Rand health quarterly最新文献

The topic of the tenth U.S. Department of Defense International State-of-the-Science Meeting on Blast Injury Research was "Toward a Unified Multiscale Computational Model of the Human Body's Immediate Responses to Blast-Related Trauma." The meeting was held August 16-17, 2022, at the RAND Corporation office in Arlington, Virginia, and more than 60 scientists, clinicians, and military leaders provided scientific overviews, presentations, and posters describing new and emerging science in the field. Before the meeting, a conference planning committee consulted on the literature review and research questions and served as a peer review panel for submitted abstracts. Five leading scientists and clinicians in related fields were invited to serve on an expert panel, lead working groups, and develop overall recommendations. These conference proceedings summarize the meeting and present key findings.

National security organizations need highly skilled and intellectually creative individuals who are eager to apply their talents to address the nation's most pressing challenges. In public and private discussions, officials and experts addressed the need for neurodiversity in the national security community. They described missions that are too important and too difficult to be left to those who use their brains only in typical ways. Neurodivergent is an umbrella term that covers a variety of cognitive diagnoses, including (but not exclusive to) autism spectrum disorder, attention deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD), dyslexia, dyscalculia, and Tourette's syndrome. Neurodivergent individuals are already part of the national security workforce. The purpose of this study is to understand the benefits that people with neurodivergence bring to national security; the challenges in recruiting, working with, and managing a neurodiverse workforce; and the barriers in national security workplaces that prevent agencies from realizing the full benefits of neurodiversity. To carry out this research, the authors conducted a review of primary, secondary, and commercial literature; they conducted semistructured interviews and held discussions with government officials, researchers and advocates for the interests of neurodivergent populations, and representatives from large organizations that have neurodiversity employment programs; and they synthesized findings from across these tasks to describe the complex landscape for neurodiversity in large organizations in general and in national security specifically.

Victims of sexual assault and sexual harassment often experience a variety of psychological outcomes and mental health symptoms related to posttraumatic stress disorder (PTSD), depression, anxiety, substance abuse, suicidal ideation, and self-harm. Sexual trauma also might affect careers. Despite a need to address these harms, some service members have reported that connecting to health care or mental health services following sexual assault or sexual harassment can be difficult-in part because of a lack of leadership support. Given these persistent challenges, the Psychological Health Center of Excellence identified an urgent need to better understand research that is pertinent to sexual assault and sexual harassment during military service so that the U.S. Department of Defense and the military services can improve the health care response for service members. RAND researchers investigated and synthesized relevant research in three topic areas: (1) the effectiveness of psychotherapy treatments designed for adult victims of sexual assault or sexual harassment in military settings; (2) barriers faced by U.S. military members to accessing and remaining in mental health care settings; and (3) associations between sexual assault or sexual harassment and mental health conditions.

Section 702 of the fiscal year 2019 National Defense Authorization Act directed the U.S. Department of Defense (DoD) to conduct a pilot study to assess the feasibility and advisability of using intensive outpatient treatment programs to address posttraumatic stress disorder (PTSD) and associated mental health problems among service members who have experienced sexual harassment or sexual assault while in the military. RAND researchers conducted a programmatic review of four intensive outpatient programs (IOPs)-two in the private sector and two in DoD-to understand different program components available to active-duty service members who have suffered sexual trauma and other trauma. A review of policies to understand TRICARE authorization procedures and other regulations governing IOPs and an analysis of data from the 2014 RAND Military Workplace Study survey on the prevalence of sexual trauma among personnel with mental health conditions helped obtain contextual information to inform the Psychological Health Center of Excellence's response to Congress. The review identified evidence-based approaches that IOPs have successfully used in programs designed for military service members and barriers to using this type of care to treat members of the military community. While examining the IOP model of care, the research team identified knowledge gaps surrounding the experiences, treatment needs, and effectiveness of different treatment components and models of care for active-duty service members affected by the mental health consequences of sexual harassment and sexual assault in the military.

The United States faces an unprecedented mental health crisis, with youth and young adults at the center. Even before the COVID-19 pandemic, nearly 50 percent of college students reported at least one mental health concern. The COVID-19 pandemic notably exacerbated these issues and underscored the urgent need to identify and implement ways to ameliorate the youth mental health crisis. In 2021, the National Academies of Sciences, Engineering, and Medicine called on the field of higher education to address growing concerns about student mental health by identifying and elevating emerging and promising approaches that offer a more holistic way to support students' mental health. Serving as the main entry point for more than 40 percent of students seeking a postsecondary degree, community colleges represent a tremendous and untapped opportunity to better address mental health in the United States, particularly for students who have been traditionally underserved (e.g., students of color, first-generation students, and low-income students). However, community colleges have limited evidence and guidance to inform the implementation of multilevel, holistic approaches to support students with varying mental health needs. To address this knowledge gap, this article shares a descriptive study of eight community colleges at the forefront of implementing multilevel approaches (a combination of prevention, early intervention, and treatment services) to support student mental health, as well as key facilitators for and barriers to their success.

The Los Angeles Diversion, Outreach, and Opportunities for Recovery (LA DOOR) program is a Proposition 47-funded program designed by the Los Angeles City Attorney's Office (LACA) to provide a comprehensive, health-focused, preventative approach that proactively engages individuals at elevated risk of returning to LACA on a new misdemeanor offense related to substance use, mental illness, or homelessness. This study documents the findings of a process and outcome evaluation of Cohort 2 of the LA DOOR program, covering services provided from January 2020 through February 2023. The goal of this evaluation is to better understand how the LA DOOR program was implemented and examine the effect of the program on various outcomes. This study describes an overview of the program, evaluation methods, the logic model that guided the evaluation, findings from stakeholder interviews and client focus groups, and analyses of program data. Qualitative interviews and focus groups revealed key strengths and challenges of the program and focused on specific challenges of operating during the coronavirus disease 2019 (COVID-19) pandemic. Analyses of quantitative data describe the population of clients who are receiving LA DOOR services, the needs of that population, and the services provided. Together, these findings shed light on opportunities for future program implementation and evaluation. Interested stakeholders of this report include LACA, the California Board of State and Community Corrections, and the City of Los Angeles, as well as other entities that provide supportive services to criminal justice populations or that might be interested in implementing a similar program.

Seasonal influenza is a significant public-health issue. In the UK, the influenza season is associated with an increased demand for and pressure on the NHS. The direct health and economic impacts of seasonal influenza have received much attention. However, less attention has been given to its broader societal burden, including its indirect economic impact. We first conducted a rapid evidence assessment of the literature to understand the societal burden of seasonal influenza in the UK. Secondly, we conducted analyses of publicly available, aggregated data from NHS England and NHS Digital to better understand the impact of seasonal influenza on the provision of NHS services both before and after the COVID-19 pandemic. We also conducted a geographically representative survey of 1,000 working-age adults across the UK, who reported having influenza or caring for a dependent with influenza during at least one of the past four influenza seasons to understand impacts related to absenteeism and presenteeism in the workplace, lost wages and out-of-pocket costs. Fourthly, we conducted interviews with 20 key stakeholders within the NHS from primary care and secondary care across the four UK nations. Lastly, we used an epidemiologic-economic framework to estimate the number of influenza cases and then applied a macro-economic computable general equilibrium model to estimate the indirect economic costs associated with lost economic productivity among working-age adults who become ill with influenza.

More than 155,000 New Yorkers were trained in Mental Health First Aid (MHFA) between 2016 and 2020. Free citywide trainings were made available to all New Yorkers and were disseminated through city agencies and community-based settings. RAND Corporation researchers conducted a mixed-methods study that included a web-based survey of past trainees and a series of focus groups with leaders of community-based organizations and city agency staff to assess the impact of the MHFA trainings and needs for future training. In this article, the authors describe the evaluation activities that took place; the methods behind them; and the results at the individual, agency, and community levels. They also offer recommendations for ways to improve future mental health education efforts. Respondents applied MHFA skills extensively and broadly across their social networks. Nine in ten respondents had contact with an individual with a mental health problem in the past six months. Among those who had contact, 84 percent indicated using their MHFA skills to help a friend or family member, and nearly half reported applying skills with a co-worker, neighbor, or acquaintance. Because MHFA was offered through city agency workplaces and community-based settings, tens of thousands of New Yorkers were given tools to come to the aid of individuals in their personal and professional lives. MHFA may be a promising approach to building supportive social networks, organizations, and communities that are primed to recognize and assist those experiencing mental health challenges.