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® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.

Date: May 2, 2014 Market: All

CareFirst’s mental health vendor, Magellan, offers resources to respond to severe weather

With the recent news of tornados and flooding occurring throughout the country, Magellan Behavioral Health,* CareFirst’s behavioral health vendor, has information available - including the following tip sheets - to help prepare, cope and deal with the aftermath of natural disasters. Please share with your accounts as you see fit.

Coping with Tornados

Supporting Employees

Survivors of Disasters

Coping with Floods (Before, During & Aftermath) Should you have any questions, please contact your Broker Sales Representative.

C. Shekar Subramaniam Vice President, Sales Small Medium SBU *MBH is a subsidiary of Magellan Health Services, Inc. Magellan Behavioral Health is an independent company that provides managed behavioral health services to CareFirst members. Magellan Behavioral Health does not provide BlueCross BlueShield products or services.

1—Magellan Health Services© 2013

Coping with tornados Tornados can happen during any time of year day or night. Knowing what to do when you see a tornado, or when you hear a tornado warning can help protect you and your family. During a tornado, people face hazards from extremely high winds and risk being struck by flying and falling objects. After a tornado, the wreckage left behind poses additional injury risks. Although nothing can be done to prevent tornadoes, there are steps you can take for your health and safety.

Injuries Injury may result from the direct impact of a tornado, or it may occur after the storm, when people walk among debris and enter damaged buildings. Common causes of injury included falling objects and heavy, rolling objects. Because tornadoes often damage power lines, gas lines, or electrical systems, there is a risk of fire, electrocution, or an explosion. Protecting yourself and your family requires promptly treating any injuries suffered during the storm and using extreme care to avoid further hazards.

Inspecting the Damage After a tornado, be aware of possible structural, electrical, or gas-leak hazards in your home.

Contact your local city or county building inspectors for information on structural safety codes and standards. They may also offer suggestions on finding a qualified contractor to do work for you.

If you suspect any damage to your home, shut off electrical power, natural gas, and propane tanks to avoid fire, electrocution, or explosions.

If it is dark when you are inspecting your home, use a flashlight rather than a candle or torch to avoid the risk of fire or explosion in a damaged home.

If you see frayed wiring or sparks, or if there is an odor of something burning, you should immediately shut off the electrical system at the main circuit breaker if you have not done so already.

If you smell gas or suspect a leak, turn off the main gas valve, open all windows, and leave the house immediately. Notify the gas company, the police or fire departments, or State Fire Marshal's office, and do not turn on the lights, light matches, smoke, or do anything that could cause a spark. Do not return to your house until you are told it is safe to do so.

Safety During Clean Up Wear sturdy shoes or boots, long sleeves, and gloves. Learn proper safety procedures and operating instructions before operating any gas-powered

or electric-powered saws or tools. Clean up spilled medicines, drugs, flammable liquids, and other potentially hazardous materials.

2—Magellan Health Services© 2013

Children's Needs After a tornado, children may be afraid the storm will come back again and they will be injured or left alone. Children may even interpret disasters as punishment for real or imagined misdeeds. Explain that a tornado is a natural event. Children will be less likely to experience prolonged fear or anxiety if they know what to expect after a tornado. Here are some suggestions:

Talk about your own experiences with severe storms, or read aloud a book about tornadoes. Encourage your child to express feelings of fear. Listen carefully and show understanding. Offer reassurance. Tell your child that the situation is not permanent, and provide physical

reassurance through time spent together and displays of affection. Include your child in clean-up activities. It is comforting to children to watch the household

begin to return to normal and to have a job to do.

NOTE: Symptoms of anxiety may not appear for weeks or even months after a tornado; they can affect people of any age. If anxiety disrupts daily activities for any member of your family, seek professional assistance through your Employee Assistance Program.

Resources Are Available Additional information, self-help tools and other resources are available online at www.MagellanHealth.com/member. Or call us for more information, help and support. Counselors are available 24 hours a day, seven days a week to provide confidential assistance at no cost to you.

Additional tools and resources: American Red Cross tornado warning tool for your Smartphone:

http://www.redcross.org/mobile-apps/tornado-app

Be informed and know what to do before and after a tornado hits: http://www.ready.gov/tornadoes

Severe weather 101 – know the basics about tornados: http://www.nssl.noaa.gov/education/svrwx101/tornadoes/

2013© Magellan Health Services

Supporting Employees Disasters can be shocking and take an emotional toll on people. Employers can be impacted too. Employees impacted by a natural disaster may find it hard to balance job demands while trying to rebuild their personal lives. Below are ways you can support your employees during these difficult times. Address the organization immediately. Senior management should meet with all levels of

the organization. Discuss ways to promote counseling services and community resources to help the employees.

Designate a contact for assistance. Designate a person in human resources or leadership as a contact person to whom employees can turn for help and resources.

Promote communication among employees. Allowing employees to discuss their feelings and experiences with co-workers can help during difficult times. Consider providing additional break times and have conference rooms available where employees can meet.

Help the community. Organize a blood drive, clothing drive or fundraiser to help those impacted. Many people not directly affected may feel helpless and unsure of how to help. When people are able to make a difference by contributing to their community, they will feel better about themselves.

Communication tips for managers:

What to do: Be sensitive to employees with mixed emotions. These are normal reactions to a critical

incident. Allow employees to express any reactions they may have about this event. Answer any questions employees may have to the best of your ability. Offer support to employees and try to be flexible.

What to avoid: Avoid statements like, “I know how you feel” or “Everything will be all right.” These

statements may make some people feel that their concerns are not understood or validated.

SUPPORTING EMPLOYEES

2013© Magellan Health Services

Resources Are Available Additional information, self-help tools and other resources are available online at www.MagellanHealth.com/member. Or call us for more information, help and support. Counselors are available 24 hours a day, seven days a week to provide confidential assistance at no cost to you.

1—2013© Magellan Health Services

Survivors of Disasters Every year, millions of Americans are affected by unexpected tragedies and natural disasters. Survivors face the danger of death or physical injury, and the loss of their homes, possessions, and communities. Such stressors place survivors at risk of behavioral and emotional re-adjustment problems. This tips and information article considers three questions often asked by survivors:

What psychological problems may result from disaster experiences? What factors increase the risk of readjustment problems? What can disaster survivors do to reduce the risk of negative psychological consequences

and to best recover from disaster stress?

What psychological problems result from disaster experiences? Most child and adult survivors experience normal stress reactions for several days, such as: Emotional reactions: temporary feelings (i.e., for several days to a couple of weeks) of shock,

fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, emotional numbness (difficulty feeling love and intimacy, or in taking interest and pleasure in day-to-day activities )

Cognitive reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, self-blame

Physical reactions: tension, fatigue, edginess, difficulty sleeping, bodily aches or pain, being startled easily, racing heartbeat, nausea, change in appetite, change in sex drive

Interpersonal reactions: with relationships at school, work, in friendships, in marriage, or as a parent, such as: distrust, irritability, conflict, withdrawal, isolation, feeling rejected or abandoned, being distant, judgmental, or over-controlling.

Most disaster survivors only experience mild normal stress reactions, and disaster experiences may even promote personal growth and strengthen relationships. However, as many as one in three disaster survivors experience some or all of the following severe stress symptoms, which may lead to lasting post-traumatic stress disorder (PTSD), anxiety disorders, or depression: Dissociation (feeling completely unreal or outside yourself, like in a dream; having “blank”

periods of time you cannot remember) Intrusive re-experiencing (terrifying memories, nightmares, or flashbacks) Extreme attempts to avoid disturbing memories (such as substance abuse) Extreme emotional numbing (completely unable to feel emotion, as if utterly empty) Hyperarousal (panic attacks, rage, extreme irritability, intense agitation) Severe anxiety (paralyzing worry, extreme helplessness, compulsions or obsessions) Severe depression (complete loss of hope, self-worth, motivation, or purpose in life)

SURVIVOR OF DISASTERS

2—2013© Magellan Health Services

What factors increase the risk of lasting readjustment problems? Survivors are at greatest risk for severe stress symptoms if any of the following are either directly experienced or witnessed during or after the disaster: Life-threatening danger or physical harm (especially to children) Exposure to gruesome death, bodily injury, or bodies Extreme environmental or human violence or destruction Loss of home, valued possessions, neighborhood, or community Loss of communication with/support from close relationships Intense emotional demands (such as faced by rescue personnel or caregivers) Extreme fatigue, weather exposure, hunger, or sleep deprivation Extended exposure to danger, loss, emotional/physical strain Exposure to toxic contamination (such as gas or fumes, chemicals, radioactivity) Studies also show that some individuals have a higher than typical risk for severe stress symptoms and lasting PTSD, including those with a history of: Exposure to other traumas (such as severe accidents, abuse, assault, combat, rescue work) Chronic medical illness or psychological disorders Chronic poverty, homelessness, unemployment, or discrimination Recent or subsequent major life stressors or emotional strain (such as single parenting) Disaster stress may revive memories of prior trauma, as well as possibly intensifying pre-existing social, economic, spiritual, psychological, or medical problems.

How to recover Observations by disaster mental health specialists who assist survivors in the wake of disaster suggest that the following steps help to reduce stress symptoms and to promote post-disaster readjustment: Protect: find a safe haven that provides shelter, food and liquids, sanitation, privacy, and

chances to sit quietly, relax, and sleep at least briefly Direct: begin setting and working on immediate personal and family priorities to enable you

and your significant others to preserve or regain a sense of hope, purpose, and self-esteem Connect: maintain or re-establish communication with family, peers, and counselors in order to

talk about your experiences—take any chance to “tell your story” and to be a listener to others as they tell theirs, so you can release the stress a little bit at a time in disaster’s wake

Select: identify key resources such as FEMA, the Red Cross, the Salvation Army, or the local and state health departments for clean-up, health, housing, and basic emergency assistance

Taking every day one-at-a-time is essential in disaster’s wake. Each day is a new opportunity to

FILL-UP: Focus Inwardly on what’s most important to you and your family today; Look and Listen to learn what you and your significant others are experiencing, so you’ll remember what is

important and let go of what’s not; Understand Personally what these experiences mean to you as a part of your life, so that you will feel able to go on with your life and even grow personally.

Resources Are Available Additional information, self-help tools and other resources are available online at www.MagellanHealth.com/member. Or call us for more information, help and support. Counselors are available 24 hours a day, seven days a week to provide confidential assistance at no cost to you.

1—2014© Magellan Health Services, Inc.

Coping With Floods - Aftermath Coping with the Aftermath of a Flood

A flood can leave a trail of structural destruction, but what about the emotional impact? The full force of the disaster is often realized after the floodwaters recede and emergency crews go home. In addition to the clean-up efforts, it’s important that you devote time to restoring your own emotional wellness. Feelings of grief, despair and frustration are normal reactions to such events. Other emotions you may be experiencing include:

Panic/Feeling out of control Despair Disorientation/Confusion Guilt Shock/Numbness Anger Anxiety/Uncertainty Grief

Coping Tips

Following the coping techniques outlined below can help you deal with the range of emotions you are most likely experiencing:

Be extra patient. Don’t expect things to instantly restore themselves. Accept that restoration (both physical and emotional) takes time.

Realize that you will experience a range of emotions, and moods can change unexpectedly. Don’t overlook the feelings of children as you deal with the situation. They need to feel that

they can count on you for extra attention, love and support. Try to keep your family diet as nourishing as possible for needed energy. Focus on the big picture, instead of the little details and little problems. It will give you a

sense of competency. Talk with friends, family, counselors or members of the clergy. In crisis situations, a

supportive network is essential. Try to get at least seven to eight hours of sleep a night to refresh your mind and body for the

next day’s activities. Make a list of things that need to be done and rank them by what needs to be done first,

second, third, etc. Learn acceptance. Don’t worry about things you cannot control. Conserve your energies for

things you can control.

2—2014© Magellan Health Services, Inc.

Adapted from materials provided by North Dakota State University Extension Services

Getting Help If you would like more information, you can call your Magellan LifeResources 866-266-2376. To find out what services are available, check your employee benefits or call your local human services agency. You can also talk with someone you can trust, such as a doctor or nurse, local mental health professional or member of the clergy. This document is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Magellan Health Services does not endorse other resources that may be mentioned here.