Health Is Vital

Health is taken for granted, until you can't any more. In this blog I hope to put down on paper some of the articles I come across and want to remember, about health. I will be personalizing these articles to apply to me. I am diabetic, over weight, have high blood pressure and tinnitus, so these are the things you will find here. I will include nutrition, exercise, and holistic health, and many other ideas. I work in the health profession, particularly mental health, and have an interest in suicide prevention; so these topics will also be covered in this blog. Please, if you are suffering reach out. Our county health and crisis line is 1-855-278-4204.

Saturday, April 22, 2017

Diabetic Podiatry Appointment for Fat Feet

I visited the podiatrist last week.  I have very fat feet, as well as diabetes.  I had a blister under a toe, and the podiatrist informed me it was likely because of my shoes.  I walk quite a bit every day with commuting.  She suggested New Balance shoes because they have side sizes.  Honestly, I usually have to buy shoes too big to get them on my wide feet.  I did go to Big Five and get a pair of New Balance, and after wearing them in they are a much better walking shoe than my Vans.  The other bit of advice was to trim my nails shorter.

Friday, April 7, 2017

Article Review: Facing Up to Sexual Violence

facing Up to Sexual Violence, unattributed, Utah State Magazine, Spring 1027.
This article in the Utah State Magazine talks about the major issue on campuses nation wide of sexual assault incidents, and the efforts of universities to deal with this crisis.  Over 300 universities across the nation are under investigation by The Department of Education Office of Civil Rights as a result.  Utah State has also has its problems.  This article deals with what is happening now to address the issue.  One of the issues is how to address the problem while allowing for confidential reporting.  Utah State has initiated two campaigns, "Consent Is" and "I Will".  As part of the4 "I Will" campaign 4000 students have pledged to do whatever they can to stop sexual violence, and create an environment that is survivors are supported.  It is estimated third parties help prevent over one million acts of sexual violence annually.  This effort wants to get people past being bystanders to stepping in when a crime is taking place.  First the individual must recognize that a crime is taking place.  They must agree that sexual crimes are intolerable.   The pledge is, "I will step in and stop sexual assault."
The "Consent Is" campaign is an educational program to make sure individuals have consent before engaging in sexual activity.  You cannot get consent when the partner is wasted, high or incapacitated.  Consent should be verbal.  Consent can by withdrawn, Consent is mutual.
Recommendations, or things being put into place are, a centralized oversight, educating about reporting options, ensure staff comply with reporting obligations, improve record keeping, improve relations with law enforcement, continually reevaluate.

Monday, April 3, 2017

The Ambulance Down in the Valley (Prevention)

I think this is the social worker in me that likes this poem.  I came across it while participating with a community group looking at teen pregnancy in Roosevelt, Utah.
A Fence or an Ambulance
[A poetic case for the value of prevention]
'Twas a dangerous cliff, as they freely confessed,
Though to walk near its crest was so pleasant;
But over its terrible edge there had slipped
A duke and full many a peasant.
So the people said something would have to be done,
But their projects did not at all tally;
Some said, "Put a fence 'round the edge of the cliff,"
Some, "An ambulance down in the valley."
But the cry for the ambulance carried the day,
For it spread through the neighboring city;
A fence may be useful or not, it is true,
But each heart became full of pity
For those who slipped over the dangerous cliff;
And the dwellers in highway and alley
Gave pounds and gave pence, not to put up a fence,
But an ambulance down in the valley.
"For the cliff is all right, if you're careful," they said,
"And, if folks even slip and are dropping,
It isn't the slipping that hurts them so much
As the shock down below when they're stopping."
So day after day, as these mishaps occurred,
Quick forth would those rescuers sally
To pick up the victims who fell off the cliff,
With their ambulance down in the valley.
Then an old sage remarked: "It's a marvel to me
That people give far more attention
To repairing results than to stopping the cause,
When they'd much better aim at prevention.
Let us stop at its source all this mischief," cried he,
"Come, neighbors and friends, let us rally;
If the cliff we will fence, we might almost dispense
With the ambulance down in the valley."
"Oh he's a fanatic," the others rejoined,
"Dispense with the ambulance? Never!
He'd dispense with all charities, too, if he could;
No! No! We'll support them forever.
Aren't we picking up folks just as fast as they fall?
And shall this man dictate to us? Shall he?
Why should people of sense stop to put up a fence,
While the ambulance works in the valley?"
But the sensible few, who are practical too,
Will not bear with such nonsense much longer;
They believe that prevention is better than cure,
And their party will soon be the stronger.
Encourage them then, with your purse, voice, and pen,
And while other philanthropists dally,
They will scorn all pretense, and put up a stout fence
On the cliff that hangs over the valley.
Better guide well the young than reclaim them when old,
For the voice of true wisdom is calling.
"To rescue the fallen is good, but 'tis best
To prevent other people from falling."
Better close up the source of temptation and crime
Than deliver from dungeon or galley;
Better put a strong fence 'round the top of the cliff
Than an ambulance down in the valley.
-- Joseph Malins (1895)

Sunday, April 2, 2017

April: Alcohol Awareness Month

This is an article from Infomail for valley Medical Center
Alcohol Awareness Month
The Santa Clara County Behavioral Health Prevention Division wants you to know the April is Alcohol Awareness Month.  Did you know that drinking too much alcohol increases people's risk of injury, violence, drowning, liver disease, some types of cancer, and causes an all-told 100,000 alcohol related deaths every year?  the good news?  We can all do our part to prevent alcohol abuse and take action to prevent it, both at home and in the community.  For more information about Alcohol Awareness Month visit
Below are a few ideas on how to prevent alcohol abuse:
Be careful using alcohol as a reward to deal with life pressures, find other ways to handle stress and unwind
Encourage friends and family members to make small changes, like keeping track of their drinking and setting limits
Choose a day or two each week when you will not drink.
Limit the amount of alcohol you keep in your home
Don't drink when you are upset
Make a list of reasons now to drink excessively
Talk with underage children in the home about the risks of alcohol
Keep a well-balanced life

Friday, March 31, 2017

Pamphlet Notes: Obsessive Compulsive Disorder

This is a pamphlet from National Institute of Mental Health.
Obsessive Compulsive Disorder is when someone has to recheck and recheck things.  Not the once or twice which is normal, but over and over.  It can include ritualistic behavior as well.  Thoughts and actions associated with OCD get in the way of daily life and cause distress.
Signs and symptoms to look for:
Repeated thoughts about things, such as fear of germs, intruders etc.
Do the same rituals over and over.
Can't control unwanted thoughts.
Don't get pleasure form the rituals, but momentary relief.
Spend at leas one hour per day on the thoughts and rituals.
The cause of OCD is still not known however there is a genetic component.
OCD responds to both psychotherapy and medication.  A preferred psychotherapy is cognitive behavioral therapy.  CBT teaches someone how to control their thoughts.  Antidepressants also are helpful when taking under a doctor's direction,
Lastly combined psychotherapy and medication are also useful.

Article Notes: A Parent's Guide to ADHD

This article points out that most children have some problem with attention from time to time.  However in cases of ADHD this problem is an ongoing issues.  However kids with ADHD can focus very well when the topic interests them, they have great energy and can be very creative.  There are three types of ADHD, Hyperactive, Inattentive and Mixed.  Although we need to avoid overgeneralization, boys more generally have hyperactive, which is noticed and diagnosed earlier.  Girls for the most part have Inattentive type, which is not noticed until later, and study habits are more important.  Mixed is when a child has characteristics of both types.  Medication treatment are two types, stimulant, which is short acting, and non stimulant which last longer.  Non medication strategies can also help.  Incorporating exercise into the child's day, keeping homework sessions short or breaking up homework, using a timer, trying to do so much homework in an allotted amount of time, staying positive, goal setting, letting kids practice working independently.
Article was written by Sarah R. Cheyette MD and published in Bay Area Parent.

Tuesday, March 28, 2017

Pamphlet Review: Depression

This is a pamphlet from the National Institute of Mental Health.  It is a pamphlet for lay people, how to determine if they have depression and whether to get help.  Signs of depression include feeling sad; feeling hopeless, anxious or guilt; loss of interest in favorite activities; feeling tired; not being able to concentrate; overeating or not wanting to eat; thoughts of suicide or attempts; aches, pains cramps, digestive issues.
Some of depression is genetically caused, but it also has an environmental component.  Sometimes genes play a role in resilience, and ability to recover from hardship.  Depression either causes, or is caused by subtle changes in the brain.
The first step for treatment of depression is to visit a doctor or mental health worker.  Depression can respond to medications, psychotherapy or both.
For those in Santa Clara County on MediCal, the number to call for assistance is 1-800-704-0900

Sunday, March 26, 2017

Training: Confidentiality and Ethical Issues in Treatment

Attending this training in February.  It was mandatory.  This training presented the requirements of confidentiality with regards to HIPAA but also 42 CFR, which sets standards for confidentiality with regards to substance abuse issues, and are much more strict generally than HIPAA.  Where our department (mental health) is now integrated with the substance abuse services, this was an important training.  We no longer call ourselves mental health, but behavioral health.  This training helps understand why people working in the substance abuse field sometimes respond the way they do, which can be very frustrating.  The statement is "I can neither confirm or deny ..."  sometime it gets in the way of screening an individual for services, but that is the way it is and there is a reason for the laws.

Saturday, March 11, 2017

The Thin Commandments were presented on KSFO the other morning by Dr. Mark Freed and I was impressed.  I would like to lose weight without trying.

Tuesday, March 7, 2017

**Watch Your Step

Surviving Suicide

Surviving suicide when you are young is important, because there is still a whole life ahead of you.  Who knows what tomorrow will bring.  Interesting how she felt suicide was the only option.

Living with Depression

This is a story of depression presented on the Mormon Channel.  Depression has two components, physical and emotional.  Often times, without first treated the physical causes of depression, it is very difficult for someone to make the needed changes to tackle the other issues.  However, talk therapy is known to help with depression.

Saturday, March 4, 2017

Documentary Review: Paper Tigers: Trauma

It been some time since I watched this, but I meant to write about it.  Paper Tigers is a movie about Lincoln High School in Walla Walla, Washington.  This is the school for those who are not making it in regular school, either due to legal or behavioral or emotional issues.
The basic philosophy of the film are that children have been subjected to complex trauma.  toxic stress or trauma can threaten brain development.  This can harm health, lead to erratic behavior.  The behavior is not the kid, but a symptom of what is going on in their life.  You have to unconditionally love them, and believe that their behavior might be out of their control.
Sant Clara County has used this movie as an introduction to their efforts to take on trauma and make a difference in the lives of others.  I must admit, as I watched I was amazed at some of the worker the teachers and counsellors were doing.  How could they stay focus and not become reactive to some of the stuff the kids were dong.
The new ad campaign for VMC

Fellow Employees:

As many of us know from the direct experience of our family, friends, and loved ones, the Santa Clara Valley Medical Center plays a pivotal role in the health and wellbeing of the entire county community.  Over 8000 of our fellow county employees are delivering outstanding patient care day in and day out, in addition to leading-edge research and medical innovation, with centers of excellence in burn treatment, diabetes, trauma, rehabilitation, childrens and womens health.  Its one of the many shining examples of what makes those who live and work in Santa Clara County proud.

For the first time in its 140-year history, the Santa Clara Valley Medical Center is launching an advertising campaign to raise awareness of the fact that our public healthcare system is providing the highest levels of medical care to all segments of our county community.  Our campaign messages will be promoted in commercials, radio, transit shelters, billboards, cinemas, the San Jose Airport, on VTA buses, print ads, and the Internet (you can view the TV ad here).  As youll see, the campaign features a provocative "go public" theme, which conveys our public foundation while illuminating themes familiar to many who live here in the Silicon Valley. 

In a very real sense, Go Public applies to us all in whatever capacity we serve on the County of Santa Clara team.   We will be doing more to promote all that we do as we move forward, proudly conveying, as the Santa Clara Valley Medical Center has just done, the value we provide to our community.  

Jeffrey V. Smith M.D., J.D.
County Executive

Monday, February 27, 2017

Visualization and Weight

Does it help to visualize yourself skinnier.  I have been writing over and over my target weight for the year.  If I write the weight enough, will my body naturally force me to do the things I need to do to get to that weight.  That is my hope.  It may take more than that, but at least it is a start.  I notice there is a book on this topic, called the Gabriel Method.

Sunday, February 26, 2017

Veritas School Emergency Response Steps

I am glad someone thinks about these things ahead of time.  When the recent happenings it might be a good time to come up with family emergency plans, where to meet, who to call, whether you can post something on line?

Friday, February 24, 2017

Risk of Static Shock and your Car

This warning advises doing two things, releasing static electricity before fueling by touching your hand against a metal surface.  Second it strongly suggests not reentering the car after you start fueling.  I am very good at the second, not so good at the first.  I am not sure how frequent this problem is; but it must happen.  Even one accident, if it involves yourself is too many.

Thursday, February 16, 2017

No smoking, No E-Cigarrettes

I have never seen a sign like this before.  This is at Mental Health Urgent Care courtyard.

Sunday, February 12, 2017

Pamphlet: How to Eat Healthy

This pamphlet from Krames Fast Guides promotes the My Plate method of eating.  This is the current dietary standard promoted by the government.

Other ideas I gleaned for healthy eating, Drink water throughout the day, don't skip breakfast, wait 10 to 15 minutes before reaching for seconds, you don't have to clean your plate, reduce salt, lower your sugars, decrease calorie intake while increasing exercise for weight loss.  store food properly and check the labels.  Leftovers should be in the fridge within two hours after the meal.  Check expiration dates.  Avoid dented or rusted jars and cans.  Wash lots while cooking to avoid cross contamination.

Saturday, February 11, 2017

**Motivational Book: Skill With People

This is an interesting booklet by Les Giblin which I have from my Amway days.  It talks about how to be good a selling, but the principles can apply to many other situations.  It is written by Les Giblin.  He points out that people would rather talk about themselves than about anything else.  The focus of interactions should be on what the other person has to say.  It talks about the need to praise, but it must be sincere and it should focus on the act and not the person.  In like fashion criticism should be made in privacy, should start with a compliment, should be impersonal (focus on the act not the person), should supply the answer (the right way to do it), ask for cooperation, criticize each offense only once, and finish on a friendly note.  In dealing with people a grateful attitude is also essential.  Mean it when you say thank you, and say it clearly and distinctly, thank people by name, and look them in the eye when you thank them.  This little pamphlet is a good thing to consult frequently to keep you brain in the right place in working with others.

Sunday, February 5, 2017

Train Safety from VTA LIghtrail

I am always preaching train safety.  It is a big enough problem in Argentina that a common good bye was "Que no te pise un tren"  "Don't let a train run over you."  SO this is good advise.

Living Well with Diabetes

Living Well with Diabetes, Krames fast Guides, Krames staywell 2000.
This pamphlet hits on the basic important health considerations for someone with diabetes.  As always, I like to add my personal observations.
Monitoring Blood Sugar: TO take control of your blood sugar, you have to know what is going on.  Daily monitoring with a monitor is important.  Also long range monitoring is important with the use of the A1C lab teat.
Treating Highs and Lows:  You have to monitor to know if you are having a high or low.  A little sugar will treat a low.  There are also glucose tablets.  I don't often have this problems.  Treating highs is more difficulty.  It could mean cutting back on carbohydrates, could mean increasing exercise, or lastly extra medication.
Taking Medication:  I take pills.  I have never had to take insulin which is usually injectable.
Staying Active:  Walking I have found is the best way to keep blood sugar low.  With walking good shoes are important.  Also drinking plenty of water is a must.

Healthy Eating:  It is important to eat carbohydrates, but in moderation.  Balance meals between 1/2 vegetables, 1/4 carb and 1/4 protein.  Serving size is important to watch.

Caring for feet with daily self foot exams and regular podiatry check ups.  Good foot ware is also important, and avoid going bare footed.

Wednesday, February 1, 2017

Pamphlet: Healthy Aging

This pamphlet simplifies the topic of healthy aging with the above topics.

Staying Fit:  This involves being active most days by getting in at least 30 minutes of moderate exercise.  This should be a lifestyle of working in the yard, walking etc.  Your activity should include stretching, strengthening and aerobic activity.
Healthy Diet includes eating a variety of food, balance what you eat with physical activity, less saturated and trans fat, more whole grains, fruits and vegetables, limit sugar, moderate salt, and if you drink, moderation only.
Mental Wellness:  This is keeping your mind active.  The more active, the less chance of memory loss.  It is more necessary however to keep things in their place so you can find them, read regularly and play games, regular physical exercise will also help.  Depression can set in at an advanced age.  Stay in contact with friends and have a regular routine, in the winter try to get sun.
Medication Use:  Use medication wisely.  This includes talking to your doctor and learning about the drugs you take.
Tests and Checkups:  Regular tests should include blood pressure, cholesterol, osteoporosis and colorectal cancer.  For women mammogram and Pap test.  For men prostrate cancer test.  Other checkups include teeth and gums, hearing and eye exam.
Preventing Falls:  Some ideas are to put things lower, wear good walking shoes, secure flooring, keep cords away from areas frequently walked, install handrails on both sides of the stairs, and secure the bathroom with suction bathmats, etc.

Monday, January 30, 2017

Mandated Reporter Training

After an incident at the hospital where two doctors were fired, as they each assumed the other had made a CPS report for a physical abuse situation, and the perpetrator eventually killed the child; mandated reporter training has become an important part of our business.  This training really makes you think as a mandated reporter.  Our training was presented by Jane Smithson J.D.

I really like her the definition of why you report.  It is not only for the safety of children, which is important enough; it can also be the catalyst for a family in trouble to get they help they need.
Much of the training revolved around when a child abuse report is needed in a sexual situation, which are sometimes mutual.  The light didn't turn on for me until I realized that statuary rape is not necessarily child abuse, although it could be reported to the police.  In this situation that would be a parent who would need to report.  A child abuse report is warranted based on the age difference of those involved.

Saturday, January 28, 2017

Second Hand Smoke

Second Hand Smoke and Apartments, Condos and townhouses: What You Can Do About It, California Department of Health Services.
Second hand smoke can be deadly.  This pamphlet estimates 53,000 American deaths annually and 4,700 in California.  The chemicals from cigarettes can kill, and they can linger for a long time.  It is much worse if there is a smoker in the home, with the gases locked inside.  However in close living quarters the smoke can come from outside the home.  This pamphlet suggests talking to smokers, having  non smoking apartments, No Smoking in common areas such as laundries and recreation areas, and effecting repairs to keep smoke out.

Monday, January 23, 2017

Immunizations for Adults and Seniors.

Center for Disease Control, California suggests three immunizations for adults.  After age 50 it suggests an annual influenza shot.  Even if you have no previous issues with the flu, as our immune system grays we need additional protection.
Immunization for pneumonia is suggested after 65 years of age.  This is generally a once a life time immunization.  It is also recommended for those with chronic health conditions.
Lastly tetanus is important for those over 50.  This immunization should not be administered more than every ten years, unless you have sustained an injury.
It is important to keep a record of all you immunizations.  The timing for some is dependent on when you last received a shot.

Friday, January 20, 2017

Magazine Article: Self-regulation and Stress Coping at the Foundation of Resilient Recovery

Self-regulation and Stress Coping at the Foundation of Resilient Recovery by Stephen Sideroff, Phd, Counselor: the Magazine for Addiction and Behavioral Health Professionals, October 2016.
I found this article very fascinating.  It is presented in two parts really.  The first is how childhood effects someone's vulnerability to addiction and relapse.  "High levels of early childhood stress alter and impair neural mechanisms of self-regulation and functioning."  He is mostly talking about attachment issues, and how impairment in attachment "impairs endorphin brain circuitry" which in turn makes it more difficult to self-soothe.  It is also partially why stress can lead to relapse in adults.  Substances become a substitute for self soothing.
The second part of the article deals with the model for self regulation as a way to teach individuals how to self-regulate rather than turning to drugs.  This is a nine-step process.  It focuses on three areas, relationships, balance and mastery and engagement with the world.  This concepts are presented as things to learn:
1. Relationship with Self.  Being able to have positive and loving self-talk is essential.  Much of the author's work involves relearning this internal script.
2. Relationship with Others.  Healthy relationships should have a ratio of at least twenty positives to one negative.  He suggests relationship with less than a five to one ratio may need to be discarded.
3. Relationship with Something Greater.  This of course is the core of 12-step programs.
4. Physical Balance and mastery.  Relaxation techniques should be a part of any recovery program.  Being able to be at peace with yourself is essential.
5. Mental or Cognitive Balance and Mastery.  The perspective of an addict is frequently flawed.  Maintaining a positive attitude is essential to recovery.
6. Emotional Balance and recovery. Emotional reactivity negatively impacts resilience.  A brain is easily high jacked by reactivity.  A four step guide: 1) Become aware of emotions and accept them. 2.)Sit with emotions and recognize what they are about and whom they involve. 3) Expressing emotions in the contest of acceptance.  It is ok to be sad or angry about past events.  however it is not always possible to change the past.  Sometime accepting reality is needed.  4) Let go.  Once a feeling has been expressed, it is important to let go, and not continue to expect the impossible.
7. Presence.  This is about our ability to be in the moment.  This also deals with how you project into the world, which is charisma.  This can involve a change of posture.
8. Flexibility.  Flexibility is the ability to adapt.  Awareness of patterns is essential to being able to confront them, and adapt other ways of coping.
9. Power: The Ability to Get Things Done.  This is having realistic expectations, and setting goals, but understanding new learning is a growth process.  Having more power leads to more freedom, and less dependence, and then increased confidence in one's self.

Thursday, January 19, 2017

Article: Eat to Reduce Belly Fat

This article is form the email stream "Living with Diabetes from Everyday Health.  I was looking for the easy fix for my belly fat, however this article basically says there is no easy fix.  However it does say that to lose one to two pounds a week then you should eat 500 to 1000 less calories per day.  Now that is a big goal.  Here is the exact quote, "To reduce weight in this area [the midsection], it's important to go on a diet that includes plenty of fruits and vegetables, lean protein, low-fat dairy, and whole grains, and to reduce portion sizes and therefore caloric intake.  It points out how belly fat can lead to problems such as heart disease and type II diabetes.  In terms of exercise, it suggest cardiovascular mixed with resistance training to build muscle.  

Saturday, January 14, 2017

Monday, January 9, 2017


RSV Respiratory Syncytial Virus is related to the common cold.  Most children or adults do not have serious symptoms from the virus other than those of a cold.  However there are some who are particularly vulnerable.  this includes small babies up to ten weeks, babies born prematurely, infants with lung conditions and infants whose immune system is compromised due to a medical condition.  The virus results in trouble breathing, rapids breathing, cough, refuses to breast feed, and dehydration.  If your child is very tired, breathes rapidly, or has a blue tint to lips or fingernails medical attention should be sought.  Although there is no medicine for this virus, symptoms are treated and monitored.  This may include oxygen, medicines to open the air passages, and fluids.  RSV is also highly contagious so washing hands frequently is necessary.
Picture from Kids Health

Suicide Prevention: LivingWorks

This is a pamphlet from Living Works entitles Imagine a suicide-safer community.  It then describes several training programs provided by this program:  these include: esuicideTALK, suicideTALK, safeTALK.  This program has as its objectives training people to move beyond brushing over suicide, being able to recognize those who are suicidal, and applying steps to connect people with help when they are suicidal.  The other programs are ASIST and suicideCARE

Saturday, January 7, 2017

Reconozca Los Senales: Suicide is Preventable

What would you do if you knew I wanted to suicide?

Suffering is not always noticed
Recognize the signs
listen and discuss
seek help

Intensive Case Management Services for the Severely Mentally Ill

This is the summary of a comparative research conducted in Santa Clara County. I don't see any dates on this but the results were released in 1993.

A Comparative Evaluation of Three Intensive Case Management Services for the Severely Mentally Ill:
Jeanette M. Jerrell, Ph.D., Director of Research
Rex S. Green, Ph.D. Evaluation Research Specialist
Santa Clara County Mental Health Services Research Center
Santa Clara County Mental Health Bureau
Bob Martinez, Director

Summary: It is certain that severely mentally ill adults with high levels of need for services can be managed and treated most effectively using intensive case management programs.  These programs clearly reduce the total direct care costs for clients over time and improve client functioning in the community as well.  These findings indicate that expansion of these case management services will result in substantial savings to the County mental health system while improving client outcome.

The Mental Health Bureau has been evaluating the relative cost-effectiveness of three of its intensive case management programs which specifically target their services to adults who are severely and persistently mentally ill and are high users of the acute and subacute treatment services.  These clients have two or more inpatient or skilled nursing facility episodes during the year prior to their entry into one of these three case management programs, as well as being noncompliant with previous outpatient services, being conserved and receiving SSI payments.  the three case management programs are: Virginia Street Project, Community Companions, and Downtown Mental Health Center.  Each program offers clients a different mix of outpatient, medication, case management, housing, and supportive day services, depending on their service philosophy and their caseload size.

Overall, the three intensive case management programs currently serving severely and persistently mentally ill adults are substantially reducing the direct service costs for these clients and improving their psychosocial functioning in the majority of clients served.  Our data also indicate that these reductions in direct mental health service costs do not increase the burden on families or other social/criminal justice services.  However, there are differences among the three programs in the degree to which they are lowering direct service costs and increasing client functioning.  The relative cost-effectiveness of the three programs depends on which outcome (treatment cost reductions versus client improvement) is considered.

The most cost-effective service from both of these perspectives is the Virginia Street Project which is reducing the total cost of mental health services to its clients by about $14,000 per year, compared to the level of care they required prior to receiving this service.  the greatest reduction is in the inpatient days and skilled nursing facility days of service used (see Figure 1).

They are also providing significantly more supportive outpatient and case management services to these clients (see Figure 2), but these services are offered at only a fraction of the cost of acute and subacute treatment facility costs.  Client functioning is improving to the greatest extent among VSP clients as well (see Figure 3).

Clients served by Community Companions demonstrate the next greatest improvement (see Figure 3) in functioning, and their total treatment costs are reduced $5,000 per client per year, the first year they are provided intensive case management services.  This outcome seems consonant with Companion's program philosophy which emphasizes client empowerment and rehabilitation as well as compliance with taking medications and explicit avoidance of hospitalization.

Downtown Mental Health Center clients showed reduced annual direct treatment costs of about $7,800, per client per year.  Client functioning improved less in the first year than for the other two programs, although Downtown MHC clients demonstrated the same pattern of overall change as the clients in VSP or Companions (Figure 3).  These outcomes seem consistent with the program's emphasis on maintaining clients in the community by providing supportive outpatient counseling and medications and with staff caseloads being twice the size of those at VSP or Community Companions during this study.

MY3 Wallet Size: Suicide Prevention App

This is a wallet size card for the MY3 suicide prevention app.

Friday, January 6, 2017

Diabetes Focus

These are some ideas I gleaned form the Diabetes Focus magazine, Spring 2016:
Sleep Balance:  By sleep balance they mean having the same sleep schedule every day, not waking later on weekends for example.  Those who have the same schedule tend to be healthier.  Those with a greater discrepancy in their sleep schedule have higher cholesterol levels, and greater insulin intolerance.
Stress: Diabetes distress is a real thing.  Managing diabetes can be stressful as you worry about diet, exercise, medical care etc.  Also there is at times a lack of support from those around you.  This can lead to diabetes distress.  It is good to talk to your doctor about stress and diabetes.
Testosterone: There is a correlation between testosterone level and insulin intolerance.  In may be a good idea to ask for blood test.
Singing:  Singing has been shown to improve mood and decrease tension.  Singing also can help with memory and social skills.  People who participate in choirs feel more confident and supported in social settings.
Feet (Socks and Shoes)  Who knew there are socks better for diabetics than other socks.  Fitted socks are best, synthetic materials will keep your feet dryer, padded styles can keep feet protected.  For more recommendations check out American Podiatric Medical Association.  Shoes should be replaced more often than you think, 300 to 500 miles, and more often if you are overweight.  Best to buy shoes later in the day as feet are larger later in the day (who knew?), and best to try them out.  If they don't feel comfortable in the store, they won't at home.  They should feel good without being "worn in."  They should have plenty of room for the toes, but not be so big they slip.  Finally, with your feet protected, we all should walk just a bit more.  For diabetics a pre and post walk check of feet is important to check for any blisters or damage.