Rand health quarterly最新文献

Psychiatric and substance use disorder (SUD) treatment beds are essential infrastructure for meeting the needs of individuals with behavioral health conditions. However, not all psychiatric and SUD beds are alike: They represent infrastructure within different types of facilities. For psychiatric beds, these vary from acute psychiatric hospitals to community residential facilities. For SUD treatment beds, these vary from facilities offering short-term withdrawal management services to others offering longer duration residential detoxification services. Different settings also serve clients with different needs. For example, some clients have high-acuity, short-term needs; others have longer-term needs and may return for care on multiple occasions. California's Merced, San Joaquin, and Stanislaus Counties, like other counties throughout the United States, have sought to assess shortages in psychiatric and SUD treatment beds. In this study, the authors estimated psychiatric bed and residential SUD treatment capacity, need, and shortages for adults and children and adolescents at various levels of care: acute, subacute, and community residential services for psychiatric treatment and SUD treatment service categories defined by American Society of Addiction Medicine clinical guidelines. Drawing from various data sets, literature review findings, and facility survey responses, the authors computed the number of beds required-at each level of care-for adults and children and adolescents and identified hard-to-place populations. The authors draw from these findings to offer Merced, San Joaquin, and Stanislaus Counties recommendations to help ensure all their residents, especially nonambulatory individuals, have access to the behavioral health care that they need.

The U.S. direct care workforce employs nearly 4.6 million people and represents one of the fastest growing occupations in the United States. Direct care workers, or "caregivers," include nursing assistants, home care workers, and residential care aides, all of whom provide basic care to older adults and individuals with disabilities in various health care settings. Despite a growing need for caregivers, supply has not kept up with demand due to high turnover and low wages. In addition, caregivers often face high levels of workplace stress, limited training and growth opportunities, and personal stressors. Ranging from 35 to 90 percent, depending on the health care setting, the turnover rates of direct care workers pose a major challenge for health systems, as well as care recipients and workers themselves. In 2019, the Ralph C. Wilson Jr. Foundation funded three health systems to support the implementation of a new program: Transformational Healthcare Readiness through Innovative Vocational Education (THRIVE). This 12-month program was designed to help address barriers that entry-level caregivers experience and reduce turnover through a comprehensive risk assessment, training, and one-on-one coaching. Researchers from RAND conducted a process and outcome evaluation to determine whether THRIVE was meeting its goals of improving retention and achieving a positive return on investment (ROI). They also examined potential areas for program improvement.

Women serving in the U.S. military are more likely to report mental health problems than men, including symptoms of depression and posttraumatic stress disorder (PTSD). Women also experience much higher rates of sexual harassment, gender discrimination, and sexual assault than men. This study examines how unwanted gender-based experiences among military service members relate to differences in health. The authors find that, once experiences of gender discrimination, sexual harassment, and sexual assault are accounted for, gender differences in health are largely attenuated. That is, the vulnerability to physical and mental health problems among female service members appears to be highly correlated with these unwanted gender-based experiences. The results highlight the possible health benefits of improved prevention of gender discrimination, sexual harassment, and sexual assault, and they indicate the need to address the mental and physical health of service members exposed to these types of experiences.

Researchers explore the literature on race and ethnicity (R/E) in relation to U.S. military service member well-being in the areas of mental health, behavioral health, family violence, marital satisfaction, and financial stress to uncover whether past research has focused on R/E differences in outcomes as a driving research question; the variables used to capture R/E; and the quality of research in terms of design, data, and analysis. The Department of Defense (DoD) has expressed commitment to improving diversity and inclusion in the military. If leaders seek to do this based on existing evidence, they will find that information about how R/E intersects with the well-being of service members and their families is extremely limited. DoD should consider developing a deliberate, strategic, and comprehensive research agenda on R/E diversity in service member and family well-being outcomes. This will help DoD identify where differences exist and where policies and programs can address those gaps.

Many of the ethnic and racial workforce inequities in the United States are present in health care systems. Low representation of African American/Black individuals in the health care system workforce can be traced to a history of exclusionary practices that leave such individuals less likely to pursue health careers. Past research found that low representation is driven by inequities in health, education, and employment that are a result of structural racism. Pathways programs have been identified as one of the methods to increase recruitment, retention, and promotion in health-related career fields for African American/Black individuals. As prior research has shown, these programs recruit and support the graduation of students from underrepresented communities at all educational stages to increase their representation in specific fields. This article describes the development of key factors in framework design for the Health System-Community Pathways Program (HCPP), which aims to increase representation of African American/Black communities in the health care system workforce and improve the quality of their experience in pursuing careers in these fields. The HCPP framework of key factors is informed by an environmental scan, interviews and focus groups, and an expert discussion panel session. The article's authors come from diverse backgrounds; the team included African American/Black physicians and members of other historically marginalized communities. The qualitative research drew insights from diverse African American/Black community stakeholders; the study was reviewed by many stakeholders to ensure that the design of the research and the end product maximally benefits the community on which it focuses.