July 2006 NACBHDD Newsletter
The Newsletter of the National Association of County Behavioral Health and Developmental Disability Directors
In this Issue...
The 2006 NACBHDD Newsletter series is brought to you by:
Medicaid Update
The Latest on Medicaid Citizenship Requirements: Some Good News, But Significant Concerns Remain
Melissa Staats recently sent the NACBHD membership a link to an article in the LA Times which reports that CMS plans to "exempt from the documentation requirements some 8 million elderly and disabled people who are enrolled in Medicare or receiving Supplemental Security Income through Social Security."
However, as she mentioned in the email communication to members, DC advocates are still concerned, "The exemption of seniors and people with disabilities ... is a commendable development," said Ron Pollack, head of the Families USA advocacy group. "Numerous other people who need healthcare the most - such as foster children, the homeless and people victimized by a natural disaster - may still lose Medicaid coverage and join the ranks of the uninsured, and that should be corrected." An analysis of the changes and the remaining concerns follows.
Important details on the concerns about Medicaid citizenship requirements
Melanie Nathanson, Director of the Center for Budget and Policy Priorities' Federal Budget Initiative, a project designed to provide technical and analytic assistance to state organizations that work on federal budget issues, has been communicating with advocates about developments in the Medicaid citizenship documentation requirements. She recently spoke with NACBHD about those developments.
While Nathanson says that the exemption for Medicare and SSI recipients from the requirements and the increased flexibility in some of the data matching rules are very positive steps forward, there are some critical areas of concern remaining, and the information is confusing and has significant impact for individuals in the behavioral health arena. Advocates are working together to repair areas of concern for applicants, foster care children, Native Americans, and individuals covered under waivers and other associated components.
Below is a summary (derived from a July 7 email from Nathanson to advocates and from her talk with NACBHD) of the positive changes and the areas of concerns, as well as steps NACBHD members can take to address and help remedy these areas of concern.
The Good News
For more detailed information on these items, click here.
Areas of Concern That Need Attention
For more information on these critical areas of concern, click here.
What can NACBHD members do to help change these requirements?
Nathanson has made a draft comment letter available to advocates regarding the interim final rule, and urged NACBHD members to use the letter as a template to let their concerns be known to members of Congress and key sate officials. To access the draft letter, click here. Comments are due August 11. To view information on monitoring the effects of the Medicaid Citizenship Documentation Requirement, click here. To access information on next steps and the administrative and legislative process, click here.
To view the rule on Medicaid citizenship documentation requirements in the Federal Register, click here.
Free Provider Toolkit on Medicaid Proof of Citizenship Requirements from National Council for Community Behavioral Healthcare
A free Provider Toolkit on Medicaid Proof of Citizenship Requirements is available from the National Council for Community Behavioral Healthcare. Behavioral health provider organizations can use the toolkit to help the Medicaid-eligible individuals they serve meet the new requirement to prove U.S. citizenship. The requirement is mandated by Section 6036 of the Deficit Reduction Act of 2005 and became effective in all states on July 1, 2006. Guidelines from the Centers for Medicare and Medicaid Services require states to ask all persons applying for or renewing Medicaid benefits to provide proof of both citizenship and identity. New applicants for Medicaid will not receive benefits until they can present the required documents. Individuals who are already covered by Medicaid will continue to receive benefits as long as they make a good faith effort to present evidence of citizenship and identity. The National Council's toolkit is designed to help direct care staff in behavioral health organizations understand the requirements and help individuals produce the required proof of citizenship. The toolkit is available at www.nccbh.org (in the Public Policy section).
CMS Medicaid Integrity Program
CMS has a new Medicaid Integrity Program. Melissa Staats recently forwarded members a CMS press release on the program. NACBHD is in the process of trying to determine impacts from the National Association of State Medicaid Directors, and will report when more information is available. To view information on the program, click here or read the press release.
CMS Fact Sheets on Medicare and Medicaid Spending Trends
From a July 17 CMS release (Please Note: NACBHD shares this report with the members to provide insight into the Administration's posturing on Medicaid spending. Membership reaction to the highlighted paragraph is welcome):
CMS has released fact sheets on spending trends for Medicare and Medicaid in the President's Mid-Session Review (MSR) for Fiscal Year 2006. The Medicare MSR shows lower projected costs for Part D, while projected expenditures for Medicare Part A and Part B are higher, primarily because of continuing rapid growth in the use of Medicare services. The Medicaid MSR highlights cost projections that are once again declining, reflecting slower Medicaid spending growth in recent years.
Medicare
Based on updated figures calculated for the 2006 MSR, Medicare Part D expenditures are now projected to be $34 billion lower over 5 years (2006-2010) than in the President's Budget, and $110 billion lower than in the MSR one year ago. The average Part D premium is almost 40 percent lower than had been projected a year ago as a result of strong competition, and 90 percent of Medicare beneficiaries are receiving prescription drug coverage.
Medicare Part A and Part B expenditures are higher, primarily because of continuing rapid growth in the use of Medicare services. Part A projected expenditures over 5 years (2006-2010) are $17 billion higher and Part B projected expenditures over 5 years are $30 billion higher than in the President's Budget. Rapid growth in physician-related services and hospital outpatient services are the main factors responsible for a projected increase in the Medicare Part B premium of 11 percent for next year.
Medicaid
Federal Medicaid spending growth is declining from over 12 percent per year in fiscal year 2000-2002 to 7.2 percent from 2002-2005, and down further to 4.6 percent projected for fiscal year 2006-2007. State Medicaid spending growth has simultaneously slowed significantly, with many states projecting lower costs in FY 2006 than FY 2005. States are also paying much less than had been predicted for drug coverage for "dual eligible" beneficiaries who are now getting coverage through Medicare.
The slowdown in Medicaid spending growth has resulted from many steps to deliver needed benefits more efficiently and effectively, implemented through innovative waivers and other collaborations between the states and the Federal government.
The Deficit Reduction Act of 2005 (DRA) has resulted in greater use of private sector health plans rather than government-run "fee for service" that rewards providers for driving demand and creating incentives for over utilization. It has also resulted in more use of community-based long-term care services that beneficiaries with a disability prefer, and more alternatives to costly Medicaid-financed nursing home care.
In addition, Medicaid reform is expected to contain spending growth through steps such as: Providing targeted benefit packages to meet the specific needs of low-income families, enabling families to enroll in the same benefit package, providing premium assistance to help individuals and their employers pay for employment-related insurance, promoting personal responsibility, enabling individuals with a disability to return to their homes, and promoting private long term care insurance.
For fact sheets for the Medicare and Medicaid Mid-Session Reviews, as well as a chart on the impact on the Part B premium:
Medicaid Fact Sheet
Medicare Fact Sheet
Premium Rate Increase
Medicare Update: Denials and Problems Continue; Fatigue Sets In
Medicare Update: Denials and Problems Continue; Fatigue Sets In
NACBHD recently spoke with Karen Sanders, Associate Director for Publicly Funded Services, and Ellen Jaffe, Medicare specialist, both at the American Psychiatric Association, about the ongoing problems with pharmacy drug plans (PDPs) failing to follow Part D continuity of care and transition policies. For detailed background on access and denial issues, see the March newsletter.
Sanders and Jaffe report that the problems are up and that petitions are denied routinely - or as the Mental Health Part D website states on the home page:
From the reports we've received so far, we have reason to believe that some PDPs may be exhibiting a pattern of noncompliant conduct rather than just making an occasional simple error, and that the exceptions and appeals process is not working as it was intended to.
We need more data from the field so that we can effectively petition CMS to use its oversight to ensure appeals are conducted appropriately and exercise its enforcement authority to make offending PDPs comply with stated CMS Part D policies.
While CMS and advocates have a good working relationship, Sanders and Jaffe explained that CMS is not viewing the pattern of problems as a systemic problem until it can be established as one. And, Sanders said, to complicate matters, it is becoming clear that patients and providers alike are becoming worn down, or fatigued, by the process. She cited a call from a pharmacist in Kentucky who was dealing with hundreds of denials and did not know where to turn. There were 1,000 reports of problems in the first three months, and now there are much fewer. However, Sanders and Jaffe think this is not because the problems have abated, but because of the fatigue factor and the possibility that people may not have the time to report the problems.
CMS is collecting data, but this is not expected to be completed for months. Sanders noted that this leaves patients in an extremely difficult position. A recent American Psychiatric Institute for Research and Education (APIRE) survey of 3,000 APA members across the country regarding Medicare access issues demonstrated that there is evidence that hospitalizations and emergency room visits have increased, and that consumers are decompensating, with the possibility that people are taking other medications.
Specific denials
Most denials are related to requests for prior authorizations and to dosage limits. Prior authorization may be good only for the length of the prescription. Advocates are working with CMS on this prior authorization issue.
Future concerns
When asked about the possible implications of the CATIE study, Sanders noted that there is some controversy around the language in the study and its possible use by policymakers in the future in terms of restricted access. While this is not happening yet, Sanders noted that the APA is concerned about the interpretation of findings of evidence-based studies, with the APA's emphasis that qualified professionals should examine what works best for individual patients.
Appealing
Sanders and Jaffe encouraged appealing, as appeals have been successful or PDPs have withdrawn immediately before the hearing. If an individual appeals, he or she is very likely to get their medication. However, they noted that at the Administrative Law Judge level, one will need a pro bono lawyer. The Medicare Rights Center can assist with this. For detailed information on the appeals process, see www.mentalhealthpartd.org. For information on the Medicare Rights Center, see www.medicarerights.org.
To report problems
Reports about problems and denials should be sent to: PartD@psych.org or by calling 866-882-6227. Consumers should also report the problem to their regional CMS; Mental Health Part D will report it to the national CMS.
Recommendations
In addition to reporting problems and appealing, Sanders and Jaffe recommended persistence. In particular, they said, "Document everything you have."
For more information on Mental Health Part D
To visit find out more about Mental Health Part D, see the website at www.mentalhealthpartd.org. The Mental Health Part D website was created as a resource for Part D through a partnership among the following mental health organizations: the American Association of Community Psychiatrists, the American Association for Geriatric Psychiatry, the American Psychiatric Association, the National Alliance on Mental Illness, the National Association of State Mental Health Program Directors, the National Council for Community Behavioral Healthcare, the National Mental Health Association, and Treatment Effectiveness Now (NACBHD's formal inclusion is pending).
Update on the Campaign for Mental Health Reform
The Campaign for Mental Health Reform continues to actively work with national advocacy partners, including NACBHD, on critical issues. An update on the Campaign's most recent activities follows. Bill Emmet, Interim Director, spoke with NACBHD about the Campaign's recent and upcoming activities.
New Board members elected at annual meeting. The Campaign just completed its annual meeting, at which two new members were elected to the Board: Dan Fisher, Executive Director of the National Empowerment Center and Linda Rosenberg, President and CEO of the National Council of Community Behavioral Healthcare. Other Board members include: Michael Fitzpatrick, President and CEO, National Alliance on Mental Illness; Robert Bernstein, Ph.D., Executive Director, Bazelon Center for Mental Health Law; David Shern, President/CEO of the National Mental Health Association; and Robert W. Glover, Ph.D., Executive Director, National Association of State Mental Health Program Directors.
Matthew Myers, President of the Campaign for Tobacco Free Kids, was the featured speaker at the annual meeting. Myers gave an interesting talk about campaign advocacy and positive approaches, as well as pitfalls. Emmet reported that it was helpful to have a source outside the mental health world shed light on the campaign process.
Policy retreat planned for the Fall. A two part policy and communications retreat is planned for the Fall. The Campaign will examine 2007 issues in September or early October, and meet again in December after the election to determine the next course of action.
Work with the Senate Mental Health Caucus. The Campaign is working with the Senate Mental Health Caucus to conduct a briefing in September, which will be the caucus' first meeting since it was formed in March. The Campaign will be present at the meeting.
Medicaid. The Campaign continues to work on Medicaid, concentrating in two areas. First, the Campaign is focusing on how provisions in Medicaid and the Deficit Reduction Act impact targeted case management and rehabilitation services; the Campaign has worked with CMS to demonstrate the value of the services so that steps are not taken to imperil peoples' ability to receive those services. Second, the Campaign is looking at provisions of the President's proposed 2007 budget as it moves through the legislative process.
Child mental health and residential treatment programs. The Campaign has provided a briefing to CMS on children's mental health to help them as they develop their requests for proposals for developing programs related to residential treatment centers.
Criminal justice. The Campaign is happy the House budget approved $5 million for the Justice and Mental Health Collaboration Program; this program was given no money in the President's budget.
Veterans' mental health. There is a group working with Senate staff on developing legislation to address the mental health needs of veterans and other returning from war zones. (See related article in this newsletter.)
Work force issues. There is a group looking closely at work force issues, with the hope that a SAMHSA commissioned report due to be released next week will offer recommendations for a national plan or work force development.
Meeting the Needs of Returning Service Members By Ralph Ibson
Ralph Ibson, Vice President for Government Affairs, National Mental Health Association, and former Staff Director of the Subcommittee on Health of the Veterans Affairs Committee in the U.S. House of Representatives, contributed the following overview of this issue, which the Campaign for Mental Health Reform has identified as one of its priorities this year. The Campaign is working to enact legislation to help meet the mental needs of those who have served in Iraq and Afghanistan and their immediate family members. For a related article on returning veterans and their families, see the April newsletter.
The Campaign is interested in eliciting feedback from NACBHD members on this issue. Please direct your feedback to Maeghan Gilmore at mgilmore@nacbhd.org, and she will forward it to the Campaign.
Meeting the mental health needs of service members returning from a combat zone might ordinarily be a matter almost exclusively for the Departments of Defense and Veterans Affairs. But, because large percentages of those serving in Iraq and Afghanistan continue to be "citizen-soldiers" in the National Guard and Reserves, the many thousands who are returning each month are already adding, or likely to add, pressure on the public mental health system. The extent to which the challenge of meeting the mental health and readjustment needs of these veterans and their families will be borne by state and local government is unclear, but will likely be linked to the capacities and funding of VA health care facilities and how extensive an effort those facilities make in reaching out to these veterans.
Emerging evidence increasingly suggests that the burden of combat-related mental health problems will be high for returning service members. (Combat deployments have historically been found to put returning service members at increased risk of both physical and mental health problems.) Reporting in 2005, Army researchers found that among soldiers who were surveyed after returning from combat duty in Iraq, 19 to 21 percent showed evidence of post-traumatic stress disorder (PTSD), depression or anxiety. A 2006 study of health care utilization during the first year after return from Iraq showed that 19 percent of these veterans reported a mental health problem. VA data show that of veterans who served in Iraq or Afghanistan, 32 percent of those who sought VA health care were seen for a possible mental disorder. Numbers of suicides among military personnel and returning veterans have already been recorded.
While there is widespread recognition that there is a high prevalence of post-traumatic stress disorder (PTSD) and other war-related mental health problems among veterans of service in Iraq and Afghanistan, much less attention has been focused on the psychic toll of these conflicts on the families of those serving. Research on PTSD, for example, has shown that that disorder can have severe, pervasive negative effects on marital adjustment, general family functioning, and the mental health of partners, with high rates of separation and divorce and interpersonal violence. PTSD can also have a substantial impact on veterans' children. Not surprisingly, in a military engagement that has required multiple tours of duty of many service-members and in which the burden has fallen heavily on citizen-soldiers of the National Guard and military reserves, the impact on families has been particularly hard, and may be implicated directly in mental health problems in family members of the veteran.
Evidence indicates that returning Guard and Reserve personnel tend to rely more heavily on community-based health care than do other veterans, who are more likely to turn to facilities of the Department of Veterans Affairs (VA). But how accessible is such care? Many Guard and Reservists and family members who seek mental health care through employer-provided health insurance, for example, are likely to encounter strict treatment limits and onerous cost-sharing requirements under their health plans. Others who ultimately turn to VA facilities or the Defense Department's TRICARE program may encounter a two-year limit on the health benefits available to them, or may find that facilities that are already overextended.
The Department of Veterans Affairs operates an integrated national health care system with facilities across the country that range from more than 150 medical centers to more than 700 community-based primary-care clinics. As a system, VA provides a full spectrum of high-quality mental health services, and, to its credit, is a leader in having enthusiastically embraced and begun to implement aggressively the recommendations of the President's New Freedom Commission on Mental Health. Yet there is significant variability from facility to facility in the range of specialized programs and services available. Historically, there has also been considerable variability in access to mental health care, even for veterans who live in reasonable proximity to a VA health-care facility. Indeed, earlier this year, a senior VA official, testified that "[i]n some communities, VA clinics do not provide mental health or substance use care or waiting lists render that care virtually inaccessible." While VA leadership has dedicated funds to increased staffing for mental health and substance-use services, it is difficult to know the extent to which the goals of equitable and timely access to quality mental health care are being realized in this large decentralized system.
The Departments of Defense and Veterans Affairs (VA) have mounted unprecedented efforts to screen returning service members for possible mental health problems (with an eye to early intervention), and have seen returning service members from Iraq particularly use mental health services at a relatively high rate in their first year after returning from deployment. But with 250,000 veterans projected to return from overseas' deployments during 2006, many challenges still lie ahead. As starkly described in the 2005 Report of the Under Secretary for Health's Special Committee on Post-traumatic Stress Disorder, Fifth Annual Report (February 2006), there appear to be real gaps between veterans' needs and the capacity to meet them. "[Even] specialized PTSD services are lacking in many VA medical centers (VAMCs) and are severely limited at Community Based Outpatient Clinics (CBOCs)," the Special Committee reported. "[And VA is] not ready to meet the ongoing needs of veterans of past deployments while also reaching out to new veterans of service in Iraq and Afghanistan." In addition, the Committee urged VA to address the compelling issues of readjustment facing these veterans, and noted, "virtually all returning veterans and their families face readjustment problems."
These experts stress that such readjustment issues are not manifestations of a mental disorder and should be seen as a normal response on the part of returning service members to the extraordinary experience of service in a combat theater. Left unaddressed, however, these problems may worsen and compromise an individual's mental health. Efforts to reinforce that readjustment issues are normal and to help the veteran reintegrate may prevent the development of chronic post-deployment mental health problems. The VA's Special Committee on PTSD urged that a public health-like approach be mounted to foster the readjustment of veterans and their families. VA has in fact dedicated funding to outreach and readjustment efforts; but they are not systemwide.
Mental health advocates have urged congressional action to ensure that returning service-members are able to reintegrate successfully into their communities and that those individuals and family members who have mental health needs receive timely, effective services, and have called for the following:
The lessons of prior wars have contributed to our unprecedented awareness of the mental health needs of veterans who are returning from Iraq and Afghanistan. It remains to be seen how well government departments and the Congress have studied and acted on those lessons, and whether the major systems designed to meet veterans' needs will have the capacity to meet them. Given the variability that exists across a decentrally-administered health-care system like the VA's, for example, we cannot assume that effective behavioral health programs and timely service-delivery at one facility necessarily represents a system norm. Given the mental health needs associated with the trauma of war, and the importance of early intervention, it behooves us all to be veterans' advocates.
NACBHD Member Testifies on Capitol Hill about Methamphetamine Crisis
On June 28, Pat Fleming, Salt Lake County, Utah, Division of Substance Abuse Services and NACBHD member, testified before the House Subcommittee on Criminal Justice Drug Policy and Human Resources regarding the methamphetamine crisis. The hearing was one of a series lead by Chair Mark Souder (R-IN) and ranking member Elijah Cummings (D-MD) to address the methamphetamine crisis. (Souder has been vocal in recognizing the methamphetamine problem is steadily spreading from the west coast eastward and has recognized its prevalence in Indiana.)
The hearing was an "interesting opportunity to testify," said Fleming. And, he added, while methamphetamine has been prevalent for the last four to five years in the western part of the U.S., "without the National Association of Counties (NACo) [of which NACBHD is an affiliate] making this an issue, it would not get the play it needed to get. NACo has done a wonderful job of putting the spotlight on methamphetamine and of keeping the message stream going." The most recent survey from NACo, released July 18, revealed that methamphetamine remains the number one drug problem in the country. See www.naco.org for complete information on the survey.
Fleming noted that Congress in no different from state legislatures in that elected officials' central concern is on making sure there is a good return for investments and that programs are working. Both Souder and Cummings had a very solid knowledge of methamphetamine and the issues surrounding it. Others testifying at the hearing included Charles Curie, SAMHSA Administrator; Nora Volkow, Director of the National Institute of Drug Abuse; and Westley Clark, Director of the Center for Substance Abuse Treatment, SAMHSA. Fleming cited Volkow's testimony in particular, noting that she explained that there was no approved pharmacological intervention for methamphetamine at this time, although there are some drugs that pharmaceutical companies are marketing as interventions. Volkow emphasized caution around these drugs, saying that they had not yet been approved by the FDA. For more information on this issue, click here.
Families who have struggled with methamphetamine also testified at the hearing, and were especially powerful in relating what it is like for families in the throes of a methamphetamine crisis.
Fleming's message focused on helping Congress understand that in the U.S., we have turned substance abuse into a social problem rather than dealing with it as a healthcare issue. As he explained, this puts the responsibility on the taxpayer and the first response is to go to Congress for money. Instead, substance abuse needs to be dealt with as a rational health care policy. In the interim, we need help in significant funding to deal with the methamphetamine crisis. As Fleming described it, "County and state governments are already under pressure, and this has pushed them over the edge." Fifty-three percent of the people in Utah's high offender program have methamphetamine as their primary drug.
In terms of funding, Fleming argued that the Substance Abuse Prevention and Treatment Block Grant should be increased from $1.75 million to $2 billion. It takes 15% longer to treat methamphetamine users, and methamphetamine is disproportionally impacting young women, who typically have two or three children and co-occuring issues such as physical abuse and marginal vocational skills.
Fleming argued that it is vital to focus on women and children in addressing the methamphetamine problem, and noted that in Utah, women and children are driving many of the costs associated with the methamphetamine crisis. Judges are increasingly incarcerating women for methamphetamine, and their children are sent to county welfare placements. It costs about $30,000 to incarcerated a woman for a year in Utah, and an additional $33,000 for each child welfare placement - this does not include the costs of treatment.
The block grant with family treatment programs, which have a successful track record, should be the focus at the national level, Fleming argued in his testimony. "The block grant is the bedrock of treatment in the United States," he said. Block grant funds go to the states and then directly to counties. In addition, Fleming contended that discretionary grants are not good for addressing a long-term problem such as methamphetamine; the money needs to be put to work, not be in a competing situation. The block grant is a population-based formula; states receive a proportion based on their percentage of the U.S. population, and counties receive funding based on a similar formula. And, he explained that the block grant has a way of leveraging public dollars; states may contribute when they see federal money coming in.
The federal budget process is currently underway, with fiscal year 2006-2007 starting October 1, 2006 and ending September 30, 2007, and the fiscal year 2007-2008 starting October 1, 2007 and ending September 30, 2008. While there is not yet a decision on funding, Fleming feels that, at a minimum, the block grant funding must start for the FY 2007-2008 period. To read Fleming's testimony, click here. To view a Power Point presentation on the impact of meth on women and children, click here.
NIMH Studies on Drug Effectiveness: CATIE, STAR*D, and STEP-BD
Recently, several leading medical journals have published the results of three studies examining the effectiveness of medications to treat mental illness. The federally-funded studies are being released in a series of phases, and are the largest of their kind. The studies are:
There are concerns that misunderstanding of the findings of these studies could result in restricted access to needed mental health treatments. NACBHD will continue to follow-up on concerns around the studies as information unfolds.
For more information on the studies, see the following:
CATIE: To view information on the CATIE study, see http://www.nimh.nih.gov/healthinformation/catie.cfm.
For an NIMH perspective on antipsychotic reimbursement using the results from CATIE, see http://www.nimh.nih.gov/about/dirupdate_catie.cfm.
To go to the CATIE website, see http://www.catie.unc.edu.
STAR*D: For information on STAR*D, see http://www.nimh.nih.gov/healthinformation/stard.cfm.
To go to the STAR*D website, see http://www.edc.gsph.pitt.edu/stard.
STEP-BD: For a press release on STEP-BD, see http://www.nmha.org/newsroom.
In addition, the National Mental Health Association has resource information about all three studies, including information for advocates, fast facts, frequently asked questions, and resources.
See http://www.nmha.org/research.
NASMHPD Calls for Paper Proposals
The National Association of State Mental Health Program Directors (NASMHPD) Research Institute, Inc. (NRI) is calling for proposals for papers to be presented at its Seventeenth Annual Conference on State Mental Health Agency Services Research, Program Evaluation and Policy, February 12-14, 2007 in Washington, D.C. For more information on submitting proposals related to Applied Research and Evaluation Outcomes to Enhance Mental Health Services, click here. Proposals are due August 11.
Mental Health Screening Program Materials Available Online
Members interested in accessing information about the National Depression Screening Day Mental Health Screening program can click here for further information. (The next upcoming screening day is October 5, 2006.) To visit the Screening for Mental Health website, see: http://www.mentalhealthscreening.org.
NAMI Survey: Depression Costs Almost Tripled for Consumers With Limited Access to Care
A NAMI survey in California, New York, Ohio, Texas, and Florida demonstrated that:
Individuals with depression and limited access to treatment incurred an average of nearly three times the annual out-of-pocket costs for medication, psychotherapy and other treatment costs than individuals with less restricted access ($4,312 versus $1,496), according to results of a new survey.
The survey also revealed that individual budget and workforce challenges may limit access to care. For more information, see http://www.nami.org.
2006 National Indicators of Child Well-Being Available Online
"America's Children in Brief: Key National Indicators of Well-Being, 2006" is now available from the Federal Interagency Forum on Child and Family Statistics, which produces this annual report. The report, which details the status of children and families in the United States, also includes an indicator for emotional and behavioral difficulties. All data are updated annually on the Forum's website at http://childstats.gov. The report can be accessed at http://childstats.gov/amchildren06.
New Initiative Will Fund School-Based Mental Health Services: Focus on Immigrant and Refugee Families
Dr. Julia Lear of George Washington University is leading a new Robert Wood Johnson Foundation-funded program for school-based mental health services for children and youth, with a focus on helping immigrant and refugee families overcome barriers to care. To access a press release and complete information on the program, click here. Questions can be addressed to: jsutherland@burnesscommunications.com.
National Institute of Justice Reports on Drug Courts Available Online
The National Institute of Justice (NIJ) has released several studies online about "what works" in drug courts, including how target populations and participant attributes affect program outcomes, the judge's role in the success of drug court participants, treatment issues, drug court interventions for juveniles, and cost-benefit analyses of drug courts.
The reports are available at: http://www.ojp.usdoj.gov.
SAMHSA Announcements
From a June 30 SAMHSA press release:
SAMHSA Announces How It Will Review Submissions to New National Registry of Evidence-Based Programs and Practices
SAMHSA has announced the agency's Fiscal Year 2007 review priorities for mental health and substance use prevention and treatment programs and practices submitted to its National Registry of Evidence-based Programs and Practices (NREPP). The notice was published in the June 30 Federal Register. NREPP is a voluntary rating and classification system designed to provide the public with reliable information on the scientific basis and practicality of interventions that prevent and/or treat mental and substance use disorders. Under the new NREPP, minimum review criteria require interventions to: demonstrate one or more positive change outcomes in mental health and/or substance use among individuals, communities or populations; have results that are published in a peer-reviewed publication or documented in a comprehensive evaluation report; and provide documentation, such as manuals, guides, or training materials, to facilitate broader public dissemination of the intervention.
Priority review areas for substance use prevention include preventing or reducing substance abuse problems such as: underage drinking; inhalant abuse; use and abuse of marijuana; drug related suicide; alcohol and drug abuse among young adults; misuse of alcohol and prescription drugs among the elderly; or HIV/substance abuse problems. Priority review areas for substance use prevention also include interventions that reduce risk factors or enhance protective factors, or address emerging substance abuse problems.
Priority review areas for substance abuse treatment include interventions to treat adolescents and adults with alcohol or drug use disorders that utilize screening, brief interventions and referral; outreach and engagement; treatment and rehabilitation; recovery support; or continuing care, self-care or aftercare.
Priority review areas for mental health include interventions that: foster consumer and family-provided mental health services; divert adults with serious mental illness and/or children and adolescents with serious emotional disturbances from criminal and juvenile justice systems; develop alternatives to the use of seclusion and restraint for adults with serious mental illness and/or children and adolescents with serious emotional disturbances; or prevent suicide in specific age groups.
Interested parties can review the complete Federal Register notice by clicking on National Registry of Evidence-based Programs and Practices on the SAMHSA home page at www.samhsa.gov.
Look for an article on the NREPP and an interview with Kevin Hennessey at SAMHSA in an upcoming newsletter.
Direct Support Professionals Report: Resource Information; Interviews with NACBHD DD Committee Members in August Newsletter
The report "The Supply of Direct Support Professionals Serving Individuals with Intellectual Disabilities and Other Developmental Disabilities: Report to Congress" was recently released by the U.S. Office of Disability, Aging and Long-Term Care Policy. Copies can be obtained from the office's website at http://aspe.hhs.gov/daltcp/reports/2006/DSPsupply.htm or hard copies can be mailed. Contact: webmaster.DALTCP@hhs.gov. Look for an interview with members of NACBHD's Developmental Disability Committee regarding the key findings of the report in the August newsletter.
