The U.S. Department of Health and Human Services (HHS) profoundly affects the lives of all Americans. Its agencies and programs protect against domestic and global health threats, assure the safety of food and drugs, advance the science of preventing and conquering disease, provide safeguards for America's vulnerable populations, and improve health for everyone. However, the department faces serious and complex obstacles, chief among them rising health care costs and a broadening range of health challenges. Over time, additional responsibilities have been layered onto the department, and other responsibilities removed, often without corresponding shifts in positions, procedures, structures, and resources. At the request of the U.S. House of Representatives Committee on Oversight and Government Reform, HHS in the 21st Century assesses whether HHS is ideally organized to meet the enduring and emerging health challenges facing our nation. The committee identifies many factors that affect the department's ability to address its range of responsibilities, including divergence in the missions and goals of the department's agencies, limited flexibility in spending, impending workforce shortages, difficulty in retaining skilled professionals, and challenges in effectively partnering with the private sector.
This guide was created to promote the early identification of children and adolescents with mental health and substance use problems as well as to provide guidance, tools, and resources for early identification-including a compendium of the most developmentally, culturally, and environmentally appropriate screening instruments. SAMHSA developed the guide using the input of the members of the Federal/National Partnership* (FNP) Early Identification Workgroup, chaired by representatives from the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA).
This handbook is intended to provide the reader with a basic understanding of the Medicaid program. There is a specific emphasis on the interplay between Medicaid principles and behavioral health services. The goal is for the reader to navigate his or her state Medicaid program so that he or she can contribute meaningfully to policy conversations related to provision of behavioral health services to individuals who are eligible for Medicaid. Throughout this document, the term behavioral health encompasses both mental and substance use disorders. When a mental or substance use disorder is addressed singularly, the reference will be only to that disorder. Because each state's Medicaid program is different from all others and because Medicaid laws and policies are ever changing, this handbook cannot contemplate every permutation of program construction.
Implementing these practical and largely achievable suggestions will improve access to timely and targeted mental health services in primary care settings. Program and clinical experts agree that the early prevention and treatment of mental disorders will result in decreases in individual suffering, family burden, and medical costs. This project provided an important opportunity to review policy and service-delivery change mechanisms aimed at improving the reimbursement of mental health services in primary care settings. By using knowledge from a variety of individuals and settings and combining empirical research with qualitative interviews and the Expert Forum proceedings, this project identified areas where Federal agencies, states, provider organizations, and commissioner associations can clarify, collaborate, educate, and provide support to improve the reimbursement of and access to mental health services in primary care settings.
Comprehensive history of the Children’s Bureau from 1912-2012 in eBook form that shares the legacy of this landmark agency that established the first Federal Government programs, research and social reform initiatives aimed to improve the safety, permanency and well-being of children, youth and families. In addition to bios of agency heads and review of legislation and publications, this important book provides a critical look at the evolution of the Nation and its treatment of children as it covers often inspiring and sometimes heart-wrenching topics such as: child labor; the Orphan Trains, adoption and foster care; infant and maternal mortality and childhood diseases; parenting, infant and child care education; the role of women's clubs and reformers; child welfare standards; Aid to Dependent Children; Depression relief; children of migrants and minorities (African Americans, Hispanics, Native Americans), including Indian Boarding Schools and Indian Adoption Program; disabled children care; children in wartime including support of military families and World War II refugee children; Juvenile delinquency; early childhood education Head Start; family planning; child abuse and neglect; natural disaster recovery; and much more. Child welfare and related professionals, legislators, educators, researchers and advocates, university school of social work faculty and staff, libraries, and others interested in social work related to children, youth and families, particularly topics such as preventing child abuse and neglect, foster care, and adoption will be interested in this comprehensive history of the Children's Bureau that has been funded by the U.S. Federal Government since 1912.
The National Agenda for Public Health Action represents a monumental step in addressing a priority health issue for women. It has been a work in progress and a true collaboration among the Centers for Disease Control and Prevention (CDC), the American Diabetes Association (ADA), the Association of State and Territorial Health Officials (ASTHO), and the American Public Health Association (APHA) – and numerous additional partnering organizations. The National Agenda for Public Health Action challenges us as a nation to reach beyond our traditional boundaries of public and private health care, federal and state politics, community programs and academic research, and media and training. It poses a vision of a nation in which diabetes among women is prevented or at least delayed whenever possible, and it outlines a rational and feasible plan for making that vision a reality. We hope that the National Agenda will become a beacon for mobilizing the collective energies and resources of multiple entities to truly make a difference in the lives of women and their families who face the daily challenges of diabetes. Diabetes is a tremendous financial burden on patients, their families and society. It's a burden that grows in conjunction with America's obesity epidemic. Diabetes costs our country $132 billion a year in direct medical costs and in indirect costs such as disability, missed work and premature death. More importantly, it costs Americans their lives, their health and their well-being. But amidst all the bad news, there is also good news: Diabetes is often preventable. Of the more than 17 million Americans with diabetes, more than half are women. An additional 16 million more Americans have pre-diabetes. We must all work to fight this disease that affects so many of our friends, neighbors and loved ones. Fighting diabetes through research and public education is one of our top priorities at the Department of Health and Human Services. That's why HHS' Centers for Disease Control and Prevention, in cooperation with partners such as the American Diabetes Association, the American Public Health Association, and the Association of State and Territorial Health Officials, developed the National Agenda for Public Health Action. We hope this agenda will guide the nation in addressing diabetes and women's health. We want an America in which: Diabetes among women is prevented or at least delayed whenever possible; Women at risk for diabetes are provided the family and community support they need to prevent or delay diabetes and its complications; Appropriate care and management of diabetes among women is promoted across the life stages; And the occurrence of complications from diabetes among women is prevented, delayed, or minimized.~
The audience for these documents includes those interested in familiarizing themselves with the child welfare, alcohol and other drug services, and court systems. These documents are also intended for jurisdictions interested in or in the process of developing cross-systems relationships. The primer and guide are targeted to management and administrative personnel in State, county, and tribal jurisdictions' alcohol and drug services, child welfare, and court systems. The primer is not an exhaustive review of each system's mandates, practices, and policies. However, this document does provide an overview of the framework, target population, key legislation and funding sources, and structure and organization of services for each system.
Treatment Improvement Protocols (TIPs) are developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and HumanServices (HHS). Each TIP involves the development of topic-specific best practice guidelines for the prevention and treatment of substance use and mental disorders. TIPs draw on the experience and knowledge of clinical, research, and administrative experts of various forms of treatment andprevention. TIPs are distributed to facilities and individuals across the country. Published TIPs can be accessed via the Internet at http: //store.samhsa.gov. Although each consensus-based TIP strives to include an evidence base for the practices it recommends, SAMHSA recognizes that behavioral health is continually evolving, and research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front-line" information quickly but responsibly. If research supports a particular approach, citations are provided.
Community-based behavioral health providers and systems have an essential role in serving individuals with mental and substance use disorders who are currently or formerly involved with the criminal justice system. These individuals are a part of every community, and as for all community members with behavioral health needs, individualized, integrated, comprehensive, coordinated, and continuous service is the standard of care. Individuals with behavioral health issues are overrepresented in jails and prisons across the United States.1 Most of these individuals return to their communities, families, and social networks and subsequently require community-based behavioral and physical health care services. Research has shown that mental and substance use disorders affect people from all walks of life, with or without justice involvement, and, with the services and supports of behavioral health providers, many people recover.
In September 2012, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare & Medicaid Services (CMS) and the Administration on Children, Youth and Families (ACYF) held a technical expert panel to identify what the research tells us about services for children in therapeutic/treatment foster care (TFC)1 with behavioral health issues (see Appendix A for meeting agenda). A non-Department of Health and Human Services2 16-member panel of researchers representing the fields of mental health, child welfare, measurement and evaluation, social work and psychology came together to provide policymakers with a responsible assessment of currently available information on services for children in therapeutic/treatment foster care with behavioral health issues (see Appendix B for participant list).
The Ryan White HIV/AIDS Program was borne of a movement that began with the onset of the AIDS epidemic in America. First by the tens, then by the hundreds, then by the thousands, brave and commit¬ted people from all walks of life made a decision to get involved. Some were public health officials; others were activists. Some were community leaders, and others—at least until that time—were citizens quietly living their lives. In this sixth edition of the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) Progress Report, we celebrate the legacy of those first responders. We also celebrate the incredible journey we have taken since 1990, when the first Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was passed into law. Who could have imagined in those early years that we would one day have treatments powerful enough to forestall the progression of HIV/AIDS? Who could have known that we would touch so many lives? This year alone, through scores of grantees and providers* in cities and towns across America, the Ryan White HIV/ AIDS Program will serve well over half a million people. We continue to face hurdles in our fight against the epidemic, but we have made enormous progress. Highlights from this year include the following: At $2.29 billion, FY 2010 appropriations for the Program were the largest in Program history; Our AIDS Education and Training Centers (AETCs) conducted more than 18,000 trainings; Under the AIDS Drug Assistance Program (ADAP), we distributed medications to more than 175,000 clients; We treated the people most disproportionately affected by HIV: 73 percent of our clients were racial and ethnic minorities, and 88 percent of our clients had no private health insurance; We conducted research on innovative, replicable models of HIV care to reduce health disparities in women of color, improve access to oral health care, establish linkages between jail settings and HIV primary care, and expand health information technology and electronic medical systems; We have been involved in the Healthy People 2010 broad-based national collaborative to meet the Nation's most pressing health needs; We continue to set the standard for HIV/AIDS care using well-respected performance measures. This response to HIV/AIDS constitutes nothing less than a modern public health miracle. . . and within it lie other miracles, too—like that of an HIV-positive person living into old age, or the promising future that unfolds before the eyes of an HIV-positive adolescent. In this publication, you will read about many of the milestones we have encountered in our 20-year journey and the many qualities that make our team successful. We embarked on a quest that many would not. We stepped up to the plate when others stepped away. And today we constitute a powerful and cohesive force seldom seen in combating a single disease. Our rewards lie in victory after victory over isolation and disease and in the improved lives of our clients. It has been an amazing and empowering journey, and it is not over. We are trained. We are committed. We are full of resolve. And we will not stop. In this Progress Report, we remember and we honor the determination of those first responders and of Ryan White himself. It was the determination to go the distance for people living with HIV/AIDS, what¬ever it took and whatever the cost. That determination has never been more alive than it is today.
The Centers for Disease Control and Prevention (CDC) define a healthcare-associated infection (HAI) as: “[A] localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s). There must be no evidence that the infection was present or incubating at the time of admission to the acute care setting.” The CDC estimates that in 2002 there were 1.7 million HAI and 99,000 HAI-associated deaths in hospitals. The four largest categories of HAI, responsible for more than 80 percent of all reported HAI, are central line–associated bloodstream infections (CLABSI, 14%), ventilator associated pneumonia (VAP, 15%), surgical site infections (SSI, 22%), and catheter-associated urinary tract infections (CAUTI, 32%). In a CDC report, national costs of HAI were estimated, based on 2002 infection rates and adjusted to 2007 dollars using the Consumer Price Index for inpatient hospital services. Estimates of the total annual direct medical costs of HAI for U.S. hospitals ranged from $35.7 billion to $45 billion. The prevention and reduction of HAI is a top priority for the U.S. Department of Health and Human Services. A call to action for the elimination of HAI has been issued jointly by the Association for Professionals in Infection Control and Epidemiology, Inc., the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the Association of State and Territorial Health Officials, the Council of State and Territorial Epidemiologists, the Pediatric Infectious Diseases Society, and the CDC. In a consensus statement issued by these groups, a plan for the elimination of HAI includes the promotion of adherence to evidence-based practices through partnering, educating, implementing, and investing. In 2003, the Institute of Medicine (IOM) published a report, Priority Areas for National Action: Transforming Health Care Quality. The report identified 20 clinical topics for which there are quality concerns because of the gap between knowledge of the topic and integration of that knowledge into the clinical setting. In response to the IOM report, the Agency for Healthcare Research and Quality (AHRQ) initiated a series of technical reviews on quality improvement strategies focused on improving the quality of care for the IOM's 20 priority areas. This systematic review updates the AHRQ Evidence Report Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Volume 6—Prevention of Healthcare Associated Infections. From here on, this report is referred to as the 2007 report. The objective of that evidence review was to identify QI strategies that successfully increase adherence to effective preventive interventions and reduce infection rates for CLABSI, VAP, SSI, and CAUTI. The current review expands the settings to be considered from primarily hospitals to include ambulatory surgery centers, freestanding dialysis centers, and long-term care facilities, where the prevention of HAI needs to be addressed as well. Where applicable, the current report also applies the recommendation of a report prepared for AHRQ by RAND Health in which the impact of context on the effectiveness of patient safety practices is assessed. The context of an intervention can have an important impact on whether preventive interventions are adopted. Key Questions for this report follow. Key Question 1. Which quality improvement strategies are effective in reducing the following healthcare-associated infections - Central line–associated bloodstream infections (CLABSI), Ventilator-associated pneumonia (VAP), Surgical site infections (SSI), Catheter-associated urinary tract infections (CAUTI)? Key Question 2. What is the impact of the health care context on the effectiveness of quality improvement strategies, including reducing infections and increasing adherence to preventive interventions?
Case management has been variously classified as a skill group, a core function, service coordination, or a network of "friendly neighbors." Although it defies precise definition, case management generally can be described as a coordinated approach to the delivery of health, substance abuse, mental health, and social services, linking clients with appropriate services to address specific needs and achieve stated goals. The Consensus Panel that developed this TIP believes that case management lends itself to the treatment of substance abuse, particularly for clients with other disorders and conditions who require multiple services over extended periods of time and who face difficulty in gaining access to those services. This document details the factors that programs should consider as they decide to implement case management or modify their current case management activities. This summary is excerpted from the main text, in which references to the research appear.
reatment Improvement Protocols (TIPs) are developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (HHS). Each TIP involves the development of topic-specific best-practice guidelines for the prevention and treatment of substance use and mental disorders. TIPs draw on the experience and knowledge of clinical, research, and administrative experts of various forms of treatment and prevention. TIPs are distributed to facilities and individuals across the country.
No single organization or person can address the multitude of services needed to help people affected by mental health or substance use conditions. The Government is no exception. While the Government can provide financial support and technical assistance to communities to deal with these challenges, it recognizes that the best sources are the people who live, serve, and work in the community and the best results are often seen when they undertake such action together. Today, in the United States, community partnerships are being established around many local challenges, including efforts to promote wellness and overcome issues associated with mental health and substance use conditions. In addressing these matters, unlikely alliances are being formed among community service organizations, the Government, the private sector, health and education systems and, in recent years, with grassroots faith-based organizations.
Crisis Services are a continuum of services that are provided to individuals experiencing a psychiatric emergency. The primary goal of these services is to stabilize and improve psychological symptoms of distress and to engage individuals in an appropriate treatment service to address the problem that led to the crisis. Core crisis services include: 23-hour crisis stabilization/observation beds, short term crisis residential services and crisis stabilization, mobile crisis services, 24/7 crisis hotlines, warm lines, psychiatric advance directive statements, and peer crisis services. The research base on the effectiveness of crisis services is growing. There is evidence that crisis stabilization, community-based residential crisis care, and mobile crisis services can divert individuals from unnecessary hospitalizations and ensure the least restrictive treatment option is available to people experiencing behavioral health crises.
American Indians and Alaska Natives have consistently experienced disparities in access to healthcare services, funding, and resources; quality and quantity of services; treatment outcomes; and health education and prevention services. Availability, accessibility, and acceptability of behavioral health services are major barriers to recovery for American Indians and Alaska Natives. Common factors that infuence engagement and participation in services include availability of transportation and child care, treatment infrastructure, level of social support, perceived provider effectiveness, cultural responsiveness of services, treatment settings, geographic locations, and tribal affliations.
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