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High rates of mental health issues among service members and a reluctance to access mental health services together represent one of the greatest ongoing threats to U.S. military readiness. Concerns about the confidentiality of mental health services received within the military have been documented as a significant barrier to service members obtaining needed treatment. At times, disclosing mental health information to commanding officers may be necessary so that informed decisions can be made about duty assignments, needed accommodations, unit resources, or deployments. The challenge the U.S. military faces is how to optimally protect service members' confidentiality so that mental health services are sought and needs are not driven underground-while also ensuring the successful execution of the military mission. In this study, the authors examine the potential impact of existing U.S. military mental health confidentiality policies on service members seeking assistance for mental health issues. The authors conducted a multimethod investigation involving key-stakeholder interviews with military mental health providers, commanding officers, and enlisted service members and a survey of the active component regarding knowledge, understanding, and practices associated with mental health confidentiality policies. Findings shed light on the perceptions held by service members on the limits to mental health confidentiality and how policy implementation influences service members' decisions regarding mental health care. The authors recommend steps that the U.S. Department of Defense could take to improve military personnel's understanding of confidentiality policies, strengthen processes to ensure that policies are implemented as intended, and mitigate the consequences associated with the limited confidentiality afforded to mental health services within the military.

Federally Qualified Health Centers (FQHCs) are outpatient health centers that provide primary care and limited specialty-care services to nearly 30 million low-income patients. Prior to the coronavirus disease 2019 (COVID-19) pandemic, FQHCs rarely delivered audio-only or video telehealth visits. However, with both temporary and permanent policy changes to facilitate telehealth use at the state and federal levels, telehealth has become an important modality of care. In 2023, approximately 9 percent of FQHC visits in the United States and 20 percent of FQHC visits in California occurred via video or audio-only visits delivered into patients' homes. In this study, the authors summarize data on the use of in-person, audio-only, and video health visits during September 2022 to August 2024, a period that included the end of the COVID-19 public health emergency in May 2023 and beyond. These data were collected to evaluate the impact of the Connected Care Accelerator program, which is an effort launched by the California Health Care Foundation in July 2020 to support health centers in implementing telehealth for low-income patients in California. This study is the final in a series of studies that were published from 2021 to 2024.

It is anticipated that extreme weather events due to climate change will increase the prevalence of a number of acute and chronic diseases. As a result, the demand for drugs to prevent or treat those conditions is likely to increase. If the anticipated increase in demand for these drugs is not planned for, already strained medical supply chains will be further strained, resulting in poor health outcomes among affected patient populations and additional costs to health systems. The authors of this study estimated how the anticipated effects of climate change on the prevalence of a sample of four chronic conditions-cardiovascular disease (CVD), asthma, end-stage renal disease (ESRD), and Alzheimer's disease-will affect demand for the drugs needed to treat them (metoprolol, albuterol, heparin, and donepezil, respectively). To generate these estimates, the authors conducted an environmental scan of the peer-reviewed and gray literature and developed a medical condition-specific systems dynamics model. The model can help inform policies for ensuring drug supply under various climate scenarios.

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.

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.

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.

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.

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.