A guide to mental health concerns for victims of violent crime
As a survivor of violent crime, you may face a wide range of emotional and physical struggles, along with some difficult questions that often surface: Why did this happen to me? How will I ever heal from this? Why can’t I connect with others the way I did before? When will I start to feel “normal” again? While the answers may be different for each individual, there are some striking similarities in how trauma affects nearly all victims. Understanding the nature and impact of violent trauma can be essential to the healing process. This brochure is intended as a guide to help you along the path to healing and to avoid some of the common pitfalls along the way.
What is Post Traumatic Stress Disorder (PTSD)?
PTSD is a mental health condition that can be caused by experiencing or observing virtually any kind of deep emotional trauma, especially one that is unexpected. Millions of people in the United States suffer from PTSD, resulting from many different types of trauma—from enduring years of domestic violence to a single violent attack that lasts but a few seconds. PTSD is characterized by both emotional and physical suffering; many afflicted by it find themselves unintentionally revisiting their trauma through flashbacks or nightmares. PTSD can make you feel isolated, disconnected, and “different” from other people—and it can even begin to affect the most routine activities of everyday life. PTSD is a potentially serious condition that should not be taken lightly.
Why is substance abuse common following a traumatic event?
Since violent trauma can bring about so many changes, questions, and uncertainties, many survivors turn to alcohol and illicit drugs in an attempt to get some relief from their almost round-the-clock emotional turmoil and suffering. Substance abuse and mental health problems often accompany violent trauma. All survivors of trauma manage their experiences in different ways. Substance abuse, however, is not only an ineffective tool in healing from trauma, but it also can present a host of additional problems that make the healing process even more difficult.
What can I do if I am experiencing PTSD or if substance abuse becomes a problem for me?
According to a recent study conducted by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, the most effective way to combat trauma, substance abuse, and mental health problems is through an integrated, holistic approach, taking into account how each individual problem affects the others. To begin, it can help to share your experiences and concerns with a service provider (e.g. counselor, physician, victim witness coordinator) who can assist in developing a plan to address all of your struggles comprehensively. Psychologists and counselors with experience treating trauma survivors can be very helpful in working through PTSD, and there are prescription drugs available to help ease PTSD symptoms.
PTSD can make you feel isolated, disconnected, and “different” from other people—and it can even begin to affect the most routine activities of everyday life.
What can I do to begin the healing process?
There are some positive steps that you can take right away to begin healing. Here are some suggestions:
Recognize your loss.
Establish safety for yourself.
Respect the way you feel and your right to feel that way.
Talk about your feelings with those you trust.
Connect with other survivors of violence, many of whom experience similar difficulties.
Do not be afraid to seek professional help.
Try to recognize triggers that may take you back to the memory and fear of your trauma.
Try to be patient and avoid making rash decisions—it can take time to figure out where you are, where you want to be, and how to get there.
Take care of yourself—exercise, eat right, and take a deep breath when you feel tense.
Try to turn your negative experience into something positive—volunteer, donate, or do something else to constructively channel your energy and emotions.
Do not abandon hope—believe that healing can and will take place.
Where can I go for help?
The healing process takes time, and many questions, hurdles and frustrations may surface along the way.
Contact Information
SAMHSA’s Mental Health Services Locator
www.mentalhealth.samhsa.gov/databases
SAMHSA’s National Mental Health
Information Center
1-800-789-2647
1-866-889-2647 (tdd)
March 24, 2010
Autism
What is autism?
Autism, also called autistic disorder, appears in early childhood, usually before age 3 (National Institutes of Health, 2001). Autism prevents children and adolescents from interacting normally with other people and affects almost every aspect of their social and psychological development.
Back to Top
What are the signs of autism?
Autism has a wide variety of characteristics ranging in intensity from mild to severe. One child with autism does not behave like another child with the same diagnosis. Children and adolescents with autism typically:
Have difficulty communicating with others.
Exhibit repetitious behaviors, such as rocking back and forth, head banging, or touching or twirling objects.
Have a limited range of interests and activities.
May become upset by a small change in their environment or daily routine.
In addition to these characteristics, some children with autism experience hypersensitivity to hearing, touch, smell, or taste. Symptoms of autism can be seen in early infancy, but the condition also may appear after months of normal development. In most cases, however, it is not possible to identify a specific event that triggers the disorder.
Back to Top
How common is autism?
Studies estimate that as many as 12 in every 10,000 children have autism or a related condition (U.S. Department of Health and Human Services, 1999). Autism is three times more common in boys than in girls (National Institutes of Health, 2001).
Back to Top
What causes autism?
Researchers are unsure about what causes autism. Several studies suggest that autism might be caused by a combination of biological or environmental factors, or both, including viral exposure before birth, a problem with the immune system, or genetics. Many recently published scientific investigations have examined the possible connection between autism and the measles, mumps, and rubella (MMR) vaccine. At this time, though, the available data do not appear to support a causal link.
Studies of families and twins suggest a genetic basis for the disorder. It is important for scientists to find the genes responsible for autism, if any, because this knowledge would give physicians new tools to diagnose the disorder and help scientists develop gene-based therapies.
Some studies have found that the brains of people with autism may function differently from those that are considered "normal." Research suggests that an abnormal slowing down of brain development before birth may cause autism. Studies also are looking at how autism-related problems in brain development may affect behavior later in childhood. For example, some researchers are investigating the ways in which infants with autism process information and how the disorder may lead to poor development of social skills, knowledge, and awareness.
Chemicals in the brain also may play a role in autism. As a normal brain develops, the level of serotonin, a chemical found in the brain, declines. In some children with autism, however, serotonin levels do not decline. Researchers are investigating whether this happens only to children with autism or whether other factors are involved.
Back to Top
What help is available for families?
Since brain development can be influenced during early childhood, the treatment of autism has a greater chance of success when initiated as early as possible. In addition, when children with autism are treated early, the cost of long-term care may be reduced. Services and treatments that may benefit children and adolescents with autism and their families include:
Training in communication, social, learning, and self-help skills.
Programs in which other children help to teach children with autism.
Parent training.
Medications to reduce symptoms related to self-injury, seizures, digestive difficulties, and attention problems.
When services are started soon after a child is diagnosed with autism, the child's language, social, and academic skills and abilities may be greatly improved. On the other hand, some children and adolescents do not respond well to treatment or may experience negative side effects from autism medications. Recent data suggest that some of the newer antipsychotic drugs may have fewer side effects than conventional drugs, but more studies are needed before experts can determine any possible safety advantages over traditional treatments.
Back to Top
What can parents do?
Parents or other caregivers concerned about a child who shows symptoms of autism should:
Talk with a health care provider about their concerns. He or she can help to determine whether the symptoms are caused by autism, a related disorder, or another condition. If necessary, the health care provider can refer the family to a mental health expert who specializes in treating persons with autism.
Get accurate information from libraries, hotlines, or other sources.
Ask questions about treatments and services.
Talk to other families in their communities who are coping with autism.
Find family network organizations.
People who are not satisfied with the mental health care they receive should discuss their concerns with the provider, ask for information, and/or seek help from other sources.
This is one of many fact sheets in a series on children's mental health disorders. All the fact sheets listed below are written in an easy-to-read style. Families, caretakers, and media professionals may find them helpful when researching particular mental health disorders. To obtain free copies, call 1-800-789-2647 or visit http://mentalhealth.samhsa.gov/child.
Autism, also called autistic disorder, appears in early childhood, usually before age 3 (National Institutes of Health, 2001). Autism prevents children and adolescents from interacting normally with other people and affects almost every aspect of their social and psychological development.
Back to Top
What are the signs of autism?
Autism has a wide variety of characteristics ranging in intensity from mild to severe. One child with autism does not behave like another child with the same diagnosis. Children and adolescents with autism typically:
Have difficulty communicating with others.
Exhibit repetitious behaviors, such as rocking back and forth, head banging, or touching or twirling objects.
Have a limited range of interests and activities.
May become upset by a small change in their environment or daily routine.
In addition to these characteristics, some children with autism experience hypersensitivity to hearing, touch, smell, or taste. Symptoms of autism can be seen in early infancy, but the condition also may appear after months of normal development. In most cases, however, it is not possible to identify a specific event that triggers the disorder.
Back to Top
How common is autism?
Studies estimate that as many as 12 in every 10,000 children have autism or a related condition (U.S. Department of Health and Human Services, 1999). Autism is three times more common in boys than in girls (National Institutes of Health, 2001).
Back to Top
What causes autism?
Researchers are unsure about what causes autism. Several studies suggest that autism might be caused by a combination of biological or environmental factors, or both, including viral exposure before birth, a problem with the immune system, or genetics. Many recently published scientific investigations have examined the possible connection between autism and the measles, mumps, and rubella (MMR) vaccine. At this time, though, the available data do not appear to support a causal link.
Studies of families and twins suggest a genetic basis for the disorder. It is important for scientists to find the genes responsible for autism, if any, because this knowledge would give physicians new tools to diagnose the disorder and help scientists develop gene-based therapies.
Some studies have found that the brains of people with autism may function differently from those that are considered "normal." Research suggests that an abnormal slowing down of brain development before birth may cause autism. Studies also are looking at how autism-related problems in brain development may affect behavior later in childhood. For example, some researchers are investigating the ways in which infants with autism process information and how the disorder may lead to poor development of social skills, knowledge, and awareness.
Chemicals in the brain also may play a role in autism. As a normal brain develops, the level of serotonin, a chemical found in the brain, declines. In some children with autism, however, serotonin levels do not decline. Researchers are investigating whether this happens only to children with autism or whether other factors are involved.
Back to Top
What help is available for families?
Since brain development can be influenced during early childhood, the treatment of autism has a greater chance of success when initiated as early as possible. In addition, when children with autism are treated early, the cost of long-term care may be reduced. Services and treatments that may benefit children and adolescents with autism and their families include:
Training in communication, social, learning, and self-help skills.
Programs in which other children help to teach children with autism.
Parent training.
Medications to reduce symptoms related to self-injury, seizures, digestive difficulties, and attention problems.
When services are started soon after a child is diagnosed with autism, the child's language, social, and academic skills and abilities may be greatly improved. On the other hand, some children and adolescents do not respond well to treatment or may experience negative side effects from autism medications. Recent data suggest that some of the newer antipsychotic drugs may have fewer side effects than conventional drugs, but more studies are needed before experts can determine any possible safety advantages over traditional treatments.
Back to Top
What can parents do?
Parents or other caregivers concerned about a child who shows symptoms of autism should:
Talk with a health care provider about their concerns. He or she can help to determine whether the symptoms are caused by autism, a related disorder, or another condition. If necessary, the health care provider can refer the family to a mental health expert who specializes in treating persons with autism.
Get accurate information from libraries, hotlines, or other sources.
Ask questions about treatments and services.
Talk to other families in their communities who are coping with autism.
Find family network organizations.
People who are not satisfied with the mental health care they receive should discuss their concerns with the provider, ask for information, and/or seek help from other sources.
This is one of many fact sheets in a series on children's mental health disorders. All the fact sheets listed below are written in an easy-to-read style. Families, caretakers, and media professionals may find them helpful when researching particular mental health disorders. To obtain free copies, call 1-800-789-2647 or visit http://mentalhealth.samhsa.gov/child.
March 22, 2010
Health Service Disparities: Access, Quality, and Diversity
Online CEUs
Health Service Disparities: Access, Quality, and Diversity
CHAIR: Spero M. Manson, Ph.D., University of Colorado.
ACCESS, BARRIERS, and QUALITY
Pathways into, through, and out of service systems are issues of critical importance when addressing access to care, adequacy or appropriateness of care, as well as quality. This panel addressed these issues examining the impact of race, ethnicity, and cultural attitudes.
David T. Takeuchi, Ph.D.,
Indiana University
Dr. Takeuchi discussed the importance of race as a separate and independent factor in children's mental health status, as well as access to and quality of care. Over the past two decades, it has been common to advocate for a more universal approach to resolving the disparities found among racial groups. Despite one's position regarding whether race has or has not declined in significance in American society, an advocacy for policies that attempt to reduce socio-economic status (SES) differentials is seen as a more effective public policy strategy to gain acceptance among all racial groups and, equally important, policy makers.
While this approach is popular and well meaning, it tends to ignore an evolving body of research that finds race to have a strong effect on mental health variables, independent of SES. For example, a recent study assessing health outcomes for 50 states found a strong association between racial composition and health. The greater the minority composition, the poorer the child health profiles. When race was included in analytical models, income and equality did not have a significant association with child health outcomes. Another significant variable linked to improved child health outcomes was the willingness of states to fund social welfare programs. These analyses suggest that simply focusing on income inequality will not resolve racism and its consequences. Racism is a continuous problem and creates a social environment characterized by alienation, frustration, powerlessness, stress and demoralization, all of which can have pernicious consequences on mental health. There are programs that are trying to make health systems more equitable through education, and attempting to reduce stereotypes and prejudice by providing information about different racial groups. Research indicates, however, that individuals who have preexisting racist beliefs may actually have these beliefs reinforced through such educational programs.
In order to address ethnic and racial inequities in children's mental healthcare, racism must be viewed in a broader context, focusing on institutional racism and the racial hierarchy of society and its systems, including healthcare. It is unclear how to do this, but two examples to consider would be Native Americans' building casinos to address economic inequity; and Native Hawaiians' current effort to achieve sovereignty. These are two natural situations in which it can be seen how health outcomes will be influenced.
Margarita Alegría, Ph.D.,
University of Puerto Rico
Dr. Alegría discussed challenges in advancing equity in mental healthcare for children of color. She presented three arguments for increased focus on racial and ethnic differences. First, race, ethnicity and culture of children play a major role in shaping the care provided to them by health institutions. Racial, ethnic and cultural differences influence the expression and identification of the need for services. Studies have shown ethnic and racial differences in youths' self-reports of problem behaviors, caregivers' value judgments of what is normative behavior, and caregiver expectations of the child. Ethnic and racial bias in who gets identified, referred and treated within certain institutions has also been documented. For example, African American youth are more frequently referred for conduct problems to corrections rather than psychiatric hospitals, even with lower or equal measures of aggressive behavior. Quality of care is also impacted. For example, ADHD is less often treated by medications in minority groups than in white populations. There is also increased probability of misdiagnoses among minority individuals, affecting subsequent care.
Second, there are challenges in identifying the mechanisms by which ethnicity, race, and culture account for disparities in behavioral and emotional problems and service delivery. Understanding these mechanisms has important implications for how to intervene correctly. Factors that mediate such challenges may be related to lack of early detection by providers and parents; untrained and culturally insensitive providers; and lack of parent and provider knowledge of efficacious treatments. For example, Latino youths have the highest rate of suicide, yet they are less likely to be identified by their caregivers as having problems. Disparities in services may be due to different barriers such as insurance status and settings where mental healthcare is delivered. Minority children tend to receive mental health services through the juvenile justice and welfare systems more often than through schools or special settings.
Third, efforts to address racial and ethnic disparities in mental health and service delivery are constrained by profound socio-environmental, institutional, and market forces. For example, managed care, by targeting medical necessity, may be constrained in obtaining the complexity of funding streams that are necessary to service minority children in the schools, juvenile justice settings or welfare agencies. Expansion of Medicaid eligibility for near poor families may not prove sufficient to increase mental health service usage, if it is not tied to increased provider availability and provider payment incentives to treat minority populations within depressed inner-city communities. Thus, a critical analysis of how residential, institutional, and market policies may create disparities is needed, and more importantly, how these policies are implemented in ways that result in disparities. There is a need to address these disparities by moving beyond the healthcare sector, examining neighborhoods where minority children live (areas of economic disadvantage, concentration of violence in certain areas), addressing the institutions with which minority children interact (i.e., the referral bias in the various systems), and addressing the role of managed care and the lack of culturally competent providers in the various systems.
Suggestions to address these disparities include: (1) Ensure that efforts focus not only on equalizing access to treatment, but also on equalizing outcomes of care; (2) Aggressively monitor institutional progress towards an equitable and compassionate system of mental healthcare for children of color; and (3) Move beyond policy interventions in the healthcare system to more socio-educational approaches, where government agencies are not agents of control but agents of support.
Kenneth B. Wells, M.D., M.P.H.,
UCLA/RAND
Dr. Wells presented new preliminary data from three national surveys on access to specialty mental healthcare. The findings demonstrated high levels of unmet need for specialty care for children and adolescents and substantial ethnic disparities in access to such care. Detailed findings will be presented in a forthcoming article. Dr. Wells also drew attention to key issues in formulating public policy to address unmet need for child services. One set of issues relates to children in the public sector, where differences within and across states in implementation of policies to cover uninsured children result in children with varying degrees of vulnerability to unmet need for mental healthcare. Policies that guarantee coverage for uninsured children across diverse populations and geographic areas are needed to address this problem. Another set of issues applies to the private sector, where there has been much debate about the feasibility of implementing parity for mental health and physical health services for both children and adults; yet prior studies suggest that children have more to gain from parity, as they tend to be high utilizers if they use services and more quickly reach plan limits on coverage (Sturm, 1997). Thus achieving parity of coverage in the private sector may be especially important for addressing the unmet need for child mental health services. Yet, Dr. Wells indicated that the meaning of parity is changing under managed care, as the defined benefit does not necessarily directly correspond to the level of care provided under management policies (Burnam and Escarce,1999). Finally, Dr. Wells provided an example of the promise of quality improvement for mental disorders for adults, Partners in Care; in that study, depressed primary care patients from clinics using quality improvement programs had better one-year clinical outcomes and retention in employment than similar patients in clinics without quality improvement programs (Wells, et. al., 2000). These kinds of studies should be developed for children and adolescents with major mental disorders, as we develop practice-based solutions across public and private sectors to address unmet mental healthcare needs of diverse child and adolescent populations.
Suggestions for future research include: (1) Develop access and mental health quality of care indicators for children and adolescents; (2) Profile unmet need for under- and uninsured subgroups in particular areas, in light of disparity in coverage and implementation across federal and state programs; and (3) Monitor access and quality of care for children and adolescents nationally. Suggestions for policy changes include: (1) For the uninsured, replace existing programs or fill the diverse gaps in federal and state policies; (2) For the privately insured, start with parity of mental health coverage with medical conditions, and enforce tougher mandates for implementation. In addition, the management and quality under parity needs to be evaluated; and (3) For the publicly insured, implement quality improvement, and reduce delays and the financial barriers to mental healthcare.
REACHING OUT TO AND ENGAGING FAMILIES
This panel discussed the challenges affecting access to and coordination of mental healthcare for children and families, including the lack of availability of non-traditional services. One critical question addressed how to better engage families in evidence-based services and treatments.
Barbara J. Friesen, Ph.D.,
Portland State University
Dr. Friesen argued that effective mental health services require cultural competence, full family participation and appropriate services and supports. Family support and participation can provide benefits, including reduced need for inpatient treatment, shorter length of inpatient stay, better service coordination, increased likelihood that a child will return home following out-of-home placement, and increased caregiver satisfaction. When families were involved in the child welfare system, they were more likely to follow through with treatment and the caseworkers were more likely to provide appropriate care.
There are several significant barriers to family participation and effective treatment for children's psychiatric disorders. First, stigma attached to mental disorders results in families feeling at fault for their child's mental illness. Low-income families are most likely to receive disrespect from healthcare providers. Second, family and service providers lack information. Third, gaps in services are a major problem. Even when a family is armed with information about exactly what they are looking for, very often they cannot find it. Other practical, tangible barriers include cost; many families have gone bankrupt trying to care for their children. The most damaging policy is one in which parents need to give up custody in order to get services for their children. Distance can also be a barrier to care. Sometimes families must travel long distances to receive appropriate care for their child.
Suggestions for engaging families include: (1) Develop anti-stigma campaigns to educate the public and healthcare providers; (2) Train services providers in effective, family-centered treatment approaches; (3) Support family members and family organizations who can improve access to services through a variety of outreach and support roles; and (4) Evaluate these practices.
C. Veree’ Jenkins,
Family Involvement Coordinator, Family HOPE, West Palm Beach, Florida
Ms. Jenkins described her family's experience overcoming the ravages of the mental illness of her son, Joel. She called it the story of "J.O.E.L.: Joy Overcoming Everything Logical." She emphasized the importance of faith in dealing with a child's mental illness. Joel had a journey through mental illness, substance abuse, the juvenile justice system and early fatherhood. All along the way, no one ever asked the family their faith and what they believed in, said Ms. Jenkins. In a substance abuse treatment program, Joel had his bible taken from him, told it was a crutch preventing him from overcoming his substance abuse problems. But, Ms. Jenkins said, you need faith in God to make it through these systems; you put faith in the hands of the therapist managing your care and sometimes are let down. Finally, Joel went to the church where he found ‘wrap-around faith’ where they provided mentoring, counseling services 24 hours a day, seven days a week, helped him get a job, and get rid of his guns and provided other assistance. Ms. Jenkins encouraged consideration of faith-based organizations, which can provide safe havens, camps, music, art, and all sorts of activities that can be very helpful to a family in need. Joel is now drug, alcohol and cigarette free. He is a law-abiding citizen, married, a good parent, employed and owns his home. A recent graduate of the McCollough Seminary, he is Assistant Youth Pastor of his church. As a family, Joel, Ms. Jenkins and her husband work together to share their faith and hope with others.
Lynn Pedraza, Ed.S.,
Family Member
Ms. Pedraza described how her family, which includes biological, foster and adoptive children, encountered many challenges trying to navigate the multiple systems often involved in the care and treatment of children with mental disorders. So much of the mental health world operates from a deficit perspective requiring families to prove their needs, rather than strengths, to get services. Workers have coerced parents and threatened to take children away when families try to fight for appropriate services. Suggestions to engage families include: (1) Put mental health at the forefront of health policy decisions and research efforts; (2) Research should focus on the human side of mental health, the connections to others, trust, pleasure, joy and respect. In other words, examine what caring looks like and what happens when this caring is incorporated into mental health services; and (3) Researchers need to become involved with families and their children long enough and deeply enough to really understand the multiple factors that affect children and their families. Researchers need to listen to families.
DISCUSSANTS
Brenda Souto,
National Alliance for the Mentally Ill
Ms. Souto described her experiences as a parent of a child with several disorders. She has been her son's case manager for 20 years and has had good experiences with psychiatrists and psychologists in Maryland, a parity-enforced state. Trying to find good services was another problem. She cited a report, Families on the Brink, that NAMI released a year ago, summarizing the stigmatization of families who often are blamed for no-fault brain disorders. She said the most unfortunate result of the lack of access to mental healthcare is when the family is forced to relinquish custody of their ill child to the state in order to get needed mental health services.
Carl Bell, M.D.,
Community Mental Health Council, Chicago
Dr. Bell described the insufficient infrastructure in the community health system. Back in 1980, President Jimmy Carter pushed for a plan to increase the infrastructure. But the plan never came into being because Carter lost the presidency. Dr. Bell encouraged conference participants to make sure they take action to ensure the agenda moves forward. He is particularly interested in African Americans. In order to fix the problems of African Americans within these various systems, African Americans must be involved in the conversations. The black community trusts the community centers but not the universities. Black people are concerned about who is testing their children and why. Partnerships between community-based organizations and the universities is one way to make technical expertise available to train community-based staff. Such efforts are underway at Dr. Bell's agency and the University of Illinois in Chicago, but they are costly. Few community agencies have the resources needed to train their staff in evidence-based interventions. Community-based organizations need to receive funding to assist them in training their staff and such support is necessary to help infuse evidence-based interventions into community-based services.
Michael M. Faenza, MSSW,
National Mental Health Association
Mr. Faenza noted that this session's presentations demonstrate children's mental health as a social justice issue. The disparities in access and treatment highlight the social injustice issues that come into play in children's services. He highlighted challenges in diagnosing mental disorders in children, and a need for more research in diagnosis and treatment. Because so much negative public attention is focused on overprescription of psychotropic medications and overdiagnosis in young children, particular sensitivity around such issues is needed to prevent the damage that such publicity could do. The prevalence of mental disorders and substance abuse disorders in the juvenile justice system suggests a starting point for change in operative services systems for children.
Phillipa Hambrick,
Family Member
Ms. Hambrick described her experiences as a grandmother and mother, providing family care to four grandchildren in need of mental health services for ADHD and major depression. She had difficulty getting services for these children, due to distance or because the children were put on a waiting list for services. The children eventually received services through the school system and through youth and family services. But such services must be expanded and made more comprehensive, she said. If she were to move, her children would lose the services because they would be in a different jurisdiction.
Health Service Disparities: Access, Quality, and Diversity
CHAIR: Spero M. Manson, Ph.D., University of Colorado.
ACCESS, BARRIERS, and QUALITY
Pathways into, through, and out of service systems are issues of critical importance when addressing access to care, adequacy or appropriateness of care, as well as quality. This panel addressed these issues examining the impact of race, ethnicity, and cultural attitudes.
David T. Takeuchi, Ph.D.,
Indiana University
Dr. Takeuchi discussed the importance of race as a separate and independent factor in children's mental health status, as well as access to and quality of care. Over the past two decades, it has been common to advocate for a more universal approach to resolving the disparities found among racial groups. Despite one's position regarding whether race has or has not declined in significance in American society, an advocacy for policies that attempt to reduce socio-economic status (SES) differentials is seen as a more effective public policy strategy to gain acceptance among all racial groups and, equally important, policy makers.
While this approach is popular and well meaning, it tends to ignore an evolving body of research that finds race to have a strong effect on mental health variables, independent of SES. For example, a recent study assessing health outcomes for 50 states found a strong association between racial composition and health. The greater the minority composition, the poorer the child health profiles. When race was included in analytical models, income and equality did not have a significant association with child health outcomes. Another significant variable linked to improved child health outcomes was the willingness of states to fund social welfare programs. These analyses suggest that simply focusing on income inequality will not resolve racism and its consequences. Racism is a continuous problem and creates a social environment characterized by alienation, frustration, powerlessness, stress and demoralization, all of which can have pernicious consequences on mental health. There are programs that are trying to make health systems more equitable through education, and attempting to reduce stereotypes and prejudice by providing information about different racial groups. Research indicates, however, that individuals who have preexisting racist beliefs may actually have these beliefs reinforced through such educational programs.
In order to address ethnic and racial inequities in children's mental healthcare, racism must be viewed in a broader context, focusing on institutional racism and the racial hierarchy of society and its systems, including healthcare. It is unclear how to do this, but two examples to consider would be Native Americans' building casinos to address economic inequity; and Native Hawaiians' current effort to achieve sovereignty. These are two natural situations in which it can be seen how health outcomes will be influenced.
Margarita Alegría, Ph.D.,
University of Puerto Rico
Dr. Alegría discussed challenges in advancing equity in mental healthcare for children of color. She presented three arguments for increased focus on racial and ethnic differences. First, race, ethnicity and culture of children play a major role in shaping the care provided to them by health institutions. Racial, ethnic and cultural differences influence the expression and identification of the need for services. Studies have shown ethnic and racial differences in youths' self-reports of problem behaviors, caregivers' value judgments of what is normative behavior, and caregiver expectations of the child. Ethnic and racial bias in who gets identified, referred and treated within certain institutions has also been documented. For example, African American youth are more frequently referred for conduct problems to corrections rather than psychiatric hospitals, even with lower or equal measures of aggressive behavior. Quality of care is also impacted. For example, ADHD is less often treated by medications in minority groups than in white populations. There is also increased probability of misdiagnoses among minority individuals, affecting subsequent care.
Second, there are challenges in identifying the mechanisms by which ethnicity, race, and culture account for disparities in behavioral and emotional problems and service delivery. Understanding these mechanisms has important implications for how to intervene correctly. Factors that mediate such challenges may be related to lack of early detection by providers and parents; untrained and culturally insensitive providers; and lack of parent and provider knowledge of efficacious treatments. For example, Latino youths have the highest rate of suicide, yet they are less likely to be identified by their caregivers as having problems. Disparities in services may be due to different barriers such as insurance status and settings where mental healthcare is delivered. Minority children tend to receive mental health services through the juvenile justice and welfare systems more often than through schools or special settings.
Third, efforts to address racial and ethnic disparities in mental health and service delivery are constrained by profound socio-environmental, institutional, and market forces. For example, managed care, by targeting medical necessity, may be constrained in obtaining the complexity of funding streams that are necessary to service minority children in the schools, juvenile justice settings or welfare agencies. Expansion of Medicaid eligibility for near poor families may not prove sufficient to increase mental health service usage, if it is not tied to increased provider availability and provider payment incentives to treat minority populations within depressed inner-city communities. Thus, a critical analysis of how residential, institutional, and market policies may create disparities is needed, and more importantly, how these policies are implemented in ways that result in disparities. There is a need to address these disparities by moving beyond the healthcare sector, examining neighborhoods where minority children live (areas of economic disadvantage, concentration of violence in certain areas), addressing the institutions with which minority children interact (i.e., the referral bias in the various systems), and addressing the role of managed care and the lack of culturally competent providers in the various systems.
Suggestions to address these disparities include: (1) Ensure that efforts focus not only on equalizing access to treatment, but also on equalizing outcomes of care; (2) Aggressively monitor institutional progress towards an equitable and compassionate system of mental healthcare for children of color; and (3) Move beyond policy interventions in the healthcare system to more socio-educational approaches, where government agencies are not agents of control but agents of support.
Kenneth B. Wells, M.D., M.P.H.,
UCLA/RAND
Dr. Wells presented new preliminary data from three national surveys on access to specialty mental healthcare. The findings demonstrated high levels of unmet need for specialty care for children and adolescents and substantial ethnic disparities in access to such care. Detailed findings will be presented in a forthcoming article. Dr. Wells also drew attention to key issues in formulating public policy to address unmet need for child services. One set of issues relates to children in the public sector, where differences within and across states in implementation of policies to cover uninsured children result in children with varying degrees of vulnerability to unmet need for mental healthcare. Policies that guarantee coverage for uninsured children across diverse populations and geographic areas are needed to address this problem. Another set of issues applies to the private sector, where there has been much debate about the feasibility of implementing parity for mental health and physical health services for both children and adults; yet prior studies suggest that children have more to gain from parity, as they tend to be high utilizers if they use services and more quickly reach plan limits on coverage (Sturm, 1997). Thus achieving parity of coverage in the private sector may be especially important for addressing the unmet need for child mental health services. Yet, Dr. Wells indicated that the meaning of parity is changing under managed care, as the defined benefit does not necessarily directly correspond to the level of care provided under management policies (Burnam and Escarce,1999). Finally, Dr. Wells provided an example of the promise of quality improvement for mental disorders for adults, Partners in Care; in that study, depressed primary care patients from clinics using quality improvement programs had better one-year clinical outcomes and retention in employment than similar patients in clinics without quality improvement programs (Wells, et. al., 2000). These kinds of studies should be developed for children and adolescents with major mental disorders, as we develop practice-based solutions across public and private sectors to address unmet mental healthcare needs of diverse child and adolescent populations.
Suggestions for future research include: (1) Develop access and mental health quality of care indicators for children and adolescents; (2) Profile unmet need for under- and uninsured subgroups in particular areas, in light of disparity in coverage and implementation across federal and state programs; and (3) Monitor access and quality of care for children and adolescents nationally. Suggestions for policy changes include: (1) For the uninsured, replace existing programs or fill the diverse gaps in federal and state policies; (2) For the privately insured, start with parity of mental health coverage with medical conditions, and enforce tougher mandates for implementation. In addition, the management and quality under parity needs to be evaluated; and (3) For the publicly insured, implement quality improvement, and reduce delays and the financial barriers to mental healthcare.
REACHING OUT TO AND ENGAGING FAMILIES
This panel discussed the challenges affecting access to and coordination of mental healthcare for children and families, including the lack of availability of non-traditional services. One critical question addressed how to better engage families in evidence-based services and treatments.
Barbara J. Friesen, Ph.D.,
Portland State University
Dr. Friesen argued that effective mental health services require cultural competence, full family participation and appropriate services and supports. Family support and participation can provide benefits, including reduced need for inpatient treatment, shorter length of inpatient stay, better service coordination, increased likelihood that a child will return home following out-of-home placement, and increased caregiver satisfaction. When families were involved in the child welfare system, they were more likely to follow through with treatment and the caseworkers were more likely to provide appropriate care.
There are several significant barriers to family participation and effective treatment for children's psychiatric disorders. First, stigma attached to mental disorders results in families feeling at fault for their child's mental illness. Low-income families are most likely to receive disrespect from healthcare providers. Second, family and service providers lack information. Third, gaps in services are a major problem. Even when a family is armed with information about exactly what they are looking for, very often they cannot find it. Other practical, tangible barriers include cost; many families have gone bankrupt trying to care for their children. The most damaging policy is one in which parents need to give up custody in order to get services for their children. Distance can also be a barrier to care. Sometimes families must travel long distances to receive appropriate care for their child.
Suggestions for engaging families include: (1) Develop anti-stigma campaigns to educate the public and healthcare providers; (2) Train services providers in effective, family-centered treatment approaches; (3) Support family members and family organizations who can improve access to services through a variety of outreach and support roles; and (4) Evaluate these practices.
C. Veree’ Jenkins,
Family Involvement Coordinator, Family HOPE, West Palm Beach, Florida
Ms. Jenkins described her family's experience overcoming the ravages of the mental illness of her son, Joel. She called it the story of "J.O.E.L.: Joy Overcoming Everything Logical." She emphasized the importance of faith in dealing with a child's mental illness. Joel had a journey through mental illness, substance abuse, the juvenile justice system and early fatherhood. All along the way, no one ever asked the family their faith and what they believed in, said Ms. Jenkins. In a substance abuse treatment program, Joel had his bible taken from him, told it was a crutch preventing him from overcoming his substance abuse problems. But, Ms. Jenkins said, you need faith in God to make it through these systems; you put faith in the hands of the therapist managing your care and sometimes are let down. Finally, Joel went to the church where he found ‘wrap-around faith’ where they provided mentoring, counseling services 24 hours a day, seven days a week, helped him get a job, and get rid of his guns and provided other assistance. Ms. Jenkins encouraged consideration of faith-based organizations, which can provide safe havens, camps, music, art, and all sorts of activities that can be very helpful to a family in need. Joel is now drug, alcohol and cigarette free. He is a law-abiding citizen, married, a good parent, employed and owns his home. A recent graduate of the McCollough Seminary, he is Assistant Youth Pastor of his church. As a family, Joel, Ms. Jenkins and her husband work together to share their faith and hope with others.
Lynn Pedraza, Ed.S.,
Family Member
Ms. Pedraza described how her family, which includes biological, foster and adoptive children, encountered many challenges trying to navigate the multiple systems often involved in the care and treatment of children with mental disorders. So much of the mental health world operates from a deficit perspective requiring families to prove their needs, rather than strengths, to get services. Workers have coerced parents and threatened to take children away when families try to fight for appropriate services. Suggestions to engage families include: (1) Put mental health at the forefront of health policy decisions and research efforts; (2) Research should focus on the human side of mental health, the connections to others, trust, pleasure, joy and respect. In other words, examine what caring looks like and what happens when this caring is incorporated into mental health services; and (3) Researchers need to become involved with families and their children long enough and deeply enough to really understand the multiple factors that affect children and their families. Researchers need to listen to families.
DISCUSSANTS
Brenda Souto,
National Alliance for the Mentally Ill
Ms. Souto described her experiences as a parent of a child with several disorders. She has been her son's case manager for 20 years and has had good experiences with psychiatrists and psychologists in Maryland, a parity-enforced state. Trying to find good services was another problem. She cited a report, Families on the Brink, that NAMI released a year ago, summarizing the stigmatization of families who often are blamed for no-fault brain disorders. She said the most unfortunate result of the lack of access to mental healthcare is when the family is forced to relinquish custody of their ill child to the state in order to get needed mental health services.
Carl Bell, M.D.,
Community Mental Health Council, Chicago
Dr. Bell described the insufficient infrastructure in the community health system. Back in 1980, President Jimmy Carter pushed for a plan to increase the infrastructure. But the plan never came into being because Carter lost the presidency. Dr. Bell encouraged conference participants to make sure they take action to ensure the agenda moves forward. He is particularly interested in African Americans. In order to fix the problems of African Americans within these various systems, African Americans must be involved in the conversations. The black community trusts the community centers but not the universities. Black people are concerned about who is testing their children and why. Partnerships between community-based organizations and the universities is one way to make technical expertise available to train community-based staff. Such efforts are underway at Dr. Bell's agency and the University of Illinois in Chicago, but they are costly. Few community agencies have the resources needed to train their staff in evidence-based interventions. Community-based organizations need to receive funding to assist them in training their staff and such support is necessary to help infuse evidence-based interventions into community-based services.
Michael M. Faenza, MSSW,
National Mental Health Association
Mr. Faenza noted that this session's presentations demonstrate children's mental health as a social justice issue. The disparities in access and treatment highlight the social injustice issues that come into play in children's services. He highlighted challenges in diagnosing mental disorders in children, and a need for more research in diagnosis and treatment. Because so much negative public attention is focused on overprescription of psychotropic medications and overdiagnosis in young children, particular sensitivity around such issues is needed to prevent the damage that such publicity could do. The prevalence of mental disorders and substance abuse disorders in the juvenile justice system suggests a starting point for change in operative services systems for children.
Phillipa Hambrick,
Family Member
Ms. Hambrick described her experiences as a grandmother and mother, providing family care to four grandchildren in need of mental health services for ADHD and major depression. She had difficulty getting services for these children, due to distance or because the children were put on a waiting list for services. The children eventually received services through the school system and through youth and family services. But such services must be expanded and made more comprehensive, she said. If she were to move, her children would lose the services because they would be in a different jurisdiction.
March 19, 2010
California Bills Regarding MFT and LCS Licenses and CAMFT Position
Unpaid Taxes Effect on Licensees
ABX8 8 (Committee on Budget)
This bill, among other provisions, would require the Franchise Tax Board, should an individual licensee fail to pay taxes, to send a notice of suspension of license. The bill provides that the licensee who fails to satisfy the unpaid taxes by a specified date shall automatically have his/her license suspended. CAMFT has joined with a coalition to oppose this bill.
Child Custody and Visitation
AB 612 (Beall)
This bill, as introduced, would have prohibited a court from considering a nonscientific theory in making a determination regarding child custody or visitation with a child. It would also have prohibited a court from considering or receiving into evidence a report, assessment, evaluation, or investigation if it included a nonscientific theory. CAMFT’s position on the bill was “oppose unless amended.” The bill was later amended in a way that we no longer opposed, providing that a child’s expression of significant hostility toward a parent may be admitted as possible corroborating evidence that the parent has abused the child. The amendment prohibited a court from concluding that an accusation of child physical or sexual abuse against a parent is false based solely on the child’s expression of significant hostility toward the parent. But, this amendment was merely a maneuver to get it out of a committee. As soon as the bill progressed, the offensive language was restored and we are once again opposed. This bill is a two-year bill.
Medi-Cal Reimbursement for Same-Day Visits
AB 1445 (Chesbro)
This bill, sponsored by the California Primary Care Association, would provide that a MediCal patient could seek treatment on the same day from more than one health care provider and the providers’ services would be reimbursed. CAMFT is in support of this legislation. This bill is a two-year bill.
MediCal: Alcohol and Drug Screening and Brief Intervention Services
AB 1599 (Beall)
This bill would establish the MediCal Alcohol and Drug Screening and Brief intervention Services Program, which would be administered in consultation with the State Department of Alcohol and Drug Programs. Its purpose would be to increase the state’s ability to make alcohol and drug screening and brief intervention services available to MediCal beneficiaries who are pregnant or of childbearing age. This bill would provide that participating in the program would be voluntary for MediCal beneficiaries. The results of any screening under the program would be confidential. CAMFT is watching this bill at this time.
Parity for Mental Health Care Services
AB 1600 (Beall)
This bill would expand mental health care coverage for certain health care service plans and health insurance issued, amended, or renewed on or after January 1, 2011, to include mental disorders defined in the DSM IV. There has been similar legislation in the two prior years that has been vetoed by the Governor. This legislation goes hand in hand with the Federal Parity law and expands on the existing California parity law that only covers severe mental and emotional disorders of adults and children. CAMFT is in support of this legislation.
Out of State Insurance Carriers
AB 1904 (Villines)
This bill would allow an insurance carrier from out of state to offer, sell, or renew a health care service plan or a health insurance policy in California without holding a license in the state of California . This bill, if successful, would be problematic for MFTs seeking reimbursement from such plans. Due to legislation that CAMFT sponsored in the 80s, out of state insurance companies are required by law to reimburse MFTs. Because they are required, if doing business in California , to abide by California law, which means that they must be licensed to do business in California . We are opposed to this bill, but we are told that the bill is not likely to move forward. There is a companion bill in the Senate as well.
Clinical Social Worker Examinations
AB 2167 (Nava)
This bill would, on and after January 1, 2014, require the Board of Behavioral Sciences to issue a license to each applicant who successfully passes the Social Work National Exam. In other words, if this legislation passes, aspiring clinical social workers would no longer take state-developed examinations, and they would instead take the examination that is used throughout the rest of the country. This change would allow LCSW licentiates in California to compete for federal loan reimbursements, which they are not currently eligible for because of the state specific examinations. CAMFT is watching this bill.
Retired License for Licensees of the BBS
AB 2191 (Emmerson)
This bill would permit persons who are licensed by the BBS to acquire a “retired” license if they choose to. Such a person would not be permitted to engage in any activity for which a license is required. The retired license fee would be nominal at only $40 for the remainder of one’s life. It would be permissible to restore the license to active state, if eligible, by paying the required fees, completing the required mandatory continuing education, and taking the required examinations if more than five years have passed since electing the retired status. If fewer than five years have passed, examinations would not be required. (The bill currently says three years, but the BBS has committed to increase this exception to five years.) CAMFT is watching this legislation. We do have concerns about licensees electing the retired status who may at a later time return to practice. If there is such a possibility of returning to practice, we would encourage the licentiate to elect to have an inactive license during the period of inaction because examinations would not be required upon re-activation.
Repeal of Antiquated Law Regarding Research on Homosexuality
AB 2199 (Lowenthal)
CAMFT has taken a position of support on this legislation that would repeal an antiquated section of law that provided for research regarding the causes and cures of homosexuality.
Child Abuse and Neglect Reporting Act
AB 2380 (Lowenthal)
This bill, among other things, adds further clarification in the Child Abuse and Neglect Reporting Act with regard to the meaning of “reasonable suspicion.” Existing law says that “. . . ‘reasonable suspicion’ means that it is objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing, when appropriate, on his or her training and experience, to suspect child abuse or neglect.” Added to this definition would be the following: “‘Reasonable suspicion’ does not require certain knowledge that child abuse or neglect has occurred nor does it require a specific medical indication of child abuse or neglect; any ‘reasonable suspicion’ is sufficient. ‘Reasonable suspicion’ may be based on any information considered credible by the reporter, including hearsay.” CAMFT is watching this bill at this time.
Continuing Education and other Requirements with regard to Elder and Dependent Adult Abuse and Older Adults
(AB 2435) Lowenthal
CAMFT’s position on this bill is “oppose unless amended.” The bill appears to be intended to affect the professions of marriage and family therapists, clinical social workers, and psychologists, but at this time appears to be solely directed at marriage and family therapists. If such legislation is warranted, we believe it should be equally applied across all of the mental health disciplines. We further object in that there appears to be no intent to affect physicians or other health care professionals and we are curious as to why not. It is also not applicable to professional clinical counselors who will also be regulated by the effective date of the proposed implementation of this legislation.
The bill proposes that elder and dependent adult abuse be added to the seven hour requirement for continuing education in child abuse assessment and reporting. The manner in which the bill proposes to add the requirement to provide for training in elder and dependent adult abuse is confusing and will result in an inability to enforce what is intended. All persons who are already licensed, as well as many who are pursuing licensure, have already fulfilled the requirement to have had training in child abuse assessment and reporting. Placing the new requirement to get training in elder and dependent adult abuse assessment and reporting within this previously existing requirement for training in child abuse and assessment confounds the situation and professionals will not be able to interpret what it is they are supposed to do, i.e., are they to take a new seven hour training that combines the content for both child abuse and elder abuse, or are they to take a three and one-half hour course in elder and dependent adult abuse, which is half of the total requirement?
While we have expressed that we are not necessarily adverse to a requirement for professionals to be knowledgeable about the reporting of elder and dependent adult abuse, as long as equally applied across the professions, this legislation needs to be clear as to what is expected. At this point, it is not. The bill does not address persons who have already taken such courses, or taught such courses, or who have had the content adequately addressed in the content of other courses. This content is typically covered in law and ethics courses and human development courses that cover the lifespan of individuals and families.
The bill proposes changing the name of one (and only one) of the degrees that may qualify for licensure as a marriage and family therapist. Such a change would place a hardship on schools that may have difficulty rapidly changing the title of their degree programs. Adding the term “older adult” without a definition as to what is meant by such a term is also problematic. We would request that this term be removed from the degree title.
The legislation proposes that the 500 required hours of experience for marriage and family therapists in working with couples, families, and children be expanded to include older adults. Again, “older adults” is not defined. Further, while we do not object to required education in working with persons who are aging, we do not want to see the essence and focus of the profession changed. This profession was known as “marriage, family and child counselors” from 1964 until 1999 and then became “marriage and family therapists.” Working with couples, families, and children is at the core of the discipline and of course includes working with persons who are aging, as they too are a part of family systems. We therefore have requested that the focus of these hours not be changed. Additionally, if there were to be such a change in the marriage and family therapist requirements, it should be equally imposed upon the other disciplines and provide greater specificity as to what is intended by the term “older adults.”
Further, persons pursuing the MFT license are currently required to have had ten contact hours of education in working with the elderly and long term care, and those already licensed prior to the effective date of this requirement were required to gain three contact hours in working with the elderly and long term care.
Unpaid Taxes Effect on Licensees
SBX8 8 (Committee on Budget)
This bill like its Assembly companion, among other provisions, would require the Franchise Tax Board, should an individual licensee fails to pay taxes, to send a notice of suspension of license. The bill provides that the licensee who fails to satisfy the unpaid taxes by a specified date shall automatically have his/her license suspended. CAMFT has joined with a coalition to oppose this bill.
Health Care Coverage and Benefits
SB 316 (Alquist)
This bill would have required full service health care service plans and health insurers to expend on health care benefits no less than 85 percent of the fees/premiums collected for policies issued, amended, or renewed on or after January 1, 2011. CAMFT is in support of this legislation. This bill is a two-year bill.
Regulatory Boards
(SB 1111) Negrette McLeod
This is a lengthy and multi-faceted bill that has numerous objectionable provisions. We are generally opposed to the bill and will be working individually and collectively with the other disciplines to modify the objectionable provisions. The purpose of the bill, generally speaking, is to “clean up” enforcement throughout the many Boards, Bureaus, and Committees under the umbrella of the Department of Consumer Affairs. The Department and Administration, rightfully so, are concerned about the excessive amount of time it takes to investigate and prosecute disciplinary actions. These actions, on average, are taking three years to bring to fruition. Of course, both consumers and licensees have an interest in swift resolution of complaints and disciplinary actions. Further, the state’s budget likely exacerbates the delays as a result of cuts within licensing boards, the California Department of Consumer Affairs Division of Investigations (DofI), and the Attorney General’s (AG) office. This bill is seeking to improve efficiency and accountability specifically within the healing arts boards.
One of the changes being sought would require a person who is disciplined to pay to the licensing board the actual costs for the investigation, prosecution, and enforcement of the case. These costs include, but are not limited to, attorneys, expert consultants, witnesses, administrative filing and service fees, and any other fees associated with the prosecution of the case. Currently the licensee, as determined by the administrative law judge, is ordered to pay the “reasonable” costs of the investigation and enforcement of the case. Changing reasonable to actual provides no incentive to the board, the DofI, or the AG’s office to be judicious in how it handles these matters. If they drag cases on for years and years, engage in actions that violate the law or due process rights, and/or needlessly pursue wild goose chases, the licentiate should not be held responsible for such costs. These costs are generally payable 30 days after the effective date of the order and there appears to be no opportunity to challenge the costs as determined.
The bill would give additional authority to the executive officer of the licensing board in many cases. For example, the executive officer would, in some situations, be given the authority to adopt a proposed default decision or adopt a proposed settlement agreement, without such action going to the board. The bill would allow the executive officer of a board, where the licentiate has failed to comply with a request to inspect or copy records, to petition the director to issue a temporary order that the licensee cease all practice and activities that require a license. In such case, the executive officer would be required, to the extent practicable, to provide telephonic, electronic mail, message, or facsimile written notice to the licensee of a hearing on such a petition at least 24 hours prior to the hearing.
The bill seems to confuse confidentiality and privilege. The bill seems to say that the provisions of privileged communications (should be confidentiality when speaking of communications between licensees and their clients) shall not apply to investigations or proceedings conducted by a healing arts board. The board and its agents are expected to maintain confidentiality, but they would have the authority to examine records in the licensee’s office in certain circumstances, apparently without authorization. The psychotherapist-patient privilege belongs to the patient and only the patient should be able to waive the privilege—not a licensing board. The bill provides, “Any document relevant to the business operations of a licensee, and not involving medical records attributable to identifiable patients, may be inspected and copied where relevant to an investigation of a licensee.”
The bill provides that a licensee shall cooperate with the licensing board and sets forth severe financial penalties for those who are deemed to be uncooperative. In such a circumstance, it may not be in the licensee’s best interest to cooperate in order to defend oneself. Such an expectation is unreasonable.
Requirement for Healing Arts Practitioners to Wear Name Tags
(SB 1132) Negrete McLeod
This is a “spot bill” surrounding legislation that has passed in prior years. Existing law requires healing arts practitioners to wear name tags while working that disclose names and license status in at least 18-point type. This requirement is not applicable to health care practitioners working in a practice or an office where a license is prominently displayed. Existing law further provides that if a health care practitioner or a licensed clinical social worker is working in a psychiatric setting or in a setting that is not licensed by the state, the employing entity or agency shall have the discretion to make an exception from the name tag requirement for individual safety or therapeutic reasons. CAMFT is watching this legislation that could become more expansive requiring practitioners to wear name tags.
Restrictions on Advertising and Designations of Licensees
(SB 1150) Negrete McLeod
At this time this bill is not applicable to MFTs, but we are nevertheless watching the bill very closely to see what it will become. The bill, among other things, would require a number of professionals, when advertising, to list the abbreviations for the licenses held immediately after their names. Among other things, the bill would require psychologists to include the designation “Ph.D.” immediately after their names. Of course, the bill is incorrect with regard to psychologists because the supposed required designation is a degree and not a license. The purpose of this legislation may be directed, to some degree, at the potential misleading use of “Dr.” preceding the name of a professional, since such a representation is limited to use by physicians.
ABX8 8 (Committee on Budget)
This bill, among other provisions, would require the Franchise Tax Board, should an individual licensee fail to pay taxes, to send a notice of suspension of license. The bill provides that the licensee who fails to satisfy the unpaid taxes by a specified date shall automatically have his/her license suspended. CAMFT has joined with a coalition to oppose this bill.
Child Custody and Visitation
AB 612 (Beall)
This bill, as introduced, would have prohibited a court from considering a nonscientific theory in making a determination regarding child custody or visitation with a child. It would also have prohibited a court from considering or receiving into evidence a report, assessment, evaluation, or investigation if it included a nonscientific theory. CAMFT’s position on the bill was “oppose unless amended.” The bill was later amended in a way that we no longer opposed, providing that a child’s expression of significant hostility toward a parent may be admitted as possible corroborating evidence that the parent has abused the child. The amendment prohibited a court from concluding that an accusation of child physical or sexual abuse against a parent is false based solely on the child’s expression of significant hostility toward the parent. But, this amendment was merely a maneuver to get it out of a committee. As soon as the bill progressed, the offensive language was restored and we are once again opposed. This bill is a two-year bill.
Medi-Cal Reimbursement for Same-Day Visits
AB 1445 (Chesbro)
This bill, sponsored by the California Primary Care Association, would provide that a MediCal patient could seek treatment on the same day from more than one health care provider and the providers’ services would be reimbursed. CAMFT is in support of this legislation. This bill is a two-year bill.
MediCal: Alcohol and Drug Screening and Brief Intervention Services
AB 1599 (Beall)
This bill would establish the MediCal Alcohol and Drug Screening and Brief intervention Services Program, which would be administered in consultation with the State Department of Alcohol and Drug Programs. Its purpose would be to increase the state’s ability to make alcohol and drug screening and brief intervention services available to MediCal beneficiaries who are pregnant or of childbearing age. This bill would provide that participating in the program would be voluntary for MediCal beneficiaries. The results of any screening under the program would be confidential. CAMFT is watching this bill at this time.
Parity for Mental Health Care Services
AB 1600 (Beall)
This bill would expand mental health care coverage for certain health care service plans and health insurance issued, amended, or renewed on or after January 1, 2011, to include mental disorders defined in the DSM IV. There has been similar legislation in the two prior years that has been vetoed by the Governor. This legislation goes hand in hand with the Federal Parity law and expands on the existing California parity law that only covers severe mental and emotional disorders of adults and children. CAMFT is in support of this legislation.
Out of State Insurance Carriers
AB 1904 (Villines)
This bill would allow an insurance carrier from out of state to offer, sell, or renew a health care service plan or a health insurance policy in California without holding a license in the state of California . This bill, if successful, would be problematic for MFTs seeking reimbursement from such plans. Due to legislation that CAMFT sponsored in the 80s, out of state insurance companies are required by law to reimburse MFTs. Because they are required, if doing business in California , to abide by California law, which means that they must be licensed to do business in California . We are opposed to this bill, but we are told that the bill is not likely to move forward. There is a companion bill in the Senate as well.
Clinical Social Worker Examinations
AB 2167 (Nava)
This bill would, on and after January 1, 2014, require the Board of Behavioral Sciences to issue a license to each applicant who successfully passes the Social Work National Exam. In other words, if this legislation passes, aspiring clinical social workers would no longer take state-developed examinations, and they would instead take the examination that is used throughout the rest of the country. This change would allow LCSW licentiates in California to compete for federal loan reimbursements, which they are not currently eligible for because of the state specific examinations. CAMFT is watching this bill.
Retired License for Licensees of the BBS
AB 2191 (Emmerson)
This bill would permit persons who are licensed by the BBS to acquire a “retired” license if they choose to. Such a person would not be permitted to engage in any activity for which a license is required. The retired license fee would be nominal at only $40 for the remainder of one’s life. It would be permissible to restore the license to active state, if eligible, by paying the required fees, completing the required mandatory continuing education, and taking the required examinations if more than five years have passed since electing the retired status. If fewer than five years have passed, examinations would not be required. (The bill currently says three years, but the BBS has committed to increase this exception to five years.) CAMFT is watching this legislation. We do have concerns about licensees electing the retired status who may at a later time return to practice. If there is such a possibility of returning to practice, we would encourage the licentiate to elect to have an inactive license during the period of inaction because examinations would not be required upon re-activation.
Repeal of Antiquated Law Regarding Research on Homosexuality
AB 2199 (Lowenthal)
CAMFT has taken a position of support on this legislation that would repeal an antiquated section of law that provided for research regarding the causes and cures of homosexuality.
Child Abuse and Neglect Reporting Act
AB 2380 (Lowenthal)
This bill, among other things, adds further clarification in the Child Abuse and Neglect Reporting Act with regard to the meaning of “reasonable suspicion.” Existing law says that “. . . ‘reasonable suspicion’ means that it is objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing, when appropriate, on his or her training and experience, to suspect child abuse or neglect.” Added to this definition would be the following: “‘Reasonable suspicion’ does not require certain knowledge that child abuse or neglect has occurred nor does it require a specific medical indication of child abuse or neglect; any ‘reasonable suspicion’ is sufficient. ‘Reasonable suspicion’ may be based on any information considered credible by the reporter, including hearsay.” CAMFT is watching this bill at this time.
Continuing Education and other Requirements with regard to Elder and Dependent Adult Abuse and Older Adults
(AB 2435) Lowenthal
CAMFT’s position on this bill is “oppose unless amended.” The bill appears to be intended to affect the professions of marriage and family therapists, clinical social workers, and psychologists, but at this time appears to be solely directed at marriage and family therapists. If such legislation is warranted, we believe it should be equally applied across all of the mental health disciplines. We further object in that there appears to be no intent to affect physicians or other health care professionals and we are curious as to why not. It is also not applicable to professional clinical counselors who will also be regulated by the effective date of the proposed implementation of this legislation.
The bill proposes that elder and dependent adult abuse be added to the seven hour requirement for continuing education in child abuse assessment and reporting. The manner in which the bill proposes to add the requirement to provide for training in elder and dependent adult abuse is confusing and will result in an inability to enforce what is intended. All persons who are already licensed, as well as many who are pursuing licensure, have already fulfilled the requirement to have had training in child abuse assessment and reporting. Placing the new requirement to get training in elder and dependent adult abuse assessment and reporting within this previously existing requirement for training in child abuse and assessment confounds the situation and professionals will not be able to interpret what it is they are supposed to do, i.e., are they to take a new seven hour training that combines the content for both child abuse and elder abuse, or are they to take a three and one-half hour course in elder and dependent adult abuse, which is half of the total requirement?
While we have expressed that we are not necessarily adverse to a requirement for professionals to be knowledgeable about the reporting of elder and dependent adult abuse, as long as equally applied across the professions, this legislation needs to be clear as to what is expected. At this point, it is not. The bill does not address persons who have already taken such courses, or taught such courses, or who have had the content adequately addressed in the content of other courses. This content is typically covered in law and ethics courses and human development courses that cover the lifespan of individuals and families.
The bill proposes changing the name of one (and only one) of the degrees that may qualify for licensure as a marriage and family therapist. Such a change would place a hardship on schools that may have difficulty rapidly changing the title of their degree programs. Adding the term “older adult” without a definition as to what is meant by such a term is also problematic. We would request that this term be removed from the degree title.
The legislation proposes that the 500 required hours of experience for marriage and family therapists in working with couples, families, and children be expanded to include older adults. Again, “older adults” is not defined. Further, while we do not object to required education in working with persons who are aging, we do not want to see the essence and focus of the profession changed. This profession was known as “marriage, family and child counselors” from 1964 until 1999 and then became “marriage and family therapists.” Working with couples, families, and children is at the core of the discipline and of course includes working with persons who are aging, as they too are a part of family systems. We therefore have requested that the focus of these hours not be changed. Additionally, if there were to be such a change in the marriage and family therapist requirements, it should be equally imposed upon the other disciplines and provide greater specificity as to what is intended by the term “older adults.”
Further, persons pursuing the MFT license are currently required to have had ten contact hours of education in working with the elderly and long term care, and those already licensed prior to the effective date of this requirement were required to gain three contact hours in working with the elderly and long term care.
Unpaid Taxes Effect on Licensees
SBX8 8 (Committee on Budget)
This bill like its Assembly companion, among other provisions, would require the Franchise Tax Board, should an individual licensee fails to pay taxes, to send a notice of suspension of license. The bill provides that the licensee who fails to satisfy the unpaid taxes by a specified date shall automatically have his/her license suspended. CAMFT has joined with a coalition to oppose this bill.
Health Care Coverage and Benefits
SB 316 (Alquist)
This bill would have required full service health care service plans and health insurers to expend on health care benefits no less than 85 percent of the fees/premiums collected for policies issued, amended, or renewed on or after January 1, 2011. CAMFT is in support of this legislation. This bill is a two-year bill.
Regulatory Boards
(SB 1111) Negrette McLeod
This is a lengthy and multi-faceted bill that has numerous objectionable provisions. We are generally opposed to the bill and will be working individually and collectively with the other disciplines to modify the objectionable provisions. The purpose of the bill, generally speaking, is to “clean up” enforcement throughout the many Boards, Bureaus, and Committees under the umbrella of the Department of Consumer Affairs. The Department and Administration, rightfully so, are concerned about the excessive amount of time it takes to investigate and prosecute disciplinary actions. These actions, on average, are taking three years to bring to fruition. Of course, both consumers and licensees have an interest in swift resolution of complaints and disciplinary actions. Further, the state’s budget likely exacerbates the delays as a result of cuts within licensing boards, the California Department of Consumer Affairs Division of Investigations (DofI), and the Attorney General’s (AG) office. This bill is seeking to improve efficiency and accountability specifically within the healing arts boards.
One of the changes being sought would require a person who is disciplined to pay to the licensing board the actual costs for the investigation, prosecution, and enforcement of the case. These costs include, but are not limited to, attorneys, expert consultants, witnesses, administrative filing and service fees, and any other fees associated with the prosecution of the case. Currently the licensee, as determined by the administrative law judge, is ordered to pay the “reasonable” costs of the investigation and enforcement of the case. Changing reasonable to actual provides no incentive to the board, the DofI, or the AG’s office to be judicious in how it handles these matters. If they drag cases on for years and years, engage in actions that violate the law or due process rights, and/or needlessly pursue wild goose chases, the licentiate should not be held responsible for such costs. These costs are generally payable 30 days after the effective date of the order and there appears to be no opportunity to challenge the costs as determined.
The bill would give additional authority to the executive officer of the licensing board in many cases. For example, the executive officer would, in some situations, be given the authority to adopt a proposed default decision or adopt a proposed settlement agreement, without such action going to the board. The bill would allow the executive officer of a board, where the licentiate has failed to comply with a request to inspect or copy records, to petition the director to issue a temporary order that the licensee cease all practice and activities that require a license. In such case, the executive officer would be required, to the extent practicable, to provide telephonic, electronic mail, message, or facsimile written notice to the licensee of a hearing on such a petition at least 24 hours prior to the hearing.
The bill seems to confuse confidentiality and privilege. The bill seems to say that the provisions of privileged communications (should be confidentiality when speaking of communications between licensees and their clients) shall not apply to investigations or proceedings conducted by a healing arts board. The board and its agents are expected to maintain confidentiality, but they would have the authority to examine records in the licensee’s office in certain circumstances, apparently without authorization. The psychotherapist-patient privilege belongs to the patient and only the patient should be able to waive the privilege—not a licensing board. The bill provides, “Any document relevant to the business operations of a licensee, and not involving medical records attributable to identifiable patients, may be inspected and copied where relevant to an investigation of a licensee.”
The bill provides that a licensee shall cooperate with the licensing board and sets forth severe financial penalties for those who are deemed to be uncooperative. In such a circumstance, it may not be in the licensee’s best interest to cooperate in order to defend oneself. Such an expectation is unreasonable.
Requirement for Healing Arts Practitioners to Wear Name Tags
(SB 1132) Negrete McLeod
This is a “spot bill” surrounding legislation that has passed in prior years. Existing law requires healing arts practitioners to wear name tags while working that disclose names and license status in at least 18-point type. This requirement is not applicable to health care practitioners working in a practice or an office where a license is prominently displayed. Existing law further provides that if a health care practitioner or a licensed clinical social worker is working in a psychiatric setting or in a setting that is not licensed by the state, the employing entity or agency shall have the discretion to make an exception from the name tag requirement for individual safety or therapeutic reasons. CAMFT is watching this legislation that could become more expansive requiring practitioners to wear name tags.
Restrictions on Advertising and Designations of Licensees
(SB 1150) Negrete McLeod
At this time this bill is not applicable to MFTs, but we are nevertheless watching the bill very closely to see what it will become. The bill, among other things, would require a number of professionals, when advertising, to list the abbreviations for the licenses held immediately after their names. Among other things, the bill would require psychologists to include the designation “Ph.D.” immediately after their names. Of course, the bill is incorrect with regard to psychologists because the supposed required designation is a degree and not a license. The purpose of this legislation may be directed, to some degree, at the potential misleading use of “Dr.” preceding the name of a professional, since such a representation is limited to use by physicians.
March 18, 2010
GIRL POWER! Is Good Mental Health
GIRL POWER!
Is Good Mental Health
GIRL POWER! is paving the way for girls to build confidence, competence, and pride in themselves, in other words, enhancing girls' mental wellness. Girl Power! is also providing messages and materials to girls about the risks and consequences associated with substance abuse and with potential mental health concerns. For instance, did you know:
Girls are seven times more likely than boys to be depressed and twice as likely to attempt suicide.*
Girls are three times more likely than boys to have a negative body image (often reflected in eating disorders such as anorexia and bulimia).*
One in five girls in the U.S. between the ages of 12 and 17 drink alcohol and smoke cigarettes.*
Girls who develop positive interpersonal and social skills decrease their risk of substance abuse.*
Girls who have an interest and ability in areas such as academics, the arts, sports, and community activities are more likely to develop confidence and may be less likely to use drugs.*
On the other hand, this also is a time when girls may make decisions to try risky behaviors, including drinking, smoking, and using drugs.*
The Girl Power! Campaign, under the leadership of the Center for Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health Services Administration (SAMHSA) is collaborating with the Center for Mental Health Services (CMHS) to provide this valuable mental health information.
* Girl Power! Hometown Media Kit, Center for Substance Abuse Prevention, 1997.
Substance Abuse and Mental Health
Results from a study of nearly 6,000 people aged 15 to 24 show that among young people with a history of both a mental disorder and an addictive disorder, the mental disorder is usually reported to have occurred first. The onset of mental health problems may occur about 5 to 10 years before the substance abuse disorders.**
This provides a "window of opportunity" for targeted substance abuse prevention interventions and needed mental health services.
** "National Comorbidity Survey," Ronald C. Kessler, Ph.D., et al., American Journal of Orthopsychiatry, June 1996.
What Is Mental Health?
Mental health is how we think, feel, and act in order to face life's situations. It is how we look at ourselves, our lives, and the people we know and care about. It also helps determine how we handle stress, relate to others, evaluate our options, and make choices. Everyone has mental health.
A young girl's mental health affects her daily life and future. Schoolwork, relationships, and physical health can be affected by mental health. Like physical health, mental health is important at every stage of life. Caring for and protecting a child's mental health is a major part of helping that child grow to become the best she can be.
Girls' independence is usually encouraged in childhood, and their strengths nurtured. Most girls become emotionally, mentally, and physically healthy young adults. But sometimes, during the transition from childhood to adolescence, extra care is necessary, so that a girl's self-esteem and coping skills are not diminished. For more information on teen mental health, call 1-800-789-2647 and ask for the brochure: "You and Mental Health: What's the Deal?" (Order # CA-0002)
Nurturing Your Child's Mental Health
Parents and other caregivers are responsible for children’s physical safety and emotional well-being. Parenting styles vary; there is no one right way to raise a child. Clear and consistent expectations for each child, by all caregivers, are important. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills. The following suggestions are not meant to be complete.
Do your best to provide a safe home and community for your child, as well as nutritious meals, regular health check-ups, immunizations, and exercise.
Be aware of stages in child development so you don’t expect too much or too little from your child.
Encourage your child to express her feelings; respect those feelings. Let your child know that everyone experiences pain, fear, anger, and anxiety.
Try to learn the source of these feelings. Help your child express anger positively, without resorting to violence.
Promote mutual respect and trust. Keep your voice level down—even when you don’t agree. Keep communication channels open.
Listen to your child. Use words and examples your child can understand. Encourage questions.
Provide comfort and assurance. Be honest. Focus on the positives. Express your willingness to talk about any subject.
Look at your own problem-solving and coping skills. Do you turn to alcohol or drugs? Are you setting a good example? Seek help if you are overwhelmed by your child’s feelings or behaviors or if you are unable to control your own frustration or anger.
Encourage your child’s talents and accept limitations.
Set goals based on the child’s abilities and interests—not someone else’s expectations. Celebrate accomplishments. Don’t compare your child’s abilities to those of other children; appreciate the uniqueness of your child. Spend time regularly with your child.
Foster your child’s independence and self-worth.
Help your child deal with life’s ups and downs. Show confidence in your child’s ability to handle problems and tackle new experiences.
Discipline constructively, fairly, and consistently. (Discipline is a form of teaching, not physical punishment.) All children and families are different; learn what is effective for your child. Show approval for positive behaviors. Help your child learn from her mistakes.
Love unconditionally. Teach the value of apologies, cooperation, patience, forgiveness, and consideration for others. Do not expect to be perfect; parenting is a difficult job. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills.
Mental Health Problems
Many children experience mental health problems that are real and painful and can be severe.
Mental health problems affect at least one in every five young people, at any given time. At least 1 in 10 children may have a serious emotional disturbance that severely disrupts his or her ability to function.
Tragically an estimated two-thirds of all young people with mental health problems are not getting the help they need. Mental health problems can lead to school failure, alcohol or other drug abuse, family discord, violence, or even suicide.
Is Good Mental Health
GIRL POWER! is paving the way for girls to build confidence, competence, and pride in themselves, in other words, enhancing girls' mental wellness. Girl Power! is also providing messages and materials to girls about the risks and consequences associated with substance abuse and with potential mental health concerns. For instance, did you know:
Girls are seven times more likely than boys to be depressed and twice as likely to attempt suicide.*
Girls are three times more likely than boys to have a negative body image (often reflected in eating disorders such as anorexia and bulimia).*
One in five girls in the U.S. between the ages of 12 and 17 drink alcohol and smoke cigarettes.*
Girls who develop positive interpersonal and social skills decrease their risk of substance abuse.*
Girls who have an interest and ability in areas such as academics, the arts, sports, and community activities are more likely to develop confidence and may be less likely to use drugs.*
On the other hand, this also is a time when girls may make decisions to try risky behaviors, including drinking, smoking, and using drugs.*
The Girl Power! Campaign, under the leadership of the Center for Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health Services Administration (SAMHSA) is collaborating with the Center for Mental Health Services (CMHS) to provide this valuable mental health information.
* Girl Power! Hometown Media Kit, Center for Substance Abuse Prevention, 1997.
Substance Abuse and Mental Health
Results from a study of nearly 6,000 people aged 15 to 24 show that among young people with a history of both a mental disorder and an addictive disorder, the mental disorder is usually reported to have occurred first. The onset of mental health problems may occur about 5 to 10 years before the substance abuse disorders.**
This provides a "window of opportunity" for targeted substance abuse prevention interventions and needed mental health services.
** "National Comorbidity Survey," Ronald C. Kessler, Ph.D., et al., American Journal of Orthopsychiatry, June 1996.
What Is Mental Health?
Mental health is how we think, feel, and act in order to face life's situations. It is how we look at ourselves, our lives, and the people we know and care about. It also helps determine how we handle stress, relate to others, evaluate our options, and make choices. Everyone has mental health.
A young girl's mental health affects her daily life and future. Schoolwork, relationships, and physical health can be affected by mental health. Like physical health, mental health is important at every stage of life. Caring for and protecting a child's mental health is a major part of helping that child grow to become the best she can be.
Girls' independence is usually encouraged in childhood, and their strengths nurtured. Most girls become emotionally, mentally, and physically healthy young adults. But sometimes, during the transition from childhood to adolescence, extra care is necessary, so that a girl's self-esteem and coping skills are not diminished. For more information on teen mental health, call 1-800-789-2647 and ask for the brochure: "You and Mental Health: What's the Deal?" (Order # CA-0002)
Nurturing Your Child's Mental Health
Parents and other caregivers are responsible for children’s physical safety and emotional well-being. Parenting styles vary; there is no one right way to raise a child. Clear and consistent expectations for each child, by all caregivers, are important. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills. The following suggestions are not meant to be complete.
Do your best to provide a safe home and community for your child, as well as nutritious meals, regular health check-ups, immunizations, and exercise.
Be aware of stages in child development so you don’t expect too much or too little from your child.
Encourage your child to express her feelings; respect those feelings. Let your child know that everyone experiences pain, fear, anger, and anxiety.
Try to learn the source of these feelings. Help your child express anger positively, without resorting to violence.
Promote mutual respect and trust. Keep your voice level down—even when you don’t agree. Keep communication channels open.
Listen to your child. Use words and examples your child can understand. Encourage questions.
Provide comfort and assurance. Be honest. Focus on the positives. Express your willingness to talk about any subject.
Look at your own problem-solving and coping skills. Do you turn to alcohol or drugs? Are you setting a good example? Seek help if you are overwhelmed by your child’s feelings or behaviors or if you are unable to control your own frustration or anger.
Encourage your child’s talents and accept limitations.
Set goals based on the child’s abilities and interests—not someone else’s expectations. Celebrate accomplishments. Don’t compare your child’s abilities to those of other children; appreciate the uniqueness of your child. Spend time regularly with your child.
Foster your child’s independence and self-worth.
Help your child deal with life’s ups and downs. Show confidence in your child’s ability to handle problems and tackle new experiences.
Discipline constructively, fairly, and consistently. (Discipline is a form of teaching, not physical punishment.) All children and families are different; learn what is effective for your child. Show approval for positive behaviors. Help your child learn from her mistakes.
Love unconditionally. Teach the value of apologies, cooperation, patience, forgiveness, and consideration for others. Do not expect to be perfect; parenting is a difficult job. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills.
Mental Health Problems
Many children experience mental health problems that are real and painful and can be severe.
Mental health problems affect at least one in every five young people, at any given time. At least 1 in 10 children may have a serious emotional disturbance that severely disrupts his or her ability to function.
Tragically an estimated two-thirds of all young people with mental health problems are not getting the help they need. Mental health problems can lead to school failure, alcohol or other drug abuse, family discord, violence, or even suicide.
March 17, 2010
Creating a Consumer and Family-Oriented Health Care System
Creating a Consumer and Family-Oriented Health Care System
--------------------------------------------------------------------------------
The Washington Business group on Health, with Support from CMHS, Has Released a Publication Focusing on An Environmental Scan of Reforms Impacting Mental Health and Substance Abuse Care.
Part I of the paper discusses environmental trends driving change in mental health and substance abuse delivery system models and practices. Trends discussed are:
Industry consolidation and the growth of managed care;
The absence of a federal regulatory framework;
Interest in health care quality and performance; and
Changing perceptions about mental health and substance abuse.
Part II reviews a wide range of public and private sector initiatives intended to enhance consumer-directed care, inform and educate consumers about health care choices and the changing health care system, and involve consumers and their advocates in the planning and monitoring of emerging health care delivery systems. Initiatives are organized under four topic headings:
Empowering consumers with information;
Performance accountability from the consumer perspective;
The consumer and family movements in mental health; and
A systems approach to health care delivery.
Part III identifies three critical challenges to creating a consumer- directed health care system:
Creating meaningful and useful information for consumers;
Stimulating health system accountability for serving people with chronic illnesses and disabilities; and
Enhancing organized consumer and family involvement in health system planning and monitoring.
It is intended as a strategic planning tool and resource document for consumer advocates and others interested in enhancing consumer involvement in improving health system accountability for mental health and substance abuse services. A glossary of terms and contact information for initiatives cited in the document are included.
Consumer Affairs Bulletin
Volume 2, No. 2 Summer 1997
--------------------------------------------------------------------------------
The Washington Business group on Health, with Support from CMHS, Has Released a Publication Focusing on An Environmental Scan of Reforms Impacting Mental Health and Substance Abuse Care.
Part I of the paper discusses environmental trends driving change in mental health and substance abuse delivery system models and practices. Trends discussed are:
Industry consolidation and the growth of managed care;
The absence of a federal regulatory framework;
Interest in health care quality and performance; and
Changing perceptions about mental health and substance abuse.
Part II reviews a wide range of public and private sector initiatives intended to enhance consumer-directed care, inform and educate consumers about health care choices and the changing health care system, and involve consumers and their advocates in the planning and monitoring of emerging health care delivery systems. Initiatives are organized under four topic headings:
Empowering consumers with information;
Performance accountability from the consumer perspective;
The consumer and family movements in mental health; and
A systems approach to health care delivery.
Part III identifies three critical challenges to creating a consumer- directed health care system:
Creating meaningful and useful information for consumers;
Stimulating health system accountability for serving people with chronic illnesses and disabilities; and
Enhancing organized consumer and family involvement in health system planning and monitoring.
It is intended as a strategic planning tool and resource document for consumer advocates and others interested in enhancing consumer involvement in improving health system accountability for mental health and substance abuse services. A glossary of terms and contact information for initiatives cited in the document are included.
Consumer Affairs Bulletin
Volume 2, No. 2 Summer 1997
March 16, 2010
Suicide Prevention
Suicide Prevention
Recent reports by the Institute of Medicine and the World Health Organization have revealed the magnitude and impact of suicide, citing it as the cause of death for 30,000 Americans annually and over one million people worldwide. These reports, as well as the President’s New Freedom Commission Report and the Surgeon General’s National Strategy for Suicide Prevention, call for aggressive efforts to reduce the loss of life and suffering related to suicide.
The Branch supports several key initiatives designed to improve public and professional awareness of suicide as a preventable public health problem and to enhance the capabilities of the systems that promote prevention and recovery, including:
Cooperative Agreements for State-Sponsored Youth Suicide Prevention and Early Intervention Program. Three-year grants to support States and tribes in developing and implementing statewide or tribal youth suicide prevention and early intervention strategies, grounded in public/private collaboration.
Campus Suicide Prevention Grants. Three-year grants to institutions of higher education to enhance services for students with mental and behavioral health problems that can lead to school failure, depression, substance abuse, and suicide attempts.
Cooperative Agreement for the Suicide Prevention Resource Center (SPRC). Funds the continuation of a Federal Suicide Technical Assistance Center to provide guidance to State, tribal, and local grantees in the implementation of the suicide prevention strategy; create standards for data collection; and collect, evaluate, and disseminate data related to specific suicide prevention programs.
Networking and Certifying Suicide Prevention Hotlines. This grant provides funding to manage a toll-free national suicide prevention hotline network utilizing a life affirming number which routes calls from anywhere in the United States to a network of local crisis centers that can link callers to local emergency, mental health and social service resources.
Linking Adolescents at Risk to Mental Health Services Grant Program. This initiative is one of SAMHSA's Service-to-Science Grants programs. The purpose of the Adolescents at Risk program is to evaluate voluntary school-based programs that focus on identification and referral of high school youth who are at risk for suicide or suicide attempts. Eligible applicants are local educational agencies or nonprofit entities in conjunction with local educational agencies.
Collectively, these initiatives will further awareness of suicide, will promote suicide prevention and intervention efforts, and will reduce the numbers of lives lost and disrupted by suicide.
Recent reports by the Institute of Medicine and the World Health Organization have revealed the magnitude and impact of suicide, citing it as the cause of death for 30,000 Americans annually and over one million people worldwide. These reports, as well as the President’s New Freedom Commission Report and the Surgeon General’s National Strategy for Suicide Prevention, call for aggressive efforts to reduce the loss of life and suffering related to suicide.
The Branch supports several key initiatives designed to improve public and professional awareness of suicide as a preventable public health problem and to enhance the capabilities of the systems that promote prevention and recovery, including:
Cooperative Agreements for State-Sponsored Youth Suicide Prevention and Early Intervention Program. Three-year grants to support States and tribes in developing and implementing statewide or tribal youth suicide prevention and early intervention strategies, grounded in public/private collaboration.
Campus Suicide Prevention Grants. Three-year grants to institutions of higher education to enhance services for students with mental and behavioral health problems that can lead to school failure, depression, substance abuse, and suicide attempts.
Cooperative Agreement for the Suicide Prevention Resource Center (SPRC). Funds the continuation of a Federal Suicide Technical Assistance Center to provide guidance to State, tribal, and local grantees in the implementation of the suicide prevention strategy; create standards for data collection; and collect, evaluate, and disseminate data related to specific suicide prevention programs.
Networking and Certifying Suicide Prevention Hotlines. This grant provides funding to manage a toll-free national suicide prevention hotline network utilizing a life affirming number which routes calls from anywhere in the United States to a network of local crisis centers that can link callers to local emergency, mental health and social service resources.
Linking Adolescents at Risk to Mental Health Services Grant Program. This initiative is one of SAMHSA's Service-to-Science Grants programs. The purpose of the Adolescents at Risk program is to evaluate voluntary school-based programs that focus on identification and referral of high school youth who are at risk for suicide or suicide attempts. Eligible applicants are local educational agencies or nonprofit entities in conjunction with local educational agencies.
Collectively, these initiatives will further awareness of suicide, will promote suicide prevention and intervention efforts, and will reduce the numbers of lives lost and disrupted by suicide.
Subscribe to:
Posts (Atom)
