Protecting the public's health in an era of bioterrorism: the Model State Emergency Health Powers Act

During the fall of 2001, public health law scholars at the Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities were asked by the Centers for Disease Control and Prevention (CDC) and a series of national partners to develop the Model State Emergency Health Powers Act (MSEHPA). The MSEHPA provides a series of modern powers for states to consider in responding to catastrophic public health emergencies, including bioterrorism events. Since December 2001, provisions based on the MSEHPA have been introduced in nearly 40 states and passed in 20. Underlying the development of the act is a long-standing debate between legal and ethical scholars and law- and policymakers as to the appropriate ways to balance individual and communal rights. The drafting challenge was to create a comprehensive model law that provides adequate powers to protect the public's health while also respecting individual and group rights. The MSEHPA empowers public health agents with broad authority and simultaneously limits the exercise of power in time, duration, and scope to accomplish communal goals of abating serious public health threats. Coercive public health powers, particularly isolation and quarantine, are exercised on a temporary basis, only so long as are reasonably necessary and only among persons who justifiably may pose a risk to others because of their contagious conditions. Individual rights to contest the coercive use of public health powers, even during an emergency, are secured.     

On the Brink of Disaster

Abstract

In recent years mental health professionals have become increasingly aware of their role in ameliorating the impact of disaster and have begun to develop models for systematizing interventions. As many have noted, however, these models are largely based on clinical wisdom due to the dearth of empirical data on disaster and its social and psychological consequences. This article describes one model of disaster intervention, the Triple ABCD Model, and provides evidence-based guidelines for determining possible hazards and risks to both individuals and communities. Key factors considered are intentionality, predictability, time frame, degree of threat, location, extent of disruption and destruction, and timeliness and sustainability of the outside resources. Implications for practice include the importance of considering both individual and community factors in assessing risk and resilience; the need for mental health practitioners to exercise both clinical and community building skills when responding to disaster; and the importance of training and education of mental health professionals that include emergency planning and response with a focus on supporting the public at both an individual and community level.     

Moving Toward Medicare Home Health Coverage for Persons with Alzheimer's Disease

ABSTRACT

Medicare home health care policy does not incorporate research evidence of effective palliative home care interventions for Alzheimer's disease and dementia patients and caregivers. This article examines the dissonance between the needs and burdens of Alzheimer's disease patients and caregivers, research results on medical and palliative care interventions, and medicalized public policy in the Medicare home health benefit. The article asserts existing research establishes a prima facie case exists for the federal government to fund a Medicare Palliative Home Care for Alzheimer's disease demonstration project. The article cites the success of the Medicare Hospice Demonstration project and Hospice Medicare Benefit in reducing costs and improving client quality of life as precedent and a model for Alzheimer's disease. Other research implications are identified.     

Conversations at the End of Life

Abstract

Oregon's Death with Dignity Act (ODWDA) has been in effect for eight years. The United States Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act. Other states may consider a law similar to Oregon's through legislative process or ballot measures. Although social work is not mentioned in the law, our profession interfaces with the terminally ill, particularly in hospice. Eighty-seven percent of those who have used the law were enrolled in a hospice program. As a pilot project, this article explores conversations that the authors have had with patients, families, team members and health systems in hospices and oncology settings under Oregon's unique environment. The following four themes emerged from these conversations: (1) mental health, education, choice; (2) team concerns; (3) family issues; and (4) values, ethics, restricted conversations and professional struggles.     

When is a Health Department not a Health Department? The Case of the US Department of Health and Human Services

Given the current policy debate over health reform in the United States, it is not possible to describe the organizational structure that might emerge from this process. This article explores five of the attributes that underpin the context for a discussion of the structure and operation of a health bureaucracy in the USA. First, ambivalence in the US society about a public commitment to health and a general scepticism about a significant public sector in this area. Second, separation within the system between types of activities (e.g. health research activities, provision of services, and financing of health efforts). Third, the health system operates in the context of a government with shared powers as well as federalism and an assumption that some issues belong to states, and sometimes localities, and not to the federal government. Fourth, difficulty in the US system when it attempts to focus on prevention activities. And fifth, the structure of HHS creates tensions between management initiatives and professional expertise and standards. The article concludes with a discussion of possible organizational alternatives.     

Engaging the public in policy development: The national bioethics advisory commission report on research involving persons with mental disorders that may affect decisionmaking capacity

U.S. bioethics commissions have used a variety of methods to involve the public. All share a common requirement: as federal advisory committees they are required to comply with the Federal Advisory Committee Act, the federal law established during the Nixon administration which provides the public with an assurance that groups established by the government to advise the government should be publicly accountable. This paper will describe some of the ways the National Bioethics Advisory Commission (NBAC) sought to involve the public in its report on Research Involving Persons with Mental Disorders that May Affect Decisionmaking Capacity.     

The State Children's Health Insurance Program: Participation and Substitution

We examine the effects of SCHIP enactment by focusing on two policy concerns: take-up and crowd-out. The literature has examined how income eligibility expansions affect the type of children's insurance coverage. However, states jointly implemented various policy instruments. The results in previous works do not control for this variety. We analyze how changes in several SCHIP factors affected decisions regarding health insurance coverage. Our analysis indicates that the estimates in the literature may have combined the effects of various policy factors. In distinguishing individual policy factors, our results provide useful information for designing effective public health insurance programs.     

社会优位下的权利本位

阶级性不是法的唯一属性,以权利为核心重构现代法理念,将成为现代法理念的核心内容。从法治国家的理念、权利和义务(权力)的关系、市场经济的需求来看,必须坚持权利本位。权利本位内涵着个人优位下的权利本位和社会优位下的权利本位。有些学者认为,西方社会已经由权利本位过渡到社会本位,这是一种误解,其实,西方社会正在由个人优位下的权利本位理念过渡到社会优位下的权利本位理念。社会优位理念和和谐社会的理念完全契合,当个人的权利和社会的权利发生冲突时,社会权利应优先于个人权利。建设和谐法治社会,应该坚持社会优位下的权利本位理念     

Living Arrangements,Depression, and Health Status Among Elderly Russian-Speaking Immigrants

Abstract

This study examines the relationship between living arrangements, depression, and health status in a community-based sample of 300 elderly Russian-speaking immigrants. Data were collected via a self-administered questionnaire survey method. The questionnaire was designed to investigate various aspects of health, mental health, health services utilization, and health behaviors. A team of bilingual professionals was involved in the construction and translation of the survey instrument. The sample consists of 150 females and 150 males. The respondents' average age was 73.2 years. The regression analysis reveals that elderly Russian-speaking immigrants who live alone are more likely to experience a higher level of depression than those living with others. This relationship remains statistically significant after controlling for age, education, income, ability to speak English, years residing in the United States, gender, and health status. Since health status appears to influence depression, we performed further regression analyses and found that living arrangements had no statistically significant relationship with health status. Health status serves as an intermediate variable between the block of demographic variables and depression. Implications for future research are discussed.     

论所有权的自由与限制

所有权对于公民的财产权利甚至整个法权具有重要意义。近代民法一直强调所有权行使的绝对自由,忽略了所有权应该受到的社会公益限制,其结果是使自由走向了反面。为克服所有权绝对自由带来的负面影响,现代民法开始由权利本位转向社会本位,逐步形成了所有权的社会化思潮,强调所有权的行使应该以尊重和维护社会公益为前提。但是由于社会公益的概念比较宽泛,范围难以确定,为了防止有人以公益之名谋私益之实,应该对社会公共利益的界定确立实体标准和程序标准,以解决因社会公共利益的界定产生的争议,寻求社会公益与个人私益的平衡,维护公民个人的实体权利。     

The SESS multisite collaborative research initiative: establishing common ground

Multidisciplinary intervention approaches are needed for meeting service needs for families in which substance abuse and mental health disorders may be interfering with child‐rearing. Experiences from the Starting Early Starting Smart (SESS) initiative, a 12‐site national collaborative investigation of integrating behavioural health services in early childhood and primary health care service settings for children aged 0–5 years and their families and caregivers, are described. This 4‐year applied research initiative was co‐funded by the Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services and Casey Family Programs, a private operating foundation. SESS, which was developed and implemented in 12 geographically and culturally diverse cities in the USA during 1997–2001, encouraged federal, state, and local public/private partnerships. Opportunities and challenges in using an inclusive, consensus‐based, stakeholder model to maximize study relevance and utility for researchers, practitioners, and fiscal sponsors are discussed, and lessons for multidisciplinary, multisite research collaborations are identified.     

International Perspectives on the Use of Community Treatment Orders: Implications for Mental Health Social Workers

Substantial changes to mental health law and policy have occurredthroughout the Western world during the last decade. The drifttowards control, particularly in the form of Community TreatmentOrders (CTOs), has profound implications for the role of mentalhealth social workers, yet this issue is rarely discussed inacademic literature. This paper seeks to redress this gap inknowledge by examining aspects of law, policy and practice usingthree case studies: Victoria, Australia; Ontario, Canada; andregions of the UK. The paper begins by critically reviewingselected literature on CTOs, revealing competing claims aboutefficacy and their impact upon service users¹ and practitioners.A discussion of policy and practice contexts in the three jurisdictionsis then presented and supported with a typology, to illustratecontrasts and comparisons. In their conclusions, the authorsassert that mental health social workers often have a crucialpart to play in the implementation of CTOs but that this isnot always acknowledged in law and organizational policy. Socialworkers’ roles and responsibilities need to be more explicitlyidentified in mental health law. At the same time, there shouldbe a continuing debate about how such coercive powers fit withcodes of ethics and practice standards, at national and internationallevels.     

Microfinance Participation and Women's Empowerment: Evidence from a Nationally Representative Sample of Women in Bangladesh

ABSTRACT

More than 30 million married women in Bangladesh access microfinance, an empowering anti-poverty tool, amidst mixed responses from scholars about microfinance's empowering effect. The present study evaluates whether microfinance participation empowers women using a culturally suitable conceptualization of empowerment constituting autonomy, decision-making power in the household, and justification of partner violence. This study utilizes data from a representative probability sub-sample of 6,150 married women aged between 15 and 49 years from the Bangladesh Demographic and Health Survey 2011 to assess the difference in empowerment between microfinance participants and a control group using propensity score matching techniques. Findings revealed that women who participated in microfinance were not statistically different at the 0.05 level from women who did not participate in microfinance in terms of empowerment when groups were matched on socio-demographic variables ensuring that treatment and comparison groups had equal propensity to participate in microfinance, casting doubt on the assertion that microfinance participation positively affects women's empowerment. Future research needs to focus on what empowerment may mean in relation to the outside world; we need to move beyond a familial understanding of empowerment to examine the individual in terms of her individual identity in the socio-political world in which she resides.     

Guinea Pigs on the payroll: The ethics of paying research subjects

Regulatory bodies and scholars have traditionally conceptualized biomedical research on healthy subjects in the same way as research on patients. Guidelines and regulations have portrayed payment to a healthy subject as a potential constraint, or “undue influence,”; on the subject's free consent. In this essay we suggest an alternative way of conceptualizing research on healthy subjects, which sees the basic issue not as one of undue influence but as one of justice. Healthy subjects generally enroll in research protocols not for humanitarian reasons but for the money they will receive. Many of these protocols are conducted by profit‐driven corporations. Yet current guidelines and regulations prohibit subjects from negotiating for fair payment for the risks, discomforts and inconveniences they undergo, and IRBs are not staffed adequately to monitor the subject's safety. We propose to remedy the situation by regulating payment to healthy subjects as a labor relation.     

Social Policy in a Cold Climate: Health and Social Welfare in Russia

The Russian Federation faces multiple challenges for its health and welfare systems and for the development of social policy responses. This article provides a review of some of the key challenges for social policy in Russia and assesses the adequacy of the responses to date. The author surveys recent developments in health and social welfare and makes recommendations on priorities for Russia's policy‐makers and international funders. A range of public health challenges including drug and alcohol misuse, health in prisons and mental health is discussed; HIV/AIDS is singled out for particular attention. While Russia is increasingly attracting the attention of social scientists in the West, there is uncertainty about models and concepts suitable for the analysis of this complex society. Although empirical trends are largely discussed in this article, it is argued that theoretical development is required and some suggestions are made about concepts of the ‘middle range’ to assist in future analyses. Intermediate theories, such as those relating to the management of personal welfare, and development of resilience in a formerly collectivized context, are identified as having explanatory potential for this task.     

The Senior Outreach Program of Park Ridge Mental Health

Abstract

Availability and accessibility of mental health services for the elderly is woefully inadequate, failing to recognize the diversity of needs in the older adult population. Stigma, confusing and exclusionary insurance regulations and restrictive mental health center policies have both limited and discouraged treatment interventions. Through innovative case finding, programming and funding arrangements, the Senior Outreach program of Park Ridge Mental Health in Rochester, New York, has proven effective in identifying and providing outreach mental health services to elderly individuals. The program utilizes a human services agency model, yet operates within a large heath care system as part of a continuum of psycho-geriatric services.     

Measuring Family Caregiver Perceptions of Support in Caring for Children and Youth With Mental Health Concerns

ABSTRACT

This correlational study assessed how families of children with mental illness perceived the levels of support they received from informal and formal resource providers and the associations between perceived support and child outcomes. Adult caregivers (N = 904) of youth receiving public mental health care services were administered the Family Caregiver Perceptions of Support Scale developed by the authors to assess family caregiver perceptions of support prior to and at termination of services. Factor analysis identified three types of caregiver anticipated supports: informal support resources, support for treatment plan influence, and health care resources. The domains were significantly and positively associated with one another but did not uniformly correlate with youth mental health outcomes. The study provides preliminary evidence that treatment gains in youth mental health outcomes are observed when caregivers perceive support in treatment processes. Suggestions for future research are made, stressing the importance of caregivers and providers working together and describing needs related to future scale improvements.     

Public health care in the balance: exploring popular support for health care systems in the European Union

Which factors explain intra‐ and inter‐country variations in levels of public support for national health care systems within the European Union, and why? We propose that public opinion towards public health care is dependent on (1) the type of welfare state regime to which the various European welfare states belong, (2) typical features of the national care system and (3) individual social and demographic characteristics, which are related to self‐interest or morality oriented motives. To assess the explanatory power of these factors, data from the Eurobarometer survey series are analysed. Support for public health care appears to be particularly positively related to social‐democratic attributes of welfare states, whereas support drops with increasing degrees of liberalism and conservatism. Further, support for public health care proves to be associated with wider coverage and public funding of national care services. We also find higher levels of support in countries with scarce social services for children and the elderly, and larger proportions of female (part‐time) employment. Lastly, with respect to individual characteristics, we find remarkably little evidence for self‐interest oriented motives affecting the preference for solidary health care arrangements.     

Social Work and Child Mental Health: Psychosocial Principles in Community Practice

Correspondence to Steven Walker, Senior Lecturer, School of Community Health and Social Studies, Anglia Polytechnic University, 2nd Floor, Ashby House, Brook Street, Chelmsford, Essex CM1 1SQ, UK. E-mail: s.walker{at}apu.ac.uk Summary The increased prevalence, complexity and earlier onset of childand adolescent mental health difficulties, has prompted governmentinitiatives to reconfigure current provision for this clientgroup, their parents and the carers who try to support them.Social workers have an important part to play in respondingto the needs of these individual children and families. A residual,care management role is not adequate in these circumstances.This paper describes the development of social work in childand adolescent mental health, and suggests that a synthesisof psychosocial principles and community practice, offers theoptimum social work model of assessment and intervention. Sucha model embraces the most useful aspects of psychodynamic theoryin the context of practice consistent with anti-discriminatory,children's rights and partnership principles.