Meet some of the Kentuckians answering the new 988 crisis line: they're first responders driven by empathy

Sunshine Randolph, an engagement specialist for New Vista in Lexington, answers calls to the 988 suicide prevention line. (Kentucky Lantern photo by Carter Skaggs)

This story discusses suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.

By Sarah Ladd
Kentucky Lantern

When Sunshine Randolph was an undergraduate student, her stepfather died by suicide.

“It really does kind of rock your world,” she said of the experience, which drew her to work in suicide prevention. “I know what it can do to a family.”

Randolph now answers 988, the suicide prevention lifeline in Kentucky, for the Lexington-based New Vista. She draws on her personal experience to help people get through some of their most challenging moments.

“We kind of have these backgrounds in psychology,” said Randolph, whose bachelor's degree is in psychology. “We maybe are more familiar with (mental health) – but experiencing it is something a little different.”

Still, she tries to empathize while not projecting her own experiences on others. “No one death by suicide or or suicidal ideation is the same,” she said.

Calls and texts to the crisis hotline rose after 988 launched in July 2022, replacing a 10-digit number. Experts said the simplification of the lifeline would save more lives.

Gov. Andy Beshear said in January that overall, the state saw a 26% increase in calls to 988 in the second half of 2022, with fewer calls dropped as well.

There were 708 more communications in August that year — the month after the launch — than in June, state data shows.

There were 646 crisis text messages from Kentuckians from January and June of 2022, the Lantern previously reported. Then, after 988 launched, that jumped to 2,286 crisis messages — an increase of 254%.

In February, 727 texts and 634 calls came in, according to a Cabinet for Health and Family Services report. In the past year, there was a 30% increase in Kentucky-based calls overall.

People who answer the line said that since the launch of 988, calls have expanded beyond suicidality. Sometimes, people are calling 988 just to talk and de-stress at the end of the day or middle of the night.

Roughly 138 Kentuckians answer the crisis line at Kentucky’s 13 participating call centers.

In March, there were 112 full-time and 26 part-time employees answering 988, according to estimates from Kentucky’s chapter of Mental Health of America.

Those Kentuckians spend their shifts saving lives behind the scenes. They also, sometimes, just listen.

Marcie Timmerman, the executive director for MHAKY, said the folks who answer 988, which was first proposed in 2019, are “first responders.”

“They’re really the first people who can respond to a mental health crisis,” Timmerman said. “They’re really crucial to the system.”

Driven by empathy

Randolph isn’t alone in pulling from personal experiences to help others who call or text 988.

Her colleague, Abby King, grew up hearing her mother advocate for mental health. That’s because before she was born, her grandmother died by suicide.

“Suicide” and “mental health” were “vocabulary words that I knew from a very, very young age,” the Bowling Green woman said. “So I think that that may have just made me more compassionate and understanding to the world at a really young age.”

King never got to meet her grandmother, but said she’s always had compassion for her, which she tries to extend to people who call the line.

That’s also made her anxious on some calls. “I know that suicide is real and does happen,” she said. “No one’s immune to it.”

It’s also difficult, once a call is over, to let go. Many times, King and Randolph said, they don’t know what happened with a caller once they hang up.

“I definitely think to myself, ‘how did this turn out?’” Randolph said. “You have to have hope and faith in the system … but yeah, I think about certain or really impactful, emotional calls all the time.”

The most important thing when taking a 988 call or text is to make sure the person reaching out is safe and feels heard, answerers say.

“The number-one priority is making sure they’re safe in that moment,” said Randolph.

Responders will balance listening to a caller vent while doing a risk assessment to see if the caller has hurt themself or plans to, if they have a suicide plan, and more.

“We have processes and protocols, like the risk assessment and then safety planning,” King explained. “But really, it’s just that natural human interaction that makes the call successful.”

Once the caller is safe and hangs up, responders may need to decompress and process what they’ve just heard.

King keeps her workspace calm, she said, for that reason. She may have essential oils or incense out or keep a virtual fireplace crackling on her TV.

Sometimes, decompressing is as simple as walking outside and feeling cool air on her cheeks.

“It can be as simple as taking a step outside, letting my dogs out,” Randolph added. “Touch the grass so to speak. Just making sure I’m reminding myself that I’m doing good work is really important. And a good face mask never hurt anyone after shift.”

 

Holliss Williamson at River Valley Behavioral Health
in Owensboro (Photo by Arden Barnes via Kentucky Lantern)

Holliss Williamson, a triage specialist in River Valley Behavioral Health in Owensboro, said she turns to her coworkers for support after especially difficult calls.

Her team of eight fills in for each other when one needs a mental health day or to just walk away from the desk for a while. They each know the toll crisis response can take on a person.

“We take secondary traumatic stress, vicarious trauma and burnout very seriously,” said her coworker Gerrimy Keiffer, a social worker at River Valley. “Working a crisis line is incredibly stressful because, in some cases, you don’t know if that person actually got help or if they got better when that phone call ends.”

River Valley crisis workers also have access to an app called Heroes Health, which lets them track their mental health and access resources.

King said she compartmentalizes her feelings while on calls.

“While I’m on the call, my main priority is to make sure that they’re safe. And that’s the perspective I try to keep to keep me calm throughout the call, even if I’m … even relating to some of the pain that they’re talking about,” she said. “It’s just reminding myself that I’m currently in a safe environment, and they’re not. So I have to make sure to provide that safety.”

A self-care action plan can also help when dealing with a lot of trauma. That can include asking:

• What brings me joy?
• What helps me reset?
• Am I getting tense?
• Am I having trouble breathing?

The effect of Covid-19 and anti-LGBTQ laws

The Covid-19 pandemic, Keiffer said, has “caused a lot of stress and unsurety” among the community, resulting in more calls to crisis lines.

“Combine that with loss of jobs for many, unstable employment, unstable economic environment that we’re entering right now, as well as a lot of the political and cultural strife we’re experiencing,” he said. “Within the last few months, we’ve also seen an uptick in individuals experiencing issues related to gender identity and LGBT concerns.”

He pointed to legislation targeting transgender Kentuckians as being a stressor for many.

River Valley has also seen an uptick in calls from youth, particularly those re-entering a public school setting after learning at home for so long because of the pandemic.

The Centers for Disease Control and Prevention reported in February that more young girls are feeling depressed.

Almost 60% of teenage girls “felt persistently sad or hopeless in 2021,” the CDC said. About 30% of teenage boys felt that way. Teens in the LGBTQ+ community suffered “ongoing and extreme distress.”

The CDC also reported that about 1 in 3 teen girls seriously considered attempting suicide in 2021.

“Add on the stressors that normally would be experienced as a youth like bullying, the anxiety of tests and just your own interpersonal issues, and then we throw on top of that the emotional triggers that you deal with that are exclusive to living during a pandemic, and that kind of unsurety,” Keiffer said. “It’s very difficult for kids, especially because that ability to emotionally regulate hasn’t fully formed. It is absolutely a concern.”

 
Will the police get involved if I call 988?

Several folks who answer 988 in Kentucky said police would be involved only as a last resort. For example, police may be called if a person admits to having a weapon and wanting to harm others.

Keeping everyone safe can be a balancing act.

“We don’t want to criminalize mental health,” Keiffer said. “If (people are) experiencing a mental health challenge, I want them to feel secure and safe to reach out for help.”

“Involving law enforcement immediately makes that person feel more stressed out,” Keiffer explained. “Having a police officer knock at your door when you’re having, for many, the worst moment in their life … we want to avoid that if we can.”

No wrong door

People who answer 988 aren’t just there to save lives. They provide an anonymous listening ear for people who just need to vent or maybe don’t have a support system.

“You can’t get to the saving,” Randolph explained, “without first listening to the client.”

They’re also focused on getting everyday resources to people in need. They may help a caller find food banks or places that can help with rent or housing. Lacking transportation or internet access, too, can lead to suicidal ideation. For teenagers, it’s often an issue of parents not supporting them or listening to them.

At River Valley in Owensboro, staff can direct callers to gambler’s addiction help, a sexual assault support line and more.

Basically, there is “no wrong door,” Keiffer said.

“I think of 988 as suicide prevention, but also a helping line,” Randolph said. “If you call me I might be able to connect you with several different things all at once or give you resources and advice on where to get those things.”

‘Please don’t prank-call 988’

Several 988 responders said they get prank calls, often from kids.

“I kind of just laugh a little bit,” King said, “because it comes from a place of: ‘I’m happy that these resources are available now.’”

Still, experts say mental health should be taken seriously.

“Mental health is not something we joke about,” said Timmerman, of Kentucky’s chapter of Mental Health of America.

So: “Please don’t prank-call 988.”

In the 2024 legislative session — a budget year — Kentucky’s chapter of Mental Health of America and the American Foundation for Suicide Prevention will be asking the General Assembly to allocate general fund dollars to 988.

“We need to fund” 988, Timmerman said, “as equally as we do 911.”

Just start with hello

Beyond funding, crisis workers say they need more awareness of the 988 number and education surrounding stigma.

“We’ve taken callers who were leery about even calling in,” Williamson said. “even some callers will hang up because … there’s a stigma … or they just don’t feel comfortable and never had to address their issues in that way.”

Some also recommended embedding social workers with police so when they do have to respond, trained mental health professionals are on hand.

Keiffer said if you don’t know where to start when calling 988, just start with hello. And: “If you don’t feel comfortable calling right away, that’s okay,” he said. “But do try again.”

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Boyle County named Kentucky's first Recovery Ready Community

Boyle County Judge-Executive Trille Bottom accepts the Recovery
Ready Community certificate from Gov. Andy Beshear. (Screenshot)

Boyle County is Kentucky's first Recovery Ready Community, a designation that reflects commitment to providing residents with access to addiction treatment and recovery support and removing barriers to the workforce. Applications for the designation opened in January.

The certification is designed to encourage communities to provide transportation to and from employment services and job interviews, allowing people to make positive changes while filling the state's need for workers at a time of record-low unemployment, said a news release from Gov. Andy Beshear.

“Boyle County has set a strong precedent that can serve as a model for the rest of Kentucky’s communities,” Beshear said in the release. “I continue to encourage each of the commonwealth’s counties and communities to apply for certification. If we work together to build a safer, healthier commonwealth, we can rise above drug and alcohol addiction in our state once and for all.”

Beshear said at his weekly press briefing that more communities are soon to follow. He was joined at the announcement by several leaders from Danville and Boyle County. Their efforts include free training for overdose response and Narcan distribution, hiring a social worker as an opioid-outreach coordinator to make EMS runs involving suspected overdoses to connect the individuals with treatment, counseling and other addiction support services.

Boyle County (Wikipedia map)

“When we came face to face with the effects of the opioid crisis on our families, institutions and workforce, we got to work to be informed, responsive and proactive,” Judge-Executive Trille L. Bottom said in the release. “We started a harm-reduction syringe-exchange program. We took a hard look at our jail becoming a place of rehabilitation. We encouraged new treatment and transitional living providers to come to Boyle County, and we trained a lot of citizens in saving lives from overdoses.”

Pam Darnall, chair of the state Recovery Ready Communities Advisory Council, which apprpoved the designation, said “We are inspired by Boyle County’s commitment to continue strengthening its local recovery-oriented system of care through persistent cross-agency collaboration and a willingness to try innovative programs and interventions aimed at increasing positive public health and safety outcomes.”

To learn more about the program and apply for certification as a Recovery Ready Community, click here.

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Hazard-area facilities, which offer a wide range of services, show that rural health clinics can be more than mere safety nets

One of the clinic's locations (Photo by Taylor Sisk)

By Taylor Sisk, The Daily Yonder

At just five weeks old, Waylon Williams is a trailblazer. He’s the first baby born in Primary Care Centers of Eastern Kentucky’s new women's residential center. The facility, called Beacons of Hope, offers temporary housing for women confronting substance-use disorder.

That recovery housing for women is available in a rural, financially challenged community is noteworthy. That it’s available for women with babies is remarkable. Equally so is the fact that PCCEK is a rural health clinic, and recovery housing is not among the services rural health clinics typically offer. A men’s residential center is soon to open.

Beacons of Hope is an extension of PCCEK’s Pregnancy & Beyond, an addiction-treatment program that offers obstetric services, medication for substance-use disorder, prenatal education, pediatrics, and counseling – services that in so many rural communities nationwide are in critically short supply or entirely absent. 

Hazard, where the largest of PCCEK’s four clinics is located, is in Perry County, which ranks 117th among Kentucky’s 120 counties in health outcomes. Life expectancy at birth is 67, as compared with 78.5 in the U.S. 

Addressing such challenges requires the full force of a health-care ecosystem that includes hospitals, clinics, private practices, public-health agencies, and a range of support services. Rural health clinics play a critical role in this ecosystem.

RHCs are safety-net providers whose original federal mandate was maionly to increase access to care for those on Medicaid or Medicare. They provided primary care and perhaps a few other services. But the Rural Health Clinic program has evolved over the years, and some clinics, like Primary Care Centers of Eastern Kentucky, have expanded their roles quite considerably.

Among the health care services, PCCEK offers are dentistry, a diabetes center, a women’s health center, extensive radiology and imaging, a range of behavioral-health services, a pharmacy, and a hospice care center. It offers a sliding scale for fees.

PCCEK has nurses in each school in the county system. It has an event space where it hosts maternity fairs and Easter, Halloween, and Christmas gatherings, and which in the wake of the region’s catastrophic flooding last July served as a distribution center for food and supplies.

Barry Martin, CEO of Primary Care Centers
of Eastern Kentucky (Photos by Taylor Sisk)

And with such a wide array of services, CEO Barry Martin contends, PCCEK is addressing arguably the greatest challenge to rural health care: a shortage of health care professionals. 

Gale said the projection is that there’ll be a shortage of 50,000 or more primary care providers nationwide by 2032, and that the majority of those available aren’t likely to want to practice in rural areas, said John Gale of the Maine Rural Health Research Center.

It’s taken some time, Martin said, to impress upon newly minted health care professionals that Perry County is a promising place to build a career, but his message appears to be resonating. He’s especially focused on enticing young people from the region to head back home and hang a shingle at PCCEK.

“Come back here,” Martin urges them. “Look at what we’ve built. It’s not a double-wide on the side of the road.”

Meeting needs, steady growth

The number of RHCs has grown significantly over the past decade or so. In 2010, there were fewer than 4,000; today, there are 5,270. They’re in every state except Alaska.

The Rural Health Clinic program was launched in 1977 as a Carter administration initiative. The impetus was to make it more viable for rural providers to stay in business with a relatively heavy load of Medicaid and Medicare recipients and few patients with private insurance by offering higher reimbursement for those federal programs.

RHCs must be in a health professional shortage area. They must take a team approach to care: physicians working with a staff of nurse practitioners, physician assistants, certified nurse midwives, and others.

RHCs differ from federally qualified health clinics in that FQHCs can’t be for-profit providers and must be governed by a board of directors of which the majority of members are patients of the clinic and demographically representative of the community. FQHCs must offer primary care and preventive and enabling service,s such as case management and transportation. In meeting these stipulations, they receive higher reimbursement from the federal government.

PCCEK is a for-profit entity. It launched in October of 2003 in a 6,700-square-foot facility with 15 employees offering family medicine, pediatrics, simple X-rays, ultrasounds, and a lab. In 2008, it expanded into a 30,000-square-foot building, and in 2015 into its present Hazard location, a 60,000-square-foot complex, formerly a discount department store. It also has clinics in nearby Hindman, Hyden, and Vicco.

More than 39,000 unique patients came through PCCEK’s doors last year, Martin said, for a total of 180,000 encounters. The clinic employs more than 400 people.

‘Ease a little bit of the burden’

“I like to say that we provide services from the head to the toe and the womb to the tomb,” Martin said. “And that is true.”

Care for diabetics is an urgent need in this region. In 2021, Kentucky had the sixth highest diabetes death rate in the country. The state Department for Public Health reports that between 2000 and 2018, the number of diabetes diagnoses had doubled. Perry County has among the highest incidence rates in the state. 

PCCEK operates the Mary E. Martin Diabetes Center for Excellence (named in honor of Martin’s mother). It’s the only diabetes facility affiliated with the University of Kentucky’s Barnstable Brown Diabetes Center. It offers comprehensive case management. 

Martha Bailey, diabetes educator

“We try to ease a little bit of the burden,” said Martha Bailey, a registered nurse and licensed diabetes educator from adjoining Letcher County. “We’re doing preventive maintenance. We’re talking to them about their diabetes.” 

Before PCCEK opened its diabetes center, people routinely drove 250 miles roundtrip to Lexington to see a doctor for it. Many simply went unexamined and undiagnosed.

“They may come in here and have an ulcer they didn’t even know they had,” Bailey said. “We’ve had patients come in that had tacks in their feet. They didn't know it until we did the exam.” 

PCCEK is the only place in Eastern Kentucky offering pedicures specifically for diabetics. “When they do the foot care here,” she said, “that’s their time to be pampered.”

The center also provides $10 vouchers for the local farmers’ market. “With the people on fixed incomes, that helps them eat a little bit healthier,” Martin said. 

Immersion in a community

John Jones, PCCEK’s medical director, oversees the diabetes center and Beacons of Hope. He’s a Hazard native, and while he believes that being homegrown certainly helps in most effectively reaching his patients – “We just know each other; the trust is there” – he hastens to add that trust can likewise be built in those who come from elsewhere, assuming you’re willing to make yourself known in the community.

“I think it’s a little different than the stereotype,” Jones said. “They’ll accept you with open arms. It’s just about being out there.”

Trust was of the essence after the July flooding. Jones tells of a father, mother, and daughter who were swept from their home, strapped themselves to a power pole, and hung on. The family now lives with relatives. 

When it rains, Jones said, the child is terrified; she has nightmares and flashbacks. When he talks to the dad about exploring counseling, “I think he doesn’t hear that from me as a doctor; he hears it from me as a friend.” 

Dealing with such issues – or dealing, on a day-to-day basis, with a patient who’s homeless with no way to refrigerate their insulin, or one with no transportation to make an appointment – such things aren’t taught in medical school. You learn through immersion in a community.

Martin trusts he’s creating an environment that will draw young professionals into his community.

He said the benefits of a comprehensive rural health clinic to a region and state are clear. “The governor is looking for people like us to help develop a second-chance workforce,” Martin said, “and that’s what we’ll be doing with Beacons of Hope.” 

The big-picture objective for all stakeholders is a continuum of care: health, housing, employment, well-being. 

“I got lucky,” Brittany Williams said of finding a temporary home at Beacons of Hope for herself and her son Waylon. “They’ve taught me self-control,” she said, “and structure. They’ve helped me structure my life.” She’s hopeful about the futur    e.

This article first appeared on The Daily Yonder and is republished here under a Creative Commons license.

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After three years of Medicaid enrollments piling up to a record number, those on the program must go through a renewal process

By Melissa Patrick
Kentucky Health News

Kentuckians on Medicaid need to pay attention to any correspondence from the state's Medicaid program. The Department for Medicaid Services has resumed its annual renewal process for Medicaid members because the pandemic rules that allowed continuous enrollment have ended. 

The process that allows Medicaid agencies to restart the annual renewals -- and kick off those who no longer qualify -- has been dubbed "Medicaid unwinding," a process that will take 12 months to complete, since it will use each Medicaid member's renewal month.

"We are currently outreaching to individuals with a May 31 renewal date. This means those individuals have until that date to renew with Medicaid," Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services, said in an email.

"The most important thing Kentuckians on Medicaid need to be doing right now relating to the unwinding includes making sure we have up-to-date contact information," Dunlap said. "That way, Medicaid can contact members about renewing, if needed. We are telling all our members to visit their account at kynect.ky.gov to review their information and make sure everything is correct. If they do not have an account, we recommend they create one." 

At a monthly stakeholder meeting in April, Deputy Medicaid Commissioner Veronica Judy-Cecil encouraged Kentuckians to use their Kynect health-benefits account for renewal. "It is going to be the fastest and easiest way for redetermination to be processed," she said.

Cabinet for Health and Family Services table; click on it to enlarge

If not signed up for Kynect, Medicaid members can complete and return forms via mail or fax, Judy-Cecil said. They can also call Kynect (1-855-459-6328) or the Department for Community-Based Services, or visit a DCBS office, a licensed insurance agent, or a Kynector, who helps Kentuckians enroll in coverage through Kynect.

As the Medicaid rolls have piled up with automatic renewals and additional enrollments, a record number of Kentuckians were enrolled in the program on April 1: 1,725,467. But on that day, the state could resume removing people from the program, and enrollment for May declined to 1,712,381. (For county-by-county enrollment numbers, click here.)

In April, the Medicaid department "estimated approximately 240,000 may lose eligibility" in the unwinding, health-cabinet spokesman Brice Mitchell said in an email. "However, until someone goes through redetermination, it is impossible to accurately forecast who will lose eligibility."

Of that 240,000, an estimated 75,000 have incomes over 138% of the federal poverty level, the Medicaid limit, and are likely to qualify for federally subsidized health insurance through Kynect.

Judy-Cecil said the state will reach out to Medicaid members about 90 days before their Medicaid renewal end date. Members will also get a notice about 60 days before their renewal end date and if there is no response by the 15th of their renewal month, they will get another notice. Members will get a renewal packet or a request for more information.

As of May 9, about 69,000 outreach calls had been made and over 17,791 calls had been received related to renewals, accoridng to the Public Health Emergency Unwinding website.

Judy-Cecil said Medicaid has prioritized contacting the Medicare-eligible population, since many Kentuckians stayed on Medicaid when they turned 65 instead of switching to Medicare. That's because the national public-health emergency rules required the state to continue coverage to get extra federal funds.

The priority from July until the end of the unwinding will be to reach out to those on Medicaid who make too much money to stay on the program. Judy-Cecil said it's important to make sure this group is aware of the ability to get federally subsidized health insurance to maintain their coverage. 

Cecil also wants providers to help out by reminding their Medicaid patients of their renewal date, which is available on each patient's KYHealthNet webpage. 

For a detailed explanation of the unwinding, see Medicaid’s response to frequently asked questions about member renewals.

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New UK medical-school graduate plans to pay it forward with a career in rural Kentucky, which needs many more physicians

Dr. Shelley Stiltner (UK photo)

By Melissa Patrick

Kentucky Health News

The University of Kentucky's Rural Physician Leadership Program is designed to increase the number of doctors in rural Kentucky, with graduates like Pike County native Shelley Stiltner.

After earning a UK undergraduate degree in nutrition, Stiltner graduated from the College of Medicine May 13. She is a first-generation college student who attended UK on a full scholarship, which she said she considered not only an investment, but also a thank-you to all of the people who helped her on her way, according to UK Medicine magazine.

Stiltner said she plans to embark on a career in rural medicine, not only to care for patients in need but to help inspire the next generation of rural physicians. 

She added that she worried when she started college and at times, even now, that the stereotype that is often applied to Eastern Kentuckians will overshadow who she is. 

"I spent so much time worrying that being from Eastern Kentucky would be my weakness, but it was my strength all along," she said.

Stiltner said she chose UK for medical school because of its "unwavering dedication to rural medicine" and called her decision to join the Rural Physician Leadership Program "one of the most rewarding decisions of my lifetime." 

" I have gained unmatched experience in rural health care and feel confident in my ability to take what I have learned and truly make a difference in a rural community," she said. "UK saw a grave health care need in rural Kentucky, which I call home, and developed a program to bridge the gap. For that, I am grateful." 

The need for more rural physicians is real and UK's RPLP program appears to be working. 

According to the federal Healthcare Provider Shortage Area tool, every rural county in Kentucky has a shortage of primary health-care providers.

And, according to a January 2020 report on the primary-care workforce shortage compiled by multiple authors at UK, "Kentucky produces and retains only about 55 new PC [primary-care] physicians per year, recruiting 55 to 60 more from out of state. This total of 110-115 new physicians falls short of the 124 PC physicians that must be added annually to avoid worsening our shortage, and far below the 246 PC physicians that Kentucky would need to add each year to reach the U.S. median in the coming decade."

The RPLP program began in 2009 and with this year's class, it has graduated 110 physicians who are well-versed in rural medicine, with their top three residency choices being areas of primary care, Allison Perry of UKnow reported in April. Two of every three RPLP alums are practicing in the state, and 92% of the participants from Kentucky now practice in rural Kentucky.

One is Stiltner. Asked what comes next, she listed several goals such as focusing on women's health, getting involved in providing medication-assisted treatment to women with substance-use disorders during pregnancy, and making an investment in the next generation of rural physicians by serving as a mentor. 

"There is no way I’d be where I am today without the help of mentors along the way," she said. "A promise I made to each of them was that I would pay it forward, and that is a promise I plan to keep. If I can inspire at least one budding rural physician that they have what it takes to make it in medicine, I will consider my career a success."

Stiltner advised future first-generation college students to "proudly be the first" in their family though it will be scary and come with a lot of uncertainty. She encouraged the students to find others who have been first-generation students and to lean on each other in that shared experience. 

"When things get hard, and you feel like giving up," she said, "remind yourself who or what your purpose is in chasing this dream."

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Questions and answers about end of public-health emergency

By Kate Yandell
SciCheck, a service of FactCheck

May 11 marked the end of the federal public health emergency for Covid-19, bringing changes to health care and public benefits. These differences include changes in the cost of Covid-19 tests and treatments and the potential loss of access to free Covid-19 vaccines for people who are uninsured.

The biggest change originally tied to the emergency designation has already gone into effect. The public-health emergency allowed states to keep millions of people on Medicaid regardless of eligibility in exchange for extra federal aid. But this continuous enrollment requirement ended March 31, and states are asking Medicaid members to reconfirm their eligibility.

The emergency began in January 2020 and was renewed every 90 days after that by the secretary of the Department of Health and Human Services. Following pressure to end the emergency with the introduction of the Pandemic is Over Act in January, the Biden administration announced on Jan. 30 that it would let the emergency declaration expire May 11.

The end of the public-health emergency is not the definitive end of pandemic-related policies. Some, including some changes to telehealth coverage and expanded access to free vaccines, are still in effect.

A declaration allowing the Food and Drug Administration to grant and maintain emergency-use authorizations for measures to combat COVID-19 has no stated end date. This means that authorized treatments and vaccines, such as Paxlovid and the bivalent Moderna and Pfizer/BioNTech vaccines, can remain in use.

How will this affect Covid-19 testing?

Costs of Covid-19 testing for individuals will rise, which the Kaiser Family Foundation called the “widest ​​ranging impact” directly resulting from the end of the public health emergency.

People on Medicaid will still be able to get free at-home or health care provider-ordered tests through September 2024, before potentially facing costs. However, the requirement that insurers cover eight at-home Covid-19 tests per month ended for most other people on May 11. Private insurers and Medicare Advantage plans could decide to keep offering this coverage, while traditional Medicare will no longer offer free at-home tests.

Tests ordered by health care providers will also get more expensive for individuals. As of May 11, private insurers and Medicare Advantage plans will be able to charge patients for these tests and related visits, following the normal rules of their health care plan. People on traditional Medicare will still be able to get provider-ordered tests for free, but they may pay for visits associated with the tests.

Depending on funding and supplies, other government programs offering free tests will continue, including a Centers for Disease Control and Prevention program designed for uninsured and other disadvantaged people. AHHS says says that the mail-order at-home test program will continue through the end of May.

How will it impact Covid-19 vaccines and treatments?

The end of the public-health emergency will not immediately change the availability and costs of Covid-19 vaccines or oral antiviral treatments. This is because the emergency constituted just one of multiple layers of laws and policies that make vaccines and some treatments free.

Currently, Covid-19 vaccines and oral antiviral drugs, such as Paxlovid, are sourced from the federal government’s own supply. These doses must be offered at no cost regardless of whether there is a public-health emergency.

However, the government supply of vaccines is only expected to last through the summer or early fall, depending on demand. It is also possible that a new version of the Covid-19 vaccine will come out, and these will be provided commercially rather than through government purchases.

Even after the federal vaccine doses run out, most people with insurance will still get recommended Covid-19 vaccines for free. Some laws requiring free vaccines for Medicaid and Medicare recipients were enacted during the pandemic, while requirements for no-cost coverage of any recommended vaccines from in-network providers were already in place for people with private insurance.

“It’s really the uninsured who will be the most challenged because there’s no permanent guarantee,” said Jennifer Kates, senior vice president and director of global health and HIV policy at the KFF.

To fill this gap, the Biden administration has proposed a Vaccines for Adults program, similar to the Vaccines for Children program, which provides free vaccines to children whose families couldn’t otherwise afford them. Congress has not been willing to enact this program, however.

On April 18, the administration announced the Bridge Access Program, which will temporarily provide vaccines and treatments to the uninsured. This depends in part on the government purchasing vaccines and treatments, but also on pharmaceutical companies being willing to provide them for free. “It’s not permanent and it’s unclear how far it will go,” Kates said.

The federal supply of Paxlovid will be depleted by early fall, Kates said, and some people with private insurance or Medicare will face cost sharing, just like with other drugs. As with Covid-19 tests, people on Medicaid will continue to have access to free Covid-19 drugs through September 2024.

Vaccine mandates and other changes

The Biden administration has announced it will lift most federal vaccine mandates. These mandates are winding down around the same time as the public health emergency but were ended by a separate action.

Mandates for health-care workers at facilities that treat patients on Medicare and Medicaid will end soon, with more details to come. The administration also announced an end to vaccine requirements for Head Start and federal workers, although these mandates had already been blocked by courts.

Some other policies and changes allowed during the public-health emergency will remain. For instance, many telehealth-related changes for people on Medicaid and Medicare have been made permanent or extended through the end of 2024, Kates said. Changes to rules about limits on take-home doses of methadone and access to controlled substances via telehealth will also be extended, with the intention to eventually make some permanent.

Many changes will not be immediately obvious to the public, although they could have an indirect impact. Just to name a couple examples, hospitals will no longer receive extra money from Medicare for treating hospitalized COVID-19 patients and a number of waivers are ending, such as relaxed rules on what types of care different providers can give.

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American Psychological Association issues research-based recommendations for use of social media by young people

Shutterstock photo via The Conversation

The American Psychological Association has issued recommendations for adolescents' use of social media, noting that while the platforms can promote healthy socialization, young people should not use them until they have taken training in social media literacy to give them skills to have "balanced, safe and meaningful experiences," APA says.

Social media are “neither inherently harmful nor beneficial to our youth,” APA President Thema Bryant said. “But because young people mature at different rates, some are more vulnerable than others to the content and features on many social media platforms that science has demonstrated can influence healthy development. Just as we require young people to be trained in order to get a driver’s license, our youth need instruction in the safe and healthy use of social media.”

Bryant appointed an advisory panel to issue the 10 recommendations, titled the American Psychological Association Health Advisory on Social Media Use in Adolescence. It recommends psychological competencies that youth should possess before using social media, plus periodic booster training to minimize the chances for harm and maximize the benefits that social media can provide.

The advisory notes that not all findings apply equally to all youth: “Scientific findings offer one piece of information that can be used along with knowledge of specific youths’ strengths, weaknesses and context to make decisions that are tailored for each teen, family and community. Age-appropriate use of social media should be based on each adolescent’s level of maturity (e.g., self-regulation skills, intellectual development, comprehension of risks) and home environment.”

Among the report’s recommendations are:

• Tailor social-media use, functionality and permissions to youths’ developmental capabilities; designs created for adults may not be appropriate for children.
• Adults should monitor younger adolescents' social media use, including discussing and coaching about content. This should be balanced with youths’ appropriate needs for privacy. Autonomy may increase gradually as children age and gain more digital literacy.
• Minimize adolescents’ exposure to social-media content that depicts illegal or psychologically maladaptive behavior, including content that instructs or encourages youth to engage in self-harm or high-risk behaviors or those that encourage eating-disordered behavior (such as restrictive eating, purging or excessive exercise).
• Minimize adolescents’ exposure to online content that promotes discrimination, prejudice, hate or cyberbullying, especially directed toward groups targeted because of race, ethnicity, gender, sexual orientation, religion or disability status.
• Monitor adolescents for signs of problematic social media use that can impair their ability to engage in daily roles and routines and may present risk for more serious psychological harms over time.
• Limit social media use so as not to interfere with adolescents’ sleep or physical activity, as each is required for healthy brain and psychological development.
• Limit adolescents’ use of social media for primarily beauty- or appearance-related content.

The report acknolwledges that it is not yet possible to determine if social media harm youth. Relatively few studies have been conducted with youth from racial, ethnic, sexual, gender, socioeconomic or differently-abled populations, and/or youth with chronic developmental or health conditions.

Researchers at Baylor University in Texas recently reported that "immersion in a world created by the social media experience drives problematic social media behaviors and addiction." The report calls for “a substantial investment in research funding” and access to more data, including data from tech companies.

“We hope these recommendations will be helpful as we all try to keep pace with the rapidly shifting social media ecosystem,” APA CEO Arthur C. Evans Jr. said. “APA will continue to keep tabs on developments within the current and future platforms, with an eye toward safeguarding our youth and enabling them to benefit from the positive aspects of social media.”

The APA said its recommendations are based on scientific research in psychology and related disciplines, conducted with thousands of adolescents who completed standardized assessments of social, behavioral, psychological and/or neurological functioning, and reported engaging with specific social media functions or content, or were observed doing so.

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