Funding the utilization of community health workers in Texas

Community health workers (CHWs) are volunteers or paid members of communities that perform outreach, patient assistance, health education, and assist in navigation of healthcare system amongst other duties. The utilization of CHWs in hospital and community setting provides health benefits to their communities while reducing cost to the overall healthcare system. ^ The general population of Texas lacks adequate access to primary care. An important indicator of such a crisis is excessive usage of emergency department services in Texas, especially by the large minority population within the state. Also, unmanaged chronic diseases have been shown to be correlated with the excessive usage of emergency services. According to a recent survey of 25 Houston metropolitan area hospitals, almost 54% of the ER visits could have been resolved in primary care settings. A Galveston based study also indicated that the ER usage was higher amongst African-Americans and Latinos. Meanwhile, 28.5% of the total ER visits were made by Latinos from the surrounding areas (Begley et al., 2007). There is substantial evidence present which indicates enormous cost-savings that CHWs have produced in Texas and nationwide through reduction in unnecessary ER visits along with better management of chronic diseases (Fedder et al, 2003). ^ This paper provides an analysis regarding the need and importance for sustainable and stable sources of funding for Community health workers (CHWs) in Texas utilizing Kingdon's model of Agenda Setting as framework. The policy analysis is also aimed at reporting on the policy process and actions taken by Children at Risk to address this critical issue. Children at Risk, a Houston based advocacy organization, has created a legislative proposal that calls on the Texas Health and Human Commission to apply for a Medicaid §§1115 waiver to provide sustainable sources of funding for CHWs, Rep. John Zerwas sponsored HB 2244 bill and it was filed on March 3, 2011. The bill would affect the use of CHWs in Texas in two ways: 1) through the establishment and operation of a program designed to train and educate CHWs 2) by creating a statewide training and certification advisory committee. The advisory committee is required in the bill to submit recommendations for providing sustainable funding and employment for CHWs. The HB 2244 failed to move out of the House Public Health committee. However, HB2244 was amended into HB 2610 introduced by Representative Guillen. The House Bill 2610 is geared towards establishing a community-based navigator program in order to assist individuals applying for public assistance through the Internet. The House Bill 2610 was signed by the Governor and will be effective September 1, 2011.^

Engaging stakeholders in community-level obesity prevention programming: Evaluation of the Fit Family Challenge

Introduction: Both a systems approach to change and a focus on multi-sector interventions ensures obesity prevention programming within the community is equitable, sustainable, and cost-effective. An authentic community engagement approach is required to implement interventions guided by best-evidence research and practice. Although there are examples illustrating the benefits of community engagement, there is no standardized method to implement it. The San Antonio Sports Foundation (SA Sports), a non-profit community-based organization, implements a variety of free events and programs promoting active life styles. One such program is the Fit Family Challenge which is a summer-long program implemented at the school level targeted at families. ^ Aims: This thesis was a culmination of the experience from the student collaborating with SA Sports as part of a practicum opportunity. Using secondary data collected by the Fit Family Challenge during the 2011 year, the goals of this thesis were: to assess individual changes; evaluate short-term impact; and describe the community engagement process. ^ Methods: SA Sports collected quantitative and qualitative data during the implementation and evaluation of the FFC program. SA Sports allowed the used of de-identified data to be analyzed to study the aims of this thesis. ^ Results: The program was able to provide families with the knowledge, information, and opportunity to exercise as a family and cook healthier meals. School district coordinators were generally satisfied and illustrated the benefits of a community partnership. An authentic community engagement was present highlighting the importance of communication, collaboration and the sustainability of such partnerships in the community. ^ Conclusion: The success of an obesity program should focus on triggers that initiate behavioral change rather than physiological changes. The evaluation was guided by a community engagement approach, which illustrated the development of new partnerships and the strengthening of other collaborations. Ultimately, the engagement approach empowered the community to identify their own problems and build collaboration, rather than tackling obesity prevention alone. ^

Family Preservation: The Parents’ Perceptions

This research documents the perspective of 100 parents who had an open case with the Department of Children and Family Service’s (DCFS) regarding their family’s well-being, reasons for referral and satisfaction with services. Two DCFS services, Family Preservation (FP) and routine Family Maintenance (FM) were examined using standardized instruments. Parents’ responses regarding reasons for involvement with the system differed from DCFS administrative data. FP parents had more children, were more likely to be monolingual Spanish speakers, and perceived greater improvement in discipline and emotional care of children and housing than FM parents. FP parents reported being satisfied with services. Implications include supporting community based culturally competent FP programs.

Assessing Treatment Integrity: A Case Example

This paper presents an example of assessing treatment integrity as part of an experimental study of home-based, intensive family preservation services (IFPS). Participants were 103 IFPS workers and 24 state public child welfare agency workers (FC). The structured, self-report questionnaire included questions about specific components of the services, as well as the characteristics of the family and the workers themselves. Findings suggest that IFPS workers delivered services according to the treatment model guidelines. The procedure yielded a good estimate of whether the structural components of treatment were delivered according to the model as delineated in the treatment manual. The paper discusses the advantages and disadvantages of this approach to assessing treatment integrity.

The Children’s Bureau’s Role in Promoting Parent Engagement and Family Support: A Brief History and Current Efforts

Over the years, federal child welfare policy has supported parent engagement and family support strategies through various Children’s Bureau funded state formula grant programs, research and demonstration discretionary grants, and technical assistance. This article highlights programs funded by two federal laws, Promoting Safe and Stable Families and the Child Abuse Prevention and Treatment Act, and Children’s Bureau’s efforts to test innovations and disseminate knowledge about promising and evidence-based practices regarding parent engagement and family support. The article begins with a brief legislative history and then describes several grant programs that are supported by the legislation. The article concludes with lessons learned and a discussion of the new opportunities for system changes through the Title IV-E Waiver Demonstration projects.

Guardians of Generations: African American Grandparent Caregivers for Children of HIV/AIDS Infected Parents

Grandparents, particularly, grandmothers in the African American community have historically provided needed care for their grandchildren (Crewe, 2003). Before there was a child welfare system that addressed the needs of African American children, there were grandmothers who served as the safety net for their biological, informally adopted grandchildren, and other minor relatives. They cared for grandchildren and others whose birth parents were unable or unwilling to care for them. For families of color, HIV/AIDS is an emerging issue that is contributing to the growing numbers of grandparent-headed households. And once again, many African American grandmothers have accepted the challenge of holding their families together. This article addresses the HIV/AIDS public health challenge in the African American community with specific focus on its impact on older grandparents responsible for raising children of infected biological parents. It advocates for a model that continues to strengthen the Children’s Bureau investment in kinship care through integrating the needs of children and their aging caregivers.

Perceptions of Family Preservation Practitioners: A Preliminary Study

This exploratory, qualitative study examined practitioners' perceptions about family preservation practice. Findings reveal a wide range of identified strengths as well as the limitations of such a model. Interestingly, the most frequently identified strengths were value based rather than practice based in perspective whereas limitations were practice based. Keeping families together was the most common perceived strength but concern about children's safety by keeping the family intact was a frequently reported limitation. Further, lack of support and a lack of theoretical clarity were identified as considerable limitations. Implications suggest these practitioners (mostly child welfare/mental health workers) believe in the approach for the sake of keeping families together but are concerned with endangering the child in the process and recognize the need for theoretical guidance.

Community structure and biodiversity in marine benthic communities during experiments, 2011

A mesocosm experiment was conducted to quantify the effects of reduced pH and elevated temperature on an intact marine invertebrate community. Standardised faunal communities, collected from the extreme low intertidal zone using artificial substrate units, were exposed to one of eight nominal treatments (four pH levels: 8.0, 7.7, 7.3 and 6.7, crossed with two temperature levels: 12 and 16°C). After 60 days exposure communities showed significant changes in structure and lower diversity in response to reduced pH. The response to temperature was more complex. At higher pH levels (8.0 and 7.7) elevated temperature treatments contained higher species abundances and diversity than the lower temperature treatments. In contrast, at lower pH levels (7.3 and 6.7), elevated temperature treatments had lower species abundances and diversity than lower temperature treatments. The species losses responsible for these changes in community structure and diversity were not randomly distributed across the different phyla examined. Molluscs showed the greatest reduction in abundance and diversity in response to low pH and elevated temperature, whilst annelid abundance and diversity was mostly unaffected by low pH and was higher at the elevated temperature. The arthropod response was between these two extremes with moderately reduced abundance and diversity at low pH and elevated temperature. Nematode abundance increased in response to low pH and elevated temperature, probably due to the reduction of ecological constraints, such as predation and competition, caused by a decrease in macrofaunal abundance. This community-based mesocosm study supports previous suggestions, based on observations of direct physiological impacts, that ocean acidification induced changes in marine biodiversity will be driven by differential vulnerability within and between different taxonomical groups. This study also illustrates the importance of considering indirect effects that occur within multispecies assemblages when attempting to predict the consequences of ocean acidification and global warming on marine communities.

A Tele-Health Communication and Information System for Underserved Children in Rural Areas of Nicaragua

Millennium Development Goals point out the necessity of actively promoting maternal-child health care status, especially in underserved areas. This article details the development actions carried out between 2008 and 2011 in some rural communities of Nicaragua with the aim to provide a low-cost tele-health communication service. The service is managed by the health care center of Cusmapa, which leads the program and maintains a communication link between its health staff and the health brigades of 26 distant communities. Local agents can use the system to report urgent maternal-child health care episodes to be assessed through WiMAX-WiFi voice and data communications attended by two physicians and six nurses located at the health care center. The health and nutritional status of the maternal-child population can be monitored to prevent diseases, subnutrition, and deaths. The action approach assumes the fundamentals of appropriate technology and looks for community- based, sustainable, replicable, and scalable solutions to ensure future deployments according to the strategies of the United Nations.

Exploring mindfulness as a culturally sensitive intervention for the Deaf community

Mental health issues are as prevalent in the deaf community as the hearing community, if not more. Yet, Deaf individuals are often treated by mental health professionals less frequently and less effectively. Many systemic barriers exist that influence the lack of services provided to the Deaf community, primarily related to a lack of cultural understanding rooted in perceptions of Deaf individuals. However, the Deaf community may be best understood as a cultural minority, a unique community sharing a distinct culture, history, and language. This paper investigates the effects of systematic barriers and cultural misunderstanding among mental health professions regarding the Deaf community, explores the historical and current mental health problems Deaf individuals most commonly struggle with, and proposes a potential culturally sensitive intervention for the Deaf community based on these factors. To examine these issues, the author conducted a thorough review of Deaf cultural history and values, as well as a review of peer-reviewed articles regarding both Deaf mental health and mindfulness outcome studies. Based on this review, mindfulness may be an effective, culturally sensitive intervention that addresses both cultural and psychological components while working with the Deaf population.

Fostering Change: Toward Understanding, Valuing, and Informing the Therapeutic Role of Foster Parents

Foster parents have the potential to effect lasting therapeutic change through their role with the children they temporarily foster. Therapists working with foster parents can understand, support, and inform foster parents in their role based on a commonality that exists between the roles of therapists and foster parents. Similarities at different stages of both the therapeutic and foster parenting relationships are addressed, as well as the use of these relationships in a therapeutic manner. Advantages (for foster parents, foster children, therapists, and the foster care system) of articulating the foster parenting relationship through the lens of the therapeutic relationship are also discussed. Future research into the experience of foster parents in their role will be essential in creating an effective and sustainable system of care for vulnerable children.

Examining the Complex Relationships of Early Intervention on Language and Psychosocial Development in Families Facing Multiple Risks with a Focus on Children of Hispanic Immigrants

Abundant research has shown that poverty has negative influences on young child academic and psychosocial development, and unfortunately, disparities in school readiness between low and high income children can be seen as early the first year of life. The largest federal early care and education intervention for these vulnerable children is Early Head Start (EHS). To diminish these disparate child outcomes, EHS seeks to provide community based flexible programming for infants and toddlers and their families. Given how relatively recent these programs have been offered, little is known about the nuances of how EHS impacts infant and toddler language and psychosocial development. Using a framework of Community Based Participatory Research (CBPR) this paper had 5 goals: 1) to characterize the associations between domain specific and cumulative risk and child outcomes 2) to validate and explore these risk-outcome associations separately for Children of Hispanic immigrants (COHIs), 3) to explore relationships among family characteristics, multiple environmental factors, and dosage patterns in different EHS program types, 4) to examine the relationship between EHS dosage and child outcomes, and 5) to examine how EHS compliance impacts child internalizing and externalizing behaviors and emerging language abilities. Results of the current study showed that risks were differentially related to child outcomes. Poor maternal mental health was related to child internalizing and externalizing behaviors, but not related to emerging child language skills. Although child language skills were not related to maternal mental health, they were related to economic hardship. Additionally, parent level Spanish use and heritage orientation were associated with positive child outcomes. Results also showed that these relationships differed when COHIs and children with native-born parents were examined separately. Further, unique patterns emerged for EHS program use, for example families who participated in home-based care were less likely to comply with EHS attendance requirements. These findings provide tangible suggestions for EHS stakeholders: namely, the need to develop effective programming that targets engagement for diverse families enrolled in EHS programs.

Social welfare laws of the forty-eight states /

Loose-leaf.

Child Support Enforcement Program [microform] : hearings before the Subcommittee on Public Assistance and Unemployment Compensation of the Committee on Ways and Means, House of Representatives, One Hundredth Congress, second session, February 23, 25; and March 2, 1988.

"Serial 100-56."

The educator's role in the prevention and treatment of child abuse and neglect /

Aug. 1979.