Pilot testing of a question prompt sheet to encourage family caregivers of cancer patients and physicians to discuss end-of-life issues.

Family members of patients with advanced illness have many questions. Unfortunately, several barriers prevent caregivers from discussing their questions with the physicians caring for the patient. Although question prompt sheets can be helpful in overcoming barriers to communication, few have been developed for family caregivers. The goal of this study, therefore, was to develop and test the acceptability and feasibility of a short question prompt sheet designed to encourage discussions about end-of-life concerns in an outpatient palliative care clinic. Our results demonstrated that caregivers wanted to discuss a variety of questions, primarily questions about medications, symptoms, support services, and what to expect. All caregivers thought that the question prompt sheet was easy to understand and felt comfortable completing it in clinic and the majority reported that the question prompt sheets made it easier for them to ask questions.

Monitoring and enforcing cultural competence in Medicaid managed behavioral health care.

In recent years cultural competence has expanded beyond language provisions to include understanding and factoring into services provision the cultural perspectives clients may have that are different from the majority culture. The federal government requires state Medicaid programs to offer culturally competent services, but little is known about how states implement such mandates and monitor and enforce them. We reviewed the origins and implications of cultural competence mandates and conducted a brief case study of 5 states to learn about the implementation of cultural competence provisions in behavioral managed care contracts. We found that states and managed behavioral health organizations (MBHOs) vary in their definitions and implementation of standards to ensure mental health care access for vulnerable populations. Although states had a variety of oversight mechanisms, varying contractual requirements ranging from optional to required, vague contract language, no existing standardized indicators or definitions, and scant data on the cultural characteristics of the populations enrolled in Medicaid managed care hamper monitoring and enforcement of cultural competence by states. Implications for MBHOs, states, and the federal government, as well as services researchers, follow.

EPSDT in the Commonwealth of Pennsylvania, 1967-1991: a case study of a federally-sponsored, state-administered program.

Understanding the state-level processes that can shape the operations of health and welfare programs is of particular importance today. This article describes the process by which the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program was implemented in the Commonwealth of Pennsylvania. The case study highlights the factors that facilitated and hindered the transformation of this federal policy into a local program. Implications for children's health programming are identified.

Immunization among African American children: implications for social work.

Although childhood immunizations have proved to be one of the most effective means of preventing and controlling the spread of infectious and communicable diseases, thousands of preschool children, particularly children from urban African American poor families, are not being immunized. This article discusses the critical problem of low rates of immunization for this population and identifies ways social workers can play an active role in ensuring that more children are immunized. Immunization of preschool children is a function of the interrelationship among health-seeking behavior of parents, financial and nonfinancial barriers to health care, and provider practices that inhibit appropriate immunization. Improving access to existing public programs, facilitating community organization efforts, assisting communities through self-help and mutual-aid initiatives, and supporting national efforts can improve immunization status among poor children.

A programmatic approach to improving the health of poor children.

There is a consensus among policy makers, physicians, child health advocates, and the general public on the need for federal action to improve the health care delivery system for poor children. What should be done, how it will be done, and who will be responsible remains a controversy. This article addresses the problems and potential of the Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program within the context of Medicaid, and proposes a programmatic strategy to make EPSDT more effective.