Rand health quarterly最新文献

Federal spending on evidence-based practices (EBPs) provides significant returns by offsetting billions of dollars in societal impacts each year. Practices are deemed evidence-based because they have demonstrated their effectiveness in addressing various social and health-related challenges. Federal agencies often invest in EBP delivery through discretionary grants, but there is limited guidance on how to optimize these grants to support large-scale EBP implementation. To address this gap, the authors held focus groups with federal and state agency officials (using the findings from ongoing RAND research to frame their discussions) to gather and synthesize their recommendations on how to optimize federal grantmaking for EBP implementation. With the focus group participants, the authors identified seven policy recommendations for federal officials to consider when designing, awarding, and executing grants for EBP implementation, including capacity-building in service delivery organizations to sustain EBPs after grant funding ends. The authors also present real-world case examples to illustrate how funding agencies have put each recommendation into practice.

There is a growing concern around the mental and behavioral health of children and youth as such conditions as anxiety disorders, depression, attention-deficit hyperactivity disorder and conduct disorders affect almost one in five children and youth ages 3 to 17. The coronavirus pandemic brought many challenges: Children missed years of in-person schooling and socialization, experienced increased social isolation, and developed an overreliance on technology and social media to stay connected, entertained, and participate in online schooling. Collectively, studies suggest that children and youth have experienced, and will continue to experience, a wide variety of mental and behavioral health concerns that can affect their academic performance, social interactions, well-being, and overall quality of life. In addition to the general stresses and strains in the lives of children and youth, military-connected children and youth face distinct challenges-such as family separation and frequent moves-that can directly or indirectly affect children's mental health and exacerbate an already stressful time in their development. To help inform an ongoing commitment to military-connected children and youth, the Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy asked RAND to assess the needs of military-connected children in the context of military child development centers, military youth programs, and schools with a significant military child population. This study provides findings from this mental and behavioral health needs assessment.

The Army Combat Fitness Test (ACFT) became the U.S. Army's physical fitness test of record in October 2022. The test is substantially different from the previous test and consists of six events intended to measure a more expansive set of capabilities: muscular strength and endurance, power, speed, agility, aerobic endurance, balance, flexibility, coordination, and reaction time. One of the Army's stated goals for the test was to reduce preventable injuries. More than half of soldiers experienced a new injury in 2021, so success in reducing the risk of injury could have a significant impact on both medical costs and lost workdays. Because the ACFT has been administered for a relatively short period, there are limited data available to assess the relationship between the ACFT and soldier health and injuries. Nevertheless, this research effort used available data to gain initial insights into this relationship. This study was part of RAND's independent assessment of the ACFT, focusing specifically on injury risk. To the extent that broader, more-holistic training is motivated by the more-expansive physical requirements of the ACFT, the literature suggests that the ACFT could in the long term lead to an overall reduction in injury rates. Many of the authors' recommendations focus on potential ACFT policy actions that the Army could take to help reduce preventable injuries and assess and monitor soldiers at risk.

In response to the increase in anti-Asian hate, the California State Legislature allocated $110 million in 2021 over three years to fund its Stop the Hate Program, which supports community-based organizations (CBOs) that offer direct services to victims and survivors of hate incidents and hate crimes, as well as prevention and intervention services to combat hate within communities in California. Although this funding was not limited to the Asian American Pacific Islander (AAPI) community, California's Stop the Hate Program was nevertheless a first-of-its-kind investment in AAPI communities throughout the state and is a significant move toward achieving equity for all residents of the state. With Stop the Hate funding, CBOs provide wide-ranging programs and services, including prevention and direct services, to community members who have experienced or are at risk of experiencing acts of hate. This study examines direct services provided to victims of hate and their families. RAND's community partner in this study, the Chinatown Service Center (CSC), is particularly concerned about older Chinese and Chinese American adults who are not using their Stop the Hate mental health services. Because of the surge in anti-Asian hate-to which older adults are particularly vulnerable-and the limited understanding around perceptions of mental health service use in the context of this surge, the authors focus on mental health services intended to help victims of anti-Asian hate incidents among older Asian American adults-and specifically older Chinese and Chinese American adults-in the wake of the COVID-19 pandemic.

Over the past decade, there has been increased awareness that U.S. military veterans often grapple with significant mental and physical health issues related to their service. In response, many policies and programs have been put in place to support veterans and improve their access to needed services. Despite these efforts, prevalence rates for physical and mental health problems and concerns about the health and overall well-being of veterans remain high. Because the specific needs of veterans and the barriers to accessing care likely differ across areas, data at the state level are critical for tailoring policies and programs to make them more effective. This study focuses on veterans in New York, specifically individuals discharged or separated from the military between January 2018 and January 2023. The authors analyzed responses from 1,122 veterans to a survey designed to assess the mental and physical health of this cohort of veterans and their access to, and experiences with, health care and other veteran services. The findings of this study will be of particular interest to policymakers, veterans' advocacy groups, and health care providers who are involved in the design and delivery of services for veterans. Additionally, researchers and academics focusing on social and economic well-being, public health, and veteran affairs will find the data and conclusions useful for further studies.

Elder mistreatment-which includes physical, psychological, and sexual abuse; fraud and financial exploitation; and neglect of older individuals-is a serious public health issue and a growing area of concern as the percentage of the U.S. population age 60 and older continues to rise. Medical, financial, legal, and social service providers who come into contact with older adults can be well positioned to identify persons at risk for or experiencing elder mistreatment and connect them with service providers to address their needs. However, these service providers require tools and training to identify elder mistreatment. Once victims or at-risk individuals are identified, there are also challenges with how best to intervene and provide victims with effective support and services. To explore these challenges and potential solutions, RAND and RTI International convened an expert panel in 2023 to identify knowledge and resource gaps and explore strategies to improve the identification of and responses to elder mistreatment. The workshop participants identified the highest-priority needs in this area, including research to support evidence-based, holistic, and culturally appropriate approaches, while also supporting the widespread adoption of effective programs to reach the greatest number of older adults who have been victimized.

Because employer-sponsored spending comes from employee wages and benefits, employers have a fiduciary responsibility to administer benefits in the interest of participants. The lack of transparency of prices in the health care market limits employers' ability to knowledgeably develop or implement benefit design decisions. This study uses 2020-2022 medical claims data from a large population of privately insured individuals, including hospitals and other facilities from across the United States, to allow an easy comparison of hospital prices. An important innovation of this study is that hospitals and hospital systems (hospitals under joint ownership) are identified by name, which is usually not allowed under data use agreements.

Service members can harm others through sexual assault, harassment (e.g., sexual harassment, bullying, hazing, reprisal, retaliation), domestic abuse, child abuse and neglect, and intimate partner abuse and can harm themselves through attempting or dying by suicide. This range of harmful behaviors can affect service members' overall physical and mental health and be detrimental to force readiness. A robust prevention system is needed to address these harms. A dedicated, qualified, and competent prevention workforce across strategic, operational, and tactical levels is one of the cornerstones of a robust prevention system. In response to a recommendation from the Independent Review Committee on Sexual Assault in the Military, the U.S. Department of Defense is hiring roughly 2,000 Integrated Primary Prevention (IPP) personnel-individuals with particular knowledge and skills in the conduct of prevention activities. These individuals' sole function will be to conduct data-informed activities to prevent various harmful behaviors experienced by service members. In this study, the authors describe the methods for evaluating progress toward fully implementing an IPP workforce. Once this five-year evaluation is completed, the findings will document how much progress has been made toward full implementation, including an understanding of the structure and functioning of the prevention infrastructure and prevention teams, leader support of IPP, and the quality and comprehensiveness of prevention plans. These findings will be useful for professionals responsible for addressing a variety of harmful behaviors (e.g., sexual assault, suicide) and for commanders and other senior-level military leaders and policymakers interested in improving the quality of efforts to prevent harmful behavior in the military.

Transgender and gender-expansive (TGE) youth often experience gender dysphoria, defined as distress related to a mismatch between one's gender identity and physical development. This study summarizes the rapidly evolving state of evidence on interventions for gender dysphoria and related health problems in TGE youth. The authors conducted a systematic review of studies that assessed interventions for gender dysphoria in TGE youth (age 25 or younger), published from 1990 to 2023, and summarized the amount, clinical significance, and certainty of evidence available. The authors reviewed and summarized the available evidence for beneficial and harmful outcomes associated with intervention categories currently recommended as the standards of care (i.e., gender-affirming psychosocial, hormonal, surgical, and reproductive health interventions) for addressing gender dysphoria and related health problems, as well as proposed alternatives to the standards of care (gender identity and expression change efforts and treatment for co-occurring mental disorders to reduce gender dysphoria). Across intervention categories and outcomes, limitations in the available evidence made it difficult to estimate with certainty the strength (and sometimes direction) of associations between intervention and outcome. Yet practitioners and policymakers can incorporate the best available science when making decisions about health care for TGE youth using evidence-informed approaches to account for these conditions of uncertainty. The authors also discuss implications for researchers seeking to improve this body of evidence so that it provides greater certainty about intervention effects and has greater practice and policy relevance.