COVID-19 treatment plans are now extensively accessible and can be accessed at quite a few pharmacies, clinics and wellbeing devices throughout the condition. These solutions can assistance stop intense disease, hospitalization and demise from COVID-19, in particular when taken early.

Not everybody who checks beneficial for COVID-19 desires to consider medicine. People who are at bigger threat for significant health issues are most likely to reward from therapy, even if they have moderate signs or symptoms. People can be large danger for several reasons. Some of the most frequent danger components are: becoming age 65 and older being overweight owning persistent medical ailments this kind of as coronary heart, lung, kidney ailment or diabetes staying on remedy that suppresses your immune method or pregnancy. To locate a comprehensive checklist of factors that may well set anyone at better threat, visit CDC: People with Sure Health care Disorders.

If you are at larger danger, get tested as shortly as achievable following currently being in get hold of with a man or woman who has COVID-19 or if you develop signs or symptoms and discuss to a health and fitness care provider ideal away. To be helpful, cure need to get started as shortly as achievable after symptoms start off or you check constructive. It is crucial for a company to overview your healthcare problems and present medicines to determine which treatment is right for you as some COVID-19 treatments might interact with some drugs.

“Early testing and treatment for COVID-19 can necessarily mean the distinction between a clinic remain and currently being equipped to get medicine at household for people who are at larger possibility for intense condition,” mentioned Dr. Ruth Lynfield, MDH condition epidemiologist and medical director. “COVID-19 remedies are now a lot more commonly readily available and acting proper absent by obtaining examined is vital simply because solutions will need to be started out early to do the job.”

To get entry to COVID-19 treatments, men and women can:


“COVID-19 therapies are a incredibly useful software in our toolbox, but protecting against an infection is additional productive than treating infection. We have the applications to avoid an infection, which stops transmission and aids to preserve degrees of COVID-19 down in our communities,” Dr. Lynfield added.

Critical instruments to retain COVID-19 stages down include things like vaccines, boosters, washing palms usually, receiving analyzed if you are sick or are uncovered to an individual with COVID-19, and staying residence when you are ill. In addition, it is important to stick to the CDC COVID-19 local community amount in your space, use very well-fitting significant-quality masks when necessary or based mostly on particular desire, and abide by other community wellbeing direction.

Dr. Lynfield mentioned that COVID-19 group amounts are currently low across the point out even so, there are still situations happening, and we do not know if circumstances could enhance all over again in the upcoming.

For a lot more information and facts on COVID-19 solutions, such as wherever to uncover treatment method locations in Minnesota, go to the MDH COVID-19 Medication Options webpage.

For extra information on COVID-19, including information and facts on vaccines and recommendations for carrying masks, go to MDH Coronavirus Disease 2019 (COVID-19). 
As additional athletes and entertainers share their tales of dealing with depression or nervousness, authorities hope this will help normalize trying to find enable for psychological health and fitness fears.
Previous month, an Ohio Point out College football player declared he would be retiring from the activity owing to psychological well being troubles and suicidal intentions.
Harry Miller, an offensive lineman, posted on Twitter that he had turned to his coaching team to share his melancholy and suicidal ideas, and they connected him with psychological wellbeing care.
“This story is a good case in point of a young individual in a place of impact, being open up about not only his psychological health issues, but the techniques he took to tackle them,” reported Jennifer Ferrand, PsyD, director of effectively-remaining for Hartford Health care. “Stories like this normalize assist-in search of and can assist youthful men and women to not really feel by itself in getting psychological wellness difficulties or suicidal ideation.”
John Santopietro, MD, Medical doctor-in-Chief, Hartford Health care Behavioral Wellness Network and Senior Vice President, Hartford Healthcare, reported he is grateful for the athletes and entertainers that are talking out and advocating for their mental well being.
“Now we have to do our career to create a process that will be there for people today,” Dr. Santopietro mentioned. “We owe it to them to make certain folks can access the treatment they need to have.”
Dr. Ferrand claimed it also is crucial to understand the mentor and OSU workers who acted promptly and compassionately to join Miller with the enable he desired.
“It’s all of our positions to glimpse out for 1 a further, and by speaking openly, displaying kindness and compassion, and sharing our personal stories we can remove the stigma related with mental health issues and support-looking for,” she stated.
Miller arrived out with his statement considerably less than two months immediately after the suicide of Stanford goalie Katie Meyer, highlighting the battle quite a few college or university college students and college student athletes are experiencing. For some college students, returning to in-man or woman lessons and social things to do can cause stress.
Miller shared in his Twitter submit that he is a large-achieving engineering scholar, and rejected the stereotype of his generation getting soft or dismissed for becoming dumb, and mentioned he hoped people would be taken more seriously when sharing mental wellbeing worries. Lots of men and women praised him for his openness and shared their possess tales or these of their young children they had shed to suicide.
Miller said he tried using to appear back to taking part in with the Buckeyes but however struggled, so he decided retiring was the ideal alternative for him to make.
If you or another person you know is in crisis, connect with the Countrywide Suicide Prevention Lifeline at 800.273.8255, textual content Household to 741741 or visit SpeakingOfSuicide.com/assets for supplemental resources.
A pop-up clinic inside of Los Angeles Intercontinental Airport provided free vaccinations and boosters for holiday break travelers final December. A new spherical of vaccinations might be wanted in advance of upcoming wintertime.
FREDERIC J. BROWN/AFP through Getty Pictures
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FREDERIC J. BROWN/AFP by using Getty Visuals
A pop-up clinic inside Los Angeles Worldwide Airport available totally free vaccinations and boosters for holiday break tourists last December. A new spherical of vaccinations may perhaps be needed right before up coming wintertime.
FREDERIC J. BROWN/AFP by using Getty Photographs
In a daylong digital conference, a panel of professionals advising the Food stuff and Drug Administration arrived out in general guidance of endeavours to create new COVID-19 vaccines tailored to variants.
The committee was not requested to vote on any particular tips to the agency but as a substitute mentioned the framework for creating selections about when to change the viral strain or strains utilised for potential vaccines, such as boosters.
“I feel we are in uncharted territory for the reason that with SARS-CoV-2 a large amount of items have happened that have never transpired before,” stated Dr. Arnold Monto, professor emeritus at the College of Michigan and acting chair of the committee.
It really is probably the panel will reconvene in May well or June to consider a far more unique proposal for reformulation of COVID-19 vaccines.
The process utilised to tweak annual flu vaccines to match circulating strains is a single model that may possibly notify the approach for COVID-19, but there are even now many unknowns about how the coronavirus may perhaps transform and stark distinctions amongst the influenza virus and SARS-CoV-2.
Drop goal for new type of booster
The crucial thing to consider is no matter whether a variant-distinct booster need to be built out there this slide. The rise of the omicron variant, and these days a subvariant known as BA.2, has sharpened the query. The vaccines now in use in the U.S. are centered on the sort of the virus that circulated at the starting of the pandemic and are much less effective from some later on strains.
“Despite the fact that we have seen a major decline in the variety of COVID-19 cases in the place, the virus proceeds to circulate and it will continue on to do so and will possibly cause waves of an enhanced quantities of cases,” said Dr. Peter Marks, head of the FDA’s Heart for Biologics Analysis and Investigation, at the start off of the assembly. “This is of notably problem as we head into the slide and winter season period.”
Marks also mentioned that the coronavirus will have had a further much more time to evolve by the time fall comes in the U.S.
In the course of the morning session, Israeli researchers presented data on the waning safety of a single booster dose of the Pfizer-BioNTech vaccine and the elevated protection of a next booster from infections, which was fleeting, and significant health issues, which was for a longer time long lasting. The rapid spread of the omicron variant contributed to the decline in security from immunization with 1 booster.
Israeli authorities accepted a second booster in early January for persons 60 and more mature and other individuals at high threat or who labored in health care. The Israeli experience contributed to the FDA’s decision in late March to authorize a second booster dose for persons 50 and older as well as for other people today with compromised immune programs.
Predicting viral evolution is ‘quite difficult’
Rapid genetic adjustments in the coronavirus are driving its ability to evade the immune response from vaccination and prior bacterial infections. The continuing changes complicate choices about which strains to contain in new vaccines.
“In normal, from every thing we’ve witnessed, we need to count on a lot of evolution heading forward, and we really should have methods to maintain up with this evolution in terms of our vaccination platforms,” stated Trevor Bedford, who studies viral evolution at the Fred Hutchinson Cancer Centre in Seattle.
He mentioned that predicting where by the virus is headed is “very challenging.” The coronavirus has been evolving have to faster than the flu. Considerable new variants of the coronavirus have emerged in just months alternatively of the years it can usually takes for the flu to make these jumps.
Based on the rate of the coronavirus’ evolution so considerably and uncertainty about what lies in advance, Bedford estimates a dangerous new variant like omicron could arise inside about a calendar year and a half or maybe not for extra than a ten years.
There is just not significantly time to make vaccine alterations in time for an immunization press this slide. “If you might be not on your way to a scientific demo by the beginning of May possibly, I imagine it really is going to be really complicated to have enough product throughout manufacturers to meet up with desire,” said Robert Johnson, deputy assistant secretary of the federal Biomedical Highly developed Study and Advancement Authority.
FDA’s Marks acknowledged that there is a compressed timetable for determining upon booster make-up, but there may well be “some wiggle space” that could allow for for a resolve in May perhaps or June.
There is certainly a whole lot using on the choice. “We basically can not be boosting people as regularly as we are,” Marks stated, adding that the 2nd booster dose authorized not long ago by Fda was “a stopgap measure” to support safeguard the most susceptible persons.
The intention for a reformulated booster someday later on this 12 months, Marks explained, would be to “improve yet again in order to safeguard from a wave that could appear at the time we are at optimum risk.”
In closing remarks, committee chair Monto explained, “We’d like to see an yearly vaccination equivalent to influenza but comprehend that the evolution of the virus will dictate how we’ll reply.”
By Taylor Knopf, NC Health News & Aneri Pattani, Kaiser Health News
DURHAM, N.C. — An addiction treatment facility, highly regarded by North Carolina lawmakers, sits in a residential neighborhood here and operates like a village in itself. Triangle Residential Options for Substance Abusers, better known as TROSA, hosts roughly 400 people a day on a campus with rows of housing units, cafeterias, a full gym and a barbershop.
The program, which began in 1994, is uniquely designed: Treatment, housing and meals are free to participants. And TROSA doesn’t bill insurance. Instead, residents work for about two years in TROSA’s many businesses, including a moving company, thrift store and lawn care service. Program leaders say the work helps residents overcome addiction and train for future jobs. Of those who graduate, 96 percent of individuals remain sober and 91 percent are employed a year later, the program’s latest report claims.
Impressed with such statistics, state lawmakers recently allotted $11 million for TROSA to expand its model to Winston-Salem. It’s the largest amount in the state budget targeted to a single treatment provider and comes on the heels of $6 million North Carolina previously provided for its expansion, as well as $3.2 million TROSA has received in state and federal funds annually for several years.
Keith Artin is the president and CEO of Triangle Residential Options for Substance Abusers, better known as TROSA. The program provides free treatment, housing and meals to residents who work for about two years in one of TROSA’s many businesses, including a moving company, thrift store and lawn care services. Photo credit: Taylor Knopf
This latest influx of taxpayer dollars — coming at a time when overdose deaths are surging and each dollar spent on treatment is crucial — is drawing criticism. Advocates, researchers, and some former employees and participants of TROSA say the program takes advantage of participants by making them work without pay and puts their lives at risk by restricting the use of certain medications for opioid use disorder. Although those who graduate may do well, only 25 percent of participants complete the program — a figure TROSA leaders confirmed.
“If I had known about this funding, I would have been the first person on the mic to [tell lawmakers], ‘I don’t think you all should do this,’” said K.C. Freeman, who interned at TROSA in 2018 and later spent two months on staff in the medical department. “You can’t look at the small number of people who had success and say this works. It’s not the majority.”
The dispute over TROSA’s funding comes amid national conversations about how to allocate billions of dollars available after landmark opioid settlements with drug companies. Two flashpoints in the North Carolina debate may provide a window into heated conversations to come. First: Are work-based rehabs legal or ethical? And second: Should every facility that receives public funding allow participants to use all medications for opioid use disorder?
Work as treatment
Work-based rehabs are widespread across the country. The investigative news outlet Reveal identified at least 300 such facilities, including some that place participants in dangerous jobs at oil refineries or dairy farms with no training and exploit workers to bolster profits.
Many of these programs use a portion of their revenue to sustain the rehab and offer residents free housing or meals. That can make them attractive to state legislators, said Noah Zatz, a UCLA law professor who specializes in employment and labor law.
“Because essentially they’re running businesses off of people’s uncompensated labor, there is a built-in funding mechanism,” he said. “If the state doesn’t have to pay full freight to run a program … that might be a reason to like it.”
TROSA’s annual reports indicate more than half of its multimillion-dollar budget is funded through its businesses at which residents work, as well as goods and services that are donated to the program. About 30 percent of its funding comes from government grants and contracts.
Although TROSA and its leaders report no significant campaign donations, they spend upward of $75,000 a year on lobbying. In presentations, they often share a 2017 study — conducted by an independent research institute at TROSA’s request — which found TROSA saves the state nearly $7.5 million annually in criminal justice and emergency care costs.
The program’s self-financing aspect is part of its appeal for North Carolina Sen. Joyce Krawiec, a Republican who represents part of Forsyth County, where TROSA is building its new site.
“The good thing about TROSA: They raised most of their own funds,” she said in a phone interview.
Benjamin Weston decided to enter TROSA at 22 years old after struggling with addiction for years. He worked in TROSA’s development office soliciting donations from local businesses after stints in the project’s thrift store and moving company. Photo credit: Aneri Pattani/KHN
It’s reasonable that residents don’t get paid for their work, she added, since they’re already receiving free treatment and housing. Other rehabs can be prohibitively expensive for many families, so TROSA provides a much-needed option.
But being a bargain doesn’t necessarily make it legal, Zatz and other labor experts said. A previous U.S. Supreme Court ruling suggests nonprofits that run businesses without paying employees could violate the Fair Labor Standards Act.
But TROSA administrators say they are not an employer; they are a therapeutic community. Clear policies guard against the exploitation of anyone, said Keith Artin, president and CEO. The jobs provide residents with structure and an opportunity to change their behaviors.
“The work-based element is essential to recovery,” Artin said. “We’re teaching people how to live.”
Toward the end of residents’ two-year stays, TROSA assists them in job-hunting and allows them to live on campus for several months while they work at a newfound job and build savings.
Diverging work experiences
TROSA’s model has widespread support among lawmakers and families affected by addiction. Benjamin Weston said it was “a blessing.”
Weston said he started using cocaine as a teenager and struggled with addiction for years. At 22, he entered TROSA. He said he was grateful for two years of free treatment.
After brief assignments in TROSA’s thrift store and moving company, Weston transitioned to the development office, where he solicited donations from local businesses. “It was meaningful work that also taught me a lot of good job skills,” he said.
Since graduating in 2016, Weston has worked in development for Hope Connection International, a nonprofit his mother started to support survivors of abuse and addiction.
Other graduates interviewed for this article talked about using the moving skills or commercial driving licenses they gained to obtain full-time jobs. Some said they’re buying houses and starting families — successes they credit to their experience in the program.
But not every resident finds the work model therapeutic. Several described working 10 to 16 hours a day, six days a week, in physically demanding moving or lawn care businesses. Several said there was little time for therapy and, with only a handful of counselors for hundreds of residents, wait times for a session could span weeks.
Richard Osborne (right) with his girlfriend, Britney Robbins (left) and their son. Osborne said he was injured while working with TROSA’s moving company in 2017. He said nobody suggested he get medical care and that he was told to go back to work the next day. “They’re taking advantage of people at their low points in life,” he says. Photo courtesy of Britney Robbins
Freeman, the former TROSA employee who has a master’s in social work, said he thought residents rarely had an opportunity to process the trauma that made them use drugs in the first place. Although Freeman did not counsel clients — his role at TROSA focused on ordering and stocking medications — he said he noticed many graduates returned repeatedly to the program, struggling to stay away from substances once they left campus.
Richard Osborne first heard of TROSA while incarcerated on drug and theft-related charges. Like 38 percent of TROSA residents, he chose to attend the program as a condition of his probation.
One day in 2017, Osborne and other residents working with the moving company were unloading large boards of plywood from a trailer, when a board fell and smashed him against the trailer, he said. His vision became blurry and he worried about having a concussion, he said.
As he remembers it, no one suggested medical care. “The next day, they told me I had to get back to work,” he claimed.
That’s when Osborne said he decided to leave.
Today, Osborne, 31, said he has not used drugs in about four years, holds a steady job, and has a loving family. But it’s no thanks to TROSA, he said.
“They’re taking advantage of people at their low points in life,” he said. The moving company brings in $4 million a year, yet residents who work for it are not even allowed to keep tips, he added.
TROSA leaders confirmed the tips policy but said they could not comment on an individual residents’ experience. In general, CEO Artin wrote in an email, “when a resident is injured we ensure that they receive immediate medical attention and would never knowingly put a resident at risk.”
As a nonprofit, TROSA funnels revenue from its businesses back into the treatment program, he added.
The program’s 2020 tax documents show its top five employees combined earned over $750,000 in salary and benefits.
Medication hesitancy
TROSA provides psychiatric care through a contract with Duke Health and offers group or individual counseling to residents who request it. The program employs four full-time counselors and partners with local providers who donate physical therapy, dental care, and other medical services.
But TROSA does not provide access to some of the most effective treatments for opioid use disorder: methadone and buprenorphine. Both medications activate opioid receptors in the brain and reduce opioid withdrawal and cravings. It’s been well documented that these medications greatly reduce the risk of opioid overdose death, and the FDA-approved drugs are considered the “gold standard” for treatment.
Right now, TROSA leaders say the only medication for opioid use disorder the program offers is naltrexone, an injectable medication that works differently than the other two because it requires patients to fully detox to be effective. Because of this, some experts are hesitant to use it, saying it puts people at higher risk of overdose death.
About one-third of TROSA participants report opioids are their primary drug of choice.
TROSA leaders said they’ve discussed adding the other addiction treatment medications but face logistical barriers. All medications at TROSA are self-administered, and leaders worry about diversion of oral methadone and buprenorphine, which are classified as controlled substances. They say they’d consider injectable buprenorphine, but it’s costly for their mostly uninsured participants.
“People choose to come here because it is a behavior modification program,” said Lisa Finlay, lead clinical counselor at TROSA. “They know that we don’t offer buprenorphine or those medications. We have people who have tried those medications in the past and believe that they actually led them back to using.”
Evidence suggests that people using medications for opioid use disorder have the best outcomes when they have access to other recovery support services, such as housing, employment, counseling and a community. But while clinicians across the country have embraced these medications, leaders of residential treatment programs founded in the more traditional 12-step, abstinence-based recovery model have pushed back.
Some old-school recovery leaders claim the use of medications is simply replacing one drug with another, which has created stigma around this form of treatment.
A 2020 study found that about 40 percent of residential programs surveyed in the U.S. didn’t offer opioid use disorder medications and 20 percent actively discouraged people from using them. In North Carolina, there are 62 licensed long-term residential treatment facilities, according to the SAMHSA treatment locator, and fewer than half accept patients who take these medications. Only 12 facilities are licensed to prescribe buprenorphine.
This has resulted in tough conversations with patients for Kate Roberts, a clinical social worker on a UNC Health team that treats people with severe IV drug-related infections. Once patients are stabilized, many start buprenorphine, she said. Some say they want to go to a residential program for structure, job training and to learn coping skills. Roberts recalled one patient saying to her: “I need to go to residential treatment and I need this medication because I fear I’ll die.”
“That’s really heartbreaking to hear a patient clearly articulate what it is that they need … which is in line with the [research] literature,” she said. “And that you know there are very few places in the state that offer that.”
Doctors and public health experts nationwide are pushing for lawmakers to fund rehab facilities that allow these medications, saying they’re the best way to combat the opioid crisis.
Some medical and legal experts have said it’s in violation of the Americans with Disabilities Act to deny recovery services such as housing to people using medications for opioid use disorder. Health experts say that funding abstinence-based addiction programs could also inadvertently cause more overdoses if people leave the program and return to using drugs with a much lower tolerance, especially as fentanyl is rampant in the street drug supply.
These conversations will become only more important as opioid settlement funds arrive, said Bradley Stein, director of the national Rand Opioid Policy Center.
“The goal isn’t just to get people into treatment; it’s to get people doing better,” he said. “You want to make sure that you’re using the money effectively.”
The conversations have begun in North Carolina. When Rep. Graig Meyer (D-Durham) tweeted his support for TROSA late last year, clinicians reached out to him explaining their concerns about the program not allowing participants to use methadone or buprenorphine.
Although Meyer still believes it’s an effective program, he said, “I also have concerns from what I learned about TROSA’s approach to treating opioid addiction in particular. I’d like to see TROSA consider what their current practices are.”
North Carolina Health News is an independent, nonpartisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs atKFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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by Taylor Knopf, North Carolina Health News April 6, 2022
Three years ago, Lauren Bryant was walking across Appalachian State University’s campus with several other Black students when they were verbally assaulted with a racist tirade.
“This guy in a pickup truck stopped at the light, rolled down his window, and just started calling us a bunch of N-words,” she recalled.
It wasn’t the only time Bryant has had an experience like this at the overwhelmingly white campus in Boone, a town in one of North Carolina’s most conservative regions. Whether it’s the ubiquity of Confederate flags, Ku Klux Klan members handing out literature, or a parade of pickup trucks flying flags in support of President Donald Trump, she believes they’re all intended to signal that students of color are unwelcome there.
College campuses are a microcosm of racial strife happening across the nation. From 2018 to 2021, the Southern Poverty Law Center identified 1,341 incidents of white supremacist pamphleteering on college campuses. The Anti-Defamation League recorded around 630 incidents of white supremacist propaganda being distributed on campuses in 2019.
Black students at predominantly white institutions report everything from instances of thinly veiled racism, homophobia, and sexism to outright racial hostility and intimidation.
Experiencing such incidents has consequences that go well beyond feeling uncomfortable. A growing body of research has documented the detrimental health effects of both interpersonal and structural racism. The Centers for Disease Control and Prevention notes that centuries of racism have had a profound and negative impact on the mental and physical health of people of color. The American Public Health Association calls racism a barrier to health equity and a social determinant of health akin to housing, education, and employment.
Racist incidents can take a toll on students’ overall health and well-being, undermine their self-confidence, and affect academic performance, said Dr. Annelle Primm, senior medical director for the Steve Fund, a nonprofit focused on supporting the mental health of young people of color.
“These kinds of feelings go hand in hand with students at predominantly white institutions, where they may feel isolated or like they don’t belong,” she said. “The experiences are associated with issues such as depression, anxiety, and difficulty concentrating or sleeping.”
A UCLA study published in the journal Pediatrics in 2021 shows that the problems aren’t necessarily transitory. Young adults who experience discrimination are at higher risk for both short- and long-term behavioral and mental health problems that are exacerbated with each new incident.
For a variety of reasons, students of color are not getting the kind and amount of help they need. A recent University of North Carolina-Chapel Hill study of first-year college students found that Black students had the highest increase in rates of depression. However, a study in the Journal of Adolescent Health found that treatment use is lower among students of color relative to white students, even when controlling for other variables. This is consistent with a 2020 report from the Steve Fund that said students of color are less likely than their white peers to seek mental health treatment even though white and Black students experience mental health issues at the same rate.
College campuses are having trouble recruiting enough therapists to meet the mental health needs of students overall. And few predominantly white colleges employ counselors and mental health professionals who are representative of the racial, ethnic, and cultural diversity of the students.
This can be problematic for patients of color in any setting who doubt white counselors can provide culturally competent care, which acknowledges a patient’s heritage, beliefs, and values.
When Daisha Williams spoke to a white counselor outside of campus about being alienated from her mother’s side of the family for being biracial, her pain was trivialized: “She was, like, ‘Sorry that happened. That sucks. They really missed out.’ And that was it.”
But even a Black counselor may not be enough to overcome reluctance. In a joint survey conducted by the Steve Fund and the United Negro College Fund, 45{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of students at historically Black colleges and universities said they would not speak to a mental health professional if they were in crisis.
Primm said a student’s background and belief system may be a factor. “They may have been raised to ‘put it in God’s hands’ or may be told that they could overcome these feelings if they prayed hard enough,” Primm said. “Certainly, prayer and religious activity are important and helpful for mental health, but sometimes you may need some additional support.”
Black students account for nearly 4{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the more than 18,000 undergraduates at Appalachian State, and Black residents make up fewer than 3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of Boone’s population. Bryant, the programming chair for the university’s Black Student Association, believes that having a university with so few Black people— in a town where Black residents are even scarcer — emboldens those who commit racist acts.
Bryant was well aware of the demographics of the school and the region before she arrived. But during a campus tour, university representatives assured prospective students that they valued diversity and would ensure that Black and other students of color felt as if they belonged.
“We were under the impression that they would make sure we are supported, but the reality of how things really are changed that dynamic,” she said. “We did not expect the amount of fight we’d have to contribute towards things that might affect our education.”
And sometimes the racism the students face is more subtle than hurled epithets but still deeply unsettling. In 2017, Williams said, she eagerly anticipated discussing Ta-Nehisi Coates’ essay “The Case for Reparations” in one of her Appalachian State classes, but the conversation soon became upsetting. A white student asserted that any residual economic or social inequality resulted from Black people’s lack of initiative, not the nation’s failure to atone for historical wrongs.
“He kept saying extremely offensive things like ‘They should just work harder’ or ‘They should try to better their lives and educate themselves,’” Williams recalled. “At one point, he made some comment about lynching. Once he said that, I just got up and left.”
Williams was especially disturbed by what she saw as the professor’s encouragement. “Rather than saying, ‘You’re making the students of color feel unsafe and unwelcome,’ she kept saying, ‘Elaborate on that.’”
Although institutions cannot control or eliminate these occurrences, they bear responsibility for how they respond. When asked about what happened to Williams and Bryant, Appalachian State Associate Vice Chancellor Megan Hayes called the incidents “abhorrent” and said the university “is committed to fostering an inclusive, safe and supportive environment for all students, faculty, and staff.”
Still, such incidents continue to happen nationwide. A white Georgia Southern University student gave a class presentation on white replacement theory, which has been linked to white supremacist ideology. When Black students complained, the university defended the presentation as free speech.
At Rhodes College in Memphis, Tennessee, pro-Nazi postings were directed at Black students and a banana was taped to the dorm room door of two Black male students. At Northern Illinois University, the N-word was spray-painted on the Center for Black Studies building. A student at the State University of New York’s College of Environmental Science and Forestry posted a video showing two men firing guns at a tree as one yells, “This is what we do to n——.”
In the wake of George Floyd’s murder in 2020, Appalachian State student organizations spoke out and led protests against what they deemed as the oppression and trauma that Black and other students of color routinely encountered. Marches through campus, into downtown Boone, and to the Watauga County courthouse drew condemnation and threats of arrests.
But the backlash and vitriol often directed at students who engage in social justice activism can take its own mental health toll. The work is often all-consuming. “It gets challenging,” Bryant said. “We shouldn’t have to advocate against things that should never have happened in the first place.”
Ebony McGee, an associate professor of diversity and STEM education at Vanderbilt University in Nashville, Tennessee, cautions students to jealously guard their emotional well-being.
“The best way students can protect their mental health is realize that they can’t change the system,” McGee said. “The best way you can support racial activism is to get your degree, because then you’ll have greater power and a greater voice within your community.”
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by Kaiser Health News, North Carolina Health News April 5, 2022
Before the pandemic, Valerie Fox almost never used telehealth — nobody did at the Veterans Affairs Medical Center in Durham, where she works as a behavioral health occupational therapist.
Now, many patients request it.
“Especially with the VA, a lot of people come from a lot of different parts of the state to here,” Fox said. “When we go to transition to outpatient work, it’s a lot easier.” With telehealth, people can more easily incorporate OT into their daily schedules — an hour here, an hour there.
“It doesn’t become this big thing,” she said.
But that’ll likely be changing soon. By July 1, North Carolina Medicaid will no longer cover occupational and physical therapy services done via telehealth — and getting to and from appointments will become, yet again, a big thing. The change was supposed to take place March 31, but the state extended coverage for 90 more days.
Kimberly Godwin, the advocacy chair at the state’s occupational therapy association, has been getting a lot of emails over the last few months from therapists such as Fox telling her how telehealth has helped them serve more clients.
“We’ve heard from a lot of businesses within the pediatric as well as other outpatient settings or specialized care, like mobility clinics, that have been able to just really broadly reach clients,” she said. “There’s been less cancellations, less no shows.”
Many providers have noted how telehealth increased access for people who can’t afford transportation to and from a clinic, or those who don’t have any transportation to begin with.
Even the state’s Medicaid program sounds supportive of keeping telehealth for physical and occupational therapy.
Data from the North Carolina Department of Health and Human Services shows that claims from people on Medicaid for telehealth services hit their height at the start of the pandemic, and have declined since. Credit: NCDHHS.
“Over the past two years, telehealth flexibilities helped children and families access valuable PT/OT services during the unprecedented circumstances of the COVID-19 pandemic,” said state health department spokesperson Catie Armstrong.
But she said that right now, the federal Centers for Medicare & Medicaid Services is not allowing any permanent changes to telehealth services. During the first few months of the public health emergency, the state recorded nearly 60,000 telehealth claims from people on Medicaid. In the months since, that number has declined.
That means, even if it wanted to, North Carolina doesn’t have the authority to permanently authorize the state Medicaid program to cover virtual OT and PT services. The coverage rollback has left many who work in the field worried about the impact it will have on people across the state, especially those in rural areas.
Unique role telehealth plays in OT and PT
Since the start of the pandemic, researchers at Duke University have been investigating the role telehealth plays in expanding access to care in general. One study is examining the impact virtual care has had for people receiving OT and PT.
Katherine Norman, a pediatric occupational therapist, is one of the investigators on the study.
“The population we looked at was children and adolescents, so that was anybody from zero to 20, enrolled in Medicaid from April 2020 to March 2021,” she said. The researchers analyzed the Medicaid claims data of about 137,000 children with a musculoskeletal health diagnosis who visited a provider during the time period.
“The data that we uncovered really suggests that removing access via telehealth could impact as many as one in five kids who were using physical therapy and one in three kids who are using occupational therapy,” Norman said. To add a qualitative dimension to their study, the researchers are also speaking with people on Medicaid, health care providers, and community leaders statewide.
Physical and occupational therapy can be critical for helping kids meet developmental milestones. PT can help children learn how to do critical physical tasks with more ease: walk and run, get on and off the floor, and play, while OT helps kids with the development of fine motor skills, such as brushing their teeth or holding a comb.
Imagining all those kids missing out on this kind of care deeply worries Norman.
Also, she says, telehealth holds a unique value within occupational therapy because of the nature of the care. If she’s seeing a patient, rather than just telling her about the stairs they have trouble climbing, or the corner they want to be able to stand behind to surprise their sibling, they can literally bring her into the room.
“They can show me exactly how they do it,” she said, “so that I can see that and be like, ‘OK, so we need to work on your ability to crouch, or your ability to jump, or [whatever] specific movement pattern.’”
Fox agrees.
In OT, “We think a lot about the environment, and how that impacts function and somebody’s ability to participate,” she said. “When it comes to having somebody leave their natural environment to come to an outpatient clinic, you have to ask a lot of questions: What does your home look like? And how do you move through your home? And what is the environment?
“Telehealth allows you to truly see that in the moment and kind of be there with someone and I think that’s another layer, in addition to accessibility.”
Also, Fox says, it doesn’t have to be all or nothing. In a perfect world, care going forward could be a blend of telehealth and in-person care.
“I just had that with a veteran,” she said. “He’s 75. He lives about an hour and a half away. So the first visit was that we do a lot of assessments, and now that we kind of know each other and I have more of an idea of his level of function, the next few sessions could be telehealth.”
“What is the harm in keeping it as an option?”
Fox, who in addition to her full-time job at the VA is also the president of the North Carolina Occupational Therapy Association, said she was unaware of any outreach the state health department had done to ask occupational and physical therapists how virtual coverage was going for them and if they’d want it to continue going forward.
“This came to our attention when we were informed of the date of the sunset,” Fox said. Medicaid refers to the end of coverage for certain services as ‘sunsetting.’
“So, we did not realize that this was coming, and definitely not that it was coming as fast as it was,” she said. “We’ve been told that they did not have the data showing that the telehealth modality was utilized enough. We are unclear on what type of data that was, or how it was collected or what their cutoff is for ‘enough,’ but that was what we’ve been told so far.”
Spokespeople from DHHS did not directly answer the question of if they conducted outreach to providers, but said that they have qualitative data from families showing support for telehealth. Still, they said, the data the department has collected and analyzed “did not demonstrate the use of these services.”
In a public webinar presentation on March 17, the associate director of program evaluations at North Carolina Medicaid, Sam Thompson, presented the data collected by Norman and the other Duke researchers, but came to a different conclusion than the researchers.
“As a proportion of care, telehealth is just substantially lower in this group,” he said. “Because it’s such a small proportion of care, it’s a little bit less meaningful”
But, Fox argues, even if utilization rates were low, if anyone used it, it’s worth keeping.
“It’s about access,” she said. “And so if five people throughout the year use it, what is the harm in keeping it as an option?”
Data collected by researchers at Duke University that NC Medicaid officials presented at the end of March. Though Thompson said utilization of these services was proportionally small, NCDHHS extended temporary Medicaid coverage of tele-OT and tele-PT services after the presentation. Credit: NCDHHS; Duke University.
The state Medicaid office did worry at first that adding telehealth as an option would increase costs, but that’s not what they’ve seen.
“We have not found it to be significantly more expensive,” Thompson said. “We have some evidence to suggest that it can help prevent complicating factors that might be more expensive.”
It’s unclear if private insurance plans will continue to cover tele-OT and PT or sunset their coverage as well. But historically, Godwin said, private insurance plans often follow what Medicaid does, meaning there’s a good chance that if telehealth for OT and PT is made permanent by the federally funded health care program, other insurance plans may follow.
While the state Medicaid office is limited in its ability to make permanent changes to its telehealth coverage policy, providers spoken to for this story want to encourage officials to do everything they can to make sure the coverage remains permanent.
If it goes away, they argue, fewer people will get the care they need.
“And that makes me really sad,” Godwin said.
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Finally, at the bottom of the story (whether web or print), please include the text:
North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org. (on the web, this can be hyperlinked)
by Clarissa Donnelly-DeRoven, North Carolina Health News April 4, 2022
