Articles - JFCS of Greater Philadelphia

Dive deeper into mental health and self-care through articles by JFCS staff as well as other specialists.

Parenting on the Frontlines – Some Practical Tips

By Leah Sorokorensky, CRNP | JFCS Nurse Practitioner, Holocaust Survivor Program

“I dropped to two shifts a week. One is Sunday and my husband watches the kids…It’s not super sustainable …It’s working for now.” “Nightshift and barely sleep. My husband watches the kids when I nap and works otherwise.”

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Healthcare and other essential workers have been put between a rock and hard place when it comes to childcare. COVID 19 has created a difficult situation for everyone but some would argue that parents and caregivers have to face some extra challenges. Working, parenting, and keeping up with housework- things that may have been outsourced in the past and no longer can be. “Who can do all of these things full time?” “It’s impossible!”

Some parents have no choice but to utilize grandparents, babysitters, essential daycares. All things that might make them uncomfortable as they are trying to protect themselves and their families, but they feel they have no choice. Others are working with their spouse to create (non-ideal) schedules to manage children. Some are working night shift, and just not getting sleep during the day. Some are forced to leave older kids home alone when they normally wouldn’t. Some have moved out or moved to the garage. Some have quit from the sheer stress of the situation.

Let us take a moment to acknowledge and salute you, the parents. If given the choice, I’m sure most would choose a week’s vacation, or sufficient PPE, over being celebrated as a hero, but nonetheless, let’s give you, the frontline worker, the recognition you deserve. You are doing mission impossible. Something no one would have ever expected any human to juggle “pre-COVID”. Not only are you managing all of these stressors outside of the hospital or facility, you are also working in a high risk, high stress situation, with very little guidance or support for some. Mother’s day, Father’s day, Nurse’s week, just doesn’t seem to do justice this year.

If you’ve gotten this far, you’re probably waiting for my advice on how to juggle this all like a pro. Sorry to disappoint you folks but you will not find an answer here. Because it is IMPOSSIBLE. Let that sink in. No human should be expected to do all of these things simultaneously. I’m here to tell you it’s all ok. Practically speaking, you need to give it your all at work. Otherwise, patients may suffer, errors may occur. Unfortunately, that means housework and family life may not be perfect. Forget Pinterest. Forget perfection. We are talking survival here. So I’d like to offer some tips on how to make things a bit less stressful and create routines that work better for your family.

Organizing helps. Constant decision making is stressful and exhausting. Planning things in advance help take the stress out of routine decisions.

Meal prep/meal plan– Taking 10 to 20 minutes once a week to inventory and plan what will be served will help decision fatigue. I will include some of my favorite time saving recipes/ideas at the end.

Schedules– Creating a routine is important for parents and children to have a sense of stability and consistency in their life. Creating a detailed schedule down to the minute did not work for my family, in fact it flew out the window pretty fast. Depending on your kids’ ages and personalities, you may have to find a schedule that works for you. For example, class time, meal times, HW times, are set in stone, but you may choose to give some flexibility for free play or other activities during break time. Or allow children to choose from a pool of pre-decided activities, to take the stress out of decision making.

Give kids responsibilities: Depending on the child’s age, they can be given different chores and responsibilities around the house. The upside is that children will be learning valuable life skills, something they won’t get in a Zoom class. They can help manage laundry, dishes. Older children can help occupy younger children.

Most importantly give yourself grace. You are not superhuman or a robot. This is not a normal situation. Drop the guilt. At the end of the day, choose quality over quantity when it comes to spending time with your children. Studies have shown links between quality time and positive outcomes. Set aside at least 10 minutes of one on one time with each kid if possible.

Save your sanity. Life will one day get back to normal, your kids will get into great colleges despite zooming through 2020, and this too shall pass. Your family needs you to have your mental health intact. Reach out to ______ if you feel you need some support.

****My Favorite “healthy” meal prep ideas- Breakfast– grab ‘n’ go oat muffins (see recipe), egg muffins. Snacks– cheese sticks, yogurts, applesauce, bananas. Lunch and Dinner – tacos, lasagna, salmon and rice, eggs, frozen veggies. And hey, frozen chicken nuggets and cereal for dinner are great options too!

Grab ‘n’ go oat muffins

(This is my favorite recipe because it’s a one bowl dump and go. I don’t usually measure ingredients, but I did my best to estimate. It’s most important to eyeball for consistency. You can add wet or dry ingredients as necessary to get the right consistency which should be a thick, sticky, oatmeal consistency. I make these on Sunday mornings. It yields 18 muffins which last about a week in my family but can last up to two weeks in the fridge. Can be frozen too!)

3 bananas mashed
4 cups of rolled oats
1 cup blueberries
1-2 cups of applesauce
2 cups plant based milk
½ cup Almond flour
1 tbsp. of ground flaxseed
1 tbsp of cinnamon
Oil spray
Chocolate chips (optional, but without this I don’t think my kids would love it as much)
Almonds or nut or seed of your choice (optional)

Mash bananas first in a large mixing bowl. Then add the oats, almond flour, apple sauce, flaxseed, cinnamon, and milk and mix together. Add additional wet or dry ingredients to achieve a thick oatmeal consistency. Then mix in blueberries, chocolate chips and any other nut or fruit you fancy. Spray muffin pan or liners with oil spray to prevent sticking. Muffins will not rise so feel free to fill them high. Bake at 350 for about 30 – 35 mins, until firm but watch for burning. Keep in fridge for up to two weeks, or freeze. My kids love them. Enjoy!

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Meaning Making in Times of COVID

Written by Carly Chodosh, LSW | JFCS Social Worker / Care Manager

We’re all looking for it – and under the current circumstances, it seems elusive to many. The world we live in is unfamiliar, the rules seem to change on a weekly, if not daily basis. Too many people we see are in pain and we feel it directly or residually. This is particularly true for the workers on the frontlines of this “Brave New World,” who may desire some return to ‘normalcy’ (whatever that means), and fear the next steps to come.

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Meaning making is the desire to find value, or inherent truth in a challenge or arena in one’s life. According to Victor Frankl, it was how he survived living in Auschwitz for 4 years. But according to Frankl, in his memoir Survival in Auschwitz, it wasn’t grand scale meaning that kept him waking up each day – it was finding the small moments of laughter, connection, and value that enabled him to face day after day.

And we’ve seen it throughout this pandemic as well. From funny memes about how many times a cat can take on the persona of zoom bomber, to that woman who turned herself into a potato in a Microsoft Teams meeting, we’re finding ways to connect amongst the chaos. But there is no place that this holds true more than in the meaning our healthcare workers are finding for their patients, for themselves, and for their communities during this time.

From Jimmy Fallon’s “Safety Dance” with frontline workers to endless story after story about last rites rituals and last-moments Facetime sessions with loved ones, nurses, doctors, respiratory therapists, and other frontline workers are doing everything they can to change the narrative from dire and hopeless to full of love and, well, meaning. Providing these opportunities for connection during the most vulnerable moments of one’s life is something that cannot be measured, and it is that part of the narrative that I am hopeful will carry throughout time.

But as our frontline workers carry that tremendous load of responsibility, how can we support them in the search for meaning throughout the murky waters? The reality is that it is a challenge, and there are no clear cut steps. However, there are areas where it may be possible to focus on the way that meaning happens, rather than the way that it’s nowhere to be found.

Mindfulness
Mindfulness is a tool that provides opportunity for curious reflection, without judgment, of feelings, behaviors, and thoughts. Utilizing this during your time on-and-off the floor will allow for moments of humor, sadness, kindness, and value to trickle in.

Self-Compassion
We are all experiencing a collective trauma – and one that we cannot expect to recover from overnight. Just as bones and muscles need care and tending to in order to recover, so do our brains and hearts as we realize the gravity of our experiences. Facing yourself with compassion and kindness will allow the small victories or “silver linings” to shine rather than the moments we may wish to forget.

Help Seeking
Every single person has limits, and it should not be taboo to ask for help before we reach our own. While stigmas and structural barriers exist in many communities when it comes to treating our own mental health, there are many opportunities available to speak with a professional when it is necessary. This is not true only in the peak of this epidemic – but will remain true for however long the recovery period is afterwards, as well.

Connection
When possible, focus on physical distancing, and not social distancing. Utilize time off to do something that you really LOVE, whether it’s time with your family/loved ones (over zoom or skype), cooking and eating your favorite foods, or spending time in nature – whatever makes your heart sing should be a priority to give you an opportunity to turn off your brain and be in the moment.

Sometimes, the answer is to simply stop looking for an answer, and start looking for a reason to put one foot in front of the other. Usually, meaning will provide those steps. And with our search for a shared meaning, we will get to the end of this pandemic, no matter what the world looks like on the other side.

For support during this time, please call our Care Navigation Line at 1-866-JFCS-NOW or go to www.jfcsphilly.org/sfhp
The National Suicide Prevention Lifeline phone number is 1-800-273-8255
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How to Soothe Yourself in Stressful Times

Written by Lilliam Rozin, LCSW | JFCS Older Adult Mobile Mental Health Therapist

It has been an incredibly challenging time for all of us lately. We have been required to change almost everything about our lifestyles, schedules and plans. We are cooped up either completely alone, or with our families and we are tired of it! Many of us are worried about being able to care for our families and pay our bills; we all wonder what our futures will be. And we all have to learn to live with uncertainty.

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One of the deepest lessons we are learning at this time is that we often cannot count on our external environment to bring us comfort and peace. So how do you find peace, calm and ease during such a challenging time?

Here are some suggestions to help you navigate this time with as much grace as you can!

  • Always do your best, but let go of perfection.
    Juan-Miguel Ruiz in his wonderful book,” The Four Agreements”, encourages us to let go of getting things exactly right! Whether you are a front-line worker or a parent with young children, this is a time to be kind to yourself and realize that you can only do what you can right now. So remember, you can’t fix or control everything. Just do your best each day. Because each day is different, and each day we may feel different!
  • Take time for yourself, any way you can.
    If you have kids and are working from home, this may seem impossible. But teach your family that you need 5, 10 or even 30 minutes of time for you. If there is no other place, go to the bathroom and lock the door! Take a few minutes to just breathe, do a guided meditation, put on your headphones, or take a cleansing shower. Everyone needs some down time to function at their best. Plus you are teaching your kids that even moms and dads need downtime…
  • Talk about how you are feeling with others who can listen and share.
    When we don’t try to handle everything ourselves, we at least feel less alone and realize that everyone else is in a similar boat. This is truly a difficult and unprecedented time for all of us. We need each other more now than ever!
  • Do something mindful for yourself at least once a day (if not more).
    Count backwards from 20 as you exhale or listen to a guided meditation on youtube. Take an online yoga class or just sit quietly and repeat everything for which you feel grateful. If you can stop every hour or so and even just stretch or take one deep breath, that would be great. The more you do these small gestures, the more they become healthy habits, and the more they will help you manage the anxiety you may be feeling with all the unknowns.
  • Find some ritual that helps you create a separation between work and home time.
    These days our workspace is our home. So teach your brain that work time is done for the day by mindfully putting your work in a folder, writing notes for tomorrow so you don’t worry about it all night, tidying up, and even putting things on a shelf or closing a drawer. This helps the mind understand that your focus will shift elsewhere for now. If you can, walk outside and physically make a break between your workday and family time. Sounds small, but it helps train the brain to focus where we want it to.
  • Do something unrelated to work that captures your attention in a one-pointed way.
    For instance, Sudoku or a crossword puzzle; watching a great movie; playing a card game, doing a craft project. It is really hard to be stressed if your mind is focused intently. Multitasking is overrated! In order to calm the mind, we can’t be doing 3 things at once.
  • Finally, remind yourself regularly that self-care is not a luxury, it is a necessity!
    If you don’t take care of your needs, you will become more anxious, depressed, angry and less able to adapt to change. We all handle our stress differently, and we can’t expect others to know what we need. So tune in to your own body and once you know what you need, let your family and friends know how they can be supportive. You are also modeling for your kids and others when you take care of yourself!

As you try any or all of these suggestions, be kind to yourself! It is harder to change and learn when our systems are under stress. So remember: all you can do is your best today. And tomorrow’s best will be different…

If I could pick out just one emotional skill I wish everyone could have, it would be to self-soothe. I find in general that people have not learned to do this for themselves, whether because they were over-protected as children, or had to survive trauma and just figure out the best they could for themselves. Mostly, when we become triggered, we revert to either numbing in some way, escaping, ignoring or self-harming. All if these survival strategies have their value at some point; but are they really getting you through the crisis/ problem or just pushing it to the side (or on to someone else!).

After working with a lot of clients over time, I have noticed that people will call me in a crisis, I talk them off the ledge, and then the next time there is a crisis, they call me again. I usually repeat the very same thing I have said before, and often, even they can recognize this pattern. How nice would it feel to be able to do that for yourself, instead of depending on another for your wellbeing?

With that in mind, we have put together a few tools on http://www.jfcsphilly.org/supportforhealthcareprofessionals you can use to identify and help you remember what you need to gracefully move through challenging times.

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Supporting the Mental Health of the Healthcare Heroes

Written by Robin Axelrod Sabag, LCSW | JFCS Assistant Director, Counseling and Therapeutic Services

Throughout this Covid-19 pandemic, much of the focus has been on social distancing. There has also been a great deal of discussion about how to stay in a sanitary environment, ways to do testing, and when our lives will return to normal.

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We also hear a lot about the healthcare professionals. However, when it comes to healthcare workers, the focus is on their need for personal protective equipment and the medical centers’ need for respirators. Healthcare professionals are seen as heroes; and they are. To an outside observer, healthcare workers look strong and resilient in the face of the unknown. They inspire us as they go to work every day at great personal risk to keep others safe. Some of us want to be like them, and wish our jobs required us to be essential workers. We worry about them having the equipment they need. However, little attention is being given to the impact that this crisis may bear on their mental health. This is a mistake.

The reality is that many healthcare professionals wear an additional type of protective armor that they do not want us to see–stoicism. But they have real feelings like anyone else. They are afraid of spreading the disease to their families. They feel guilty for not spending enough time with their families, as many are staying isolated in hotels. They feel inadequate for not being able to do enough for their dying patients. They serve the role of child/parent/spouse for their dying patients who cannot have their loved ones in the rooms with them. They are exhausted and lonely.
Added to this is the fact that there is so much uncertainty. They are seeing a multitude of chronic cases on a daily basis, are facing shortages in equipment and are having to make major decisions for their patients while trying to fill the role of their patients’ loved ones. Some healthcare workers are also concerned they might die from COVID-19. They have seen this happen in China, Italy, the United States and thus, have begun drafting living wills. The combination of these factors contribute to PTSD, anxiety, and depression. At a time when healthcare workers would typically have family and friends for emotional support, some have opted to physically isolate themselves in order to protect their loved ones from getting the virus.
This past week, we learned about a Manhattan Emergency Room physician who died by suicide. A young Bronx EMT did the same. Few people are talking about the impact that this crises is bearing on the first responders.

Finding support for medical workers’ mental health should also be a priority in the battle against COVID-19. We need to plan ahead to have measures in place to help protect not only their physical health, but also their mental health. This was done in China, and we should follow its lead. Mental health support can come be delivered in a variety of ways. At JFCS, we have implemented various supports to meet the individual needs of healthcare professionals such as: Telemental health counseling sessions, drop-in support forums for healthcare providers on the front lines of the pandemic and their spouses/partners, along with short self-care videos, helpful articles, and inspirational emails that healthcare workers can access at any time. For more information, go to www.jfcsphilly.org/supportforhealthcareprofessionals.

We can ALL be mental health first responders. This requires us to have the awareness and knowledge of the impact that this crisis is having on healthcare workers. We need to ask questions such as: “how are you”, and even probing ones, like, “are you thinking about suicide?”. Although it may be uncomfortable, research indicates that those are the exact questions that people need to hear.
Now, it is more important than ever to provide these services. People on the front lines could die from the virus, or even from suicide, as we have already seen. We waited far too long to find ways to protect health care workers physically. Now is the time to talk about how to protect them emotionally.

For support during this time, please call our Care Navigation Line at 1-866-JFCS-NOW or go to www.jfcsphilly.org/supportforhealthcareprofessionals

The National Suicide Prevention Lifeline phone number is 1-800-273-8255

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Saying Good-Bye When You Cannot Be at Bedside

Written by Rabbi Tsurah August | JFCS Chaplain

The voice on the phone said: “There is a family whose father is dying in the ICU. They would like you to help them.”

The call came to me from a fellow hospital chaplain, because I work with dying patients and their families, helping them cope with and help make their final hours with their loved ones more comforting, and meaningful.

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3 months ago, I would have quickly gotten the room number and made an appointment to meet the family there. But this was 2 weeks ago, and that scenario was already impossible. No visitors – no family and no chaplain!
Our “visit” was made entirely by phone, without the family or chaplain present at their father’s bedside. And it was moving and beautiful!

Saying our final Good-bye to a loved-one is hard enough. Not being able to say Good-bye at all can be agonizing.

This time of Covid-19 has prevented one of the most important natural human yearnings from being expressed: Being with and saying good-bye to a dying loved-one.

What can we do to have a “Loving Good-bye” with our loved ones when we cannot be with them?

Over the years, I’ve received many phone calls like the one I shared at the beginning of this article. And, much as I would have liked to rush to a patient’s bedside, this was not always possible, so I guided their family members by phone in saying good-bye. Now, without a chaplain available, you can still make this a meaningful and comforting time for your loved one and family.

Here are some practices that have worked for me by phone, when extenuating circumstances prevented me and the family from being physically present.

In advance of the “visit”, invite your family members to join you in this “loving good-bye” and set the means (Zoom, FaceTime, etc.) and time frame. Cap the time at 20-40 minutes, depending on how many people will be on the call.

(BTW, this definitely can work with only the family members on the call. However, there may be a nurse or other staff able to help you connect the patient to the call. Even unconscious patients can hear. I recently had a doctor set up a FaceTime call. The Pastoral Care Office may be able to help you in this.)

You may want to begin the call by having everyone light a candle in their own homes or having a photo of your loved one in front of you. Feel free to be creative! Do whatever makes this feel like a special moment.

If your family has a connection to a spiritual or religious path, you may consider beginning and ending the “visit” with a prayer or blessing.

There are 5 categories of “good-bye gifts” that end-of-life professionals consider to be helpful. They can be said out loud by whomever wants to speak, or held silently.

The first is an expression Gratitude.
Gratitude for how the patient has enhanced your life. This can include general or specific acts or words, such as “I am grateful for how hard you worked to support us”, “I am grateful for your unconditional love”. Or “ I am grateful for the time you….”.

The second is to assure them that They Are Not Alone.
This may seem strange, since they are physically alone. However, this lets them know you all are thinking of them and that your love is with them.

The third is Forgiveness.
This can be a challenging one. Throughout our lives there are moments when we may act or speak in ways that are painful to others. A sharp word, a teen-age acting out, a fib, etc. Even the kindest of people have these moments. This is the time to ask for and offer forgiveness, even if the patient cannot initiate or respond.

However, there are situations where asking or giving forgiveness is not authentic, because the pain is too deep or unresolved. In this situation, I recommend simply saying “We have done the best we could”.

The fourth is We Want the Best For You.
We Will Take Care of Each Other the Best We Can. This can be very comforting to the dying person who will no longer be able to take care of you. It can also help deepen the family bond and reassure frail and vulnerable survivors.

(Many End-Of-Life counselors suggest saying something in the order of “You can let go now, we will be OK”. )

The fifth, and final, is You Will Be Loved and Remembered.
This speaks for itself.

Now take time to share memories! Laugh, cry!

I hope these suggestions help you find a way to say “Good-bye” that is right for your family. No matter how near or far you are from each other and your loved one, your care and love transcend time and space. No matter what!

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Tips for Coping and Stress Reduction

Written by Robin Axelrod Sabag, LCSW | JFCS Assistant Director, Counseling and Therapeutic Services

Times are uncertain. We are experiencing a worldwide pandemic. Countries and borders are shutting down. Some of us are in areas that are hot spots for coronavirus. Many of us stay glued to the news, wondering, “what will happen next?” This is not easy to embrace. Humans do not like uncertainty.

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With so much unknown, it is normal to feel stressed. While this reaction is understandable, it can wreak havoc when there is a sense of uncertainty and conflicting information around us. None of us was prepared to simultaneously juggle zoom calls, parent quarantined kids, change diapers or help children to log into online learning all while finding the time to cook three meals and several snacks per day. Parents were also ill – prepared to support their kids who formerly were over-scheduled but now have to navigate endless down time, screen time and no real-time friendships. People were not prepared to dodge the disease, worry about leaving the house, and then return from grocery shopping only to wash their hands incessantly and disinfect the bags in which the food was packaged.

With stressors such as these, our overall well-being is likely to suffer, without us even being aware it is happening. Some of us may feel more anxious, on edge, depressed, and frustrated. Those with underlying mental health issues will feel this even more intensely.

During this precarious time, it is important to gain perspective and to know that we are not helpless. We can arm ourselves with tools and choices. Here are some things we can do to take care of our mental health in the face of uncertainty:

Accept That it’s Normal to be Stressed Out Right Now. Don’t Judge Yourself For How You’re Feeling
One of the first steps to coping with anxiety and uncertainty is to recognize that it is a normal and reasonable response. Symptoms of stress, like elevated heart rate and racing thoughts, evolved as the body’s way of signaling to your brain that it is in danger. This is what is commonly knows “flight or fight” and is a basic human instinct. Keep in mind that stress tells us that something is off and that we need to adjust. We cannot simply do away with stress; we have to find ways to manage and cope with it.

Separate What Is in Your Control From What is Not
There are things you can do, and it’s helpful to focus on those, not on what you cannot control. Stay home. Wash your hands. Remind others to wash theirs. Take your medicines and supplements. Limit your consumption of news to certain times per day and only from reliable sources. Take care of yourself.

Stick With a Routine
Having a daily routine in place can help you to feel grounded. Try to: wake up at the same time every day; eat regular meals; do an at-home workout; get your work done; plan for enjoyable activities etc.

Get Outside in Nature
Get outside; you can still walk through nature while keeping a safe distance from others. Take several walks a day. Get your dose of vitamin D; don’t stay inside all day. Exercise also helps both your physical and mental health.

Challenge Yourself to Stay in the Present
You may not only be worrying about current events, but also projecting into the future. You might be concerned about the state of the economy, whether you will have a job next week, whether your sister will be able to have her wedding this spring, or whether your aging parents will be able to survive without catching this virus. These are real concerns. Some you can prepare for; others you have no control over. When you find yourself worrying about something that hasn’t happened, gently bring yourself back to the present. Engaging in mindfulness activities is one way to stay grounded when things feel beyond your control.

Stay Connected—Even When Physically Isolated:
Humans are social animals, hard-wired for connection. Social distancing comes with risks. Staying in isolation can cause depression. Prioritize connections. Do what you can to schedule daily check-ins with friends and family. Join an online support group. Utilize social media to stay connected to your community. Remember, you are not in this alone.

Prioritize Exercise and Proper Nutrition
This is always good advice, but it’s worth emphasizing during times of uncertainty. Since you cannot get to a gym, there are many online at-home workouts available. Anxiety increases the stress hormones – adrenaline and cortisol. Physical exercise reduces the levels of these hormones and stimulates the production of endorphins, which serve to elevate mood and well-being. Although it is tempting to seek comfort in food, sticking to a healthy diet is also important and can also help improve your outlook. A recent study found that a Mediterranean-style diet, rich in fruits and vegetables, whole grains and lean protein help reduce the symptoms of depression and anxiety among a group of young adults.

Don’t Let Coronavirus Be the Center of All Your Conversations
Keep in mind, there was a life before coronavirus. There are other topics of conversations. When connecting with others, try to take a break from the stress. Remember to laugh and try to find ways to enjoy the company of others, apart from this misfortune.

Seek Professional Help
If your mental health is being impacted by the stress of the coronavirus, then you may want to seek professional help. A licensed mental health professional can help you to manage your fears while also empowering you to make the best decisions for you and your family. Most, if not all mental health professionals, are practicing Tele Mental Health now and can provide support during this stressful time. You do not have to be alone with your worry, and it is okay to ask for help from a professional.

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For support during this time, please call our Care Navigation line at 866.JFCS.NOW (866.532.7669)

The National Suicide Prevention Lifeline phone number is 800.273.8255.

JFCS’ Support for Healthcare Professionals is made possible through generous funding from Jeffrey Lurie and the Philadelphia Eagles.

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