The Mental Health Workforce: A Primer

[Excerpt] Congress has held hearings and some Members have introduced legislation addressing the interrelated topics of the quality of mental health care, access to mental health care, and the cost of mental health care. The mental health workforce is a key component of each of these topics. The quality of mental health care depends partially on the skills of the people providing the care. Access to mental health care relies on, among other things, the number of appropriately skilled providers available to provide care. The cost of mental health care depends in part on the wages of the people providing care. Thus an understanding of the mental health workforce may be helpful in crafting policy and conducting oversight. This report aims to provide such an understanding as a foundation for further discussion of mental health policy

The National Health Service Corps

The National Health Service Corps (NHSC) provides scholarships and loan repayments to health care providers in exchange for a period of service in a health professional shortage area (HPSA). The program places clinicians at facilities—generally not-for-profit or government-operated— that might otherwise have difficulties recruiting and retaining providers. The NHSC is administered by the Health Resources and Services Administration (HRSA), within the Department of Health and Human Services (HHS). Congress created the NHSC in the Emergency Health Personnel Act of 1970 (P.L. 91-623), and its programs have been reauthorized and amended several times since then. The Patient Protection and Affordable Care Act of 2010 (ACA; P.L. 111-148) permanently reauthorized the NHSC. Prior to the ACA, the NHSC had been funded with discretionary appropriations. The ACA created a new mandatory funding source for the NHSC—the Community Health Center Fund (CHCF), which was intended to supplement the program’s annual appropriation. However, since FY2012, the CHCF has entirely replaced the NHSC’s discretionary appropriation. The CHCF is time-limited. Initially an appropriation from FY2011 through FY2015, the CHCF was subsequently extended in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10) for two years (FY2016 and FY2017). As of the date of this report, no funding has been approved for the NHSC in FY2018. The program does not currently receive discretionary appropriations; consequently, funding for this program was not included in the continuing resolution for FY2018 (P.L. 115-56). From FY2011 through FY2016, the most recent year of final data available, the NHSC offered more than 33,500 loan repayment agreements and scholarship awards to individuals who have agreed to serve for a minimum of two years in a HPSA. In FY2016, the NHSC made 6,129 awards. The number of awards the NHSC makes is only one component of program size, because not all awardees are currently serving as NHSC providers; some are still completing their training (e.g., scholarship award recipients). As such, the NHSC also measures its field strength: the number of NHSC providers who are fulfilling a service obligation in a HPSA in a given year. In FY2016, total NHSC field strength was 10,493. NHSC providers are currently serving in a variety of settings throughout the entire United States and its territories. The majority of NHSC providers serve in outpatient settings, most commonly at federally qualified health centers

The Mental Health Workforce: A Primer

[Excerpt] Congress has held hearings and introduced legislation addressing the interrelated topics of the quality of mental health care, access to mental health care, and the cost of mental health care. The mental health workforce is a key component of each of these topics. The quality of mental health care depends partially on the skills of the people providing the care. Access to mental health care relies on, among other things, the number of appropriately skilled providers available to provide care. The cost of mental health care depends in part on the wages of the people providing care. Thus an understanding of the mental health workforce may be helpful in crafting policy and conducting oversight. This report aims to provide such an understanding as a foundation for further discussion of mental health policy

The Veterans Health Administration and Medical Education: In Brief

Training health care professionals including physicians1 is part of the VA’s statutory mission. It does so to provide an adequate supply of health professionals overall and for the VA’s health system. This mission began in 1946, when the VA began entering into affiliations with medical schools as one strategy to increase capacity. Some trainees in particular, those in the later years of training may provide direct care to patients, thereby increasing provider capacity and patient access. In the long term, training physicians at the VA creates a pipeline for recruiting physicians as VA employees. In 2014, the Veterans Access, Choice, and Accountability Act of 2014 (VACAA, P.L. 113 46, as amended) initiated an expansion of the VA’s medical training by requiring the VA to increase the number of graduate medical education positions at VA medical facilities by 1,500 positions over a five year period beginning July 1, 2015, through 2019.5 P.L. 114 315 extended this time period to 10 years (i.e., through FY2024)

The Changing Demographic Profile of the United States

[Excerpt] The United States, the third most populous country globally, accounts for about 4.5% of the world’s population. The U.S. population—currently estimated at 308.7 million persons—has more than doubled since its 1950 level of 152.3 million. More than just being double in size, the population has become qualitatively different from what it was in 1950. As noted by the Population Reference Bureau, “The U.S. is getting bigger, older, and more diverse.” The objective of this report is to highlight some of the demographic changes that have already occurred since 1950 and to illustrate how these and future trends will reshape the nation in the decades to come (through 2050). The United States Is Getting Bigger. U.S. population growth is due to the trends over time in the interplay of increased births, decreased deaths, and increased net immigration. The United States Is Getting Older. Aside from the total size, one of the most important demographic characteristics of a population for public policy is its age and sex structure. This report illustrates how the United States has been in the midst of a profound demographic change: the rapid aging of its population, as reflected by an increasing proportion of persons aged 65 and older, and an increasing median age in the population. The United States Is Becoming More Racially and Ethnically Diverse, reflecting the major influence that immigration has had on both the size and the age structure of the U.S. population. This section considers the changing profile of the five major racial groups in the United States. In addition, trends in the changing ethnic composition of the Hispanic or Latino Origin population are discussed. Although this report will not specifically discuss policy options to address the changing demographic profile, it is important to recognize that the inexorable demographic momentum will have important implications for the economic and social forces that will shape future societal well-being. There is ample reason to believe that the United States will be able to cope with the current and projected demographic changes if policymakers accelerate efforts to address and adapt to the changing population profile as it relates to a number of essential domains, such as work, retirement, and pensions; private wealth and income security; the federal budget and intergenerational equity; health, healthcare, and health spending; and the health and well-being of the aging population. These topics, among others, are discussed briefly in the final section of this report. This report will be updated as needed

Power & Planning: A Critical Comparison of Tribal and Non-Tribal Wildfire Protection Plans

In 2003, the US government passed the Healthy Forest Restoration Act, which urged wildfire-prone communities to develop Community Wildfire Protection Plans (CWPPs). These plans allow local groups to contextualize risk, practice social learning, and develop social capital while addressing wildfire risk. Within planning realms, however, decision-making power is usually concentrated unequally between social groups which can limit the influence of marginalized communities. Tribal nations, specifically, have been excluded from wildfire planning since European contact, signaling that CWPPs may not reflect Indigenous worldviews and priorities. Given the recent push from the federal government to increase land management collaboration with tribes, it is necessary to understand how power shapes collaborative planning processes such as CWPP development. My research views the production of wildfire plans as an exercise of discursive power, as they construct narratives around wildfire that reflect particular cultural values. Through a critical discourse analysis of Oregon wildfire plans and interviews with Indigenous and non-Indigenous wildfire planners, I seek to 1) identify ideological differences between tribal and non-tribal wildfire planners, 2) explain these differences from cultural, structural, and historical perspectives, 3) critique approaches that infringe upon tribal rights to self-determination, and 4) provide alternative planning approaches that better reflect tribal priorities

Why Do Institutional Plan Sponsors Hire and Fire their Investment Managers?

This paper examines the investment allocation decisions of pension plans, endowments, foundations, and other institutional plan sponsors. The experience and education of plan sponsors and the environment (both regulatory and agency) of the institutional market suggests that institutional investors rely less on past performance and use diffe rent criteria when evaluating performance compared to mutual fund investors. Institutional investors are expected to be less concerned with total returns and more considerate of benchmark-adjusted excess returns, and the consistency with which they are delivered, over longer time horizons. An examination of asset and account flows for actively-managed U.S. equity products is largely consistent with these expectations. The consistency with which managers deliver positive or negative active returns relative to the S&P500 over multiple horizons, without regard to the magnitude of these returns, plays a key role in determining the flow of assets among investment products. Style benchmarks play a larger role in determining account movements, which is found to employ more criteria than asset moves. However, total return is also considered, as the magnitudes of a one-year loss and 3 and 5-year total returns are found to be incremental factors in plan sponsors’ allocation decisions. One explanation for this result is the principal-agent arrangement faced by plan sponsors. Although the sponsors may be more sophisticated than the typical retail investor, their clients, investors and the investment board, may not be. Plan sponsors may minimize job risk by hiring and firing managers based on excess returns with incremental allocations based on total returns, thereby satisfying both their mandate and their clients. It is also found that smaller and older products capture relatively greater flows.pension plans, endowments, foundations

Central activity in 60 micron peakers

The authors present charge coupled device (CCD) imaging results of their sample of Infrared Astronomy Satellite (IRAS) galaxies with spectral energy distributions peaking at 60 microns (Vader et al 1988). The results support the author's suggestion that the activity in 60 micron peaking galaxies is centrally concentrated, and represents an early stage of dust-embedded nuclear activity. This activity is probably triggered by a recent interaction/merger event as indicated by their peculiar optical morphologies. The authors propose that 60 micron peakers are the precursors of SO's in the case of amorphous systems, and ellipticals in the case of interacting galaxies

A radio Search for high redshift HI absorption

Ground based optical observations have yielded considerable information on the statistics of damped-lyman alpha systems. In particular these systems are known to be the dominant repository of the observed neutral gas at high redshift. However, particularly at high redshift, there is the possibility that optical observations could be biased due to the exclusion of damped-lyman alpha systems that contain moderate to significant amounts of dust. Independent observational constraints on the neutral hydrogen content at high redshifts and the amount of dust in high redshift systems can be obtained from a radio search against the bright lobes of distant radio galaxies (which is less affected by the presence of dust in foreground damped-lyman alpha systems). We describe here a pilot radio survey along the line of sight to a small sample of high redshift radio galaxies, and also present some preliminary results. The survey uses a novel observing mode at the WSRT which enables one to make sensitive searches of a large redshift interval in a modest amount of telescope time.Comment: A version with figures is available at http://www.nfra.nl/~chengalu/ To appear in "Cold Gas at High Redshift", Eds. M.Bremer et al. (Kluwer, Dordrecht

Swarming of Self-Propelled Camphor Boats

When an ensemble of self-propelled camphor boats move in a one-dimensional channel, they exhibit a variety of collective behaviors. Under certain conditions, the boats tend to cluster together and move in a relatively tight formation. This type of behavior, referred to as clustering or swarming here, is one of three types recently observed in experiment. Similar clustering behavior is also reproduced in simulations based on a simple theoretical model. Here we examine this model to determine the clustering mechanism and the conditions under which clustering occurs. We also propose a method of quantifying the behavior that may be used in future experimental work.Comment: 4 pages, 5 figure