Rand health quarterly最新文献

The Military Health System does not have enough military mental health providers to meet demand among active-duty service members, despite efforts in the U.S. Department of Defense (DoD) to leverage special pays to recruit and retain staff. Maintaining adequate military mental health care services is important for maintaining the readiness of the overall force. To expand its mental health workforce and stabilize its care delivery system, DoD needs cost-effective options for increasing the force size of military mental health providers in both the short and long terms. In this study, the authors used the RAND Dynamic Retention Model to simulate how changing retention bonuses for uniformed mental health providers increased active component retention and per capita personnel cost. Using these results, the authors determined the most cost-effective way to increase the force size of the uniformed mental health provider workforce; specifically, accessing more providers or retaining more providers. The authors also compared military compensation for psychiatrists, clinical psychologists, social workers, and mental health nurse practitioners with expected civilian compensation for these types of providers. DoD leaders and personnel managers can use the key findings and recommendations offered to make informed choices among potential strategies for expanding its uniformed mental health workforce.

Ensuring that service members who receive behavioral health (BH) care receive routine readiness assessments is critical to maintaining a ready military force. Routine assessments of service members' medical readiness and deployability help identify any acute or chronic health conditions-physical or psychological-that could negatively affect a service member's ability to perform their military duties. Service members may receive BH care from a military treatment facility (MTF) provider (often referred to as direct care) or from a TRICARE-contracted civilian provider in the community (often referred to as private-sector care). While readiness assessments are routinely included in clinical encounters at MTFs, it has been unclear how readiness assessments are being conducted for service members seen in private-sector care. This study presents the findings and integration of two analyses-of administrative treatment data and of qualitative interviews with MTF administrators and clinical staff-that can inform policymaking and planning to improve readiness assessments and command communication for service members receiving private-sector BH care.

Alzheimer's dementia, the most common type of dementia, afflicts more than 6 million Americans. More than 80 percent of people living with dementia (PLWD) live in the community, either with caregivers or alone. As cognitive impairment becomes more severe, behavioral and psychological symptoms of dementia (BPSD) become more difficult to manage, and those with severe or dangerous BPSD may need to be treated in an inpatient psychiatric facility (IPF). The immediate goal of an IPF stay is to stabilize patients in a psychiatric crisis. IPFs primarily serve people with serious mental illness and substance use disorders, whose care needs may overlap with but also differ from the needs of PLWD. Little is known about PLWD who use IPFs. The goal of this research was to conduct exploratory analyses focused on PLWD who use IPFs to (1) characterize the population and compare them with IPF users without dementia, (2) examine characteristics and utilization patterns for different services and settings that may be associated with IPF stays, and (3) analyze outcomes following IPF stays. The authors used Medicare fee-for-service data to conduct descriptive analyses characterizing beneficiaries with dementia who experienced an IPF stay in 2018 and compare them with beneficiaries without dementia. The research team used regression analyses to explore predictors of IPF use and service use and outcomes after IPF discharge.

Policymakers in Connecticut have used state funding to expand eligibility for HUSKY, Connecticut's Medicaid and Children's Health Insurance Program (CHIP), to children (through age 15) and to pregnant people who do not qualify for federally funded Medicaid or CHIP coverage because of their immigration status. Policymakers are considering further expansions of eligibility for HUSKY for the remaining population of children and adults. In addition to expansions of HUSKY A (Medicaid for children, parents or caregivers, and pregnant people), HUSKY B (CHIP), and HUSKY D (Medicaid for adults without minor children), policymakers are also considering expanding eligibility for HUSKY C, the program for residents who are ages 65 and older, blind, or disabled, to immigrants. In this study, the authors use microsimulation modeling to estimate the effects of expanding HUSKY eligibility to additional groups by age and eligibility category.

Since fall 2021, the authors of this study have conducted regular enumerations of the unsheltered populations in three Los Angeles neighborhoods known for having high concentrations of people experiencing unsheltered homelessness: Hollywood, Skid Row, and Venice. In addition to counts, the authors have conducted surveys of unsheltered residents in these same neighborhoods to better understand the characteristics, experiences, and needs of these populations. The results of the first year of this study, known as the Los Angeles Longitudinal Enumeration and Demographic Survey (LA LEADS), were presented in a report published by RAND in 2023. The authors continued their enumeration and survey efforts in these three neighborhoods throughout 2023 using an updated survey instrument that includes new questions about employment, income, experiences with service providers, health conditions, and substance use. This study presents their findings from the 2023 data collection period and includes comparisons with the previous year's effort and new information about unsheltered populations' experiences and needs across the same three Los Angeles neighborhoods.

The patchwork of laws and regulations that affect abortion access in the United States has become increasingly complex since the 2022 Dobbs v. Jackson Women's Health Organization U.S. Supreme Court decision that gave states the right to enact and enforce policies facilitating or restricting abortion access. The authors examined state, local, and institutional policies in Virginia-which is one of the only remaining states in the South post-Dobbs with legal access to abortion care past 13 weeks gestational age-to better understand how the policy landscape is influencing provision of care in the state. The authors reviewed existing legislation, bills, and sources detailing the policy landscape in Virginia and interviewed a sample of clinicians and nonclinicians working at organizations providing or supporting abortion care. The study principally focused on state laws, local policies and actions, institutional policies, and reported implementation experiences affecting access to abortion care.

The authors analyze the relationship between heat events in Los Angeles County and (1) emergency medical services, (2) emergency room visits, (3) deaths investigated by the medical examiner, and (4) bookings for violent offenses. Heat events are classified according to the National Weather Service HeatRisk system. Days classified as moderate, major, and severe HeatRisk days are associated with worse results for all these outcomes.

The Los Angeles County Rapid Diversion Program (RDP) is a pretrial mental health diversion program operating in seven courthouses in Los Angeles County, California. Established in 2019 as a faster approach to pretrial mental health diversion compared with the traditional approach, RDP allows for the diversion of individuals who have a mental health diagnosis or substance use disorder and certain qualifying misdemeanor or felony charges. Individuals who complete the program have their case dismissed. In this study, the authors present findings from a formal assessment of program implementation to date. Using a mixed-methods evaluation, they explore current program operations, characteristics of and case outcomes for individuals who participate in RDP, and strengths and areas for improvement. Lessons learned from this evaluation have the potential to inform efforts to scale the program within Los Angeles County and to other counties interested in implementing a similar pretrial diversion program.

Healthy child development is a key driver for better health and well-being throughout a person's life, and the early years set that important foundation. Early childhood development programs play a critical role in mitigating risks to the cognitive, social, behavioral, and physical development of children. Increasingly, there is recognition that early intervention to support child development requires more than separate programs and services. Instead, a full system transformation, such as the national Help Me Grow initiative, is necessary. Help Me Grow Western New York (HMG WNY), a regional effort, aims to build and strengthen a comprehensive and coordinated system of early childhood development services and care to support the development and well-being of children in this region. HMG WNY serves eight counties in western New York that form a diverse community whose socioeconomic composition varies but which all share at least some level of need for better coordination and provision of early childhood development programs and services. In this study, the authors assess how HMG WNY addresses this regional need. The authors focus on how HMG WNY is working to strengthen and expand the early childhood network in western New York and provide insights that will inform the next steps for HMG WNY.

The No More Adverse Childhood Experiences (NACES) pilot project addresses Adverse Childhood Experiences (ACEs) in rural farmworker communities in central California. Informed by engagement of farmworkers, the project included a clinic-based intervention that provided ACE education, screening, and response services during routine health visits with adult and pediatric patients. To understand the impact of the clinic-based intervention, the evaluation team developed a mixed-methods approach that collected and analyzed administrative data on ACE education and screening; clinic readiness for trauma informed health care self-assessments; staff training surveys; and interviews with staff, adult patients, and caregivers of pediatric patients. The evaluation found that clinic staff trained by NACES partners gained confidence in their ability to provide ACE education and screenings to the rural farmworker community they serve. In addition, adult patients and caregivers of pediatric patients said that ACE education was easy to understand and agreed that ACE education and screening was acceptable during routine visits with their or their child's doctor. Overall, results provide early evidence for the feasibility, acceptability, and potential for positive impact of an ACE education, screening, and response model that is informed by farmworker voices.