This is a discussion post. Please use the book chapter that I am uploading as the basis for this discussion.

1) This must be original...no direct quotes.
2) You must use 2 peer-reviewed, evidence-based sources (in addition to the book text that is being uploaded).
3) This post should be used to spur discussion but be based on the chapter from the text.

Instructions:
Mental health services have changed dramatically over the past 50 years. How have changes in reimbursement and medications been a major driver in these policy and treatment changes?
Answer this question based on the perspective of the role of a Chief Nursing Officer,. Consider how your response would vary if your organization was in-patient or out-patient based (or a combination of both).

This must be completed on time!
Chris.
There are faxes for this order.

Customer is requesting that (Researchpro) completes this order.

Purpose: This activity is meant to introduce you to policy issues in mental health and the impact of these policies on agencies, counselors, and clients. Please take reading notes as you go (reactions, questions, insights, concerns).

Description:
FEDERAL GOVERNMENT INITIATIVES & RESEARCH:
1. SAMHSA - Substance Abuse and Mental Health Services Administration ? a division of the Department of Health and Human Services (DHHS)
a. Read the ?Leading Change? document (attached)

http://store.samhsa.gov/product/SMA11-4629
2. NIMH - National Institute of Mental Health - A federally funded research institution
a. Read the NIMH Strategic Planning Report (attached)

http://nimh.nih.gov/about/strategic-planning-reports/index.shtml
CONSUMER ADVOCACY POLICY POSITIONS:
1. National Alliance on Mental Illness (NAMI) - a grassroots organization for people with mental illness and their families
a. Spend some time perusing the site and see what NAMI?s definition of recovery is and the programs and advocacy they offer.

http://www.nami.org/
CHARITABLE ORGANIZATION
1. The Carter Center
a. Familiarize yourself with the purpose of the Carter Center?s Mental Health division.
http://www.cartercenter.org/health/mental_health/index.html

When you are done with the readings, compose a 9-10 page paper (Times New Roman, 12 point, double spaced). Please follow APA style guidelines using proper headers, citations, reference page, etc. Please use headers for Parts 1, 2, & 3.

? Part One of the paper should summarize each of these readings in no more than three short paragraphs and be no more than 4 pages.

? Part Two of the paper should reflect on how what you?ve learned in these readings impact your practicum or internship site or place of employment. How does your agency/community setting work with the ideas set forth in these readings? How does the Affordable Care Act affect your agency/community setting? These are just examples of what I?m looking for. Please make it fit your agency. This section should be no more than 3-4 pages

? Part Three of the paper should be your personal reflection. What do these readings cause you to wonder about in our profession? How do you see yourself as an advocate in relation to these readings? This section should be 2-3 pages long.

XYZ Mental Health Services inc. is a nonprofit agency.

-In this mental health practice describe and develop the followings

a)The agency type;overview of its services,purposes and include initial steps in creating A 501 (c)(3) nonprofit organization.

b)Mission Statement; decide the focus, clarify the mission, goals and exactly whom this practice will like to serve.

c) Board selection,
1, Who is on the board(fictiticuos or real and why) at least 5 board memebers and life history, life experience, work experiences etc.
2. Officer positions, kind of expectations, their names, positions eg chairman, treasury, seccretary etc.and also what they bring to the agency.
3. List of 5 member standing commitees their names, age, gender, ethnicity and what they bring to the board.
This paper should have the following.
-A coverage of conceptual and theoretical materials
-Application of concetual and theretical material to existing systems.
-Organization, development and intergration of material.
-Technical detail related to grammar, syntax, punctuation and spelling.
-Overall logic,conciseness, and clarity of material.

Title; " Critically appraisal reecent mental health legislation and its effect upon service users and carers"
Learning Outcome:
1. Distinguish between the medical and social models of mental health. ( I have covered this, see attached bellow. This can be added in my essay which will not include in your word account - 2475 words/9 pages.)
2. Appreciate the perspectives of mental health service users and their carers
3. Understand differing professional roles and systems for communication and collaboration (look at the groups that work together and how they communicate with the carer and other professionals about the service uses rights).
4. Understand the relevant legislation to the appropriate client group

The content have to include ; Legal constraints, Importance of Service user / carer perspective and Multiprofessional roles and tasks.

Note:
* The sources must use English law (particulalrly England and Wales); The MHA 1983-2007, The MCA, Carers (Recognition and Services)Act 1995, National Servicxe Framework Mental Health, Carer and disabled children's act 2000, carers (Equal oppertunity)act 2004, work and families Act 2006, Equity act 2010 and The european convention on human rights
* use Harvard referencing, Writing style: UK Style.

Trauma informed care is an approach to mental health service delivery and nursing practice. Trauma informed practice recognises that diverse emotional (and physical) problems, conditions and disorders are trauma-related. Clinicians who use this approach recognise the complexity of the impacts of trauma and work from the foundation principles of safety, trustworthiness, choice, collaboration and empowerment.

By examining an approach to mental heath care, (trauma informed care) students identify how this approach affects care of consumers at both a policy and individual level. This written reflection essay assists to broaden, and perhaps challenge, own understandings of mental health care, and to identify their role in working within these principles.

PAPER TO BE WRITTEN IN RELATION TO THE UK (USING UPTO DATE REFERENCES FROM THE UK)

Write an in depth critical analysis of a chosen area of mental health service delivery (Black and Ethnic Minority Groups), within social care practice.

Incorporate the 5 learning outcomes into your writing:


Learning outcomes of the module


1 Develop a critical understanding of the key theoretical ideas and processes within the current mental health system and how to apply these to practice situations.
2 Critically analyse current services and therapeutic approaches available to mental health service users, their families and carers.
3 Evaluate and critically review social policy and legislative developments that apply to social work practice with mental health service users, their families and carers.
4 Evaluate and apply the principles of anti-oppressive practice and equal opportunities to interactions with mental health service users, their families and carers.
5 Critically evaluate current assessment procedures in mental health

READING LIST:
American Psychiatric Association (2004) Diagnostic and Statistical Manual of Mental Disorders: DSM IV, Fourth Edition, American Psychiatric Association

Barnes, M and Maple N (1992) Women and Mental Health British Ass. of Social Workers

Barber, P., Brown, R., Martin, D. (2012) Mental Health Law in England and Wales, 2nd Edition, Learning Matters

Bentall, R. (2004) Madness Explained: psychosis and human nature Penguin

Bentall, R. (2009) Doctoring The Mind, Penguin

Breggin, P (1993) Toxic Psychiatry: drugs and electroconvulsive therapy: the truth and the better alternatives. Harper Collins

Churchill, S. (2011) The Troubled Mind, Palgrave

Coleman, R. and Smith, M. (2007) Working with Voices, Victim to Victor, P&P Press

Davidson, J (2009) The Dark Threads, Accent Press

Department of Health (1990) The NHS and Community Care Act, Department of Health/HMSO

Department of Health (2002) Dual Diagnosis Good Practice Guide

Department of Health (2006) Dual diagnosis in MH inpatient and day hospital settings

Department of Health (2006) International experiences of using community treatment orders

Department of Health (2007) Safe,Sensible,Social. The next steps in the national alcohol strategy

Department of Health /CSIP (2008) Themed Review Report ? Dual Diagnosis

Department of Health /NTA (2006) Models of Care for Alcohol Misusers (MoCAM)

Department of Health (2003) Mainstreaming Gender and Women?s Mental Health

Department of Health (2008) Code of Practice, Mental Health Act 1983, DOH

Department of Health (2009) New Horizons A Shared Vision For Mental Health (DOH, 2009)
Department of Health (2011) No Health without Mental Health. DOH

Fernando S. (2010) Mental Health Race and Culture, 3rd Edition. Palgrave

Gofman, E (1968) Asylums: essays on the social situation of mental patients and other inmates, Penguin

Golightly, M. (2011) Social Work and Mental Health. 4th ed. Learning Matters

Grant, A (2010) Cognitive Behavioral Interventions for Mental Health Practitioners, Learning Matters

Heller, T et al (1996) Mental Health Matters: A Reader, Palgrave

Heller, T et al (2009) Mental Health Still Matters, A Reader, Palgrave

Hornstein, G. (2009) Agnes?s Jacket, Rodale Press

Johnstone, L (2000) Users and Abusers of Psychiatry: a critical look at psychiatric practice. 2nd ed., Routledge

Johnston, J.( 2005) To Walk On Eggshells? is to care for a mental illness. The Cairn

Johnston, S. (2004) The Naked Bird Watcher. 2nd ed. The Cairn

Jones, R. (2010) Mental Health Act Manual. 13th ed. Thomson Sweets & Maxwell

Kinney, M (2009) Being Assessed under the 1983 Mental Health Act?Can it Ever be Ethical? Ethics and Social Welfare, 3: 3, 329 ? 336


Laing, R. (1967) The Politics of Experience and The Bird of Paradise. Penguin

Laurance, J. (2003) Pure Madness, How Fear Drives The Mental Health System, Routledge

Littlewood, R., and Lipsedge, M. (1997) Aliens and Alienists, Ethnic minorities and psychiatry, 3rd edition, Routledge

Mental Health Act Commission (2009) Coercion and consent 13th Biennial Report, TSO, London

McLaughlin, K.(2008) Social Work, Politics and Society, Policy Press

Morris, G. (2006) Mental Health Issues and The Media, Routledge

Morris, K. (2008) Social work and multi-agency working, Policy Press

National Treatment Agency (2002) models of care for the treatment of drug misusers

Newbigging, K (2006) Supporting Women into the Mainstream: Day Services for Women

NHS (1999) Mental Health, National Service Framework, Department of Health

Read. J. (2009) Psychiatric Drugs, Key Issues and Service User Perspectives, Mind

Reeves, A (2000) Recovery: an Holistic Approach. Handsell

Rogers, A., Pilgrim, D.(2010) A Sociology of Mental Health and Illness, McGraw Hill

Romme, M. (2000) Understanding Voices, Handsell Publishing

Soothill, Morgan & Dolan,( 2008) The Handbook for Forensic Mental Health, Willan Publishing

Tew, J. (2011) Social Approaches to Mental Distress, Palgrave

Tantam, D., Husband, N. (2009) Understanding Repeated Self-Injury, A Multidisciplinary approach, Palgrave

Turning Point (2007) Dual Diagnosis Good Practice Handbook, London

Shepherd, G., Boardman, J., Slade, M. (2008) Making Recovery a Reality, Sainsbury

Stastny, P.and Lehman, P. (2007) Alternatives Beyond Psychiatry, Lehman Publishing

Szasz, T. (1973) Ideology and Insanity: essays on the psychiatric dehumanization of man. Penguin

Szasz, T (2007) Coercion as Cure, Transaction Publishers

Taylor, K., Coleman, R., and Baker, P.(2007) Working to Recovery, Victim to Victor 3, P&P Press

Tew, J. (2005) Social Perspectives in Mental Health. Jessica Kingsley

Timimi, S. (2005) Naughty Boys, Palgrave

Tummey, R., Turner, T. (2008) Critical Issues in Mental Health, Palgrave

Warren, J (2007) Service User and career Participation in Social Work, Learning Matters

Webber, M. (2008) Evidence-based Policy and Practice in Mental Health Social Work, Learning Matters

Wilson, J. (1995) How to Work with Self Help Groups, Arena

Women?s Aid (2008) Domestic Violence and Mental Health Factsheet (www.womensaid.org.uk)

Women?s Resource Centre (2008) Violence against women, health, and the women?s voluntary and community sector

WEBSITES:

? The Anti psychiatry Coalition - www.antipsychiatry.org
? Black Mental Health UK's ? www.blackmentalhealth.org.uk
? The Centre of Excellence in Interdisciplinary Mental Health - http://www.ceimh.bham.ac.uk/index.shtml
? Critical Psychology - www.psychminded.co.uk
? Critical Mental Health Forum - www.critpsynet.freeuk.com/criticalmentalhealth.htm
? CRITICAL PSYCHIATRY NETWORK - www.critpsynet.freeuk.com
? Department of Health - www.dh.gov.uk
? Mental Health Foundation - www.mentalhealth.org.uk
? Mental Health Forum - www.mentalhealthforum.net
? Mental Health Media - http://www.insidestories.org/node/304/play
? Mental Health Alliance - www.mentalhealthalliance.org.uk
? MIND - www.mind.org.uk
? Philadelphia Association - www.philadelphia-association.co.uk
? Sainsbury Centre - www.scmh.org.uk
? SANE - www.sane.org.uk
? SCIE Research briefing 26: Mental health and social work - http://www.scie.org.uk/publications/briefings/briefing26/index.asp
? http://www.workingtogetherforrecovery.co.uk/
? York Retreat - www.theretreatyork.org.uk

This is for a Scholarship Application

Background
Essay should reflect knowledge of current clinical priorities in healthcare for Veterans and it will use academic program to impact quality of nursing care provided to Veterans.

Academic program is DNP in Executive Nursing Leadership. My medical center recently designated as a 1A facility, which means all services must be provided for evening and weekend hours. We are in process of ensuring mental health services are available during these hours . I will work the evening hours of 12:30 to 11:00 p.m. This tour will include working every other weekend. Change management skills and strategic planning are essential components that will be required to ensure a smooth transition. Marketing and effective collaboration will also be required. I am currently employed as Program Coordinator for Mental Health Intensive Case Management (MHICM) Programs, which is an Executive Career Field (ECF) position. ECF employees responsible to ensure the T21 initiatives are successfully implemented.

1. Describe the current specific priorities for clinical care for veterans and nursings role in your facility in providing healthcare to meet those clinical needs. Examples of clinical priorities include but are not limited to mental health, traumatic brain injury, homelessness, PTSD, virtual care, diabetes care, rehabilitation, long term care, womens health, and rural health.


Providing mental health services in the home, in the community, and rural areas. Close liaison with homeless program staff, primary care clinics to assist with meeting goals for T21 Initiatives, which includes missed opportunities, clinical video telehealth (CVT), and no shows.
350 word limit


2. Describe your role in the following key issues for Veterans:

A. Access to care

Liaison for Veterans who present to ER for mental health related issues for evening hours until 11:00 p.m.

B. Veteran centered care

Assist with providing alternatives to inpatient care for mental health related issues
CVT available for evening and weekend hours
Patient preference for providers and appointments

C. Performance Measures
Ensure screenings are completed at encounters to ensure that ECF Measures are met. Includes Suicide Risk, Depression, PTSD, Tobacco Use, Alcohol Use, and HUD-VASH Vouchers if homeless

D. Transition Care (DOD to VA).
Schedule for appropriate providers, clinics, and follow-up

350 word limit

3. Identify and describe at least one measurable outcome related to providing healthcare for

Veterans that will result from your completion of your academic program.
Outcome: Decrease in ER visits for mental health issues.
Outcome: Decrease hospital admissions for mental health related issues.

350 word limit


There are faxes for this order.

Domestic Violence/ Mental Health



:
READ:
1. Laura Weiss Roberts, M.D., John Battaglia, M.D. and Richard S. Epstein, M.D.
Frontier Ethics: Mental Health Care Needs and Ethical Dilemmas in Rural Communities (http://psychservices.psychiatryonline.org/cgi/content/abstract/50/4/497)

2. Look through this website - http://ruralhealth.hrsa.gov/pub/WicheMH.asp AND http://ruralhealth.hrsa.gov/pub/domviol.htm

3. http://www.narmh.org/

4. http://www.raconline.org/info_guides/public_health/dvfaq.php#poverty



Suggested Reading:

1. http://www.wiche.edu/mentalhealth/
2. http://www.nmha.org/
3. http://www.ruralwomyn.net/domvio.html












Domestic Violence



- 2-4 million women are physically abused every year = one women being battered every 18 seconds in the US
- Partner violence is increasing and becoming a recognized public health problem
- Very few database studies of rural women exist
o The problems regarding rural domestic violence are made worse by:
? Poverty
? Lack of transportation
? Shortage of health care providers
? Lack of education
? Lack of community programs
? Lack of health insurance
o These reasons make it very difficult for a women to leave an abusive situation

Lets Talk About Rural Alaska
- Alaska epitomizes the huge problem regarding domestic violence in rural America
- Alaska State Troopers reported that 67 percent of all homicides they investigated during 1995 were related to domestic violence
- In 1997 12,072 females were new or continuing clients at one of states 21 domestic violence shelters/safe houses
- In 1996 there were 290,669 women of all ages living in Alaska which means approximately 1 out of every 25 women sought services at a domestic violence program
- There is still very little documentation regarding prevalence and incidence rates of violence.

Where is the Medical Attention?
- Women in violent relationships frequently sustain injuries that require medical attention
- Due to the lack of medical facilities, women living in rural areas fail to obtain proper treatment
- In 1995 Elliot and Johnson conducted interviews with 42 women in a mid-west primary care clinic, These were their findings :
o 45% of the sample reported experiencing physical, social and emotional abuse from an intimate partner
o Of the 36% who reported this abuse (physical) 38% went to the clinic for health maintenance reasons
? Reference ( Elliot B. and Johnson M. (1995). Domestic violence in a primary care setting: patterns and prevalence. Archives of Family Medicine, 4:113:119
- Rural providers are increasingly held accountable to these emerging standards of practice, even in the absence of appropriate resources and training.

How Can We Put an End to Domestic Violence?
- successful strategies for improved care to rural battered women are still relatively unknown and absent from the research literature
- Several emerging policy issues have been identified by surveys and telephone interviews during 2000
- Policy issues that were cited by these surveys include:
o Appropriate training and support for health care providers
o Mandatory reporting of domestic violence by health professionals
o Employee assistance programs for hospital and clinic employees
o Conflicting issues with confidentiality, safety and support
o Funding
- Universal Screening is an excellent opportunity for prevention
- This screening provides early identification of and intervention with individuals at risk for the health consequences of violence in the home
- FUND The Family Violence Prevention Fund
o A national domestic violence advocacy organization that been an early leader in calling for universal screening
o The organization recommends routine screening for domestic violence victimization for all female patients over the age of fourteen in primary care
o All practitioners in these settings implement programs to ensure routine screening
o The screening is carried out in private settings
o Confidential

Mental Health Issues in Rural America


- 15 million of the 62 million rural U.S. residents struggle with mental illness and substance abuse
- There are huge obstacles in the way for rural America to obtain proper health care and treatment
- Ethical dilemmas also affect rural mental health care
o There are 6 attributes of an isolated setting in conjunction with limited resources that appear to intensify the problems
? Overlapping relationships
? Conflicting roles
? Altered therapeutic boundaries between caregivers, patients and families
? Challenges in preserving patient confidentiality
? Heightened cultural dimensions of mental health care
? Limited resources for consultation about clinical ethics

Problems with Mental Illness and Substance Abuse in Rural Areas

- Basic community services like transportation, electricity, water and communication systems are sometimes unavailable in rural communities ? this makes it very hard for the mentally ill to obtain treatment
- Approximately 56 percent of rural residents have been identified as current drinkers and more than 6 percent manifest three of more signs of physiologic alcohol
o There are very little community run/ social groups put into place to help these individuals
o Where can they turn for help?
- Mood and anxiety disorders, trauma, cognitive development, psychotic disorders all appear to be common among rural residents
- Rural suicides rates have surpassed urban suicide rates over the past 20 years
- Rural women who are poor, elderly or of a minority have proved to have heightened psychiatric symptoms

Mental Illness Regarding Rural Adolescents
- Urgent problems regarding mental health services for teens in rural areas are increasing
- Teens in rural areas face
o Isolation
o Loneliness
o Poor access to transportation
o Increased economic conflict
o Unemployment
o Poor housing/ divorced families
o Lack of specialized mental health services
- Teens often turn toward risk taking behaviors such as alcohol and drug abuse as well as sexual activity

What Can be Done?
- Medical clinics need to provide assessment for mental health with adolescent contacts
- Opportunities for counseling need to be available
- Child and adult mental health resources need to be made more available
- In rural America a trip to the doctor or counselor may require a 120 mile drive ? that means a day off from work for the parents. In a lot of house holds that cannot be done ? transportation is needed
- Nurses are a great resource to the mentally ill
o Nurses tend to see the whole picture they need to explore the concept of resiliency for practical application
- Education professionals need to consider mental health screening
- Social workers need to be aware of local resources
- Opportunities for volunteerism need to be explore

References
http://psychservices.psychiatryonline.org/cgi/content/abstract/50/4/497

Rural Health Response to Domestic Violence: Policy and Practice Issues EMERGING PUBLIC POLICY ISSUES AND BEST PRACTICES, Rhonda M. Johnson, MPH, CFNP August 30, 2000

VIOLENCE AND VIOLENCE PREVENTION IN RURAL AMERICA
Molly Nolan, MSN-c, RN, SANE Guest Columnist http://www.rno.org/journal/index.php/online-journal/article/viewFile/39/49

Using above reading materials please answer these questions.

Discussion Questions
A) Domestic Violence
1. Since little exist, what are some ideas on how to increase data-based studies of rural battered women? How would you go about reaching out to the women who are afraid to reveal their abuse.?

B) Mental Health
1. Create a teen center that will help combat the rising number of teens who have mental illness/substance abuse problems. What are some funding ideas, educational/counseling programs, and job opportunities that your clinic can provide?

Exercises:(80 points)
1.
Given the increasing longevity of Americans and the costs of providing long-term care, anticipation of the costs should be a major element of every familys financial planning. Current information suggests however, that very few families or individuals give this consideration. What factors might impede this advance planning? What measures might be effective in raising awareness among Americans about this important matter?
2.
Identify the major factors that have resulted in the shift in utilization from inpatient hospitalization to ambulatory care services. What are the implications of this shift for hospitals, consumers, and the health care delivery system as a whole?
3.
The recipients of mental health services in the US represent only a small percentage of those in need of services. Discuss the factors that impede access to mental illness treatment.
Attach your assignment as a Word document or comparable file format.

Additional Discussion Question (Module 3)
Please add as a separate paragraph at the end of above essay

Hospital emergency departments continue to be used as a source of primary medical care by large numbers of the communitys medically underserved population. What are the implications of this practice for the patients, and on health care costs and quality of care? What would you propose as a means to change this situation?
There are faxes for this order.

This is the situation:
A) I need to write a Thesis proposal. The topic approval form is a group of seven questions as follows:




TOPIC APPROVAL FORM




1. What specific topic or subject area do you propose to explore?

I am currently working with a small group of Mexican-Americans with Schizophrenia and their families. I am interested in identifying barriers related to their continuity of mental-health care.

2. What is your working title?

The working title that I am considering is:
Continuity of Mental-Health Care for Mexican-Americans with
Schizophrenia

3. What is the theoretical foundation for your work

The theoretical foundation of my work is the Qualitative Family Psycho educational approach

4. What is your research question (or questions)?

Please see addendum A

(The questionnaire consists of six main hierarchizied social dimensions
and forty short well wording indicators and subdimensions, using questions of the open type according to a logical sequence).

5. What research methods do you propose to answer your research question?

I am currently working with nine individuals and their nuclear families. If my formal proposal is approved, all participants and their family members would complete the proposed outline interview guide. I have spoken with my supervisor who has given me tentative permission to conduct research with this particular group. I plan to code and analyze all data myself, and I will preserve confidentiality of all questionnaires answered by assigning numbers to each file. I plan to share the results of my research with my supervisor and my group of Mexican-Americans with Schizophrenia and their families.

6. What is the purpose of your research?

To identify barriers that impede the continuity of Mental Health Care in Mexican-Americans with Schizophrenia.

7. What source material have you located thus far to support your research plans?

Andersen RM: Revisiting the behavioral model and access to health care: Does it matter? Journal of Health & Social Behavior 1995; 36:1-10

Briones DF, Heller Pl, Chalfant HP, et al.: Socioeconomic Status, ethnicity, Psychological distress, and readiness to utilize a mental health facility. American Journal of Psychiatry 1990; 147: 1333-1340

Burnam MA, Hough RL, Escobar JI, et al.: Six-month prevalence of specific psychiatric disorders among Mexican-Americans and non-Hispanic whites in Los Angeles. Archives of General Psychiatry 1987; 44:687-694

Cheung FK, Snowden LR, Community mental health and ethnic minority populations. Mental Health Journal 1990; 26: 277-291

Council on Scientific Affairs: Hispanic Health in the United States. Journal of the American Medical Association 1991; 265:248-252

Estrada Al, Trevino FM, Ray LA: Health care utilization barriers among Mexican-Americans: Evidence from HHANES 1982-1984. American Journal of Public Health 1990; 80 (supplement): 27-31

Hall LK: Providing culturally relevant mental health services for Central American immigrants. Hospital and community Psychiatry 1988; 39: 1139-1144

Higginbotham JC, Trevino FM, Ray LA, : Utilization of Curanderos by Mexican-Americans: Prevalence and predictor findings from HHANES 1982-1984. American Journal of Public Health 1990; 80 (supplement): 32-35

Hough RL, Landsverk JA, Karno M, et al.: Utilization of health and mental health services by Los Angeles Mexican ?American and non-Hispanic whites. Archives of General Psychiatry 1987; 44: 702-709

Karno M, Hough Rl, Burman MA , et al.: Lifetime prevalence of specific psychiatric disorders among Mexican-Americans and non-Hispanic whites in Los Angeles. Archives of General Psychiatry 1987; 44: 695-701

Keefe SE: Mexican-Americans? underutilization of mental health clinics: An evaluation of suggested explanations. Hispanic Journal of Behavioral Sciences 1979; 1: 93-115

O?Sullivan MJ, Peterson PD, Cox GB, et al.: Ethnic populations: Community mental Health Services ten years later. American Journal of Community Psychology 1989; 17:17-30

Rogler LH, Malgady RG, Constantino G, et al.: What do culturally sensitive mental health services mean? The case of Hispanics. American Psychologist 1987; 42: 565-570

Rogler LH, Malgady RG, Rodriguez O: Hispanics and Mental Health: A Framework for Research. Malabar, Florida, Robert E. Krieger Publishing Company 1989

Sofaer S: Qualitative methods : What are they and why use them? Health Services Research 1999; 34 (5Pt 2): 1101-1118

Solis, JM, Marks G, Garcia M. et al.: Acculturation, access to care, and use of preventive services by Hispanics: Findings from HHANES 1982-1984. American Journal of Public Health 1990: 80 (supplement): 11-19

Trevino FM, Moyer E, Valdez RB, et al.: Health insurance coverage and utilization of health services by Mexican-Americans, mainland Puerto Ricans, and Cuban-Americans. The Journal of the American Medical Association 1991;265: 233-237

U.S. Bureau of Census: Statistical Abstract of the United States , 111th Edition Washington DC, 1991

Wells KB, Hough RL, Golding JM, Burnam AM, et al.: Which Mexican-Americans underutilize mental health services? American Journal of Psychiatry 1987; 144:918-922


Wells KB, Hough RL, Golding JM, et al.: Acculturation and the probability of use of health services by Mexican-Americans . Health Services Research 1989; 24: 237-257

Woodward AM, Dwinell AD, Arons BS, : Barriers to mental health care for Hispanic Americans: A literature review and discussion. The Journal of Mental Health Administration. 1992;19: 224-236


Zarate R, Kopelowicz A, Gonzales V, Tripodis K: Mental Health services for Latinos with serious mental illness. A literature review and discussion. Community Mental Health Journal, in press











































ADDENDUM A


OUTLINE OF PROPOSED INTERVIEW GUIDE

How are you doing? Como esta Usted?

Is this a good time to talk for you? Es un buen momento para hablar con Usted?

I. Family and Social Network Supports Sistemas de apoyo familiar y
Social

A. Who lives with you in your household? Quien vive con usted en
la casa?

B. Tell me about your family. Cuenteme acerca de su familia

C. What?s a typical day like for you? With your Family? With your

friends? Como pasa Usted el dia? Con su familia? Con sus amigos?

D. Tell me about your friends Cuenteme sobre sus amigos

E. Who are the people you can count on the most in time of need?

Quienes son las personas con las que puede contar cuando las necesita?

F. Do you belong to groups or organizations that you feel you get
support from? Examples? What kind of support?
Pertenece a algun grupo u organizacion que le proporciona apoyo?
Pongame algun ejemplo, que tipo de apoyo?

G. How does the family and friends support you and your family?

Como le apoya la familiay/o amigos a usted y su familia ?





II. Language Idioma ( About relative) (acerca del familiar)

A. What Languages do you speak fluently? Que idiomas habla Ud.
con fluidez?

If Spanish: Do you read and write Spanish? Sabe usted leer y escribir en espanol?

If English: Do you read and write English? Sabe usted leer y
escribir en Ingles?

B. Do you find it easier talking to people in your native language?

Le parece mas facil hablar con la gente en su propio idioma?

C. If bilingual, where did you learn your second language?

Donde aprendio su segundo idioma?

D. What is your language of preference? What is your preference in
Language when talking with your family? Friends? Strangers?

Cual es su idioma de preferencia? Que Idioma prefiere cuando habla con su familia? Amigos? Extranos?

E. Are most of your friends bilingual? Son la mayoria de sus amigos
bilingues?

F. How difficult is for you to comprehend English? Cuan dificil es
para ud. Comprender Ingles?

G. What is your level of education and where did you study?
Cual es su nivel educativo? Y donde estudio? (familiar)













III. Access Problems (Financial, insurance status, transportation and
Child care)

Problemas de accesibilidad (economicos, seguro medico, transporte
Y cuidado de los ninos) ( acerca del paciente y su familia)

A. Who in your household works? Do you work? Quien trabaja
en su casa? Trabaja usted?

B. What do you use for transportation? Que medio de transporte usa? (carro, bus etc)?

C. Do you have access to childcare if needed? Tiene acceso a cuidado
de ninos si lo necesita?

D. Do you have medical insurance? If so, what kind? If not so, how
Do you manage with healthcare payments? Tiene seguro medico?
De que tipo? Como hace para pagar los gastos medicos?




























IV. Experience of the Hospital Experiencia del Hospital

A. What?s is like going to the hospital? Como se siente
Al hospital?

B. What do you like about going to the hospital? Que
le gusta de ir al hospital? Why? Porque?

C. What do you dislike about going to the hospital?
Que no le gusta de ir al hospital? Why? Porque?

D. Do you procrastinate when going to the hospital?
Evita ir al hospital? Why? Porque?

E. Do you have obligations that impede going to the
Hospital (such as job, financial problems, etc.)?
Tiene obligaciones que le impiden ir al hospital
Como trabajo, problemas economicos, etc.)?

F. Are there times when going to the hospital is time
Consuming? Example?
Hay veces que ir al hospital le supone por mucho tiempo? Pongame un ejemplo.

G. Is it difficult to travel to the hospital? Why or why
not? Es dificil el transporte hasta el hospital? Por que si o por que no?

H. Do you have difficult in obtaining mental mental healt
Services because of the lack of lack of chilcare? Tiene dificultades en obtener servicios de salud mental por que no tiene nadie que le cuide los ninos?

I. Does language matter to you when going to the
hospital ? Why? How? Le importa en que Idioma le hablan cueando va al hospital? Porque? Como le afecta?

J. How well can you communicate with clinicians at the
hospital? Que bien se comunica con el personal medico del hospital?

K. Is that a strong determinant to using the hospital?
Why? Example? Es esto un factor determinante
para que usted vaya al Hospital? Porque ? Puede darme un ejemplo?
V. Cultural differences. Diferencias culturales

A. What do you expect from mental health treatment for
(relative?s name)? (Do not prompt).
Que espera del tratamiento para la salud mental que
Su familiar recibe?

What are your preferences for mental health
treatment for (relative?s name)
Que tratamientos para la salud mental prefiere
que reciba su familiar?


B. Before taking (relative?s name) to the hospital, what
did you think about mental health treatment?
Antes de traer a su familiar al hospital , que opinaba
usted de los tratamientos de salud mental?

Were you familiar with mental health treatment?
How? Estaba usted familiarizado(a) con los
tratamientos para la salud mental? Como?

C. What mental health services and treatments do you
know of?
Cuales servicios y tratamientos de salud mental conoce
Usted?

D. What is your understanding about (relative?s name)
condition or situation? Que sabe usted de la condicion
o situacion de su familiar?

E. How does the Psychologist/Psychiatrist treats
(relative?s name)? Como el Sicologo/Siquiatra trata a su familiar?

Do you feel comfortable with how the Psychiatrist /Psycologist treats {relative?s name)?Se siente a gusto con el trato que el psiquiatra da a su familiar?
Why? Porque?

F. What other things do you think would help (relative?s
Name)? Que otras cosas cree usted que ayudarian a su familiar?

VI. Future Considerations. Consideraciones futuras.

A. Do you think that (relative?s name) will need
Treatment after the hospital?

Cree usted que su familiar necesitara tratamiento despues de salir del hospital?

B. What will you do if the doctor advises (relative?s
name) to continue treatment after he or she is disrcharged? Why? Que haria usted si el doctor le dijera que su familiar necesita continuar con su tratamiento despues de salir del hospital?

C. Do you think that family and/or friends will encourage
Or discourage continuing treatment after discharge?
Cree usted que su familia y/o amigos le animaran o le desanimaran a continuar su tratamiento despues de salir del hospital?

D. Do you have obligations that impede going to
Treatment at the clinic after discharge from the hospital (such as any of the factors mentioned in the hospital section)? How will these factor impact (relative?s name) ability to receive aftercare?

Tiene obligaciones que le impiden ir a recibir
Tratamiento a la clinica despues de salir del hospital (tales como aquellas mencionadas en la seccion IV (hospital)? Como le afectaran estos factores para poder ir a recibir tratamiento a la clinica?















I submitted to them the answers I believed were the right ones; however this is what this is what the research Topic approval Committee Review answered to me:


Question #1 Describe the general area of Schizophrenia and place it within the context of your target population, Mexican-Americans.

Question # 2 Revise

Question #3 Expand

Question # 4 State the research question(s) that you wish to answer. At present, you have provided a measure in the form of a questionnaire.

Question # 5 Fully describe the research methods and statistical analyses you propose to use in answering your research questions (t-tests, ANOVA, multivariate statistics?).

Questions # 6 expand desensitization


Obviously, I need a custom research service. Will you please do it for me? Also, I suggest to review carefully the outline of the proposed interview guide in order to have a better idea how to answer question #4.

Sincerely,

Edgar
[email protected]
[email protected]

This is a discussion post. Please use the book chapter that I am uploading as the basis for this discussion.

1) This must be original...no direct quotes.
2) You must use 2 peer-reviewed, evidence-based sources (in addition to the book text that is being uploaded).
3) This post should be used to spur discussion but be based on the chapter from the text.

Instructions:
Changes in reimbursement and medications have significantly affected mental health service delivery. This discussion focuses on how behavioral health, rehab, and detox diagnoses are treated in outpatient and inpatient environments.
Review the unit studies (book chapter I am uploading) and use the Internet to research changes regarding inpatient and outpatient treatment for behavioral, rehab, and detox health services. Identify one specific type of health care facility that provides these services, and discuss how treatment has changed due to advances in pharmaceutical treatments, constraints by reimbursement structures, and socioeconomic considerations. Take the role of a health care leader when discussing these issues and state how the issues affect that role's ability to provide quality, effective care to these population groups.

Thanks,
Chris.
There are faxes for this order.

Customer is requesting that (Isak) completes this order.

write a policy to better serve the needs of racial, ethnic and cultural minorities with mental health illness.
Used this article as one of your research to do this policy:
Cross-cultura Barriers to mental Health services in United States. By Frederick T.L. Leong,PHD and Zornitsa Kalibatseva
this article was published from the Dana Fundation . Please used another journal,or book to back the finding and support the policy.

It is review paper. It is about communication barriers in mental health or illness in Deaf community or patients. How can they solve the problems in order to get better mental health services. Slate few "horror" stories about deaf patients being mistaken labeled insane.

Topic: Mental Illness and Homelessness in Los Angeles County.

Please write a 4 pages research proposal paper. The research proposal is a document describing a project that has yet to be conducted. The researcher's thinking begins with the present, acknowledges and draws from the past, but primarily leads to the future. This paper should include the following: Needs assessment, The purpose of the need of assessment is to evaluate the need for the homeless population in los angeles county that suffers from mental illness. Discuss what kinds of governments assistance not serving this population, how these individuals are being denied from government assistance such as: SSI, Welfare, General Relief, Medical or Medicare to be able to receive proper mental health services. Discuss how the county mental health centers are crowded and unable to meet the need of all the homeless population in los angeles county with a mental illness. Describe a project that need to be assessed for this poulation to change their status from being homeless to having permanent housing and proper mental health treatment. The paper should include:

1) Introduction- which sets the stage for the problem to be researched. The introduction must express the rationale for the study in an unbiased, objective manner. The introduction should first discuss the general issues and then outline a more specific problem. It is not a lengthy section and may contain only three or four paragraphs.

2) Problem Statement- The problem statement, which reflects problems emanating from the broad picture described in the introduction. This section must be focused and concise and should describe what precipitated the need for the study or why the problem is of concern. The problem statement provides a reason for conducting the study. Once the reader has read the problem statement, he or she should agree with the researcher that this problem is significant and worthy of investigation. It may be only two or three paragraphs in length and it should be written in the past tense.

3) Purpose of the Study- The purpose of the study is a succinct statement describing exactly what the study will accomplish. It must follow logically from the rationale presented in the introduction and problem statement.

4) Research Hypotheses- A research proposal will have either one or more hypotheses. In general, a study should contain no more than three or four research hypotheses since more than that can become unwieldy. A hypothesis is a statement of the expected relationship between the variables under study. A hypothesis generally is used if the research study is more experimental or explanatory than descriptive in nature.

5) Methodology- The section describing the methods used to conduct the study is the most important part of the research proposal. Since it describes a proposed study, it is presented in the future tense in the research proposal and rewritten in the past tense once the study is completed and submitted for publication.
It is not a creative process but must be well-organized and clear in meaning. This section generally consists of four subheadings that describe the following
- subjects: The subjects participating in the study must be thoroughly described. Who are they? Were they a sample of convenience, or was randomization involved in their selection? Researchers must be sure the sample describes the population at large.

- Instruments: The instrumentation or materials section can include a description of equipment, questionnaires, per reviewed articles, evaluation forms or measurement instruments used to collect data in the study.

- Data collection or procedures: When writing the procedures or data collection section of the research proposal, researchers must ask themselves who, what, where, when, why and how. This section describes in detail what will be done in the study from start to finish.

- Methods of data analysis: This section should contain a description of both qualitative and quantitative methods used to record, store, reduce, manipulate, analyze and interpret the data collected during the study. The level of statistical significance must be stated in this section.

6) Intended results: This section describes the result of the research.

7) A conclusion/Summary: proposal consists of an introduction, problem statement, statement of purpose, hypotheses or research questions, methodology (which contains sections describing the sample, instrumentation, data collection and methods of analysis).

8) References.
Please follow APA guide lines and be sure the paper is 0% plagiarism.

Instructions:

Identify the clinical mental health setting that you would like to work in when you become licensed. It is okay to choose a setting that you are merely interested in and would like to explore further; you do not need to have already made this decision.

Identify a licensed counselor who is working in your preferred setting and request an interview. You must interview a licensed counselor, not a social worker or psychologist.

Prior to the interview, you will develop at least 15 questions for the counselor. Use these questions as guidelines to get started:
Please describe your education and training to become a licensed counselor
What licensure and other professional credentials do you have? Professional memberships?
What drew you to the mental health counseling profession?
What client populations do you serve as a counselor?
What do you like most about your day-to-day professional life? What do you like the least?
How do managed care policies impact your work?
What advocacy activities do you engage in?

Write a 2 page summary of this interview. Do not submit a transcript of the interview.
Using the information from your reading, this interview and any journal articles that you find, discuss the impact that public policies have on the roles and responsibilities of clinical mental health counselors working in diverse communities. Be sure to discuss the roles and responsibilities of counselors providing services to clients of diverse ages, backgrounds, and exceptional abilities, including strategies for differentiated interventions. (How do counselors ensure that interventions "fit" for diverse clients?)
Discuss how the policies of professional, governmental, and accrediting organizations have impacted the practice of this counselor.
Share your impressions of the information that the counselor shared, anything that you found particularly interesting, surprising, or that you expected to hear. Discuss the impact that the interview had on your beliefs, expectations, and goals related to becoming a clinical mental health counselor working in this setting.
Requirements

Written communication: Develop accurate written communication and thoughts that convey the overall goals of the project and do not detract from the overall message. Your paper should demonstrate graduate-level writing skills.
References: Your reference list must include at least 2 sources. You must use proper APA style to list your references.
Number of pages: 3 double-spaced pages. (Note: page count does not include cover page or references)

Formatting: Use APA formatting, including: correct in-text citations, proper punctuation, double-spacing throughout, proper headings and subheadings, no skipped lines before headings and subheadings, proper paragraph and block indentation, no bolding, and no bullets. Refer to the APA Style and Formatting module for more information.

To the writer: As long as the end result is achieved you can make up the interview. Thank you for your help on this.. I will be traveling on business for the next month, thus it is hard for me to get this completed properly. However, I will be able to be reached via email if you have any issues.
Rubric Tool
Use the following scoring guide, along with the project information, for evaluating each learner's work.

Criteria Non-performance Basic Proficient Distinguished Comments
Articulate the role and functions of a licensed mental health counselor needed to provide effective mental health services to clients of diverse ages, backgrounds, and exceptional abilities, including strategies for differentiated interventions.
(16%)
Does not identify functions of a licensed mental health counselor, or differentiated interventions for clients of diverse ages, backgrounds, and exceptional abilities. Identifies some functions of a licensed mental health counselor, but does not explain differentiated interventions for clients of diverse ages, backgrounds, and exceptional abilities. Articulates the role and functions of a licensed mental health counselor needed to provide effective mental health services to clients of diverse ages, backgrounds, and exceptional abilities, including strategies for differentiated interventions. Analyzes the role and functions of a licensed mental health counselor needed to provide effective mental health services to clients of diverse ages, backgrounds, and exceptional abilities, including strategies for differentiated interventions, and identifies some of the rewards and challenges faced in this role.
Articulate the importance of advocacy methods and strategies in the role of a mental health counselor.
(16%)
Does not describe the importance of advocacy methods and strategies in the role of a mental health counselor. Describes vaguely the importance of advocacy methods and strategies in the role of a mental health counselor. Articulates the importance of advocacy methods and strategies in the role of a mental health counselor. Analyzes the importance of advocacy methods and strategies in the role of a mental health counselor and its impact in providing clients with the services they need.
Summarize the impact of licensure and accreditation standards in the practice of a mental health counselor in a specific setting.
(17%)
Does not identify the impact of licensure and accreditation standards in the practice of a mental health counselor in a specific setting. Identifies licensure and accreditation standards in the practice of a mental health counselor in a specific setting. Summarizes the impact of licensure and accreditation standards in the practice of a mental health counselor in a specific setting. Analyzes the impact of licensure and accreditation standards in the practice of a mental health counselor in a specific setting and recognizes the need to keep current with such standards.
Analyze how public policy and regulatory processes influence licensure, accreditation standards, and practices of the mental health counselor.
(17%)
Does not describe how public policy and regulatory processes influence licensure, accreditation standards, and practices of the mental health counselor. Describes how public policy and regulatory processes influence licensure, accreditation standards, and practices of the mental health counselor. Analyzes how public policy and regulatory processes influence licensure, accreditation standards, and practices of the mental health counselor. Analyzes how public policy and regulatory processes influence licensure, accreditation standards, and practices of the mental health counselor, and explains in detail with examples.
Support assessment with theory and relevant literature.
(17%)
Does not support assessment with theory and relevant literature. Partially supports assessment with theory and relevant literature. Supports assessment with theory and relevant literature. Supports assessment with theory and relevant literature in a clear and direct manner.
Communicate effectively through the consistent use of APA guidelines for grammar, punctuation, and mechanics expected of a clinical mental health counseling professional.
(17%)
Does not communicate through the use of APA guidelines for grammar, punctuation, and mechanics expected of a clinical mental health counseling professional. Uses APA guidelines for grammar, punctuation, and mechanics inconsistently. Communicates effectively through the consistent use of APA guidelines for grammar, punctuation, and mechanics expected of a clinical mental health counseling professional. Communicates effectively through the consistent use of APA guidelines for grammar, punctuation, and mechanics expected of a clinical mental health counseling professional, and in a way that enhances the message and supporting points.

Do people in your local area have access to community mental health services? If so, what types of programs are available? In not, determine the reasons why these types of programs do not exist. How could you, as a community health care leader, help make such programs more readily available in your local area?

Discussion 2: Emerging Issues in Mental Health Care
Like so many areas of practice in social work, mental health is dynamic and ever-evolving. Research continues to provide new information about how the brain functions, the role of genetics in mental health, and evidence to support new possibilities for treatment. Keeping up with these developments might seem impossible. However, being aware of and responsive to these developments and incorporating them into both your practice and social policy is essential to changing the lives of individuals and families who live with a mental health diagnosis and the impact it brings to their daily lives.

For this Discussion, review this week?s resources. Search the Walden Library and other reputable online sources for emerging issues in the mental health care arena. Think about the issues that are being addressed by social policy and those that are in need of policy advocacy and why that might be the case. Then, consider what social workers can do to ensure that clients/populations receive necessary mental health services. Also, think about the ethical responsibility related to mental health care social workers must uphold in host settings when they encounter conflicts in administration and home values. Finally, search your state government sites for the mental health commitment standards in your state and reflect on the mental health services covered under your state?s Medicaid program.

By Day 4, post an explanation of those emerging issues in the mental health care arena that the policymakers address and those that are in need of policy advocacy and why. Then, explain what strategies social workers might use to ensure that clients/populations receive necessary mental health services. Finally, explain the mental health commitment standards and mental health services in your state. In your explanation, refer to the services covered under your state?s Medicaid program.

Support your post with specific references to the resources. Be sure to provide full APA citations for your references.

To complete your Discussion, click on Discussions on the course navigation menu, and select "Week 6 Forum" to begin.

Write a 750- to 1,200-word paper introducing a conceptual model of your choice. Suggested models include:

Learning Team Community Conceptual Model Paper Health belief model



Include the following elements:

? Introduction to the conceptual model with a description of historical development
? Two data points (local, state, national, or international)
? Description of the type of data that is available at local, state, national, or international levels, including if there are data gaps
? Define and relate at least three concepts within the model.
? Compare the model application to the nursing process. What are the similarities or differences?
? Reference two current community health problems where this model has been applied.
? Explain the importance of community partnership in community health projects.
? Cite at least four current references, dated within the last three years.

Format your paper consistent with APA guidelines.

Paper start with:
Community Conceptual Model Annotated Bibliography
During the 1950?s the Health Belief model (HBM) was developed from the field of social psychology. The theoretical framework offers an explanation of why individuals are motivated to participate in preventive health behaviors. The model has five perception constructs of susceptibility, severity, benefits, barriers, and cues to action. In this setting the HBM predicts what prevention behaviors diabetic patients will engage in to avoid foot pathology and ultimately amputation. Current research indicates that the Health Belief Model (HBM) is the most common model used to study health- related behaviors. According to Ganz, Rimer, and Lewis (2002) an assumption of this model indicates people are more inclined to demonstrate disease prevention activities when they perceive (a) an increased susceptibility to the illness; (b) the illness is severe; (c) the actions are valuable; (d) the behavior has few obstacles; and (e) are prompted to execute the actions.
The application of the Health Belief Model to examine the rates of influenza vaccines in connection with a sense of vulnerability found that ?it is more likely for vaccination to correlate positively with perceived susceptibility? (Chen, Wang, Schneider, Tsai, Jiang, & Lin, 2011). In addition, the model has been applicable in identifying factors influencing the underutilization of mental health service related to ?perceptions of symptoms and vulnerabilities, views of the value of mental health care, the nature and severity of related barriers, and beliefs that one might be able to make effective use of mental health interventions? (Smith, 2009). Lastly, Mahmoodi, Kohan, Azar, Solhi, and Rahimi (2011) found that ?education aimed at improving men?s participation in family planning may enhance the individuals ?awareness and attitude, thus contributing to family health? with the use of the health belief model.



Below you find the references:


References
Baghianimoghadam, M. H., Sharifirad, G., Afkhami-Ardekani, M., Mashahiri, M. R., Baghianmoghadam, B., Zulghadr,, R., Ranaee, A. (2011). Foot care in diabetic patients based on health belief model in Yazd ? Iran (2009). Iranian Journal of Diabetes and Obesity. (3)1, 25-31.
Chen, M., Wang, R. Schneider, J., Tsai, C., Jiang, D., Hung, M., & Lin, L. (2011). Using the health belief model to understand caregiver factors influencing childhood influenza vaccinations. Journal of Community Health Nursing, 28(1), 29-40. doi:10.1080/07370026.2011.539087.
Mahmoodi, A., Kohan, M., Azar, F., Solhi, M., & Rahimi, E. (2011). The impact of education using Health Belief Model on awareness and attitude of male teachers regarding their participation in family planning. Journal of Jahrom University of Medical Sciences, 9(3), 45-49.
Smith, T.W. (2009). If We Build It, Will They Come? The Health Belief Model and Mental Health Care Utilization. Clinical Psychology: Science & Practice, 16(4) 445-448. doi: 10.1111/j.1468-2850. 2009.01183.x

Two ethical principles, confidentiality and boundaries, and write a paper (academic APA style) about how these principles relate to the various competencies of a mental health service provider (i.e. change agent, collaborator, advocate, mental health care worker, registered psych nurse etc) Further, discuss various ethical dilemmas that may rise when working in this field and how they would be resolved. So, in the role of a change agent, how would you make sure confidentiality is maintained. A definition of a change agent would be helpful. And then look at the next role...

We will pay $105 for the completion of this order.

This report is an actual interview with someone. Please, if you can not do this please let me know right away. I can supply a number where you can call someone for the interview. That number is 1-800-560-9990. It is in New Jersey.

The report should identify:

Type of Healthcare Provider/Facility: Jersey Shore Medical Center, Hospital

Name of Health Information System/Software: Please find out there Health Information System and Software.

I. Background
Discuss key system/software components and applications. Discuss how system/software selection contributed to facility needs and goals.
a. How long has the system been in place
b. Did it replace another system
c. Did it improve patient care
d. Cost / benefits
e. What system interfaces are used in this project (user interfaces, system to system interfaces etc)

II. User Needs
Identify the primary users of the health information and their needs; discuss how user needs are met by using this system/software
a. How long have they been working on the system
b. Advantages to new system vs old system (vice versa)
c. Did it improve productivity
d. What type of training will take place
e. How was the system implemented

III. Application of Knowledge
Discuss how the application of knowledge attained in this class support your ability to critically analyze they system/software. Assess of the strengths weaknesses of this organization in using the system/software. Provide recommendations for improvement as may be appropriate to the situation .

IV. Analysis
Discuss some examples of the types of healthcare organizations that may be appropriate subjects for this type of system/software other than the type of facility you discussed. Consider hospitals, hospital systems, integrated healthcare systems; multi-specialty medical clinics; physician groups practice offices; ambulatory surgical centers; mental health service providers; public health clinics; rehabilitation or long-term care facilities

a. How was the information about the requirements collected? (research, site visits etc)
b. How will maintenance be handled?

V. Works Cited/Bibliography

This will be a professional paper of 15-18 text pages presenting the most current information from the professional supervision literature relevant to supervision in social work and related human services. Emphasis should be research evidence of best practices in clinical supervision.

The paper should be written in APA format; this means a Title Page, an Abstract Page; 15-18 Text pages; and the Reference List, which will take as many pages as needed. Minimum citation level for an MSW paper should be 20 articles.

The paper should be prepared as a Word Document and submitted as an attachment to an email to me.

Supervision of clinical work in a specific field of practice (mental health): for example, you could explore supervision of persons providing professional social work interventions in mental health services; this would include differences in supervision needs for those in public, non-profit, not-for-profit, and private organizations; differing demands imposed on supervision by differing theoretical understandings of mental health treatment [psychodynamic, social learning, cognitive-behavioral, humanistic, existential]; differing supervision needs in different settings [in-patient mental health units, forensic mental health settings, out-patient mental health clinics, private practice settings]; differing supervision needs of persons working with mental health issues at different stages of the life cycle [childrens mental health, adolescent mental health, adult mental health, elderly mental health]; or some combination of these and other foci.

Instructions:

Using information from your readings and additional peer-reviewed journal articles that you find, discuss the roles and approaches used by clinical mental health counselors across a range of mental health delivery systems.

Discuss the impact that public policies have on the roles and responsibilities of clinical mental health counselors working in diverse communities. Be sure to discuss the roles and responsibilities of counselors providing services to clients of diverse ages, backgrounds, and exceptional abilities, including strategies for differentiated interventions. (How do counselors ensure that interventions "fit" for diverse clients?)

Discuss the role of the CMHC in both providing and seeking professional consultation. Give a few examples of times when a CMHC might be asked to provide consultation as well as times when a CMHC is likely to seek professional consultation.

Discuss how the policies of professional, governmental, and accrediting organizations impact the practice of clinical mental health counseling and share examples of how these policies might benefit potential clients.
Discuss how local, state, and national public policies potentially affect the quality and accessibility of clinical mental health services.

Requirements:
Written communication: Develop accurate written communication and thoughts that convey the overall goals of the project and do not detract from the overall message. Your paper should demonstrate graduate-level writing skills.

References: Your reference list must include at least 5 sources. You must use proper APA style to list your references.
Number of pages: 5 double-spaced pages. (Note: page count does not include cover page or references.)

Formatting: Use APA formatting, including: correct in-text citations, proper punctuation, double-spacing throughout, proper headings and subheadings, no skipped lines before headings and subheadings, proper paragraph and block indentation, no bolding, and no bullets. Refer to the APA Style and Formatting module for more information.
There are faxes for this order.

Discuss in detail the following:

a. Describe the criteria and standards for becoming a licensed professional counselor in your state of proposed practice. Include educational and experiential requirements for licensure, and the scope of practice for the selected state of practice.

b. Distinguish between licensure, certification, and accreditation

c. Specifically describe the Ethical Code of Conduct or Professional Standards used for licensed professional counselors in your state of proposed practice.

d. Describe the concept of core provider status and the implications of this concept to accessibility to and funding for mental health services.

e. Describe public policies that would impact the quality and accessibility of mental health services. Include the concept of advocacy in your response.

References must be from journal articles, no websites

Instructions

Instructions

Required Assignment

Sexton, T. L. (1999). Evidence-Based Counseling: Implications for Counseling Practice, Preparation, and Professionalism. ERIC Digest.

Hauenstein, E. J. (2008). Building the rural mental health system: From de facto system to quality care. Annual Review of Nursing Research, 26, 143-173.

Complete the following:
1. Review the Sexton article and make a case for the utilization of EBTs in counseling.

2. Review the Hauenstein article and identify as many outcome measures as possible and the results used by this researcher to evaluate a rural mental health service delivery system.



?
Topic

Required Assignment Sexton, T. L. (1999). Evidence-Based Counseling: Implications Counseling Practice, Preparation, Professionalism. ERIC Digest. Hauenstein, E. J. (2008). Building rural mental health system: From de facto system quality care.
Topic

Instructions Required Assignment Sexton, T. L. (1999). Evidence-Based Counseling: Implications Counseling Practice, Preparation, Professionalism. ERIC Digest. Hauenstein, E. J. (2008). Building rural mental health system: From de facto system quality care.

Select two policy areas or three such as welfare reform, education reform and the NCLB legislation, and health insurance reform, Write an essay in which you (1) identify three general points about the policy making process that are part of the multiple streams framework or the advocacy coalition framework and that you consider particularly interesting, and (2) use the two or more policy examples to illustrate how these points are supported or contradicted by the facts in these cases.

(WELFARE REFORM)

??????Of the 9.7 million uninsured parents in the United States, as many as 3.5 million living below
the federal poverty level could read-
ily be made eligible for Medicaid under current law.
?URBAN INSTITUTE
Brief 24, April 2012
Welfare Reform
What Have We Learned in Fifteen Years?
Sheila R. Zedlewski

The Temporary Assistance for Needy Families (TANF) program is the only federal means-tested cash safety net program for poor families with children.1 TANF was created in 1996 to replace Aid to Families with Dependent Children (AFDC), in effect for 60 years.2 Its passage was part of the sweeping Personal Responsibility and Work Opportunity Reconciliation Act, designed to improve the lives of low-income families.
During its 15-year history, TANF has oper- ated in good and bad economic times. What have we learned since its passage? Has the caseload changed substantially? Has the program increased family self-sufficiency? Do we know how to move families into jobs and how to provide critical train- ing and education for disadvantaged parents? How does the program work within the larger safety net? What do we know about family outcomes associated with TANF? What dont we know?
This brief draws primarily from a set of research briefs that address these questions
(box 1).3 The briefs extract lessons for state
and federal policymakers from the best avail- able research. This synthesis, augmented by the research briefs, provides the required background for those interested in the program, as well as ideas for how to strengthen it.
What Is in the TANF Legislation?
Most elements of the original TANF legislation remain in place today. The program was reauthorized only once through the 2005 Deficit Reconciliation Act (DRA), and the American Recovery and Reinvestment Act (ARRA) enacted emergency funds to shore up states programs during the Great Recession.
The key provisions of TANF include giving states primary responsibility for TANF design
within broad federal requirements (table 1). Federal rules require states to meet work partici- pation rates (or face financial penalties), prohibit using federal dollars to fund a familys cash assis- tance for more than five years (with some excep- tions), and provide federal block grant funding fixed in 1996 with a maintenance of effort (MOE) requirement for states. Elimination of federal eligibility for documented immigrants in the United States less than five years was a funda- mental part of the legislation.
The TANF reauthorization strengthened the original work requirements by more narrowly defining allowable work activities and specifying the number of hours that could be spent in each activity. While the new requirements restricted states flexibility by defining the types of activi- ties and the hours certain activities can count, the final federal rules helped states meet their new obligations by allowing them to count hours rather than days of participation and expanding the types of assistance credited toward MOE requirements. The DRA also required states to apply work participation requirements to more of their caseloads, and it updated the basis for credits that can reduce states required work participation rates.
The ARRA provided $5 billion in emergency federal funding for states with a 20 percent match requirement. Funds could be used for cash benefits, emergency assistance, subsidized jobs programs, or supports to help families find work. ARRA also modified the basis for calculating caseload reduc- tion credits, temporarily ameliorating states work participation requirements.
State program rules vary considerably within broad federal rules, leading to extreme variation in the size and make-up of caseloads across the country. Generally state TANF programs can be

??PERSPECTIVES ON LOW- INCOME WORKING FAMILIES
?An Urban Institute Program to Assess Changing Social Policies
?BOX 1. Temporary Assistance for Needy Families ProgramResearch Synthesis Brief Series
All briefs are available at http://www.urban.org/welfare/TANF.cfm.
?1. TANF Recipients with Barriers to Employment, Dan Bloom, Pamela Loprest, and Sheila Zedlewski.
2. Disconnected Families and TANF, Pamela J. Loprest.
3. TANF Child-Only Cases, Olivia Golden and Amelia Hawkins.
4. TANF and the Broader Safety Net, Sheila Zedlewski.
5. TANF Work Requirements and State Strategies to Fulfill Them, Heather Hahn, David Kassabian, and Sheila Zedlewski.
6. Improving Employment and Earnings for TANF Recipients, Gayle Hamilton.
7. Facilitating Postsecondary Education and Training for TANF Recipients, Gayle Hamilton and Susan
Scrivener.
8. The TANF Caseload, Pamela J. Loprest.
These briefs were funded through a contract from the U.S. Department of Health and Human Services, the Office of Planning, Research and Evaluation of the Administration for Children and Families, and can also be found on their web site.
?states: 30 percent of the national TANF caseload lives in California.
TANF program rules, the economy, and other safety net programs affect caseloads. Studies document that declining unemployment and the strong economy in the late 1990s contributed to the post-TANF caseload decline. TANF policy explained roughly 20 percent of the decline. Changes in other policies, primarily expansion of the earned income tax credit (EITC), also reduced caseloads. While there has been little rigorous study of caseload trends during the most recent recession, most experts believe that TANF is less responsive to an economic downturn than its predecessor.
Research also shows that specific TANF poli- cies can significantly affect caseloads. In fact, most TANF changes have tended to reduce caseloads, including declining real benefits, mandated work activities, and diversion policies that require sub- stantial evidence of job search or offer a one-time payment in lieu of enrollment. Sanctions either eliminate a case or create a child-only TANF unit. Time limits reduce caseloads, although so far only modestly, since most do not stay on long enough to reach the limit. On the other hand, policies that allow TANF recipients to retain more of their earn- ings and still receive a benefit increase caseloads.
The caseload decline reflects both an increase in the number of families leaving welfare (exits) and a decrease in the number entering (entrants). Studies show that declining TANF entries play
an important role in caseload decline, although
?characterized by shrinking real benefits, strate- gies that divert families from enrolling, sanctions that penalize families for failing to meet program requirements, and benefit time limits. For exam- ple, 30 states paid maximum TANF benefits at less than 30 percent of the federal poverty level (FPL) in 2008, compared to 17 states in 1996.4 Only one states benefit exceeded 50 percent of the FPL in 2008, compared with 10 states in 1996. Diversion strategies, not part of the pre- TANF entitlement program, were used in
42 states in 2008 to provide short-term assistance or simply discourage enrollment. States also use sanctions amply. For example, 22 states now impose full family sanctions (elimination of the entire benefit) the first time a family fails to meet program requirements. Such a sanction was not allowed in the AFDC program.
How Has the Caseload Changed?
Caseloads have declined dramatically since passage of TANF (figure 1). The steepest decline occurred shortly after passage of TANF during a period of strong economic growth. In her TANF research brief, Pamela Loprest explains that caseloads have increased somewhat following the 2007 recession, although the number of familis receiv- ing assistance remains below prerecession levels. Caseload trends have varied across the states; some declined more than 80 percent between 1997 and 2010 and others, only 25 percent. As
a result, the caseload is concentrated in a few
??2
?An Urban Institute Program to Assess Changing Social Policies
?TABLE 1. The Temporary Assistance for Needy Families Program: Federal Legislation
Legislation Purposes Key provisions
?Personal Responsibility and Work Opportunity Reconciliation Act
of 1996, establishing TANF through 2002
Provide assistance so children could be cared for in own homes or homes of relatives.
End parental dependence on government benefits by pro- moting job preparation, work, and marriage.
Discourage pregnancies outside of marriage.
Encourage formation and mainte- nance of two-parent families.
Strengthen work requirements. Increase family self-sufficiency. Improve reliability of work par-
ticipation data and program integrity.
Emergency funding for state TANF programs in response to recession beginning in 2007.
Give states primary respon- sibility for program design.
Set state work participation rates within 12 categories of activities. Set minimum hours/week to count as participating.
Award caseload reduction credit allowing states to reduce requirement by % of caseload reduction since 1995.
Set time limits on federal benefits.
Fund fixed block grants and require state maintenance of effort (MOE).
Grant bonuses for reducing illegitimacy, achieving high performance.
Define 12 work activities. Define methods for report-
ing and verifying work. Include all families in work
participation requirement. Change the caseload reduc-
tion credit by moving base
year to 2005 from 1995. Broaden expenditures that
count toward MOE. Eliminate bonuses and
establish grants for healthy marriage.
Award $5 billion with state 20% match required.
Increase TANF assistance. Increase short-term benefits. Subsidize employment.
Deficit Reduction Act of 2005, extending TANF through fiscal 2010
American Recovery and Reinvestment Act, effective through fiscal 2010
?Sources: Personal Responsibility and Work Opportunity Reconciliation Act, Pub. L. No. 104-193, 110 Stat. 2105, (1996); Deficit Reduction Act of 2005, Pub. L. No. 109-171, 120 Stat. 4 (2006); American Recovery and Reinvestment Act, Pub. L. No. 111-115, 123 Stat. 115 (2009).
of adults on welfare in 2009 had been on for four years or more. We know little about how many not currently on TANF have accumulated years toward their time limits. We also know little about rates of return to welfare. Some evidence shows that returns declined somewhat between 1997 and 2002 after a two-year period of exiting, but we dont know whether this has continued during a weaker economy.
??increasing exits explain most of the decline in the programs early years. TANF take-up rates, defined as the share of eligible families that enroll, have declined from 79 percent in 1996 to 36 percent in 2007 (the latest data available).
Similar to patterns found in studies of AFDC, the time spent on welfare remains fairly short for most families with adult recipients. For example, administrative data indicate that only 12 percent
??3
?An Urban Institute Program to Assess Changing Social Policies
?FIGURE 1. TANF Caseload and Composition: Millions of Families, Selected Years 4.6
???69.2%
7.7% 23.1%
Single-parent family Two-parent family Child-only cases
?2.3
2000
61.5%
4.0% 34.5%
2.0
2004
54.0%
2.5% 43.6%
1.7
2009
47.3% 4.5% 48.1%
?????????????????1996
Source: Table 3, Characteristics of TANF Active Cases, Various Years. http://www.acf.hhs.gov/programs/ofa/character/.
?Child-Only TANF Cases
As shown in figure 1, in 2009 child-only cases, those without a parent eligible for benefits, make up about half of the TANF caseload, compared with about one in five just prior to TANF imple- mentation in 1996. Only 800,000 adults received TANF cash assistance in 2009. Two-parent fami- lies remain a small share of the caseload5 per- cent in 2009 compared with 8 percent in 1996. While the large increase in child-only cases can be attributed to declining numbers of parent families on TANF, it is critical to understand that in half of TANF cases only the children receive benefits.
Olivia Golden and Amelia Hawkins explain that child-only cases have generated little research given their importance to TANF. About 4 in 10
of these families do not include a parent, and two-thirds of children in nonparental cases live with a grandparent. The 6 in 10 child-only TANF families with parents present include parents ineligible due to citizenship rules (42 percent), par- ents receiving Supplemental Security Income (SSI) benefits and therefore ineligible (34 percent), and sanctioned parents (10 percent).5 The child-only shares of cases and the share in each subcategory vary widely across states. Some variations can be explained by state policy or demographic charac- teristics, but no systematic analysis exists.
Golden and Hawkins describe important connections between nonparental child-only units and the child welfare system. State-specific
?studies have documented that one-third to one- half of these cases involved child protective ser- vices to some degree. Studies have also suggested particular concerns about these childrens well- being. Federal and state policies affect how these TANF cases form by whether local agencies seek kin to care for maltreated children and whether kin can be licensed as foster parents who receive caregiver subsidies as permanent guardians or adoptive parents. These subsidies would typically make them ineligible for TANF.
Child-only units created through parent ineligibility present different questions. Children born in the United States to undocumented immigrants are automatically citizens and eli- gible for TANF if their parents resources are low enough to qualify. (Some states also fund ben- efits to the parents.) In most states, parents who receive SSI disability payments are not themselves eligible for TANF (because the SSI benefit is too high), but their children may be. And states that sanction parents but not their children for some or all rule violations create child-only units. Unlike parents in other child-only cases, sanctioned par- ents may count as work eligible and be included in states work participation calculations.6
Characteristics of Parents Receiving TANF
The characteristics of adults receiving welfare have changed little since passage of TANF. Pamela Loprest reports that some state-specific studies
??4
??application requires extensive documentation of disabilities and, sometimes, multiple hearings. States may connect recipients to legal services
or other providers to help them through the process. A few TANF programs have their own medical assessments that mimic those used by SSI to ensure applicants have a high probability of eligibility. States typically exempt TANF recipi- ents applying for SSI from work activities, which could jeopardize their approval. However, federal rules count SSI applicants in states work partici- pation rate calculations. Some states move SSI applicants into separate state-funded programs so they do not count in the participation rate, and so the applicants waiting time does not count against the TANF time limit.
How Do States Meet the Work Participation Requirements?
In most states, work is TANFs primary focus.
Heather Hahn, David Kassabian, and Sheila Zedlewski describe how most states have met the DRA requirements, despite the weakening econ- omy. States adopted multiple strategies, such as creating more unpaid work opportunities, keep- ing working families in the caseload longer, and moving some families into solely state-funded programs (SSFs) outside of TANF.
Since its inception, TANF has required states to engage at least half of all TANF families with a work-eligible individual and at least 90 percent of two-parent TANF families with two work-eligible individuals in work or work activities. Nearly
all TANF adult recipients are classified as work eligible.7 While states can exclude certain groups from these requirements, federalregulations require states count all work-eligible adults in the participation rate.
With a couple of exceptions, work-eligible TANF recipients must participate in work activi- ties for at least 30 hours a week, including at least 20 hours in a core activity (including employ- ment) and the remaining hours in core or non- core activities (such as education). Single parents with children under age 6 must participate for
a total of 20 hours per week, and teen parents count as participating as long as they are attend- ing school. The DRA carefully defines allowable core and noncore activities and in some cases limits the amount of each activity that can count. Post-DRA regulations allow states to count hourly equivalents toward these requirements. Many states had to set up new systems for reporting and verifying hours of participation to meet the new requirements.
?find evidence of increases in health problems, and administrative data show small increases in the Hispanic and Native American shares of recipi- ents. The share of noncitizen cases has declined.
When TANF first passed, many hypoth- esized that parents in the program would become an increasingly hard-to-employ group as the more work-ready recipients moved into jobs. Yet, the share of the TANF adult caseload with barriers to employment has remained fairly constant.
Dan Bloom, Pamela Loprest, and Sheila Zedlewski report that, generally, studies find most adults receiving TANF have at least one barrier to employment, including low educa- tion, limited work experience, mental or physical health challenges, and caregiving responsibilities for special needs children. Nationally representa- tive and state-specific studies generally find that about 4 in 10 adults on TANF have multiple barriers. Most barriers are associated with lower employment, and the likelihood of work declines as the number of barriers increases.
Programs that identify and serve TANF recipients with barriers to employment are com- plex. States often provide a range of services apart from work supports, including intensive case management, rehabilitative services, job coach- ing, support groups, and referrals. Many create individual plans geared to overcoming multiple, varied challenges.
The literature shows that some services help move these recipients to work. Interventions
that have been tested and rigorously evaluated fall along a continuum of service strategies, from models focused on work experience to those focused on treatment. Evaluations of eight post- TANF interventions conclude that most achieved at least some positive impacts. For example, pro- grams focused on employment that include a mix of job preparation and work experience show small increases in employment, sometimes last- ing for several years. Programs focused primarily on treatment succeed in their immediate goal
of increasing participation in substance abuse
or mental health services. However, increases in treatment participation do not typically translate into better health or employment outcomes. Some evidence suggests that expensive, intensive case management models that include small caseloads and a home visiting component hold promise.
As part of states strategies for serving the hard-to-employ, many help TANF recipients apply for SSI, the federal program for low-income persons with disabilities severe enough to pre- vent work. The complex, time-consuming SSI
??
??Caseload reduction credits can lower the required participation rates. Credits can be earned either by reducing the TANF caseload relative
to a base year or by contributing more than the required MOE on TANF-related activities. The DRA changed the base year from 1995 to 2005, substantially reducing this avenue for achieving credits since most of the TANF caseload declined in the years just after TANF passed. However, excess MOE credits have increased. A state can deduct from its participation requirement the number of cases that could be funded with excess MOE dollars.8 This has allowed many states to earn enough credits to meet their work participa- tion rates. Just prior to the DRA, 17 states met their rates through caseload reduction credits alone, compared with 21 states in 2009.
States employ numerous strategies to achieve these work participation rates. Most states count a combination of job-related education and train- ing and employment activities. Creative strategies include keeping working families in the caseload and removing nonworking families. More gener- ous earned income disregards or small monthly supplements for families with earnings high enough to otherwise disqualify them increase
the share of the adult caseload with earnings.
Full family sanctions cut nonworking families from the caseload. Moving hard-to-employ and two-parent families into SSFs also reduces the nonworking part of the caseload. Diversion strat- egies that offer a short-term cash payment in lieu of enrollment or that require substantial proof of employment search before enrollment also keep nonworking adults off the caseloads.
The national all-families work participa- tion rate has ranged between 31 and 35 percent for most of TANF history.9 Individual states all-families rates ranged from 10 to 68 percent in 2009. Yet, most states were able to meet the fed- eral requirements by combining these work par- ticipation rates with caseload reduction credits.10
What Employment and Education Programs Increase Self Sufficiency?
Policymakers often want to know what strategies would help TANF parents or those with similar characteristics move into employment and long- term self-sufficiency. Gayle Hamilton synthesizes a large body of evidence evaluating such strate- gies, and Gayle Hamilton and Susan Scrivener describe the effectiveness of initiatives to increase postsecondary education and training.
Employment models. Rigorous research shows that both work-first and education-first strategies
?can increase work and earnings compared with having no program, even after five years. But mandatory job search gets people into jobs sooner, and education-first strategies do not ultimately increase likelihood of holding a good job or even more jobs. Mixed strategies that combine high-quality program services (such as training, case management, and support services) delivered by community colleges with a strong employment focus work best. The literature shows a clear role for skills enhancement, partic- ularly when credentials are earned, but job seek- ing and work along with education and training are important.
Other research examines the effectiveness
of subsidized work models that use public funds to create or support temporary work opportuni- ties. These experiments have typically targeted very disadvantaged individuals. The results sug- gest these programs have boosted employment
in the short run but rarely in the longer term. Transitional jobs programsdefined as providing a temporary, wage-paying job with support ser- vices and some case managementmay also cre- ate useful work opportunities and reduce welfare receipt. However, the one available rigorously- evaluated program did not improve longer-term unsubsidized employment or earnings.
Other interventions focus on sectoral training initiatives that connect employment programs
to specific businesses and industries through integrated skills training. One study that rigor- ously tested the effects of such training for low- income individuals (all of whom had completed high school or GED) showed promise based on increased employment and earnings in a two-year follow-up period.
Many studies show that supplementing low-wage workers earnings can promote employ- ment, and longer-lasting effects may be attain- able. Effects are larger when these incentives are combined with job search services. These studies also show that wage supplements can affect work hours since individuals can work less and still maintain income, suggesting an important trade- off in designing incentives.
Other initiatives seek to increase job reten- tion. Current and former TANF recipients have trouble maintaining employment and consistentlyearning wages. Programs such as job search assis- tance after a job loss, job coaching, and assistance in accessing work supports such as food stamps and child care may increase employment reten- tion and earnings. Evaluation results have been mixed. Numerous programs have lacked proven impacts, but others showed success. Financial incentives for employment retention along with
??
??promise. Low-income parents in such programs were more likely to attend college full time, earn better grades, and earn more credits. They also registered for college at higher rates.
What Other Services Does TANF Provide?
All discussions about hard-to-employ TANF recipients, work participation rates, and initia- tives to increase employment or education miss
a large part of the TANF program. In fiscal year 2009, states spent 73 percent of TANF funds (federal and state MOE) for purposes other than cash assistance, compared with 30 percent in fis- cal year 1997 (U.S. GAO 2011, 8). This non- assistance includes spending that furthers TANF goals, such as child care, transportation, refund- able tax credits, short-term assistance (including diversion payments), and employment programs. Some spending directly helps current and for- mer TANF cash assistance recipients and some
is directed to a broader population that never received TANF.
A large share of states nonassistance spend- ing (about 30 percent in 2009) gets categorized as other on federal reporting forms, and states were required to provide additional detail on this spending in 2011 (U.S. DHHS 2011). The early results indicate that most goes toward child wel- fare payments and services (25 percent). Other spending is divided across a wide range of activi- ties, including emergency assistance, domestic vio- lence, and mental health and addiction services.
Many low-income families served through the TANF block grant are not reflected in the caseload counts. There is a wide range of non- assistance spending across states: California spent 62 percent of expenditures on assistance for TANF recipients (including cash payments, child care, and transportation), compared with only 20 per- cent in Wisconsin.
How Does TANF Fit with the Broader Safety Net?
Sheila Zedlewski shows how TANF often serves as a portal to other safety net benefits for low- income families with children. Families that enroll in TANF typically get enrolled in the Supplemental Nutrition Assistance Program (SNAP) and Medicaid automatically, and work- ing recipients receive child care subsidies. Most families receive these benefits when they transi- tion off TANF, although rules vary across the states. As noted, TANF programs may help those with significant disabilities apply for SSI.
?job coaching, and close ties between providers or staff and employers seem to work best.
Education models. Whether TANF should promote increased education, particularly post- secondary education, to help recipients to reach self-sufficiency is a long-standing debate. As noted above, the DRA limited how much educa- tion can be counted as a work activity, consistent with results showing that education before job placement does not work better than job place- ment alone. DRA limited vocational training to 12 months for a given recipient, and training and education directly related to employment can only count when combined with 20 hours in a core work activity.
Arguments for increasing education derive from evidence showing more education leads
to higher earnings. Over the last 25 years wages have increased for those with college or more, wages for high school graduates have remained stagnant, and wages for high school dropouts have fallen. People with an associates degree or who completed a certificate program earn more than those with only a high school diploma or GED. Since only one-third of low-income work- ers with children have more than a high school diploma and one-third are high school dropouts, many seek to increase education among this population.
Gayle Hamilton and Susan Scrivener con- clude that the evaluations of models focused on increasing postsecondary education for low-wage workers contradict the broader evidence that more education increases earnings. Initiatives that aim to increase postsecondary education and train- ing typically test whether training occurs and whether the increased education increases earn- ings. Results for recent models that target TANF recipients by combining referrals to community college or training with at least 20 hours a week
of paid work are not encouraging. For individuals with a high school diploma or equivalent, add- ing education to mandated work when compared with a typical work-first program had little or no effect on participation in education or training
or completion of certificates or diplomas. On the other hand, sector-based training models that tar- get individuals with specific aptitudes for specific occupations (such as health care or information technology) and assist with job matching did increase those who began and completed train- ing. Sector-based training programs also increased earnings, although gains were generally modest.
Other programs aim to help those already enrolled in community college stay in school. Performance-based scholarship programs that pay students if they meet academic benchmarks hold
??
??TANF itself represents a relatively small part of the safety net. Medicaid, SSI, SNAP, and the federal EITC expenditures (even considering only the portion focused on families with chil- dren), far exceed spending on TANF. In 2009, 81 percent of TANF families also received SNAP, 98 percent received Medicaid, and 16 percent received SSI. Nonetheless, TANF families com- prise relatively small shares of these programs. They make up about 19 percent of all SNAP households with children and 14 percent of the SSI awards to nonelderly individuals.
Other important parts of the safety net
for TANF families include child care subsidies, Workforce Investment Act (WIA) services, and child support enforcement. TANF parents who work are guaranteed subsidies for child care; other low-income parents not on TANF may also qualify. Rules vary tremendously across states. The latest administrative data indicate that 9 percent of all TANF cases receive child care subsidies. (Since only half of TANF cases have a work- eligible adult and about 30 percent of them engage in work activities, the share requiring child care is relatively small.)
WIA provides employment services (job search and preparation, training and education) that are typically available to low-income indi- viduals outside of TANF. Some states have strong connections between their TANF and WIA programs to create a more streamlined employ- ment support system, while others simply refer TANF clients to WIA agencies. In general, few low-income workers receive WIA employment services owing to limited and declining funds ($3 billion in 2009).
The Office of Child Support Enforcement funds programs to locate parents, establish paternity and support orders, and collect sup- port payments. These services are available automatically for families receiving TANF assis- tance and for other families upon request. The program distributed $26 billion in child support payments in 2009, an important source of sup- port for custodial parents. In 2009, 14 percent of TANF parents received some child support income.
A small share of unemployed TANF parents receives Unemployment Insurance (UI) benefits. When TANF first passed, many hoped that more low-income parents with children would qualify for benefits as they gained more work experience. UI benefits would then reduce the need for cash welfare benefits. While the share of unemployed single parents receiving UI benefits has increased, it is still only 30 percent (Nichols and Zedlewski 2011).
?Studies show that low-income families rarely receive all of the safety net benefits for which they are eligible. Complex program rules and inter- actions often make it difficult to learn about eli- gibility and access services, and participation rates vary across programs. Studies documenting pst- TANF coordination of benefits show that some states use several structures such as colocation
of services, but service delivery in most states is uneven. Studies document that the complexity of forms and regulations, hassles and hurdles to get on and stay on the rolls, and unfriendly offices all contribute to low participation.
How Have Families Been Affected?
Most research on the effect of TANF on family and child outcomes concludes it has had few measureable effects. A 2009 book edited by James Ziliak summarizes these findings: Rebecca Blanks chapter outlines what we know about work and welfare participation (see above in the discussion of caseload decline), health and health insurance, child outcomes and child care usage, and family composition and fertility. One caveat is that most reviewed studies reflect only data through 2000 and 2002; in two cases, data carry through 2004.
Blanks review of the evidence concludes that welfare reform reduced health insurance coverage, but the effects on single women were quite small. Also, any evidence of the impact of insurance changes on health outcomes is limited.
Blank also concludes that childrens outcomes do not appear to be significantly affected by wel- fare reform. Some evidence suggests that young children do slightly better if child care subsidies allow newly working parents to place children
in formal child care settings. One motivation of welfare reform was the hope that moving moth- ers into work would increase childrens aware- ness of the value of education and the need to prepare for work, but little evidence supports or refutes these claims. Evidence of any effects of welfare reform on marriage is also quite weak. Cohabitation has increased, but this is likely because single mothers have more need to share incomes. Research continues to show minor effects of welfare reform on fertility.
More recent attention has focused on dis- connected families, a potentially negative effect of welfare reform. As Pamela Loprest explains, many pointed to caseload declines and increases in working single parents as evidence of TANFs success. Yet national and state studies also began to note that a significant minority of former
??
??recipients did not leave welfare with employment. Coupled with declining TANF enrollment, con- cerns were raised about families disconnected from the labor market and cash public assistance (TANF or disability benefits).
One national study estimates that one in five recipients who left TANF in the past two years were disconnected. Among all low-income single mothers, estimates range from 17 to 26 percent. While incomes are low, child support is one important source of income. Many also receive SNAP or housing assistance.
Studies also show that disconnected families are more disadvantaged than other low-income single-mother families. They have a high rate of barriers to work, such as physical and mental dis- abilities. Many live with other adults (about one- third with a cohabiter and one-third with relatives and friends) and one-third live alone. Studies that include cohabiters income show that these families typically still have incomes below poverty.
While the evidence on the length of time spent as a disconnected family is scant, some research indicates that many families move in and out of this state, but a substantial minority are dis- connected for long times For example, one study finds 17 percent of disconnected single-mother families were disconnected for an entire year.
Summing Up
TANF is a very different program than its pre- decessor that primarily paid cash benefits to very low income parents with children:
1. The nature of the caseload and focus of spend- ing have changed dramatically.
???? Only half the TANF caseloadabout
800,000 familiesincludes parents receiving benefits. Child-only units
make up the rest. While 6 in 10 of these families include ineligible parents (due to receipt of disability benefits, immigration status, or sanctioned status), 4 in 10 do not. Children in these families live with relatives (mostly grandparents) or legal guardians.
???? Over 7 in 10 TANF dollars pay for services that do not count as assistance or affect
the caseload counts. Low-income families with children may receive emergency cash intended to divert them from enrolling, child care or transportation assistance, or even a refundable state EITC. In some states TANF dollars help fund child welfare programs.
?2. TANF programs usually focus on moving par- ents who receive benefits into employment.
???? Federal regulations require states to meet
work participation rates of 50 percent
for all families. States employ numerous strategies to count adult recipients in work activities, including incentives that allow parents to keep some TANF benefit when working and penalties that remove nonparticipating families from the case- load. States, on average, only reach a
30 percent work participation rate. The remainder of the requirement is met through credits earned through caseload decline and monies spent on services for low-income families in excess of states MOE requirement.
???? About 8 in 10 parents on TANF have at least one barrier to employment, and 4
in 10 have multiple barriers (poor mental or physical health, lack of a high school diploma, limited work experience, or care of a disabled family member). States often have specialized services for the hardest to employ, although effective solutions seem illusive.
3. Strong evidence is scarce on strategies that move families to self-sufficiency.
???? Rigorously evaluated programs to increase
employment or education among TANF recipients or similar populations have not held much promise, especially in terms of long-term employment or earnings increases.
???? Evaluations of both types of interventions suggest that models combining work with skills training and targeting specific indus- try needs work best.
4. TANF serves as a portal for access to other safety net programs.
???? While TANF families do not make up
large shares of other safety net programs, they do tend to receive other benefits, especially SNAP and Medicaid, to aug- ment TANF.
???? Despite increased labor market experience among single mothers over the last decade, few qualify for UI.
???? While some studies conclude that connec- tions across safety net programs should
be better coordinated, TANFs assistance with access to disability benefits, SNAP, subsidized child care, and employment and child support services fills a critical need for low-income families.
??
??When Congress finally tackles the next reauthorization of TANF (originally due in 2010), it needs to recognize that TANF does not provide much regular cash assistance. Instead, the program lives up to its name of Temporary Assistance for Needy Families. Families in need are more likely to receive a helping hand than what many think of as a welfare check. The programs nature leads to concerns, especially in a weak economy, about parents who cannot find a job or who have a disability and do not qualify for other income supports. The share of low-income single par- ents classified as disconnected from work and cash assistance will likely continue to increase without new reforms.
We could strengthen the safety net through proposals to expand UI coverage for more job losers, offer broad support for specialized training connected to employer needs, subsidize jobs with targeted support services, and guarantee regular, but temporary, cash assistance for families that have no other income. ARRA funded subsidized jobs programs, and states showed they could quickly gear up effective programs. The DRA focused states resources on counting work activities rather than developing and testing programs that effectively move parents into jobs. TANF reauthori- zation should learn from these experiences.
Rep. Gwen Moore (DWI) has introduced the Rewriting to Improve and Secure an Exit Out of Poverty Act (the RISE Act) to overhaul TANF. The bill includes numerous improvements such as updating and indexing of the block grant funds, eliminating time limits on types of work prticipation (such as education), and eliminat- ing full family sanctions. These proposals, along with other ideas based on 15 years of experience, should be debated to strengthen TANF and the safety net for vulnerable families.
Notes
1. The other means-tested cash assistance program, Supplemental Security Income, serves individuals with serious disabilities.
2. AFDC was created in 1935 through Title IV of the Social Security Act.
?3. The research briefs were developed under contract to the Administration for Children and Families of the U.S. Department of Health and Human Services.
4. This summary of rule changes is taken from Zedlewski and Golden (2010).
5. The numbers do not add to 100 percent because 14 per- cent of these families cannot be categorized.
6. States may disregard an adult penalized for refusal to work in that month, unless the adult has been penalized for more than 3 of the last 12 months (U.S. DHHS 2011).
7. At state option, single parents of children under age 1 may be excluded. Child-only families are not included.
8. The excess MOE credit is deducted from the number of cases required to participate in work activities.
9. The two-parent rate has averaged between 40 and 50 percent.
10. In 2009, eight states failed to meet the all-families rate but nearly all avoided penalties by providing reasonable cause or submitting corrective compliance plans to HHS.
References
Nichols, Austin, and Sheila Zedlewski. 2011. Is the Safety Net Catching Unemployed Families? Perspectives on Low-Income Working Families brief 21. Washington, DC: The Urban Institute. http://www.urban.org/url. cfm?ID=412397.
U.S. Department of Health and Human Services, Administration for Children and Families. 2011. Engagement in Additional Work Activities and Expenditures for Other Benefits and Services. A TANF Report to Congress. Washington, DC: Administration for Children and Families.
U.S. Government Accountability Office. 2011. Temporary Assistance for Needy Families, Update on Families Served and Work Participation. GAO-11-880T. Washington, DC: U.S. Government Accountability Office.
Zedlewski, Sheila, and Olivia Golden. 2010. Next Steps for Temporary Assistance for Needy Families. Perspectives on Low-Income Working Families brief 11. Washington, DC: The Urban Institute. http://www.urban.org/url. cfm?ID=412047.
Ziliak, James, ed. 2009. Welfare Reform and Its Long-Term Consequences for Americas Poor. New York: Cambridge University Press.
??
??????????Nonprofit Org. US Postage PAID Easton, MD Permit No. 8098
??????????2100 M Street, NW Washington, DC 20037-1231
Return Service Requested
??This brief is part of the Urban Institutes Low-Income Working Families project, a multiyear effort that focuses on the private- and public-sector contexts for families success or failure. Both contexts offer opportunities for better helping families meet their needs.
The Low-Income Working Families project is currently supported by The Annie E. Casey Foundation.











(EXAMPLE 2)

(No Child Left Behind)Required reading: Andrew Rudalevige, No Child Left Behind: Forging a Congressional Compromise, in Paul Peterson and Martin West, eds., No Child Left Behind? (Brookings Institution, 2003)


Richard Kahlenberg, editor, Improving on No Child Left Behind, Century Foundation Press, 2008, Chapter 1.




Adolino and Blake, Comparing Public Policies, Chapter 10.
Additional Optional Readings: Paul Mann, Collision Course: Federal Education Policy Meets State and Local Realities, CQ Press, 2011.


??Required reading: John Kingdon, Agendas, Alternatives and Public Policies, Epilogue, pages 231-248.


?
?
?
?
?
?
?
?
?
?
?
?
?
??
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?