RESUMO
Eleven states offer 1915(c) Home and Community Based Services (HCBS) Medicaid waivers to organize and fund programs that provide in-home and community support services to address the unique needs of children and youth with complex mental health concerns and their families. However, as the COVID-19 pandemic-imposed restrictions on community movement and school engagement were enacted, these children and youth lost in-person access to needed supports through school-based programs and professional community providers. The well documented mental health impacts of the pandemic on children and youth necessitates understanding how behavioral health programs and policies were adapted to the constraints of pandemic life for this uniquely at-risk population. This study examines and characterizes trends in modifications made to these programs. Appendix K applications amending HCBS waiver programs targeting children with serious emotional disturbances (SED) were collected from the Center for Medicaid & Medicare Services (CMS) website. In total, 33 applications from 10 states were included in the study. Utilizing a policy mapping approach, applications were coded by hand comparing text from elements in the applications across all 10 states. A summary of program changes reported in applications was created and changes were tracked over the course of the federal public health emergency. States modified programs by adding services for waiver participants, changing the service settings allowed, removing service limit restrictions, and offering electronic/remote service delivery. All states also issued measures to either expand or retain their provider workforce, adding family members as providers, modifying experience requirements, and offering financial incentives via increased payment rates or retainer payments. Modifications to mental health assessment processes ranged from changing the evaluation tools or documentation requirements, extending deadlines, and allowing for remote evaluations. Service plan development processes were adapted by allowing virtual service plan development meetings, allowing participants or representatives to electronically sign plans of care, and permitting verbal consent to begin receiving services. Documenting programmatic adjustments provides a context for further research to understand the experiences of youth, families, and providers in navigating these changes and the relative success or failures of these policies.
Assuntos
COVID-19 , Serviços de Assistência Domiciliar , Idoso , Criança , Adolescente , Humanos , Estados Unidos , Saúde Mental , Serviços de Saúde Comunitária , Pandemias , Medicare , MedicaidRESUMO
As COVID-19 public health emergency measures come to an end, socially vulnerable communities have reduced access to resources that address social and health disparities created or exacerbated by the pandemic. Social workers must uphold access to healthcare as a human right in the post-pandemic era by reducing social vulnerability and strengthening community resilience to respond to future health emergencies and natural disasters. This paper draws on the experiences of a team of social work researchers, students, and practitioners engaged in efforts to disseminate information on COVID preventive measures and broker access to local health and social resources. This project, based in one of the fastest-growing metropolitan areas in the United States, formed part of the federal research response to promote community engagement in regions most disproportionately impacted by the COVID-19 pandemic. Through participation in health fairs and community events that targeted persons with limited access to healthcare resources, we gathered critical insights on how to build community capacity for meaningful community engagement. Drawing on a conceptual model for evaluating community engagement strategies, we describe three main barriers to collaborative community outreach: weak organizational communication and coordination, inconsistent strategies for requesting on-site health services, and low neighborhood awareness of outreach events. We advance strategies for improvement that engage community-based organizations, health systems, backbone organizations, and community members in targeted activities to build community resilience. This includes inter-organizational communication during outreach event planning, formal processes to promote greater use of mobile health services, centralized event communication, and grassroots outreach event promotion.
Alors que les mesures d'urgence de santé publique liées au COVID-19 prennent fin, les communautés socialement vulnérables ont un accès réduit aux ressources permettant de remédier aux disparités sociales et de la santé créées ou exacerbées par la pandémie. Les travailleurs sociaux doivent défendre l'accès aux soins de santé en tant que droit humain dans l'ère post-pandémique en réduisant la vulnérabilité sociale et en renforçant la résilience des communautés pour répondre aux futures urgences sanitaires et catastrophes naturelles. Cet article s'appuie sur les expériences d'une équipe de chercheurs, d'étudiants et de praticiens en travail social engagés dans des efforts visant à diffuser des informations sur les mesures préventives du COVID et à faciliter l'accès aux ressources santé et sociales locales. Ce projet, basé dans l'une des zones métropolitaines urbaines à la croissance la plus rapide des États-Unis, faisait partie de la réponse fédérale en matière de recherche visant à promouvoir l'engagement communautaire dans les régions les plus touchées de manière disproportionnée par la pandémie de COVID-19. Grâce à notre participation à des foires sur la santé et à des événements communautaires ciblant les personnes ayant un accès limité aux ressources de santé, nous avons recueilli des informations essentielles sur la manière de renforcer les capacités communautaires pour un engagement communautaire significatif. En nous appuyant sur un modèle conceptuel pour évaluer les stratégies d'engagement communautaire, nous décrivons trois principaux obstacles à la sensibilisation communautaire collaborative : une communication et une coordination organisationnelles faibles, des stratégies incohérentes pour demander des services de santé sur place et une faible sensibilisation du quartier aux événements de sensibilisation. Nous proposons des stratégies d'amélioration qui engagent les organisations communautaires, les systèmes de santé, les organisations de base et les membres de la communauté dans des activités ciblées visant à renforcer la résilience communautaire. Cela comprend la communication inter-organisationnelle lors de la planification des événements de sensibilisation, les processus formels visant à promouvoir une plus grande utilisation des services de santé mobiles, la communication centralisée des événements et la promotion des événements de sensibilisation au niveau local.
RESUMO
We present four cases of patients admitted to an acute geriatric unit with a presumptive diagnosis of bronchiolitis obliterans organizing pneumonia between 2001 and 2005. Because of the difficulty of performing transbronchial biopsy in these patients, who showed a variety of clinical presentations, the suspected diagnosis was based on clinical and radiological findings and a favorable response to empirical corticosteroid treatment. The clinical and radiological features of this entity in the elderly, as well as the therapeutic options, are reviewed.
Assuntos
Corticosteroides/uso terapêutico , Pneumonia em Organização Criptogênica/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Pneumonia em Organização Criptogênica/diagnóstico , Feminino , Humanos , MasculinoRESUMO
Se presentan 4 casos de pacientes ingresados entre 2001 y 2005 en una unidad geriátrica de agudos hospitalaria con diagnóstico de presunción de bronquiolitis obliterante con neumonía organizada (BONO). En esos pacientes, ante la dificultad de la realización de la biopsia transbronquial, con diversidad de presentación clínica, se realizó el diagnóstico de sospecha de BONO sobre la base de los hallazgos clínicos, radiológicos y la respuesta favorable a tratamiento empírico con corticoides. Se realiza una revisión clínica, radiológica y terapéutica de esa afección en el anciano
We present four cases of patients admitted to an acute geriatric unit with a presumptive diagnosis of bronchiolitis obliterans organizing pneumonia between 2001 and 2005. Because of the difficultyof performing transbronchial biopsy in these patients, who showed a variety of clinical presentations, the suspected diagnosis was based on clinical and radiological findings and a favorable response to empirical corticosteroid treatment. The clinicaland radiological features of this entity in the elderly, as well as the therapeutic options, are reviewed
