Category: Healthcare

Parents are birdnesting to keep their children in their homes.

So what is birdnesting? Birdnesting is like nesting. Parents take turns going back to the nest to care for their little ones. Separated parents rotate in and out of the family homes so the children do not have to bounce back and forth from one parent to the other. Exes may stay in a spare bedroom, built in apartment, or some other way that the house is converted for nesting.

Many millennials believe this is the best way to raise stable children. Others disagree. Malin Bergström, a scientist at the Karolinska Institute in Stockholm and a child psychologists disagrees that birdnesting parents are doing the right thing for their children. “This is a type of protecting children and sheltering them from reality, basically. I think that is a threat to mental health.” Instead she thinks that moving the children about makes them resilient and gives them the “tools they need”.

A health equity study Malin Bergström was involved in shows little difference in the mental health of children who lived in a traditional nuclear family with two parents and children that live with typical joint custody arrangements. Nonetheless. Divorce can be unsettling for children as well as for the rest of the family and many parents are choosing to birdnest as a way to keep family stability.

Lawyers say that birdnesting is on the rise in family courts. A study by Coop Legal Services out of the United Kingdom says that 11% of divorced or separated parents have tried it. In Sweden, divorced parents have rotated homes since the 1970s. Recently westerners are picking up on the idea and it is showing through pop culture. Mad Men’s Anne Dudek and Matthew Heller went public about nesting after their divorce in 2016. Splitting Up Together is a television show about birdnesting on-again off-again parents. Off duty parents get the garage which seems kind of “normal” to me.

A family law attorney from Britain Stephen Williams, says that birdnesting cuts court fees and is a cost-effective solution for parents that split up. Another British lawyer from Ashtons Legal believes that birdnesting is more about an increase awareness to children’s mental health. “People have become far more savvy about needing to think about their children’s development,” he says. “I think that is a really, really good progression, basically, because often those issues were pushed to the background, and it was the parents’ often problematic separations which came to the fore.”

Birdnesting parents believe that they are raising healthier children. Linnea Andersdotter who was birdnested as a child and is now 36 says that “It felt like a very dramatic thing when they first let me know that they were going to split up, and when I found out I didn’t have to move, that really helped me not freak out about the situation,” she says. “I was kind of kept in a safe little bubble whilst they were sorting out the break-up thing.”

But critics argue it can create a “halfway house” situation which doesn’t help children process the reality of their parents’ separation. Eline Linde, who lived in a nesting household says she found the experience “strange and confusing”. “I didn’t know if it was mum or dad’s house, or if they were working out if they were getting back together”.

Family-law solicitor Ben Evans believes it works for some couples because it can help “buy them a bit of time and ease the pressure on them. Both parties can mull over future steps, he argues, and avoid knee-jerk or costly decisions”. Buscho says a nesting period also provides “breathing space” that can facilitate reconciliation or help partners figure out what they want their long-term co-parenting plan to look like. t Bergström argues that nesting stalls the divorce. Åse Levin, a 50-year-old graphic designer agrees with Bergström’s argument and says that birdnesting made it difficult for her to move on with her life. “I know that both of us had real anxiety being in that apartment… you didn’t have your things, so it wasn’t a cosy place to go to,” she recalls. “You’re stuck in some kind of bubble or something, you cannot do anything. You cannot go forward.” I wonder though of maybe the apartment was too small to feel like a home to begin with and if a bigger home would have made a difference in her perceptions about birdnesting. Nesting can raise new challenges for parents though because they may have to change their routine. Bodil Schwinn says birdnesting is working well for her and her former partner, “You need to have a good relationship with your ex,” she states.

I like the idea of birdnesting parents and believe that this new trend will make stronger healthier families. Let me know what you think.

Mom got $9.6M. Now the daughter is suing the state after a wrongful removal. A look at the Right To Lie Case.

A look at the “Right To Lie” case where Mom got $9.6M and then, the daughter sued Orange County.

Child Protection workers costs taxpayers billions every year in lawsuits that most people are completely unaware of, and would be outraged about if they understood. I found Kathlee Arthur a few years ago in my research on the subject. Kathlee Arthur is a woman from Washington State who advocates nationally for foster children and their biological families. She informed me about the “Right To Lie” case that at the time she was using to raise awareness to legislators to show how devastating it is when social workers get away with lying on the stand to keep children separated from their biological families.

Deanna Fogerty-Hardwick lost custody of her minor children, Preslie and Kendall. Deanna Fogerty-Hardwick filed suit and won. Later, her daughter Preslie filed suit under 42 U.S.C. 1983 against the County and employees of the SSA. In 2011, a jury awarded Fogarty-Hardwick $4.9 million in damages. Orange County then appealed the case all the way to the U.S. Supreme Court at the taxpayer’s expense. The U.S. Supreme Court declined to hear the case. During that time though, interest and additional attorney fees were racking up the costs that Orange County was charging taxpayer’s to fight for the “Right To Lie”. The total payout came to $9.6 million. The county also incurred an additional $1 million for its own legal costs on the case. None of the social workers that fought were ever held accountable for lying in court to destroy the family. None of the people making the decisions to fight for the right to lie in court ever had to pay out of their own pocket to make that argument.

Preslie showed the courts that the social worker employees acting under color of state law maliciously used perjured testimony and fabricated evidence to secure her removal from her mother and that the state abused it’s power when it violated her Fourth and Fourteenth Amendment constitutional rights to her familial relationship with her mother. Federal appellate court No. 15-55563 D.C. No. 8:13-cv-01390-JLS-AN opinion affirmed that Orange County is not immune from liability when workers perjure themselves to adopt a child out to complete strangers.

The ruling issued by a three-judge panel of the 9th U.S. Circuit Court of Appeals is based on the same events that caused a jury to award Deanna Fogarty-Hardwick $9.6 million from Orange County in 2011 after she alleged that social workers used fabricated evidence to cause a court to remove her two daughters from her custody for six and a half years! The district court denied absolute and qualified immunity to the individual defendants.

Preslie’s complaint targets conduct well outside of the social workers’ legitimate role as quasi-prosecutorial advocates in presenting the case. The court concluded that Beltran v. Santa Clara County disposes of the issue. In Beltran, the court held that social workers are not entitled to absolute immunity from claims that they fabricated evidence during an investigation or made false statements in a dependency petition affidavit that they signed under penalty of perjury, because such actions are not similar to discretionary decisions about whether to prosecute. The court also concluded that defendants’ use of perjured testimony and fabricated evidence in court in order to sever Preslie’s familial bond with her mother was unconstitutional. In this case, Preslie has produced more than sufficient admissible evidence to create a genuine dispute as to whether her removal from her mother’s custody violated her clearly established constitutional rights, and defendants’ case for qualified immunity from these charges is not supported by the law or the record. Accordingly, the court affirmed the judgment. (Justia, Hardwick v. County of Orange, No. 15-55563, 9th Cir. 2017)

The County could be on the hook to pay out once again. Still, California’s social worker employees that are fighting for the right to lie in court have not been held accountable for perjuring themselves. Those workers did not lose their jobs, go to jail, or spend any money out of their own pocket. Instead, after trying to destroy this family completely and then lying about it, they get to spend money they can access that we put in the Social Security Fund for retirement and disabled people. And Congress let’s state employees get away with this every day.

“No official with an IQ greater than room temperature in Alaska could claim that he or she did not know that the conduct at the center of this case violated both state and federal law,” Judge Stephen Trott wrote in the opinion. “Perjury is a crime under both federal and California state law, as is the knowing submission of false evidence to a court. … Because they are supported by the record as a whole, we construe the facts Preslie offers in support of her allegations in the light most favorable to her.”

Hardwick’s allegations are the same as her mother’s. In 2000, Orange County Social Services agents Marcie Vreeken and Helen Dwojak fabricated testimony “that (Fogarty-Hardwick) had caused her daughters to skip a mandatory visit with their father, when in fact the problem was caused by a visitation monitor.”

Hardwick said that there are other lies that the social workers delibertly and maliscously told the court; when they said that Fogarty-Hardwick had turned her daughters against their visitation monitor and when they told the court that Fogarty-Hardwick had told her children that their father was trying to take them away from her.

Thankfully the court disagreed with the assertion that Orange County attorneys argued that it was not clearly established in civil court at the time of the events in question that in situations such as Hardwick’s, those involved had “the right to be free from deliberately fabricated evidence.”

Orange County officials have maintained that its social workers never wronged Fogarty-Hardwick or her family. Neither employee was disciplined and Vreeken was later promoted to a position in which she trains other social workers. County records show Vreeken was still employed in 2015, when she earned $132,466 in total compensation. County Supervisor Todd Spitzer said that social workers often face difficult decisions when deciding when and whether to separate a child from their parents and that it was important for those employees to know that the county backs their decisions. “Social workers have an immense responsibility to protect children, and I’d much rather have a social worker err on the side of taking a child from the home than leave a kid where there might be suspected child abuse,” Spitzer said. “It’s a delicate balance, and social workers needs to know that if they do that the county will back them up.”

I have to disagree that social workers are lying In court to protect children. They are lying in court to get away with destroying the very people they are created to serve. I hope others will consider this case and seriously ask themselves if anyone should ever have a right to lie about another in court.

Related Articles : What I wish I had known. Case Preparation Child Welfare Cases, From a mom shoved in the system:,How to approach a legislator, lawyer, judge, and any other important person in a legal case.

Are clones property?

Are clones property, or human beings? What rights do clones have? And what rights do others have over clones?

Cloning is something that I think we need to discuss more. I agree with you that healthcare professionals are constantly challenged. Saving lives and making lives better are not easy tasks. The idea of cloning humans raises so many questions in my mind. Why should humans be cloned? What purpose does cloning humans serve? Why would someone want to produce individuals, entities or populations, identical to the parent or original organism from which they were obtained or derived (Iqbal et al., 2020)?

I agree that the idea of saving stem cells from umbilical cords can be useful and ethical, but how many people can afford to store the stem cells once they are harvested? Cloning organs this way is probably the most ethical way to clone organs, and it is certainly better for the patient receiving identical body parts. Are scientist considering cloning people for their organs? That is scary! I would hate to know that the only reason for me being on earth is so that someone could harvest my organs.

Cloning can be useful and improve some people’s lives, but there are still so many unanswered questions about it that I hope the experiments would be limited to plants although I have read about experiments using animals. Legal and ethical issues arising from the human genome project at the Indiana University School of Law-Bloomington in 2001 included discussions about the methods used to clone, whether or not cloning is feasible, and property rights issues (Hilmert, 2001).

There are two methods used in cloning; blastomere separation which involves splitting an embryo soon after fertilization and the somatic nuclear technique (SNTC) that was used to clone Dolly (Collins, 2006) which is a technique that removes the egg cell and replaces it with the nucleus from a somatic cell (Hilmert, 2001). Both methods are capable of creating clones.

Back in the early 2000s when lawmakers were making legislation to ban cloning, a former ethicist for the NIH, John Fletcher, commented, “the reasons for opposing this are not easy to argue.” (Hilmert, 2001). We are now twenty years down the road and scientists are cloning organs. Therapeutic cloning, which is also known as organ cloning, is the process of creating new human organs and tissues, never newborn babies, from the cultivation of stem cells. As such, the resultant organ has an identical gene structure as the recipient such that there are theoretically little chances for rejection (Surfcrs, 2011).

We have a moral obligation to cure diseases when we can, and to save lives when we can, but it is still unclear what rights a clone has and who owns the rights to a tissue. Could a clone ever be developed for the well being of the clone?  Cloning plays an important role in the development of stem cell research for embryonic stem cells transplantation into patients because the stem cells would be a genetic match for the donor patient. There would be no risk of rejection and for xenotransplantation which is the cloning of organs using animals that has a higher rejection rate.

Who owns the clones? Courts already recognize a property interest in living material.” Several different parties may potentially claim cloned organs or tissues: the DNA/tissue donor, the clone, and the scientist who developed the cloned tissue/organ or transgenic animal (Hilmert, 2001). Property law governing renewable and nonrenewable body parts addresses ethical and moral questions. The DNA donor to has an interest in his or her own DNA and any claim over the organs of the clone. In the cloning case, Moore v. Regents of the University of California, the court determined Moore had a cause of action for breach of fiduciary duty, but the court declined to find a cause of action for conversion.’ To bring an action

for conversion, Moore had to “establish an actual interference with his ownership or right of possession” (Hilmert, 2001). In other words, he had to have retained ownership of his cells after they had been removed. The court in Cornelio v. Stamford Hospital” followed a similar line of reasoning. However, other cases indicate that there may be property interest in cryopreserved pre-zygote and the Hecht v. Superior Court that involved property rights concerning sperm(Hilmert, 2001).

Patentability of living things is addressed in the Diamond v. Chakrabarty case where the respondent filed a patent application for a genetically engineered bacterium capable of degrading oil, something which no naturally occurring bacteria is known to do. The patent examiner rejected the claim on the grounds that “micro-organisms are ‘products of nature,’ and… as living things they are not patentable subject matter.” But the Court of Customs and Patent Appeals, Supreme Court found the bacterium is  patentable subject matter under § 101 of the Patent Act and reversed the decision (Hilmert, 2001).

Patent US 6,211,429, granted to the University of Missouri on April 3, 2001 by the United States Patent and Trademark Office (PTO) was written so broadly that it appears to include human cloning and products of cloning in its protection (Cunningham, 2002). Cunningham’s vision of public policy concerning humans either conceived or created through science entails; a right to autonomy, i.e., that his or her bodily integrity must not be invaded or compromised by others; No person or entity has the right to enslave, own, or control any human being, regardless of stage of biological development; Any organism that is genetically human is a human being; A cloned embryo is distinct and separate from the person donating the genetic material, and therefore is a unique being protected in law; No person or institution has the right to control or profit from any process designed to clone a human being.

Related Articles: BioEthics of using Stem Cells, Cloning, Genetic Enhancements, Brain Machine Interfaces, and rapidly growing technological advances in science.

References

Collins, F. S. (2006). The language of God: A scientist presents evidence for belief. New York,          NY: Free Press. ISBN: 9781416542742.

Cunningham, Comstock, (2002), The Right to Patent a Human Being: Fact, Fiction, or Future Possibility?, The Center for Bioethics and Human Dignity, https://cbhd.org/content/right-patent-human-being-fact-fiction-or-future-possibility

Hilmert, Laura, J., (2001), Cloning Human Organs: Potential Sources and Property Implications, J.D., Indiana University School of Law-Bloomington 2001; B.S. Biology, Indiana, University, 1998, Retrieved from, http://ilj.law.indiana.edu/articles/77/77_2_Hilmert.pdf

Pozgar, G. D. (2019). NVPMD: Legal aspects of healthcare administration. 13E-Liberty Custom. Burlington, MA: Jones & Bartlett. ISBN: 9781284170931.

Surfcrs, (2011), Organ Cloning Ethics, http://www.cloneorgans.com/organ-cloning-ethics/18/

Stem Cells, Cloning, Genetic Enhancements, Brain-Machine Interfaces, and rapidly growing technological advances in science.

Discussing bioethics and rapidly growing technological advances in science.

I was a little confused this week when I started looking at the different ways that scientists can use technology to enhance patient’s lives. Actually, I think I still am a little fuzzy on the subject and the differences between techniques. The discussion surrounding genetic enhancements is similar to the discussion about the use of stem cells. Cell therapy can be defined as a technique that infuses or transplants stem cells into patients to treat diseases or repair tissues. The key difference between gene therapy and stem cell therapy is that in gene therapy, genetic material is injected to patients while, in stem cell therapy, whole cells are injected to patients to treat diseases (Samanthi, 2017). Both bring up varying ethical issues about how this knowledge should be used and when it should be used.

The somatic cell nuclear transfer (SCNT) that scientists used to clone Dolly the sheep stirred the entire world (Collins, 2006). People wondered how long it would be before scientists cloned people and when and if so, if those people would be spiritual human beings. The good that came from the experiment is that life-saving human organs can be cloned. Would it be ethical to clone a human for organs? It is scary to think of where this science is capable of going.

Technology is advancing faster than the ethical guidelines for it are. Karen Moxom created a mind-over-matter project decades ago to help patients regain use of their limbs (Moxon, et al., 2019). It sounded like sci-fi fiction back then and it still does to some people today. As with neurotechnology, stem cell technology is also a rapidly advancing science that can greatly improve patient’s lives. One of the most useful and least questioned techniques to harvest stem cells is from the umbilical cord. The cost of getting the stem cells and then storing them until they are needed is more than most people can afford though. Deciding right and wrong, costs, and equality concerns, and the overall benefit to humanity will help us put guidelines in place for future experiments.

Stem cell research and cloning raise the issue of clones having a living soul. I looked up the definition for personhood at dictionary.com and found it defined as; the state or fact of being a person, the state or fact of being an individual or having human characteristics and feelings. Genetics makes up our physical bodies, and environmental factors form our developed feelings. Maybe our DNA holds more than we think it does. Bioethics addresses complex issues about how vulnerable people should be treated. Clones would most definitely be a vulnerable population that people would want to know the answers to many questions about.

Related Articles: Ethics regarding clones

References

Collins, F. S. (2006). The language of God: A scientist presents evidence for belief. New York,  NY: Free Press. ISBN: 9781416542742.

Moxon, Karen,  Guglielmo Foffani, (Brain-Machine Interfaces beyond Neuroprosthetics, School of Biomedical Engineering, Science and Health Systems, Retrieved From, http://dx.doi.org/10.1016/j.neuron.2015.03.036

Moxon, K, Ph.D., Ignacio Saez, Ph.D., and Jochen Ditterich, Ph.D., (2019), Mind Over Matter: Cognitive Neuroengineering, The Dana Foundation, Retrieved From, http://dana.org/Cerebrum/2019/Mind_Over_Matter_Cognitive_Neuroengineering/

Pozgar, G. D. (2019). NVPMD: Legal aspects of healthcare administration. 13E-Liberty  Custom. Burlington, MA: Jones & Bartlett. ISBN: 9781284170931.

Samanthi , (2017), Difference Between Gene Therapy and Stem Cell Therapy, Key Difference – Gene Therapy vs Stem Cell Therapy, https://www.differencebetween.com/difference-between-gene-therapy-and-vs-stem-cell-therapy/

Fostered or Forgotten?

It is time to stop the foster care to prison pipeline.

See the source image

We have to stop the foster care to prison pipeline. There are people sitting in jails and mental hospitals that do not even know who their family is or where they came from and public defenders and social workers “drop the ball”. Leaving them there with no one to advocate for them, and do you want to know how it almost always ends? It almost always ends in solitary confinement until they kill themselves or a jailer loses it and kills them.

In a related article: Speaking of the foster care to prison pipeline….PBS interviewed Ken Mascara, the sheriff of St. Lucie County in Florida.

Ken Mascara has been the sheriff of St. Lucie County in Florida for the past 20 years. He has seen funding for mental health facilities plummet, and as a result, more and more mentally ill patients end up languishing behind bars. Now, he gives his Brief But Spectacular take on making county jails safer, and smarter.

It is going to take everyone, a village, the legislators, the governors, the presidents, and every day people like you and me to make the world a better place for foster children. As some of you already know from my past reports, more than 80% of the children placed in foster care are “prescribed psychotropic drugs to help them cope”. Once they age out statistics show that 75% of the aged-out youth end up incarcerated within two years. Often because they did not have access to the drugs they were prescribed as children, and they turn to street drugs. They have no family to support them. Most of the time family times are severed and children are moved away from anyone and everything they know. We have to do better!

Should healthcare managers use social media?

The Use of Social Media as a Communication Tool in the Healthcare Industry.

Facebook, YouTube, Twitter and other social media tools has become an effective way to gather and disseminate timely information, network with colleagues, and to advertise services. Consumers also now have the opportunity to research and compare treatments. And though social media is an effective communication tool, there are also lessons to be learned from the past that human resource managers have to consider when making an organization’s social media policy.

No one policy will work for every business so human resource managers will have to decide what is appropriate for each organization and each employee. Relevant labor laws, employer rights and employee rights are some of the things that HR will have to consider when crafting a social media policy.

The use of social media will have a positive effect on healthcare industries for several reasons. Social media is a way that healthcare professionals can communicate with each other and with consumers. Advertising a business or service on social media is cheaper than traditional methods such as billboards, radio stations, newspapers, and television. Consumers can also use social media to compare healthcare services and this will increase competition which should drive the costs down making going to a doctor more accessible and more affordable. Consumers are also now able to research diseases and treatments and that gives consumers more decision-making power and makes their healthcare treatment more patient-centered. Individual patients can also review the service received by their healthcare providers on social media sites. This can deter negative doctor-patient experiences.  Social media apps that track health are also increasing access to preventive healthcare instantly. Social media is evolving to be used in just about every aspect of healthcare. Healthcare professionals can use social media as a tool to share information with colleagues, patients, and the general public. Social media is also evolving as a training tool to educate and introduce new healthcare professionals.

There are risks to using social media. Patients can leave bad reviews on social media sites after having a negative experience. Another negative experience that seems to be common is that a hospital or government organization that has our private medical information has been breached and we are increasingly being told that we should change our passwords. There is controversary surrounding HIPPA laws and the use of social media. Previously I studied to be a family counselor and one of the issues the counseling profession is addressing is whether or not it is appropriate for professional counselors to be on social media. Should a counselor be friends with a patient? Does it violate HIPPA rights if a counselor accepts a friend request from a patient? What if it is a small town where everyone knows everyone? As online peer support groups grow this will become more of an issue that professionals will have to address. One of my friends recently graduated and at that moment she chose to deactivate her social media account.

Strategies to improve healthcare through the use of social media can include having clear communication objectives and identifying each goal that each professional in a healthcare organization will have for using social media. There will most likely be different reasons for professionals of an organization to use social media so each goal should be clearly identified. The target audience will also have to be defined so that relevant information will reach the intended audience. Developing trust with the audience is important. This can be accomplished by collaborating with other reputable organizations, and by offering science-based information in ways that make it easy for others to interact and communicate with the healthcare provider.

In conclusion, social media can be a useful communication tool for both providers and consumers. As we saw last year through the pandemic, the use of telemedicine grew. Patients are better informed to make personal decisions about their healthcare treatment and treatment is becoming more accessible because of information that is shared through social media.

There are controversies about whether or not the use of technology will raise or lower the costs of healthcare, but I think that healthcare will become more affordable has healthcare technology and healthcare apps evolve. Social media is also increasing preventative measures that will make society healthier. On the other hand, there are consequences to using social media in healthcare. The biggest consequence is addressing ethical issues surrounding the use of social media.

While the use of social media is evolving, it does offer transparency and that is a good thing. It builds necessary trust between patients and doctors. Social media was not around in the days that the Bible was written, but people socialized with each other. Word got around that a King was born and when Jesus grew to begin teaching, people traveled and gathered to hear him. Values included in ethical guidelines for medical practitioners are similar to Jesus’ teaching. In other words, Jesus taught us to work for good (Beneficence), and he taught us to avoid harming others (Nonmaleficence). God also gave each of us free will and with that Jesus taught us to treat others as we want to be treated (Justice and Equity). As Christians, we also strive to deal truthfully (Veracity) with others and to fulfill our responsibilities (Fidelity) and promises to others. As Biblical scholars and human resource managers I believe that we can easily apply these principals to our every day use of social media and policy. When we write policies, I believe that each of these values is in our as we consider the rights and responsibilities of the companies that we work for, the people we work with, and the patients that we serve.

Words Matter.

Labels are necessary in many fields and for many reasons. Doctors use labels to diagnose, treat, and refer patients to other specialized services. Teachers use labels to organize, test, grade, and categorize students. There is no doubt that labels are not going to go away, but it is important to think about how and why we label people. Our words matter. Our jobs, our looks, and our religion define how the world sees us and how we see ourselves and this is how we see others.

Labels are all around us in everyday life and we seldom ask why. We are labeled, and we learn to label at early ages and throughout life. Pastor, criminal, crazy, artistic, police officer, judge, teacher, unworthy, insignificant, shameful, low-life, fat, ugly, bad, good, selfish, worthy, lazy, incompetent, nice, rude are some of the labels that people commonly use and we need to talk about this.

Getting the labels out in the open with our colleagues, friends, and family gives us the chance to discuss what the labels mean and why we use them. Is it appropriate to use labels? Discussing labels will make us aware of our own thoughts and prejudices.

Once we become aware of our own thoughts and prejudice we can make sense of them. We can accept that we are wrong sometimes. And as we become aware of how what we think and say affects how we treat others, we become more aware of how we want others to see us. Nobody wants to be the bad person that mistreats others.

There are things that we can do to remove stigmas and negative effects that happen because of labels. Be less judgmental and more supportive. Empowering other people is empowering. It feels good to make others feel good. Smile and the world smiles back. Don’t be judgmental and challenge your friends, but let your friends know how their words can affect other people in negative harmful ways. We catch more bees with honey. Identify stereotypes and negative feelings. Choose your words carefully, be supportive, and focus on the positive.

Doctors, teachers, and other professionals are going to label people as a way of communicating with each other. Some children may need special education classes even though they are excellent athletes and mechanics. The criminal justice system labels people with an intent to deter crime and protect society. And there are a lot of negative effects that happen when people are labeled.

Labels change the way that we feel about ourselves. Someone that has been convicted of a felony may have a lower self-esteem and that can lead to other unacceptable behavior and even self-fulfilling prophecy. Felons often have a hard time entering back into society and finding employment after serving time in prison.

Labeling theories hypothesize that official assignment as a deviant or criminal can lead to a person taking on the identity and criminal behaviors that eventually lead to a self-fulfilling prophecy with the person ending up in jail.

Labels have a ripple effect that ripples through a person’s entire lifetime. It is why it is so important to think about how and why we use labels. Labels can lead to changes in a patient’s self-esteem causing reduced contact with peers, unemployment, and even lead to deviant behavior. Labels can also increase confidence and self-esteem. With that in mind, it is important to consider the implications that labeling has on a person and on society.

Labels lead to a chain of events, but what is not accepted in one culture may be perfectly normal in another culture. Culture plays a huge role in labeling. Culture is more than just a person’s ethnicity. It can be a social group, a neighborhood, and even an occupation. Behavior that is accepted in one group may be thought of as deviant in another. For instance, here in the United States boys putting their hands in a basket full of stinging ants is not something anyone is going to do and if they did we would probably wonder if they had lost their mind. However, in Brazil boys put their hands in a basket full of stinging ants as an initiation process to show that they are brave.

Other examples of cultural differences can be seen in the way that we think about time. In the United States and in Japan someone will be considered unreliable if they do not show up on time and are not punctual. In other countries though, people do not see time the same way and may be offended by our hurriedness.

Labeling is an important subject to think about because in the real-world people are labeled at home by parents, in school by teachers and peers, and people are labeled by doctors when they are diagnosed with a disease or disorder. People are also labeled because of their occupation and income. Labels change the way the world looks at us and the way we look at ourselves.

Culturally deviance is decided by what is acceptable in a society and the United States is a mixture of many different cultures and not everyone has the same background experiences or values. People from different cultures will interpret experiences differently.

Here in the United States laughing is seen as a sign of happiness, but in Japan laughing is seen as a sign of confusion and embarrassment. Commonwealth countries such as Ireland understand the word “compromise” to be a positive word because it means that two parties agree.

Here in the United States, we think of compromise as giving in or giving up. Someone labeled as happy in the United States may be labeled as a confused lunatic in Japan and someone that is labeled a loser here in the United States for compromising may be praised in Ireland for their ability to negotiate compromise.

Related Articles: Homeless People, Interview With A Homeless Couple, Fostered or Forgotten?

Is the foster care to prison pipeline the only answer for children whose parents have mental health conditions? Addictions?

Parents, Mental illness, Homelessness, Addiction, Foster Care, Prisons

A social worker recently confronted me with her concerns about parents who have been diagnosed with mental illness and homeless families. I have to agree with her that there are problems that should be addressed. However my personal belief is that family units should be preserved whenever possible.

Right now, state and federal governments are just beginning to make policy changes that are required by the Family First Preservation Act of 2018. Three years later states have not implemented the new law! Currently, as in the past decades, services are geared towards adoptive and foster families.

Biological family is almost always overlooked because before the Family First Act of 2018 the funding was only provided to states if the children were taken out of their homes, away from their entire families, and placed in out-of-home placements with complete strangers.

This led to children being crammed into group homes, stranger’s houses, and out-of-state placements with complete strangers. Many of the children are abused in the state placements and end up running away. Sometimes the children are killed in state placements. The children’s parent’s lives are also negatively affected. Their lives spiral out of control and become filled with grief, anger, and loss. Grandparent’s lives are also saddened and cut shorter by negative emotional and financial burdens that occur when governments destroy family units.

Children will run away and parent’s lives spiral out of control. The system causes more harm than good so new laws were made and states are supposed to be making the needed changes.

My response is as follows: Homelessness can lead to mental health issues such as depression and anxiety. Mental health issues can also lead to homelessness. Families are for the most part ill-equipped to handle a family member with a mental condition. We need more NAMI’s to help everyday people cope with these kinds of issues. The National Alliance of Mental Health Illness (NAMI) has volunteers and paid counselors that can help individuals, family members, teens, youth, veterans, and others dealing with mental health issues.

Depression, unshakeable feelings of dread, despair, loneliness, and hopelessness seem to be leading signs and causes of suicide. Most of the suicide letters that I have seen include statements about “not seeing a way out”, or that the family “will be better off without me”. The context is usually about child support and custody situations taking place in family courts.

America has a problem! Family is the foundation of any society and courts are tearing our families apart! Parents who suffer from mental conditions fall into even deeper despair when their families are destroyed and they are told that they can never be parents because of their condition.

Studies also show that there is a high prevalence of mental illness in the foster care population and that many of the children will be homeless when they age out. When they age out, they do not have access to the drugs they have been prescribed to “help them cope” while they were in foster care. They turn to street drugs because the state’s literally have them addicted to prescription medicines they no longer have access to. Homeless people have difficulty accessing healthcare.

The National Conference of State Legislatures (NCLS) has collected data that tells us that children are prescribed doses higher than the maximum levels cited in guidelines developed by the FDA and that legislative action is being taken to address how states are doing this (NCSL, 2021).

The last I looked over 300,000 children less than a year old were prescribed adult doses of medications. Some I would guess were born of parents that were either taking street drugs or prescribed medications, but even if they were born addicted to some substance the amounts of psychotropic drugs they are being prescribed is concerning. What will their lives turn out to be like with no family ties and a bunch of pills to ease the pain?

Serious mental illness costs the United States an estimated $193.2 billion in lost earnings annually and only about 41% of persons with a mental disorder receive any treatment. Mentally ill patients are at higher risks of becoming homeless and homeless people do not have access to medical care and experience higher rates of adverse physical and mental health conditions, suicides, substance abuse, and respiratory diseases.

SAMSHA’s national mental health statistics show that yearly, about 42.5 million (18.2%) American adults suffer from some mental illness. Approximately 9.3 million adults (4%), experience severe mental illness that interferes with their daily lives. Nearly half, (45%) of those with any mental disorder meet criteria for two or more disorders, with severity strongly related to comorbidity. Mood disorders affect about 20.9 million American adults (9.5%) with the median age being around 30 years old.

Homelessness does lead to bigger problems for an individual and for society. People with mental conditions and former foster children make up much of the homeless and prison populations. Reports showed that 50% of the girls in foster care become pregnant before 19 years of age, many (about half) before 18 years of age, 50% of foster children will be in prison within two years of aging out and 74% of foster children will end up in prison, 80% of the people on death row were in foster care (HHS, DOJ, Casey Family Foundation, National Coalition for Foster Children). Less than 3% of foster children will go to college!

The foster care system is broken and parents are having difficulty working through mental health and legal systems. Foster children don’t stand a chance! They are too young to advocate for themselves and are often passed through several homes. Usually more than one a month! They don’t get to have a permanent doctor or team to help them make it through life. This results in missed appointments, miscommunications, and a lack of proper care. Only about 25% of foster children receive services at any given time (Polihronakis, Tina, 2017).

Legislation was made a few years ago to provide for pediatricians to address mental health conditions in children, but are they actually qualified to make the diagnoses and help the child through what is happening in their lives to a healthy recovery. What I see is pediatricians prescribing medications for mental health issues and discussing it with lawyers and social workers instead of doctors and family members. 

As Christians I believe that we have to do better. In Biblical times children became orphans when their parents died. In today’s times, even Mary would be under fire by the state. After all, she did ride around the desert on a donkey, homeless and some would say hallucinating because she said she talked to angels and they talked to her. Jesus was not born in a hospital. He wasn’t even born in a house. Jesus was born in a barn. When I think about how to deal with homelessness, mental illness, and foster care, I have to think of it from a Christian perspective and ask myself, What would Jesus do?

Related Articles: Homeless People, Runaways, Mental Health Disparities, and Homelessness, Is It Ever Appropriate to “coerce” children into loving someone through force and court orders?

References

Casey Family Programs, (2021), https://www.casey.org/

Health.am, (2015), Mental Health Disorder Statistics, http://www.health.am/psy/more/mental-health-disorder-statistics/

KJV, King James Version of the Holy Bible, https://www.kingjamesbibleonline.org/

NAMI, (2021), National Alliance on Mental Illness, https://www.nami.org/home

NCSL, (2021), National Conference of State Legislatures, https://www.ncsl.org/research/human-services/mental-health-and-foster-care.aspx

Polihronakis, Tina, (2017), Information Packet: Mental Health Care Issues of Children and Youth in Foster Care, http://www.hunter.cuny.edu/socwork/nrcfcpp/downloads/information_packets/Mental_Health.pdf

SAMHSA, (2021),  mission is to reduce the impact of substance abuse and mental illness, Substance Abuse and Mental Health Service Administration, https://www.samhsa.gov/

Shi, L., & Singh, D. A. (2019). Essentials of the U.S. health care system with access (5th ed.). Burlington, MA: Jones & Bartlett Learning. ISBN: 9781284156720.

Healthcare Reform 2021

The United States healthcare system is a uniquely complex system made of both private and public sectors. From an international perspective, The United States spends more than any other country on healthcare though we do not necessarily have the best healthcare delivery system. The Department for Professional Employees (DPE) 2016 Fact Sheet shows though the US has the best doctors in the world, but that the treatment in the U.S. is inequitable, overspecialized, and neglects primary and preventative care (DPE, 2016). The result is that American’s health care is poor in comparison to other advanced industrialized nations. 

There is much division in the United States over the Affordable Care Act and lawmakers are consistently trying to implement policies and reforms that will make our healthcare system better. American citizens want quality healthcare at affordable prices but can’t seem to agree how that can best be achieved. Right now, there are executive orders on President Biden’s desk that some groups are pushing for him to sign. Most recently, in March 2021, the President signed the American Rescue Act of 2021 (H.R.1319 – 117th Congress, 2021-2022) that focuses on incrementally implementing changes to the United States healthcare system and supporting citizens in need because of the Covid pandemic. Changes that President Biden is implementing now are similar to previous healthcare reform efforts made during the Obama administration.

The Affordable Care Act (ACA) is the name for a comprehensive health care reform law and its amendments. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010, and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The law reduced the number of uninsured but failed to provide insurance for millions and was repealed under the Tax Cuts and Jobs Act of 2017 (HHS.gov, 2021).

Health insurance is high, and many Americans still do not have health insurance. Vulnerable populations such as the homeless and people suffering from severe psychological disorders may not have access to healthcare at all. The American Public Health Association’s website focuses on how important the ACA is in the move towards making healthcare coverage affordable and accessible. The goal is to  increase the number of Americans with coverage by funding community-based public health and prevention programs, and by supporting research and tracking on key health measures (APHA, (2021).  APHA focuses on showing five reasons why repealing the ACA hurts Americans; (1) “Millions still need insurance: Though the ACA has helped about 20 million get health insurance, about 29 million people still lack coverage, (2) Unsustainable spending: Health care spending represented 17.7% of our gross domestic product in 2019, (3) Lack of emphasis on prevention: Today, seven in 10 deaths in the U.S. are related to chronic diseases such as obesity, diabetes, high blood pressure, heart disease, and cancer, which are largely preventable. Additionally, 90% of our health care dollars are spent treating such diseases. However, only three cents of each health care dollar spent in the U.S. goes toward prevention, (4) Poor health outcomes: The U.S. spends far more on medical care than any other industrialized nation but ranks 28 among 36 OECD countries in terms of life expectancy, and (5) Health disparities: While inequities related to income and access to coverage exist across demographic lines, population-based disparities are impossible to deny.” (APHA, (2021).

Socioeconomic factors prevent many people from receiving both preventative and curative healthcare. Emergency rooms end up being overwhelmed with people seeking emergency help that could have been prevented or treated in doctor’s offices. Poorer, less educated populations receive less care than educated, more financially stable Americans. Minority group membership is associated with lower overall health care access. Racial or ethnic minorities are less likely than their white counterparts to have a specific source of ongoing care (Shi & Singh, 2019). Blacks and Hispanics are more likely than Caucasians to visit hospitals for healthcare rather than doctor’s offices (36% versus 21%). Nonwhite beneficiaries of Medicare have fewer cancer screenings, fewer flu shots, less mental health care, and fewer ambulatory and physician visits than their white counterparts (Shi & Singh, 2019).

Geographic disparities also present barriers to access. It is believed that rural Americans have higher mortality and morbidity rates and shorter life expectancies because they have fewer doctors and because they have to travel to get medical and mental healthcare. Suicide rates in Wyoming are the highest in the U.S. while New Jersey has the lowest rates for suicide. Depression, unshakeable feelings of dread, despair, loneliness, and hopelessness seem to be leading signs and causes of suicide. The Pacific Northwest, and the Midwest seem to suffer more from mental illness than other regions.

Serious mental illness costs the United States an estimated $193.2 billion in lost earnings annually and only about 41% of persons with a mental disorder receive any treatment (Shi & Singh, 2019). Mentally ill patients are at higher risks of becoming homeless and homeless people do not have access to medical care and experience higher rates of adverse physical and mental health conditions, suicides, substance abuse, and respiratory diseases. SAMSHA’s national mental health statistics show that yearly, about 42.5 million (18.2%) American adults suffer from some mental illness (Health.am, 2021). Approximately 9.3 million adults (4%) experience severe mental illness that interferes with their daily lives. Nearly half (45%) of those with any mental disorder meet criteria for two or more disorders, with severity strongly related to comorbidity. Mood disorders affect about 20.9 million American adults (9.5%) with the median age being around 30 years old.

Racial profiling can traumatize people of color making their daily life experience different from Caucasians. Racial and ethnic minorities have less access to medical and mental health services and may not receive the same level of care. Statista shows that as of April 2021, around 25.5% of U.S. black, non-Hispanic public health workers reported having depression in the past 2 weeks, while 32.4% of white, non-Hispanic health workers reported the same. The numbers may not be accurate because other populations are not included in the study and because some people such as homeless people, do not have access to care. Stigmas surrounding mental health also prevent people from reporting mental health concerns.

Stakeholder Health is an organization on a mission to educate, examine, learn, and teach new ways to approach community health, especially to those with a vested interest in accountable care (Miller, & Peterson, 2021). Because many people may not have the ability to drive to doctor’s offices or have access to transportation that can get them to a doctor, community health centers are encouraged to team up with mobile teams to improve access to care. Mobile teams can greatly benefit low-income rural communities that cannot easily access medical care.

“About 3.6 million Americans miss or delay medical appointments every year because they lack a ride to the doctor”, writes Therese McMillan for the U.S. Department of Transportation (Miller, & Peterson, 2021).

Mental and physical health outcomes improve by closing the transportation gap. Other insightful approaches to making healthcare more accessible include “staffing retail outpatient health systems with nurse practitioners and physician assistants in places such as Target, Safeway and Kroger” (Miller, & Peterson, 2021). Expansion for such CHCs is provided for through the ACA (Shi, & Singh, 2019).

The Robert Wood Johnson Foundation is also closing the transportation gap and other barriers to healthcare to reduce economic, racial, and ethnic disparities, and to provide models for national quality health care reform in selected communities (AF4Q, 2021). There are 16 participating geographically, demographically, and economically diverse populations that the Robert Wood Johnson Foundation and Aligning Forces for Quality (AF4Q) cover and, together it covers 12.5% of the United States communities (AF4Q, 2021). The organization makes use of primary care practices and hospitals to improve healthcare. The organization’s products and resources provide lessons learned by regional alliances of providers, patients, and payers as they worked to transform their local health care and provide national models for reform.

Costs of healthcare is rising and there is a critical shortage of healthcare professionals that has to be addressed. Serious issues remain in the areas of coverage, quality, administrative costs, access, affordability, and training. One study shows that CNA supervisors were concerned that 16 clinical hours was insufficient to adequately prepare new CNAs for employment in long-term care facilities and that patients in long-term residential treatment do not feel they are getting the care they deserve (Trinkoff, et. al., 2017).  

Intervention and the ability to challenge colleagues who are in authority when something does not seem right or is clearly wrong can save lives and create better outcomes. Identifying barriers between colleagues helps in the development of tools that can be implemented to create improved future outcomes. Because mistakes by medical professionals can be deadly and because challenging hierarchy in healthcare teams can be difficult if not impossible, the Royal College of Surgeons of Edinburgh runs popular regular non-technical skills courses for surgeons that teach how to ensure safety through good communication and teamwork (Green, et. al., 2017). 

A physician workforce shortage was forecasted by a public database that was constructed to predict changing future healthcare needs (Zhang, et. al., 2020). As a result, “The Physician Shortage Reduction Act of 2017 (H. R. 2267) was introduced in Congress to increase by 3000 the annual number of residency slots from 2019 to 2023. States such as Arkansas, Kansas, Missouri, and Utah have also passed legislation to provide provisional licenses to some medical school graduates who have not been able to find residency spots. With these provisional licenses, they can practice primary care under the medical license of another physician, but only in medically underserved areas” (Zhang, et. al., 2020). The study also shows how doctors from other countries are filling the gaps in the United States healthcare system.

Understanding professional roles and being able to communicate with providers is important and trained multidisciplinary teams are showing improved trusts, teamwork, patient benefits, accessibility, convenience, treatment outcomes, patient satisfaction, waiting times, access to care, and that MDTs prevent and reduce complications. On the other hand, the review shows that poor interactions between healthcare professionals can hamper quality patient care (Tan, et. al., 2020).  

The United States spends more than any other country on research and development (R&D) and advances in healthcare technology is changing the way that health care is delivered. Many believe that technology is a major cause of the rising costs of healthcare while others will argue that technology is making healthcare more affordable. Americans want the latest technology and although the initial costs of training and implementing new technology may raise the costs of healthcare, it is believed that technology will provide better outcomes and become cheaper over time.

Internet now enables patients and practitioners to access information and facilitates interaction between consumers and providers. The internet has added a convenience that is making virtual visits possible. Electronic health records (EHRs) have replaced the traditional paper medical records making it easier and faster for medical providers to share information about patients. Clinical applications support patient care delivery. Administrative information systems are designed to assist in carrying out financial and administrative support activities such as payroll, patient accounting, staff scheduling, materials management, budgeting and cost control, and office automation. Decision support systems forecast patient volume, project staffing requirements, evaluate financial performance, analyze utilization, conduct clinical research, and improve quality and productivity to provide information and analytical tools to support managerial decision making. Clinical decision support systems (CDSSs) are interactive software systems designed to help clinicians with decision-making tasks, such as determining a diagnosis or recommending a treatment for a patient. (Shi, & Singh, 2019)

Governments also use technology to improve healthcare delivery systems and to make healthcare more affordable. Lessons learned from providers, patients, and payers are transforming healthcare by identifying problems and inspiring national models for reform. MONAHRQ software is a digital software system that is used by state data organizations, chartered value exchanges, and hospital organizations to advance healthcare quality, safety, and effectiveness through the evidence collected from digital healthcare systems research (AHRQ, 2021). Risa Lavizzo-Mourey, MD, MBA, President and CEO of the Robert Wood Johnson Foundation says. “Aligning Forces for Quality has been a tremendous journey. Insights we’ve gained will shape our future work to build a national Culture of Health … one that will enable all Americans to live longer, healthier lives — now and for generations to come.” (AHRQ, 2021).

There are concerns about the use of technology in healthcare delivery. There are ethical and moral issues that have to be decided about the patient’s healthcare such as when a physician should use technology to save a life (Shi, & Singh, chapter 5, p140, 2019). Some Americans are concerned that too much data is being shared and that the internet is not secure enough to keep their personal data private.

The goal of healthcare reform is to lower the costs of healthcare and make it more affordable and accessible. The implementation of the Affordable Care Act (ACA) was intended to do that, but it failed to insure millions of Americans and was ultimately repealed in 2017. The United States healthcare system is complex and mostly misunderstood because it is financed by both by public funds and by private funds. Healthcare reform is still on the table, but there are many issues that have to be worked out. There are also disagreements among Americans about how healthcare reform should be accomplished. America is an independent nation. Many Americans do not trust the government to provide for them and believe that healthcare reform will limit the care that they can receive. Americans do not want to wait in line or wait for months to see a doctor. Americans also want to be able to choose their doctor and have a choice in treatment options.

One way the government measures the quality and outcomes of services provided to patients and accounting for the costs of resources used to produce them is MACRA. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 is a health information system that established incentives for clinicians to produce better outcomes. It ended the Sustainable Growth Rate formula that for years resulted in congressional intervention to avoid reductions of payments to physicians. There is a concern though that Incident To Billing Coding can undermine the integrity of MACRA because with incident to billing, accurate measurement of both quality and costs are not possible. A solution may be for Medicare to adjust billing procedures so that payment identifies with the clinician that provides services (Buerhaus, et. al., 2018).

The financial status of a trust fund appropriately considers all sources of financing provided for that fund, including the availability of trust fund assets that Medicare or Social Security can use to meet program expenditures. From a budget perspective general fund transfers represent a draw on other Federal resources for which there is no source of revenue from the public. “The budget perspective does not reflect that publicly held debt and interest payments to the public are both lower because the trust funds hold some of the debt.” (Spitalnic, Paul, 2021).  The financial status of the trust funds and financial operations of Medicare and Social Security in the context of the programs’ trust funds or in the context of the overall Federal budget are often misunderstood but are important when considering ways that we can reform healthcare to better meet the needs of populations (Spitalnic, Paul, 2021). The 2020 Annual Report Of The Boards Of Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds, Associate, Society of Actuaries Member, American Academy of Actuaries, Chief Actuary, Centers for Medicare & Medicaid Services 2020 Federal Trustee Report states, “Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation. Such legislation should be enacted sooner rather than later to minimize the impact on beneficiaries, providers, and taxpayers.” (Spitalnic, Paul, 2021).

Researchers wanted to know if lower Medicaid reimbursement rates would be associated with poor access to providers. The odds of being unable to access primary care providers, access specialty care providers and receive a needed doctor’s appointment in a timely manner were assessed and give insight into the effectiveness of the ACA (Relias Media, 2019).  The study concluded that ACA insurance exchange offerings differed from other non-exchange insurance options in terms of access to healthcare. “The results show that poor access to primary care providers was seen among private coverage purchased via exchanges, relative to private coverage purchased on the individual market. Similar trends were seen with employer-based coverage that may not be attributable to reductions in Medicaid fees. If we are going to make improvements, we need to find ways to prevent barriers to care for those with on-exchange and off-exchange individual private insurance plans and Medicaid.” (Alcalá, et. al., 2018).

The ACA insured millions of previously uninsured people. However, barriers to quality healthcare persist for some populations (Relias Media, 2019). The study shows  the ACA insurance exchange offerings differed poorly from other non-exchange insurance options in terms of access to healthcare (Alcalá, et. al., 2018). At the time that the reports of the study were published, Alcalá did not know how his team’s findings would affect hospitals. What he discovered later further suggested “Hospitals can offer financial counseling to help people understand what all this means. But if providers are unwilling to take patient’s health insurance coverage, this is unlikely to help those who are unable to pay for care out of pocket” (Relias Media, 2019). 

Like most United States government policies that affect billions of people around the world, changes in our healthcare system will be slow. We are only in the beginning stages and experts have not figured out the answers although they do have promising visions of a better future for healthcare delivery systems. The goal will be to provide high-quality healthcare that is convenient and affordable. There are several bipartisan bills on the table as I am writing this paper and that gives me hope that we will find solutions to provide affordable quality healthcare to everyone. Surely the best doctors in the world with the help of interested organizations, stakeholders, and technology can find a way to provide equitable, affordable healthcare that does not leave anyone out or neglect primary and preventative care.

Related Articles: Should healthcare managers use social media? , Parents Mental Health, Foster care, Addictions, and Prisons, Runaways, Mental Health Disparities, and Homelessness

References

AHRQ, (2021), Agent for Healthcare Research and Quality, Healthcare systems research, practice improvements, and data analytics, Retrieved From, https://www.ahrq.gov/

AF4Q, (2021), Aligning Forces for Quality, Improving Healthcare in Communities Across America,  Robert Wood Johnson Foundation, Retrieved from http://forces4quality.org/

Alcalá HE, Roby DH, Grande DT, McKenna RM, Ortega AN., (2018) Insurance Type and Access to Health Care Providers and Appointments Under the Affordable Care Act. Med Care. 2018 Feb;56(2):186-192. doi: 10.1097/MLR.0000000000000855. PMID: 29271819, Retrieved From,  https://pubmed.ncbi.nlm.nih.gov/29271819/

APHA, (2021),  Health Reform, American Public Health Association, Topics, and Issues, Retrieved From, https://www.apha.org/topics-and-issues/health-reform

Buerhaus, Peter, Skinner, Jonathan, McMichael, Benjamin J., Auerbach, David,  Perloff,  Jennifer. Staiger, Douglas, Skinner, Lucy, (2018), “The Integrity Of MACRA May Be Undermined By “Incident To Billing” Coding, ” Health Affairs Blog, DOI: 10.1377/hblog20180103.135358, Retrieved From, https://www.healthaffairs.org/do/10.1377/hblog20180103.135358/full/

CDC, (2020), Homelessness as a Public Health Law Issue, Center for Disease Control, Retrieved From, https://www.cdc.gov/phlp/publications/topic/resources/resources-homelessness.html

DPE, (2016), The U.S. Health Care System: An International Perspective; 2016 FACT SHEET, Department for Professional Employees, Retrieved From, https://www.dpeaflcio.org/factsheets/the-us-health-care-system-an-international-perspective

Green, B., Oeppen, R. S., Smith, D. W., & Brennan, P. A. (2017). Challenging hierarchy in healthcare teams – ways to flatten gradients to improve teamwork and patient care. The British journal of oral & maxillofacial surgery, 55(5), 449–453. Retrieved From, https://doi.org/10.1016/j.bjoms.2017.02.010

Health.am, (2015), Mental Health Disorder Statistics, http://www.health.am/psy/more/mental-health-disorder-statistics/

HHS.gov, (2021). About the Affordable Care Act, U.S. Department of Health & Human Services Retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html

H.R.1319 – 117th Congress (2021-2022): American Rescue Plan Act of 2021. (2021, March 11). https://www.congress.gov/bill/117th-congress/house-bill/1319

Miller, Moly, and Peterson, Tom, (2021), 10 Ways Hospitals Can Improve Healthcare Access, Transforming Health Through Community Partnership, Stakeholders, Retrieved From, https://stakeholderhealth.org/healthcare-access/

Relias Media, (2019), Millions More Are Insured, Relias Media, But Barriers to Care Persist, The trusted source for healthcare information and continuing education, Hospital Access Management, Retrieved From, https://www.reliasmedia.com/articles/144428-millions-more-are-insured-but-barriers-to-care-persist

Shi, L., & Singh, D. A. (2019). Essentials of the U.S. health care system with access (5th ed.). Burlington, MA: Jones & Bartlett Learning. ISBN: 9781284156720.

Spitalnic, Paul, (2021),  2020 Annual Report Of The Boards Of Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds, Associate, Society of Actuaries Member, American Academy of Actuaries, Chief Actuary, Centers for Medicare & Medicaid Services, Retrieved from, https://www.cms.gov/files/document/2020-medicare-trustees-report.pdf

Statista, (2021), Prevalence of depression, anxiety, PTSD, and suicidal ideation in the past 2 weeks among public health workers in the United States as of April 2021, by race/ethnicity, https://www.statista.com/statistics/1255157/prevalence-select-mental-health-conditions-by-race-in-us/

Tan, H. Q. M., Chin, Y. H., Ng, C. H., Liow, Y., Devi, M. K., Khoo, C. M., & Goh, L. H.  (2020). Multidisciplinary team approach to diabetes. an outlook on providers’ and  patients’ perspectives. Primary Care Diabetes, 14(5), 545-551. Retrieved From, https://doi.org/10.1016/j.pcd.2020.05.012

Trinkoff, Alison M. ScD, RN, FAAN, Storr, Carla L. ScD, Lerner, Nancy B. DNP, RN, Bo Kyum Yang, MSN, RN, Kihye Han, PhD, RN, (2017), CNA Training Requirements and Resident Care Outcomes in Nursing Homes, The Gerontologist, Volume 57, Issue 3, 1 June 2017, Pages 501–508, https://doi.org/10.1093/geront/gnw049

Zhang, X., Lin, D., Pforsich, H. et al. Physician workforce in the United States of America: forecasting nationwide shortages. Hum Resource Health 18, 8 (2020). Retrieved From, https://doi.org/10.1186/s12960-020-0448-3

Runaways, Mental Health Disparities, and Homelessness

Socially, people may be afraid of the homeless population. There are many people that believe that there is something severely psychologically wrong with homeless people. Some cities even criminalize homelessness.

Not all homeless people suffer mental illnesses, but they are more likely to develop mental and physical illnesses so we need to think about runaways and what happens to homeless people. How do we treat them? How should we treat homelessness? Sometimes, people that suffer from mental illnesses will end up in the homeless population.

Homelessness is a growing problem and affects all of us. Homeless people can come from all walks of life. Some have good families that worry about them. Others may not. We find mentally ill people walking the streets, runaways, and children. We find homeless people living in the streets, in bathrooms, on downtown benches, in tents close to busy traffic lights, in temporary shelters, and sleeping on their friend’s couch. Homelessness is a growing problem both in the United States and globally.

Both the homeless population and people with mental illnesses face stigmas and biases that may prevent them from asking for help. It is hard sometimes for anyone to ask for help. For someone with a mental illness to get up and go to a doctor may be impossible for them to accomplish on their own. The same is true for a homeless person. They probably do not have access to doctors, dentists, and mental health professionals. They probably can’t take a shower and get ready to go see a doctor because they do not have access to the simple things that they need.

Serious mental illness costs the United States an estimated $193.2 billion in lost earnings annually and only about 41% of persons with a disorder receive any treatment. Homeless people though are more concerned with where their next meal is coming from and where they will find a safe place to sleep than they are about getting to a doctor’s office.

Homeless people do not have access to medical care and experience higher rates of adverse physical and mental health conditions, suicides, substance abuse, and respiratory diseases. One in two homeless people are without shelter making them susceptible to extreme weather conditions. Many homeless youth have been found living in uninhabitable dwelling places. Many homeless people face depression because of the stigmas that people have about them.

Homeless people will have difficulty qualifying for and receiving public assistance because they have no address or access to communicate with service providers. There is much debate about whether or not treatment first or housing first is the best approach to ending homelessness.

Nursing.net posted a study concluding that the treatment first approach gets people with substance abuse problems in treatment first but that the housing first approach costs less.

The housing first approach is not only more cost-effective but also a better approach to ending homelessness and the underlying issues that cause it. The housing first approach is a longer-lasting approach that enables homeless people and people with mental illnesses to access medical and mental health services.

Someone that is experiencing homelessness or a mental health episode may not be ready to ask for help or accept help right now, but next week or next month they may want help. I just can’t imagine trying to keep a doctor’s appointment if I didn’t know where I was going to sleep or where my next meal was going to come from, so I like the housing first approach is probably the best approach in most circumstances though sometimes treatment is needed right away to save someone’s life and should also be considered at the intake.

Most homeless people are men and a large number of them are under the age of 25. In January 2020, there were 580,466 people experiencing homelessness in America. Most were individuals (70%), and the rest were families with children. They lived in every state and territory, and they reflected the diversity of our country.

Specific subpopulations policymakers are concerned with include people in families with children (30%), unaccompanied youth (under age 25, 6%), people experiencing “chronic homelessness” belong to another group that is often singled out for attention (19%), and veterans (6%).

Risks of becoming homeless is significantly tied to gender, race, and ethnicity, and the biggest risks happens because of poverty. Males are far more likely (70%) to experience homelessness than their female counterparts.

Race is another significant predictor. Marginalized groups are more likely to be disadvantaged within the housing and homelessness spheres. Higher unemployment rates, lower incomes, less access to healthcare, and higher incarceration rates are some of the factors likely contributing to higher rates of homelessness among people of color.

Numerically, white people are the largest racial group within homelessness, however, racial groups are far more likely to experience homelessness as a result of segregation and discrimination in employment and housing. Native Hawaiians and other Pacific Islanders have the highest rate of homelessness (109 out of every 10,000 people). Native Americans (45 out of every 10,000) and Black or African Americans (52 out of every 10,000). These rates are much higher than the nation’s overall rate of homelessness (18 out of every 10,000).

Children are often a priority for homeless services systems. As a result, families with children are least likely to be unsheltered, but runaways and young people not living with their families do not receive the same access to services.

It is estimated that unaccompanied youth make up 50% of the homeless youth population and they are unsheltered. 66% of all homeless people live with no shelter at all and often in places that are not meant for human habitation. Poverty is the highest risks factor that leads to homelessness.

SAMSHA’s national mental health statistics show that yearly, about 42.5 million (18.2%) American adults suffer from some mental illness. Approximately 9.3 million adults (4%) experience severe mental illness that interferes with their daily lives. Nearly half (45%) of those with any mental disorder meet criteria for two or more disorders, with severity strongly related to comorbidity. Mood disorders affect about 20.9 million American adults (9.5%) with the median age being around 30 years old. Suicide rates in Wyoming are the highest in the U.S. while New Jersey has the rates for suicide. Depression, unshakeable feelings of dread, despair, loneliness, and hopelessness seem to be leading signs and causes of suicide. Schizophrenia affects about 2.4 million American adults (1.1%) in any given year (Health.am, 2021). The Pacific Northwest and the Midwest seem to suffer more from mental illness than other regions.

Racial profiling can traumatize people of color making their daily life experience different from Caucasians. Racial and ethnic minorities have less access to mental health services and may not receive the same level of care. Statista shows that as of April 2021, around 25.5% of U.S. black, non-Hispanic public health workers reported having depression in the past 2 weeks, while 32.4% of white, non-Hispanic health workers reported the same. The numbers may not be accurate because other populations are not included in the study and because some people such as homeless people, do not have access to care.

Related Articles: Homeless People, Interview With A Homeless Couple, Fostered or Forgotten? , Our Words Matter.

References

All Answers Ltd. (2018). Comparison of the Housing First and Treatment First Methods of Reducing Homelessness. Retrieved from https://nursinganswers.net/case-studies/comparison-of-the-housing-first-and-treatment-first-methods-of-reducing-homelessness.php?vref=1

CDC, (2020), Homelessness as a Public Health Law Issue, Center for Disease Control, Retrieved From, https://www.cdc.gov/phlp/publications/topic/resources/resources-homelessness.html

Community Solutions, (2021), The Challenge, Homelessness is a problem that’s more costly to ignore than to solve. Homelessness is a complex, life-threatening problem. It can be solved — but only if systems are built to get to zero.  Retrieved From, https://community.solutions/the-challenge/

Health.am, (2015), Mental Health Disorder Statistics, http://www.health.am/psy/more/mental-health-disorder-statistics/

Shi, L., & Singh, D. A. (2019). Essentials of the U.S. health care system with access (5th ed.). Burlington, MA: Jones & Bartlett Learning. ISBN: 9781284156720.

State of Homelessness: 2020 Edition, National Alliance to End Homelessness, Retrieved From, https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-2020/

Statista, (2021), Prevalence of depression, anxiety, PTSD, and suicidal ideation in the past 2 weeks among public health workers in the United States as of April 2021, by race/ethnicity, https://www.statista.com/statistics/1255157/prevalence-select-mental-health-conditions-by-race-in-us/