Integrated Care for Asian American, Native Hawaiian and Pacific Islander Communities

On April 8, 2011 the U.S. Department of Health and Human Services (US DHHS) issued an action plan to reduce racial and ethnic health disparities. As part of its ongoing commitment to enhance health equity and eliminate disparities in behavioral health for racial and ethnic minority populations, the US DHHS Office of Minority Health (OMH) partnered with the National Asian American Pacific Islander Mental Health Association (NAAPIMH) to convene an historic summit titled Integrated Care for Asian American, Native Hawaiian and Pacific Islander Communities: A Blueprint for Action. The August 15-16, 2011 meeting in San Francisco, California brought together more than 40 key stakeholders— all committed to improving the quality of life for Asian American, Native Hawaiian, Pacific Islander (AANHPI) communities. For the first time, providers, consumers, policy makers, evaluators and administrators from the areas of primary healthcare, integrated care, mental health, substance use and disabilities came together to develop a national agenda to examine the benefits integrated care for AANHPIs. Participants identified core components most relevant to AANHPI overall health and healthcare. Recommendations were designed to inform both governmental and non-governmental partners on best approaches and models of care that take into account the unique cultural and language needs of this diverse AANHPI population.

The four break-out sessions were designed to work as think tanks and were selected based on best evidence and practices available; and resulted in the following: 1) develop strategies to implement integrated care; 2) workforce training and development; 3) use of health information technology; and 4) community based participatory research and evaluation. Although each group made independent recommendations, they collectively agreed to the following:

• Disparities exist in quality of care for AANHPIs that is a detriment to the overall health and mental health of AANHPI communities.
• Integrated care must take a public health approach, be holistic, work across the life span, include prevention and early intervention, and be person-centered, strength-based and recovery-focused.
• AANHPI leadership must be represented at OMH, SAMHSA along with other federal partners to provide oversight to implementing the recommendations outlined in this Blueprint for Action.
• There is a need to expand the current workforce; focusing on who and how we train providers to work in integrated care. Workforce must include consumers and para-professionals in addition traditional health and behavioral health practitioners.
• Research and data collection must include AANHPIs; including granular data to reflect the diversity within and between various AANHPI populations.
• All services and research must reflect the culture and language of AANHPI communities.

Read the report (pdf).

Homeless Heavy Drinkers Imbibe Less when Housing Allows Alcohol

A study of a controversial housing project that allows chronically homeless people with severe alcohol problems to drink in their apartments found that during their first two years in the building residents cut their heavy drinking by 35 percent. For every three months during the study, participants drank an average of 8 percent fewer drinks on their heaviest drinking days. They also had fewer instances of delirium tremens, a life-threatening form of alcohol withdrawal. The study titled Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories was published in the American Journal of Public Health.

Housing for chronically homeless people usually comes with many conditions, including abstinence from drugs and alcohol and compliance with psychiatric and substance abuse treatment. But such requirements can become barriers to staying in housing. "These individuals have multiple medical, psychiatric and substance abuse problems, and housing that requires them to give up their belongings, adhere to curfews, stop drinking and commit to treatment all at once is setting them up to fail. The result is that we are relegating some of the most vulnerable people in our community to a life on the streets," said Susan Collins, lead author and University of Washington research assistant professor of psychiatry and behavioral sciences. Because they are unable to cope with the rules, they often do not qualify for housing or are asked to leave. Once back on the street, they cost taxpayers' money through use of emergency room visits, shelter and sobering center stays, arrests and jail bookings.

In response, an approach called project-based Housing First has been developed by the Downtown Emergency Service Center, a Seattle-based housing agency. Project-based Housing First provides immediate, permanent and supportive housing to chronically homeless people within a single housing project. It is considered "low-barrier" because it removes some of the traditional barriers to housing, such as abstinence from alcohol. The idea behind it is that if chronically homeless people are provided with stable, permanent housing, then their medical, psychiatric and substance abuse problems will become more manageable. 

"A lot of people believe in the 'enabling hypothesis' – that allowing homeless, alcohol-dependent individuals to drink in their homes will enable them to drink more, and their drinking will spiral out of control," Collins said. "But instead what we found are across-the-board decreases in alcohol consumption and problems." Health also improved. Residents reporting recent bouts of delirium tremens dropped by more than half over the two-year study, from 65 percent to 23 percent. In the study:

• 94 percent of the 95 participants were men and most were white (40 percent) or American Indian/Alaska Native (27 percent).
• The average number of drinks consumed on the heaviest drinking day of the month decreased from 40 to 26 across two years, a decrease of 35 percent.
• The median number of drinks, a more accurate view of drinking patterns for this study's participants, showed a change from 20 to 12 drinks per typical drinking day – a 40 percent drop.
• By the end of one year, 80 percent of participants remained in the study. That was reduced to 79 percent after 18 months and 61 percent after two years. Severity of drinking and demographic variables were ruled out as reasons why participants left the study.

Read more on EurekAlert!. Read the abstract of the study.

Binge Drinking: Nationwide Problem, Local Solutions

Binge drinking accounts for more than half of the estimated 80,000 average annual deaths and three quarters of $223.5 billion in economic costs resulting from excessive alcohol consumption in the United States. CDC analyzed data collected in 2010 on the prevalence of binge drinking (defined as four or more drinks for women and five or more drinks for men on an occasion during the past 30 days) among U.S. adults aged ≥18 years in 48 states and the District of Columbia; and on the frequency (average number of episodes per month) and intensity (average largest number of drinks consumed on occasion) among binge drinkers.

• Binge drinking is about more than just the number of binge drinkers. The amount and number of times binge drinkers drink are also important to address.
  • Age group with most binge drinkers: 18-34 years
  • Age group that binge drinks most often: 65+ years
  • Income group with most binge drinkers: more than $75,000
  • Income group that binge drinks the most often and drinks most per binge: less than $25,000
• Most alcohol-impaired drivers binge drink.
• Most people who binge drink are not alcohol dependent or alcoholics.
• More than half of the alcohol adults drink is while binge drinking.
• More than 90% of the alcohol youth drink is while binge drinking.

Everyone can help prevent binge drinking.

States and communities can:

• Implement effective community strategies to prevent binge drinking such as those recommended by the Community Guide.
• Routinely track and report how many people binge drink, how often, and how much they drink when they binge.
• Develop community coalitions that build partnerships among schools, community- and faith-based organizations, law enforcement, health care, and public health agencies to reduce binge drinking.

Doctors, nurses, and other providers can:

• Recognize that drinking too much causes 80,000 deaths in the US each year and contributes to over 54 different injuries and diseases.
• Recognize that most binge drinkers are not alcohol dependent or alcoholics.
• Support effective community strategies to prevent binge drinking such as those recommended by the Community Guide.
• Screen patients for binge drinking and advise those who do to reduce their use. Read the U.S. Preventive Services Task Force -- Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse.

Download the CDC factsheet on Binge Drinking (pdf). Read the CDC Report Vital Signs: Binge Drinking Prevalence, Frequency, and Intensity Among Adults — United States, 2010.

Geographic & Sociodemographic Patterns in Prevalence of Mental Health Conditions Among Children

In a study titled Mental Health Conditions Among School-Aged Children: Geographic and Sociodemographic Patterns in Prevalence and Treatment the authors have provided state-level estimates of the prevalence of diagnosed pediatric emotional and behavioral mental health conditions and treatment received by children and adolescents ages 6-17 with these diagnoses. "Our results show significant variation in the prevalence of diagnosed mental health conditions among children and youth by state of residence in addition to documented sociodemographic and health-related factors. In contrast, receipt of treatment was more strongly related to socioeconomic and health-related factors," write the authors of an article published in the January 2012 issue of the Journal of Developmental and Behavioral Pediatrics. The prevalence of mental health conditions and potential for both long-term and widespread negative impacts underscore the importance of early identification and treatment. Identifying variations in the prevalence of diagnosed mental health conditions and the receipt of treatment among this population may help to illustrate disparities and to highlight examples where policies and systems could better support both identification and treatment of children and adolescents with mental health problems.

Data for the study came from the 2007 National Survey of Children's Health. Mental health conditions were identified using parents' responses to three questions about whether a doctor or health professional had ever told them that their child had depression, anxiety problems, or behavioral or conduct problems. Receipt of treatment was determined by parents' report of whether their child had received any treatment or counseling from a mental health professional in the past 12 months. Although state of residence was the primary covariate of interest, seven sociodemographic and health-related variables shown to be associated with mental health conditions and access to treatment in previous research were also assessed: child's or adolescent's sex, age, race and ethnicity, poverty status, insurance type, health status, and maternal health status.

The authors found that

• Nearly 8 percent of children and adolescents ages 6-17 had ever been diagnosed with depression or anxiety, and 5.4 percent had ever been diagnosed with behavioral or conduct problems, according to parental report.
• Lifetime prevalence of parent-reported depression or anxiety varied significantly by state of residence, ranging from 4.8 percent in Georgia to 14.4 percent in Vermont.
• Lifetime prevalence of parent-reported behavioral or conduct problems ranged from 3.2 percent in California to 9.2 percent in Louisiana.
• Regardless of diagnosis, nearly 10 percent of all children and adolescents and 53.1 percent of those who had ever been diagnosed with an emotional or behavioral condition received mental health treatment or counseling within the past year, according to parental report.
• The odds of receiving past-year parent-reported treatment did not differ by state of residence with the exception of Louisiana and Nevada: children and adolescents ever diagnosed had more than two times the odds of not receiving past-year treatment in these states.

The authors conclude that "further research at both the state and national levels is needed to determine how different approaches to the provision and financing of mental health services may affect both the prevalence of diagnosis and access to treatment for these conditions."

Read the abstract of the study.

Younger Americans’ Health Disparity Gets Worse

According to a new study titled Variance Function Regression in Hierarchical Age-Period-Cohort Models - Applications to the Study of Self-Reported Health, the gap between the least and the most healthy is widening for Americans born after 1980. While the baby boom generation has consistently reported better health than any other generation, today’s young adults are expected to be less healthy as they age. According to Ohio State University researcher Hui Zheng, today’s young adults are projected to experience growing health disparities in their lifetimes. “As young people today reach middle age and preceding cohorts with a smaller health gap die off, we expect health disparities in the whole population to grow even larger,” said Zheng. The Ohio State study used data from the National Health Interview Survey from 1984-2007 to investigate how the health gap varies by age and cohort.

According to Zheng, indicators of health have been on the decline for more than decade, despite advances in medicine and technology. Future research is necessary to pinpoint factors contributing to the increased health gap among younger generations and to identify potential solutions.

Read more on the Kaiser Family Foundation website. Read the study (pdf).

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