Equity for Transgender Healthcare

By John T. Engel | Counselor, MSW, LMSW

Healthcare equality means everyone who comes to NOAH receives the same care, respect, compassion, and one-on-one focus from their providers. Some groups in our society have experienced inequality in their care, often called disparities. One of the groups at the highest risk for healthcare disparities is our transgender community.

Transgender is a term use to describe a diverse group of people whose gender identity or expression may not align with societal expectation of how they should look, act, or identify based on the gender they were assigned at birth. Cisgender is a term that professionals use to describe individuals who do identify with the gender assigned to them at birth and who follow societal expectations for how the gender should look, act, dress and interact with others. Since cisgender individuals make up most people in contemporary society, transgender and other gender non-conforming people are often targets of discrimination and harassment. This can lead to negative health outcomes.

Due to a lack of knowledge, social stigma, ignorance, and discrimination, transgender people are often ignored and underserved by health care providers.

National Coalition of STD Directors

The most pressing health concerns to the transgender community are an increased risk of HIV infection, especially among transgender women of color. In addition, transgender men experience a lower likelihood of preventative cancer screenings. Making things worse, transgender people are less likely than the general population to have health insurance, and therefore more likely to need public programs such as Medicare or Medicaid. These barriers to care are too common in the lives of transgender and gender non-conforming people.

Social stigma associated can also directly contribute to dangerous situations, particularly for people of color.  According to Human Rights Campaign Foundation, at least 85% of violence against transgender and non-conforming people were persons of color. Fortunately, many physicians recognize this and recommend consultation with a mental health professional if the client desires.

Under the Health Care Rights Law, it is illegal for most public and private insurers, providers, and medical centers to discriminate against someone because of their sex. Learn more about rights at National Center for Transgender Equality.

As a professional counselor and a cisgender man, I cannot begin to imagine or to speak from a perspective of being gender fluid or transgender, however as a member of the LGBGQ+ community I feel that healthcare is an essential right for all colors of the rainbow. Sadly, I am aware that healthcare equity for my transgender brothers and sisters has been a concern for years, and if you are a person of color this can have serious consequences.

Our NOAH team works to ensure health care equity for all, by listening, validating, and building upon NOAH’S commitment of inclusivity. If you want to talk with a NOAH counselor, request an appointment today.

Child Abuse Prevention – It Takes A Village

By Glenda Henman, Behavioral Health Counselor

April is National Child Abuse Prevention Month. Most people avoid thinking or talking about child abuse and neglect because it is upsetting and difficult. However, in 2014, there were more than 700,000 children who were victims of child abuse and neglect. Knowing how big the problem is means we can take action to reduce this number and support these children as they recover.

We know now that child maltreatment (a phrase that includes abuse and neglect) can have lifelong and even generational impacts on physical and mental health known as Adverse Childhood Experiences (ACEs). It might be Child Abuse Prevention Month, but at NOAH, we work to prevent and heal child abuse every day.

Impact on Children

People usually think of visual, physical abuse or injuries, but child abuse takes many forms. Emotional neglect, medical and educational neglect, and sexual abuse are other forms of child maltreatment. Too often, these children are also facing other negative experiences like parental substance abuse, domestic violence, and poverty.

What to look for:

  • Talking about the abuse
  • Sexual knowledge beyond their age
  • Withdrawing, running away, or avoiding a specific person
  • Nightmares, bed wetting
  • Changes in mood or appetite
  • Being fearful of a parent or caregiver
  • Sudden changes in behavior

Preventing Abuse and Neglect

Many of us here at NOAH, like doctors, nurses, dentists, psychologists, and others are Mandatory Reporters and must report abuse or suspected abuse of children or vulnerable adults. Reporting abuse is an essential step, but we can all be an advocate to prevent child abuse.

The best way to prevent child abuse is by promoting protective relationships and environments. Protective factors are tools and support that help a family stay strong so they can face challenges together like:

  • Social connections
  • Parenting knowledge
  • Reliable and safe support in times of need

If you or someone you know needs additional support, NOAH is a great place to start! Our Community Resource team can connect families to resources, and our Behavioral Health team is here to support parents develop resiliency to face challenges.

Actions for everyone

Whether we have children in our lives or not, we can all take steps to help protect children and support families in our lives and our communities.

  • Read books or articles, attend trainings or classes on parenting, or get involved with trusted resources like community leaders, schools, libraries, clergy, or these organizations:
  • Ask for help when you need it.
  • Offer to help people in your life who are parents or raising young children.
  • Be a friend to a child you know; remember their name, show them you care.
  • Teach children how to be safe from sexual abuse with age-appropriate, open conversations with your children about bodies, sex, and boundaries. If you need help in having these conversations, or how to prepare, our counselors can help.
  • Find out about local resources and refer families. Learn more on 211arizona.org.  

The phrase ‘it takes a village’ is thrown around a lot when talking about raising children. But all too often, people who need that ‘village’ the most, don’t know where to find it. The best way to make sure children are safe and cared for is with a safe, healthy, supported family.

If you have questions, NOAH’s Community Resource team and Counseling team are a great place to start. Request an appointment today!

Is Kindness Contagious?

By Katelyn Millinor, LPC | Behavioral Health Quality Manager

Being kind to others is known to have lasting effects on our mental and physical health. But have you heard that kindness is contagious? That’s because it is!

Being kind lights up the pleasure center of the brain and releases serotonin and oxytocin.

  • Serotonin centers our mood, happiness, and overall feelings of well-being.
  • Oxytocin, often known as the “love hormone” controls social interactions, triggers the bond between mother and infant, and so much more.

The release of the hormone oxytocin is tied to decreasing blood pressure and reducing inflammation. Therefore, kindness feels good and is actually good for you.

Catching Kindness

Have you ever had a stranger pay for your coffee or hold the door for you? Experiencing an act of kindness can bring a smile to your face and improve your mood. In today’s fast-paced world, these gestures can be even more meaningful. Kindness benefits both the giver and the receiver. 

We often attach kindness to feelings of happiness. We may think of happiness as a mood or emotion, but really we are usually just feeling neutral which can make you feel cheerful. The feeling of happiness comes and goes with things like giving or receiving kindness, giving a compliment, or getting good news.

So, how can you continue giving random acts of kindness during a global pandemic? The possibilities are endless. With technology, people can send thoughtful text messages, social media comments or posts, Zoom or FaceTime interactions, and more. Outside of technology, think about leaving your mail carrier a “Thank you” letter, sending a picture or card to a front-line worker, or simply making a nice comment while picking up your groceries. Here are a few other ways to spread kindness in your day.

Everyone has experienced some sort of increased stress during this pandemic. That’s why kindness – in big and small ways – is more important than ever. Your one random act of kindness could change someone’s day and start a chain reaction of kindness!

It’s About More Than Just Food

By MaKayla Kellor, Case Manager

When you hear the phrase “eating disorders,” your mind immediately thinks about food, but what most people do not know is that eating disorders are so much more than just food. This year, during National Eating Disorder Awareness week, we hope to shed light on the deadliest mental illness, because though eating disorders are characterized by obsession with food, body weight and size, the root of an eating disorder is so much deeper.

What is an eating disorder?

  • A way to feel in control when everything else in your life feels out of control.
  • Numbing your undesirable feelings with lack of nutrition.
  • An attempt to achieve higher self-esteem and perfectionism through body image.

The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Though they all have their own signs and symptoms, they all have an equally negative impact on someone’s health, emotions, and ability to function in day-to-day life.

People with eating disorders usually do not think they have a problem. Here are some signs and symptoms to look for if you think someone in your life may have an eating disorder:

  • Skipping meals
  • Making excuses for not eating
  • Intense dieting
  • Excessively working out
  • Avoiding social activities involving food
  • Eating alone rather than with others
  • Lots of talk about body image or weight
  • Using dietary supplements or laxatives
  • Using the restroom immediately after mealtime
  • Eating much more food than a normal portion
  • Shame or guilt around eating

If you are worried that you, or someone you love, has an eating disorder, the best thing you can do to support them is show them love. Eating disorders, like any addiction, are not easy to let go of. You may feel frustration in the process with your loved one and notice that they are not always honest about their progress in recovering from their eating disorder.

Individuals recovering from an eating disorder need compassion and accountability. It may seem as simple as “just eating,” but the depth of an eating disorder and the control, safety, and comfort it provides individuals is much deeper. The unhealthy coping mechanism is still a coping mechanism that has gotten them through their pain, and it will require a lot of inner work. The goal is to get to the root issue that is being masked with disordered eating patterns. People suffering with an eating disorder can’t get better for someone else, so the best thing you can do is show patience and continuous support.

If you have questions about getting help for you or a loved one through an eating disorder, NOAH’s team can help. Call to schedule an appointment with one of our experienced providers.

Children’s Mental Health & Learning During COVID: A Series

By Zach Clay, Licensed Marriage, Family, and Child Therapy

During this unprecedented and often challenging time in the world, we need to consider the impact everything has on children. The COVID-19 pandemic can be particularly tough for children’s mental health and their ability to learn. NOAH’s Behavioral Health team shares expert insight, best practices, and resources in this series of posts to help children maintain mental health in the era of COVID-19, social distancing, and distance learning.  

Identifying Depression & Developing Coping Skills for Children

Children experience the world around them – the good, the bad, the stressful, the happy, the uncertain – and sometimes need support to navigate everything. In many ways, children are similar to adults with mental health; identifying what is happening, talking about what is happening, and developing healthy coping skills. Here, we highlight ways to identify depression in young children and coping skills that are easy for children to do and remember.

Signs of depression in children

Children who are experiencing depression may show it in a variety of ways. They may express feeling hopeless, helpless, and discouraged and as caregivers, we should listen and help them explain what they are thinking and how they’re feeling. But we must listen without judgement, or without trying to “fix” things. Parents and other caregivers don’t need to agree with what they are saying but do need to let them know that they are heard and supported. For example, “I hear you. That sounds really hard and I’m sorry you are feeling sad. I love you.”

Symptoms of depression may include:

  • Changes to sleep patterns
  • Gaining or losing weight
  • Sadness or irritability
  • Loss of interest in activities they usually enjoy
  • Unusual sadness or irritability, even when circumstances change
  • Reduced feelings of anticipation or excitement
  • Sluggish or lazy
  • Overly critical of themselves, like “I’m ugly.” “I’m no good.” “I’ll never make friends.”
  • Feelings of worthlessness, hopelessness
  • Thoughts of or attempts at suicide

It’s important to understand that this is more than a bad day or two, or occasional behavior changes that go away. If you see one or more of these symptoms for two weeks, they can suggest depression and you should make an appointment to get them professional help and support.

Developing coping skills

An important part of managing anxiety and fear is with healthy coping skills. These skills help you deal with stressful situations in a healthy and productive way. Mindfulness techniques are beneficial for all ages and are especially helpful for children. Mindfulness means taking time to focus on the present, be thoughtful about your feelings, focus your thoughts, and be in the moment.

These exercises take a little effort, but the investment is worth it especially now when there is such uncertainty about the future and what our world will be post-pandemic. These activities can make mindfulness work for both parents and children.

  • Squeeze Muscles: Starting at your toes, pick one muscle and squeeze it tight. Count to five. Release, and notice how your body changes. Repeat exercise moving up your body.
  • Belly Breathing: Put one hand on your stomach and one hand on your chest. Slowly breathe in from your stomach (expand like a balloon) and slowly breathe out (deflate).
  • Meditation: Sit in a relaxed, comfortable position. Pick something to focus on, like your breath. When your mind wanders, bring your attention back to your breath. Do this for just a few minutes.
  • Blowing Bubbles: Notice and talk about their shapes, textures, and colors.
  • Coloring: Color something. Focus on the colors and designs.
  • Listening to Music: Focus on a whole song or listen to a specific voice or an instrument.

Mindfulness doesn’t have to be a big deal or extra work. Take a few minutes in the morning, after school, before bed, or a time that works for your child and family to practice mindfulness.

NOAH’s comprehensive team of behavioral health experts  can work with you, your child and your entire family to address stresses, depression, coping skills, and more.

Children’s Mental Health & Learning During COVID: A Series

By Zach Clay, Licensed Marriage, Family, and Child Therapy

During this unprecedented and often challenging time in the world, we need to consider the impact everything has on children. The COVID-19 pandemic can be particularly tough for children’s mental health and their ability to learn. NOAH’s Behavioral Health team shares expert insight, best practices, and resources in this series of posts to help children maintain mental health in the era of COVID-19, social distancing, and distance learning.  

Adjusting to Changes in School and Learning

School is important for children. Even with more children learning through homeschooling or virtual schools before the COVID-19 pandemic hit, most children were still attending school in-person. When schools had to close and switch to remote learning in early 2020, children and families across the county faced a major adjustment.

While education is the primary goal, the school environment also provides access to friends, teachers, routines, and so much more. All of these things are critical for children’s academic and social development. On top of that, many students rely on schools for mental health care, along with nutritious and consistent meals.

Children experienced these changes while living through the uncertainty because of COVID and things outside of their control. That is a lot to ask of our kids.

How to best support children’s learning

Regardless of whether school is virtual or in-person for your child, this school year is different. Navigating remote learning or new rules, restrictions, and cancellations of regular school activities will be something parents and children need to do. Here are a few tips:

  • Set and keep a routine. Children benefit from routines, particularly in stressful times. Routines offer people of all ages comfort and predictability, so parents and other caregivers benefit too. Setting and keeping routines help children cope and can make school time more productive. More on coping skills for children in our next post!
  • Understand that (mis)behavior is often caused by emotions. Often times, a child may misbehave or have negative reactions for basic, emotional reasons. Frustrations with remote learning, cancelled parties, or other disappointments and unmet expectations can cause these emotions and behaviors. As the parent or caregiver, make the connection first to help change the behavior.
  • Develop important life skills. Remote learning can help children learn important self-regulation skills. Virtual classrooms and independent classwork offer the chance to set new goals, be accountable and independent, and learn to adapt if needed.
  • Be engaged in their education. This is always important for parents and caregivers to do. Ask about what children are learning and what they think is interesting. Help them organize their school day if it is virtual. Guide them through big assignments, help set goals, and give them choices about how you can help.

Monitor screen time

Screens are part of our daily lives. Before the pandemic, kids may be used to screens for fun activities like watching shows, being creative, and connecting with friends. Now, screen time might also be their classroom, group activity, class project and other extracurricular activities increasing their screen time even more. Here are some tips for managing screen time:

  • Kindness and some compassion go a long way. We are living through a once-in-a-lifetime event with the COVID-19 pandemic. A little unstructured screen time may be an important break or comfort for many kids. Letting your kids know that you understand their needs is a simple way to reduce stress for everyone.
  • Screen time can be a bonus. Try using extra screen time as an incentive for good behavior. If you try this, let your child know exactly what they need to do to earn the extra time. Write down the goal together and post it in their workspace as a reminder.
  • Keep a schedule. This can be part of the routine mentioned above. It’s helpful for kids to know when they’ll be allowed to use their devices. For example, maybe they always get 30 minutes before dinner. That structure helps kids know what to expect and can limit their requests for more screen time.
  • Set the example. It is so important for parents and caregivers to lead by example. If you set down your phone or tablet during set times (during dinner, after school/work, etc.), your children will be more likely to do the same. Plus, we all need to take breaks from technology and media, and we can all benefit from less time with our devices, and more moments with our kids.

Remember, we are all living through a challenging time, and children are experiencing everything happening around them. Spend some quality time with your child, which is proven to help kids feel appreciated and loved and gives them confidence in adapting to changes. NOAH offers comprehensive behavioral health services to help parents, children, and families during COVID-19 challenges, remote learning adjustments, and everyday life.

Above all, parents should know this: Do the best that you can. Your child appreciates it, even if they don’t show it now.

Children’s Mental Health & Learning During COVID: A Series

By Zach Clay, Licensed Marriage, Family, and Child Therapy

During this unprecedented and often challenging time, we should consider the impact it has on children. The COVID-19 pandemic can be particularly tough for children’s mental health and their ability to learn. NOAH’s Behavioral Health team shares expert insight, best practices, and resources in this series of posts to help children maintain mental health in the era of COVID-19, social distancing, and distance learning.  

Help children understand COVID

It is approximately 11 months after the COVID-19 pandemic began. In many ways, we are still adjusting to different phases of routines and “normal” life activities, and that includes children. Parents and caregivers should be able to talk about the impacts of the virus to help children understand without causing them to feel overly worried or anxious. NOAH experts support the following recommendations from the Child Mind Institute to help guide parents and other caregivers in these conversations with children.

  • Welcome their questions. Kids have questions! Any parent, teacher, grandparent, neighbor, babysitter, and friend knows that children have many questions. It’s a good thing because curiosity is an important quality in kids. Questions can range from serious, like “Will Grandma be okay?” to the much less serious, like “Will my favorite videogame store still be there?”. Encourage their questions and take their concerns seriously. Your goal is to help your children be heard and to answer their questions with fact-based information.
  • Don’t avoid questions you can’t answer. Telling a child “I don’t know.” is an acceptable answer when it is the truth. There is a lot of uncertainty right now, and things change frequently. While we want to tell our children that everything will be “back to normal soon,” we may not know. Helping your child learn how to accept uncertainty is key to reducing anxiety and helping them build resilience.
  • Be developmentally appropriate. Being honest is important, but that doesn’t mean giving too much information which can be overwhelming or confusing for children. Answer their questions honestly and clearly, and if they have follow-up questions they will ask because you have shown them you will answer their questions.
  • Deal with your own anxiety. We are living through a global pandemic and economic crisis. This isn’t an easy or normal situation for anyone of any age. It’s okay, and expected, for parents or caregivers to have sadness, stress, or anxiety about everything happening. But don’t try to talk to your children about their questions or stresses if you are feeling anxious or overwhelmed. Take some time before having a conversation or answering your child’s questions because it will be hard to help them if you are struggling. If you are experiencing stress and anxiety about COVID-19 or anything else, NOAH’s counseling team is available.
  • Be reassuring. Children may be worried that they will catch the virus or become afraid other people they care about will become sick. Reassure them that children don’t usually get very sick, and that as a family you are doing everything you can to keep them – and other people – safe and healthy by wearing masks, socially distancing, and following other recommendations.
  • Focus on what you’re doing to stay safe. Children will feel safe by having parents and other caregivers emphasize the safety measures that you, and others around you (like teachers, coaches, etc.) are taking. Remind kids that washing their hands is helping everyone by stopping the spread of COVID-19 and other viruses.

Keep talking to your kids. When they know you will answer their questions, help find answers together, tell them the truth, and help them feel calm and safe, they will likely keep talking. Many children (and adults) are visual learners and might enjoy learning about the virus with a comic book created by NPR. More on this series for Children’s Mental Health & Learning During COVID to come!

Meet Nikky

Our goal at NOAH is to provide compassionate, quality healthcare for our community. The truth is that doing this can and should look different for every person. Some people benefit from nutrition services to help tackle medical concerns. Others find relief from migraines through our dental team. Because comprehensive healthcare is individualized, NOAH takes the time to understand patients, and meet them where they are.

Meet Nikky

When Nikky was introduced to NOAH, it was at one of the lowest points in her life. She had recently left the hospital after an overdose. The mother of three had struggled for years with addiction, despite having had a happy childhood and a family she loved. Addiction impacts many people regardless of their income, education, address, or other factors.

After the third of fourth person from NOAH called to check on Nikky after being discharged, she paused and wondered if maybe NOAH was different. She was right; NOAH was different, and her life would never be the same.

Despite the COVID-19 pandemic changing everyone’s lives and stress levels, Nikky found stability and support in early 2020 from Pamela, her Peer Support Specialist at NOAH. Peer Support Specialists are uniquely qualified, caring team members. Five months after their first conversation, Nikky is seeing the amazing woman she was all along. Pamela is just a text or phone call away, but the progress Nikky has made is her own.

Watch Nikky’s Video

True Comprehensive Healthcare

NOAH offers services that treat the whole person. There is no one-size-fits-all way to help someone live a healthy life, especially if other challenges are standing in the way. Beyond medical, behavioral health, and dental services, NOAH offers community resources and a team working to ensure patients have other needs met with resources like income assistance, health insurance enrollment, and referrals to other programs.

Learn more about the services NOAH offers the community.

Coping Skills for this Holiday Season

Holidays and emotional health go hand in hand. In 2020 though, after living through about 10 months of a global pandemic, emotional and mental health this holiday season should be taken seriously for everyone. We will all benefit from using coping skills.

Whether people are adjusting to a holiday without loved ones, or are trying to keep everyone happy with adapted holiday celebrations, everyone should give themselves a break.

The behavioral health experts at NOAH want to see everyone enjoy the holiday season safely and happily.

First, we hope you have readjusted your expectations for 2020. Having really high expectations can actually impact your brain and your reaction. If you expect a holiday season that is picture perfect, when real life doesn’t meet your expectation, the reaction can be very real and very difficult.  

Next, our experts share ways to cope when things like stress, anxiety and depression start to take hold of you, your day and however you are celebrating the holidays this year. Coping skills can be different from person to person, and some may work in certain situations and not others.

Try these coping skills and use what works best for you

  1. Acknowledge your feelings. There is a lot more about this important step in a previous post, so read about that here.
  2. Talk to someone. This can be a counselor or therapist, or it can be a friend or family member who helps you feel heard and calms the situation without getting involved.
  3. Slow down. If you are doing too many things, being everything for everyone, and more, you need to slow down and take a break.
  4. Make a list. If you have a lot to do (see #3 above), and it is starting to cause stress, make a list. Crossing things off your list also gives you a sense of accomplishment which is a positive feeling.
  5. Do deep breathing exercises. Deep breathing exercises can have a lot of benefits to your overall health. Take deep breaths in, hold it for several seconds and slowly exhale. Repeat this for a minute or two.
  6. Get distracted. Step away from what is causing you anxiety or depression. Try to lose yourself in something else, like a puzzle, an easy project, adult coloring books, yard work or whatever can keep you distracted for a while.
  7. Take a walk. Walking outdoors is great for your health. Not only is the exercise good, getting fresh air and sunshine are also helpful for your overall health. Plus, taking a walk can distract you (#6) and help you slow down (#3) as well.
  8. Use your five senses. Do something that engages different senses. Notice what is around you using sight, touch, smell, sound, and taste. This will give your mind a break from things that may be causing stress.

This holiday season may not be what anyone is used to or what anyone expected, but that is okay. Be kind to yourself and others and enjoy the holiday season however you celebrate it.

Ways to Celebrate Family Caregivers this Holiday Season

While National Family Caregiver Month may be over, NOAH knows two things:

  1. Caregivers deserve to be honored, appreciated, and supported all year.
  2. Being a family caregiver during 2020 has meant something different than in past years.

Caregivers who are helping family members, friends, or loved ones who are aging in place or dealing with an illness (or both) give so much of themselves all year. How should you celebrate a caregiver in your life through the holiday season; especially during the 2020 COVID pandemic? We have some ideas.

But first, understand that being a caregiver during 2020 has been a much different experience.

Many adult and child daycare centers have closed at some point during 2020. Now, many of those places are functioning at a reduced capacity. What those care centers provide is a sense of community for the aging or ill individual, and respite for the caregiver.

Organizations that may have provided other types of support, like meal deliveries, have changed or cancelled how they serve people because of COVID. These services could provide much-needed support and a welcome face.

Lastly, there is stress and concern. Caring for older adults and people chronic illnesses or diseases can be even harder when a virus is in the community that is especially dangerous to the individual you are caring for. Caregivers may be taking extra precautions.

This gives everyone even more reason to celebrate these individuals throughout the holiday season! Here are some ideas:

  • Food is always a welcome choice! If you can order meals to have delivered or drop off something for the caregiver so they don’t have to cook for themselves later, that will be a welcome gift.
  • Help stock their supplies. If you know what they need to provide care, you can help them out with extra supplies, or even books, games, puzzles, or other activities the patient or caregiver enjoy.
  • Personal pampering for caregivers. A personalized coffee mug for the coffee lover, a calming candle for the caregiver who likes to create a peaceful space, a journal for the writer, and lotion for everyone – because we are all (thankfully) washing our hands a lot more – are all great ways to show appreciation.

Everyone loves a thoughtful gift but showing gratitude and understanding for the hard work caregivers do every day is one of the nicest ways to celebrate them this holiday season and all year.