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Promoting Self-Regulation in Children

For people living with Autism Spectrum Disorder, Attention Deficit Disorder, or other developmental challenges, it can be difficult to follow behavior patterns which are typically expected in society. A child who appears to be throwing a tantrum may not be poorly behaved – he or she may be feeling overwhelmed and is asking for help in their own way. Many children struggle with self-regulation, and by understanding  the topic we are better equipped to help them achieve their full potential.

Joel Desotelle, licensed pediatric occupational therapist and program director of Keystone Pediatric Developmental Center in Chambersburg, often helps his patients cope with self-regulation difficulties. In today’s article, he explains what everyone, and especially parents, should know about self-regulation.

What is Self-Regulation?

Self-regulation is a person’s ability to manage thoughts, feelings and behaviors to be able to accomplish a task, adapt to a challenge or situation, or achieve a goal. Individuals who struggle with self-regulation tend to have difficulty staying focused, keeping still, and are often impulsive and disorganized. This makes it hard to complete tasks or cope with challenges at home, in school, and/or in their community. Likewise, building and maintaining relationships can be very difficult.

Self-Regulation and Behaviors

Certain behaviors are common for children with self-regulation issues. Tasks or demands that require attention and focus are hard, especially when the child needs to sit down for any given time. New or challenging situations can be overwhelming and often lead to emotional outbursts. Kids with self-regulation issues quickly learn that these behaviors can be used to avoid challenging or non-preferred situations, clearing the way for preferred tasks, such as video games and television, which have a low investment, high reward benefit. These behaviors can put a significant strain on parents, siblings, friends, as well as teachers and others. The key is to understand that behaviors related to self-regulation issues are a tool a child uses to try and cope with the demands of their environment. Over time, these become habit, especially if more effective coping strategies are not developed.

Self-Regulation and Self-Esteem

Kids with self-regulation issues and their related behaviors tend to get into trouble more frequently than their peers. This can have a dramatic impact on his or her self-esteem, overshadowing other talents and abilities. It is easier to be patient when one understands that their child is both still developing and also coping with trying to regulate. Helping a child learn to cope with self-regulation issues is critical to their long-term success. It is important that the message stay positive and encouraging instead of punitive. For example, instead of saying, “Why do you always do that,” you can say, “I see you are trying to do this, do you mind if I show you a better way?”

Self-Regulation and the Environment

The environment can have a tremendous impact on how a child regulates, as well as how he or she learns to cope. Environments that are often disorganized, loud, cluttered, etc. challenge these kids who are struggling to organize themselves. Keeping a clean and organized environment helps a child to focus better without being distracted by everything else around them. It is equally important to model the behaviors you expect from a child. A young child is still learning how to cope with stress and other demands and that learning starts at home. Modeling good stress management and communication skills will help a child to manage those situations as they grow up.

Self-Regulation and Therapy

Kids who struggle with self-regulation benefit from occupational and speech therapy services. Kids with self-regulation issues often avoid difficult situations and as a result, many skills are delayed. Occupational Therapists and Speech Language Pathologists can help bridge that gap, focusing on the skills a child needs to be successful. Additionally, Pediatric Occupational Therapists specialize in self-regulation problems and can help to develop a program to improve regulation, while also offering strategies to help a child be more successful at home and school.

If your child is struggling, it’s best to be proactive. Talk to your child’s healthcare provider about your concerns. Therapy can be a great step towards helping your child reach his or her full potential.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

SpravatoTM – A New Treatment Option for Depression

Across the world, Major Depressive Disorder (MDD) continues to be a leading source of suffering and disability. MDD causes a staggering burden with the highest morbidity rate in the world, with a great deal of the cost being the indirect expense of loss of productivity. For many people, standard treatment with medications and/or psychotherapy is either not effective or causes serious side effects. New and more effective treatments are needed urgently, and thankfully, medical advancements have been made in recent years. One new form of treatment is SpravatoTM.

Dr. Irakli Mania, Psychiatrist and Medical Director of Keystone Behavioral Health, talks about this new type of treatment for MDD which he hopes will help many people in the community.

What is SpravatoTM?

SpravatoTM is a new medication for depression (low mood) that is delivered through the nose with a nasal spray. It is an exciting step forward in the treatment of depression and is a valuable addition to the growing list of treatment options. SpravatoTM contains the medication Esketamine, and works differently compared to all other available antidepressants. Usually it is used in addition to traditional antidepressants because this was evaluated as an “add-on” treatment.

Who is a good candidate for this treatment?

SpravatoTM is for individuals who have treatment resistant depression, which is depression that has failed to respond to standard treatment approaches with medications and therapy. In other words, SpravatoTM may be considered if patient’s condition has not improved with two or more medication trials. Usually this is also a requirement by the insurance companies in order to have this treatment approved.

There are instances where use of SpravatoTM would not be appropriate. For example, this is not to be used during pregnancy or by a woman who is breastfeeding. It should not be used by anyone who is allergic to SpravatoTM or any of its ingredients. Patients with a history of bleeding in the brain or any blood vessel disorders should inform their doctor as this treatment may not be right for them. SpravatoTM only treats MDD and is not used for other mental health disorders like anxiety, schizophrenia, PTSD, OCD, etc.

Is it effective?

As of March 2019, SpravatoTM was approved by the Food and Drug Administration for the treatment of depression. It has been evaluated in several trials establishing its effectiveness. Its precursor, Ketamine, has been around for longer and has strong evidence for effectiveness.

What are the side effects?

Even though SpravatoTM was designed to remove side effects of its parent drug Ketamine, it still has some side effects. These may include feeling sleepy and an increase in blood pressure. Due to the potential side effects, treatment must be given in a doctor’s office. For more information on all the potential side effects and whether you would be a good candidate for this treatment, please talk to your healthcare provider.

What should people know before trying this treatment?

Treatment is done in a doctor’s office under physician supervision because there is a requirement that patients are monitored for side effects for at least two hours. In my office, during this time, the patient is sitting in a comfortable reclined chair in a private room, and medical staff will monitor them for side effects like an increase in blood pressure.

There are only two possible dosages of this medication, and if needed, a higher dosage can be given within first week. It is very important to note that the patient will need to make arrangements to have designated driver after receiving treatment. It is not recommended that they drive or operate machinery the rest of the day until they’ve had a restful night’s sleep. If the patient is taking sedating medications, they are advised to avoid them the day of the treatment.

How long do the results last?

The treatment schedule is twice a week for the first month. If the patient is responding well to treatment, it can be decreased to once a week. Eventually, treatments may be decreased to every other week.

Benefits can be seen as quickly as the first day or during the first week. The fast result is a big advantage of this drug because we know that with many antidepressants, we have to wait weeks to months before dosage can be adjusted and real benefits are observed. Unfortunately, the benefits of this medication are short-lived, requiring twice-a-week administration. With time, if the patient responds well, we start seeing longer-term improvement allowing us to decrease the frequency of administration. There is no good data yet as to how long this treatment needs to continue for. Depression is a chronic and recurrent disorder and often we need to continue effective treatments in order to prevent symptoms from returning.

How should patients prepare for the appointment?

You will need to have a psychiatric evaluation by a qualified psychiatrist before this treatment can be recommended for you. When preparing for an appointment with a doctor, make sure you have a complete list of medications that you have tried for treating depression. You should also have a complete list of current medications, whether they are used for psychiatric reasons or not, available to the doctor at the time of appointment. You should know your medical history or have somebody come with you who can help in providing this information.

If you are struggling with depression, or any other mental health concerns, please contact your healthcare provider as help is available. While there is no cure for MDD, by finding the right treatment for you, there is hope to lead a full, happy and productive life.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Keystone Health offers Free Pap Tests

January is Cervical Cancer Awareness Month.

For most women between the ages of 21-65, Pap tests are one of the most important steps in keeping themselves healthy and protecting themselves from cervical cancer.

During the months of January and February, Keystone Health is offering FREE Pap screenings for women who are due for this important test. Show or mention the coupon below at Keystone Community Health Services (located at 111 Chambers Hill Drive, Suite 102, Chambersburg) and receive a Pap test free of charge. Each patient who is due for this test and completes an appointment will receive a $5 gift card!

Call (717) 709-7909 to schedule your appointment.

For more information about the importance of cervical cancer screenings, visit this blog post by Keystone provider Cathy McAfee.

Keystone Behavioral Health Receives Award

From left to right: Kelly Goshen, Director of Keystone Behavioral Health, Joanne Cochran, Keystone Health President and CEO, David S. Keller, Chairman for Franklin County Board of Commissioners, and Dave Grant, Keystone Health Chief Operating Officer

Keystone Behavioral Health was presented with an Agency Partner Award from Franklin Together Reentry Coalition on January 9, 2020. David S. Keller, Chairman for the Franklin County Board of Commissioners, presented Keystone with the award during a Franklin Together Reentry Coalition meeting held at St. Paul United Methodist Church.

Keystone Behavioral Health was nominated for this award due to its work with formerly incarcerated individuals while helping them to reintegrate into the community. These annual awards acknowledge the contributions of organizations or individuals in the community that serve this population.

“Keystone Behavioral Health provides psychiatric evaluations, medication management, and therapy to individuals with Medical Assistance or other insurance. Keystone has been a collaborative partner with many county programs including those that assist returning individuals such as the CARE (Case Assisted Re-Entry program for returning individuals with mental health issues) and IRCM program (Intensive Reentry Case Management which was a grant funded program that helped inmates with home plans). This partnership helps people gain access to services that would otherwise be delayed which could lead to a deterioration of mental health due to a lack of medication or monitoring. This imperative link to mental health services when released from the jail back to the community is extremely important for returning individuals. Keystone deserves to be recognized as an agency willing to work with individuals with criminal records and willing to collaborate with programs that case manage this population,” said Kimberly Eaton, Director of Reentry and Clinical Quality Assurance for Franklin County.

Newly diagnosed with Diabetes or Want to prevent Type 2 Diabetes? Click here!


The Prevent T2 program is through the CDC.  To be eligible for the program you must:

  • Be at least 18 years old and
  • Be overweight (Body Mass Index ≥25; ≥23 if Asian) and
  • Not be pregnant and
  • Have no previous diagnosis of type 1 or type 2 diabetes and
  • Have a blood test result in the prediabetes range within the past year:
    • Hemoglobin A1C: 5.7–6.4% or
    • Fasting plasma glucose: 100–125 mg/dL or
    • Two-hour plasma glucose (after a 75 gm glucose load): 140–199 mg/dL


    • Have a previous clinical diagnosis of gestational diabetes


Plantar Fasciitis – Facts and Treatment

Dr. David Pagnanelli Jr.

Those who have suffered from foot and ankle pain know the burden it causes. Everyday tasks that require standing or walking can become extremely difficult, and the pain can greatly affect a person’s quality and enjoyment of life. One of the most common causes of foot pain is plantar fasciitis.

Dr. David Pagnanelli Jr. of Keystone Foot and Ankle Center frequently treats patients with this condition and wants people to know they don’t have to live with this pain – help is available.

What is plantar fasciitis and what causes it?

Plantar fasciitis is inflammation of a thick band of tissue from the inner side of your heel to your toes. This band supports and holds up your arch in your foot. Sometimes it becomes so inflamed and tensed that you can get micro tears or even complete tears of the tissue.

What are the symptoms?

Symptoms include pain with the first step in the morning or after sitting/resting for some time, stabbing, sharp pain with walking, aching within the heel bone, aching with standing in place for long periods of time, and tight calf muscles.

Who is most at risk of developing it?

Plantar fasciitis is most often seen in people who have flat feet and do not wear orthotics or arch supports. Runners are typically most at risk. In addition, people who are overweight and those who wear shoes with inadequate support or no shoes at all on hard surfaces have an increased risk of plantar fasciitis.

Why is it important to seek treatment sooner rather than later?

Plantar fasciitis can lead to the formation of bone spurs as well tears within the fascial band which may require surgery. The inflammation can also cause pressure on adjacent nerves and muscles which can increase pain and cause temporary or permanent damage. The pain will likely not go away until the proper support or therapy is given.

What are the treatments and when is surgery needed?

I treat plantar fasciitis aggressively from the start. On average, 95% of my patients get better without surgical intervention. On the first visit you will get an x-ray to check for bone abnormalities and the overall alignment of your joints. Then, depending on the pain level and inflammation present, you may get a steroid injection to reduce the inflammation and pain. You will get stretching exercises to help reduce the tension and pull on the fascial band and Achilles tendon. The stretching exercises are the most important part of the treatment protocol. You will likely get athletically taped with a Lodi Taping. You may also get a night splint as well as a heel cushion.

You may require up to three injections, spaced two to three weeks apart, to relieve all the pain and inflammation. Some patients only require one injection, but others require a series. During this time, on the second visit, if the athletic taping helped with the pain we know then that custom orthotics will help consistently relieve the pain and support the fascial band. You will then be casted for custom orthotics. Some over-the-counter orthotics might be sufficient given the shape and alignment of your feet.

It may also be necessary in severe cases to send the patient to aggressive physical therapy to help loosen and stretch out the plantar fascia. Surgery is performed if complete relief of pain is not achieved with conservative therapy and orthotics. Surgery consists of endoscopically cutting the medial 1/3 of the plantar fascia. It is a 10-15 minute procedure with two ½ inch scars on either side of the heel. The patient can walk out of the surgery with a surgical shoe or large boot and will be back in shoes in three to four weeks.

Are there ways to reduce the pain with lifestyle changes?

Avoid walking barefoot or on hard surfaces. Try to always wear orthotics or arch supports. Stretching on the calf muscles daily, twice a day, will help reduce the tension of the plantar fascia.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

What You Need To Know About Marketplace Insurance Enrollment

Pam Laye

The enrollment period for 2020 Marketplace insurance coverage is now underway. While many people view the process as complicated, there are places to turn for help. Pam Laye, supervisor of outreach and enrollment at Keystone Health, answers some frequently asked questions in today’s article.

Why is it important to have health insurance?

No one plans to get sick or hurt, but almost everyone will need medical care at some point. Health insurance covers most costs, protecting you from unexpected, high medical bills and offers many other important benefits as well. You pay less for covered in-network health care, even before you meet your deductible. Without health insurance, you are faced with paying the bills yourself and those bills could amount to a lot of money and debt which could take you years to pay off.

A three-day hospital stay could cost you as much at $30,000 if you don’t have insurance; a broken leg from skiing, bicycling or playing sports could cost you $7,500 if you don’t have insurance. The American Diabetes Association estimates that the average cost of diabetes is $13,700 in medical expenses per person per year. To help address the affordability of health insurance, tax credits and cost-sharing subsidies are available from the government that may make premiums more manageable or may help lower out of pocket expenses such as co-payments at the doctor’s office or the pharmacy.

When is the open enrollment period?

The Marketplace opened November 1, and will remain open until December 15 for coverage to begin on January 1. After the Marketplace closes, you can enroll or change plans only if you qualify for a special enrollment period. Circumstances that may qualify you for special enrollment include: marriage, a birth, adoption or fostering of a child and a change in your current insurance, income or citizenship.

What are the main options when it comes to plans?

In Franklin County the only two options are Capital Blue Cross and Highmark. Capital Blue Cross plans which are  offered are Preferred Provider Organization (PPO) plans. This means if you go to a provider who accepts Capital Blue Cross insurance, you will pay a lower cost for care. If you go out of network (to a provider who does not accept your insurance plan) the cost will be higher than in network, but still lower than full cost. Highmark is offering only Exclusive Provider Organization (EPO) plans. This means if you go out of network, insurance is not going to cover your service and you will have to pay full price.

The deductible and out of pocket cost are about the same for both options which could be as high as $15,800 and as low as $2,000 depending on your plan.

When will my coverage begin?

If you enroll or change plans by December 15, 2019, your coverage will begin January 1, 2020.

Do I need to do anything if I enrolled last year?

If you do not update your application by December 15, 2019, you will probably be re-enrolled automatically. However, it is best to review your options every year. Prices and plans change annually and there may be a new plan that is more affordable for you. If the plan you selected last year is no longer available, you will likely be enrolled in a similar plan. It is important to make sure your healthcare provider accepts the plan you are using.

If I choose to be uninsured is there a penalty?

Starting with the 2019 calendar year, it was determined that there will not be a penalty for remaining uninsured. So if you do not have health insurance when you file your taxes after January 1, 2020, there will not be a penalty.

But keep in mind: No one plans to get sick, but most people will need health insurance at some point in their life. Health insurance covers most costs, protects patients from unexpected high medical bills and offers many other important benefits. Patients pay less for covered in-network health care, even before they meet their deductible or coinsurance, and pay a small co-pay when seeing a family physician. Without health insurance, patients are faced with paying health related costs themselves, which could amount to a lot of money and debt that could take years to pay off.

How do I enroll?

There are several ways you can enroll. Most people choose to enroll online at www.healthcare.gov but you can also enroll by phone, with a paper application or with a trained helper or certified Marketplace counselor. The department I oversee, Keystone Health’s outreach and enrollment department, is one community resource that provides this service for free. Our certified enrollment navigators can meet with you and walk you through the process, and can also help you complete charity applications. You can call (717) 709-7969 for further information or to schedule a free appointment to meet with a Keystone Certified Assistance Counselor.

Marketplace agents can also help complete applications, but there is typically a fee for the use of this type of assistance. There is no cost or charge if you use a Keystone Certified Application Counselor.