Managed behavioral health care: an instrument to characterize critical elements of public sector programs

OBJECTIVE: To develop an instrument to characterize public sector managed behavioral health care arrangements to capture key differences between managed and "unmanaged" care and among managed care arrangements. STUDY DESIGN: The instrument was developed by a multi-institutional group of collaborators with participation of an expert panel. Included are six domains predicted to have an impact on access, service utilization, costs, and quality. The domains are: characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability. Data are collected at three levels: managed care organization, subcontractor, and network of service providers. DATA COLLECTION METHODS: Data are collected through contract abstraction and key informant interviews. A multilevel coding scheme is used to organize the data into a matrix along key domains, which is then reviewed and verified by the key informants. PRINCIPAL FINDINGS: This instrument can usefully differentiate between and among Medicaid fee-for-service programs and Medicaid managed care plans along key domains of interest. Beyond documenting basic features of the plans and providing contextual information, these data will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care. CONCLUSIONS: If managed behavioral health care research is to advance beyond simple case study comparisons, a well-conceptualized set of instruments is necessary.     

Promoting health: intervention strategies from social and behavioral research

This report, released by the Division of Health Promotion and Disease Prevention within the Institute of Medicine at the National Academy of Sciences, asserts that behavioral and social interventions such as health promotion and disease prevention offer great promise to reduce disease morbidity and mortality in the United States, but as yet their potential has not been recognized or tapped by the federal government. Two overarching recommendations are the need to address generic social and behavioral determinants of health rather than the clinical causes of disease and death, and the need to intervene at multiple levels of influence including the individual, interpersonal, institutional, community, and policy levels. Seven recommendations for intervention strategies, nine recommendations for research, and three recommendations for funding are offered.     

Assessing psychological health and empowerment in women: the Personal Progress Scale Revised

Empowerment is a primary outcome of many health interventions with women. Typical outcome measures, however focus exclusively on specific symptoms, neglecting the clinically important attitudes and behaviors associated with increased empowerment and well-being. Empowerment is conceptualized as enabling women to access skills and resources to cope more effectively with current as well as future stress and trauma. This study investigated a new measure of personal empowerment in women, the Personal Progress Scale-Revised (PPS-R). Results suggest that the PPS-R is a promising measure of empowerment in women, demonstrating excellent reliability and validity in diverse sample of women. Additionally, the PPS-R demonstrated preliminary utility with a subgroup of abused women, a vulnerable group of women for whom empowerment is a variable of high importance.     

养老机构老年人社会资本量表的编制及信效度检验

目的 编制养老机构老年人社会资本量表并检验其信效度。方法 依据课题组前期构建的养老机构老年人社会资本评价指标体系编制问卷,于2021年5月至7月,采用便利抽样法,在广州市某养老机构的两个院区选取449名老年人进行问卷调查,将总样本随机分成两部分,样本1(n=225)进行项目分析及探索性因子分析,样本2(n=224)进行验证性因子分析及信效度检验。2周后随机抽取30名老年人进行重测。结果 本研究编制的养老机构老年人社会资本量表包含5个维度,19个条目。量表条目水平内容效度指数(I-CVI)为0.833～1.000,平均内容效度指数(S-CVI/Ave)为0.938。验证性因子分析中各指标均达到适配标准(χ²/df=1.776,CFI=0.921,TLI=0.905,RMSEA=0.056,SRMR=0.068),模型拟合良好。总量表Cronbach’s α系数为0.802,分半信度为0.879,重测信度为0.887。结论 养老机构老年人社会资本量表信效度良好,可作为评价养老机构老年人社会资本水平的工具。     

Network Environments and Well-Being: An Examination of Personal Network Structure,Social Capital,and Perceived Social Support

ABSTRACT

Previous studies have demonstrated the role of social networks, social capital, and social support in individuals’ well-being. However, the ways in which these related constructs simultaneously influence one’s well-being outcomes and relate to one another have not been closely examined. This study pays particular attention to the structural characteristics of personal networks, distinction between offline and online social capital, and different indicators of well-being outcomes. Based on survey data collected from 574 college students, the study found that two dimensions of personal networks—density and gender homophily—and social capital in the form of offline bonding capital explained perceived social support. Further, perceived social support consistently predicted well-being outcomes and played a mediating role between personal network density and well-being, as well as between offline bonding capital and well-being. The results offer implications for a more nuanced understanding of the role of individuals’ interpersonal and social environments in well-being outcomes.     

Capital financing techniques for health care facilities: an historical overview

Realizing that a thorough discussion of capital financing techniques for health care facilities would fill several volumes, this article presents an overview of the techniques currently used in the industry. Included is an outline of the basic features, applications, and costs of the various techniques. Because financing techniques in current use evolved from earlier forms, the chronological format adds a measure of clarity and logic to the development of health care financing. The primary focus will be on private, voluntary hospitals since they comprise the majority of the health care financing volume. A particular technique's applicability to public facilities, nursing homes, retirement centers, for-profit facilities, and freestanding facilities is noted, however, when appropriate.     

Development of an instrument for monitoring adolescent health issues

The aim of the project was to develop a survey instrument to monitor relevant health status and health-related behaviors among secondary school students. The development of the instrument occurred in three main phases: collection of existing surveys, workshops with relevant health professionals and focus groups with adolescents. The topics for inclusion were refined using Health Goals and Targets for Australian Children and Youth and consultations with health professionals, and included alcohol/illicit drug use, smoking, nutrition, exercise, injury, mental health, violence and sexual health. Content validity was demonstrated through a comprehensive literature review, review and application of existing instrumentation, dialog and exchange with health professionals, and focus groups with adolescents. The process of peer review through correspondence with health professionals, and the coordination of workshops and focus groups established face validity. Responses from students also indicated that they interpreted the questions as intended. The instrument was piloted in five secondary schools during class periods. Process evaluation was also conducted to determine the appropriateness of the survey and the procedures used in administering the survey. Feedback from school staff was supportive and favorable with respect to the choice of issues. Reliability was assessed by a test-re-test procedure 2 weeks apart. In general, most of the questions showed moderate to high reliability (kappa > 0.5) indicating agreement of 50% or greater. This instrument was developed as a monitoring instrument and places emphasis on determining prevalence levels of a range of health issues and health behaviors to assist with identifying clustering patterns of negative health outcomes. Although the instrument is primarily for use with students in school hours, the nature of the instrument allows modification for use in older groups of adolescents and out-of-school youth. The final version of the questionnaires for senior and junior students can be accessed via the Internet (http://;+www.spmed.uq.edu.au/CHPCPR /qu estionnaire).     

Social inequalities in health and public health: from research to policies

This paper analyses the main results and prospects concerning research and studies about social inequalities in health in France. Research orientations, which may contribute usefully to defining health and social policies in this field and favour their development are then proposed. Health policy content and implementation placing high priority on the problem of social inequalities in health are discussed.     

Nursing and planning in health: management report as an instrument of health planning

The involvement of the future nurse in the construction of the Management Report of the Actions of Health of a city in the interior of Rio Grande do Sul was the main objective of this study. The methodological strategy consisted of meetings with coordinators and technicians responsible for the sanitary units, the General Director Group and planning team of the health of the city, participation in the collection of data and elaboration of the related report. The literature revision contemplated: politics of health, a management report as an instrument of health planning, continued education and the role of the nurse on SUS improvement. This work contributed to the improvement of the report of health management, with sights to the planning and implementation of resolute and effective actions.     

In-home behavioral health case management: an integrated model for high-risk populations

The escalating health care costs attributed to high-risk populations have fueled a need for a proactive approach to deal with people affected by complex mental health issues that often coexist with chronic medical conditions. Through an in-home behavioral health case management (CM) program, patients with mental illnesses (some with coexisting medical conditions) receive integrated medical and mental health services through a disease-management approach that has proven effective in treating high-risk patients.     

Personal privacy and public health: potential impacts of privacy legislation on health research in Canada

Despite variation in Canadian privacy laws between provinces and territories, increasing legislative protection of personal privacy has imposed restrictions on health research across the country. The effects of these restrictions on patient recruitment include increased study costs, durations, and decreased participation rates. Low participation rates can jeopardize the validity of research findings and the accuracy of measures of association by introducing non-response, or participation bias. We constructed simulations to assess potential effects of non-response bias on the accuracy of measures of association in a hypothetical case-control study. Small biases that alter the probability of selecting an exposed case can lead to dramatic inflation or attrition of the odds ratio (OR) in case-control studies. ORs are more unstable and subject to error when the true probability of selecting an exposed case is greater, such that strong positive associations are subject to error even at low levels of bias. Well-powered, population-based epidemiological research is a cornerstone of public health. Therefore, when weighing the benefits of protecting personal privacy, the benefits of valid and robust health research must also be considered. Options might include special legislative treatment of health research, or the use of an "opt-out" (vs. the current "opt-in") construct for consent in confidential research.     

Personal quality improvement and individualized health process control: an update

Chronic disease management is about personal quality improvement. This involves tracking personal health measures over time to develop the patient's understanding of common and special cause variation. This can be done through the use of run, control, and time between charts. This review gives examples of different methods taken from the literature.     

Housing as an instrument of health care

Housing is a key instrument of health care. This was recognized long ago when the Victorians introduced public health measures to tackle unhealthy city slums. The links between housing and health have since been forgotten by some people, as general housing standards have improved and housing has developed as a separate area of public policy. This paper attempts to show that in the late twentieth century housing is still a fundamental factor in determining health. A number of policy issues now point to the need to rebuild the links between housing and health: evidence of persistent inequalities in health, a recognition that those with the poorest health still live in the worst housing, and the new care in the community policy which demands closer working relationships between agencies. The current political and economic climate does not encourage or foster links between services. The government's approach to health focuses on personal behaviour rather than environmental factors as determinants of health, there is a rift between entrenched professional interest groups which provides no incentive for cooperation, and there is a lack of research which demonstrates clear financial and service benefits from coordinating housing and health planning and provision. However, a renewed concern for public health is becoming more prominent (which recognizes the fundamental links between environment and health). This paper argues that housing is a key factor in individual, and hence public health, and should therefore play a more central role in this debate. The challenge now is to gain wider recognition of the essential policy and financial links between housing and health-care services. This involves clearly identifying exactly what aspects of housing are important for health and in what way, including housing issues in health and public health concerns at all levels, and suggesting priorities for policy makers. It must be demonstrated that expenditure on housing is still an effective way of achieving improvements in health. Housing is an enduring instrument of health care.