Rand health quarterly最新文献_第7页

Evaluating the U.S. Military's Progress Toward an Integrated Primary Prevention Workforce: Five-Year Process Evaluation Plan. 评估美军迈向综合初级预防队伍的进展：五年过程评估计划。

Rand health quarterly Pub Date : 2025-03-17 eCollection Date: 2025-03-01

Joie D Acosta, Matthew Chinman, Patricia M Herman, Stephanie Brooks Holliday, Wenjing Huang, Kyleanne M Hunter, Kirsten M Keller, Sapna J Mendon-Plasek, Laura L Miller, Amy L Shearer, Kayla M Williams

{"title":"Evaluating the U.S. Military's Progress Toward an Integrated Primary Prevention Workforce: Five-Year Process Evaluation Plan.","authors":"Joie D Acosta, Matthew Chinman, Patricia M Herman, Stephanie Brooks Holliday, Wenjing Huang, Kyleanne M Hunter, Kirsten M Keller, Sapna J Mendon-Plasek, Laura L Miller, Amy L Shearer, Kayla M Williams","doi":"","DOIUrl":"","url":null,"abstract":"Service members can harm others through sexual assault, harassment (e.g., sexual harassment, bullying, hazing, reprisal, retaliation), domestic abuse, child abuse and neglect, and intimate partner abuse and can harm themselves through attempting or dying by suicide. This range of harmful behaviors can affect service members' overall physical and mental health and be detrimental to force readiness. A robust prevention system is needed to address these harms. A dedicated, qualified, and competent prevention workforce across strategic, operational, and tactical levels is one of the cornerstones of a robust prevention system. In response to a recommendation from the Independent Review Committee on Sexual Assault in the Military, the U.S. Department of Defense is hiring roughly 2,000 Integrated Primary Prevention (IPP) personnel-individuals with particular knowledge and skills in the conduct of prevention activities. These individuals' sole function will be to conduct data-informed activities to prevent various harmful behaviors experienced by service members. In this study, the authors describe the methods for evaluating progress toward fully implementing an IPP workforce. Once this five-year evaluation is completed, the findings will document how much progress has been made toward full implementation, including an understanding of the structure and functioning of the prevention infrastructure and prevention teams, leader support of IPP, and the quality and comprehensiveness of prevention plans. These findings will be useful for professionals responsible for addressing a variety of harmful behaviors (e.g., sexual assault, suicide) and for commanders and other senior-level military leaders and policymakers interested in improving the quality of efforts to prevent harmful behavior in the military.","PeriodicalId":74637,"journal":{"name":"Rand health quarterly","volume":"12 2","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research. 对跨性别和性别膨胀青年的性别焦虑和相关健康问题的干预：对实践、政策和研究的益处和风险的系统回顾

Rand health quarterly Pub Date : 2025-03-17 eCollection Date: 2025-03-01

Alex R Dopp, Allison Peipert, John Buss, Robinson De Jesús-Romero, Keytin Palmer, Lorenzo Lorenzo-Luaces

{"title":"Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research.","authors":"Alex R Dopp, Allison Peipert, John Buss, Robinson De Jesús-Romero, Keytin Palmer, Lorenzo Lorenzo-Luaces","doi":"","DOIUrl":"","url":null,"abstract":"Transgender and gender-expansive (TGE) youth often experience gender dysphoria, defined as distress related to a mismatch between one's gender identity and physical development. This study summarizes the rapidly evolving state of evidence on interventions for gender dysphoria and related health problems in TGE youth. The authors conducted a systematic review of studies that assessed interventions for gender dysphoria in TGE youth (age 25 or younger), published from 1990 to 2023, and summarized the amount, clinical significance, and certainty of evidence available. The authors reviewed and summarized the available evidence for beneficial and harmful outcomes associated with intervention categories currently recommended as the standards of care (i.e., gender-affirming psychosocial, hormonal, surgical, and reproductive health interventions) for addressing gender dysphoria and related health problems, as well as proposed alternatives to the standards of care (gender identity and expression change efforts and treatment for co-occurring mental disorders to reduce gender dysphoria). Across intervention categories and outcomes, limitations in the available evidence made it difficult to estimate with certainty the strength (and sometimes direction) of associations between intervention and outcome. Yet practitioners and policymakers can incorporate the best available science when making decisions about health care for TGE youth using evidence-informed approaches to account for these conditions of uncertainty. The authors also discuss implications for researchers seeking to improve this body of evidence so that it provides greater certainty about intervention effects and has greater practice and policy relevance.","PeriodicalId":74637,"journal":{"name":"Rand health quarterly","volume":"12 2","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Perceptions of Mental Health Confidentiality Policies and Practices in the U.S. Military. 美国军队对心理健康保密政策和实践的认识。

Rand health quarterly Pub Date : 2025-03-17 eCollection Date: 2025-03-01

Eunice C Wong, Molly Waymouth, Ryan K McBain, Terry L Schell, Grace Hindmarch, Julia Vidal Verástegui, Jonathan Welch, Robin L Beckman, Michael W Robbins, Charles C Engel, Kristie L Gore

{"title":"Perceptions of Mental Health Confidentiality Policies and Practices in the U.S. Military.","authors":"Eunice C Wong, Molly Waymouth, Ryan K McBain, Terry L Schell, Grace Hindmarch, Julia Vidal Verástegui, Jonathan Welch, Robin L Beckman, Michael W Robbins, Charles C Engel, Kristie L Gore","doi":"","DOIUrl":"","url":null,"abstract":"High rates of mental health issues among service members and a reluctance to access mental health services together represent one of the greatest ongoing threats to U.S. military readiness. Concerns about the confidentiality of mental health services received within the military have been documented as a significant barrier to service members obtaining needed treatment. At times, disclosing mental health information to commanding officers may be necessary so that informed decisions can be made about duty assignments, needed accommodations, unit resources, or deployments. The challenge the U.S. military faces is how to optimally protect service members' confidentiality so that mental health services are sought and needs are not driven underground-while also ensuring the successful execution of the military mission. In this study, the authors examine the potential impact of existing U.S. military mental health confidentiality policies on service members seeking assistance for mental health issues. The authors conducted a multimethod investigation involving key-stakeholder interviews with military mental health providers, commanding officers, and enlisted service members and a survey of the active component regarding knowledge, understanding, and practices associated with mental health confidentiality policies. Findings shed light on the perceptions held by service members on the limits to mental health confidentiality and how policy implementation influences service members' decisions regarding mental health care. The authors recommend steps that the U.S. Department of Defense could take to improve military personnel's understanding of confidentiality policies, strengthen processes to ensure that policies are implemented as intended, and mitigate the consequences associated with the limited confidentiality afforded to mental health services within the military.","PeriodicalId":74637,"journal":{"name":"Rand health quarterly","volume":"12 2","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Telehealth Visits in Health Centers Serving Low-Income Patients in California: Final Results from the Connected Care Accelerator Initiative (2022-2024). 加州为低收入患者服务的医疗中心的远程医疗访问：连接护理加速器倡议（2022-2024）的最终结果。

Rand health quarterly Pub Date : 2025-03-17 eCollection Date: 2025-03-01

Lori Uscher-Pines, Jessica L Sousa, Colleen M McCullough, Shirley Dong, Kandice A Kapinos

{"title":"Telehealth Visits in Health Centers Serving Low-Income Patients in California: Final Results from the Connected Care Accelerator Initiative (2022-2024).","authors":"Lori Uscher-Pines, Jessica L Sousa, Colleen M McCullough, Shirley Dong, Kandice A Kapinos","doi":"","DOIUrl":"","url":null,"abstract":"Federally Qualified Health Centers (FQHCs) are outpatient health centers that provide primary care and limited specialty-care services to nearly 30 million low-income patients. Prior to the coronavirus disease 2019 (COVID-19) pandemic, FQHCs rarely delivered audio-only or video telehealth visits. However, with both temporary and permanent policy changes to facilitate telehealth use at the state and federal levels, telehealth has become an important modality of care. In 2023, approximately 9 percent of FQHC visits in the United States and 20 percent of FQHC visits in California occurred via video or audio-only visits delivered into patients' homes. In this study, the authors summarize data on the use of in-person, audio-only, and video health visits during September 2022 to August 2024, a period that included the end of the COVID-19 public health emergency in May 2023 and beyond. These data were collected to evaluate the impact of the Connected Care Accelerator program, which is an effort launched by the California Health Care Foundation in July 2020 to support health centers in implementing telehealth for low-income patients in California. This study is the final in a series of studies that were published from 2021 to 2024.","PeriodicalId":74637,"journal":{"name":"Rand health quarterly","volume":"12 2","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of Climate Change on Health and Drug Demand. 气候变化对健康和药物需求的影响。

Rand health quarterly Pub Date : 2025-03-17 eCollection Date: 2025-03-01

Mahshid Abir, Raffaele Vardavas, Zohan Hasan Tariq, Emily Hoch, Emily Lawson, Sydney Cortner

引用次数: 0

Assessing Readiness in Service Members Who Receive Private-Sector Behavioral Health Care. 评估接受私营部门行为保健服务的服务人员的准备情况。

Rand health quarterly Pub Date : 2025-03-17 eCollection Date: 2025-03-01

Jessica L Sousa, Kimberly A Hepner, Carol P Roth, Lia Pak, Teague Ruder

{"title":"Assessing Readiness in Service Members Who Receive Private-Sector Behavioral Health Care.","authors":"Jessica L Sousa, Kimberly A Hepner, Carol P Roth, Lia Pak, Teague Ruder","doi":"","DOIUrl":"","url":null,"abstract":"Ensuring that service members who receive behavioral health (BH) care receive routine readiness assessments is critical to maintaining a ready military force. Routine assessments of service members' medical readiness and deployability help identify any acute or chronic health conditions-physical or psychological-that could negatively affect a service member's ability to perform their military duties. Service members may receive BH care from a military treatment facility (MTF) provider (often referred to as direct care) or from a TRICARE-contracted civilian provider in the community (often referred to as private-sector care). While readiness assessments are routinely included in clinical encounters at MTFs, it has been unclear how readiness assessments are being conducted for service members seen in private-sector care. This study presents the findings and integration of two analyses-of administrative treatment data and of qualitative interviews with MTF administrators and clinical staff-that can inform policymaking and planning to improve readiness assessments and command communication for service members receiving private-sector BH care.","PeriodicalId":74637,"journal":{"name":"Rand health quarterly","volume":"12 2","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost Trade-Offs Between Accessing and Retaining Uniformed Mental Health Providers. 获得和保留统一精神卫生服务提供者之间的成本权衡。

Rand health quarterly Pub Date : 2025-03-17 eCollection Date: 2025-03-01

Avery Calkins, Michael G Mattock, Shannon D Donofry, Daniel Schwam, Anthony Lawrence, Kimberly A Hepner

{"title":"Cost Trade-Offs Between Accessing and Retaining Uniformed Mental Health Providers.","authors":"Avery Calkins, Michael G Mattock, Shannon D Donofry, Daniel Schwam, Anthony Lawrence, Kimberly A Hepner","doi":"","DOIUrl":"","url":null,"abstract":"The Military Health System does not have enough military mental health providers to meet demand among active-duty service members, despite efforts in the U.S. Department of Defense (DoD) to leverage special pays to recruit and retain staff. Maintaining adequate military mental health care services is important for maintaining the readiness of the overall force. To expand its mental health workforce and stabilize its care delivery system, DoD needs cost-effective options for increasing the force size of military mental health providers in both the short and long terms. In this study, the authors used the RAND Dynamic Retention Model to simulate how changing retention bonuses for uniformed mental health providers increased active component retention and per capita personnel cost. Using these results, the authors determined the most cost-effective way to increase the force size of the uniformed mental health provider workforce; specifically, accessing more providers or retaining more providers. The authors also compared military compensation for psychiatrists, clinical psychologists, social workers, and mental health nurse practitioners with expected civilian compensation for these types of providers. DoD leaders and personnel managers can use the key findings and recommendations offered to make informed choices among potential strategies for expanding its uniformed mental health workforce.","PeriodicalId":74637,"journal":{"name":"Rand health quarterly","volume":"12 2","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Estimating the Effects of Further Expanding Health Insurance Coverage to Noncitizen Populations in Connecticut. 估计进一步扩大健康保险覆盖到康涅狄格非公民人口的影响。

Rand health quarterly Pub Date : 2025-03-17 eCollection Date: 2025-03-01

Preethi Rao, Federico Girosi

引用次数: 0

Use of Inpatient Psychiatric Facilities by Medicare Beneficiaries with Dementia. 老年痴呆症医疗保险受益人住院精神病设施的使用。

Rand health quarterly Pub Date : 2025-03-17 eCollection Date: 2025-03-01

Mark J Sorbero, Yaou Flora Sheng, Swad Komanduri, Jodi L Liu

{"title":"Use of Inpatient Psychiatric Facilities by Medicare Beneficiaries with Dementia.","authors":"Mark J Sorbero, Yaou Flora Sheng, Swad Komanduri, Jodi L Liu","doi":"","DOIUrl":"","url":null,"abstract":"Alzheimer's dementia, the most common type of dementia, afflicts more than 6 million Americans. More than 80 percent of people living with dementia (PLWD) live in the community, either with caregivers or alone. As cognitive impairment becomes more severe, behavioral and psychological symptoms of dementia (BPSD) become more difficult to manage, and those with severe or dangerous BPSD may need to be treated in an inpatient psychiatric facility (IPF). The immediate goal of an IPF stay is to stabilize patients in a psychiatric crisis. IPFs primarily serve people with serious mental illness and substance use disorders, whose care needs may overlap with but also differ from the needs of PLWD. Little is known about PLWD who use IPFs. The goal of this research was to conduct exploratory analyses focused on PLWD who use IPFs to (1) characterize the population and compare them with IPF users without dementia, (2) examine characteristics and utilization patterns for different services and settings that may be associated with IPF stays, and (3) analyze outcomes following IPF stays. The authors used Medicare fee-for-service data to conduct descriptive analyses characterizing beneficiaries with dementia who experienced an IPF stay in 2018 and compare them with beneficiaries without dementia. The research team used regression analyses to explore predictors of IPF use and service use and outcomes after IPF discharge.","PeriodicalId":74637,"journal":{"name":"Rand health quarterly","volume":"12 2","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Annual Trends Among the Unsheltered in Three Los Angeles Neighborhoods: The Los Angeles Longitudinal Enumeration and Demographic Survey (LA LEADS) 2023 Annual Report. 洛杉矶三个社区无庇护者的年度趋势：洛杉矶纵向枚举和人口调查（LA LEADS） 2023年度报告。

Rand health quarterly Pub Date : 2024-12-30 eCollection Date: 2024-12-01

Jason M Ward, Rick Garvey, Sarah B Hunter

{"title":"Annual Trends Among the Unsheltered in Three Los Angeles Neighborhoods: The Los Angeles Longitudinal Enumeration and Demographic Survey (LA LEADS) 2023 Annual Report.","authors":"Jason M Ward, Rick Garvey, Sarah B Hunter","doi":"","DOIUrl":"","url":null,"abstract":"Since fall 2021, the authors of this study have conducted regular enumerations of the unsheltered populations in three Los Angeles neighborhoods known for having high concentrations of people experiencing unsheltered homelessness: Hollywood, Skid Row, and Venice. In addition to counts, the authors have conducted surveys of unsheltered residents in these same neighborhoods to better understand the characteristics, experiences, and needs of these populations. The results of the first year of this study, known as the Los Angeles Longitudinal Enumeration and Demographic Survey (LA LEADS), were presented in a report published by RAND in 2023. The authors continued their enumeration and survey efforts in these three neighborhoods throughout 2023 using an updated survey instrument that includes new questions about employment, income, experiences with service providers, health conditions, and substance use. This study presents their findings from the 2023 data collection period and includes comparisons with the previous year's effort and new information about unsheltered populations' experiences and needs across the same three Los Angeles neighborhoods.","PeriodicalId":74637,"journal":{"name":"Rand health quarterly","volume":"12 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0