Oct 1 2014
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Getting More Funding Mental Health Preventive Services and Treatment: Q&A with Mary Giliberti, NAMI

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The U.S. Department of Health and Human Services last week announced grants totaling almost $100 million aimed specifically at mental health services for young adults. The grants will go to several organizations—including those that work with at-risk kids—within schools and in communities to reduce gun violence.

New private funds have also emerged. For example, in November the National Alliance on Mental Illness (NAMI) will announce the winners of the Connect 4 Mental Health Community Innovations Awards they launched last year along with the National Council for Behavioral Health and several pharmaceutical companies. Applications for the awards close October 3. The goal of the competition is to increase awareness of successful mental health treatment models that can be replicated in other parts of the country.

Recently, NewPublicHealth spoke with NAMI Executive Director Mary Giliberti, JD, about improvements in U.S. mental health care, issues that still need to be addressed and how the work of the award winners can help improve mental health care treatment.

NewPublicHealth: What progress do you point to with respect to treating mental health in the United States and what still needs work?

Mary Giliberti: In terms of progress, I think there is some increased recognition of mental health and substance use conditions as real health conditions, and the need for mental health to be addressed as part of the overall health care system. That includes federal parity requirements in health insurance—including plans offered through state health insurance marketplaces, Medicaid expansion plans and in private insurance—and efforts to coordinate mental health and physical health care, such as incentives and expectations outlined in the Affordable Care Act (ACA). Some examples of this include:

  • Incentives for community mental health centers to improve capacity to treat individuals in their care holistically and via integrated care. This latter point is being supported through the distribution of demonstration grants offered as part of the ACA.
  • Creative use of technologies, including tele-mental health and future potential through health information technology innovations.
  • The evidence of some communities working hard to align and better coordinate systems, including criminal justice solutions.

Other examples of progress include continued development of community-based services, such as adding peers and families as part of the treatment system. 

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Oct 1 2014
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Idea Gallery: What is Population Health, Anyway?

Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Jeffrey Levi, PhD, Executive Director of Trust for America’s Health (TFAH), writes about the importance of identifying and implementing policies and practices that can benefit health across all populations.

Jeffrey_Levi Jeffrey Levi, Executive Director of TFAH

I go to countless meetings where people debate the meaning of “population health”—often for hours and with no resolution.

What’s become clear to me is that no matter what perspective we’re coming from, our actual goal for population health is the same. We want to improve the health of Americans.

But, at the end of day, the problem may be that the hang up on a clear definition is getting in the way of solving one of the health system’s most pressing problems: How do we get the different silos of the system to work better together and improve health inside and outside the doctor’s office?

Because this is so vital, the Robert Wood Johnson Foundation has supported an upcoming National Forum on Hospitals, Health Systems and Population Health, which will go beyond semantics to specifically identify policies and practices that can benefit health, no matter what population you’re talking about. Some of the below examples will be highlighted at the National Forum.

Hennepin Health, a Social Accountable Care Organization (ACO)

When Minnesota expanded Medicaid to a poor, childless adult population in Hennepin County, the relevant parties formed a social ACO, called Hennepin Health. The ACO is comprised of Hennepin County Medical Center; NorthPoint Health and Wellness (a Federally Qualified Health Center); Metropolitan Health Plan; and the county’s Human Services and Public Health Department (including Health Care for the Homeless, the county’s Mental Health Center and other social services). The County has a global budget to spend annually, and the partners take on all the risk as they bill the plan per service and then, at the end of the year, split the gains or losses.

Hennepin Health serves more than 6,000 enrollees. Of this group, 45 percent have chemical dependencies, 42 percent have mental health needs, 32 percent have unstable housing and 30 percent suffer from at least two chronic diseases.

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Oct 1 2014
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Public Health News Roundup: October 1

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EBOLA UPDATE: First U.S. Case of Ebola Diagnosed in Dallas
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The U.S. Centers for Disease Control and Prevention (CDC) has confirmed the first Ebola case to be diagnosed in the United States. The patient flew from Liberia—at the time not showing symptoms—and fell ill several days later, seeking treatment at Texas Health Presbyterian Hospital of Dallas. He was admitted on Sept. 28. The CDC is monitoring people he came in contact with and feels confident that the disease will not spread further. “Ebola can be scary. But there’s all the difference in the world between the U.S. and parts of Africa where Ebola is spreading. The United States has a strong health care system and public health professionals who will make sure this case does not threaten our communities,” said CDC Director, Tom Frieden, MD, MPH. “While it is not impossible that there could be additional cases associated with this patient in the coming weeks, I have no doubt that we will contain this.” Read more on Ebola.

FDA: New Recommendation to Protect Patients from Cybersecurity Risks
The U.S. Food and Drug Administration (FDA) is taking steps to ensure patient safety and security with the finalization of recommendations to medical device manufacturers for managing cybersecurity risks. Potential risks include malware infections on network-connected medical devices or computers, smartphones, and tablets used to access patient data; unsecured or uncontrolled distribution of passwords; failure to provide timely security software updates and patches to medical devices and networks; and security vulnerabilities in off-the-shelf software designed to prevent unauthorized access to the device or network. “There is no such thing as a threat-proof medical device,” said Suzanne Schwartz, MD, MBA, director of emergency preparedness/operations and medical countermeasures at the FDA’s Center for Devices and Radiological Health. “It is important for medical device manufacturers to remain vigilant about cybersecurity and to appropriately protect patients from those risks.” Read more on technology.

HUD: $112M in Grants to Protect Kids, Families from Lead-Based Paint and Other Housing Dangers
The U.S. Department of Health and Human Services (HHS) has awarded more than $112 million in grants to help protect children and families from the dangers of lead-based paint and other home health and safety hazards. The grants will go to 39 local and state government agencies and research institutions, helping almost 7,000 low-income homes while also supporting research to improve safety efforts. "Millions of families and children are seeing their hope for the future threatened by poor health simply because of where they live," noted Matthew E. Ammon, Acting Director of HUD's Office of Lead Hazard Control and Healthy Homes.  "Every child deserves to grow up in a healthy home and yet far too many continue to be exposed to potentially dangerous lead and other health hazards in the home." Read more on housing.

Sep 30 2014
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Have a Story about Implementing the National Prevention Strategy? The Office of the Surgeon General Wants to Hear It

The National Prevention Strategy (NPS), a federal-level initiative coordinated by the Office of the Surgeon General (OSG), was launched three years ago with the goal of promoting prevention and improving the nation’s health by engaging all sectors, not just health care.

Communities across the country are hard at work integrating different sectors in the joint purpose. For example, transportation agencies and senior health agencies are working to improve travel logistics for seniors who have different needs and schedules than the average commuter. The benefits for seniors can be many and huge, including engaging in social activities, recreation, timely visits to doctors, access to food shopping and greater independence.

In its 2014 required annual status report to the president and Congress on the progress of implementing the National Prevention Strategy, the OSG shared for the first time stories—called Partner Implementation Models (PIMs)—about communities and organizations implementing the strategies. One PIM showcased the work of the Robert Wood Johnson Foundation (RWJF), including:

  • In 2013, RWJF re-convened the Commission to Build a Healthier America—an interdisciplinary group of leaders in the public, nonprofit and private sectors originally brought together in 2008—to develop recommendations to reduce health disparities. The Commission’s January 2014 report references the National Prevention Strategy.
  • RWJF’s County Health Rankings & Roadmaps show how health is influenced by where people live, learn, work and play. Counties are ranked using data on health behaviors; clinical care; the physical environment; and social and economic factors such as family and social support. In 2014, new measures related to housing, transit, access to mental health providers, injury-related deaths, food environment and exercise opportunities were added to the Rankings. All of these measures directly reinforce the priorities outlined in the National Prevention Strategy.

Another PIM was shared by the Henry Ford Health System (HFHS) in Detroit, Mich., the fifth-largest employer in the city, which launched Henry Ford LiveWell (HF LiveWell) to improve the health of HFHS employees, patients, and surrounding communities. 

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Sep 30 2014
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Public Health News Roundup: September 30

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EBOLA UPDATE: UN Finds That Orphaned Children Risk Being Shunned Due to Ebola Deaths
(NewPublicHealth is monitoring the public health crisis in West Africa.)
With more than 3,000 people now dead in the ongoing Ebola outbreak in West Africa, more than 3,700 children in the afflicted countries who lost one or both parents are now at risk of being shunned, according to the United Nations. UNICEF—which is taking donations to assist the children—says that people to care for the children are desperately needed, but many believe that taking care of the children has turned “into a potential death sentence.” Read more on Ebola.

HUD: $75M to Improve Public Housing, Housing Choice Voucher Residents’ Access to Service Programs
The U.S. Department of Housing and Urban Development (HUD) is awarding $75 million in grants to give public housing and Housing Choice Voucher residents increased access to programs to improve their education and employment status, with an ultimate goal of putting them on a path to self-sufficiency. The grants will enable public housing agencies (PHAs) to work with social service agencies, community colleges, businesses and other local partners. “These grants will link people to the computer access, financial literacy, job training, childcare and other tools they need to compete and succeed in the workplace,” said HUD Secretary Julián Castro, in a release. “Every American deserves access to the skills and resources necessary to become self-sufficient.” Read more on housing.

AAP: IUDs the Most Effective Contraceptive Method for Teen Girls
Intrauterine devices (IUDs) and contraceptive implants are more reliable than birth control pills and condoms when it comes to preventing U.S. teen pregnancies, according to the American Academy of Pediatrics (AAP), which now recommends the devices as the “first-line” choice of birth control for teenage girls who do not want to be abstinent. According to the AAP’s new policy statement, approximately 750,000 U.S. adolescents become pregnant each year, and more than 80 percent of the pregnancies are unplanned. Read more on sexual health.

Sep 29 2014
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Ebola Outbreak Prompts Concern for Impact of Other Infectious Diseases

As the number of cases and deaths soar, the Ebola outbreak in West Africa is rightfully front and center in the news, both in terms of the disease’s progress and of the need for funds and manpower. However, infectious disease specialists are urging public health leaders to also stay vigilant in preventing and handling outbreaks of many other infectious diseases. Earlier this month, the White House issued the first ever executive order on antibiotic resistance to help prevent the 20,000 U.S. deaths that occur each year because of infections are resistant to available antibiotics.

Writer David Olsen reported last week in GlobalHealthHub that, based on figures from the World Health Organization (WHO) and UNAIDS, at least three disease in West Africa are currently claiming more lives than Ebola: Malaria, tuberculosis and AIDS. No one is suggesting a slow down in the Ebola efforts—in fact public health experts are urging ever greater ramping up—but as Olsen points out, “another of [Ebola’s] terrible legacies may be that it will distract attention and resources from other diseases that are killing far more people worldwide.”

Over the next few weeks NewPublicHealth will be doing a series of research and outbreak updates on several infectious diseases and their impact in both the United States and globally, starting today with HIV/AIDS.

This Saturday was HIV/AIDS awareness day for U.S. gay and bisexual men. According to the U.S. Centers for Disease Control and Prevention (CDC), one in five gay men in 20 major cities is estimated to be HIV positive, with about one third not knowing they are positive. The Kaiser Family Foundation (KFF) estimates that, based on CDC data, 12-13 percent of gay men are HIV positive and that there is evidence that the situation is worsening. Between 2008 and 2010, the CDC reported new infections rose 12 percent overall among gay men, and 22 percent among younger gay men, with the highest increases among men of color.

A new survey released late last week by KFF found that at a time when infections among gay and bisexual men are on the rise, more than half of gay and bisexual men say they are not personally concerned about becoming infected; only three in ten say they were tested for HIV within the last year, despite CDC recommendations for at least annual testing, with even more frequent testing recommended by many health departments. 

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Sep 29 2014
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Public Health News Roundup: September 29

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EBOLA UPDATE: NIH Admits Ebola-Exposed U.S. Physician for Treatment
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The National Institutes of Health (NIH) yesterday admitted an Ebola-exposed U.S. physician for treatment at the NIH’s Clinical Center in Bethesda, Md. The unidentified physician became exposed to the virus while volunteering in Sierra Leone; the NIH declined to comment on whether the physician had been infected. "When someone is exposed, you want to put them into the best possible situation so if something happens you can take care of them," said NIH infectious disease chief Anthony Fauci, MD, according to the Associated Press. Read more on Ebola.

Electronic Devices Can Keep Kids Up at Night, Should Be Out of Bedrooms
Almost three out of four U.S. children ages 6 to 17 sleep in a bedroom with at least one electronic device—and such children sleep an average of one fewer hour per night, according to Jill Creighton, MD, Assistant Professor of Pediatrics Stony Brook Children’s Hospital. According to Creighton, backlit electronic devices such as tablets, smartphones and video games can interrupt sleep and keep people awake, making it important for parents to get their kids in electronics-free bedtime routines. “The hour before bed should be a no-electronics zone,” she said in a release. “The burst of light from a phone (even if it’s just to check the time) can break a sleep cycle. A regular alarm clock is best.” Read more on pediatrics.

Study: Kids as Young as 6 Can Already See Academic and Social Issues Due to ADHD
Children as young as 6 to 8 years old can experience academic problems and difficulty with social skills due to attention-deficit/hyperactivity disorder (ADHD), which is exacerbated by the fact that approximately 80 percent of kids with ADHD symptoms have not been diagnosed with the disorder, according to a new study in the journal Pediatrics. Researchers tested approximately 400 kids at 43 Australian schools, finding 179 with ADHD and 212 without; by following their academic careers, the researchers determined that by the second grade the kids with ADHD were more likely to be below-average in reading and mathematics, and to experience more difficulty connecting with their peers, indicating the need to identify and treat ADHD earlier. "Already at this stage, which is relatively young, it's very clear the children have important functional problems in every domain we registered," said study lead author Daryl Efron, MD, a developmental-behavioral pediatrician with the Royal Children's Hospital Melbourne, according to HealthDay. "On every measure, we found the kids with ADHD were performing far poorer than the control children." Read more on mental health.

Sep 26 2014
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The Ever-Evolving Traffic Light Could See More Changes Ahead

A one-of-its-kind pedestrian traffic walk signal recently turned heads in Portugal with a dancing figure that entertained people as they waited for him to tell them when it was safe to cross the street.

The signal—not planned for mass circulation anytime soon—was developed by the manufacturer Smart to advertise its cars’ safety features. And if it saves lives along the way, it’s in sync with the U.S. Department of Transportation (DOT), where the National Highway Traffic Safety Administration (NHTSA) has found that 4,432 pedestrians died in traffic crashes in 2011, up 3 percent from 2010. More than a quarter of the accidents resulting in death happened at traffic intersections, both at marked crosswalks and intersections with traffic lights. Andrea Gielen, PhD, head of the Johns Hopkins Center for Injury Research and Policy at Johns Hopkins University, says the school’s research shows that many of these accidents occur because pedestrians are distracted by music in their earphones or by speaking or texting on cellphones.

NHTSA began a campaign to keep pedestrians safer last year and highlights community projects that improve pedestrian safety in a stories section on its website on pedestrian safety. One project, developed at University of California, San Diego, was a presentation at a low-income elementary public school in San Diego, Calif. The English- and Spanish-language presentation demonstrated dangerous scenarios and how to prevent them, such as kids dressed in only dark clothing, which makes them difficult to see at night. NHTSA is updating the site regularly to help communities develop their own safe walking programs.

As for traffic lights themselves, makeovers could be ahead. The Transportation Research Board of the National Academies of Sciences has a traffic light subcommittee that presents new research on traffic signal safety at the board’s annual meeting each January. Upcoming topics of interest are likely to include computerized traffic signals that can respond to traffic flow by switching to green sooner when there’s no congestion ahead, as well as a recent study from the Massachusetts Institute of Technology (MIT) that found that traffic lights are easily hacked, which could lead to traffic jams and collisions. Preventing some of the hacking could be as simple as strengthening the passwords of the engineers who control the traffic signals, according to computer engineers at MIT.

Wendy Landman, executive director of the pedestrian advocacy group Walk Boston, says intersections could be safer if city agencies talked more. She said the deciding factor for how long a traffic signal should be green for pedestrians is often based on how quickly traffic experts think drivers want to be back on the gas pedal—but that may be too short for many pedestrians, especially at intersections on main roads.

>>Bonus Content: Read a previous NewPublicHealth interview with Andrea Gielen.

Sep 26 2014
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Public Health News Roundup: September 26

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EBOLA UPDATE: American Physician Declared Ebola-Free, Released From Hospital
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Rick Sacra, MD, an American physician who was working in an obstetrics clinic in Liberia when he became infected with the Ebola virus, has been cleared as disease-free by the U.S. Centers for Disease Control and Prevention and released from The Nebraska Medical Center. He entered the facility, which includes one of the United States’ few biocontainment units, three weeks ago. Kenty Brantly, MD, who was previously and successfully treated for Ebola at Emory Hospital in Atlanta, had donated two pints of his blood for Sacra’s treatment. Read more on Ebola.

UTHealth to Use $1.3M Grant to Study Asthma Risk for Health Care Workers
As asthma prevalence continues to rise across the country, the University of Texas Health Science Center at Houston (UTHealth) School of Public Health will utilize a four-year, $1.3 million grant from the U.S. Centers for Disease Control and Prevention (CDC) to study how the risk of asthma has changed for Texas health care workers over the past decade. The health care field is one of the population groups that see a higher risk for the breathing disorder. For the study, researchers will repeat a 2003 survey which found that, after entering the field, 7.3 percent of nurses and 4.2 to 5.6 percent of doctors, respiratory therapists and occupational therapists developed asthma. “Practices in hospitals have changed in 10 years. There are new cleaning chemicals, including many environmentally friendly ones, but are those products without risk? We want to find out,” said George Delclos, MD, PhD, co-principal investigator and professor in the Division of Epidemiology, Human Genetics & Environmental Sciences at the UTHealth School of Public Health. Read more on health disparities.

HHS: $212M to Strengthen State, Local Programs Designed to Prevent Chronic Diseases
The U.S. Department of Health and Human Services (HHS) announced yesterday that it will award nearly $212 million in grants to help all 50 states and the District of Columbia strengthen efforts to prevent chronic diseases. A total of 193 awards will go to state and local programs, and are funded in part through the Affordable Care Act. “Tobacco use, high blood pressure, and obesity are leading preventable causes of death in the United States,” said U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, in a release. “These grants will enable state and local health departments, national and community organizations, and other partners from all sectors of society to help us prevent heart disease, cancer, stroke, and other leading chronic diseases, and help Americans to live longer, healthier, and more productive lives.” Read more on prevention.

Sep 25 2014
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Preparing for Ebola in the U.S. Makes Good Public Health Sense

U.S. public health officials have continually said that it is highly unlikely that the Ebola virus will spread in the United States, even if infected travelers land here. Officials at the U.S. Centers for Disease Control and Prevention (CDC) say that the disease is most contagious when people come into contact with the bodily fluids of someone who is ill—and someone that ill would be very likely be identified by border and airline personnel quickly. If hospital admission became necessary, U.S. infection control procedures could stem an outbreak, according to Tom Frieden, MD, the CDC’s director and the point person for the U.S. government on the current Ebola outbreak. Frieden has discussed the issue repeatedly during several news conferences in the last few weeks.

Of course, that changes if the virus becomes transmissible through the air, rather than just via bodily fluids, as Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, suggested in the New York Times last week. While Osterholm often addresses the direst potential outcomes of infectious disease outbreaks, it’s prudent to at least know what to do, which is why agencies such as the CDC and the Network for Public Health Law say what’s needed is information and procedures...but not panic.

Last month, the Network held an online webinar on preparedness measures and Ebola which was watched by more than 1,200 public health officials. Following the webinar, Network experts posted answers to follow-up questions, including one about the right of public health or hospital workers to refuse to care for/help with someone suspected of having Ebola.

The Network also recently created an online primer on preparedness and legal issues surrounding the Ebola outbreak, both for public health officials engaged in the response overseas and for those with current or future responsibility for handling Ebola-related issues in the United States.

>>Bonus Link: Richard Besser, MD, now the chief health editor for ABC News, was formerly the CDC’s head of disaster response and led the early response to the H1N1 outbreak in the United States several years ago. In a recent opinion piece for the Washington Post, Besser laid out what’s being accomplished and what still needs to be done to stem the Ebola outbreak in West Africa.