MCH Alert


Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.


March 23, 2007

1. Compendium Provides Latest Information Available on Mental Health Services
2. Briefs Present Information for Programs on Issues That Can Affect Adolescent Well-Being
3. Authors Analyze Historical and Projected Trends in Federal Spending on Children
4. Study Investigates Trends in Emergency Medicaid Spending for Immigrants
5. Article Examines Vaccine-Induced Immunity to Varicella Over Time

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1. COMPENDIUM PROVIDES LATEST INFORMATION AVAILABLE ON MENTAL HEALTH SERVICES

Mental Health, United States, 2004 addresses recent recommendations by the Institute of Medicine for coordinated primary and mental health and substance use care and the application of quality improvement to the mental health field. The 2004 compendium, the latest in a series published every 2 years since 1983 by the Substance Abuse and Mental Health Services Administration's Center for Mental Health Services (CMHS), is divided into five sections. Section 1 introduces the quality-improvement model and its application to the mental health field. Section 2 reviews measures of quality essential for any quality-improvement initiative. Section 3 highlights the role of mental health care provided in primary care settings. Section 4 examines population assessments to identify individuals with mental illness from community surveys and cost assessments drawn from encounter-payment data for consumers served in major public and private funding programs. Section 5 presents annual national service statistics collected through the CMHS National Mental Health Statistical Reporting Program. The appendices provide sources and qualifications of data from the Survey of Mental Health Organizations and the 1997 Client/Patient Sample Survey, and from mental health consumer organizations and mental health practitioners and trainees. The compendium is intended for use by program administrators, policymakers, and others in helping to guide program and policy direction and identify a course toward system transformation in mental health care. The compendium is available at http://download.ncadi.samhsa.gov/ken/pdf/SMA06-4195/CMHS_MHUS_2004.pdf.

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2. BRIEFS PRESENT INFORMATION FOR PROGRAMS ON ISSUES THAT CAN AFFECT ADOLESCENT WELL-BEING

Child Trends recently released three new briefs in the Research-to-Results series that offer guidance on adolescent health for out-of-school-time policymakers and program administrators. Each brief provides background information on selected adolescent health issues, practical tips for recognizing signs of problems among program participants, and outcome measures that can be used in program evaluations. The briefs include the following:
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3. AUTHORS ANALYZE HISTORICAL AND PROJECTED TRENDS IN FEDERAL SPENDING ON CHILDREN

Kids' Share 2007 examines trends in child expenditures, child expenditures within the children's budget, and the future of federal spending on children. The report updates and expands previous research published in 2000 by the Urban Institute, adding additional years and programs and projecting spending within the children's budget against other federal spending for the period 1960-2017. Children are defined as "individuals ages 18 and younger who are not yet engaged in post-secondary education," and about 100 federal programs are classified within eight major budget categories including income security, nutrition, housing, tax credits and exemptions, health, social services, education, and training. The report is based on actual budget outlays and projections of spending under current law. The authors do not assess the success, efficiency, or merit of any particular type of spending. Conclusions and selected references are provided. The report is available at http://www.urban.org/UploadedPDF/411432_Kids_Share_2007.pdf.

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4. STUDY INVESTIGATES TRENDS IN EMERGENCY MEDICAID SPENDING FOR IMMIGRANTS

"Medicaid spending for emergency care of recent and undocumented immigrants, although a small proportion of the total Medicaid budget, is increasing rapidly in this new immigrant growth state," write the authors of an article published in the March 14, 2007, issue of JAMA, The Journal of the American Medical Association. A steady increase in the number of foreign-born adults and children living in the United States has fueled debate about the financial burden new immigrants may place on publicly funded health care, but relatively little is known about the health status and health services use of this population. Federal law generally excludes undocumented immigrants, as well as legal immigrants who have been in the United States less than 5 years, from Medicaid eligibility. These individuals can, however, receive Medicaid coverage for emergency medical services (Emergency Medicaid) if they are in a Medicaid-eligible category and meet state income and residency requirements. The study described in this article analyzed 2001-2004 administrative claims data related to the Emergency Medicaid program in North Carolina, a state in which the immigrant population has increased substantially in recent years. Objectives were to describe sociodemographic characteristics of the population served, expenditures including trends over time, and distribution of principal diagnosis by cost and by frequency of hospitalization.

Administrative data included all 317,090 paid Medicaid claims for services received between 2001 and 2004 by undocumented and legal immigrants who were eligible only for Medicaid coverage of emergency care. Patient characteristics, program expenditures, and trends in spending by eligibility category were analyzed with basic descriptive statistics using all claims paid from 2001 through 2004.

The authors found that
The authors conclude that "Emergency Medicaid is predominantly a program for childbirth coverage, although use and spending are shifting toward nonpregnant adults, particularly those who are elderly and disabled." They continue, "increased access to comprehensive and prenatal care, injury prevention initiatives, preventive care, and chronic disease management may make better use of the public health care dollar by improving the health status of this population and alleviating demand for costly emergency care."

DuBard CA, Massing MW. 2007. Trends in Emergency Medicaid expenditures for recent and undocumented immigrants. JAMA, The Journal of the American Medical Association 297(10):1085-1092. Abstract available at http://jama.ama-assn.org/cgi/content/abstract/297/10/1085?etoc.

Readers: More information is available from the MCH Library's knowledge paths, Child and Adolescent Health Insurance and Access to Care, at http://www.mchlibrary.info/KnowledgePaths/kp_insurance.html and Preconception and Pregnancy, at http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html, and from the bibliography, Cost Effectiveness of MCH Programs, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_costeffec.html&-MaxRecords=all&-DoScript=auto_search_costeffec&-search.

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5. ARTICLE EXAMINES VACCINE-INDUCED IMMUNITY TO VARICELLA OVER TIME

"Our analysis provides evidence that the protection afforded by one dose of varicella vaccine in children may wane with time," state the authors of an article published in the March 15, 2007, issue of the New England Journal of Medicine. The implementation of a universal varicella vaccination program in the United States in 1995 has resulted in a substantial reduction in morbidity, mortality, and health care costs associated with the disease. Despite this success, however, outbreaks of varicella continue to occur. But investigations of small outbreaks have not been sufficiently powerful to conclude that immunity to varicella wanes after vaccination. The article describes a study designed to assess whether vaccine-induced immunity to varicella wanes over time. Waning of immunity is of particular interest because it may result in increased susceptibility later in life, when the risk of severe complications could be greater than that in childhood.

Data for the study were drawn from the Varicella Active Surveillance Project, an enhanced community-based surveillance for varicella that has been ongoing among a population of 350,000 individuals in Antelope Valley, California, since January 1995. Using data on doses of varicella vaccine administered each month to children ages 1-12 from 1995 through 2004, the researchers examined the independent effect of the time since vaccination on the severity and incidence of breakthrough varicella (defined as a rash that developed more than 42 days after the child had been vaccinated). Adjustments were made for the child's age at both disease onset and at vaccination and for the calendar year when the disease developed as potential confounders for changes in the likelihood of exposure to the virus.

The authors found that
"The findings from our study and other scientific evidence were taken into account when, in June 2006, the Advisory Committee on Immunization Practices adopted a recommendation that children between the ages of 4 and 6 years receive a second dose of varicella vaccine," conclude the authors, adding that "the panel also recommended that a second catch-up dose of varicella vaccine be given to children, adolescents, and adults who previously had received one dose."

Chaves SS, Gargiullo P, Zhang JX, et al. 2007. Loss of vaccine-induced immunity to varicella over time. New England Journal of Medicine 356(11):1121-1129. Abstract available at http://content.nejm.org/cgi/content/short/356/11/1121.

Readers: The Advisory Committee on Immunization Practices' recommendation is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5551a7.htm.

More information about immunizations is available from the MCH Library's bibliography at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_immuniz.html&-MaxRecords=all&-DoScript=auto_search_immuniz&-search.

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MCH Alert © 1998-2006 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02MC00001) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
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