Vital Signs: A Prescription for Our Health Care System

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Vital Signs

by Rick Ybarra

In Health Affairs most recent blog post, the new Institute of Medicine (IOM) report, Vital Signs, hones in on a proposed set of 15 core measures leading to better health and lower costs. The measures focus on a wide range of areas including well-being, addictive behavior, access to care, evidence-based care, care matched with patient goals, individual engagement, and community engagement.

The report makes the strong argument that a shared vision and accountability among health care providers, administrators, payers, policymakers, patients, and families in the pursuit of measurement and performance improvement are essential to improving the health of our people, communities, and the nation.

Safety-net organizations such as community health centers play a critical role in demonstrating improvement on these proposed core measures. The report notes that patients who receive their health care from safety-net providers experience the deepest disparities in these 15 measures. These populations have poorer health status, have lower health literacy, and may experience more significant barriers in accessing care than others. In addition, poor, uninsured, under-insured and publicly-insured patients are more likely than others to experience trauma and depression.

If safety-net providers do not attend to these measures while the rest of the health system does, health disparities will continue to widen. Furthermore, the Health Affairs blog post argues that patients served by community health centers may benefit the most from focused attention on these 15 core measures, so improving the health status for the most vulnerable populations will raise the health status for the nation as a whole.

Clearly, this has huge implications for safety-net providers working with limited resources, as they face the challenges of implementing and monitoring these measures. The Vital Signs authors offer recommendations based on their current work with safety-net providers in California for using the principles of the Triple Aim — population health, patient experience, and cost—to drive system change and deliver effective and efficient care.

Although it may seem overwhelming for safety-net providers to implement the core measures outlined in the IOM report, it is possible, since many of these measures are already collected by community health centers. The Health Affairs authors conclude that health care organizations can and should focus attention on improving measurement to support the delivery of high-quality, cost-efficient, patient- and population-centered care.

Now that’s a prescription we can all follow!

Farewell, Jemila!

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In July we will be saying good-bye to our policy fellow, Jemila Lea. Her two years at Hogg, during which she helped to further the foundation’s public policy priorities on issues such as foster care and guardianship reform, were successful and rewarding. Among her highlights:

  • She participated on the Texas CASA Mental Health Task Force, which met over the course of a year from August 2013 until August 2014. The task force developed a report titled, “Respecting the Needs of Children and Youth in Foster Care: Acknowledging Trauma and Promoting Positive Mental Health Throughout the System – Recommendations of theTexas CASA Mental Health Task Force.” Jemila worked on a subcommittee that provided recommendations on Empowerment and Normalization of Youth in Substitute Care. Those recommendations became the basis for legislation, S.B.1407, which aimed to encourage foster youth to participate in age-appropriate normalcy activities, by allowing substitute care giver to approve or disapprove a child’s participation in activities, using a reasonable and prudent parent standard, without prior approval from the Department of Family and Protective Services. The bill was signed into law by Gov. Abbott. Jemila also had the pleasure of facilitating a panel on Normalcy, Empowerment, and Positive Mental Health Outcomes, which included two former foster youth, at the Texas CASA Child Welfare Primer held in Austin.
  • She participated on the Guardianship Reform and Supported Decision Making work group over the course of her fellowship. This provided her an opportunity to learn about the intricacies of guardianship and alternatives to guardianship such as supported decision-making. She actively tracked a number of bills aimed at amending the estates code concerning guardianship as they made their way through the legislative process this session.
  • Jemila was an invaluable help in contributing to the second edition of A Guide to Understanding Mental Health Systems and Services in Texas, the foundation’s one-of-a-kind guide to the mental health system in Texas.
  • She was part of the implementation team for the foundation’s new grant management software, Fluxx. With the flood of new proposals that the foundation typically receives during the spring and summer months, a seamless transition to the new software was essential, and Jemila was an asset to that process.
  • On June 30, 2015, Jemila contributed her expertise to a webcast sponsored by the State Bar of Texas about recent developments in mental health and disability issues in the 84th Texas Legislature.

Jemila will be returning to the Dallas/Fort Worth area to pursue her career in law.

“It’s hard to spend two years working as a policy fellow for an organization like Hogg and not come away transformed,” said Jemila. “I hope to utilize the experiences from this policy fellowship to the benefit of future clients I may have the opportunity to serve.”

Into the Fold, Episode 12: Rebecca Bigler on Internalized Sexualization in Adolescent Girls

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One of the biggest challenges for adolescent girls is developing an effective sense of self amid the sexualizing gaze of popular culture, their peers, and society at large. There is now evidence that the everyday process of contending with, and placating, this sexualizing gaze imposes cognitive costs that can negatively impact girls’ performance on the kinds of mentally demanding tasks required to excel in school and the workplace. In this episode of Into the Fold, Dr. Rebecca Bigler (pictured above), professor of psychology at The University of Texas, discusses her recent study, in which a sample of adolescent girls is asked to conduct a mock news broadcast. We delve into its compelling finding that the preoccupation with being “hot” (i.e. conventionally attractive, feminine and sexually available) can come at the expense of job-related performance. ​ Read the rest of this entry »

Dr. Ira Iscoe, 1921-2015

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Dr. Ira Iscoe
Dr. Ira Iscoe

We are saddened by the recent death of Dr. Ira Iscoe, who passed away on Friday, June 12 at the age of 94. For decades he was a steadfast ally of the Hogg Foundation, working behind the scenes in the foundation’s campaign in the 1950s and 1960s to reform the state hospitals and special schools, as well as helping to lead the push toward community mental health.

Iscoe joined the psychology faculty at the University of Texas in 1951. He and his wife Louise were vocal supporters of racial integration at the University of Texas at Austin. Ira recruited and taught some of the first African American students in the psychology program, among them Bertha Holliday, the first African American Ph.D in psychology at UT. She earned her Ph.D. in 1978 in Community Psychology (a program Iscoe started) and went on to direct the APA’s Office of Ethnic Minority Affairs.

In 1963 Iscoe authored a Hogg Foundation pamphlet, Women View Their Working World, based on a survey of about 100 women who worked in different professions. As Iscoe put it: “There is no telling how much frustration we actually bring about by imbuing a competent and potentially professional woman with the ideas of freedom and achievement and then bringing her face to face with social pressures which prevent her potential from coming to fruition.”

After the infamous UT Tower shooting in 1966, Iscoe led the foundation’s efforts to help improve and reform counseling services at the university, and would go on to direct student counseling at the university in its first decade of existence.

The Hon. Rodney Griffin (UT Austin, Class of ’70), a Texas Democratic Party committeeman, was mentored by Iscoe and remembers him fondly.

“I am deeply saddened by the loss of Dr. Ira Iscoe. Ira was one of my mentors during my student years at The University of Texas At Austin,” said Griffin in a comment posted on Iscoe’s obituary page. “Director Iscoe entrusted me with facilitating a study about African American students collective mental health in the UT environment. The research was funded by The Hogg Foundation. My prayers go out to his widow Louise and the entire family. Dr. Iscoe will be missed.”

Jon Stewart Gets It Right: It is Not All About Mental Illness

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by Colleen Horton

Whether you like Jon Stewart or not, it’s difficult not to appreciate the truthfulness in his statements relating to the murders in Charleston, South Carolina. During his broadcast on Thursday night, he points out that much of the tragic violence happening today is not about individual incidents or the individuals committing them, but is more about a societal problem that we have refused to admit continues to exist. All too often mass murders are pushed aside with the excuse that the person almost certainly suffered from mental illness. Last night one cable news anchor referred to the murderer as “a psychotic” without really knowing anything about his mental health history. Far too often we ignore the more societal causes of these horrendous acts such as racism, revenge, fear, anger, rage, terrorism and despair. Using mental illness as the sole reason for these tragedies lets us all off the hook too easily.

Some of you might remember Dr. Joel Dvoskin, who addressed mass homicide and mental illness in several events put on by the Hogg Foundation in February. He is featured in a series of short video interview segments now available on our YouTube page.

Mental Health and Social Policy: A Q&A with Lauren Rosales

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Lauren Rosales
Lauren Rosales

by Ike Evans

On the Hogg Foundation website, there are currently policy briefs that were each authored by a graduate student at The University of Texas at Austin. What else do they have in common? All of the students were either Hogg Foundation graduate research assistants or recently completed an interdisciplinary graduate seminar, “Mental Health and Social Policy,” taught by the Hogg Foundation’s own Dr. Lynda Frost, director of planning and programs. Though the briefs do not reflect official positions of the foundation, we are happy to share them in the hopes that they will further inform policy discussions, decision making, and smart action on complex issues in mental health policy in Texas.

Over the coming weeks, we will be featuring Q&A interviews with the some of the graduate students in this blog space. This interview is with Lauren Rosales, a dual master’s candidate in public policy and social work. She talks about her work in the area of forensic peer support.

Tell us about yourself. At what point did you decide to pursue a dual master’s in public policy and social work, and what influenced that decision?

Being a first generation college graduate, I wanted to give back to the community and inspire youth to pursue their dreams through a year of AmeriCorps service before beginning my graduate studies. As I considered various graduate programs, social work’s focus on social justice and fighting for marginalized populations resonated with me. I was drawn to this, because the church I attended since childhood is very social justice oriented and instilled in me a value for helping those affected by social injustices. I decided to couple my social work training with a degree in public affairs, because I recognized the benefit of advocating on a macro level to impact the policies that govern social service practices.

Your brief is titled, Forensic Peer Specialists in Correctional Facilities: What Are the Training Needs Beyond Traditional Peer Support Training?

Ever since I was a child, the health field has intrigued me. My initial interest in criminal justice and providing services to justice-involved individuals was sparked during my first social work field placement. For my group facilitation training, I co-facilitated groups in the Travis County jail for maximum security justice-involved females. This experience opened my eyes and heart to the staggering prevalence of racial and mental health disparities that are represented by the individuals within the criminal justice system in a way that simply reading statistics could not. Many of the participants expressed a current or former need for mental health services. The lack of programming available to these women led me to look into what could be done to improve access to mental health services for the justice-involved population. During the summer of 2014, I worked at Via Hope, which is the state’s credentialing agency for mental health peer support specialists. Working there, I learned more about peer specialists and the value, insight, and hope that they bring to consumers in the recovery process. Recent conversations and efforts to expand peer specialist work into forensic settings prompted me to write this brief, because the literature is limited on how training for forensic peer specialists may need to be different or expanded upon relative to traditional peer specialists training. The primary questions I am trying to address are: What additional training or support is needed for peer specialists in forensic settings? How can training be developed to address these needs?

Are you interested in engaging in the policy process (local, state, federal) in other ways in addition to your academic work? Are there people or organizations you consider champions on your issues?

I am interested in engaging in the policy process in addition to my academic work. As part of my work experience as a mental health policy intern at the Center for Public Policy Priorities, (CPPP) I was involved in efforts to improve the access and quality of mental health services available to individuals. As a social work student, I think that it is important for the voices of individuals who are most directly affected by social services and the associated policies to be heard. Throughout my career, I hope to bring their voices into policy discussions. The Hogg Foundation for Mental Health and the Center for Public Policy Priorities are two champion organizations that are exploring the feasibility of forensic peer support programs in Texas. Nationally, Peerstar, LLC based in Pennsylvania is a leader for forensic peer support services within correctional facilities.

Are there any resources that you can recommend for those who might wish to learn more about the topic?

Peerstar, LLC, which is Pennsylvania’s provider of forensic peer support services, has a presentation about its forensic peer support program. CPPP has a report that explains forensic peer support and explores the possibility of establishing forensic peer support in Texas.

How do you plan on using what you learned while authoring your brief in your future work? What are those future aspirations?

My primary interests are focused on the intersections of mental health and criminal justice. I am especially interested in restorative justice and envision myself being involved with both direct practice, particularly in correctional facilities, and policy work. Whether I am in a policy-oriented or direct practice role, the process of writing this brief serves to help me better understand the challenges that individuals within correctional facilities face, especially if they are living with mental illnesses. In addition, it will remind me of the strength and perseverance they have and will serve as continued motivation to improve access to and quality of services for these populations.

Editor’s note: In December 2014 the Hogg Foundation hosted a forum on forensic peer support. Video of the forum was recorded and can now be viewed on our YouTube page.

Webcast: Mental Health and Disability Issues in the Texas Legislature

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Medicaid rally at Texas CapitolOn Tuesday, June 30,  TexasBarCLE is hosting a webcast, “Legislative Update 2015: Mental Health and Disability Law,” an overview of the 84th Legislature’s hits and misses for Texans with disabilities. Three policy experts discuss key successes and failures of the Legislature on a host of issues that affect Texas families and communities.  Chase Bearden, the Director of Advocacy & Community Organizing for the Coalition of Texans with Disabilities (CTD), and Chris Masey, CTD’s Developmental Disability Policy Fellow, will speak about legislative changes affecting people with physical, developmental, and intellectual disabilities. Jemila Lea, a Policy Fellow at the Hogg Foundation for Mental Health, will address mental health-related legislation. The webcast will be moderated by Lynda Frost, Director of Planning and Programs at the Hogg Foundation and a member of the Disability Issues Committee of the State Bar of Texas. For those who are interested in guardianship, civil commitment, child welfare, criminal law, health law, housing, and civil rights, this webcast should not be missed.

Register for the webcast here. Participants will earn one hour of MCLE credit.

“I was most excited to see bills pass that aim to promote positive mental health outcomes in the foster care system and bills that support self-determination and less restrictive alternatives to guardianships,” said Jemila Lea. “With funding from the Hogg Foundation, Texas CASA formed a Mental Health Task Force in August 2013, which met over the course of year. As a member of the task force, I know the hard work that went into identifying a variety of mental health issues facing children and youth in the child welfare system.”

The Mental Health Task Force developed a written report of policy recommendations providing background on the most impactful issues affecting mental health outcomes of children and youth in foster care. The report was instrumental in informing child welfare legislation such as S.B. 1407, which empowers caregivers to make decisions regarding age-appropriate normalcy activities for children in the foster care system without prior approval of the Department of Family and Protective Services.

Guardianships for adults with disabilities was another issue addressed by the Legislature. H.B. 39, now signed into law, provides for guardianships that promote self-reliance and independence for individuals who have been deemed to be incapacitated including the presumption that individuals under guardianship maintain the right to decide where they want to live. The law also establishes supported decision-making agreements as a less restrictive alternative to guardianships for adults with disabilities who need assistance with decisions regarding daily living but who are not considered incapacitated for purposes of establishing a guardianship.

According to Jemila, a key bill that did not pass was S.B. 204, the Department of Aging and Disability Services sunset bill, that would have required the development of crisis intervention teams for individuals with intellectual disabilities and would have offered an opportunity to study and plan for an effective delivery system for long term services and supports.

“The 84th session was particularly successful for people with disabilities in decreasing barriers and reforming specific problematic issues, as long-standing legislative champions allied with an emerging new group of champions in advancing programs that increased self-sufficiency, focused in decreasing government restrictions, and stressed independence,” said Chris Masey of CTD. “Most of the new champions were conservative with family members who have disabilities. These new coalitions created true bipartisan support for initiatives that have made the lives of people with disabilities significantly better.”