It’s a commonly accepted perspective in the field of mental health that all behaviors have a goal. When it comes to understanding youth who are challenged with an autism spectrum disorder (ASD), the key is realizing that all behaviors represent efforts to communicate. Rigid expectations of social behaviors and decision-making based on age can interfere with supporting a person on the spectrum, especially when communication is expressed differently when compared to the general population. While the behaviors of someone on the spectrum may seem unusual or even at times disruptive, the best approach for understanding a person with autism, especially youth, is to determine the goal, how the goal is communicated through their behaviors, and the intersectionality of those behaviors with peer interaction, transitioning to adolescence and adulthood, and adapting to new environments due to a military permanent change of station (PCS) or sudden absence of a parent. Intentionally diversifying sources of support can improve outcomes for youth especially as they transition into adulthood.

Understanding Autism[1]^,[2]

Autism Spectrum Disorder (ASD) is defined as a neurological disorder that, because of its effects on brain functioning, can negatively impact daily interactions such as socializing, displaying affection, and communicating. This impact has far-reaching implications, spanning multiple domains and presenting in an unpredictable manner. The severity of the disorder is compounded by co-occurring conditions and adverse reactions to sensory stimuli, such as lighting and noise.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides further clarifying terms, using two identifying categories of symptoms to provide a basis for diagnosis of autism:

• Persistent deficits exist in social communication and social interaction across multiple contexts and restricted, repetitive patterns of behaviors, interests, or activities.
• Some of the characteristics include repetitive movements and speech, inflexibility, fixated interests, and hyper-/hypo-reactivity to sensory input.

Similarities With Other Youth[3]^,[4]

Youth with autism are prone to experience the same desires for friendships and intimacy as their peers. They share the same right to have educators and family educate them on this topic. These youth will also experience peer pressure and bullying, as all youth do. Kids with ASD crave same-aged allies just like others their age. They are vulnerable to missing non-verbal cues that mask sarcasm, teasing and even malicious intent. Peers who are not on the spectrum but have demonstrated healthy social skills are ideal for helping youth with autism to communicate and understand communication.

Differences From Other Youth[5]

Understanding autism in youth is more than a simple exercise in definitions and categorizing symptoms—a concerted and diligent effort for research is needed across disciplinary domains. The CDC’s Study to Explore Early Development (SEED) has provided the most comprehensive study of ASD in the United States, examining the health, functioning, risk factors, and signs present in preschool-aged children. Such a study empowers others to support the ability of a person with autism to effectively communicate. Amid a scarcity of research exploring ASD among pre-/teens, the SEED’s usefulness has been further expanded to survey the families of 800 children between the ages of 12-16 who were a part of the initial phase of SEED. Although similarities between neurodivergent youth and neurotypical youth can easily be identified, this study shines a necessary light on the differences between adolescent cohorts.

The findings in this report reveal that adolescents with autism experience a need for greater support in the areas of physical and mental health, as well as extending the use of healthcare beyond the stage of adolescence, in contrast to peers their age.

In comparison to adolescents in the control group of this study, children with autism were 90% more likely to have co-occurring mental or physical health conditions and at the same time more than three times likely to not access appropriate health care for those needs.

Being included in general education classrooms is a boon to social competence in youth with ASD, but not a fix. Social deficits create a need for interventions that coach social skills for them, such as initiating or inviting others to play and engage, while these skills naturally occur in typically developing youth.

A peer helper can assist with bridging the gap between these differences, offering the chance for youth from both cohorts to experience and engage in friendly behavior in a variety of environments, such as classrooms, recreational areas, or after-school events.

It may be difficult for a child from either cohort to articulate the differences, but the relational tension will be present, nonetheless. Interventions should assist both children, equipping them with clearly defined choices that improve the likelihood of forming a healthy social connection between them.

Challenges for Military Families

Military sources indicate that more than 13,000 military dependents, the majority being children, have some form of autism. No matter where they go, their families will always be the immediate support system, a system vulnerable to emotions and challenges related to the difficulties of military life: a permanent change of station, frequently absent or deployed parents, changing primary care managers and parental/marital stress.

A diagnosis of ASD means that every day a caregiver must plan every activity to prevent behaviors that will likely be misunderstood by those untouched by ASD. Even when connecting the youth with an organization that can provide care and interaction outside of the home, the caregiver will need to provide specifics about their child’s needs and determine if the environment they are entering is an adequate fit. The environment should include staff trained to intervene and redirect especially by understanding what behavior that seems disruptive is trying to convey on behalf of the child. Most parents and caregivers find themselves repeatedly having to explain to other professionals why their child reacted the way they did.

Another frustrating factor that families looking for support outside of the home encounter is simply a lack of affordable and competent sites. The emotional toll on a parent or caregiver from frequently reaching a dead end can exhaust even the most resilient. The chances of finding a great fit for a youth with ASD is generally cut in half by the lack of behavior management services, the expense of the programs, and the sad reality of untrained staff.

Military families also encounter increased hardship introduced by the search for evidence-based treatment services, especially when a new duty station proves to be a disruption to receiving quality care. Not all stations have ease of access to needed services.[6] Military children and their families move every few years. These frequent changes hinder the ability to maintain secure relationships in the school setting and with each move, the rigors of advocacy for individualized services are reborn. Any family who has dealt with a military move can vouch that the process is replete with paperwork. A family who has a child with autism has their work nearly doubled. Important documents and steps to take include, but are not limited to, the most recent copy of an IEP, a current behavior plan, medical documentation, connecting with the receiving school play son, a new therapist, and finding a neighborhood accessible to community-based services.

Financial strain is another stressor faced by military families. Spousal unemployment can easily become a dynamic for a family with a child on the spectrum. It is often simpler and more cost effective to care for the child at home, especially when hours for paid time off become depleted due to frequent calls from the school for a parent to come deescalate the child.

Frequent moves, financial strain, and harried reintegration processes can mount into a tremendous pile of stress leading to feelings of isolation and marital discord in many cases. Finding and building a support system, albeit challenging, is not impossible and is worth its weight in gold. Despite all the barriers and challenges of a military lifestyle, friendships and systems that are built often turn out to be lifelong relationships. Military living means that a challenge posed for one is a challenge accepted by all.

How the MFLC Program Can Help with Communication

The Military and Family Life Counseling program supports service members, their families and survivors with confidential non-medical counseling where they are stationed. Recognizing behavior as a form of communication is a skill possessed by Military and Family Life Counselors (MFLC) counselors. MFLCs are in an excellent position to support families and schools by providing referrals and psychoeducation about the need for behavior to be interpreted rather than reacted to.

Anxiety for anyone is an emotion that disables executive functioning. MFLCs can equip staff and family with language that prevents and even deescalates anxiety in youth with autism. A person with ASD may look away for a moment or two before responding to directions. Rightly interpreting this behavior can prevent the wrong reaction and a misunderstanding. A pause in responding doesn’t necessarily mean unawareness or lack of intellect—for the person with ASD, looking away may mean, I need a quick break from stimuli.

MFLCs can also help by increasing awareness of incorrect assumptions, such as the aforementioned “pause” as a lack of emotionality, and biases built into labels such as low or high functioning. MFLCs can coach staff and family to ask, “what support do you need,” rather than assuming wrongly about the support needed at any point on the spectrum.

Effective communication is essential in at least two settings: school-based and healthcare. Data show a strong correlation between time spent in general education classrooms and increased academic skills and knowledge, receipt of a high school diploma, and/or increased access to typical peers, which promotes a primary desire for youth in general: healthy social relationships. The ultimate benefit is enhanced integration in the community. Youth participation in work opportunities, paid and unpaid, during high school is also connected to better outcomes in adulthood. To get started with the MFLC program contact your installation’s Military and Family Support center.

Tips for Preventative Healthcare

The single greatest external factor in fostering support for a teen preparing to enter adulthood is preventative healthcare. While under the care of their family, youth with autism benefit from services such as the Exceptional Family Member Program (EFMP), Extension for Community Healthcare Outcomes (a virtual interdisciplinary network for providers which includes parental feedback), Tricare, and Individualized Education Plans (IEP)/504 plans. However, as discussed, youth with autism are less likely to continue healthcare into adulthood. The goal for preventative healthcare is to equip the person receiving the healthcare with an awareness of what their health can and should look like and the right to receive that care.

An ideal strategy for improving health outcomes and reducing service gaps for youth with autism involves interdisciplinary training promoting the use of evidence-based interventions. Operation Autism lists several, including the most widely used, Applied Behavioral Analysis (ABA), Picture Exchange Communication Systems (PECS), and Speech and Language Therapy (SLT) across multiple contexts. At a minimum, as recommended by the CDC, care should be timely, coordinated, and family centered. Practitioners and school administrators should encourage parents and caregivers to enroll youth early in services, such as insurance plans and residential living, that support the transition to adulthood.

According to measures included in the Health Resources and Services Administration Maternal and Child Health Bureau National Performance as reported by the CDC SEED 2 study, practitioners should ensure three elements are met when establishing a wholesome health care transition:

• The youth should spend time alone with the primary care provider,
• The PCP should actively work with the child to understand healthy living, and
• The parent should know how the child will be insured when they reach adulthood.

Conclusion

The research-to-practice gap is steadily closing with studies such as SEED and the increase of evidence-based practices (along with the collective disapproval of ineffective and harmful treatment practices). Understanding the needs of youth with autism has been difficult but is no longer the apprehensive feat it once was, and while military families with ASD may have additional stressors, there is a system of support available to help navigate these challenges. Ultimately, communication is a gift for all human beings to use in the quest to understand one another, and establishing healthy communication with youth with autism is not simply a matter of teaching them what to say but it largely entails the ability to interpret what they are already saying.

This article was originally published on MFed Inform.

[1] Low Functioning to High Functioning Autism: A Prescriptive Model for Counselors Working With Children Across the Spectrum. Katherine Feather, 2016. https://www.counseling.org/docs/default-source/vistas/article_11d2bf24f16116603abcacff0000bee5e7.pdf?sfvrsn=4ca9442c_4

[2] Operation Autism. (n.d.). Life Journey through Autism: A Guide for Military Families

[3] Autism Speaks. 2013. Leading The Way: Autism Friendly Youth Organizations. https://www.autismspeaks.org/tool-kit/leading-way-autism-friendly-youth-organizations

[4] https://www.plannedparenthood.org/planned-parenthood-massachusetts/local-training-education/parent-buzz-newsletter/parent-buzz-e-newsletters/sexuality-education-youth-autism-spectrum

[5] Health Status and Health Care Use Among Adolescents Identified With and Without Autism in Early Childhood — Four U.S. Sites, 2018–2020. Powell PS, Pazol K, Wiggins LD, et al. https://www.cdc.gov/ncbddd/autism/autism-spectrum-disorder-in-teenagers-adults.html

[6] Toward Innovative, Cost-effective, and Systemic Solutions to Improve Outcomes and Well-being of Military Families Affected by Autism Spectrum Disorder. 2015. Klin et al. https://pubmed.ncbi.nlm.nih.gov/25745376/

Throughout the month of April, we are celebrating National Volunteer Month. We’re expressing our gratitude to all individuals who donate their time and resources to local or national efforts. In this spotlight are three Magellan Health employees who explain why they volunteer and what organizations are most important to them:

• Stephen Towns, director of project & program management, Magellan of Virginia
• Matthew Podjeski, vice president, Human Resources
• Barb Borowy, administrative assistant II

Continue reading to learn more about how Barb, Stephen, and Matthew donate their time:

What volunteer work do you participate in and for what organizations?

Stephen: In 2016, I launched a church campaign to help remove the stigma of mental illness among Black Americans. I began lecturing and teaching classes throughout the faith-based community to eradicate the demonization of those with a mental illness, inform our community on suicide prevention, and offer alternative solutions for substance abuse.

Shortly after the start of the COVID-19 pandemic, a government-sponsored food program approached me, seeking a partnership with our ministry to distribute food to our community. In August 2020, we began distributing over 36,000 pounds of food to our community every Saturday morning. At our peak, we had several Saturdays where we gave away over 72,000 pounds of food in less than three hours! The community embraced our ministry, and in March of 2021, we secured the building where we currently reside. Last month, we graciously accepted an award for a grant to sponsor a program I created, “Eat Well – Be Well,” which allows us to distribute $400 of fresh fruits and vegetables bi-weekly to a senior community we adopted. Helping to overcome the health disparities of aged people of color has been a tremendously joyful experience. We hope that if even in a small way, we can positively move the bar for the health of this community.

Matthew: I volunteer at Canterbury Enterprises, an organization that provides meaningful and nurturing onsite employment opportunities for individuals with disabilities. Our entire focus is on creating a supportive, engaging, and respectful workplace for folks whose abilities may not align with traditional workplaces. At Canterbury, our associates are part of a team, they are proud of the work they do, and everyone is dedicated to making it the best experience for each of our associates, as well as for their families. It has been fascinating learning the intricacies of running a sheltered workshop and navigating the legislative, accreditation, and business development opportunities involved, while never losing focus on those we serve – the employees who work at Canterbury.

I am also on the board for Clare’s House. Similarly, when my friend Terry Economos told me her vision for helping seniors and people who are challenged to keep their beloved family dog at home, I knew I wanted to dive in. Clare’s House walks dogs for people who cannot; we take beloved family dogs to visit their owners in assisted living and in rehab facilities. We offer fostering for those temporary periods where the owner is not able to care for their dog. We take dogs to groomers and help pay for medications and surgeries for folks who would otherwise consider relinquishing their beloved furry friend to a shelter. Clare’s House partners with VA centers and other facilities to support their residents to house their family pets if they cannot.

I also have the pleasure of providing leadership and support for the passionate group of Magellan employees who affiliate with the Maryland Heights (St. Louis), MO office, and volunteer to lead awareness and fundraising efforts for our highlighted local charities. Each year, these employees to select the charities to be highlighted for the year. The planning team initiates communication campaigns, onsite volunteering activities, and general awareness. In 2022, our employees touched the lives of many people in our communities, raising over $28,000 in donations.

Barb: Although I continue to actively support NAMI Maryland and the Maryland Food Bank locally, I’m currently focusing my efforts on donating to organizations, rather than in-person volunteering.

How did you get involved with this organization and volunteering in general? How long have you been volunteering?

Stephen: In 2016, I accepted the invitation to lead the Glen Allen VA chapter of Magellan Cares where I created the first onsite volunteer fair. Our Magellan Cares team engaged our coworkers to attend and commit to volunteering. The fair resulted in over a hundred employees signing up to volunteer at participating organizations.

Matthew: I started at Canterbury in 2015 where my friend served as the executive director. I shared with my friend that I was interested in volunteering and knowing I work in Human Resources, he recommended I join the board of Canterbury. I started volunteering at Clare’s House in 2020, the Women’s Safe House in 2002, and Room at the Inn in 2014.

Barb: I joined the company in 1992 and was quickly asked to join the newly forming Community Affairs Committee. Our focus was supporting NAMI Maryland and United Way of Central Maryland. Once our Columbia presence grew, we added support to American Red Cross with monetary donations and blood drives held at the office, Toys for Tots during the Holidays, Grass Roots (a Howard County organization dedicated to assisting victims of domestic violence), and the Maryland Food Bank. Recently we participated in and obtained a corporate sponsorship for the 2022 Walk to support the American Foundation for Suicide Prevention. Additionally, we are currently gearing up for the upcoming 2023 NAMI Walks event.

Why is it important for others to volunteer in their communities?

Stephen: When we can find commonality with others, despite our racial, political, ideological, cultural, or socioeconomic differences, that commonality can overshadow any differences and fulfill our human need for community. When that human need is fulfilled, it motivates us to want to do our part, not just for ourselves, but for others. And, particularly for those who are unable to do for themselves.

Matthew: I hope Volunteer Month serves as the bright light that gets you thinking about how you can help, and whose lives you can touch, at any time of the year.  There are so many people and families in our local communities who struggle in one way or another.

Barb: As Magellan employees, we are fortunate to be able to help and most have a cause dear to their hearts. All small donations add up, and participation in a local event that raises awareness and visibility to an organization that is personally important can be life altering to someone in need.

Is there anything else about what National Volunteer Month you’d like to highlight?

Stephen: Magellan employees are fortunate to work for a company that encourages everyone to volunteer. Many non-profit organizations are dependent on people like us who are willing to volunteer and help others in need.

Matthew: Thank you to those people who had a vision to create a service or pull a group of like-minded people together to help meet those needs. Vision is not enough – to make a vision a reality, organizations depend on people who have similar passions and a desire to make the world a better place for others.

Barb: I, personally, am a huge supporter of the American Red Cross. In most cases, they are first on the scene of natural disasters, man-made disasters, personal disasters, or wherever assistance is most needed. Then there are the blood donation management efforts. It just seems like, whatever is needed, the Red Cross is always there; and I try to be there for them!

Read more about additional volunteer work done by Magellan Health employees in the communities we serve here.

“Oh my! It’s raining cats and dogs out there!” A second-grade girl remarked as she stared out of a classroom window. Another child, wide-eyed and twirling her braid, turned and stared in shock and disbelief at the raindrop scattered windowpane. “What do you mean, those poor puppies!?” she cried. “Nooooo….” scoffed another classmate, “There are NO ANIMALS. She means it’s raining REALLY HARD.” The concerned child saddened about the well-being of the possible tumbling animals outside, slumped down in her chair, trying to avoid the gaze of everyone. Her eyes welled with tears, and she remained silent throughout the rest of the class. She continued to twirl her hair with more vigor. Soon the sun began to shine via the droplets on the windowpane, and she stopped twirling her hair to stare at the beautiful array of light. “This is a prism, a spectrum of light.” She whispered to herself.

Children with Autism Spectrum Disorders have their own unique struggle. Like the spectrum of light, Autism diagnosis defines a broad range of conditions that demonstrate marked struggles with language (expressive/receptive), repetitive/restrictive behaviors, social skills, and nonverbal communication. This vignette of an interaction between three 8-year-old children provides an example of a receptive language issue. For this little girl, she struggled to understand an idiom likening the raindrops to “cats and dogs falling from the sky.” Dr. Stephen Shore stated, “If you met one person with Autism, you have met one person with Autism.” He is an author, a professor of Education, and a member of the board of Autism Speaks, an organization created to educate and advocate for those affected by Autism throughout their lifespan. His quote incites awareness that while a child may be diagnosed with autism, their presentation and needs will be unique. (APA, 2013)

Autism Speaks shares statistics and trends that have shown a steady increase in the diagnosis of autism spectrum disorders (ASD). Diagnosis has become more comprehensive in recent years. Awareness and early detection have been associated with an increase in the frequency of diagnosis. The Centers for Disease Control (CDC) reported in 2021 that 1 in 44 children was diagnosed with an autism spectrum disorder in the United States. Autism affects children across all socioeconomic statuses and minority groups. Minority groups are diagnosed at a later age and at a lesser frequency than other demographic groups. Families face multiple challenges after diagnosis. These include parents having difficulty maintaining ‘out of the home’ employment while becoming full-time advocates for their children. The additional cost of providing treatment and care per child with ASD is approximately $60,000 per year (Autism Speaks, 2017).

Risk Factors of Military Children with Autism

While 1 in 44 children in the general population is reported to be diagnosed with Autism, the statistics are not entirely clear for military children. In 2020, TRICARE reported that across all branches of service, 34,361 military children were diagnosed with an autism spectrum disorder, with about 60% being children of active-duty Service members. It is suspected that these numbers are underreported (Klin et al., 2015). Military children with Autism and their families face unique stressors and struggles compared to their civilian counterparts. Military families must secure a treatment provider and participate in testing, diagnosis, treatment, and educational support while remaining mission-focused.  Stress is escalated with uncertainties about deployment, war, and geographic separation from their support systems in permanent changes of duty station (PCS) (OAR, 2019).

Case Study/Expertise

Although there have been many systemic improvements in services for military children, there are still barriers that exist due to the high mobility nature of military life. Most military families move every 2-4 years, requiring parents to establish new care providers for their children once they arrive at their new location. For children who require specialized care, it is even more daunting. After months of treatment in their current duty station, they are required to “go back to the end of the line” once they locate a new service provider. High frustration levels were also reported due to a lack of satisfaction with the quality of the care their child receives at their new provider. Families not only geographically isolated from their previous providers, but military parents with children with autism reported higher stress levels and social isolation across qualitative research after relocation and during separation (Klin, et al, 2015).

Deployment cycles lead to increased behavioral and emotional issues for military children. Parents have reported that once their child’s problematic behaviors have stabilized after their parent has deployed, their behaviors may increase once again once the parent returns from deployment. Children exhibit increased emotional withdrawal and repetitive behaviors when their Service member parent is deployed. It has been reported that the parent left behind to manage the care of the entire household can experience feelings of guilt and worry about providing adequate parenting alone (Davis and Finke, 2015).

Permanent Change in Duty Station (PCS) also takes a unique toll on the military child with autism. Friendship and social interaction are protective factors and good for overall mental health. Military children move frequently and must make new friends in their new hometown and school. Autistic children innately struggle with making social connections, making it harder to establish new positive social connections with peers. Autistic children were reported to be lonelier and more withdrawn after relocating to their new location (Davis and Finke, 2015).

Magellan Federal Best Practices

As mission partners, Magellan Federal Military & Family Life Counselors (MFLCs) can become the help multiplier for these special families. MFLCs may serve as referral linkages, connecting families to the life-changing services locally or at their next duty station before moving. MFLCs may create an Autism Resource Connect (ARC)—a smooth connection to autism resources for military families from one base to the next. This proposed program component can partner with base resources to maintain an updated roster of local providers to ensure that before, during, and after the process of permanent changes of duty station (PCS), families can ensure a comprehensive and smooth transition to local support. Utilizing the current Military Family Life Counseling network of counselors, resource lists can be maintained locally and can be shared with their counterparts at other installations.

Although MFLCs do not provide direct support for the child diagnosed with autism, their families may benefit from the non-medical counseling support. MFLCs can provide support through individual, marriage, and family counseling. MFLCs can also connect with local Exceptional Family Members Programs (EFMPs) to provide MFLC briefings/presentations to families currently within the program advising of support that can be provided to the family unit. Although the child with exceptional needs is out of the MFLC program scope, the parents and siblings are not.

Another gap that appears to exist in care for these military families is the support of the siblings of children with autism. School MFLCs have particularly great advantages in identifying and serving these unique children. Siblings of children with autism, particularly older siblings, tend to externalize stress and frustration through negative behaviors. MFLCs situated in middle schools and high schools may be instrumental in providing support for these children. These siblings empirically have shown higher tendencies to experience loneliness, academic struggle, and aggression (Walton & Ingersoll, 2015).  MFLCs can create spaces of peer support in the groups.

In April, we celebrate the Month of the Military Child. We wear purple in support and solidarity-creating awareness of the unique challenges of the military child. Military children and families affected by autism experience these challenges compounded by navigating life’s daily routine challenges. While awareness is wonderful, awareness is the first step. Magellan Federal supports children diagnosed with an autism spectrum disorder and their families by bridging gaps in support and care. Specifically, MFLCs provide briefings and psychoeducation regarding available services to supportive base programs. Autism is a life-long disability. With support, every individual can reach their potential. The outcomes for children are exponentially better with early diagnosis and intervention. MFLCs can make a difference. One Team. One Mission.

Resources

OAR. A Guide for Military Families(2019) https://operationautism.org/wp-content/uploads/2019/12/A_Guide_for_Military_Families.pdf

Autism Speaks www.autismspeaks.org

Exceptional Family Member Program https://www.militaryonesource.mil/special-needs/efmp/

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Autism Speaks(2019). Autism and Health Report https://www.autismspeaks.org/sites/default/files/2018-09/autism-and-health-report.pdfb

Davis, J., & Finke, E. (2015). The Experience of Military Families with Children with Autism Spectrum Disorders During Relocation and Separation. Journal of Autism and Developmental Disorders, 45(7), 2019-2034.

Klin A, Wetherby AM, Woods J, Saulnier C, Stapel-Wax J, Klaiman C, Jones W, Rubin E, Scahill L, Call N, Bearss K, Gunter C, Courtemanche CJ, Lemieux A, Cox JC, Mandell DS, Van Decar JP, Miller RA, Shireman CL. Toward innovative, cost-effective, and systemic solutions to improve outcomes and well-being of military families affected by autism spectrum disorder. Yale J Biol Med. 2015 Mar 4;88(1):73-9. PMID: 25745376; PMCID: PMC4345541.

OAR. A Guide for Military Families(2019) https://operationautism.org/wp-content/uploads/2019/12/A_Guide_for_Military_Families.pdf

Walton, K.M &Ingersoll, B.R. (2015) Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protector Factors.

Those that raise their right hand to serve our country in the military, make a minimum of two huge transitions during their lifetime; the transition in by taking an oath to support and defend the Constitution of the United States against all enemies, foreign and domestic; and the transition out. Personally, I remember my transition into service being filled with a spectrum of emotions and above all, the feeling of being proud—proud to be able to make the commitment to my country; proud to say I was a member of the most elite military in the world; proud to become part of something bigger. Though each experience is unique, I believe feelings of pride are common with those that make the commitment to serve their country. Military members are immediately immersed in an unfamiliar world with new rules, language, friends, and many new opportunities. It is a time filled with excitement, change, growth, and fear of the unknown. Many military members look back on this time with fond memories—many with a yearning to go back, like the common wish to reunite with childhood. In contrast, the transition out of the military, also a huge transition point in one’s life, is not the same. I’d like to offer my unique personal experience of what I found most challenging and provide some excellent resources that are available to all veterans and family members through the Transition Assistance Program and Military and Family Life Counseling Program.

The Challenges of Transitioning Out of Service

For me, the “transition out time” was a period filled with excitement and opportunity for growth, but it was not at all easy to navigate. Although I had always had a plan in my head for what I would do once I was discharged, the guidance and resources were not as formulaic as the transition into military life. I was excited to become a civilian free to take any job I wanted, but it was overwhelming not to have concrete steps for how to get there.

It is widely known that the military has a way of building its members up to feel as though they can accomplish anything and believe that they have a step up when it comes to the civilian population. While this may be true, it can be harmful to solely rely on this expectation. It is better to be aware of the potential challenges in advance so you can arm yourself with available resources and tools to navigate a successful transition.

In my experience, these are the top three challenges when transitioning back into civilian life:

1. Unrealistic expectations

• It will be easy to get any job I want.
• I will get paid more as a civilian doing the same thing.
• Working 40 hours a week will be east compared to being on call 24 hours a day.
• My experience will be respected; everyone loves military members.

I will get paid enough retirement that I won’t need to work.

2. Loss of identity

• No longer a leader or looked up to by others daily
• Loss of purpose
• No one really understands what you did in the military
• Bored with the new job
• Loss of connection to your familiar support system
• Work no longer makes a difference on a large scale
• Communication style in the civilian world is not the same

3. Limited immediate support 

• Just a number to the VA
• No longer have a chain of command to help
• Waiting list to get support
• Navigating resources alone

Combat Veteran’s Careers states, “The military provides a sense of purpose, well-defined roles and hierarchy, camaraderie, honor and mission—things that can be hard to find or define in the civilian world.” In my experience, this could not be more true. Although I planned and prepped for my exit, I still fell victim to some of these common beliefs and challenges. So, if you have a plan—or even if you don’t—I encourage you to take advantage of the programs and resources available to you while you are still in service to get a jump start on your transition to a successful civilian career. Here are a few I found helpful, and that Magellan Federal assists in delivering.

Available Career Resources

Transition Assistance Program (TAP)
The Department of Defense TAP provides lots of information, tools, and training to share tips on everything from resume prep to financial planning. For example, I remember them bringing in models to our installation from a local suit store to help us prepare for business dress. TAP is available to all transitioning service members and has a wealth of eLearning guides, trainings, and workshops. Connect with your local Transition Assistance Office or view more information on the DoD TAP website.

Military and Family Life Counseling Program (MFLC)
Military and Family Life Counselors (MFLCs) are on the ground at installations around the world providing confidential non-medical counseling to service members and their families to address issues such as improving relationships, stress, parenting, and grief. MFLCs are also armed with a plethora of training resources specific to making the transition from the military to civilian life. I highly suggest connecting with an MFLC at least a year out from your final separation date, even if it is just to help you organize your thoughts and help you more clearly define the path to your future. Contact your installation’s Military and Family Support Center to get started.

Education and Employment Initiative (E2I)
E2I is a Department of Defense program that assists wounded, ill, and injured Service members with education and career opportunities as part of their recovery and transition to civilian life. E2I’s Regional Coordinators work with Service members to identify skills and match those skills to a desired career path. Contact your Regional Coordinator to request an application, or visit the E2I website.

Tips for Successful Transition
While these programs and other resources will help you build a good foundation, it is ultimately up to you to put a detailed plan in place and complete the necessary steps to prepare for your civilian career.

1. Learn about careers—complete a self-assessment, compare occupations, and research industries
2. Find training—research basic adult education, apprenticeships, certifications, and scholarships
3. Network—connect with professionals in your career of choice to help with advice, job leads, and contacts; inform them of your skills and employment goals

It’s never too early to get a head start on preparing for a career that’s best for you and your family after service. I hope these tips will get you started planning today with confidence.

References
• CombatVeteranstoCareers.org, “5 Reasons Veterans Struggle to Transition to the Civilian Workforce,” view article
• Military OneSource

With the start of Autism Acceptance Month in April, Senior Manager of Clinical Care Services Cara Albanese is focused on creating innovative and inclusive ways to better serve the needs of individuals with autism spectrum disorder (ASD). Albanese, who has been with Magellan for over six years, oversees the Applied Behavioral Analysis (ABA) operations in the California markets, including ABA Services for some commercial accounts. As manager of a team of eight employees, Albanese and her team review treatment plans and work directly with ABA providers to ensure adherence to the main objectives for their membership and that treatments align with the Magellan Health standards that provide members with the best care possible. Continue reading to learn more about what innovative programs and new initiatives for individuals with ASD Albanese is working on:

What sort of projects are you currently working on?

We started piloting a value-based model for ABA in October in our California market. Magellan is pioneering this type of program for ABA services. Now we are working on evaluating the findings to establish evidence-based practices and drive outcomes-based programs across the ABA industry. Implementing this program will allow us to evaluate treatment planning and delivery to continuously improve care for children with ASD and help the families who care for them.

What are your thoughts on the culture here at Magellan? How does that culture make Magellan the best place to do these innovative projects?

Magellan has a very strong culture of innovation and values our members’ satisfaction. We’re always looking to grow the field and improve data-driven outcomes for our membership. At Magellan, we continue to expand our knowledge and look at autism services across the industry as we continue the growth of our department. We work with a multidisciplinary team giving us insights from a variety of medical professionals. Being able to work with a variety of medical professionals ensures that our members are receiving the best care, as we can provide a holistic and prudent approach to care. Our clinical leadership at Magellan creates a supportive and collaborative environment to think outside the box and increase innovative thinking.

What does Autism Awareness and Acceptance Month mean to you?

The prevalence of autism has continued to rise to a rate of one in 36 children in the United States. Most individuals know someone who has autism or some experience with someone diagnosed with autism. This increased awareness allows us to start to support this population as a community. We can do this as clinicians by modifying and changing the science around ABA to support the current needs of the ASD population and their families. We can continue to increase inclusivity of children and adults with ASD, as they may learn and engage differently. Everyone should be embraced for their individual abilities.

Have you ever been so happy or upset that it was difficult to function and go about your daily tasks and responsibilities? Or maybe something was bothering you and you didn’t feel quite right, but you couldn’t pinpoint exactly why. Sometimes it’s easy to identify our emotions, especially when they are very strong or overwhelming, like in the case of grief or joy. Other times, it can be more difficult, such as when experiencing shame or even love.

Identifying our emotions is a first step in managing them, and both are important skills in getting through life’s ups and downs and feeling more in control about how we approach and react to people and situations. Of course, we must feel our feelings. We should acknowledge and celebrate happy times, listen to our instincts if we are afraid, and otherwise give ourselves the time we need to fully experience our emotions. In this post, we’ll focus on and provide support for when we are struggling with nagging or intense emotions.

Recognizing your emotions

You might be wondering why recognizing your emotions and feelings is important. Maybe you think it’s obvious what you are feeling at any given moment. In some cases, it is. Even then, it is important to name the emotion or feeling. This allows you to get what you need from it and effectively manage it so it doesn’t become disruptive in your life. It can be difficult to deal with an emotion and move on if you haven’t identified what it is.

For example—You’re sitting at your desk at work and not feeling like yourself. You’re anxious about the work you must complete. You could sit there and continue trying to push through with the nagging feeling. Or you could take a moment to identify and name the emotion so you can take the appropriate steps to move on from feeling less than your normal self. This could be as easy as saying to yourself, “I am overwhelmed.” Now that you’ve identified the emotion and given a name to it, you can use your knowledge about how to deal with feeling overwhelmed and seek additional help if necessary.

A great resource for helping to identify your emotions is an emotion wheel. Magellan provides a tool you can use here. Print it or keep it open in your web browser so it’s handy when you need to name an emotion that may be distracting you or getting you down.

Accepting your emotions

You’ve recognized and named the emotion you’re feeling. Now what? What do you do to get to a better place of focus and contentment? You can start with accepting what you’re feeling is legitimate and worthy of your attention. And while you may not be happy about the situation that is causing your emotional response, we know that situations will arise that are out of our control. For instance, we may experience negative emotions due to a breakup with a partner, seeing a child make a poor decision, or watching a friend go on the vacation we so badly want. No matter the situation, fighting our emotions only serves to give them more fuel to thrive, which may not be exactly welcomed.

A tool to help you accept your reality and let go of resentments is called radical acceptance. Find more on this technique along with a short video and helpful exercise worksheets linked on our website for Mental Health Month.

Managing your emotions

When we know what we’re feeling, have accepted it, and are giving ourselves grace to deal with it, we’re in a better place to act and feel better. One technique that can help you do this is looking at your thoughts from a different perspective. For example, if you’re feeling lonely, think about the supports that are available to you—some may be just a phone call away. When you flip that lonely feeling and remember there are people who are there for you, your thoughts become more rooted in reality. You can then take action to feel less lonely by calling upon family or friends or searching online for ways to meet new people.

Throughout the often-challenging process of dealing with emotions, it’s important to be kind to yourself and practice self-care. Take time to do the things you enjoy. While you’re doing them, you can revel in the positive emotions you feel in the moment.

Support is also available in the form of mood tracking apps, which can help us understand the stressors and triggers that cause negative emotions. Find a clinically-reviewed list of these apps linked on our website for Mental Health Month.

Finally, when emotions are overwhelming and causing distress in your life, like causing changes in your personality, eating or sleeping habits, it’s important to seek the support of a therapist or other mental health or medical professional. You don’t need to suffer. There is help available that can make a difference.

Additional emotional support resources

For more on recognizing, accepting and managing emotions, visit our website for May Mental Health Month, MagellanHealthcare.com/Mental-Health-Month, and be sure to check out the Mental Health Awareness Campaign Toolkit.

According to the National Institutes of Health’s (NIH) National Institute on Alcohol Abuse and Alcoholism, alcohol contributes to more than 200 health conditions and about 99,000 deaths in the U.S. each year.[1] According to the CDC, one in six adults in the U.S. binge drinks with 25% doing so at least weekly.[2]

April is National Alcohol Awareness Month, which is a time to increase your personal awareness about alcohol abuse and alcoholism and to recognize these disorders, which can be treated.

Magellan Federal’s Senior Manager in the Adolescent Support & Counseling Services (ASACS), Allison Welliver, LMHC, MCAP, shares her insights on why this month is important. Welliver is a licensed mental health counselor and a master’s level certified addiction professional.

Q: Why is National Alcohol Awareness Month important?

Allison Welliver: National Alcohol Awareness Month is important because it brings awareness to alcohol abuse and dependency and allows people to be screened to see where their use of alcohol falls (low, moderate, or high risk for alcohol abuse or dependence). It also allows people to see how their use of alcohol compares to alcohol use by other people of the same age and sex.

Since alcohol is a legal drug, and so often used in social situations and celebrations, it can be difficult to see when alcohol abuse is happening.

Q: What are signs that someone is addicted to alcohol?

AW: Signs of dependence on alcohol can be behavioral/social or physical. Behavioral/social signs include secretive use, heavy drinking, drinking alone, drinking at inappropriate times of the day (in the morning), and continuing to drink despite the negative impact it has on your relationships, job, and health. Physical signs may include developing a tolerance, developing the “shakes” when not drinking alcohol, disrupted sleep, lethargy, or headaches, and needing a drink to alleviate negative symptoms.

Q: What is the connection between this addiction and mental health?

AW: Addiction and mental health problems are frequently comorbid, meaning that they often occur at the same time. It is a question of which comes first – does the mental health problem cause the addiction or vice versa? Many times, people turn to alcohol or other drugs to cope with mental health concerns that they are having. They could use alcohol to cover up depression or other pain underneath.

Q: What are some steps someone should take if they recognize they need help and what does Magellan offer to support someone who is dealing with alcohol addiction?

AW: First, reach out to a therapist. A therapist can evaluate your use and determine what setting is best to treat your alcohol use. Surround yourself with a positive, supportive network who understands that you need help. You may identify support through connecting with your company’s Employee Assistance Program (EAP), if one is available to you. When contracted with an employer, Magellan offers EAP services to employees and their household members who may question if their use is abnormal, or if they have been having problems related to drinking. EAP services, including counseling, are free and confidential.

Q: Is there anything you would like to add or any resources you want to provide?

AW: There is a free online screening tool that anyone can use to gauge their level of alcohol use. https://alcoholscreening.org/

Additional Resources

• NIH Rethinking Drinking
• Work Stress and Drinking: A Vicious Cycle?
• How to say no to drugs and alcohol
• Maintain Your Recovery During the Pandemic

[1] Helping Your Patients with Alcohol-Related Problems: https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol?utm_source=twitter&utm_medium=social&utm_campaign=jul-2022

[2] Centers for Disease Control and Prevention: https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

April is the Month of the Military Child, which celebrates and acknowledges the children of our service members. While living with a military family member can make children resilient and strong, this lifestyle can sometimes make them more susceptible to bullying in a school setting.

The Army’s Adolescent Support and Counseling Services (ASACS) program is a wonderful resource for military families looking for bullying awareness and prevention tactics. The ASACS program provides confidential counseling for adolescents and families to help them thrive while supporting a loved one stationed overseas.

Magellan Federal provides 23 ASACS counselors and four Clinical Supervisors at 22 Department of Defense schools worldwide and is intimately familiar with bullying issues that are prevalent within the military adolescent population. If you are a teacher, counselor, parent, or caregiver, here are some effective techniques our counselors have used to educate and help safeguard military children against bullying.

Educate with Games with Prizes

Create a bullying awareness event to open a discussion about what bullying looks like and how to take action. Have students write down what they would do if their friend was bullied on a sticky note wall and participants spun a wheel to answer questions about bullying scenarios to win a prize. This helps children understand how to identify bullying and actionable skills they can call upon to get help.

Encourage Role Play
We have also found success with conducting lessons on healthy communication through role play. Ask kids to create skits to demonstrate different communication styles. These will help participants identify assertive, aggressive, passive-aggressive, and passive communication, body language, and appropriate social filters to promote healthy communication and dialogue.
Then discuss how other communication styles could be hurtful and why social filters help to improve relationships and decrease instances of bullying.

Organize a Kindness Event
Organizing a school-wide prevention activity can help promote kindness and gratitude on a greater scale. Encourage students to write notes to friends, students, teachers, and staff about what they appreciated about that person. One of our recent events had about 700 messages written!

Schedule Ongoing Discussions
Conduct mini lessons on topics such as bullying prevention and empathy building. Setting aside a scheduled time to chat about bullying-related topics will keep it top of mind and build trust. These talks can also be used as an alternative to detention.

Bullying is a serious issue for military children, who may be more vulnerable in school settings due to their unique lifestyle. As caregivers, educators, and advocates, we must collaborate to provide resources and support to create a safe and inclusive environment for all children. By implementing these effective techniques, such as educating through games, encouraging role play, organizing kindness events, and scheduling ongoing discussions, we can equip military children with the necessary skills to identify and stand up to bullying. Let’s continue to prioritize the safety and well-being of our military children, not just in April — but every day.