BISMARK, N.D. – Rural North Dakota is getting a digital solution to the lack of mental-health resources for children who've been victims of abuse.
Children's Advocacy Centers of North Dakota launched telehealth therapy services this week for kids handling trauma. Interim director of the centers, Paula Condol, says the method is based on University of South Carolina research on cognitive behavioral therapy, which she calls the "gold standard" for treating traumatized kids.
The research has found virtual care is just as effective as in-person therapy, and so Condol jumped on the opportunity.
"And I thought, that's what we need to have in North Dakota," says Condol, “something that creates that equal access, so kids who are in Dunn County or in Williston can have the same exact services as if you were right here in Bismarck, North Dakota, or in Fargo, North Dakota.”
She says the organization is the first in the nation to use telehealth for this kind of therapy, which is sorely needed in the state. Condol says 90% of North Dakotans live in areas that have few, if any, mental-health counselors.
Twelve therapists in Bismarck, Fargo and Grand Forks are on deck to help kids remotely, which also eliminates weekly, hours-long drives for families.
Condol says deep breathing is the cornerstone of treatment. She explains to kids how proper breathing affects the body, clears out the thinking process and can be used as a coping mechanism.
"When we're teaching deep breathing we talk about, 'So when you think about that bad situation that happened, or you wake up in the middle of the night from a nightmare, this is a skill that you can use to calm your body down,’" says Condol. “Because, again, if your heart is beating at 100 beats per minute and you're trying to sleep at night, that's not going to work."
She says a parent or caregiver has to be nearby during therapy sessions. And at the end of a session, kids teach them about what they've learned, so that everyone in the household can practice these skills.
The centers can provide the tools to families to connect with doctors, such as an iPad, and will bill insurance but never bill the families directly.
Condol adds that most of the kids they've treated have been victims of sexual abuse.
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Summer will be here before you know it, and experts say now is the time to get prepared for Arizona's scorching and life-threatening temperatures.
Some 645 heat-associated deaths were confirmed by Maricopa County's Department of Public Health in 2023, breaking the previous year's record by more than 50%.
Dr. Rebecca Sunenshine, the health department's medical director, said the 2023 Heat Related Deaths Report demonstrates this is a significant public health concern for Arizona's most populous county.
"This is really a call to action," she said, "to make sure that we all come together across the county - community-based organizations, cities, the county government - to prevent these deaths almost all of which are preventable."
In 2023, an average of 13 heat related deaths per day occurred during July, with people who were unhoused making up the largest proportion. With hotter months on the way, Sunenshine encouraged Arizonans to check on neighbors and seniors who may live alone, make sure air conditioning systems are working and follow the county's "10 tips" to stay safe in the heat.
In addition to tracking heat-related deaths, the Department of Public Health also conducted an evaluation of cooling and respite centers that were part of Maricopa County's Heat Relief Network last year. Sunenshine said they learned valuable details - including that two-thirds of respondents didn't have a stable home, and that many people found the cooling centers only through roadside signs advertising them.
"Some of the biggest barriers to accessing cooling centers are not knowing they exist, not knowing where they're located and not having transportation," she said, "and we based all our actions this upcoming summer on the results of this cooling center evaluation."
She said they were able to establish a call center, operated by bilingual community health workers, to help connect people not only to heat-relief resources but to energy and security-assistance programs.
Arizonans can call 211 to help find transportation to the nearest heat-relief location, when they open again on May 1.
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This week, an Alabama group is drawing attention to the need for Medicaid expansion.
Currently, approximately 300,000 people are stuck in a health care coverage gap, earning too much for Medicaid but not enough for private insurance.
Debbie Smith, Cover Alabama campaign director for Alabama Arise, said they are reaching out to legislators statewide and sharing information about the stakes involved.
"About 19 of our rural hospitals are at risk of immediate closure," Smith reported. "That means they are at risk of closing in the next year. And having patients that come in that don't have health insurance coverage is not good for their bottom lines."
The Cover Alabama Coalition is engaging lawmakers through meetings in their districts and encouraging residents to share their experiences and thoughts on Medicaid expansion via social media. Although 19 rural hospitals are due for immediate closure, a report on rural hospitals from advisory firm Chartis highlighted more could be at risk in the long run. The report revealed nearly 74% of Alabama's rural hospitals are operating at a loss.
Smith sees Medicaid expansion as a life-or-death matter, which can greatly enhance the quality of life for many residents. She noted it would provide access to preventive care and vital medications, and can help people enter or remain in the workforce. She pointed out the current Medicaid threshold creates barriers for families in need.
"Let's say a single mom with two kids, she can't make more than $4,656 a year and still qualify for Medicaid unless she has a disability or is pregnant," Smith observed. "And at the other end of the perspective, they have to make at least around $25,000 to qualify for the health insurance marketplace."
She added the expansion could also benefit around 5,000 veterans who lack coverage. Currently, 41 states including District of Columbia, have already expanded Medicaid. Mississippi has also recently passed legislation in its House, it is now waiting for a Senate vote.
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On Tuesday, Care4All California, a coalition fighting for affordable health care, unveiled a package of bills its members say they would like state lawmakers to pass.
Assembly Bill 3129 would give the California Attorney General the power to accept, reject or modify health care transactions involving private equity or hedge funds.
Asm. Jim Wood, D-Healdsburg, Assembly Speaker Pro Tempore and author of the bill, said mergers often improve the corporate bottom line but lead to higher prices for patients.
"We're often led to believe these consolidations will save money, that it's good for consumers," Wood observed. "But what we're actually seeing in health care is just the opposite, and it reduces competition."
Opponents said the bill would give government officials too much power. Care4All California also endorsed bills to help the state enforce requirements around implicit bias training for women's health providers in an attempt to make sure patient complaints are taken seriously and to reduce the number of people of color who die from pregnancy complications.
Asm. Laura Friedman, D-Glendale, is behind Assembly Bill 2297, which she said aims to make sure people do not lose their homes due to medical debt.
"A loophole allows debt collectors to place liens on patients' homes to collect unpaid medical debt," Friedman pointed out. "AB 2297 closes that loophole, and prohibits liens on property when collecting medical debt from financially qualified patients."
Another bill in the package would allow a 12-month grace period to cover people who qualify for Medi-Cal but were kicked off due to an administrative issue.
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