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Talking Grievances And Health Care, An Outsider Kentucky Dem Found The Inside Track

So in July, with a bit of money in the bank and desperation beginning to set in, McGrath’s campaign manager, Mark Nickolas, decided that he had to do something crazy. He told McGrath, who hadn’t yet unpacked from her move, to dig her bomber jacket out of a box. He took his fledgling candidate to Lexington’s Blue Grass Airport, stood her in front of a fighter jet, and told Mark Putnam, the ad man who has made Democratic candidates from Missouri to Wisconsin go viral, to start filming.

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The Surprising Link Between Procrastination and Threats to Your Health

We all know the negative consequences of procrastination firsthand; we wait too long to start a project, or delay that important phone call, then end up feeling more pressure than we would had we started things sooner.

Related: 11 Ways to Beat Procrastination

All of us do this from time to time, and, according to research by Joseph Ferrari, about 20 percent of us are what’s known as “chronic procrastinators,” frequently and intentionally delaying work on projects with no gain other than to temporarily delay the inevitable.

In school, we’re taught not to procrastinate because the practice leaves us less time and more pressure, and those issues certainly aren’t good. But, later in life, the consequences of procrastination might go even further than we realize.

The correlation with heart health

Research by Fuschia Sirois, from Bishop’s University in Quebec, suggests that trait procrastination (the tendency to regularly delay  important tasks) is correlated with both hypertension and cardiovascular disease. The correlation exists even when researchers control for variables like age, race, education level and personality factors.

The procrastination habit itself may not directly cause hypertension or damage to your heart, but it’s correlated with other factors that could influence your health:

  • Stress. It’s no secret that procrastination is a major source of stress. People most often procrastinate on their most stressful tasks as a strategy to cope with that stress. But in turn, they prolong the time they spend thinking and worrying about those tasks, thereby increasing the amount of time that they feel stress. In addition, they leave themselves with less time to finish the task, and feel even more stressed than just doing it would prompt.
  • Behavioral disengagement. Sirois’s study also noted the tendency for participants to demonstrate behavioral disengagement; in other words, they procrastinate as a way to distance themselves from a given problem. It’s a coping strategy, and not a healthy one, so chronic procrastinators aren’t able to manage their stress effectively.
  • Self-blame. Procrastinators also tend to feel bad after procrastinating, understanding that this is a bad habit and knowing they’ve put themselves in a difficult situation. But that self-blame can make them even more stressed.
  • Health procrastination. Chronic procrastinators, it’s also worth noting, are also likely to delay health-related tasks; they might avoid seeing the doctor until their health problems are more obvious (and more difficult to correct), or might delay starting a new diet or exercise program because of the perceived discomfort. Those delays leave them in even worse health, and allow years of damage to accrue unabated.

The bright side

Though procrastination’s health consequences are impossible to ignore, it’s not fair to cast all instances in a negative light. For example, one study from the Journal of Social Psychology noted two distinct types of procrastinators: active and passive.

Related: 6 Steps to Go from Procrastinating to Productive

Passive procrastinators delay tasks until absolutely necessary because they find themselves unable to summon the discipline to do them sooner. Active procrastinators intentionally decide to delay their work as a time-management strategy.

As you might suspect, while active procrastinators spend the same amount of time procrastinating, they display a more productive use of time and more adaptive coping skills.

Overcoming procrastination

So, what can you do to overcome procrastination in your own life?

1. Become an active, rather than passive, procrastinator. Instead of allowing procrastination to manifest in your life, make an active decision to procrastinate. Take charge of your delay, and deliberately choose a time to deal with the problem.

2. Think about why you’re procrastinating. If you feel like putting a task off until tomorrow, ask yourself why. Are you doing this because it’s going to genuinely make the task easier to deal with, or just because you don’t want to deal with it now? Recognizing these influences can help you make more logical decisions.

3. Manage your self-blame. If you do procrastinate — and almost all of us do from time to time—avoid the tendency to blame yourself, and try not to feel too guilty. Procrastination happens to all of us, and your lack of action doesn’t have to haunt you the rest of your week.

4. Set tighter deadlines. You could also try setting stricter deadlines for yourself, so you don’t have as much time to fill with procrastination. Unfortunately, self-imposed deadlines won’t do you much good, so you may need to ask a supervisor, coworker or friend to help you stay accountable to your new deadlines.

Procrastination is something that has and will continue to affect all of us from time to time, but it doesn’t have to control your life — nor do you have to let it affect your health.

Related: 4 Reasons People Procrastinate and a Cure for Each One

Understanding the consequences of procrastination, and fighting back against the habits that make you more susceptible to it will keep you productive and in better overall health.

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Alyssa Milano on battling mental illness stigmas: We’re more likely to hurt ourselves than we are other people’

Actress and activist Alyssa Milano spoke on “The View” today about living with anxiety and called for the Trump administration to provide care for others with mental illness.

“I have a mental illness,” Milano said today. “I’m going to say it just like that, because I feel like there is such a stigma around mental illness. I want people to know that if you have anxiety, depression, whatever your mental illness may be, you are not alone.”

Milano said she found comfort in the fact that she was not alone. According to the National Alliance of Mental Illness, nearly 44 million Americans experience mental illness in a given year.

She also pointed out that under the latest Trump tax plan passed in December, 13 million Americans could lose health insurance.

“So to me, I think we have to rededicate ourselves to really making mental illness a priority,” Milano said.

Milano called on the Trump administration to fix the problem, especially because the president has cited mental health as a cause for the prevalence of mass shootings in our country.

In February, President Trump tweeted that the accused Parkland High School shooter showed signs of being “mentally disturbed” and after the deadly 2017 church shooting in Texas, Trump said, “Mental health is your problem here. … This isn’t a guns situation.”

“We see this administration blaming these mass shootings on mental illness. … If that’s what you are going to blame it on, you have got to step up to the plate and do something,” Milano said. “Get them the care that they need.”

She also said that if the White House refused to make progress on mental health care, “I think the NRA should stand up there and help us fund mental health programs throughout the country.”

According to the American Psychiatric Association, mass shootings by people with serious mental illness represent 1 percent of all gun homicides each year.

“We’re more likely to hurt ourselves than we are other people,” Milano said.

PHOTO: Alyssa Milano joined The View on May 18, 2018, to discuss her activism with the #MeToo movement and working to get care for those with mental illness.Candice Elle Frank/ABC
Alyssa Milano joined “The View” on May 18, 2018, to discuss her activism with the #MeToo movement and working to get care for those with mental illness.

Milano said today that she had struggled with anxiety her “whole life,” but that “it got really bad” after the birth of her son Milo.

She said she was “overwhelmed” with working, dealing with her role as a new mom and her anxiety’s physical manifestations.

“I get a knot in my stomach or it feels like someone is wringing out a washcloth and I get shaky and I can’t breathe,” Milano said, describing those manifestations. “It’s a panic attack but it’s generalized — so it’s always in that state.”

Milano said she ultimately “went into an emergency room, asked to speak to the psychiatrist and had them drive me” to be “committed … to a mental institution.”

She said that time was particularly frustrating because others were telling her that she looked totally fine.

“I needed help,” she said. “People just kept telling me, ‘You’re fine. Go for a hike. It’s a big change having a baby.’ And I knew I wasn’t OK.”

While Milano acknowledged that she was “blessed” to have the means and insurance for the care she received as well as the support, she said: “What does the woman, what does the mother, do that doesn’t have that?”

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Intermountain, Home Care Provider Team Up in New Joint Venture

For almost two years, Intermountain Healthcare—a Utah-based health system that boasts 22 hospitals, more than 180 clinics and its own health insurance plan—has been searching for the perfect home care partner to help it proactively keep elderly patients well and away from its own facilities.

It found that partner more than 1,400 miles away.

Earlier this month, Intermountain announced it’s partnering with Minnesota-based Lifesprk—an innovative provider of in-home care services and one of the fastest growing companies in Minneapolis—to jointly launch Homespire, a new private-duty home care model for Utah’s rapidly aging population. The goal of the partnership: copy Lifesprk’s proven in-home approach to wellness at Homespire and, in turn, cut health care costs, slash rehospitalization rates and prevent emergency room visits.

“We, historically, have been a great hospital system with an awesome health plan and some post-acute care on the side,” Todd Neubert, home care and hospice nurse administrator at Intermountain, told Home Health Care News. “We are transforming now to the full continuum, really focusing on the community-based care side, needing to grow there… We need to be in patient’s homes.”

Since it was founded in 2004, Lifesprk has worked with more than 14,000 patients and seen revenue growth of about 20% annually. Its team currently stands at about 450 total employees, more than half of whom are home health aides. The cornerstone of Lifesprk’s business is its private-duty home care team, but it has also rolled out a variety of Medicare-certified home health services, including skilled nursing, in recent years. It now offers senior housing placement services, too.

About 75% of Lifesprk’s revenue is private pay, Joel Theisen, its CEO, told HHCN.

The Lifesprk approach to wellness, “quarterbacked” for each patient by a personal care manager who’s also a registered nurse, has been shown to reduce emergency room visits by about 48% and hospital readmissions by about 57%, Theisen said. Among their responsibilities, Lifesprk’s 24/7 care managers help patients and their families develop, implement and execute a custom-built life plan targeting health, social supports, home safety, finances and identity—important aspects of what the company calls its “essential elements of wellbeing.”

“Our whole approach is to break that rollercoaster of health care crisis for people, as far as individuals going in and out of hospitals and having crisis after crisis, only getting worse,” Theisen, who will also serve as CEO of the Intermountain-Lifesprk joint venture, said. “These partnerships are absolutely necessary to create an integrated delivery system and really get at the full continuum that has been missing for a lot of seniors in the past.”

Homespire, which has about two dozen employees, began taking patients living in Salt Lake Valley at the start of May. So far, it has provided services to a handful of clients, and is expecting continued growth across Utah in the next year.

Intermountain owns 55% of the joint venture, while Lifesprk owns the remaining 45%, according to Theisen.

“The success of [Homespire] is on the backs of both of us,” Neubert said.

Filling a gap 

Today, Utah’s population ranks among the youngest of all U.S. states. But that’s changing—and fast.

Over the next half-century, Utah’s 65-and-older population will likely double, according to data from the University of Utah’s Kem C. Gardner Policy Institute. In 2015, people between the ages of 65 and 85 made up about 10% of Utah’s population. By 2065, they’ll likely account for more than one-fifth of it, according to the data.

Functioning alongside its existing health system, Homespire will aid Intermountain’s efforts in providing better care for older adults, keeping them engaged, involved and contributing to their communities, Neurbert said.

“We really noticed a gap,” he said. “The gap we recognized was in providing care kind of before individuals fell ill, and, then, in supporting them during the transition back to the home, helping them to be independent really quickly.”

On a big-picture level, Intermountain’s partnership with Lifesprk is in line with the health care industry’s steady pivot toward wellness and value-based care. Likewise, it also echoes moves made by other health systems—including Toledo-based ProMedica—to expand across the entire care continuum. ProMedica announced in April plans to acquire the operations of HCR ManorCare, including the company’s vast home health segment.

For Intermountain, insurance coverage also becomes part of the mix. Of the patients Intermountain cares for, it assumes the risk for about 40% of them through its SelectHealth coverage, according to a spokesman for the health system.

In addition to Homespire, Intermountain also recently rolled out Alluceo, a new independent company offering team-based mental health integration services and technology.

“That shift is really something we’re focused on right now, and it’s a huge focus for our entire system,” Neubert said. “We not only have hospitals and home care, hospice, medical equipment and all those things that you need, but we also provide health insurance.”

Intermountain’s partnership with Lifesprk was the result of an extensive nationwide search and multiple rounds of consultations with non-medical home care organizations in several states, Neubert said. No local home care agencies matched Intermountain’s ambitious plans, he said.

“What Lifesprk does is deliver on whole-person senior care, using a model where we discover what’s important in someone’s life by looking at purpose, passion, identity, as well as health, wellness, cognitive [ability], financial [standing] and other supports,” Theisen said. “Through that, we don’t build just a care plan, but we build a life plan.”

Its services are currently available in an eight-county area surrounding the Twin Cities.

An eye on Medicare Advantage

Homespire—despite only launching early this month—already claims to have lower care costs, estimated at $2,500 per month.

By comparison, the national median monthly cost of a semi-private nursing home room in 2017 was more than $7,000, according to the most recent Glenworth Cost of Care Survey. Median monthly costs for homemaker or home health care services, meanwhile, were both about $4,000.

In the future, out-of-pocket expenses could be even less for Homespire clients, as Medicare Advantage (MA) begins to include more non-medical benefits. Non-skilled in-home care supports will be allowed as a supplemental benefit for MA plans in 2019 for the first time, the Centers for Medicare Medicaid Services recently announced.

“Right now, we’re using Homespire as a self-pay model, but I imagine if Medicare eventually did… offer reimbursement for some of the things provided through home care, we’d of course go after that,” Neubert said. “But it’s not our internet, and the survival of [Homespire] is not based on that.”

Theisen will also be paying attention to MA changes at Lifesprk, he said.

“It’s a positive move of for sure,” Theisen said. “I’m just not sure how it’s going to be deployed.”

Written by Robert Holly

Robert Holly

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Strong Earnings Season Boost Home Health Stocks

The market values of some of the biggest home health companies ticked in April, thanks in part to positive earnings results at the start of the year.

The Home Health Index, managed by Stoneridge Partners, has long tracked the market value of three of the largest home health companies. Previously, three companies comprised the index: Almost Family, [NASDAQ: AFAM] LHC Group (NASDAQ: LHC)  and Amedisys (NASDAQ: AMED).

Following the mega-merger between LHC Group and Almost Family at the beginning of April, the HHI now consists of two companies: LHC Group and Amedisys. Almost Family is no longer traded as an individual stock.

Lafayette, Louisiana-based LHC Group stock jumped 20.9% in April. Year-to-date, stock is up 21.5%. Following the completion of its merger, LHC Group is now the second-largest home health care company in the nation, with approximately 775 locations and an annual revenue of $2 billion. Even after its mega-merer,  the company shows no signs of slowing down on its mergers and acquisitions activity.

During the company’s recent first quarter earnings call, CEO Keith Meyers stated his organization has a pipeline of 24 ongoing discussions with health systems and hospitals. These discussions revolve around forming home health joint ventures.

As the only other company in the HHI, Baton Rouge, Louisiana-based Amedisys also saw stock prices rebound by 9.3%. The company revealed during its first quarter earnings call that Q1 2018 saw its margins increase to their highest levels since 2015. Amedisys stock, year-to-date, is up 25.2%.

As April ended, the HHI was up 18.4% as a result of removing Almost Family and recalculating the index. The uptick is a stark difference from March, when the HHI declined 2.7%. Compared to this point in 2017, the HHI is up 24.4%. And it wasn’t just home health stocks that bounced back in April — the SP 500 slightly rose 0.9%.

Both company’s strong first quarter earnings were likely boosted by a proposal from the Centers for Medicare Medicaid Services. At the start of April, CMS announced that non-skilled in-home care supports will be allowed as a supplemental benefit for Medicare Advantage plans, starting in 2019. Large home health care providers view Medicare Advantage as a growing opportunity.

“On top of the completion of a major transaction that changed the face of the home health care industry, the news from CMS definitely helped companies overcome a turbulent March,” said Stoneridge Partners President Rich Tinsley. “And with strong first quarter earnings, the coming months may be even better for home health companies.”

Also of note, Frisco, Texas-based Addus HomeCare (NASDAQ: ADUS) also posted positive gains. At the end of April, Addus stock rose 7.19%, and year-to-date, it’s up nearly 50%. While Addus is a major personal care services provider, it’s not part of the HHI, as little of its revenue is from Medicare.

Erik Prado on EmailErik Prado on LinkedinErik Prado

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Stress and serious anxiety: how the new GCSE is affecting mental health

On Monday morning, what may be the most dreaded and feared set of public exams England’s teenagers have ever sat began in school assembly halls up and down the country.

It is 30 years since GCSEs (General Certificate for Secondary Education) were first introduced under Margaret Thatcher, replacing O-levels and CSEs. The new exam was designed to cover a broad spectrum of ability rather than dividing pupils between high achievers, who sat O-levels, and lower-ability students, who took CSEs. Now, three decades later, following claims of grade inflation and dumbing down, GCSEs have been revised and re-formed and a brand new set of exams is being rolled out.

Gone are the old-style assessments with their forgiving modules, repeat exams and coursework. In their place are Michael Gove’s super-tough, “gold-standard”, highly academic qualifications. Gove, secretary of state for education between 2010 and 2014, believed the old GCSEs’ reliance on coursework assessment was open to abuse. He argued that the content of the revised examinations should be pitched at a more sophisticated level, claiming: “By making GCSEs more demanding, more fulfilling, and more stretching we can give our young people the broad, deep and balanced education which will equip them to win in the global race.”

Each GCSE has therefore been designed to be more challenging, with increased content, which is tested almost exclusively by end-of-course examinations and measured by grades that run from 9 to 1 (rather than the previous A* to G). The new 9-1 measure sets a 4 as equivalent to a C, while the top grades, A* and A, are split into three grades, 7, 8 and 9, with 9 awarded to those with marks at the top of the old A* grade. As a result, far fewer students will end up achieving the very top grade available, and many who would have been A* students under the old system will wrongly regard a 7 or 8 as a failure.

The 2018 summer exam season kicked off with computer science and religious studies on Monday, followed by French and biology on Tuesday. How pupils fare will not be known until 23 August when GCSE results are published. What has become clear, however, is the distress that these new and untested exams have caused.

A Guardian call-out last week asking for our readers’ views about the new GCSEs prompted more than 200 responses, an outpouring that was overwhelmingly – although not exclusively – negative. The more extreme responses included accounts of suicide attempts by two pupils at one school, breakdowns, panic attacks and anxiety levels so intense that one boy soiled himself during a mock exam.

The then education secretary Michael Gove announcing the government’s planned review of the National Schools Curriculum. Photograph: Stefan Rousseau/PA

Some of the responses from pupils were alarming. “GCSEs have been a horrible experience,” says one 16-year-old. “I have suffered from panic attacks and a high increase in anxiety. It’s quite scary how as a student I find it normal to see my peers break down in lessons as they are scared of what’s going to happen to them in the future if they fail.”

Another writes: “I have seen the mentally toughest people crack and it’s painful to watch. People crying over being unable to do a maths question. Is this what we want as a nation, to be put under this mental stress?”

Pressure in classrooms has been intense for the past two years as teachers have grappled with the new specifications, for which they say there are inadequate resources or revision materials. The new exams have been launched at a time when budgets are shrinking, schools are in deficit and parents are increasingly being asked to fill the gaps with everything from monthly cash donations to glitter glue, pens and even toilet paper. Nonetheless, schools are doing their best, with some laying on relaxation sessions, yoga classes and resilience programmes to support worried pupils. “For the first time in 10 years of teaching, I have no idea what to expect come results day,” says one bemused history teacher from Worcestershire.

Chances are that the final headline results may not be dramatically different from previously as the exam boards will peg this year’s outcomes to previous years so as not to disadvantage the latest cohort. The grade boundaries could prove telling, however. When the new mathematics and English GCSE courses were tested for the first time last summer – ahead of the main wave of re-formed GCSEs – it emerged that scores in one maths exam were so low that the pass mark was set at just 18%. This year, a further 20 new exams are being rolled out, including sciences, modern languages, history and geography, with more to follow next summer.

Phil Beadle, an award-winning teacher and education consultant, says this year was bound to be stressful but that things will improve. “People are stressed because, with the exception of in English and maths, no one really knows exactly what an 8 or a 9 looks like. Your first run through of a new syllabus is rather less skilled than your fifth.”

But this is of little comfort to schools where study leave has been cancelled this summer because staff have been unable to cover the volume of work required by the new qualifications; students are being taught the curriculum to the very last minute. What’s more, because assessment is now virtually all exam-based, students may be sitting up to 28 exams in the space of two or three weeks, some of them spending a little short of 40 hours lined up in rows in exam halls, folded over constricted desks.

“I have 10 different subjects and 28 – yes, 28 exams,” says one 16-year-old from Greater Manchester. “They are a minimum of 75 minutes. Maths now has three papers, six science papers for dual award. Oh, and three geography papers. It is ridiculous.”

The NSPCC reported this week that the number of referrals by schools in England seeking mental health treatment for pupils has risen by more than a third in the past three years. A Gloucestershire teenager told the Guardian she believes about 50% of her year group are suffering from mental health problems. “I know that everyone struggles with the exams and the importance of them,” she says, “however, the new courses have amplified the pressure and surely they shouldn’t be causing my fellow students to have suicidal thoughts.”

Schools are also coming under pressure to perform well in league tables. A student from Dorset describes the countdown to exams in his school, with posters showing the number of days left and notices warning that if you get grades 1-4 you’re likely to end up cleaning or working in a shop, whereas if you get 8s and 9s you’ll be off to university to enjoy “a great lifestyle”.

“I have seen near enough all my friends cry over our exams, worry (to the point of having a panic attack!) about not having done enough revision and failing,” writes one GCSE student who contacted the Guardian, adding: “In fact, I don’t think a single one of my friends currently are happy.”

This may have been true of many teenagers faced with make-or-break exams over the years. But teachers who responded to our call-out told the same unhappy story and expressed alarm at the increase in mental health problems among their students. A 26-year-old English teacher says he has watched his year 11s go through anguish. Like most of his colleagues, he has laid on countless revision sessions during lunchtimes and holidays to try to get his students through. “In one week recently, there were two suicide attempts by students. This is in a high-achieving school in a middle-class area, so I am sure problems must be heightened for already disadvantaged students, too.”

His own subject – assessed by four exams over eight hours – has become hugely daunting for students who are no longer allowed copies of their set texts and must rely entirely on memory for quotations from two novels, a Shakespeare play and 15 poems. “This seems both cruel and futile,” he says. “The most able students will still come out on top, but those who already struggle will barely be able to access these exams. I can only wish them the best of luck and hope that I have done enough to see them through, because these students are under more pressure than at any point in living memory.”

At a school in north London, another English teacher describes a student cohort in apparent meltdown. “They have been assessed on the same texts since year 9,” he writes. “They have been forced into after-school and weekend revision sessions that I have been forced to run since September; they have been denied study leave, and now that the exams are looming they are imploding, emotionally, mentally and literally (a boy soiled himself in a recent mock exam he was so nervous).

Welsh teenagers sit an exam. Photograph: Alamy Stock Photo

“These young people are angry, and they have every right to be. At 16 years old, the stress, anxiety and pressure in our current educational climate is now manifesting itself in adolescent molten rage.”

“The whole thing is a mess,” says a school governor in Worksop, Nottinghamshire. “Preparation and implementation rushed, not enough help and support from exam boards, teachers not sure of syllabus until there was little time left to prepare. Grade boundaries not clear, exemplar material limited. Training meetings late or non existent. For students, chaos, stress and loads more exams than before.”

“I have never, in over 20 years of teaching, seen pupils suffer with so much anxiety and other symptoms of poor mental health in the run up to exams,” says another English teacher.

“The number of students with mental health issues is definitely on the increase,” says a Cheshire teacher. “We now have a significant proportion of students who cannot take exams in the exam hall but require smaller rooms and rest breaks to stay calm. Attendance is increasingly affected with students off with anxiety.”

This from a psychology teacher from the West Midlands: “It is unfathomably hard. I’m all for raising the bar but it has been risen so very much it is inaccessible to the majority of students.”

And from a history teacher in Norfolk: “The new GCSEs have broken my best students, left some with serious stress-induced illnesses, and isolated the majority, leaving them completely apathetic towards their own learning. My lunch times are filled with crying students who feel they are not doing enough, despite doing full days at school and revising until 1am every single day.

“They have heart palpitations and panic attacks and migraines and they are all so, so tired. Worst of all, I feel like a hypocrite, because I’m not even sure I could achieve the grades I am asking them to get.

“I am lying to my students when I smile and say it will be fine, because they have worked so hard. Ultimately, I feel I have failed them.”

This year is particularly challenging for all concerned. There has been enormous change over a short space of time, when schools are so cash-strapped that some are unable even to afford the books required for the re-formed exams.

Mary Bousted, joint general secretary of the National Education Union, who still has nightmares about her O-levels, says the new exams are regressive and harmful. “I think it’s absolutely tragic,” she says. “It’s tragic for the pupils concerned and it’s tragic for UK PLC. We are not thinking intelligently about the sort of education and assessment that’s needed for the modern world.”

The Department for Education defends the new GCSEs. Its statement says: “In order for pupils to be successful, rigorous examinations are vital. They are not, however, intended to cause significant anxiety. Good leaders know that positive mental wellbeing helps pupils fulfil their potential and make that part of their overall school ethos. This government has taken steps to reduce examination burdens upon young people. At GCSE level we have removed the incentives for multiple resits that were not helping children’s education, giving pupils at least two full years of study before they sit exams.

“We are helping schools to spot mental health problems as early as possible and have allocated £300m of funding to transform mental health services for children and young people. Where staff are struggling with stress we trust headteachers to take action to tackle the causes and have issued guidance that is clear they have a responsibility to take work-life balance into account when managing staff.”

No doubt subsequent years will see some of the pressures ease as the new GCSEs are tweaked and teachers and pupils become more familiar with what is expected of them. But a broader question remains about the continuing relevance of the exams.

Testing times … Kenneth Baker, education secretary under Margaret Thatcher, 1985-1986. Photograph: Graham Turner for the Guardian

Critics say that English children are among the most tested pupils in the world, starting with the new baseline assessment in the first weeks of school; a phonics screening check in year 1; and standardised national tests (SATS) in years 2 and year 6. With pupils in England now required to stay in school, college or work-based learning until 18, many are starting to question the rationale of high-stakes exams at 16 and then again two years later.

Among those critics is the Conservative peer Kenneth Baker, who was education secretary between 1985 and 1986 when the first GCSEs were being tested. “When I took the equivalent in 1952, it was before O-levels,” he told a radio show last year. “Ninety-three per cent got a job at 16 when I took the exam. And so they had to clutch in their hands a certificate showing what they’d achieved and that was very important. But now the school leaving age is 18, in effect. Education goes on from four to 18. So what are you testing people at 16 for?”

Baker has his supporters, none more so perhaps than the tens of thousands of students frantically prepping for their GCSEs this week, with A-levels to look forward to two years down the line. But given the enormous upheaval and expense of these latest reforms, it seems likely to be some time before any major change is attempted again.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at

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White House Keeps Details of Melania Trump’s Health Under Wraps

“Usually a one-night stay does more than enough,” Dr. Hong said, “and the next day the patient is discharged with oral analgesics or painkillers. It’s sort of unusual to keep someone longer.”

Dr. Hong said patients typically went in for the procedure after experiencing symptoms like blood in the urine or back or stomach pain. Once patients were discharged, Dr. Hong said, he normally would not see them for another month.

At this point in Mrs. Trump’s recovery, specialists say it is hard to know why she would remain in the hospital for the better part of a week. It is possible that a patient could stay longer after an embolization procedure if there were underlying medical conditions, or if an infection, pain or discomfort developed afterward, Dr. Joseph A. Vassalotti, the chief medical officer at the National Kidney Foundation, said in an interview.

“I would say that I hope that when she is ready she’ll come out and tell the American public about what condition she has and what happened,” Dr. Vassalotti said.

Given Mrs. Trump’s desire to keep her private life private, that is probably unlikely. The first lady’s team kept her procedure, and details about when she actually entered Walter Reed, under lockdown. White House aides who were near Mrs. Trump wore blue scrubs in the hours immediately after the procedure, according to a person who saw several of the first lady’s aides at Walter Reed.

Wearing scrubs, Dr. Hong said, would be unnecessary for people interacting with a patient who had undergone an embolization procedure.

The president visited Mrs. Trump for the first three days of her stay at Walter Reed, stopping on Wednesday for a photo op with wounded soldiers. But on Thursday, the White House offered no further details on Mrs. Trump’s health, and Mr. Trump did not visit. According to a White House official, who spoke on the condition of anonymity to detail the president’s travel plans, a weekend trip to Camp David had been canceled and Mr. Trump had plans to stay in Washington.

Since moving to Washington with the couple’s 12-year-old son, Barron, last year, Mrs. Trump has made it clear that his privacy is of paramount importance, and hers nearly as important. It is a directive her small team of 10 aides has taken seriously, even as Mrs. Trump’s popularity has surged amid a series of high-profile appearances, including a state dinner with France and the launch of Be Best, her official platform that focuses on teaching kindness to children.

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Group therapy turns crisis into mental health success story

AURORA – Few people are willing to publicly share their experiences with mental illness because of the stigma.

However, Robin and Mark Cutright are sharing the struggles and successes of their oldest son Zach to inspire others in crisis to seek help.

May is Mental Health Awareness Month, and Zach’s story is an example of what can happen with the right kind of help.

“Even though he has high-functioning autism, it was a struggle once the depression hit,” Zach’s mom said. “He couldn’t quite do it on his own.”

She said it started about 16 months ago. Zach’s depression resulted in about 50 emergency room visits and dozens more stops at crisis centers.

“Just major depression where it felt like Groundhog Day,” she said. “Every few days he would just regress backwards and start feeling depressed and not be able to cope.”

When Zach would start to think about taking his own life, he would seek help at an ER.

His family’s health insurance eventually approved treatment in The Medical Center of Aurora’s partial hospitalization program.

Zach spent about five weeks in the program, which uses art therapy, recreational therapy, music therapy, occupational therapy and other kinds of group activity-based therapies.

“I think Zach’s struggle with the autism was really around the kind of social interaction,” Director of Outpatient Services at The Medical Center of Aurora Jeff Johnson said.

“So, having those other outlets for Zach to express himself through music, through the art, through the rec therapy, really helped Zach feel comfortable in the environment that he was in because we didn’t really ask him to process or talk for five hours. We gave him other interventions to be able to express himself.”

Zach had been diagnosed with major depressive disorder and autism.

Johnson said when Zach started the treatment program, he was anxious, nervous and reluctant to have any faith that this program would be any different.

“The first week was awful,” Robin said. “He didn’t want to stay. Finally, after about a week, I could start to see him getting better. It was just amazing. I think part of the problem was that he – that Zach was just not thinking that he needed help. He kept thinking he could do it on his own.”

Johnson said therapy gave Zach the tools, techniques and strategies to manage himself. He learned to cope with negative emotions and uncomfortable feelings by getting outside and being active, listening to music and accepting help from his family.

“I think that’s the ultimate tool in mental health is how do I cope with the challenges that life throws at us, the curve balls, and when we get flipped upside down,” Johnson said. “How do I cope with that in a healthy, productive manner that keeps me moving forward in life.”

Zach’s mom said the program gave him the feeling that he was worth the work and that when he got better, people wanted to be with him.

“I think having a person in your family that has a disability makes for a stronger family, quite honestly,” she said. “And I don’t see it as a burden to our family at all.”

Zach is now able to participate again in trivia night with his dad at a local restaurant once a week, and his mom encourages him to have some sort of daily social interaction. That could be as simple as talking to the cashier at the grocery store or going out to eat.

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As families struggle to get behavioral health coverage, enforcement of parity laws lags

In 2011, Rocky and Keith Schwartz’s two teenage sons both started exhibiting symptoms of mental illness and substance abuse.

Seven years and many ordeals later, the Lebanon, N.J., family has spent more than $300,000 out of pocket for their sons’ treatment due to coverage denials, first by UnitedHealthcare and later by Cigna, their insurers through Keith’s job. They filed six appeals, losing every time.

In November, Rocky Schwartz testified about her experiences with insurers before the President’s Commission on Combating Drug Addiction and the Opioid Crisis. She also has joined a New Jersey coalition that’s working to toughen enforcement of the federal Mental Health Parity and Addiction Equity Act of 2008.

“It’s so laborious to do these appeals when you’re living with terrifying situations with your children,” said Schwartz, whose sons currently are in stable condition. “It feels like they just try to wear you down until you won’t fight any more.”

In the midst of a national epidemic of drug addiction and overdose deaths, many families report similar battles with insurers in getting coverage for needed mental healthcare and/or addiction treatment.

This includes situations when patients at high risk of relapse were discharged from residential care over clinicians’ objections because their insurer stopped paying, or when patients in acute withdrawal had to wait for their insurer to approve payment for medication-assisted treatment. Some patients reportedly have died due to delays in getting needed coverage and care. Insurers blame access problems on the national shortage of behavioral health professionals and a lack of reliable quality measures for behavioral health facilities.

Based on these experiences, providers, advocacy groups and some policymakers are pressing for stronger enforcement of federal and state parity laws. The laws require health plans to provide coverage for mental health and substance abuse treatment that’s comparable to coverage for medical treatment.

But congressional Republicans and Democrats disagree about giving the federal government more enforcement power, even though Labor Department Secretary Alex Acosta, whose department oversees parity compliance, has repeatedly asked Congress for it.

Meanwhile, some observers say HHS has been sluggish in enforcing parity in its areas of responsibility, including Medicaid and the Children’s Health Insurance Program.

Critics say insurers increasingly are using undocumented utilization review rules and procedures, known as non-quantitative treatment limitations, or NQTLs, to deny claims, and that the approval process for behavioral care is significantly more stringent than that for medical care.

These include limits on the scope or duration of benefits that are not explicitly stated in policy documents, such as guidelines regarding utilization review, medical management and provider network criteria, along with rules that patients must fail at lower levels of care before receiving more intensive care.

“We run into the problem that the days the insurer has approved for residential treatment have ended, and we’ll want to prescribe an anti-craving medication before the patient leaves,” said Michael Morrison, executive vice president of Preferred Family Health Care, a behavioral health and substance abuse treatment provider in Missouri and four other states. “But the insurer often won’t make a decision until after the person is already discharged. It’s a Catch-22, and our clients are the ones who suffer.”

Advocates also want regulators to certify that health plans are in compliance with parity rules before they can be offered on the market. Only a handful of states currently conduct pre-market review for parity compliance. They say the current retrospective, complaint-driven regulatory model isn’t effective.

“If there aren’t complaints from the field, regulators think everything is fine,” said Ellen Weber, vice president for health initiatives at the Legal Action Center, which is involved in a five-state campaign to strengthen parity enforcement. “But that’s not true. The last thing that individuals in the middle of a mental health or substance abuse crisis want to do is challenge insurers’ discriminatory barriers to care.”

A Cigna spokesman said that while he couldn’t discuss the Schwartz’s case due to privacy rules, the company conducts ongoing oversight of its utilization management processes to ensure compliance with federal parity requirements. A UnitedHealthcare spokesman also said he couldn’t comment due to privacy rules.

“I wish people could sit in my shoes for a week and see the efforts our plans make to ensure they understand and are complying with parity,” said Pamela Greenberg, CEO of the Association for Behavioral Health and Wellness, which represents insurers providing behavioral health benefits. “But parity now means a lot more than what was initially meant in the law. It’s not as easy as people think.”

A spokeswoman for America’s Health Insurance Plans said focusing on more aggressive enforcement ignores the problem of the national shortage of behavioral health professionals, which makes it difficult to ensure timely access to quality care.

The federal parity law, which was broadened and beefed up by the Affordable Care Act and the 21st Century Cures Act, gives federal and state regulators significant authority to enforce parity in private and public health insurance.

If it finds a parity violation in an individual case, the Labor Department’s Employee Benefits Security Administration can require plans to pay all similar claims that were denied, known as a global correction. It also can force the plan to reform its policies and procedures.

The Labor Department in April reported to Congress that of the 136 citations issued in 2016 and 2017 for parity violations, about half were for NQTLs.

For instance, a California plan was cited for refusing to cover mental health and substance abuse services unless there was a written treatment plan for a condition that could be favorably changed. There was no comparable requirement for medical and surgical benefits. Regulators required the insurer to remove those provisions from 3,034 group plans with nearly 290,000 members.

The New York attorney general’s office found in 2015 that two insurers, ValueOptions and Excellus Health Plan, denied behavioral health claims at least twice as often as other insurers did for medical or surgical claims. ValueOptions, which was renamed Beacon Health Options, was found to deny claims four times as often for addiction treatment.

A National Alliance on Mental Illness report released in November found that nearly 35% of privately insured mental health patients said they had difficulty finding any therapist who would accept their plan. Twenty-eight percent used an out-of-network mental health provider, compared with 7% who used an out-of-network medical provider.

Beefing up enforcement

In its April report, the Labor Department made clear that examining NQTLs to determine whether they meet parity requirements is a difficult, time-consuming task, especially given the limited resources. There are about 400 investigators and 100 benefits advisers to oversee more than 5 million health plans covering 143 million people.

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Donald Trump proposes cutting funding from women’s health organisations that offer abortions

Anti-abortion activists won a major victory on Friday when President Donald Trump’s administration announced plans to cut federal funding to hundreds of American clinics providing the service.

The move would effectively strip Planned Parenthood, one of the largest abortion providers in the US, of millions of dollars.

The organisation called the proposal “dangerous” and “outrageous”, warning it would “have devastating consequences”.

The proposed policy “would ensure that taxpayers do not indirectly fund abortions,” a White House statement said.

Under the proposal, clinics that receive federal money from a family planning programme known as Title X will be banned from referring clients for abortion or sharing space with abortion providers.

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