18-25.

(https://www.nimh.nih.gov/health/statistics/index.shtml)

During a study in June 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation. (CDC, https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm)

Nearly half of Americans report the coronavirus crisis is harming their mental health, according to a Kaiser Family Foundation poll. A federal emergency hotline for people in emotional distress registered a more than 1,000 percent increase in April compared with the same time last year. Last month, roughly 20,000 people texted that hotline, run by the Substance Abuse and Mental Health Services Administration. (Washington Post, https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/)

Online therapy company Talkspace reported a 65 percent jump in clients since mid-February. Text messages and transcribed therapy sessions collected anonymously by the company show coronavirus-related anxiety dominating patients’ concerns. (Washington Post, https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/)

What are some of the specific services your organization provides that help individuals with these concerns?             

As behavioral health clinicians who are integrated into primary care our focus is to work with patients around improving health outcomes.  Patients are referred to behavioral health via their primary care provider, and our sessions are generally 30 minutes in length with periodic follow ups as needed or recommended.  We do refer patients to other services as needed; this can include linking with Tillamook Family Counseling Center or a private therapist. Behavioral health is intended to be a short-term consultative service, it is not intended to be long-term intensive psychotherapy.

We engage patients using motivational interviewing, cognitive behavioral therapy, focused acceptance and commitment therapy, behavior activation, and many other tools.

We have a medication assisted treatment (MAT) program for individuals with opioid use disorder; this means we have providers who can prescribe suboxone to treat opioid use disorder.  Individuals must be a patient of the clinic or be willing to establish care, they must have an assessment by the behavioral health provider before they are determined eligible for the program.  MAT participants are then seen by the prescribing provider and behavioral health clinician on a pre-determined schedule to monitor effectiveness, and address any challenges the individual may be experiencing, along with working on their individual goals.

Psychiatry services are available in our clinic; your primary care provider can consult with the psychiatrist, and if needed, the psychiatrist can provide direct services for patients (such as evaluation, follow up, medication starts or changes, and then facilitate return to your primary care provider for ongoing management). Currently this service is only available for patients of the Health Center.

What are common outcomes for people who receive these services?   

We have seen improvements in diabetes management (reduction in a1c’s), improvement in blood pressure control, medication adherence, improved nutrition, improve sleep, and improvements in depression, anxiety, weight management, and stress.

In our MAT program we have seen a reduction in use of opioids and other substances, increased education about overdose and the use of Narcan, and we have seen patients meet their goals, such as getting stable housing, stable employment, improved relationships, etc.

Are these services covered by insurance and/or do you offer a sliding scale for payment?     

TCCHC accepts all forms of insurance, including Oregon Health Plan (OHP), private insurance, and self-payments. We have a sliding fee scale and will not refuse services based on the inability to pay.

What else should people know about your services?

We are a team-based clinic that will assist you in accessing needed resources and services.  We can collaborate with other treatment facilities, and community agencies to help coordinate the care you need.

Individuals may contact us at 503-842-3900 or 800-528-2938.  TTY at 800-735-2900.