A pilot demonstration of comprehensive mental health services in inner-city public schools

BACKGROUND: National policy statements increasingly espouse the delivery of comprehensive mental health services in schools. In response to the limited evidence supporting this recommendation, the purpose of this study was to assess the need for, and feasibility, desirability, and outcomes of a full model of comprehensive mental health services in 2 public elementary schools in inner‐city neighborhoods. METHODS: The program, based upon a national model for comprehensive school mental health services, comprised universal and indicated preventive as well as clinical interventions designed to target needs identified in a baseline screening survey. The program was implemented over 1 school year by mental health professionals in collaboration with school teachers. Mental health outcomes comparing baseline to follow‐up data were assessed in multiple domains among students and teachers. RESULTS: After 1 year of intervention, students had significantly fewer mental health difficulties, less functional impairment, and improved behavior, and reported improved mental health knowledge, attitudes, beliefs, and behavioral intentions. Teachers reported significantly greater proficiency in managing mental health problems in their classrooms. School staff overwhelmingly endorsed satisfaction with the program. CONCLUSION: If the observed favorable findings from this pilot demonstration can be replicated in methodologically rigorous studies, additional support would be garnered for national policy recommendations about comprehensive school mental health services.     

School Heart Health Promotion: The National Heart Foundation (Western Australian) Approach

ABSTRACT: The National Heart Foundation of Australia's commitment to school health promotion expanded progressively since 1983. Following establishment of health education curriculum documents by the state Ministries of Education, the Foundation targeted schoolchildren with primary prevention programs and resources. The Foundation looked beyond instructional settings to examine the influence of the school environment on the health of students and school personnel. This paper describes a school heart health promotion model implemented by the Western Australian Division of the National Heart Foundation, serving one of Australia's eight states and territories. The model incorporates elements of policy, curriculum, environment, health services, and community interaction. Though similar to comprehensive models of school health education, this model limits its application to heart health. The program operates in a nongovernment agency with unmatched potential for national reach.     

Is public health ready for reform? The case for accrediting local health departments.

Reform of the governmental public health system in the United States has been stymied by changes in political, economic, and medical care landscapes since public health was called to action by the Institute of Medicine report in 1988. Despite a new national health objective calling for 90 percent of the population to be served by a local health department effectively addressing public health's three core functions by the year 2000, capacity building initiatives have not been deployed extensively, and there is little likelihood of reaching the year 2000 objective. A national program of accrediting local and state health departments could energize public health capacity building. Accreditation would build on recent initiatives in states like Washington and Illinois, promote wider use of the Assessment Protocol for Excellence in Public Health, and facilitate reform of the public health system around public health's core functions. Key questions addressing the why, how, and who of such an initiative set the stage for consideration of a national accreditation program.     

The Health-Grant University: a comprehensive national health education plan

Although the need for universal and better health education has been recognized, no nationwide comprehensive program has been established. Consequently, we are proposing founding a national program of statewide health education networks, comparable in some ways to the Cooperative Extension Services of Land-Grant and Sea-Grant Universities. One institution in each state would qualify for designation as the State Health-Grant University, and all other public and private colleges located throughout the state would be encouraged to appoint one faculty member to serve as the health educator for the corresponding service area. Each health educator would receive an adjunct appointment at the health-grant university and would be required to participate in special training sessions and to master progressive health education strategies. The health educator would link the academic world and the community, educating the community about health and disease prevention and the significance of lifestyle. By catalyzing and coordinating efforts with teachers, ministers, nurses, physicians, business leaders, and others, the health educator would make an important contribution to the community. By addressing disease prevention and health maintenance, the Health-Grant University Program would strive to motivate the community to achieve greater individual health initiatives, while helping develop skills for personal health management and providing access to needed health services. Federal legislation would be required to create a national commission to coordinate the program, but community volunteers would make the program cost-effective and self-sustaining.     

Of road blocks and school health

India's school health program has suffered from lack of institutional commitment and compartmentalization at the school level. Health forms an important component of the Human Development Index, and some countries have successfully improved their own human development status through an integration of primary health care and primary education. In India, however, health services and health education have been seen as separate issues. In 1984, the Ministry of Health and Family Welfare adopted the National Programme for School Health (NPSH). The goal was to assist primary school teachers in implementing: regular medical check-ups for children, an immunization program, health and population education, safe and healthy school environments, and nutrition information. Unfortunately, NPSH's program suffered from conceptual and methodological limitations concerning the training of teachers for school health activities. The author recommends a conceptual model that emphasizes: 1) developmental and habit formation aspects; 2) small group and whole school activities involved in shared and cooperative learning; and 3) teaching and learning new knowledge and skills. This model views all teachers as involved the health education process, and it moves away from the current academic or service-oriented health program to a new participatory, problem solving, and life skills model. While the training of teachers would be necessary, it is also clear that the instructors would need increased support. The head school teacher would need to be committed to such a program, school performance evaluations would reflect an emphasis on health education, and teachers would have access to technical support.     

男性流动人口主动参与生殖健康活动状况分析

目的:通过对育龄男性流动人群有关生殖健康问题的调查和访谈,了解其参与的主动性。方法:采取多阶随机抽样的方法,对台州市5个县、市、区共计2432名浙江省外来育龄男性人群进行调查和访谈。结果:浙江省台州市男性流动人群的文化程度总体较低,以小学和初中为主(72.3%).他们对生殖健康知识的了解较少,对计划生育/生殖健康服务的可得性明显不足,接受过避孕宣传的占29.1%,参与生殖健康活动主动性差,79.7%缺乏当地社会认同感和归属感。结论:加大对男性流动人群的生殖健康宣传教育力度,提高其生殖健康意识,促进其更多参与计划生育,有利于提升整体人群生殖健康水平。     

Health literature: a neglected resource

The health and medical sciences can enjoy outstanding information support through a vast literature made accessible by secondary services such as abstracting journals and data bases. Yet, for various reasons, few national health plans make use of bibliographic services, libraries, or documentation services. In many developing countries health science libraries are institution-based, and their services limited to research personnel, medical school staff, and postgraduate students. Even among these access to library resources may be severely restricted. Thus, collections are underutilized, and whole segments of the health community are denied access to the literature. A 2nd need is for the coordination of health literature at a national level, in activities such as inter-library lending, photocopy provision, and centralized cataloguing. In countries where there is more than 1 sizeable medical library, users would benefit by gaining access to a much wider range of resources than would otherwise be available. 3rd is a need for the extension of facilities to underserved groups such as health administrators and health care personnel, ministry of health staff, and hospital physicians. While these personnel may have access to statistics generated in national health systems, new ideas, views, criticisms, theories, and other nonnumerical data is needed outside literature. The literature needs of these health personnel is obviously different than those of medical research and teaching staff, and a bibliographic service must be developed to reflect these needs. The final improvement needed is the integration of health literature services into national health systems. Steps necessary for government to initiate integration are: 1) formulation of national policy for health literature services, 2) inclusion of health literature services in national health plans, 3) allocation of funds to health literature services in national budgets, and 4) bibliographic control of national health literature. For progress to occur, action must come from 3 groups: national health and education authorities, with their administrative and financial control; information mediators librarians, documentalists, bibliographers); and the users themselves.     

Blood banking services in India

India's health care sector has made impressive strides toward providing health for all by the year 2000. That progress, however, has not been supported by a modern transfusion services network which continues to improve itself. In India, blood collection, storage, and delivery occur mainly in blood banks attached to hospitals, most of which are under central and state government controls. A significant portion of blood banking activity is also done by voluntary agencies and private sector blood banks. A study found the blood transfusion services infrastructure to be highly decentralized and lacking of many critical resources; an overall shortage of blood, especially from volunteer donors; limited and erratic testing facilities; an extremely limited blood component production/availability/use; and a shortage of health care professionals in the field of transfusion services. Infrastructural modernization and the technical upgrading of skills in the blood banks would, however, provide India with a dynamic transfusion services network. The safety of blood transfusion, the national blood safety program, HIV testing facilities, modernization of blood banks, the rational use of blood, program management, manpower development, the legal framework, voluntary blood donation, and a 1996 Supreme Court judgement on the need to focus greater attention upon the blood program are discussed.     

Sustainability of public health programs: the example of tobacco treatment services in Massachusetts

Sustaining important public or grant-funded services after initial funding is terminated is a major public health challenge. We investigated whether tobacco treatment services previously funded within a statewide tobacco control initiative could be sustained after state funding was terminated abruptly. We found that 2 key strategies-redefining the scope of services being offered and creative use of resources-were factors that determined whether some community agencies were able to sustain services at a much higher level than others after funding was discontinued. Understanding these strategies and developing them at a time when program funding is not being threatened is likely to increase program sustainability.     

The Medical Education Partnership Initiative: PEPFAR's effort to boost health worker education to strengthen health systems

The early success of the President's Emergency Plan for AIDS Relief (PEPFAR) in delivering antiretroviral medications in poor countries unmasked the reality that many lacked sufficient health workers to dispense the drugs effectively. The 2008 reauthorization of PEPFAR embraced this challenge and committed to supporting the education and training of thousands of new health workers. In 2010 the program, with financial support from the US National Institutes of Health and administrative support from the Health Resources and Services Administration, launched the Medical Education Partnership Initiative to fund thirteen African medical schools and a US university. The US university would serve as a coordinating center to improve the quantity, quality, and retention of the schools' graduates. The program was not limited to training in the delivery of services for patients with HIV/AIDS. Rather, it was based on the principle that investment in medical education and retention would lead to health system strengthening overall. Although results are limited at this stage, this article reviews the opportunities and challenges of the first year of this major transnational medical education initiative and considers directions for future efforts and reforms, national governmental roles, and the sustainability of the program over time.     

Long term care needs and personal care services under Medicaid: a survey of administrators

Home and community based care services constitute a public initiative in the development of a long term care service network. One such home based initiative is the personal care service program of Medicaid. The authors conducted a national survey of administrators of this program. They received a response from 16 administrators of such programs in 1987-1988. The responses raise significant issues regarding training, access to and equity of services, quality of services, administrative oversight and the coordination of home-based care in a network of available services. Based on administrator responses, the authors draw several conclusions.     

The United States health centers initiative: a state by state status report

In 2001, the United States federal government began a 5-year initiative to expand services offered by health centers to people who live in area designated "underserved" because there are insufficient primary care medical practitioners. There were national targets for expansion. How the Health Resources and Services Administration (HRSA) reviewed and monitored State plans to expand health centers is presented. These early results suggest that collectively the States would meet the target. Several States would require major efforts to move toward the national average and they were examined more closely.     

A Model to Increase Consumption of Fruit and Vegetables by Implementing the "5-A-Day" Initiative

ABSTRACT: The National Cancer Institute, in conjunction with the Produce for Better Health Foundation, launched a 5-A-Day initiative to increase fruit and vegetable consumption. State departments of health in 24 states were licensed to participate to implement behavior change interventions at the community level aimed at both adults and children. This article describes how schools could use the eight components of the expanded school health program to initiate a 5-A-Day program, and why schools need to participate in the 5-A-Day initiative. Specific strategies to implement in each component of the comprehensive school health program are described.     

Health without wealth? Costa Rica's health system under economic crisis

The recent history of Costa Rica's health system is reviewed, emphasizing the health-related effects of the economic crisis of the 1980s. This economic crisis has stopped and in some instances reversed the marked health improvements Costa Rica realized during the decade of the 1970s. The effects of the economic crisis emerge in 4 areas: deterioration in health status, as poverty contributed to higher disease rates; reductions in the government's ability to maintain public health and medical services; increased reliance on foreign aid to finance the health system; and growing national debate over the role of the state in health care. The result of the economic crisis was a reduction in health services and a questioning of the Costa Rican health model. This occurred following the implementation of an expensive health infrastructure and at a time when people most needed health services. During the 1941-70 period, domestic initiative can account for much of the expansion of Costa Rica's social security system, but also at this time international agencies such as the US Agency for International Development (USAID) and the Inter-American Development began to assist in the expansion of the health system. In 1971 a plan was initiated to create a nationalized health system. By 1980 the success of the health sector reorganization was evident in the statistics: marked improvements in life expectancy, infant mortality, and infectious disease mortality had surpassed the goals set by the Pan American Health Organization (PAHO) and the Ministry of Health. Costa Rica's success was a vindication of both policy goals and funding priorities, for it has been "proved" that primary health care was capable of improving health indices, particularly where the agencies had the active and conscientious support of the national government. By 1977, foreign contracts for aid had expired, and the Ministry declared that the rural health program would be supported totally by the government. The Minister of Health continued in 1982 to champion self-sufficiency despite a changed economic climate, but by early 1984 Costa Rica had to abandon its plan to wean the health sector from outside aid. In 1982 the health sector became the center of a nationwide debate. Representatives of the large agricultural export sector, who usually support free-market solutions to economic problems, lobbied for "reprivatization" of medical care. Those committed to expansion of the welfare state argued from the other extreme. The government offered concessions to both groups. The debate did end in 1986, most likely because of the overall easing of the economic crisis. The government needs to maintain state control over the health system while not exceeding its austerity budget and not reducing health services.     

Effects of the Strategic Prevention Framework State Incentives Grant (SPF SIG) on State Prevention Infrastructure in 26 States

The Strategic Prevention Framework State Incentive Grant (SPF SIG) program is a national public health initiative sponsored by the U.S. Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention to prevent substance abuse and its consequences. State grantees used a data-driven planning model to allocate resources to 450 communities, which in turn launched over 2,200 intervention strategies to target prevention priorities in their respective populations. An additional goal was to build prevention capacity and infrastructure at the state and community levels. This paper addresses whether the state infrastructure goal was achieved, and what contextual and implementation factors were associated with success. The findings are consistent with claims that, overall, the SPF SIG program met its goal of increasing prevention capacity and infrastructure across multiple infrastructure domains, though the mediating effects of implementation were evident only in the evaluation/monitoring domain. The results also show that an initiative like the SPF SIG, which could easily have been compartmentalized within the states, has the potential to permeate more broadly throughout state prevention systems.     

Insite: Canada's landmark safe injecting program at risk

InSite is North Americas first supervised injection site and a landmark public heath initiative operating in Vancouver since 2003. The program is a vital component of that cities internationally recognized harm reduction approach to its serious problems with drugs, crime, homelessness and AIDS. InSite currently operates under a waiver of Federal rules that allow it to provide services as a research project. An extensive evaluation has produced very positive results for thousands of users. Normally such strong evidence documenting the successes of such a program, and the medical and public health significance of these positive outcomes, would be the basis for celebration and moves to expand the model and provide similar services elsewhere in Canada.     

Ensuring quality preventive care: the Texas Department of Health's Put Prevention into Practice initiative.

In the current public health arena, assurance of quality clinical preventive services to all populations will be possible only if collaborations are nurtured between public health and the private sector health care delivery systems. This article explores key preventive health programs that serve as the historical context for the evolution of the Texas Department of Health-Put Prevention Into Practice (TDH-PPIP) initiative, outlines documented barriers to implementation of preventive services in primary care, and reviews national public health programs launched to reduce these barriers. Lastly, a discussion regarding the joint responsibilities of the public health and the private sector professionals in assuring quality preventive services to all populations is initiated. Collaborative efforts, such as the TDH-PPIP, initiative improve the availability and quality of clinical preventive services and, thus, result in significant advances in the public health goal of ensuring conditions in which people can be healthy.     

A community pediatric prevention partnership: linking schools, providers, and tertiary care services

Integrated school health services traditionally have been provided through the local board of education or health department. However, increased competitiveness in the health care arena has challenged providers to find innovative models to deliver health services to school-aged children. This article describes a partnership among a hospital, a university, private providers, and a local school system and health department to provide school health services. Noteworthy aspects of the project include the organizational structure and funding of the program, implementation of a case management model, and a focus on documenting outcomes. This program has been successful in building local alliances to provide health care services to school children. Implications for other school systems struggling to fund health services for school-aged children are discussed.     

Health promotion for older Americans

As American lifespans increase, there is greater concern for the quality of those longer lives. The Department of Health and Human Services, through its many component agencies, has inaugurated a major initiative to promote health and fitness among older Americans to improve life quality and to reduce health care costs. The older population is a fertile ground for such an initiative, because studies indicate that the elderly are extremely health-conscious and very willing to adopt habits that will maintain good health. Investigation disclosed six target areas of concentration at which the health promotion initiative could be aimed: fitness-exercise, nutrition, safe and proper use of drugs and alcohol, accident prevention, other preventive services, and smoking cessation. The initiative includes cooperative programs with States; dissemination of printed information; nutritious meals for the elderly; a Food and Drug Administration consumer education program; Centers for Disease Control programs on accident prevention; a special task force to deal with Alzheimer's disease; and, in cooperation with states, a media campaign of health promotion for the elderly. At least three national health and senior citizens organizations are working closely with HHS agencies on the initiative. A separate Department effort involves the encouragement of fast-growing health maintenance organizations to promote health and prevention for their Medicare members and the persuasion of Medicare beneficiaries generally to seek second medical or surgical opinions. State and local government and the private sector, responding to Department initiatives, have also been developing programs for the aging. Their interest and participation ensures that special health promotion and disease prevention efforts directed toward elderly Americans will continue and proliferate.