grey literature February 2008 archives
February 29, 2008
Social and health care services have made great strides in identifying their values and vision for the future in order to achieve successful change and improvements. This knowledge review explores the processes and actions that have proven most effective in bringing about and sustaining improvement in social and health care services. The findings focus on three key action points that organisations should implement at all stages of an improvement programme:
- leadership that propels change and improvement
- employee involvement and participation in improvement
- stakeholder involvement and participation in improvement.
A decade ago, Congress and the Clinton administration lit a fire under the child welfare establishment with the Adoption and Safe Families Act of 1997, which attempted to shorten the amount of time children spent in foster care. In New York, a great deal has changed since then. The number of foster children declined steeply after 1999. But ASFA was not the jolt that caused the sudden drop. Rather, major changes in policy and practice—in child protective investigations, in services designed to help families before they tumble into disaster, in new child care subsidies—as well as a dramatic fall in once-staggering rates of crack cocaine addiction among city residents, combined to reduce the pace of new foster care placements. Nor is it ASFA’s doing that, since early 2006, more New York City kids are once again spending longer periods in foster care and more families are in court facing charges of child abuse or neglect. These changes, too, are driven by local policy and circumstance, namely, the after-effects of the much-publicized Nixzmary Brown murder two years ago this month. The substantial growth in the number of abuse and neglect reports that began in January 2006 has abated only slightly. And the Bloomberg administration sharply increased the number of city child protection investigators and attorneys in 2007, contributing to the higher flow of cases to Family Court.
This document provides SHAs, PCTs, training providers and service providers with an overview of what is needed to deliver the implementation of IAPT. The additional funding from the Comprehensive Spending Review 2007 will pay for the major training programme that provides the necessary number of suitably trained therapists and enables progressive expansion of NICE-compliant local Psychological Therapies services.
This knowledge review looks at current literature and practice around service user involvement, the extent to which service user involvement has brought improvements to social work and social care and where the change has become established practice.
The Multiethnic Placement Act requires the diligent recruitment of potential foster and adoptive
families that reflect the ethnic and racial diversity of children in the state for whom foster and
adoptive homes are needed. Therefore, The Child Welfare Professional providing adoptive
services may find themselves interacting with families from cultural backgrounds with which
they may have had little experience or exposure. There is a need to understand how the degree
of knowledge of the important differences and similarities of minority groups affect the ability of
the Child Welfare Professional to connect and sustain a relationship with a minority family.
Through this relationship, the Child Welfare Professional can support the family through the
adoption process and through the post-placement period. Coupled with this knowledge is an
awareness of how the attitudes and values of both the Child Welfare Professional and the family
can affect the relationship, and by extension, the success in recruiting and retaining minority
adoptive homes.
This issue of A Closer Look examines:
Definitions of family involvement;
Families in child welfare, yesterday and today;
Grant communities respond to challenges in strengthening family involvement;
Operationalizing family involvement in system change; and
What leaders can do to support family-agency partnerships for system transformation.
We invest a lot. We already spend at least $14 billion to support children’s mental health (out of a national behavioral health expenditure report of $104 billion), but a large proportion of the children and youth who need services and supports do not get what they need, as Dr. Knitzer has explained. If they get services at all, it may not be the most appropriate and there is concern that the quality of mental health services needs improvement. Prevention and early intervention services are not widespread.
February 28, 2008
This statistical bulletin presents information on activity relating to community penalties in Scotland, mainly derived from Local Authority Social Work management information systems. The bulletin also presents information on the characteristics of offenders who receive community sentences (age, gender, previous convictions and reconviction rates). Information is presented at a National level; additional information at Local Authority and Community Justice Authority (CJA) level is available on the Scottish Government website.
FIGHT CRIME: INVEST IN KIDS has taken a hard-nosed look at what works—and what doesn’t work—to cut crime and violence. Exciting new research, combined with prior evidence, shows that most abuse and neglect in high-risk families can now be prevented. Doing so will spare thousands of Illinois children from terror, agony, and despair and will also save lives. Sharply reducing abuse and neglect in Illinois will save billions of dollars, while greatly reducing the number of children who would otherwise grow up to become criminals.
This knowledge review sets out to identify what is known about the social care needs of children with complex health care needs (CHCN) and their families, and about the services designed to meet those needs. The review is made up of three distinct parts:
- a consultation with children with CHCN and their families
- a review of relevant research
- a survey to identify examples of good practice in service provision.
Recovery is a concept that is gaining prominence in the discourse about mental health. However, there is no consensus about what it means and debate continues about how it can be used to develop person-centred mental health services. This paper is from one of the study days organised by Social Perspectives Network, which brings together the more diverse and seldom heard voices in the recovery debate.
Youth with Disabilities in the Foster Care System: Barriers to Success and Proposed Policy Solutions
The goal for our country’s youth is to live healthy, happy lives and to become self-sufficient, contributing members of society as adults. However, there are subsets of youth who cannot reach these goals with ease. These youth need additional supports to assist them in their journey toward a healthy adulthood, as they are more vulnerable than the “average” youth and thus are more apt to fall through the cracks during their journey. Youth development researchers have determined that some specific youth populations are more vulnerable than others. This report examines one exceptionally challenged group in particular: older youth (specifically, preteen through young adult) with disabilities who are involved in the foster care system. The child welfare community generally accepts the fact that while the American foster care system has come a long way in recent years, there is still much to be done to ensure the health and well-being of the children and youth it serves. Likewise, the disability community has seen great improvements in recent years but still advocates for additional needed change. But what is often overlooked among experts in both of these realms is the idea that foster care is indeed both a child welfare issue and a disability issue. This is due to the alarmingly high numbers of foster youth with mental, developmental, emotional, learning, and physical disabilities. The purpose of this report, therefore, is to shift the lens through which youth advocates and service providers view the importance of ensuring the well-being of foster youth. This new lens asserts the importance of understanding the prevalence of disability among foster youth and better ascertaining who should be held accountable for this uniquely challenged and often underserved population.
Children in the Child Welfare system have already experienced parental separation and loss. Child Welfare Professionals have recognized the harm caused by interruption of the parent-child relationship. While working to provide permanency for the child, the Child Welfare Professional must continually be aware of the magnitude of the changes the child experiences when he is placed and how these changes can contribute to the trauma experienced by the child. It is possible to lessen some of the trauma that accompanies moves into an adoptive home. The Child Welfare Professional has an important role in preparing the child and the people involved with the child before the child is adopted. The extent to which the child and family are prepared for adoption has a significant impact on easing the transition. Using available resources and strategies based on the child’s developmental levels have been found to be successful in alleviating the child’s anxieties and minimizing the stress associated with change.
This report synthesizes current research and other available information on the assets and liabilities of low-income households into a variety of portraits. These data allow practitioners and researchers to begin to form a comprehensive representation of the balance sheets of low-income households and sets the stage for future research and policy discussion around the finances of low-income households.
February 27, 2008
• During 2006/07 there were 44,794 exclusions from local authority schools in Scotland, an increase of four per cent from 2005/06. The number of exclusions has risen each year since 2002/03. About 22,800 different pupils (three per cent of pupils) were excluded during the year.
• Overall, male pupils accounted for 78 per cent of exclusions, the same as 2005/06. The proportion has decreased from 81 per cent in 1999/2000.
• There were 6,018 exclusions from local authority primary schools, 13 per cent of the total, and equivalent to 16 exclusions per 1,000 pupils. The number is a four per cent increase from 5,779 exclusions in 2005/06.
FIGHT CRIME: INVEST IN KIDS has taken a hard-nosed look at what works—and what doesn’t work—to cut crime and violence. Exciting new research, combined with prior evidence, shows that most abuse and neglect in highrisk families can now be prevented. Doing so will spare thousands of Pennsylvania children from terror, agony, and despair and will also save lives. Sharply reducing abuse and neglect in Pennsylvania will save billions of dollars while greatly reducing the number of children who would otherwise grow up to become criminals.
On September 12-13, 2006, the Annie E. Casey Foundation/Casey Family Services brought together leading child welfare researchers from across the United States to lend their collective expertise to the urgent need of achieving family permanence for older children and youth in foster care. The Research Roundtable served as a forum for a rich dialogue on the successes and challenges in achieving family permanence for this population. Through formal presentations, responses, and open discussion, the invited researchers and other guests identifi ed critical issues and explored emerging policy and practice opportunities. Together they developed recommendations for policymakers, child welfare service providers, and the child-welfare research community to increase the likelihood that each youth in foster care will leave the system with an enduring family relationship that he or she can count on for life. This report addresses the results of the Research Roundtable as the discussion, and recommendations focused on the policy and advocacy responses that are needed to promote family permanence. The report is organized into three sections that look at the same key themes from different perspectives.
The Northern Ireland Social Care Council (NISCC), the Regulation and Quality Improvement Authority (RQIA) and the Social Care Institute for Excellence (SCIE) commissioned this research with the aim of strengthening user involvement in Northern Ireland. Report 18 looks across health and social care services for children, young people and adults with four aims:
- To provide a short summary of the history and principles of user involvement.
- To describe the current situation in Northern Ireland.
- To discuss a range of options for the further inclusion and participation of users in the work of NISCC, RQIA and SCIE.
- To make recommendations to inform the development of a future strategy for user
The Child and Family Services Improvement Act of 2006 (CFSIA) represents an important step toward providing crucial services to children and families involved or at risk of becoming involved with the child welfare system. Of particular benefit are the addition of $40 million annually and the attention given to improving the workforce and addressing substance abuse, specifically methamphetamine abuse. The provisions of the law are outlined below.
Childhood success begins with parenting at its best. Home visiting is an early childhood intervention that can enhance parenting and promote the growth and development of young children. In high-quality programs, home visiting increases the odds that children from at-risk families will enter kindergarten ready to learn.
On any given day, tens of thousands of inmates with serious medical or mental health conditions are housed in Federal, State, and local correctional facilities around the Nation. Prevalence rates for certain mental illnesses such as schizophrenia and bipolar disorder; chronic diseases such as asthma; and infectious diseases such as tuberculosis, hepatitis C, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are estimated to be significantly higher among prison and jail inmates than among the population at large. In addition, for a major portion of these inmates, regular use of drugs or alcohol has contributed to or exacerbated their health or mental health conditions. Both before and after incarceration, many experience precarious lifestyles marked by periods of homelessness, joblessness, incarceration, hospitalization, family instability, and limited or sporadic health and
mental health care.
Charting the Course towards Permanency for Children in Pennsylvania: an Administrator's Overview is designed to give Children and Youth Administrators an abbreviated version of the 120 hours Charting the Course towards Permanency for Children in Pennsylvania foundation certification training for caseworkers. The Administrators are introduced to the federal, state, and local agency statutes, rules, policies, procedures, and best practice standards related to case planning. They will examine the entire casework process from case screening to case closure, the phases of the casework process and the interactional skills that facilitate those phases being completed successfully, and the strength based, solution focused method of casework practice.
Using the 2005 Citizenship Survey to examine the socio-demographic and attitudinal predictors of community cohesion in England, both at the individual and community levels, this study shows that:
- Both individual and community-level factors influence cohesion
- Ethnic diversity is, in most cases, positively associated with community cohesion while disadvantage erodes cohesion
- Crime and fear of crime strongly undermine cohesion
- Empowerment is important
- Volunteering leads to more positive views on cohesion
- Vulnerable groups have more negative perceptions of cohesion
The predictors of cohesion vary across ethnic groups
February 26, 2008
Particularly with the passage of the Adoption and Safe Families Act, Children and Youth agencies will be required to pursue terminations and adoptions for an increasing number of children in their care. Unfortunately, because termination of parental rights is pursued under a separate statute (the Adoption Law versus the Juvenile Act) and is litigated in a different court (Orphans Court versus Juvenile Court) most agencies concentrate on the differences between termination and dependency rather than the connections. Very often, agencies effectively abandon all of the previous work they have done and attempt to prove termination cases by representing in the termination proceeding all of the witnesses and testimony that has previously occurred in the dependency proceeding. This process is inefficient and counter productive. The purpose of the training is to (1) familiarize participants with what work product they have already accomplished in the dependency proceedings, (2) familiarize the participants with the specific requirements for termination of parental rights and (3) apply the concept of proving a termination case by use of the findings and court orders of the dependency proceedings.
In September 2007, NIMH held a multidisciplinary workshop to identify major trends, gaps, and opportunities in clinical and basic research on repetitive behavior and resistance to change in autism. Autism is a neurobiological disorder with extreme heterogeneity in its behavioral presentation. The core symptoms of the disorder include markedly abnormal or impaired development in social interaction and communication. In addition, a third component of autism includes restricted, repetitive, and stereotyped patterns of behavior, interests, and activities.
The Child and Family Services Improvement Act of 2006 (CFSIA) represents an important step toward providing crucial services to children and families involved or at risk of becoming involved with the child welfare system. Of particular benefit are the addition of $40 million annually and the attention given to improving the workforce and addressing substance abuse, specifically methamphetamine abuse. The provisions of the law are outlined below.
The shifting pension landscape raises questions about the financial security of future retirees. About one-half of private-sector workers are not covered by employer-sponsored pension plans on their current job. Many private-sector employers have replaced traditional pensions with 401(k)-type plans, which protect benefits for workers who change jobs frequently but expose participants to investment risks. This primer describes pensions, workers with coverage, and related policy issues.
Required for newly employed Child Welfare Professionals by the Commonwealth's Protective Services Regulations, Chapter 3490, Charting the Course towards Permanency for Children in Pennsylvania (Charting the Course) is a 120-hour curriculum designed to provide a cohort of new Child Welfare Professionals with the fundamental concepts needed when working with children, youth, and families. These fundamental concepts include awareness, knowledge, understanding, and skills related to child welfare efforts. Each of these fundamental concepts gained through Charting the Course assists Child Welfare Professionals in providing quality services for abused and neglected children and in stabilizing families.
The absence of health insurance creates a range of consequences, including lower quality of life, increased morbidity and mortality, and higher financial burdens. This paper focuses on just one aspect of this harm—namely, greater risk of death—and seeks to illustrate its general order of magnitude. In 2002, the Institute of Medicine (IOM) estimated that 18,000 Americans died in 2000 because they were uninsured. Since then, the number of uninsured has grown. Based on the IOM's methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006.
This review was led by Hampshire Director of Children's Services and ADCS President John Coughlan and found that whilst Department for Children, Schools and Families (DCSF) is showing signs of a real commitment to the new performance framework, there is still a long way to go. The report recommends that councils providing a good service should only be inspected every two years and DCSF has to avoid inventing new ways of rating councils. The DCSF's regional Field Forces must have a clear focus, with the purpose of helping councils to improve rather than looking over their shoulders. The review found that well intentioned national IT projects such as the Integrated Children's System have often been poorly planned and actually create more difficulties for social workers than they solve, as well as diverting attention away from professional approaches to meeting the needs of children and families.
February 25, 2008
According to the National Assessment of Educational Progress, a majority of ninth-graders in low-performing high schools begin their freshman year with significant reading difficulties. Poor reading ability is a key predictor of academic disengagement and, ultimately, dropping out. This report presents early findings from the Enhanced Reading Opportunities (ERO) study, a demonstration and random assignment evaluation of two supplemental literacy programs — Reading Apprenticeship Academic Literacy and Xtreme Reading — that aim to improve the reading comprehension skills and school performance of struggling ninth-grade readers. The supplemental literacy programs are full-year courses targeted to students whose reading skills are two to five years below grade level as they enter high school. The ERO class, designed to serve 12-15 students, replaces a ninth-grade elective, and it is offered in addition to students’ regular English language arts classes. The programs seek to help ninth-grade students learn and employ the strategies used by proficient readers, improve their comprehension skills, and increase their motivation to read more and to enjoy what they read. For this demonstration, one teacher at each school was trained to teach the literacy program, and she or he exclusively taught the course to four sections of students. This report focuses on the first of two cohorts of ninth-grade students who are participating in the study and discusses the impact that the two interventions have had on their reading comprehension skills.
On December 6, 2007, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) and the Health Care Compliance Association (HCCA) co-sponsored a government-industry roundtable called Driving for Quality in Long-Term Care: A Board of Directors Dashboard. The roundtable discussions provided representatives from the long-term care industry with an opportunity to share experiences and inform OIG and HCCA of issues surrounding boards of directors’ oversight of quality of care. The roundtable discussions were opportunities for members of the industry to share with each other ways to improve boards of directors’ oversight of quality and to discuss issues related to such oversight. One of the goals of the roundtable was to specify items that could be included on a “Quality of Care Dashboard” to be offered as a tool for boards of directors of long-term care organizations.
- From 1995 to 2005, the percentage of substance abuse treatment admissions for primary abuse of methamphetamine /amphetamine more than doubled from 4% to 9%.
- In 2005, about 1.8 million substance abuse treatment admissions were reported to SAMHSA's Treatment Episode Data Set (TEDS). Of these, 169,500 were for primary methamphetamine /amphetamine abuse and 80,000 admissions were for secondary or tertiary methamphetamine/ amphetamine abuse.
- The duration of use of their primary drug before admission to treatment was, on average, six years less for persons admitted to treatment for primary methamphetamine /amphetamine abuse than it was for persons admitted for abuse of other primary substances.
- The criminal justice system was the principal source of referral for 49% of primary methamphetamine /amphetamine treatment admissions compared with 34% of admissions for other primary substances.
This report focuses on the first of these three interventions—medicationassisted maintenance treatment for drug dependence—an area in which the United States has considerable experience and strength and that offers an opportunity to expand engagement in global HIV efforts. U.S. efforts should be coordinated with those of recipient governments and other donors in an integrated, comprehensive approach that ultimately will be the most effective strategy to curb the rapid growth of injection-driven HIV epidemics. This paper first reviews why medication assisted maintenance treatment is an essential HIV prevention intervention. Second, it details the medical nature of opioid addiction, the medications best suited for treatment, and their efficacy in HIV prevention. It then assesses the availability of treatment in 12 developing countries: 10 with IDU-driven HIV epidemics, and 2 with emerging IDU-driven epidemics. Finally, it offers recommendations for U.S. policymakers to more fully integrate drug treatment services and HIV prevention efforts into the next phase of the President’s Emergency Plan for AIDS Relief (PEPFAR).
Disability and Work: The Transformation of the Legal Status of Employees with Disabilities in Canada
The rise of the accommodation duty, and particularly the accommodation rights of employees with disabilities, has been the greatest single innovation within Canadian labour law over the past twenty years. High Law principles on disability accommodation have been developed through a series of Supreme Court of Canada rulings, and these principles have been applied through the voluminous Low Law decisions of labour arbitrators and human rights tribunals. This article examines the dismal employment status of employees with disabilities in Canada, traces the emergence of the Supreme Court of Canada rulings, and critically examines the caselaw on disability accommodation from labour arbitrators, human rights tribunals and the common law courts. Although Canadian labour law transplanted the accommodation duty from the early civil rights jurisprudence in the United States, recent Canadian law on disability accommodation has headed in a much different direction than its American progenitor.
This report presents the findings of a study that aimed to provide systematic evidence at the individual beneficiary level of the extent to which, and ways in which, global grants moved people from disadvantaged groups closer to the labour market.
February 22, 2008
The purpose of this study is to investigate the gaps in coverage and the systemic problems that cause insured people to accrue medical debt, as well as the consequences of the debt for individuals and families. The findings are based on in-depth interviews with 45 people in seven states who had accrued medical debt while they were privately insured, either through an employersponsored or an individually purchased plan. The findings are summarized below. However, because summary fi ndings cannot easily convey the complexity of our interviewees’ experiences, we recommend that all readers also review the stories and comments in the body of the report. To facilitate this process, we have highlighted some of the stories and comments within the text. Our interviews suggest that medical debt among the insured results from a variety of causes and the interaction of a number of factors, including the adequacy of people’s insurance plans, the nature of their medical needs, the cost of their treatments, and their fi nancial resources. In all cases, however, interviewees found that their insurance failed to fulfi ll its primary function—to protect them from fi nancial losses and guarantee access to needed care when they became ill.
This publication is a summary report that brings together statistics produced by a range of agencies relating to the experience of women within the criminal justice system. The publication fulfils a statutory obligation for the Secretary of State to publish information relating to the criminal justice system with reference to avoiding discrimination on the ground of sex.
This paper argues against the policy position that begins with a doomsday scenario of publicly provided health insurance and pension systems threatened with collapse under the stresses imposed by population ageing, and instead contends that the threat of crisis in these systems is policy driven. The central thesis of the paper is that a range of policies lead to the creation of an ageing crisis by inhibiting the efficient reallocation of female labour from the home to the market in response to the decline in fertility. The analysis focuses on family support policies that create large effective tax burdens on female labour supply, by means testing the support on family income, or selectively on the second income. Examples include Family Tax Benefit Part A and Part B, the Medicare Levy and the Medicare Safety Net. The analysis draws on household survey data to show that female labour supply is strongly positively associated with household saving, the purchase of private health insurance and spending on family health generally. Policies that inhibit female labour supply therefore have the effect of reducing the tax base for funding public pensions and health care, while simultaneously reducing the capacity of families to fund them privately.
This report focuses on Sources of Financial Aid for Social Work Students in Mental Health and serves as a complementary document to A Strategic Plan to Increase the Flow of Minority, Bilingual and Culturally Competent Professional Social Workers into California’s Mental Health System report. It was prepared by the Center for Social Services Research at the University of California, Berkeley, and funded by The California Endowment.
Abstract: Written for prospective adoptive parents and existing adoptive families, this handbook outlines the adoption process in Vermont and identifies resources for information. The text begins with a series of questions to explore when considering adoption, suggestions for sources of information about adoption, and strategies for estimating the costs of adoption. Chapter 2 discusses special considerations in adoption, such as attachment issues, gay and lesbian family adoption, single parent families, transracial adoption, older child adoption, open adoptions, and talking with an adopted child about adoption. Following chapters describe steps in the adoption process, post adoption services, and school issues. Behavioral challenges, advocacy, positive adoption language, and child development are discussed. The guide also explains the types of information that can be accessed through the Vermont Adoption Registry and other adoption search organizations. Each chapter closes with a list of additional resources. Appendices include lists of adoption agencies in Vermont, Vermont probate courts, and private attorneys.
- While there are many routes that men will use to access women, research suggests that advertisements placed in local papers are the most commonly used method of making contact with women for sexual purposes.
- Research suggests that there is a relationship between classified advertising and the presence of commercial sex premises in an area.
- The audit confirmed that the practice of advertising women and services supplied by women in regional newspapers is widespread. Almost 75% of the publications audited in this review carried advertisements mentioning services from women, and almost half carried classifieds specifically mentioning non-British women.
The performance ratings summarise our independent judgement of performance on a scale of zero to three stars. This year we have sought to strengthen our focus on the delivery of outcomes for those people eligible for social care services arranged or provided by councils. Accordingly, this year’s ratings are based on a new assessment framework, incorporating the seven outcomes from Our Health, Our Care, Our Say and councils’ leadership, commissioning, and use of resources. Our judgement about the delivery of outcomes contributes to the Audit Commission’s overall Comprehensive Performance Assessment of each council. CSCI issues the adults’ social services performance ratings alongside separate summary reports for each council, that identify the key strengths and areas in need of improvement for the coming year.
February 21, 2008
Every year, three million people fall victim to scams, losing an average of £850 each. Fake lottery and prize draw wins, bogus psychic predictions, get-rich-quick investment cons and ‘miracle’ health cures are just some of the tricks scammers try. Though anyone can fall for a scam, the elderly and vulnerable are more likely to be targeted.
The Disability Discrimination Act (DDA) 1995 defines a disabled person as someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities. The amendments made in the DDA 2005 widened this definition to include mental health service users and people with cancer, HIV and multiple Sclerosis. These amendments also placed a general duty on all public authorities to promote equality for all disabled people, with a physical or mental impairment, when carrying out their functions and, to have due regard to the need to:
• Promote equality of opportunity between disabled persons and other persons.
• Eliminate discrimination that is unlawful under the Act.
• Eliminate harassment of disabled persons that is related to their disabilities.
• Promote positive attitudes towards disabled persons.
• Encourage participation by disabled persons in public life.
• Take steps to take account of disabled person’s disabilities, even where that involves treating disabled persons more favourably than other persons.
Public policies to reward healthy behaviors are emerging as part of a national trend in health care toward consumer direction. Consumer-directed health care encourages people to take charge of their health and health care by promoting personal responsibility and quality- and cost-conscious decision making. In Medicaid, there are a growing number of consumer-directed policies that give consumers control over their own health care purchasing. One policy that a number of states are considering is Health Opportunity Accounts, which are essentially savings accounts for purchasing health care services. These accounts are coupled with a high deductible version of Medicaid.
MSM continue to account for the largest share of AIDS cases in the U.S. and Florida. In Florida, MSM represent 44% (46,045) of all 105,500 AIDS cases and 41% (14,672) of all 36,127 HIV cases reported to the Florida Department of Health (DOH) through 2006; 26,735 MSM with HIV/AIDS have died, accounting for 45% of 60,028 HIV/AIDS deaths through 2006. In Miami-Dade County, approximately 1 in 6 MSM (18%) are HIV infected, based on the best available research study of HIV seroprevalence (positivity) rates among MSM. The analysis of routinely collected surveillance data in this report focuses on MSM with HIV/AIDS in Florida (reported cases), according to race/ethnicity.
Although family members commonly undertake care for an ill or elderly loved one willingly and find it to be a great source of personal satisfaction, caregivers themselves need support services. A large and growing body of evidence confirms that providing care for a chronically ill person can have harmful physical, mental and emotional consequences for the caregiver. Recent medical advances, shorter hospital stays, limited discharge planning, a shortage of homecare workers, and the expansion of home care technology have increased the caregiving responsibilities of families. Family caregivers are being asked to shoulder greater burdens for longer periods of time. In addition to more complex care, conflicting demands of jobs and family, increasing economic pressure, and the physical and emotional demands of long-term caregiving can result in major health impacts on caregivers.
Every day in America, children are abused, neglected and abandoned. Thousands enter the foster care and juvenile justice system through no fault of their own and are subsequently permanently removed from their homes because their birth families are unable or unwilling to provide a safe environment for them. Today, 114,000 children in the U.S. foster care system are available for adoption. The average wait for a child is nearly four years in continuous care. These children may have moved multiple times and all too frequently grow up in the system (the average age of the waiting child is now 9 years old). More children are made available for adoption from foster care each year than are adopted and most compelling, more than 20,000 youth will turn 18 and exit the system without an adoptive family this year.
The current paper sets out some of the findings from the most recent EWCS data collected in late 2005. It is based on interviews with nearly 30,000 workers in 31 European countries, including all of the Member States. It looks at the data primarily in relation to psychological as opposed to physical forms of violence. In the survey, the question on bullying refers to ‘bullying / harassment’ while the question on exposure to ‘unwanted sexual attention’ in the previous twelve months is used as a proxy for sexual harassment. In order to simplify the presentation, this paper differentiates between workplace ‘bullying’ on the one hand and ‘sexual harassment’ on the other. These are distinct and quite separate phenomena but working women are exposed to a higher risk than men for both and the survey is used to investigate some of the reasons why this is the case.
February 20, 2008
Policies to reward healthy behaviors have emerged as part of a national trend in health care toward consumer direction. Consumer directed health care encourages consumers to take charge of their health and health care, by promoting personal responsibility and cost conscious decision making. Health Savings Accounts (HSAs) are the most notable of these policies. In Medicaid, there are a growing number of consumer directed policies that emphasize recipient control over Medicaid dollars. These include giving disabled and frail elderly recipients monthly allowances for purchasing personal care services and supplies in what are known as Cash and Counseling programs, and the new Health Opportunity Accounts, which are savings accounts for purchasing health care services coupled with a high deductible version of Medicaid. The Florida Agency for Health Care Administration (AHCA) views the financial incentive program as part of the consumer direction trend: “The program will provide a direct incentive to enrollees to take an active role in their health and further the consumer driven model as they will have direct control over funds earned.”
The Medicare Modernization Act (MMA) of 2003 established the Low-Income Subsidy (LIS)
program to reduce the financial burden on low-income Medicare beneficiaries of paying out of
pocket costs for prescription drug coverage under Medicare Part D. MMA requires both the
Social Security Administration (SSA) and state Medicaid agencies to accept and process LIS
applications. It also requires states to screen LIS applicants who apply through Medicaid
agencies to determine if they are eligible for Medicare Savings Programs (MSP), which pay low income beneficiaries’ share of costs for Medicare-covered hospital and outpatient services.
This study assesses how the LIS application processes set up by SSA and state Medicaid
agencies help or hinder Medicare beneficiaries who may be eligible for LIS to apply for benefits
if they are not automatically enrolled as existing Medicaid or SSI beneficiaries. It also examines
whether and how LIS application processes increase the potential for LIS applicants to be
screened for MSP eligibility. The study defines application processes as: (1) the application
forms, (2) modes for submitting the forms, (3) procedures used to inform applicants of approval
or denial, (4) appeal provisions, and (4) methods for referring applicants to other programs for
which they might be eligible instead of or in addition to LIS and MSP.
Our analysis paints a stark picture: Nearly one out of four Americans under the age of 65—61.6 million people—is in a family that will spend more than 10 percent of its pre-tax income on health care costs in 2008. Shockingly, the vast majority of these people (82.4 percent) have health insurance. And 17.8 million non-elderly Americans—more than three-quarters of whom have health insurance—are in families that will spend more than 25 percent of their pre-tax income on health care costs in 2008. This analysis also reveals the growth in the number of people in families with high health care costs over the last eight years. Between 2000 and 2008, the number of people who are in families that spend more than 10 percent of their pre-tax income on health care will have increased by nearly 19.9 million. Over that same period, the number of people in families that spend more than 25 percent of their pre-tax income on health care will have increased by nearly 6.2 million.
Many of Medicaid’s 52 million beneficiaries are members of racial and ethnic subgroups, and over 60 percent of them are enrolled in managed care. By virtue of the diverse populations enrolled, Medicaid health plans are uniquely positioned to identify and address disparities in health care utilization and outcomes. This toolkit details the experiences of a collaborative workgroup of Medicaid managed care organizations, Improving Health Care Quality for Racially and Ethnically Diverse Populations. The workgroup was directed by CHCS and funded by the Robert Wood Johnson Foundation and The Commonwealth Fund. From 2004 to 2006, 10 Medicaid health plans and one state primary care case management program worked together to develop new ways to identify members of racial and ethnic subgroups in their enrolled populations, to measure the gaps in their care, and to explore ways to reduce disparities and improve overall health care quality.
In 2003, the most recent year for which data are available, 16 percent of children lived in neighborhoods that are never or only sometimes safe, while 34 percent lived in neighborhoods that are usually safe, and half lived in neighborhoods that are always safe, according to parent reports. . . . About three out every 10 non-Hispanic black and Hispanic children live in neighborhoods that are described as never or only sometimes safe, compared with less than 1 in 10 white children (8 percent), according to parent reports.
This study investigates carers’ preferences for services to support their caregiving role. Carer preferences were investigated using a discrete choice experiment, in which 168 carers were asked first to choose between two packages of care and then between the chosen package and their current support. Data were analysed using mixed logit. The DCE results showed that the support most wanted was palliative care nursing, general nursing, and telephone advice available 24 hours. Carers providing high levels of care wanted respite care provided at home and help with the patient’s personal care. Where the care-giving need was relatively low, carers wanted help with household tasks, transport and a case co-ordinator. Overall, carers appeared to be satisfied with the support they received from palliative care services, but this varied with the personal circumstances of the carer.
February 19, 2008
We find that more than one in seven married and one in 13 never-married women aged 15–49 have an unmet need for contraception in the countries reviewed in this report. In Sub-Saharan Africa, 24% of married women have an unmet need for contraception. The regional average level of unmet need ranges from 10% to 12% in South and Southeast Asia, North Africa and West Asia, and Latin America and the Caribbean. In the past decade, the level of unmet need has improved least in Sub-Saharan Africa, compared with other regions. In Sub-Saharan Africa, 9% of never-married women have an unmet need for contraception, and in the Latin American region, 5% have an unmet need. Regional estimates of unmet need are not available for never married women in Asia or North Africa.
Our research and that of others highlight important opportunities to improve the quality of care for frail, older persons dying of chronic progressive illness. 3-6 Far too many persons experience pain, with between 33% and 83% of nursing home residents having ongoing pain that impairs mobility, results in depression, and diminishes quality of life.5,7-9 Additionally, over 42% of dying nursing home residents are hospitalized one or more times during their last month of life,10 and far too many residents undergo burdensome aggressive treatments. Beyond consistently unmet pain management needs, striking state variation exists in other measures of the quality of end-of-life care, and in overall satisfaction.11
This set of studies is part of the ROI Evidence Base, which was developed by the Center for Health Care Strategies and Mathematica Policy Research, Inc. to help policymakers identify intervention strategies with the potential to both improve quality and reduce health care costs.
With the field of mental health undergoing transformation due to Prop. 63/Mental Health Services Act, family-strengthening organizations across California are forming new partnerships. This policy brief from the California Family Resource Association presents CFRA's Guidelines for Strong Community-Based Mental Health Programs. It also features model mental health programs that family-strengthening organizations are delivering in communities across California.
Welcome to the Massachusetts Adoption Resource Exchange’s (MARE) guide for social workers. Founded in 1957, MARE is a private, non-profit organization that works with public and private adoption agencies to recruit adoptive families for children in foster care. MARE provides extensive resources, programs and services related to foster care adoption. Please visit the Social Worker Info section of the MARE website at www.mareinc.org to access the forms mentioned in this booklet, keep updated with MARE events and professional adoption information, and much more. Through our programs and services, MARE assists with the adoptive placements of approximately 150 children from foster care each year.
• In 2006, 24% of adults (aged 16 or over) in England were classified as obese. This represents an overall increase from 15% in 1993.
• Men and women were equally likely to be obese, however women were more likely than men to be morbidly obese (3% compared to 1%).
• Thirty seven per cent of adults had a raised waist circumference in 2006 compared to 23% in 1993. Women were more likely then men to have a raised waist circumference (41% and 32% respectively).
February 18, 2008
In response, many of the nation’s health care stakeholders are seeking to reduce health disparities by improving health care services, delivery, and access for members of racial and ethnic groups. This issue brief, which draws from CHCS efforts funded by The Commonwealth Fund and the Robert Wood Johnson Foundation, reports on practical strategies that purchasers and plans nationally are implementing to address documented gaps in care. It highlights the need for standardized collection of race, ethnicity and language data, culturally competent approaches, as well as the involvement and commitment of multiple stakeholders.
This issue brief frames some of the considerations states take into account when developing public health recovery plans. . . . Planning for recovery is most effective if done before an event occurs. Recovery is a dynamic process, however, and planning for every circumstance is often impossible, but a robust recovery plan acknowledges that unexpected contingencies will occur. It can provide a framework for the state health agency to adapt to the evolving situation.
Multiple studies have shown that in many U.S. nursing homes, feeding assistance is inadequate and of poor quality (Blaum et al. 1995, Kayser-Jones et al. 1999, Simmons et al. 2002, Simmons et al. 2003). Nurses’ aides report that they lack sufficient time to adequately help all of the eating-dependent residents for whom they are responsible (Kayser-Jones J. 1996; Kayser-Jones J. and Schell E. 1997). Most nursing home residents in need of mealtime assistance do not receive enough feeding assistance to ensure adequate nutrition and hydration (Simmons et al. 2002). Concerns about the adequacy and quality of feeding assistance care and staffing shortages of certified nurse aides (CNAs), led to action by the Centers for Medicare & Medicaid Services (CMS).
This document summarizes the views and issues addressed by invited speakers and discussants at the Surgeon General's Women’s Mental Health Workshop. The views expressed in this Report reflect the opinions of the individual participants at the Workshop and do not necessarily reflect the official position of the Office of the Surgeon General, the Department of Health and Human Services, or other Federal entities.
- In the Gulf State areas affected by Hurricanes Katrina and Rita, the rate of past month marijuana use among adults aged 18 or older was lower in the year following the hurricanes than in the year before the hurricanes. There were no significant differences in the prevalence of illicit drug use, binge alcohol use, cigarette use, mental health problems, mental health treatment, or unmet need for mental health treatment in the same time period
- Adults aged 18 or older who were displaced from their homes for 2 or more weeks following the hurricanes had higher past month rates of illicit drug use, marijuana use, and cigarette use and higher past year rates of serious psychological distress, major depressive episode, and unmet need for mental health treatment or counseling in 2006 than those who were not displaced in the affected areas
Q. What happens if an agency or person provides one of the adoption services and seeks to become accredited or approved?
A. The agency or person seeking accreditation or approval must still substantially comply with all the standards, even though the standards cover adoption services that the agency or person itself has not provided, does not want to provide, or says it will not be providing. As stated in the Intercountry Adoption Act, to be accredited or approved, an adoption service provider must demonstrate that it has the capacity to provide all adoption services, either directly or through arrangements with others.
Intensive Family Support Projects (IFSPs) seek to provide families at risk of eviction because of anti-social behaviour with intensive support to address their often multiple and complex needs (Nixon et al 2006a, 2006b). When the study began in January 2004, IFSPs were in their infancy and the six projects included in the evaluation were unique. Recognising the damaging consequences of cycles of eviction and repeat homelessness, they sought to provide a new and more sustainable approach to dealing with anti-social behaviour. The particular form of support employed by IFSPs varies from family to family but commonly comprises of practical assistance in the home, provision of advice, liaison and advocacy support, sign-posting to other relevant services, help in managing finances and claiming benefits, personal skills development, anger management, parenting skills training, and behaviour management.
February 15, 2008
House of Commons
There are over 560,000 people in the UK with dementia, costing the economy some £14 billion a year, yet dementia has not been a NHS priority. In response to the C&AG's report the Department is now developing a National Dementia Strategy. The Strategy should have a clear timetable for implementation, and should include criteria for evaluation and reporting progress and addressing areas of underperformance such as poor diagnosis or availability of interventions recommended by NICE. It will also require an effective communication strategy to engage patient groups, health and social care professionals, the Royal Colleges, health and social care inspectorates, and the voluntary sector, all of whom are essential to improving care for people with dementia.
To develop this "portrait" of beneficiaries with comorbidities, CHCS worked with Rick Kronick, PhD, and Todd Gilmer, PhD, experts in Medicaid disease prevalence from the University of California, San Diego. The resulting data show that beneficiaries with three or more chronic conditions are responsible for a significant portion of Medicaid spending. The findings shed light on how Medicaid stakeholders can rethink care management approaches for high-need, high-cost beneficiaries with multimorbidity. Traditional disease management programs focused on single diseases that "silo" beneficiaries into disease specific interventions do not address the complex needs of those with multiple conditions. By clearly identifying the complex needs of these beneficiaries, states, plans and providers can develop integrated and coordinated delivery systems that incorporate clinical care with behavioral and non-medical supportive services.
Despite increasing average real family incomes in Costa Rica in the late 1990s and early 2000s, poverty rates did not fall. In this paper, we argue that during this period economic growth in Costa Rica did not translate into reduced poverty because of changes in family structure and in the labor market, and that these changes had an important gender dimension. Specifically, an increase in the proportion of Costa Rican households headed by single mothers led to an increase in the number of women with children entering the labor force. Many of these mothers, new entrants to the labor force, were unable or unwilling to find full-time work in the high-paying formal sector, and ended up unemployed or working parttime as self- employed workers. These labor market phenomena, in turn, contributed to low incomes for households vulnerable to poverty, especially those households headed by single mothers.
Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients and providers attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
In December 2005, the Center for Health Care Strategies (CHCS) launched the Integrated Care Program (ICP) to promote state programs that integrate the financing, delivery, and administration of primary, acute, behavioral health, and long-term supports and services for those dually eligible for Medicaid and Medicare (as well as Medicaid-only persons with disabilities). . . . Over the two-year initiative, CHCS has collected and/or developed a number of tools and publications related to integrated care. This online toolkit is designed to facilitate the sharing of key resources that are used by, or that were developed on behalf of, the ICP states. It is CHCS' hope that the resources provided through this toolkit will enable other states to develop their own integrated care programs.
In this paper we investigate how fertility decisions respond to unexpected career interruptions which occur as a consequence of job displacement. Using an event study approach we compare the birth rates of displaced women with those of women unaffected by job loss after establishing the pre-displacement comparability of these groups. Our results reveal that job displacement reduces average fertility by 5 to 10% in both the short and medium term (3 and 6 years) and that these effects are largely explained by the response of white collar women. Using an instrumental variable approach we provide evidence that the reduction in fertility is not due to the income loss generated by unemployment but arises because displaced workers undergo a career interruption. These results are interpreted in the light of a model in which the rate of human capital accumulation slows down after the birth of a child and all specific human capital is destroyed upon job loss.
February 14, 2008
Women were already in a precarious economic position, and the economic downturn is hitting them hard. Although the stimulus plan agreed to by House leaders and the Administration includes tax benefits for millions of low-income families who would have been left out of the President’s initial stimulus proposal, it omits measures that would provide more timely and targeted assistance to those most in need, especially low-income women and their families.
Like their counterparts elsewhere, more young Australians than ever are delaying the move to establish residential independence from their parents. This paper reviews the developing economics literature surrounding young people’s decisions to continue living in their parents’ homes in order to begin to assess the causes and consequences of this decision. In particular, co-residence with parents appears to be an important form of intergenerational support for young adults. It is important to understand the extent to which young people rely on this form of support as they complete their education, enter the labour market, and establish themselves as independent adults. Specific attention is paid to the ways in which Australian income-support, education, and housing policies may influence these patterns.
Building on prior research, this report examines factors related to job retention and labor market advancement among low-wage workers, and suggests effective policy strategies for improving their labor market outcomes. Using data from a national longitudinal survey, The Survey of Income and Program Participation, the report assesses the importance of various factors that facilitate or hinder job retention among low-income mothers. It also investigates what happens when they leave a job: are they moving to a better job, and if so, what helps or hinders their move to a better-paying job? Since a majority of welfare leavers and low-wage workers are women, particularly single mothers, the study pays special attention to work supports that can be important for job stability among working mothers, such as employer-provided health insurance, child care subsidies, and child care arrangements. Other major factors considered in the study are: personal/family characteristics (race/ethnicity, education, marital status, health status, presence of young children, etc.) and job characteristics (full-time status, occupation, hourly wages, union membership, etc.).
An independent review of the diversion of offenders with mental health problems or learning disabilities away from prison, led by the Rt Hon Lord Keith Bradley, is due to report this Summer. This letter from the Lord Bradley invites comments and suggestions from stakeholders regarding the review, by 28th February 2008.
Provides data on delinquency cases involving drug offenses handled between 1985 and 2004 by U.S. courts with juvenile jurisdiction. In 2004, U.S. juvenile courts handled an estimated 193,700 delinquency cases in which a drug offense was the most serious charge. Between 1991 and 2004, the number of cases involving drug offenses that juvenile courts handled more than doubled. Drug offense cases accounted for 12 percent of all delinquency cases in 2004, compared with 7 percent in 1985. This Fact Sheet is based on the OJJDP report Juvenile Court Statistics 2003–2004 which focuses on cases involving juveniles charged with law violations (delinquency or status offenses). The data used in the analyses were contributed to the National Juvenile Court Data Archive by nearly 1,900 courts with jurisdiction over 77 percent of the juvenile population in 2004.
In this paper we study the contribution of inflows and outflows to the dynamics of unemployment in three European countries, the United Kingdom, France and Spain. We
compare performance in these three countries making use of both administrative and labor
force survey data. We find that the impact of the 1980s reforms in Britain is evident in the
contributions of the inflow and outflow rates. The inflow rate became a bigger contributor after
the mid 1980s, although its significance subsided again in the late 1990s and 2000s. In
France the dynamics of unemployment are driven virtually entirely by the outflow rate, which
is consistent with a regime with strict employment protection legislation. In Spain, however,
both rates contribute significantly to the dynamics, very likely as a consequence of the
prominence of fixed-term contracts since the late 1980s.
February 13, 2008
Treatments for mass trauma survivors are difficult to study using traditional research methods, such as randomized clinical trials. As a result, there has been a general lack of research-based evidence to help communities and agencies plan for mental health care following a disastrous event. In fact, recent studies show that some current treatments that are commonly used after mass traumas, such as psychological debriefing, may not be helpful in reducing distress or the risk for post-traumatic stress disorder (PTSD) and other long-term, trauma-related illnesses. In some cases, these treatments may actually increase distress and risk.
Gay/bisexual workers tend to earn less than other men. Does this occur because of discrimination or because of selection? In this paper we address this question and collect new information on workplace disclosure to separate out discrimination effects from selection effects. Using a large sample of recently graduated men in the Netherlands, we find that gay/bisexual workers earn about 3 to 4 percent less than other men. Our disclosure estimates, however, provide little evidence that the labor market discriminates against gay/bisexual workers. They rather support the selection story, most prominently observed among undisclosed gay/bisexual workers who concentrate in lower paid occupations, and earn about 5 to 9 percent less than other men.
An extensive body of research in the past two decades has established the detrimental impact of poverty and economic hardship on children’s development and wellbeing. We have learned that exposure to economic and other risks arising from the sociodemographic characteristics of parents and families, the patterns of intra-family interaction and communication, as well as from the poor quality of the environment in the home, the neighborhood and the broader community negatively impacts on children’s cognitive development, socioemotional functioning, and school performance. Risk factors commonly examined include: poverty; food insecurity; low parental education; low maternal IQ; parental unemployment; single parent status; teen parenthood; use of social assistance; poor parental physical and mental health; large family size; living in rented housing; overcrowding and poor housing conditions; homelessness; child maltreatment; non-stimulating home environment; little parental responsiveness, teaching and interaction; over-reliance in harsh discipline techniques; little contact with the father; parent involvement with the justice system; stressful life events; and quality of the child care environment.
Discusses petitioned status offense cases in five major categories: running away, truancy, curfew law violations, ungovernability, and underage liquor law violations. Between 1995 and 2004, the number of petitioned status offense cases handled by U.S. courts with juvenile jurisdiction increased 39 percent. Truancy cases increased 69 percent, curfew violation cases increased 38 percent, liquor law violation cases increased 17 percent, while the number of petitioned runaway cases remained relatively stable between 1995 and 2004. This Fact Sheet is based on the OJJDP report Juvenile Court Statistics 2003–2004 which focuses on cases involving juveniles charged with law violations (delinquency or status offenses). The data used in the analyses were contributed to the National Juvenile Court Data Archive by nearly 1,900 courts with jurisdiction over 77 percent of the juvenile population in 2004.
More residents affected by Hurricane Katrina are enduring mental disorders than was initially determined a few months after the storm, according to a study published online January 8, 2008, in the journal Molecular Psychiatry. The trend runs counter to the typical pattern of recovery after a natural disaster, in which the prevalence of mental disorders among the survivors gradually decreases and fades out after about two years.
In 2007, advances in the methodology of estimations of HIV epidemics applied to an expanded range of country data have resulted in substantial changes in estimates of numbers of persons living with HIV worldwide. However the qualitative interpretation of the severity and implications of the pandemic has altered little. The estimated number of persons living with HIV worldwide in 2007 was 33.2 million [30.6–36.1 million], a reduction of 16% compared with the estimate published in 2006 (39.5 million [34.7–47.1 million]). (UNAIDS/WHO, 2006) The single biggest reason for this reduction was the intensive exercise to assess India’s HIV epidemic, which resulted in a major revision of that country’s estimates. Important revisions of estimates elsewhere, particularly in sub-Saharan Africa, also contributed. Of the total difference in the estimates published in 2006 and 2007, 70% are due to changes in six countries: Angola, India, Kenya, Mozambique, Nigeria, and Zimbabwe. In both Kenya and Zimbabwe, there is increasing evidence that a proportion of the declines is due to a reduction of the number of new infections which is in part due to a reduction in risky behaviours.
February 12, 2008
Tuberculosis (TB) is a disease that is spread from person to person through the air. This disease is particularly dangerous for persons infected with HIV. Worldwide, TB is a leading cause of death among persons infected with HIV . . . This high level of risk underscores the need for TB screening and preventive treatment programs for HIV-infected persons and those at greatest risk for HIV infection. Everyone infected with HIV should be tested for TB. Everyone infected with TB should complete preventive therapy as soon as possible to prevent progression to TB disease.
Our analysis paints a stark picture: Nearly one out of four Americans under the age of 65—61.6 million people—is in a family that will spend more than 10 percent of its pre-tax income on health care costs in 2008. Shockingly, the vast majority of these people (82.4 percent) have health insurance. And 17.8 million non-elderly Americans—more than three-quarters of whom have health insurance—are in families that will spend more than 25 percent of their pre-tax income on health care costs in 2008. This analysis also reveals the growth in the number of people in families with high health care costs over the last eight years. Between 2000 and 2008, the number of people who are in families that spend more than 10 percent of their pre-tax income on health care will have increased by nearly 19.9 million. Over that same period, the number of people in families that spend more than 25 percent of their pre-tax income on health care will have increased by nearly 6.2 million. As more families join the ranks of those with high health care costs, a transformation is occurring in the way health reform is viewed by the American public.
- Nicotine dependence was measured in SAMHSA's National Survey on Drug Use and Health among past month cigarette smokers, using criteria derived from the Nicotine Dependence Syndrome Scale and the Fagerstrom Test of Nicotine Dependence. A major depressive episode was defined using the DSM-IV diagnostic criteria which specifies a period of two weeks or longer during which there is (1) either depressed mood or loss of interest or pleasure AND (2) at least four other symptoms that reflect a change in functioning (such as problems with sleeping, eating, energy, concentration, and self image).
- Based on SAMHSA's National Survey on Drug Use and Health, of the 61.6 million persons aged 12 or older who in 2006 smoked cigarettes in the past month, 57.7% (35.5 million) met the criteria for nicotine dependence in the past month.
- Persons aged 12 or older who were dependent on nicotine in the past month were more likely than those who were not nicotine dependent to have engaged in alcohol use (61.7% vs. 49.1%), binge alcohol use (40.1% vs. 20.1%), and heavy alcohol use (14.9% vs. 5.5%) in the past month.
Maternal depression is a significant risk factor affecting the well-being and school readiness of young children. Low-income mothers of young children experience particularly high levels of depression, often in combination with other risk factors. This policy brief provides an overview of why it is so important to address maternal depression as a central part of the effort to ensure that all young children enter school ready to succeed.
Presents statistics on delinquency cases processed between 1995 and 2004 by U.S. courts with juvenile jurisdiction. The number of delinquency cases handled by juvenile courts decreased 7 percent between 1995 and 2004. During this period, public order offense cases increased 41 percent, drug law violation cases increased 19 percent, person offenses increased 2 percent, and property offense cases decreased 33 percent. This Fact Sheet is based on the OJJDP report Juvenile Court Statistics 2003–2004 which focuses on cases involving juveniles charged with law violations (delinquency or status offenses). The data used in the analyses were contributed to the National Juvenile Court Data Archive by nearly 1,900 courts with jurisdiction over 77 percent of the juvenile population in 2004.
February 11, 2008
The manuals present clear, helpful information to aid drug treatment practitioners in providing the best possible care that science has to offer. They describe scientifically supported therapies for addiction and give specific guidance on session content and how to implement these techniques. Of course, there is no substitute for training and supervision, and these manuals may not be applicable to all types of patients nor compatible with all clinical programs or treatment approaches. These manuals should be viewed as a supplement to, but not a replacement for, careful assessment of each patient, appropriate case formulation, ongoing monitoring of clinical status, and clinical judgment. The therapies presented in this series exemplify the best of what we currently know about treating drug addiction. As our knowledge evolves, new and improved therapies are certain to emerge. We look forward to continuously bringing you the latest scientific findings through manuals and other science-based publications. We welcome your feedback about the usefulness of this manual series and any ideas you have on how it might be improved.
The remarkable increase in the prevalence of obesity among children and youth in the United States over a relatively short timespan represents one of the defining public health challenges of the 21st century. The country is beginning to recognize childhood obesity as a major public health epidemic that will incur substantial costs to the nation. This report brief summarizes the recommendations and next steps made in the report.
Much of the US $100 billion/year worldwide investment in biomedical and health research is wasted because of dissemination and implementation failure.
By 2030 there will be about 70 million people in the United States older than 64, nearly 22 percent of the population. In anticipation to the societal changes that are sure to follow, this podcast covers some of the findings from the NRC report by the same name.
The RE-AIM Model for Planning, Evaluation and Reporting on Implementation and Dissemination Research
Purposes of RE-AIM:
- To broaden the criteria used to evaluate programs to include context and external validity
- To evaluate issues relevant to program adoption, implementation, and sustainability
- To help close the gap between research studies and practice
Since Charles Booth produced his remarkably detailed maps depicting inequality in Victorian London, poverty maps have been used to inform policy. But not until recently have high-resolution maps become available, making it possible to interpret and apply poverty maps in creative new ways to better understand poverty and improve policy making on behalf of the poor. Where the Poor Are: An Atlas of Poverty brings together a diverse collection of maps from different continents and countries, depicting small area estimates of vital development indicators at unprecedented levels of spatial detail.
February 8, 2008
This third report from the Commission for Social Care Inspection:
- Describes trends in the range, quality and availability of social care services in 2006-07 across public, voluntary and private sectors.
- Reports on what is happening to people seeking support who are not eligible for council-arranged care or who fund their own care.
Conclusions: Patients with neurologic or general conditions associated with an increased risk of falling should be asked about recent falls and further examined for the presence of specific neurologic deficits that predict falls, which include gait and balance disorders; deficits of lower extremity strength, sensation, and coordination; and cognitive impairments. If substantial risks of falls are identified, appropriate interventions that are described in other evidence-based guidelines may be considered.
QUERI’s mission: To enhance the quality, outcomes and efficiency of VA health care by systematically implementing evidence-based clinical guidelines and innovations into routine clinical practice.
For parents, the key to handling mental disorders of children is to recognize the problem and seek appropriate treatment. These disorders have specific diagnostic criteria and treatments, and a complete evaluation by a mental health provider can determine whether a child needs help. Some of the mental disorders commonly seen in children are depression, ADHD, and conduct disorder.
The Psychological First Aid (PFA) Field Operations Guide, 2nd Edition was created by the Terrorism Disaster Branch of the National Child Traumatic Stress Network and the National Center for PTSD as well as others involved in disaster response. Production of this information was supported by SAMHSA. PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning. It is for use by mental health specialists including first responders, incident command systems, primary and emergency health care providers, school crisis response teams, faith-based organizations, disaster relief organizations, Community Emergency Response Teams, Medical Reserve Corps, and the Citizens Corps in diverse settings.
From fiscal year 1997 through 2006, backlogged disability claims in the Social Security Administration’s processing system doubled, reaching about 576,000 cases. Backlogs of varying degrees have occurred at most stages of the claims process. The only significant decline occurred at the last stage—-the Appeals Council—where fewer cases are processed. At the initial claims level, handled by state Disability Determination Services (DDS), a backlog developed in fiscal year 1998 and grew to about 155,000 claims in fiscal year 2006. At the hearings level, backlogged claims exceeded 415,000 that year and accounted for 72 percent of the total backlog. Insufficient data prevented GAO from identifying trends in backlogs at the reconsideration stage. Processing times, meanwhile, increased with claimants generally waiting significantly longer—for example, an additional 95 days at the hearings level—for a decision.
Demographic data should document family moves, changes in family composition, socioeconomic circumstances, family illness, legal difficulties, and altered family structure. The family's historical report should be supplemented by ancillary sources of data. These sources can include history from other professionals who have evaluated or treated family members, as well as information from schools, local social service agencies, the courts, and child welfare agencies. These sources often provide a broader perspective of family functioning by providing information that the family either sees as unimportant or is unable or unwilling to communicate clearly to the clinician. Parents must give their consent for clinicians to gather history from these sources, with an adolescent's assent also prudent practice. Gathering family history by interviewing ex-spouses, common-law partners, and stepparents also raises legal issues. The clinician may receive history from any individual regarding a child but should divulge information about the child only to those who have a legal right or permission to receive it. The following is a guide to the areas that should be covered in gathering a detailed family history.
Some evidence that exercise has positive short-term effects on self-esteem in children and young people Improving self-esteem may help to prevent the development of psychological and behavioural problems which are common in children and adolescents. Strong evidence exists for the benefits of exercise on physical health, but evidence for the effects of exercise on mental health is scarce. This review of trials suggests that exercise has positive short-term effects on self-esteem in children and young people, and concludes that exercise may be an important measure in improving children's self-esteem. However, the reviewers note that the trials included in the review were small-scale, and recognise the need for further well-designed research in this area.
Training Package contents that are available for downloading