12 Ways to Bust Brain Fog

Brain fog has become a common occurrence across age groups. Clear strategies can ease the stress and bust those brain fog symptoms.

As colleagues and peers know, I’m in a Doctorate of Behavioral Health program. My quest for learning is insatiable, especially in a curriculum focused on integrated care, medical literacy, leadership, healthcare quality, and entrepreneurship. Amid my zest to gain knowledge, my brain and I can be at odds. This precious organ periodically reminds me it will only absorb so much information. My critical-thinking is challenged by episodes of brain fog: a collection of symptoms impacting the ability to think, such as distraction, memory lapses, word-finding, and utter frustration.

Activities that would previously take me 30 minutes, took hours. Anxiety kicked in, then rapidly escalated. I worried my brain fog was caused by a medical condition. At times, I thought it was due to being a post-menopausal women on a rigorous academic journey. Instead, I learned there was another explanation. I was among a new generation of persons dealing with the condition. Brain fog has become a common occurrence across age groups, impacting hundreds of millions of persons around the globe.

Brain Fog More Norm Than Exception

A variety of medical conditions are associated with brain fog (e.g., anemia, autoimmune disorders, COVID, diabetes, migraines, pregnancy), as well as stress. In fact, brain fog and stress are in a synergistic dance. We become easily overwhelmed by daily tasks. We struggle to remember the name of the last movie we watched, our beloved actor, favorite restaurant, or just the last thing we ate. Studies have addressed the traumatic impact of the recent waves of chronic, pandemic-related stress on populations: fear of virus transmission and personal/family safety, grief and loss, job and economic security, increased isolation, profound fatigue. Simultaneously occurring societal tensions have meant an added psychological hit for the population. 

Stress and the Brain

Prolonged stress and associated allostatic overload amplify cortisol production. This can lead to behavioral health manifestations, such as anxiety, depression, and insomnia. It can also exacerbate co-occurring chronic illnesses (e.g., asthma, cardiac issues, diabetes, lupus, multiple sclerosis). Our pre-frontal cortex is in peril, as continuous stress impacts the ability to engage in mental calisthenics necessary for normal cognition. Carry-over of new learning, concentration, focus, and memory are all at risk. We become stressed about being stressed, which sends us spiraling further. Neural plasticity falters as the brain loses its ability to rewire itself. Fear reigns as we worry brain cells are leaking out faster than they can ever regenerate! 

Take Control to Bust the Block

Managing our stress is key to busting brain fog! Here are 12 ways to bust those brain blocks:

  1. Breathe: 4,7,8 breathing is a must: breath in for 4 seconds, hold the breath for 7 seconds, then exhale for 8 seconds. It can be done anywhere, anytime, and any frequency. 4 cycles work, 3 times a day works wonders.
  2. Take a break: We can become too committed to finishing tasks at any expense, even if our brains don’t wish to cooperate. This floods our system with stress and cortisol. Even a brief break will enhance your efforts to regroup and refocus.
  3. Exercise: Physical activity increases blood flow, brain activity, and motivation.
  4. Get rest: Good sleep hygiene, promotes restful sleep, which is a priority. The Sleep Foundation has a lengthy list of easy ways to achieve this goal. 
  5. Monitor your diet: Hydrate, nourish, rinse, repeat. Also, watch caffeine and spicy-food intake, particularly late at night or close to bedtime.
  6. Engage in at least one peer interaction daily: Don’t let too much time go by without a quick text or meet-up with friends. They enhance your spirit!
  7. Monitor internet and social media use: ‘Doom-scrolling’ is an energy-drainer, so set limits on social media use!
  8. Engage in one positive activity daily: What one thing do you engage in daily that is energy replenishing versus depleting?  Cooking, gardening, meditation, journaling, taking a drive with the music blaring, or solo dance parties are all considerations.
  9. Set limits and SAY NO: Toss those tasks that stress you out. Ask for extensions of deliverables. These actions ease those pressures on you!
  10. Give yourself grace: Accept that you may not get a task done when you want: Ease the stress by taking 10, whether seconds, minutes, or hours. Give your brain permission to stop. This allows you time to regenerate, restore brain activity, and ready yourself for other cognitive conquests to come. 
  11. Be the master of one versus none: We all multi-task and simultaneously juggle activities, yet there are limits. Even the highest functioning brains hit a wall! Instead, take charge by approaching activities one by one. This relieves those internal and external pressures, while reducing your cortisol levels.
  12. Seek support: It is easy to isolate, but don’t give in! Reach out to friends and family, but also behavioral health professionals, as needed. Use employee assistance programs (EAP), organizational and community therapy resources, whether in-person or virtual. 

***This blog post is not meant to replace a medical evaluation. Scheduling an evaluation with a trusted primary care provider may be your first step!

RELAX, REPLENISH, RECHARGE, RENEW, then REFOCUS to RESTORE YOUR RESILIENCE! 

Get going! What are you waiting for?

I’ll look forward to seeing what other suggestions you have to bust brain fog; add them in the comments space below!

Are Safety Net Programs Losing Their Safety Net?

A far bigger safety net must be in place to support these essential facilities, programs, providers, and the communities who rely on them. More must be done quickly to ensure safety net sustainability.

The nation’s 56 official safety nets strive to provide quality health and mental health to the nation’s most in need populations. Yet, new struggles to do so are endangering the lives of patients and mandate swift action.

Safety Net Realities 

A quilt of >14,000 sites comprise the safety net system: disproportionate share hospitals, federally qualified health centers (FQHCs), rural, and community health centers. Location maps and listings are accessible at HRSA’s FQHC with a safety net hospital list at their trade association website (America’s Essential Hospitals). These sites provide care:

  • Independent of patient ability to pay and immigration status
  • To the highest share of Medicaid and uninsured patients: 75% and 60% of the population respectively!
  • Across rural and urban regions and both, public and non-profit entities 

Pandemic-related financial headaches continue for the industry, safety net hospitals shouldering more than their share of this burden. Rural regions have seen a waning hospital presence, adding pressure to remaining FQHCs. The Sheps Center displays >100 closures in the past decade, 50% of 2020 closures for safety net facilities alone.

A recent Kaiser Family Foundation issue brief reviewed COVID’s disproportionate impact on populations covered by Medicaid and Medicare, including people of color and those who use long-term services and supports. Providers serving these patients were less likely to have received monies from the $178 B in pandemic federal provider relief funds; barely $13.1B went to safety net hospitals with a mere $11B to rural providers. This reality contributes to national health expenditures soaring to $4.1 Trillion dollars. The amount accounts for early 2020 through the pandemic’s first wave, which hit safety net facilities hard. Pandemic-related losses for the largest safety net hospitals (e.g., 1000 beds) are as high as 50% of their quarterly revenue. 

Loss of 340B Drug Discounts

Recent loss of 340B drug discounts has meant major fiscal challenges for safety-net programs. The legal battle against drug makers wages in the courts. HRSA has stepped up, imposing fines against drug makers when possible. A study of 510 urban facilities identified losses at 23% of savings from due to loss of 340B, a median of $1 M. Critical access hospitals saw 40% of savings lost, roughly $220,000. While that amount seems small, it is a major hit to these rural hospitals with a max of 25 beds, located 10 miles from other providers. While dollars and losses are relative to each organization, the bottom line is the same; patient endangerment from cuts and closures of needed programs, potentially the only facility or service provider for miles.

How to Save the Safety Nets

7 ideas are posed by experts to strengthen the safety-net foundation: 

  1. Increase federal funding: Target funds to hospitals that qualify for Medicaid disproportionate-share hospital (DSH) payments. Use hospital census data to more equitably distribute payments to facilities that primarily treat uninsured and Medicaid patients (and not Medicare patients). 
  2. Clear Guidance: Federal agencies, as the CDC should use hospital census data to more equitably distribute payments to facilities primarily treating uninsured and Medicaid patients. This action is a sound public health reimbursement strategy moving forward. 
  3. Streamline Regulation: Reduce regulatory burdens to foster reimbursement, such as ongoing expansion of telehealth and virtual requirements and reimbursement, lengthen quality reporting programs, and extend leniency with value-based purchasing programs. These will help hospitals to recover financially from pandemic-related losses.
  4. Loan Forgiveness: Expand programs that incentivize new clinicians to accept positions in safety-net programs. This action will bolster the workforce of providers who accept new Medicaid patients.
  5. Expand Coverage Options: Advance these options to limit growth of uninsured patients and uncompensated care
  6. State And Local Initiatives: Enact policies to mitigate effects of hospital closures. Keep public and surrounding healthcare systems informed so regions can best plan for, and provide necessary outreach to service shortage areas. This will also minimize service gaps, providing safer transitions of care.
  7. Community and Volunteer Efforts: Target corporate and community investing to bridge gaps in care: create grants, fundraising campaigns, horizontal mergers, to build satellite clinics, services, and programs. 

A far bigger safety net must be in place to support these essential facilities, programs, providers, and the communities who rely on them. More must be done quickly to ensure safety net sustainability.

I know there will be other suggestions, so add them in the comment area below.

#safetynet #accesstocare #bridgethosegaps #340B #funding #interprofessionalimpact #interprofessional insights 

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5 Ways to Use SDoH and MH Data to Advance Your Advocacy

All that health disparities data gets overwhelming. Here are distinct ways to use and leverage the data to your advantage

What don’t the SDOH and MH impact?

This last few weeks has seen the usual litany of published research on how the social determinants of health and mental health (SDoH & MH) impact health and mental health outcomes. All denote significant care disparities across disease states and populations, including but not limited to the following embedded studies:

I’m a research nerd; my colleagues, mentees, and students are most likely breaking into big smiles about now. If there is relevant literature on a topic, I’ll find it. While I’m not a researcher, I will use any metrics and outcomes to craft sustainable solutions, and motivate others to do so. 

Data is Overwhelming, BUT

Many persons share their frustration with me about the abundance of SDoH & MH data. It can feel like the massive data speaks to a worsening state of affairs. However, the data is meaningful; you can’t fix what you don’t know! Remember, each piece of literature provides vital validation for necessary legislation, funding, and reimbursement to bridge those identified gaps in care. Here are 5 ways to use the data to advance your SDoH & MH advocacy:

  1. Stay current on relevant legislation: A flurry of federal and state legislation is on the horizon, all driven by dedicated research. My friends at Aligning for Health maintain an updated roster of SDoH legislation on their site that can be accessed here; current heavyweights include the Social Determinants Accelerator Act of 2021 and Leveraging Integrated Networks to Communities (LINC) to Address Social Needs Act. I’d encourage those interested to sign up for weekly bi-weekly notifications on these, and other laws.
  2. Follow the Funding: Dollars are available to build services and programs that bridge health equity gaps.
  3. Join relevant advocacy efforts: Along with RISE Association and Aligning for Health mentioned above, Root Cause Coalition is a national group of organizations committed to reverse and end systematic wholistic health inequities. 
  4. Prioritize the data important to you!: That research churns fast and furiously; follow and sign up for notifications from sites and entities covering the SDoH & MH that matter to you and your organization. This may be research from JAMA or Lancet, Health Affairs, Brookings Institute, Hastings Center, or the CDC. This recent issue brief from the Kaiser Family Foundation hones in on current pandemic priorities; scroll down to a stellar graphic detailing the wholistic health landscape. The Satcher Institute has updated their Health Equity Tracker with SDoH and PDoH (political determinants of health) by state; they’ve also added behavioral health to the mix!
  5. Sign up for notifications from those, in the know: That inbox gets busy, so take charge by signing up for notifications from key players in the SDoH space. If you liked this blog post, click on the, Follow Ellen’s Interprofessional Insights button in the sidebar of this page to receive my bi-weekly blog and vital health equity information.

I look forward to your comments on this blog post, and other strategies you use to keep your finger on the pulse of wholistic health equity priorities. 

#SDoH #SDoMH #Healthequity #funding #interprofessionalimpact #accesstocare #bridgethosegaps  

Trauma-Informed Leadership: The Antidote for Collective Occupational Trauma

Workforce sustainability, retention, and quality of care are among the adverse side effects of the current interprofessional emergency

The healthcare workforce is amid a unique epidemic, coping with the ravages of collective occupational trauma. Physicians and nurses have been heavily impacted, but also an endless list of behavioral health professionals (behavioral analysts, counselors, social workers, psychologists), case managers, community health workers, medical assistants, nutritionists, pharmacists, phlebotomists, public health workers, rehabilitation professionals, respiratory therapists, not to mention those professionals employed in other sectors (e.g., school and occupational health nurses). Workforce sustainability, retention, and quality of care are among the adverse side effects of this interprofessional emergency.


An Emotional Plea

A recent article by the Hastings Center posed an emotional plea; “the pandemic has laid bare the significant shortcomings of a health system rooted in an unsustainable financial model that exploits the physical and emotional labor of its nurses”. A Time Magazine cover story, was equally riveting with a focus on physician suicide that brought me tears; the respected workforce is concerned for its ability to “emotionally, physically, and mentally face the tsunami of patients” who need care. Data out of Canada reveals prevalence of physician burnout, upwards of 68%. Succinctly stated, the healthcare workforce is under attack with unparalleled rates of mental health, substance use, and post-traumatic stress disorder. The daily deluge of data is overwhelming with the severity of workforce trauma evident; the recent report out of the CDC focused on public health workers and was my breaking point: high incidence of depression, anxiety, PTSD, and suicidal ideation all detailed. The research is validating and valued, though yields a chilling reality: organizations and employers must implement trauma-informed leadership (TIL) models to bolster their staff, before they have none left.

Collective Occupational Trauma in High Gear

We are past the point of no return, 80% of healthcare professionals are ready to exit the industry. Practitioner burnout from vicarious trauma is a long-standing dynamic that has only intensified amid the pandemic. Earlier this year, I published a blog post, 10 Ways to Tackle Collective Occupational Trauma and Restore Resilience. I remain alarmed about the ongoing pandemic pressures and their impact on the workforce. A fierce dynamic is in motion, the Cycle of Collective  Occupational Trauma (the graphic viewable on the original blog post, click the embedded URL above). Intense levels of collective induced stress are experienced by the population and passed to involved practitioners as collective infused trauma. In addition, these personnel are exposed to a wide range of all-encompassing professional and personal stressors. Collective occupational trauma results, and ultimately leads to PTSD if not addressed: acute and chronic sleep disruptions (e.g., nightmares, insomnia), diet challenges (e.g., gastrointestinal upset), physical health issues (e.g., headaches, back or joint pain, psychophysiologic disorders), and behavioral health symptoms (e.g., brain fog, motivation, depression, anxiety, substance use, suicidal ideation and action). Academic, occupational, and social activities of daily living become impaired and imperiled.

Trauma-Informed Leadership as Antidote for Collective Occupational Trauma

I’m confident most readers of this blog know the value and success of Trauma-informed care (TIC). For those less familiar, five principles are intentionally woven into each interaction, bolstering intervention with individuals who have experienced or perceived trauma, whether single event or ongoing experiences: safety, choice, collaboration, trustworthiness, and empowerment. The intervention can be implemented in any setting with patients, their support systems, as well as those persons rendering their care.

TIC also serves as an antidote to mitigate collective occupational trauma, and can be aligned through Trauma-informed leadership (TIL). This unique approach expands on Servant, Transformational, and other leadership models that encourage managers “step-up and in” to support staff. TIL shifts the long-held “process and roll” culture of healthcare organizations. Instead, a new atmosphere is created where leadership and staff relationships are nurtured with actionable efforts: partnering toward meaningful, reciprocal interactions that empower (staff) resilience. TIL strategies include, but are not limited to these 10 tactics:

  • Encouraging staff to “Take 10”, whether:
    • 10 seconds to breathe
    • 10 minutes for fresh air, grounding, or use of the Calm App
    • 10 hours, or a mental health day to restore resilience
    • 10 days, yup, it’s vacation time
    • 10 weeks or 10 months means a whole different conversation, and potentially a job change
  • Providing attention to staff health, mental health, and well-being:
    • Monitor for signs and levels of stress: from agitation, sadness, frustration, to more profound forgetfulness, chronic illness exacerbation, depression, or anxiety.
    • Decrease behavioral health stigma through discussion & referrals for intervention, as needed
    • Support and model self-care
  • Engaging in 2-way communication:
    • Don’t just tell staff what to do, but also why
  • Staying visible and accessible to staff
  • Recognizing not only staff limits and vulnerability, but acknowledging those as the leader
  • Building team camaraderie vs. opposing fronts of leadership and staff, or among staff
  • Providing encouragement when, and where possible
  • Establishing and addressing the root cause of retention issues
  • For virtual roles, ensuring visual interactions where leaders “see” staff several times during the week; cameras and webcams on!
  • Recognizing culture shifts are not achieved by a “one and done” approach; stay consistent for the long-term win.

Let these times inspire your opportunity to rebuild, fortify, and sustain the workforce. TIL is a solid means to accomplish this endeavor. Feel free to reach out to me with questions at efssupervision@me.com.

This blog post originally appeared on PACEsConnection

Workforce Trauma, Shortages, and Retention are Interprofessional Challenges: Resolution Tactics

Disregard for the health, mental health, and well-being of all members of the workforce is a grave concern. What tactics can be implemented?

The full scope of professionals must be recognized for their sacrifices and dedication to patient wellness; anything less is unacceptable.

 One year ago, I wrote how the pandemic, and other societal narratives prompted a new dimension of collective occupational trauma; an already worn workforce was forced to wrestle with constant and intense levels of suffering. As we enter 2022, and year 3 of COVID’s wrath, this trauma remains unrelenting. Pervasive burnout, retention issues, and staff shortages are ravaging disciplines and settings, cumulative costs into the billions. These realities put quality patient care at severe risk.

     Global data emphasizes the impact of chronic and recurrent COVID-waves for front-line physicians and nurses; no doubt these disciplines have endured, and continue to take a powerful hit; >80% ready to leave the industry. The ‘Great Resignation’ is decimating healthcare, the sector experiencing the largest job transition rates and among the highest number of job openings. Concern exists whether there will be enough practitioners to render care. However, what of other disciplines? Disregard for the health, mental health, and well-being of all members of the workforce is a grave concern.

The Entire Workforce Mandates Attention

     The health and behavioral health workforce is vast and comprises many professional disciplines: behavioral health professionals (behavioral analysts, counselors, social workers, psychologists), case managers, community health workers, medical assistants, nutritionists, pharmacists, phlebotomists, psychiatrists, public health workers, rehabilitation professionals, and respiratory therapists, etc. Valued personnel are also employed by other sectors (e.g., schools, businesses, prisons), such as teachers, occupational health, and school nurses, to name a few. Each of these groups have suffered more than their share of deaths, illness, and long-haul syndrome disability; the mental and emotional toll of their work yielding intense emotional trauma across:

Despite these graphic realities, too many personnel are excluded from industry/employer recognition for their contributions to the pandemic, whether awards or merit raises. Even media focus on these individuals is limited. A recent article discussing, hazard pay, focused on nurses and doctors alone; why are others not deserving?

     A vicious cycle unfolds where stressed, underappreciated team members experience a higher incidence of negative mood, emotional exhaustion, and thus, increased medical errors. More than 250,000 medical errors and 100,000 deaths annually were attributed to workforce frustration pre-pandemic; poor team member communication and fragmented care ensued with a ripple effect of order entry mistakes, medication, and treatment missteps, among other occurrences. Considering all the disciplines to interact with patients, at what point does the risk to patient care become too great?

Professional Advocacy is a Mandate

     There must be greater advocacy and action to acknowledge the vital interprofessional contributions rendered by entire workforce. Professional associations, their leadership, and those in positions to do so, must assert influence to promote the value of their requisite members. Language promoting self-care and professional advocacy has started to appear in standards of practice and ethical codes. However, these efforts must continue to amplify. Many colleagues actively use their social media presence to write articles, blogs, and other messaging to lead this charge; more must join the discussion and advocate for action through employers, and the industry overall. Media attention to this cause must be swift, fierce, and consistent.

There must be collective accountability across the professional landscape to acknowledge, and reconcile this issue, spanning academia, credentialing and regulatory entities, professional associations, and of course, employers. Workforce sustainability directly impacts quality health and behavioral healthcare, ultimately saving lives and dollars. Reaching this goal takes the expertise and contribution of each interprofessional team member.

How this goal is accomplished varies across each setting and far from a cookie-cutter approach, spanning:

  • tangible acknowledgements and recognition (e.g., free staff meals, merit raises or other benefit enhancements, staff appreciation awards, weekly formal and informal “shout-outs” of workforce contributions)
  • investment in staff professional development, as in payment for professional association dues, credentialing, continuing education
  • implementation of on-site mental health programming
  • scheduling teamwork celebrations
  • flexible scheduling as possible
  • plan departmental/organizational townhall meetings with actionable items and follow-up on deliverables
  • ensure staff mentoring and support programs
  • have informal staff-check ins
  • effective communication by leadership with staff (include the why of each action)
  • provide a culture where all persons, and their input are valued and respected
  • deliver and demonstrate consistent verbal appreciation
  • ensure professional regulations, credentialing entities, and associations highlight professional self-care and advocacy in all standards, and hold requisite workforce members and employers accountable to uphold the language
  • set a tone of mutual respect in academia and education programs through collaborative programs, events, and classroom activities (e.g., co-teaching across disciplines and programs) that empower interprofessional learning
  • implementation of Trauma-informed Leadership models and strategies (PS: my last blog post will jump-start this action)
  • Have other ideas? Add them below in the comments section

The full scope of professionals must be recognized for their sacrifices and dedication to patient wellness; anything less is unacceptable.

This blog post originally appeared on PACEsConnection

Bio: Ellen Fink-Samnick is an award-winning industry subject matter expert on interprofessional ethics, wholistic health equity, trauma-informed leadership, and supervision. She is an esteemed professional speaker, author, and knowledge developer with academic appointments at George Mason University and the University of Buffalo. Ellen is a clinical supervision trainer for NASW of Virginia, and serves in national leadership and consultant roles. She is also a Doctoral in Behavioral Health Candidate at Cummings Graduate Institute of Behavioral Health Studies. Further information is available on her LinkedIn Bio and website