NCLR takes a close look at chronic disease among Hispanics in the United States

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NCLR (National Council of La Raza) examines the challenges faced by millions of Latinos who live with one or more chronic conditions that affect their daily lives in An Inside Look at Chronic Disease and Health Care among Hispanics in the United States.  The report, "documents a high rate of chronic disease and obesity among the Latinos surveyed, with nearly half of those with a chronic condition reporting their health as poor to fair."

Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid

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White House Report: Missed Opportunities and the Consequences of State Decisions Not to Expand Medicaid

Today, the Council of Economic Advisers released a report, Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid, which details the effects of state decisions regarding Medicaid expansion on access to care, financial security, overall health and well-being of residents, and state economies.

The Affordable Care Act has expanded highquality, affordable health insurance coverage to millions of Americans. One important way in which the Affordable Care Act is expanding coverage is by providing generous financial support to States that opt to expand Medicaid eligibility to all nonelderly individuals in families with incomes below 133 percent of the Federal Poverty Level.

To date, 26 States and the District of Columbia have seized this opportunity, and since the beginning of the Affordable Care Act’s first open enrollment period, 5.2 million people have gained Medicaid or Children’s Health Insurance Program (CHIP) coverage in these States, a tally that will grow in the months and years ahead as Medicaid enrollment continues. In contrast, 24 States have not yet expanded Medicaid—including many of the States that would benefit most and sometimes because State legislatures have defied even their own governors—and denied health insurance coverage to millions of their citizens. Researchers at the Urban Institute estimate that, if these States do not change course, 5.7 million people will be deprived of health insurance coverage in 2016. Meanwhile, these States will forgo billions in Federal dollars that could boost their economies.

This analysis uses the best evidence from the economics and health policy literatures to quantify several important consequences of States’ decisions not to expand Medicaid. That evidence, which is based primarily on careful analysis of the effects of past policy decisions, is necessarily an imperfect guide to the future, and the actual effects of Medicaid expansion under the Affordable Care Act could be larger or smaller than the estimates presented below. However, this evidence is clear that the consequences of States’ decisions are farreaching, with implications for the health and wellbeing of their citizens, their economies, and the economy of the Nation as a whole.

Laura's Law: Innovative compromise proposed around assisted outpatient treatment

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An important read from our colleagues at No Health without Mental Health. As the debate about assisted outpatient treatment continues, San Francisco is exploring some innovative approaches to making it work in a way that addresses need, is respectful of individual choice and includes family involvement.

On July 8, 2014 the 11 member San Francisco Board of Supervisors (city council) voted 9-2 to implement a 2002 California state law, called Laura’s Law, which can compel certain individuals suffering from serious mental illness to undergo, under strict safeguards, outpatient treatment. The ordinance now goes to the Mayor Ed Lee who supports it. Los Angeles County is considering a similar ordinance next week.

In so doing, San Francisco reached a potentially historic compromise in the battle between treatment for serious mental illness versus patients right to decide their care. It may set an example for the rest of the country.

The setting for this landmark compromise is dramatic and telling. As the widely acknowledged most beautiful city in America, with its iconic Golden Gate Bridge and long history of incoming migrants, San Francisco has long been a magnet for people with mental illness, creating a large population of those with psychiatric disorders. The “City” (as locals call it) has also been dubbed “the most liberal city in America” going back to the UC Berkeley free speech movement of the 1960s. For years the issue of whether to implement Laura’s Law, which focuses strictly on persons with severe mental illness who due to the illness cannot ask for help themselves, has been a political hot potato. Families, mental health providers and law enforcement have pleaded for ways to be able to treat these individuals. Conversely, many patient advocates have strenuously argued that the individual’s right to determine their own care, should be paramount.

Laura’s Law is named for Laura Wilcox, a 19 year old college sophomore shot and killed, while working as a temporary receptionist in a government office, by a psychiatric patient with untreated mental illness. Laura’s parents had for years fought to create an option of seeking court-ordered mandatory treatment for patients unable to seek help themselves. In 2002 the State Legislature enacted Laura’s Law but requires each county in the State to opt-in before it is effective. Many in the patients’ rights field and some behavioral health advocates fought its implementation, believing that individuals should never be coerced to accept care.

With last week’s historic vote, San Francisco may be setting an example for Washington, D.C. in how to reach across aisles and find new solutions to complex health care policy debates.

The Compromise:

  • The law does not mean the mentally ill will be forced into locked psychiatric wards, rather the involuntary care prescribed may take place while living in their homes;
  • A court order compelling treatment will apply to a tiny fraction of the population, the county health department estimates 100 out of SF’s total population of 800,000: specifically, those hospitalized, with a history of unsuccessful psychiatric treatment, or jailed twice in the prior three years due to mental illness, who have been violent to themselves or others, or threatened violence in the past four years;
  • Family, mental health providers, probation officers, police and others can request that authorities evaluate individuals for inclusion in the program; the order for treatment can be obtained only for those who have refused voluntary treatment and have a “substantially deteriorating” condition; the requestors must obtain the agreement of the county mental health director who then petitions the court for involuntary treatment; the civil court order is implemented by the country department of public health;
  • A “care team” must be established that includes another person with a mental illness, a forensic psychiatrist, and a person who has a family member suffer from mental illness; this care team will engage with the patient prior to court-ordered treatment with the aim of steering people towards voluntary treatment; voluntary treatment with the same level of outpatient services must be offered throughout the process;
  • Law enforcement will be summoned to take someone to a hospital only if person a danger to him/herself or others;
  • An independent outside group will conduct an assessment of Laura’s Law after three years;

Another California county, Nevada County, where Laura Wilcox lived and died, has a record of Laura’s Law implementation with documented positive results: with just 41 cases in 10 years in that county, data show a decrease in patients’ rates of hospitalizations and incarcerations, and sufficient stabilization of formerly homeless people to secure housing. San Francisco County went even further in creating an innovative list of new ground rules for how Laura’s Law is implemented.

Washington pay attention! This is how compromise gets done when there is a will to find a way to help vulnerable citizens, while at the same time listening to all points of view. Out in the States, in municipalities across this country, leaders and activated citizens are finding creative negotiated solutions to balancing both the need for mental health treatment access, along with respect for patient rights and dignity and civil liberties. It’s time Washington’s elected representatives take note of what the States and cities can teach them In the art of compromise.

Florence C. Fee, J.D., M.A. 
Executive Director, No Health without Mental Health

Beyond the Screening: Treatment Services under the Medicaid Benefit for Children and Adolescents

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State Medicaid programs offer a variety of treatment services to meet the needs of children with physical and behavioral health conditions. Under federal law, Medicaid programs must cover services for children, as long as the treatments are necessary to correct or ameliorate the child's condition, even if the services are not covered for adults. Join this NASHP webinar to hear a federal perspective from the Centers for Medicare & Medicaid Services on how states can leverage the Medicaid benefit for children and adolescents (also known as EPSDT) to meet the treatment needs of children. This will be followed by a conversation with presenters from Colorado and Washington about treatment services under the EPSDT benefit and their processes for determining service coverage.

This webinar is the fourth in a series on the Medicaid benefit for children and adolescents: the final webinar in the series will focus on care coordination services for children. Previous webinars in the series focused on improving service delivery for childrenengaging adolescents, and promoting oral health. In conjunction with this webinar series, NASHP launched a Resource map on to disseminate state-specific resources and info rmation about strategies that state policymakers and Medicaid officials can use to deliver the Medicaid benefit for children and adolescents.

  • Thursday, July 24, 2014 from 2:00 – 3:00 pm ET 
  • Register Here 
  • Please contact Mike Stanek ( with any questions on this webinar. 





Analysis of kindergarteners shows wide differences in school readiness skills

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Important announcement from our friends at Sesame Workshop and Mathematica!

New research shows there is still a strong relationship between socio-economic factors and how well American children fare when entering kindergarten. In fact, a new study finds 44 percent of children enter kindergarten with one or more risk factors based on their home environment. These risk factors are incrementally associated with lower school readiness scores for children than for those with no such circumstances. Despite an increase in programs to level the playing field by giving disadvantaged children opportunities for preschool education, these gaps persist.

The findings are part of the Kindergartners' Skills at School Entry report released today by Sesame Workshop, the nonprofit educational organization behind Sesame Street. The report, commissioned by the Workshop and written by Mathematica Policy Research, provides an analysis of the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 focusing on the school readiness and abilities of beginning kindergartners.

  • "Preparing children for school has been part of Sesame Workshop's mission since the beginning," said Dr. Jennifer Kotler Clarke, Vice President, Research & Evaluation, Sesame Workshop. "There has not been an examination of children's school readiness of this magnitude in more than 10 years and it's important to us to understand the needs of children as they enter school. Given the risk factors children face, which put them at a disadvantage for school success, we are continuing to find ways to use our educational content to help change these outcomes."

The analysis examined four risk factors that have been shown to affect children's development and school achievement: single parent households, mothers with less than a high school education, households with incomes below the federal poverty line, and non-English speaking households. High-risk children (those with all four risk factors) were found to be almost a year behind their peers with no risk factors in their reading and math abilities.

The researchers also created composite readiness scores based on teacher ratings of children's academic and social skills. Based on the researchers' calculation, less than one-third of children were rated by teachers as "in-progress" or better on both reading and math skills.

  • "These nationally representative data show that at-risk children start kindergarten well behind their more advantaged peers," notes Jerry West, Senior Fellow at Mathematica and director of the study. "The evidence points to an opportunity to better support their healthy development before they enter kindergarten."

Sesame Workshop is sharing its Sesame Street Framework for School Readiness in response to the findings of the Kindergartners' Skills analysis. The Framework is a guide for content developers to use to better understand the features of a typical developmentally age-appropriate content experience in relation to the fundamental school readiness skills. Developed by the Workshop's Education and Research Department, the Framework describes the developmental progressions across the preschool years for specific curriculum objectives within the 20 core school readiness skills. It guides Sesame Street content across all media platforms, as part of the organization's mission to help children grow smarter, stronger, and kinder. The Workshop is also encouraging developers to use this resource to enhance the educational benefits of their content.

Based on the findings of the analysis, Sesame Workshop will convene an advisory meeting with experts in education and child development to discuss potential uses for Sesame Street's library of content, as well as other actions that can support school readiness and academic success.

Kindergartners' Skills at School Entry uses data from the Early Childhood Longitudinal Study, which is a national examination of about 15,000 children who entered kindergarten in fall 2010, and uses direct child assessments in addition to interviews with parents, teachers and school administrators. The study will follow children through the fifth grade. The ECLS is funded by the U.S. Department of Education.

Sesame Workshop is the nonprofit educational organization behind Sesame Street, which reaches 156 million children across more than 150 countries. The Workshop's mission is to use the educational power of media to help children everywhere grow smarter, stronger, and kinder. Delivered through a variety of platforms, including television programs, digital experiences, books, and community engagement, its research-based programs are tailored to the needs of the communities and countries they serve. For more information, visit


National Council offers webinar on gender and trauma

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Webinar announcement from our friends at the National Council for Behavioral Health.

Upcoming Webinar

Gender and Trauma

Date: Monday, July 14, 2014, 3:00 – 4:30pm EDT

Register for free at

Presenters: Cheryl Sharp, MSW, ALWF, Senior Advisor for Trauma-informed Services at the National Council for Behavioral Health, and Dan Griffin, MA, of Griffin Recovery Enterprises, Inc.

When it comes to healing trauma, gender matters. Traumatic experiences do not discriminate based on gender, race, ethnicity, or socioeconomics. Trauma impacts the brain similarly, no matter the person.  What is different is how a person approaches and responds to services. A trauma-informed approach recognizes the importance of being gender responsive and provides an array of services that supports gender and cultural differences.

Join Cheryl Sharp, MSW, ALWF, Senior Advisor for Trauma-informed Services at the National Council for Behavioral Health, and Dan Griffin, MA, of Griffin Recovery Enterprises, Inc. to explore the importance of understanding gender’s role in trauma healing and recovery whether in addictions, mental health, or primary care. Cheryl Sharp’s work in trauma-informed care implementation has helped hundreds of organizations nationwide transform their programs. Dan Griffin is the author of A Man's Way through Relationships, the first trauma-informed book focused solely on helping men navigate the challenges of creating healthy and intimate relationships. He is also author of A Man’s Way Through the Twelve Steps (Hazelden), the first trauma-informed book taking a holistic look at men’s experience of recovery from addictions.

All webinars and recorded and posted afterward at

No CEUs are given out for National Council webinars.

Familias moving forward on mental health

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Mayra E Alvarez MHA, Associate Director, Office of Minority Health, US Department of Health and Human Services 
This blog post originally appeared on

I grew up in a large Latino family.  On any given weekend, I would find my extended relatives over at our house—the kitchen steaming with food, kids running around, and multiple conversations happening. I had three sisters, but if you counted my aunts, uncles, and numerous primos and primas, we were anything but the average-sized family. I was lucky--I had a number of people to talk to about school and relationships, or worries or stresses I was feeling.

Having a support system of friends and family, especially in Latino families, is a helpful way to alleviate stress and live healthier. But sometimes, friends and family alone are not enough and it becomes necessary to seek professional help.

Within our community, there are often negative perceptions about mental health that can discourage people from seeking treatment. Latino youth have been found to be at risk for higher levels of emotional distress because of the pressures to rapidly adopt the values of their culture as well as inequality, poverty, and discrimination. In the United States, the prevalence of having seriously considered attempting suicide was higher among Hispanic students (18.9%) than whites (16.2%) and blacks (14.5%). The disparity was even more apparent among Latina students who were 1.2 times as likely as white female high school students to seriously consider attempting suicide, even going so far as to create a plan.  

lets talkTo encourage conversations in the Hispanic community and across the country about mental health problems, identifying needs, and helping individuals get treatment, I am proud to spread the word about a new website and toolkit developed by SAMHSA and available in English and Spanish. and en Español have information about prevention, treatment, and recovery from mental health conditions and can help individuals and communities access treatment and resources. The website focuses on the importance of talking about mental health and engaging parents, young people, Latino-serving advocates, and other community leaders in conversations about mental health.

The Toolkit for Community Conversations About Mental Health (Diálogos comunitarios acerca de la salud mental)supports community mental health and helps begin this important dialogue. 

Check out these toolkit resources:

Mental Health in my Community information graphic (La salud mental en mi comunidad: Gráfico informativo)

Talk to your familia about it today!


Addressing the needs of young adults in transition with justice system involvement

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Network partner in all things good - Creating Community Solutions - is offering a timely webinar that will focus on how communities can develop strategies to meet the needs of young adults in transition with justice system involvement. Speakers will discuss how this population crosses over many related systems and issues (i.e. housing, education, transitions between adult and juvenile systems, and accessing supportive services). Topics will include strategies to assess and address the mental health problems that youth/ young adults are facing and best practices in providing services to this population.


  • Wendie Veloz, (Facilitator) SAMHSA- National Dialogue on Mental Health Staff Lead/Public Health Advisor
  • Eric Lulow, SAMHSA Children's Mental Health Initiative- Public Health Advisor
  • Jim Saintgermain, Preparing Leaders of Tomorrow (PLOT)
  • Christian Mitchell, Massachusetts' Department Youth Service- Boston Juvenile Re-Entry Initiative District Manager
  • John Coppola, Maryland Healthy Transitions Initiative- State Director

Date: July 11, 2014  2:30 pm - 4:00 pm Eastern

Suit charges Springfield, MA school warehouses students with mental health needs

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SPRINGFIELD – Students with mental health needs are being warehoused in a segregated Springfield school without educational opportunities or therapeutic supports, according to a class action lawsuit filed Friday in US District Court.

The lawsuit charges the Springfield school system, Superintendent Donald J. Warwick and Mayor Domenic Sarno are violating the Americans with Disabilities Act by placing hundreds of children with mental health needs in the so-called Public Day School where the focus is on behavior control using drastic methods including dangerous physical restraints, forced isolation in padded rooms, and repeated arrests and suspensions for minor offenses.

“The Public Day School is exclusively for students with mental health needs, and the children segregated there do not need to be there,” said Robert Fleischner from the Center for Public Representation, which brought the suit along with the Judge David H. Bazelon Center for Mental Health and Bingham McCutchen.

Added Ira Burnim, Bazelon legal director, “These students can be educated successfully in Springfield’s neighborhood schools with reasonable modification of school programs and appropriate school-based behavioral services.”  Such services include a school-based intervention plan that relies on positive support, training for teachers, staff and parents, and coordination with non-school providers.

Notably, the Massachusetts Department of Elementary and Secondary Education cited the Springfield school system in April for being in violation of federal and state law as a result removing students with disabilities from regular classrooms without appropriate justification, failing to provide needed behavior services to children, and denying children in the Public Day School the opportunity to participate in extra-curricular and vocational programs.

In 2013-14, there were 233 students at the Public Day School, where the drop-out rate exceeds 41%, in contrast to the overall 6.5% rate in Springfield schools.  

The lawsuit was brought on behalf of a 15-year-old student who for the last four years has been consigned to the Public Day School, and the Parent/Professional Advocacy League (PPAL), a statewide, grassroots family organization that advocates for improved access to services for children with mental health needs and their families.  During the past year, more than 150 Springfield families have sought help from or joined PPAL’s network, which extends to more than 7,000 families statewide.

“These children face real obstacles, but they can also have amazing futures with the right educational supports and opportunities,” said Lisa Lambert, PPAL executive director. “We hope this lawsuit will make sure they get that chance.”

New draft quality measure on antipsychotics available for comment

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A draft quality measure to assess the safe use of antipsychotics in children has been released for public comment on AHRQ’s United States Health Information Knowledgebase (USHIK) website. The measure, “Use of Multiple Concurrent Antipsychotics in Children,” was released on the website by the Centers for Medicare & Medicaid Services (CMS), along with the Office of the National Coordinator for Health IT (ONC). It was developed under the CMS/ONC Children’s Health Insurance Program Reauthorization Act Project.

All feedback is sent to CMS and ONC for review. USHIK is an online, publicly accessible registry and repository of health care-related data, metadata and standards. USHIK is funded and directed by AHRQ with management support and partnership from CMS and the Centers for Disease Control and Prevention's National Center for Health Statistics.

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