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information for practice June 2008 archives

June 30, 2008

NSW in Focus provides extensive information about the people, economy and environment of NSW. 'Statistical Highlights' provide analysis and graphs on selected indicators. 'Summary Table' provides time series indicators.

Results—The age-adjusted death rate for the United States decreased from 798.8 deaths per 100,000 population in 2005 to 776.4 deaths per 100,000 population in 2006. Age-adjusted death rates decreased significantly between 2005 and 2006 for 11 of the 15 leading causes of death: Diseases of heart, Malignant neoplasms, Cerebrovascular diseases, Chronic lower respiratory diseases, Accidents (unintentional injuries), Diabetes mellitus, Influenza and pneumonia, Septicemia, Intentional self-harm (suicide), Chronic liver disease and cirrhosis, and Essential hypertension and hypertensive renal disease. Age-adjusted death rates for Alzheimer’s disease, Nephritis, nephrotic syndrome and nephrosis, Parkinson’s disease, and Assault (homicide) did not change significantly between 2005 and 2006. Life expectancy at birth rose by 0.3 years to a record high of 78.1 years.

In April 2006, Massachusetts passed legislation intended to move the state to near-universal coverage within three years and, in conjunction with that expansion, to improve access to affordable, high-quality health care. In roughly the first year under reform, uninsurance among working-age adults was reduced by almost half among those surveyed, dropping from 13 percent in fall 2006 to 7 percent in fall 2007. At the same time, access to care improved, and the share of adults with high out-of-pocket costs and problems paying medical bills dropped. Despite higher-than-anticipated costs, most residents of the state continued to support reform.

This report presents interim findings of the Urban Institute's evaluation of the Gang Reduction Program (GRP), a $10 million, multi-year, federal initiative to reduce gang crime in Los Angeles, California; Milwaukee, Wisconsin; North Miami Beach, Florida; and Richmond, Virginia. The evaluation found substantial variation in collaboration levels among partners in each site, but each site achieved significant implementation successes. The effects of GRP in each site were mixed, and only one site, Los Angeles, showed a significant reduction in crime levels. By late 2007, however, three sites had undertaken significant steps towards sustaining GRP beyond the federal funding period.

A report on a consultation exercise that took place between September 2007 and December 2007 relating to draft Code of Practice guidance and two sets of draft regulations concerning the deprivation of liberty safeguards introduced into the Mental Capacity Act 2005 by the Mental Health Act 2007.

New commitments in the carers’ strategy include: £150 million towards planned short breaks for carers; £38 million towards supporting carers to enter or re-enter the job market and £6 million towards improving support for young carers. Other schemes include the piloting of annual health checks for carers to help them stay well and training for GPs to recognise and support carers. A more integrated and personalised support service for carers will be offered through easily accessible information, targeted training for key professionals to support carers, and pilots to examine how the NHS can better support carers.

June 27, 2008

There is growing public concern about how much alcohol young people drink in their teenage years. The evidence set out in this Action Plan, which was promised in the Children's Plan, shows the extent of the problem. Young people who drink too much put their own health at risk, and are more likely to get involved in anti-social behavior and contribute to crime. To tackle these problems, we need to work closely with parents, schools, health services and the police. This Action Plan sets out the Government's five priorities.

This report demonstrates that there is significant underuse of effective preventive care in the United States, resulting in lost lives, unnecessary poor health, and inefficient use of health care dollars. All of the services examined in this report are extremely cost effective: they all provide an excellent return on investment. It is a national imperative to make these and other cost-effective preventive services affordable and accessible for all Americans.

Examines the involvement of girls in violent activity (including whether such activity has increased relative to the increase for boys) and the contexts in which girls engage in violent behavior. Increasing arrest rates of girls led the Office of Juvenile Justice and Delinquency Prevention (OJJDP) to convene the Girls Study Group. The Girls Study Group examines strategies to reduce girls’ involvement in violence and delinquency. This OJJDP Bulletin assesses trends of juvenile arrest rates for violent crimes, focusing on simple and aggravated assault.

This short booklet explains the Government’s plans for countering violent extremism to protect the security of the UK in the long term. To be successful, we need to undermine extremist ideology, strengthen our institutions, support individuals who are susceptible to radicalisation, help our communities resist violent extremism and address the grievances on which extremists prey. Local partners, particularly police and local authorities, have a vital role to play in achieving the strategy’s objectives. The Guide for local partners gives detailed guidance to support those working in this field, including the importance of work with young people and the need to include schools, colleges, children's and youth services in strategic planning and local delivery for work on preventing violent extremism.

The SAMHSA report, Substate Estimates from the 2004-2006 National Surveys on Drug Use and Health, measures and analyzes 23 substance abuse and mental health-related behavior levels in 345 substate regions representing all 50 states and the District of Columbia. In most states, the substate regions are defined in terms of counties or groups of counties. In a few states, these areas are defined in terms of census tracts. The results were based on the combined data from SAMHSA's 2004 to 2006 National Surveys on Drug Use and Health (NSDUH) and involved responses from 203,870 people age 12 or older throughout the United States.

This report covers the Children in Need census, which gathers information on the numbers and characteristics of children in need, such as children receiving care and other social services support.

- Public perceptions of government in Scotland changed substantially across a range of measures between 2006 and 2007.
- The proportion who trusted the Scottish Executive to act in Scotland's interests 'just about always' or 'most of the time' increased from 51% in 2006 to 71% in 2007.
- Similarly, the proportion who trusted the Scottish Executive 'a great deal' or 'quite a lot' to make fair decisions increased from 31% to 47%.

June 26, 2008

Social insurance protects families against common risks to their economic security, such as the loss of earnings and the cost of health care. To share these risks as widely as possible, social insurance programs aim to be universal in their coverage. Approaches to achieve broad coverage include tax-financed public programs, subsidized voluntary programs, requirements for employers to provide for their employees, and requirements for individuals to obtain insurance. This issue brief summarizes these approaches. An appendix considers the role that an individual mandate might play in expanding health insurance coverage.

Illegal sales of tobacco products to underage youth have reached an all-time low under the Synar Amendment program, a federal-state partnership program aimed at ending illegal tobacco sales to minors, the Substance Abuse and Mental Health Services Administration announced today. The national average of illegal tobacco sales to minors has dropped since the program’s inception from 40.1 percent in fiscal year 1997 to 10.5 percent in fiscal year 2007, the report said. Nearly all states and the District of Columbia have achieved a major Synar program goal – having 20 percent or less of their state’s tobacco product retailers engaging in illegal sales of tobacco to minors. These levels stand in sharp contrast with the situation 11 years ago at the Synar program’s inception, when only four states met this goal.

lthough much is known about how to help unemployed welfare recipients find jobs, little is known about how to help them and other low-wage workers keep jobs or advance in the labor market. This report presents an assessment of the implementation and effects at the one-year follow-up point of a program in Salem, Oregon, that aimed to promote better initial job placements, employment retention, and advancement among applicants to the Temporary Assistance for Needy Families (TANF) program who were unemployed. The program is part of the Employment Retention and Advancement (ERA) project, which is testing 16 models across the country. The ERA project is being conducted by MDRC, under contract to the U.S. Department of Health and Human Services, with additional funding from the U.S. Department of Labor.

In 2007, the share of families with an unemployed member was 6.3 percent, little changed from the prior year, the Bureau of Labor Statistics of the U.S. Department of Labor reported today. The proportion of families with an unemployed member remained lower than the recent peak of 8.1 percent in 2003. Of the nation’s 77.9 million families, the propor tion that had at least one employed member was little changed in 2007 at 82.6 percent. These data on employment, unemployment, and family relationships are collected as part of the Current Population Survey (CPS), a monthly sample survey of approximately 60,000 households. Families include married-couple families, as well as families maintained by a man or woman with no spouse present.

Caring for children is one of the most important jobs of every community. Relatives play an essential role in helping to meet the needs of children who are unable to live with their parents.
The connection to family, relatives and community is very important to a growing child because:
• children can live with people they already know and trust;
• children can maintain their personal and cultural identity;
• families learn to rely on their own resources and strengths;
• relatives participate as responsible and integral members of the child and family’s support team.
This booklet will help you to understand the reasons children come into the care of the Office of Children’s Services (OCS), the responsibility of the state, the role of the court, the importance of relatives and the options available to relatives.

This Statistics Publication Notice contains revised estimates on alcohol consumption from the 2003 Scottish Health Survey following the development of new alcohol unit conversion factors. This publication covers the headline results. A more detailed publication on 24 June 2008 will update all of the analyses included in the 2003 Scottish Health Survey alcohol chapter for adults (Volume 2: Chapter 1) and one table from the children’s report (Volume 3: Chapter 1) published in November 2005.

June 25, 2008

Since the early 1990s, New York’s health policymakers have promoted Medicaid managed
care as a way to change the delivery of health care services, improve quality of care, and
control growth in Medicaid spending. Today there are more than 2.5 million beneficiaries
enrolled in managed care, and state officials are pressing ahead with efforts to encourage the
more than 1.6 million remaining in fee-for-service to enter some type of managed care
system. Despite this broad public policy agenda, there are still surprisingly few efforts to
examine how well the program is achieving its basic goals. This report examines eight key issues related to Medicaid managed care in New York.

Gender, Poverty and Environmental Indicators on African Countries 2008 is divided in three main parts: Part One presents the 2008 special feature article on the linkages between poverty and the environment in Africa; Part two focuses on Africa's progress towards attaining the Millennium Development Goals with three sections presenting comparative cross-country data on Gender, Poverty and the Environment; and Part Three provides detailed country-specific data for each of the 53 countries.

Identifying the effect of parental incomes on child outcomes is difficult due to the correlation of unobserved ability, education levels and income. Previous research has relied on the use of instrumental variables to identify the effect of a change in household income on the young adult outcomes of the household’s children. In this research, we examine the role that an exogenous increase in household incomes due to a government transfer unrelated to household characteristics plays in the long run outcomes for children in affected households. We find that children who are in households affected by the cash transfer program have higher levels of education in their young adulthood and a lower incidence of criminality for minor offenses. These effects differ by initial household poverty status as is expected. Second, we explore two possible mechanisms through which this exogenous increase in household income affects the long run outcomes of children – parental time (quantity) and parental quality. Parental quality and child interactions show a marked improvement while changes in parental time with child does not appear to matter.

Federal funding to states supported more than 200,000 youth in residential facilities in 2004, many seeking help to address behavioral or emotional challenges. However, federal investigations have identified maltreatment and civil rights abuses in some facilities. GAO was asked to provide national information about (1) the nature of incidents that adversely affect youth well-being in residential facilities, (2) how state licensing and monitoring requirements address youth well-being in these facilities, and (3) what factors affect federal agencies' ability to hold states accountable for youth well-being in residential facilities. GAO conducted national Web-based surveys of state child welfare, health and mental health, and juvenile justice agencies and achieved an 85 percent response rate for each of the three surveys. We also visited four states, interviewed program officials, and reviewed laws and documentation.

This paper presents an overview of the IRC Child Injury Series, a working paper series on child injury that has its first focus on injury in developing countries. The series summarizes the findings of six national and subnational surveys in Asia: Bangladesh, China (two regions), Philippines, Thailand and Viet Nam. The surveys, undertaken using a new methodology resembling a census, found that injury is the leading cause of death after infancy in children through 17 years of age in all countries surveyed. The methodology involved creating a very large, representative sample of households in each national/subnational survey and directly counting all mortality events in the previous three years and all morbidity events that required missing work, school, or being hospitalized from injury in the previous one year. The results show that prior estimates of child mortality have omitted most injury deaths in early childhood as they did not include children aged five years and over. As a result, injury, which is a leading cause of death in children under five, and the leading cause of death in children aged five years and over, has been largely invisible to policymakers and is not included in child health programmes. The surveys show a consistent pattern of types of injury in the different stages of childhood in the countries surveyed. Drowning, greatly underestimated by traditional methods of surveillance, is the leading injury cause, responsible for over half of all injury deaths in children. Evidence from the surveys shows that the social, health and economic burden of non-fatal injury is significantly high. While falls, road traffic, cuts and burns were found to be leading causes of morbidity, injury caused by animals also emerged as a leading cause of mortality and morbidity. Addressing injury is necessary to continue current progress in child mortality and morbidity reductions in the region.

The purpose of this study was to provide an expert review of the Oregon Children, Adults and Families (CAF) safety intervention system in comparison to the state of the art of Child Protective Services (CPS) safety intervention nationally. The state of the art consists of 1) the state of the knowledge base that defines, directs and supports the concept, standards and practice of safety intervention and 2) actual application occurring nationally in case practice. Notably the knowledge base is generally well formed and continuing to evolve while the nature and quality of application lags behind. Simply stated, what is known about safety intervention exceeds what currently is being done in practice.

June 24, 2008

Every year, 120,000 children 14 years of age and younger suffer some form of permanent damage due to unintentional/accidental injuries. Infants and toddlers are at high risk of unintentional injury or death due to their inability to recognize and react to protect themselves from the danger. . . . While it may be impossible to eliminate all the dangers children encounter in their homes, one of the most important factors in reducing those dangers is parent education. The Home Safety Checklist, when properly used with parents and caregivers, provides an effective home safety assessment and educational tool that will assist in promoting the safety of children.

This publication presents results from the 2006-07 Family Characteristics and Transitions Survey (FCTS) and compares them to results from the 2003 and 1997 Family Characteristics Surveys (FCS), providing information about changing patterns of family and household composition in contemporary Australia. Information on family transitions such as relationship history, relationship expectations, children born and fertility expectations is also presented in this publication. Information is presented for the Australian population living in private dwellings, excluding very remote parts of Australia.

Using a unique data source on marital status, partnership and sexual orientation of academics and administrators at British universities, we estimate the impact of personal relationships upon earnings for men and women. While university data cover a relatively homogeneous group of workers, the two sides of the university are very different, with administrative jobs being more like the general job market in the economy. We find a large and significant married male premium, but only on the administrative side of the university. There is no female marriage premium, and no partnership return to gay men or to either heterosexual or homosexual women.

Today, the retirement income system — comprising Social Security and employer-sponsored pension plans — is contracting. To compensate, people need to work longer to ensure an adequate income over many years throughout retirement. A few additional years in the labor force can make a big difference. Working longer directly increases current income; it avoids the actuarial reduction in Social Security benefits; it allows people to contribute more to their 401(k) plans; and it shortens the period of retirement. Indeed, people have begun to respond. The long-term trend toward earlier retirement ages came to a halt in the mid-1980s, and labor force participation rates at older ages actually began to increase in the mid-1990s.

Kentucky’s Family Preservation Program (FPP) refers globally to an array of short-term crisis interventions and support services provided in the family home. FPP services are a part of a continuum of prevention interventions designed to reduce abuse and neglect, maintain children safely in their home, improve parenting capacity, and facilitate the safe and timely return home for a child in out-of-home care (OOHC). To qualify for FPP services, families must be at imminent risk of losing children to OOHC or have a child in OOHC returning home. FPP service is available in every county (120 counties) through a state network of non-profit contract agencies with coordination and referral to FPP at the regional DCBS office. FPP providers intervene within 72 hours of a DCBS (Department for Community Based Services) referral and are available 24/7 to work with the family. They teach skills, promote and model positive parenting, and connect families with community services.

In the United States, 72% of all deaths among persons aged 10--24 years result from four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2007 national Youth Risk Behavior Survey (YRBS) indicated that many high school students engaged in behaviors that increased their likelihood of death from these four causes. Among high school students nationwide during 2007, 11.1% had never or rarely worn a seat belt when riding in a car driven by someone else. During the 30 days before the survey, 29.1% of high school students had ridden in a car or other vehicle driven by someone who had been drinking alcohol, 18.0% had carried a weapon, and 5.5% had not gone to school because they felt they would be unsafe at school or on their way to or from school. During the 12 months before the survey, 6.9% of high school students had attempted suicide. In addition, 75.0% of high school students had ever drunk alcohol, and 4.4% had ever used methamphetamines. Substantial morbidity and social problems among youth also result from unintended pregnancies and STDs, including HIV infection. Results from the 2007 survey indicated that 47.8% of students had ever had sexual intercourse, 35.0% of high school students were currently sexually active, and 38.5% of currently sexually active high school students had not used a condom during last sexual intercourse. Among U.S. adults aged >25 years, 59% of all deaths result from two causes: cardiovascular disease and cancer. Results from the 2007 national YRBS indicated that risk behaviors associated with these two causes of death were present during adolescence. Among high school students nationwide during 2007, 20.0% had smoked cigarettes during the 30 days before the survey, 35.4% had watched television 3 or more hours per day on an average school day, and 13.0% were obese. During the 7 days before the survey, 78.6% of high school students had not eaten fruits and vegetables five or more times per day, 33.8% had drunk soda or pop at least one time per day, and 65.3% had not met recommended levels of physical activity.

The past decade has seen an increase in the evidence base on housing and disabled children, which has in turn contributed to greater awareness of this issue among practitioners working in housing and children's services. The issue has also moved up the policy agenda, with government reporting that more needs to be done to improve the housing situation of families with disabled children (Department of Health, 2004; Cabinet Office, 2005). On-going policy developments within children's services and housing may provide further opportunities for change at a policy level, and the implementation of those policies locally offers the chance for local services to reconsider the way they currently meet the housing needs of families with disabled children living in their area (Beresford, 2006). . . . This round-up provides an overview of what is currently known about the housing circumstances of disabled children and their families. Published government statistics, secondary analysis of government surveys, and primary quantitative and qualitative research are used.

June 23, 2008

The Texas Health and Human Services Commission (HHSC) contracted with Navigant Consulting, Inc. for assistance in the optimization of the state’s case management services. In 2005, the Texas Legislature enacted Senate Bill 1188, which directs HHSC to assess, review and undertake optimization of case management programs and services across the HHSC enterprise. In response to Section 2.4.2.5 of the HHSC RFP, this document reports on the use of stakeholder involvement in the analysis of the current case management system and in the development of case management optimization recommendations which are described in detail in the Analysis of the Current Case Management System in Texas report and the Recommendations for Improving Case Management in Texas report. This report also includes a summary of stakeholder comments and the contractor’s approach to obtaining comments.

This update to the 2004 report will briefly review the issues identified by NASTAD’s Native American Networking and Stakeholder groups and the ways in which health departments and Native American tribes and urban organizations have worked to address these concerns. In addition, we hope to dispel some of the commonmisconceptions about Native Americans, including eligibility for health services. In addition to discussing how specific issues are being addressed, this update also includes a list of several important resources: a description of how HIV/AIDS services for Native Americans are organized at the federal level; a list of pertinent U.S. laws related to Native Americans, and a glossary of important terms related to HIV/AIDS and Native Americans. This update emphasizes strategies and approaches to consider for health departments and Native American advocates wishing to do more to address HIV/AIDS in Native American communities.

This paper investigates the possibility of intergenerational transmission of unhealthy eating habits from parents to adult children. It uses the 2003 Scottish Health Survey and estimates the association between the present healthy eating behaviour of adult children and the past parental death from cardiovascular disease (CVD). It uses parental CVD death as an adverse health signal which may cause a healthy eating compensatory response in adult children. This response is due to increased chances and perception of genetic predisposition of adult children as well as an indicator for parental past unhealthy eating habits which may have been passed onto the adult children. Regression analysis suggests that paternal history has no impact on either sons or daughters, and maternal history influences negatively the eating behaviour of daughters only. Unhealthy eating intergenerational transmission appears to be more intense amongst lower household income individuals.

This paper investigates the possibility of intergenerational transmission of unhealthy eating
habits from parents to adult children. It uses the 2003 Scottish Health Survey and estimates
the association between the present healthy eating behaviour of adult children and the past
parental death from cardiovascular disease (CVD). It uses parental CVD death as an adverse
health signal which may cause a healthy eating compensatory response in adult children.
This response is due to increased chances and perception of genetic predisposition of adult
children as well as an indicator for parental past unhealthy eating habits which may have
been passed onto the adult children. Regression analysis suggests that paternal history has
no impact on either sons or daughters, and maternal history influences negatively the eating
behaviour of daughters only. Unhealthy eating intergenerational transmission appears to be
more intense amongst lower household income individuals.

Lumina Foundation for Education created the Dreamkeepers and Angel Fund Emergency Financial Aid Programs to assist community college students who are at risk of dropping out because of unexpected financial crises. Both programs are multiyear pilot projects that began in 2005 and are administered by Scholarship America and the American Indian College Fund, respectively. Eleven community colleges are participating in Dreamkeepers; 26 Tribal Colleges and Universities (TCUs) are participating in Angel Fund. Each Dreamkeepers college receives up to $100,000 over three years; each TCU receives nearly $26,000 over five years. The colleges are responsible for designing the programs and raising funds, both to sustain their programs and to continue receiving matching funds from the initiative. Lumina asked MDRC to evaluate these programs during their first two years of program design and implementation.

Data from the Annie E. Casey Foundation’s 2008 KIDS COUNT Data Book are now available in our easy-to-use, powerful online database, the KIDS COUNT Data Center, which allows you to generate custom graphs, maps, ranked lists, and state-by-state profiles; or, download the entire data set as delimited text files.

This report examines processes for reviewing child deaths. Formal review processes serve a valuable public health function in providing contemporary and comprehensive information on patterns of child death, promote action to prevent child deaths, and support wider aspects of inter-agency working to safeguard children and promote their welfare.

In 2006, the number of uninsured children in moderate-income families increased, leaving 1.4 million children from families with incomes from 200%-299% of poverty ($41,228 to $61,842 for a family of four in 2006) uninsured. Although two-thirds of uninsured children are below 200% of the poverty level, the growing number of uninsured children in these moderate-income families reflects mounting concerns about the affordability of health insurance for middle class families. Currently, 44 states and DC have authorized coverage to children with family incomes at or above 200% of poverty. Twenty of those states have authorized coverage to children in families at 300% of poverty, including New Jersey which now covers children up to 350% of poverty.

The Onsite Review Instrument is used to review both foster care and in-home services cases during the onsite review component of the Mini Child and Family Services Reviews (Mini-CFSR) of Wyoming child welfare systems. In completing the Onsite Review Instrument, reviewers will conduct case file reviews and case-related interviews with children, parents, foster parents, caseworkers, and other professionals involved with the child. The instrument is organized into a Face Sheet and three sections. On the Face Sheet, reviewers document general information about a case, such as the type of case. Reviewers are to document the names of individuals involved in the case on the Face Sheet. For the remainder of the instrument, reviewers are not to use proper names, but should use titles (for example, biological mother, target child, caseworker, etc.) when referencing individuals. When it is necessary to identify a child to clarify a response on the instrument, enter the child’s first name only. No surnames are to appear anywhere in the instrument, except on the first page.

June 20, 2008

Scientific discoveries over the past two decades have transformed the way in which researchers, policymakers, and the public think about early childhood. For example, recent research in brain science has provided a biological basis for prevailing theories about early child development, and cost-benefit analysis has reoriented some of the discussion about early childhood toward prevention programs. Several recent reports have been particularly helpful in translating research findings into practical information that improves policy. This paper summarizes the contributions from the field of economics, which has played an increasingly prominent role in recent discussions about early childhood policy. The insights from economics also have broader implications for social programs focused on prevention, especially during childhood, rather than later-in-life remediation. This research will be of value to individuals who are interested in early childhood policy, including decisionmakers in the public and private sectors, service providers, and the public more generally.

GlobalHealthFacts.org, a project of the Henry J. Kaiser Family Foundation, provides free, up-to-date and easy-to-access data by country on HIV/AIDS, tuberculosis, malaria and other key health and socio-economic indicators. The data are displayed in tables, charts, and color-coded maps and can be downloaded for custom analyses. GlobalHealthFacts.org is a companion site to GlobalHealthReporting.org, a project operated by the Foundation with major support from the Bill & Melinda Gates Foundation.

Do social cash transfer schemes in countries with high HIV and AIDS prevalence that target a broad spectrum of poor or extremely poor households, but do not explicitly target HIV and AIDS affected persons or households, have a significant AIDS mitigation impact? The study attempts to answer this question by presenting and analysing literature on the five biggest social cash transfer schemes in South Africa and data from pilot schemes in Zambia and Malawi. The analysis tries to establish the degree to which the different schemes reach HIV and AIDS affected households and in which ways the beneficiary households and the children living in these households benefit from the schemes. By comparing the different schemes the study identifies the main factors that determine both the share of HIV and AIDS affected households reached and the impact achieved.

In 2003, GAO designated federal disability programs as a high-risk area because federal disability programs remained grounded in outmoded concepts that have not been updated to reflect the current state of science, medicine, technology, and labor market conditions. In addition, the Social Security Administration (SSA) and the Department of Veterans Affairs (VA) faced management challenges, especially with their disability claims processing. Further, disability experts have expressed concerns about the level of coordination among the many federal agencies that provide benefits and services to individuals with disabilities. GAO was asked to determine: (1) what steps SSA and VA have taken to modernize their disability programs and (2) to what extent SSA and VA coordinate with other federal agencies that provide services to individuals with disabilities. To do this, GAO reviewed literature, agency strategic plans and performance and accountability reports, and interviewed agency officials.

1. Overall, substance use (drinking alcohol and using illicit drugs) among teens in East and Central Harlem, Bedford-Stuyvesant and Bushwick, and the South Bronx is similar to that among teens in the rest of New York City.
2. Teens in East and Central Harlem, Bedford-Stuyvesant and Bushwick, and the South Bronx are more likely to be hospitalized for asthma than teens in other parts of the city.
3. Symptoms of depression among teens citywide is common, and rates are higher
among females and among lesbian, gay, bisexual and questioning youth.
4. Obesity and overweight are more prevalent among teens in Bedford-Stuyvesant and Bushwick, the South Bronx, and East and Central Harlem than among teens in the rest of New York City.
5. Teens in the DPHO neighborhoods of East and Central Harlem, Bedford-Stuyvesant and Bushwick, and the South Bronx are more likely to be sexually active than teens in the rest of New York City.

DHS Child Protective Workers and Case Managers provide critical analyses and recommendations about safety and risks of harm for a child. These formal assessments are tools to help assess safety and risk and which occur at key decision points throughout the life of the case, but are only one part of this assessment. Staff and their supervisors use their professional judgment and expertise to evaluate the entire situation.

By addressing the epidemiology of drug use and the of additional schools and by encouraging all 50 States to economics of drug markets, the National Drug Control adopt prescription drug monitoring programs. Strategy has produced measurable results for the American people. But significant challenges remain, such as the continuing threat posed by the abuse of pharmaceuticals and other synthetic drugs. With tools that have proven effective, we will rise to these challenges and seek to achieve a further 10 percent reduction in youth drug use in 2008, using 2006 as the baseline.

June 19, 2008

This paper provides an economic perspective on the prevention of chronic diseases, focusing in particular on diseases linked to lifestyle choices. The proposed economic framework is centred on the hypothesis that the prevention of chronic diseases may provide the means for increasing social welfare, enhancing health equity, or both, relative to a situation in which chronic diseases are simply treated once they emerge. Testing this hypothesis requires the completion of several conceptual and methodological steps. The pathways through which chronic diseases are generated must be identified as well as the levers that could modify those pathways. Justification for action must be sought by examining whether the determinants of chronic diseases are simply the outcome of efficient market dynamics, or the effect of market and rationality failures preventing individuals from achieving the best possible outcomes. Where failures exist, possible preventive interventions must be conceived, whose expected impact on individual choices should be commensurate to the extent of those failures and to the severity of the outcomes arising from them. A positive impact of such interventions on social welfare and ealth equity should be assessed empirically through a comprehensive evaluation before interventions are implemented.

GAO reports since 1998 have demonstrated that state surveyors, who evaluate the quality of nursing home care on behalf of CMS, sometimes understate the extent of serious care problems in homes because they miss deficiencies. CMS oversees the effectiveness of state surveys through the federal monitoring survey program. In this program, federal surveyors in CMS's regional offices either independently evaluate state surveys by resurveying a home (comparative surveys) or directly observe state surveyors during a routine nursing home survey (observational surveys). GAO was asked to evaluate the information federal monitoring surveys provide on understatement and the effectiveness of CMS management and oversight of the survey program. To do this, GAO analyzed the results of federal monitoring surveys for fiscal years 2002 through 2007, reviewed CMS guidance for the survey program, and interviewed headquarters and regional office officials.

• Opioid dependence is a significant public health problem and is increasing due to growing
abuse of opioid pain medication.
• Buprenorphine is an effective treatment for opioid dependence.
• Primary care physicians can initiate and manage opioid-dependence treatment.

Are individuals more likely to smoke when they are surrounded by smokers? In this paper, we examine the evidence for peer effects in smoking. We address the endogeneity of peers by looking at the impact of workplace smoking bans on spousal and peer group smoking. Using these bans as an instrument, we find that individuals whose spouses smoke are 40 percent more likely to smoke themselves. We also find evidence for the existence of a social multiplier in that the impact of smoking bans and individual income becomes stronger at higher levels of aggregation. This social multiplier could explain the large time series drop in smoking among some demographic groups.

In NYC, asthma is a leading cause of absences from school and the most common cause of hospitalization for children ages 14 and younger. Although NYC asthma hospitalizations are higher than national levels, the number has declined since the mid-1990’s, most likely as a result of improved asthma control. This report examines the prevalence of childhood asthma and factors that may influence its control among NYC children ages 0 to 17. The results are based on findings from a large, representative telephone survey of adults in 2003 who were asked about the health conditions of children in their household, including asthma.

A project investigating the Alignment of the Standards in Social Work Education (SiSWE) to the Scottish Credit and Qualifications Framework (SCQF). This project shines a spotlight on the social work qualifying degrees in Scotland with a particular emphasis on the relationship between the SiSWE and the SCQF. It seeks to understand how these two frameworks align to support improved standards of student attainment at a time when the profession has moved from a diploma to degree level qualification.

June 18, 2008

The majority (69%) of immigrants are in the U.S. legally, and the primary reason many immigrants come to the U.S. is for employment opportunities. Most non-citizen immigrants (83%) are in working families, and they are just as likely as citizens to have at least one full-time worker in the family. However, because non-citizens tend to be employed in low-wage jobs that do not offer health insurance, they are much more likely than citizens to be low-income and are significantly less likely to have employer-based health coverage. They also have more limited access to public health coverage due to eligibility restrictions.

Dementia is a clinical syndrome of loss or decline in memory and other cognitive abilities. It is caused by various diseases and conditions that result in damaged brain cells. To be classified as dementia, the syndrome must meet the following criteria:
• It must include decline in memory and in at least one of the following cognitive abilities:
1. Ability to generate coherent speech and understand spoken or written language;
2. Ability to recognize or identify objects, assuming intact sensory function;
3. Ability to execute motor activities, assuming intact motor abilities, sensory function and comprehension of the required task; and
4. Ability to think abstractly, make sound judgments and plan and carry out complex tasks.
• The decline in cognitive abilities must be severe enough to interfere with daily life.

This fourth issue in the current four-volume series of Social Security Programs Throughout the World reports on the countries of the Americas. The combined findings of this series, which also includes volumes on Europe, Asia and the Pacific, and Africa, are published at 6-month intervals over a 2-year period. Each volume highlights features of social security programs in the particular region. This guide serves as an overview of programs in all regions. A few political jurisdictions have been excluded because they have no social security system or have issued no information regarding their social security legislation. In the absence of recent information, national programs reported in previous volumes may also be excluded.

In nearly all developing countries, the number of women of reproductive age (ages 15 to 49) will grow between 2005 and 2015 because of the large numbers of young people in these countries. In addition, the demand for contraceptives is projected to grow due to couples’ desires for smaller families. As a result, the total cost of contraceptive supplies to meet couples’ needs is projected to rise by nearly 50 percent (in today’s U.S. dollars) in countries such as Tanzania and Nepal. The costs are certain to grow throughout the developing world, placing pressure on governments to increase their family planning budgets, raise additional donor funds, obtain better prices for commodities, and/or shift a greater share of costs to users.

Outside of Africa, UNAIDS estimates that nearly one of three new HIV infections is now due to injecting drug use. Contaminated injection equipment accounts for the largest share of HIV infections not only in Russia and Ukraine, but in China, Indonesia, Malaysia, Vietnam, the Baltics, the former Soviet Union, and much of South America. The International Harm Reduction
Development Program (IHRD), a division of the Public Health Program of the Open Society Institute (OSI), works to reduce HIV and other harms related to injecting drug use, and to press for policies that reduce stigmatization of illicit drug users and protect their human rights. IHRD, which has supported more than 200 harm reduction service organizations in Central and Eastern Europe, the former Soviet Union, and Asia, bases its activities on the understanding that people unable or unwilling to abstain from drug use can make positive changes to protect their health and the health of others. Since 2001, IHRD has prioritized advocacy to expand availability and quality of needle exchange, drug treatment, and treatment for HIV; to reform discriminatory policies and practices; and to increase the opportunities for political engagement by people who use drugs and who are living with HIV.

This guide sets out a range of key approaches to tackling violent street gangs used in the four Tackling Gangs Action Programme (TGAP) areas and other cities. It aims to support your local partnership in devising a gangs strategy, and then in understanding the range of tools available to deliver that strategy. Each section provides a number of possible interventions that your local area might consider adapting to your local circumstances.

A revised guide to replace the National Probation Service ‘Good Practice Guide on Delivering Effective Services for Women Offenders in the Community’. The Offender Management Guide highlights current good practice and provides additional information to offender managers working with women offenders, supporting the offender management model. It informs probation staff of the changes that have occurred since the original guidance; in particular highlighting the importance of the Corston report and describing how offender managers can support the objectives of the National Service Framework.

June 17, 2008

This edition of the Dartmouth Atlas will focus on disentangling the phenomenon known as “unwarranted variation,” or variation in different regions of the country that is not explained on the basis of illness, patient characteristics or preferences, or the dictates of evidence-based medicine (see box). Like the last edition, it focuses on supply-sensitive care delivered to chronically ill Medicare beneficiaries in the last two years of life. The beneficiaries all died between 2001 and 2005, and they were suffering from one or more of the nine chronic diseases listed above. The extent of variation in Medicare spending and utilization and the evidence that more care does not result in better care or better outcomes indicate that some chronically ill and dying Americans receive too much care: more than they or their families actually benefit from. Unlike the previous Atlas, this version includes Medicare spending not just on inpatient care, but also the amount spent on ambulatory care, skilled nursing care, long-term care, home health care, and hospice care. The final chapter of this Atlas will outline a proposal for reforming the Medicare payment system, a plan that is intended to simultaneously improve the quality of care for the chronically ill and rein in spending.

The National Healthcare Disparities Report (NHDR) describes the quality of and access to care for multiple subgroups across the United States, and also represents a source of information for tracking the Nation’s progress over time. The observed disparities vary by condition and population. Overall, disparities in quality and access for minority groups and poor populations have not been reduced since the first NHDR. Based on 2000 and 2001 data compared with this year’s 2004 and 2005 data (depending on the data source), the number of measures on which disparities have gotten significantly worse or have remained unchanged since the first NHDR is higher than the number of measures on which they have gotten significantly better for Blacks, Hispanics, American Indians and Alaska Natives, Asians, and poor populations. While some of the biggest disparities in quality remain, progress has been made in reducing disparities.

In 1965, Congress enacted the Older Americans Act, establishing a federal agency and state agencies to address the social services needs of the aging population. The mission of the Older Americans Act is broad: to help older people maintain maximum independence in their homes and communities and to promote a continuum of care for the vulnerable elderly. In successive amendments, the Act created area agencies on aging and a host of service programs. The “aging services network,” broadly described, refers to the agencies, programs, and activities that are sponsored by the Older Americans Act. The Act’s funding for services is supplemented by other federal funds, such as Medicaid, as well as state and local funds. As the number of older people increases with the aging of the baby boom population, the need for a wide spectrum of services is expected to place pressure on aging services. Whether the aging services network will be able to sustain its momentum and fully realize its potential will depend on its ability to attract and retain additional resources.

As the country heads into economic downturn, 28 states (including the District of Columbia) are forecasting budget deficits for the coming fiscal year, which collectively exceed $39 billion. Because the current downturn is following unusually quickly on the heels of the last economic slowdown, states are less well-positioned than they were in the past to withstand the adverse effects of lost revenue and increased costs. Without federal help, many states may be required to increase taxes or cut spending for Medicaid and other services to meet balanced budget requirements. Already, Medicaid and SCHIP cuts are proposed in 13 states; K-12 education is targeted in 9 states; higher education funding is proposed for reductions in 12 states; and 7 states have either increased taxes or are considering such increases. In light of these economic conditions, this paper examines:
􀁸 The effect of an economic downturn on Medicaid and SCHIP enrollment and spending as well as the number of uninsured;
􀁸 Whether past federal fiscal relief was effective in preventing Medicaid cuts and providing economic stimulus, and
􀁸 Options for structuring federal fiscal relief in the future.

Most Americans are aware that income inequality has increased in the last 30 years. Less well known is that income instability—how much families’ incomes fluctuate up and down over time—has also grown substantially. The Great Risk Shift (Hacker 2006; revised and expanded in 2008) documented a major post-1970s rise in family income instability and argued that it was one indicator of an increasing shift of economic risk from government and employers onto workers and their families. This Briefing Paper updates, improves, and extends these earlier estimates of rising family income instability and discusses potential causes and implications of this trend.

The National Service Framework aims to improve the services we deliver to women offenders in line with the commitments made in the Government’s Response to the Corston Report. It does so by setting out the Government’s strategic aims and objectives for how we propose to meet the needs of women offenders. It goes on to set out high-level service expectations, both through the reducing re-offending pathways, and for the delivery of statutory services.

June 16, 2008

"If fighting breast cancer weren’t bad enough, try beating it while losing your job to outsourcing."

HIV/AIDS has a disproportionate impact on incarcerated populations in the U.S., with prevalence among prisoners more than three times higher than the general U.S. population (see Figure 1). The presence of HIV-infected persons and those at high risk of infection in the correctional system is a critical challenge to both the correctional health system and the public
health community. This challenge offers unique opportunities to reach these high-risk individuals and engage them in HIV prevention, treatment, and care.

A growing body of research on happiness or subjective well-being (SWB) shows, among other things, that people adapt to many injuries more rapidly than is commonly thought, fail to predict the degree of adaptation and hence overestimate the impact of those injuries on their SWB, and, similarly, enjoy small or moderate rather than significant changes in SWB in response to significant changes in income. Some researchers believe that these findings pose a challenge to cost-benefit analysis, and argue that project evaluation decision-procedures based on economic premises should be replaced with procedures that directly maximize subjective well-being. This view turns out to be wrong or, at best, premature. Cost-benefit analysis remains a viable decisionprocedure. However, some of the findings in the happiness literature can be used to generate valuations for cost-benefit analysis where current approaches have proven inadequate.

DOD has taken positive steps to implement mental health standards for deployment and pre-deployment mental health screening. However, DOD’s policies for providers to review medical records are inconsistent. DOD issued minimum mental health standards that servicemembers must meet in order to be deployed to a combat theater and identified the pre-deployment health assessment as a mechanism for ensuring their use in making deployment decisions. DOD’s November 2006 policy implementing these deployment standards requires a review of servicemember medical records during the pre-deployment health assessment. However, DOD’s August 2006 Instruction on Deployment Health, which implements policy and prescribes procedures for conducting pre-deployment health assessments, is silent on whether such a review is required. Because of this inconsistency, providers determining if Operation Enduring Freedom and Operation Iraqi Freedom servicemembers meet DOD’s mental health deployment standards may not have complete medical information.

Children typically enter the child welfare system after a report of suspected child abuse or neglect. In 2005 approximately five million children in the United States were involved in the child welfare system, with as many as 800,000 children in foster care. Depending on the circumstances, children might remain at home under supervision of the child welfare agency, be in a subsidized adoption, or be placed in out-of-home foster care, kinship care, or other residential programs. These children have an understandably high level of psychosocial needs, but are also highly likely to have chronic physical and behavioral health problems. Access to physical and behavioral health services varies drastically, with some youth receiving too much or disjointed care, and othersreceiving too little care. Medicaid's costs for these children are disproportionately large relative to this population's share of Medicaid enrollment.

It is very important that you ensure that mental health facilities under your control are ready to be fully compliant with the requirements of smokefree legislation from 1 July 2008. It is your responsibility to ensure that all staff understand the requirements of smokefree legislation and what it means for them and their units, as breaking the law can result in penalties.

June 13, 2008

The challenges associated with reentry from jail are daunting—large in scale and complex in task. Each year, U.S. jails process an estimated 12 million admissions and releases. That translates into 34,000 people released from jails each day and 230,000 released each week. In three weeks, jails have contact with as many people as prisons do in an entire year, presenting numerous opportunities for intervention. The lives of many who cycle in and out of jail are unstable at best. Substance addiction, job and housing instability, mental illness, and a host of health problems are part of the day-today realities for a significant share of this population. Given that more than 80 percent of inmates are incarcerated for less than 1 month—many for only a few hours or days—jails have little time or capacity to address these deep-rooted and often overlapping issues. Moreover, no single organization or political leader in the community is responsible—or held accountable—for improving reentry outcomes.

To help the elderly and disabled with prescription drug costs, the Congress passed the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), which created a voluntary outpatient prescription drug benefit (Medicare Part D). A key element of the prescription drug benefit is the low-income subsidy, or "extra help," available to Medicare beneficiaries with limited income and resources to assist them in paying their premiums and other out-of-pocket costs. To assess the Social Security Administration's (SSA) implementation of the subsidy, GAO is providing information on (1) the number of applicants approved for or denied the low-income subsidy and (2) challenges of identifying individuals eligible for the subsidy and targeting outreach efforts. This statement is based on a prior GAO report on the subsidy and associated spending issued in May 2007, selected aspects of which we updated in May 2008.

To date, at least 18 states have made or proposed budget cuts that threaten vital services for many residents, including some of the state’s most vulnerable residents. . . . When the economy weakens, state and local revenues decline but the need for public programs increases, as residents lose jobs, income, and health insurance. Already, more than half the states are projecting deficits for the upcoming fiscal year or beyond. In the 27states (plus the District of Columbia) for which specific estimates are available, the combined deficits are expected to total at least $47 billion for fiscal 2009. (In most states, fiscal year 2009 starts July 1 of this year.) These deficits average 9.7 to 10.0 percent of these states’ general fund budgets

Quick facts on key states:
- Issues marriage licenses to same-sex couples: Massachusetts, California*
- Recognizes same-sex marriages from other states: Rhode Island
- Allows civil unions, providing state-level spousal rights to same-sex couples: Connecticut, Vermont, New Jersey, New Hampshire
- Statewide law provides nearly all state-level spousal rights to unmarried couples (Domestic Partnerships): California, Oregon
- Statewide law provides some state-level spousal rights to unmarried couples (Domestic Partnerships): Hawaii, Maine, District of Columbia, Washington

Social Work Practices will be organisations that contract with a local authority to discharge the statutory duties and responsibilities of the local authority in relation to children in care. They will be social workled, but in order to meet the range of needs of children they will also involve or appoint others to support the formation of a strong ‘team around the child’. Social Work Practices will focus on supporting children who are likely to be in care for some time, rather than those who are in care short-term as part of a package of intensive family support. It is this group of children who will be in care long-term who have most to gain from the greater continuity and stability that a Social Work Practice may provide. There are three models proposed for the Social Work Practices pilots: a professional model run by qualified and registered social workers; a third sector model run by a third sector organisation; and a private sector model.

This is a short report based on a small-scale survey of good practice in schools in relation to looked after children. It does not cover all aspects of looked after children or claim to be a full review of related reports and studies of these children. However, it does illustrate good practice for others to consider.

June 12, 2008

This report focuses on the fertility and socioeconomic characteristics of mothers in 2004 related to participation in six public assistance programs: Temporary Assistance to Needy Families (TANF); food stamps; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Medicaid; housing assistance; and other assistance (see the “Assistance Programs” description box). It continues the series of reports that began in 1993 and were revised in 1996 and 2001. The data come from Wave 2 of the 2004 Survey of Income and Program Participation (SIPP), which was conducted from June through September 2004. This report provides a long-range view of the participation of mothers in these programs since the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) was enacted.

This publication examines variations in the self-reported views of NHS patients from different ethnic groups across a range of healthcare settings, and the work was undertaken jointly by the Department of Health and the Healthcare Commission. Results include data from the national surveys of patients published by the Healthcare Commission up to and including 2006/07.

A new addition to the suite of FRANK leaflets. Cocaine: What you need to know, contains the real facts on cocaine from how it's produced, what the risks and effects are, dangers of mixing with alcohol, the law and the impact on producing countries. It also includes information on addiction and the impact on relationships and features stories from young people.

Of the approximately 7.2 million applicants for the low-income subsidy, SSA approved approximately 2.8 million as of March 2008, and SSA has improved some key measures for its subsidy application processes. SSA approved about 570,000 applicants, denied about 403,000 applicants, and determined that no decision was required for about 281,000 applicants in fiscal year 2007. The table below shows that excess income was the primary reason applicants were denied benefits, while many other applicants were denied benefits because their resources exceeded program limits. Further, SSA has collected data and established some goals to monitor its progress in implementing and administering the subsidy benefit.

Children typically enter the child welfare system after a report of suspected child abuse or neglect. In 2005 approximately five million children in the United States were involved in the child welfare system, with as many as 800,000 children in foster care. Depending on the circumstances, children might remain at home under supervision of the child welfare agency, be in a subsidized adoption, or be placed in out-of-home foster care, kinship care, or other residential programs. These children have an understandably high level of psychosocial needs, but are also highly likely to have chronic physical and behavioral health problems. Access to physical and behavioral health services varies drastically, with some youth receiving too much or disjointed care, and others receiving too little care. Medicaid's costs for these children are disproportionately large relative to this population's share of Medicaid enrollment.

SCHIP has significantly reduced the number of low-income children who lack health insurance. According to the Congressional Budget Office’s (CBO’s) estimates, the portion of children in families with income between 100 percent and 200 percent of the poverty level who were uninsured fell by about 25 percent between 1996 (the year before SCHIP was enacted) and 2006. In contrast, the rate of uninsurance among higher-income children remained relatively stable during that period. The difference probably reflects the impact of the SCHIP program. The states’ outreach efforts and simplified enrollment processes for SCHIP appear to have also increased the share of eligible children who participate in Medicaid—and contributed to a decline in the percentage of children living below the poverty level who are uninsured.

June 11, 2008

Some Local Authorities (LAs) and voluntary sector groups have suggested to us that it would be helpful for them to develop local indicators that would help to maintain the profile of work they are doing locally to promote take up of benefits amongst older people, as the new National Indicator Set in England does not include a pensioner poverty indicator.

Income tax provisions affect the buildup of retirement assets during workers' careers and after-tax income following retirement. This paper uses the Urban Institute's DYNASIM model to simulate how potential changes in the tax treatment of retirement saving, Social Security benefits, and income from assets outside retirement accounts may affect boomers' retirement incomes. Changes in the income thresholds for taxing Social Security benefits have the largest impact on middle-income boomers, while changes in contribution limits for retirement saving plans and tax rates on capital gains and dividends have the largest impact on the highest-income boomers.

The majority of respondents (51%) stated that they do not know how much longer they will continue to live in social housing. Approaching one in five (18%) think they will be living in social housing for the next 20 years or more and around one in ten (12%), for 10 to 20 years. Equal proportions stated 1 – 5 years and 5 – 10 years (both 7%). When asked what their previous expectations were for housing, the largest proportion (44%) stated that they had always thought they would own their own property. Following this, around one in three (31%) had never thought about it and over one in ten (13%) agreed they had always thought they would be in rented accommodation. There were various reasons behind the development of the expectations of tenants, including the cost of buying or a having a low wage, life not turning out the way they had hoped, ill health or disability or due to divorce, bereavement or relationship breakdown.

Conclusion: These findings refute the prior hypothesis that use of antidepressants by elderly patients increases the risk of hospitalization for pneumonia or for aspiration pneumonia. Decisions regarding use of antidepressants in elderly persons should not be affected by concern about pneumonia risk. Data-derived hypotheses should be independently confirmed before being acted upon.

Statistical neighbour models provide one method for benchmarking progress in children's services. This tool allows the user to display up to five outcome measures from a list. The outcome measures displayed will be updated regularly by DCSF.

Advances in neuroscience, developmental psychology, and program evaluation have been combined to develop a unified framework that provides evidence-based guidance related to early childhood policy. This research shows how insights from the field of economics — human capital theory and monetary payoffs — also contribute to that framework.

June 10, 2008

Key messages
- The total of 175,000 young carers identified in the 2001 UK Census is likely to be a substantial underestimate.
- Over one third of young carers provide care for someone with a serious mental health problem who is their parent or holds a parental role.
- Mothers are more likely to suffer mental health problems than fathers, and care for mothers is most often given by a female child.
- The unpredictable nature of some mental health problems can create difficulties for young carers whose behaviours are not always correctly attributed.
- The high level of stigma attached to mental health problems may lead young carers to exclude themselves from social involvement.
- The needs of young carers could often be better met by validating their input, concerns and skills.
- The education system can play a major role by recognising the impact of the caring role on children and young people’s experience of education, and making appropriate onward referrals.

Rising health care costs threaten financial security at older ages and lead many older Americans to delay retirement. Continued work reduces the risk of high out-of-pocket health care costs for workers receiving health benefits from their employers. Working longer also increases retirement incomes, making health care costs more affordable. This report shows that men with very high expected health care costs after age 65 retire 11 months later than those with very low health care costs. For women, the difference is 12 months.

This study of the fear of crime funded by the Economic and Social Research Council (ESRC) aimed to build upon previous research showing that the fear of crime is not as widespread as previously thought and may even have been misrepresented. The study sought to confirm findings from a pilot project and explore what the new questions arising out of this project said about the fear of crime, and the sort of people to report having experienced such fear.

The number of poor adults age 65 and older has declined dramatically since the official poverty rate was designed back in the 1960s. Today the federal government considers fewer than 1 in 10 older adults to be poor, compared with about 1 in 3 in the 1960s. These estimates show the share of people with insufficient income to meet basic living expenses, such as food and housing. However, substantial research shows that the official poverty measure no longer reflects the true resources or needs of older adults. The lack of an accurate poverty measure for older adults hampers efforts to reform Medicare and Social Security, which face significant revenue shortfalls. Reform proposals often aim to reduce costs by combining benefit cuts with increased cost sharing for older adults. To target any cuts or increased costs to older adults with the greatest ability to pay, an accurate measure of economic well-being is critical.

The purpose of this guidance is to help schools in areas where ‘gangs’ or offending by groups of young people may be of particular concern. It provides:
• information on the prevalence and characteristics of gangs and finding out about local patterns of gang and group offending;
• advice on prevention: how to create a safer school environment, identification and intervening with pupils at risk;
• advice on what to do if an incident occurs, including emergency planning;
• working with external partners and agencies; and
• examples of good school practice resources.

In order to meet the needs of the children from Eldorado, caregivers should be aware of and prepared to deal with their unique cultural practices and beliefs. The purpose of this is guide to provide information on how these children have been cared for prior to placement outside the FLDS compound and since April 4/5, 2008, when they were placed in shelters. In addition, a glossary of terms that the children may use in their every day language is provided. Although this information is not all inclusive, it can be helpful when communicating with and caring for these children.

This study uses the Regulatory and Statistical Return (RSR) time series database to examine how the stock of housing aimed at particular needs and owned and managed by housing associations has changed since the 1988 Housing Act.

June 9, 2008

Although The Nursing Home Reform Act, passed in 1987, established residents' rights and quality standards for nursing homes nationwide, serious concerns remain about quality of care and quality of life for nursing home residents. The "culture change" movement is working to radically transform nursing home care, and help facilities transition from institutions to home. This report presents results from the Commonwealth Fund 2007 National Survey of Nursing Homes, fielded to examine the penetration of the culture change movement at the national level and measure the extent to which nursing homes are adopting culture change principles and practicing resident-centered care. Results are mixed, with much room for improvement. The survey highlights important lessons, including the finding that the more a nursing home has adopted culture change principles, the greater the benefits that accrue to it, in terms of staff retention, higher occupancy rates, better competitive position, and improved operational costs.

The VA administers two disability programs. These programs pay monthly cash benefits to disabled veterans. Disability compensation provides a monthly benefit if the veteran is disabled as a result of his/her military service. Disability compensation relates specifically to a disability which directly resulted from military service. A disability pension is paid to a wartime veteran if the veteran has limited income, is no longer able to work, or is age 65 or older. The pension is not related to a service-connected injury or medical condition. Award of the pension takes into consideration the material needs of the veteran (i.e., it is a “needs-based” pension). There is no deadline or time limit for applying for disability benefits. A veteran cannot simultaneously receive both disability compensation and a disability pension. There are certain basic criteria which must be met in order to be eligible to receive either of these benefits. This report examines the eligibility criteria and the fundamentals of the VA administered disability benefit programs and related issues.

What percentage of people (aged 15 years and older) who live in the United States participated in sports and exercise activities on an average day in recent years? About 16 percent. In comparison, consider that the number of people who watched television on an average day is roughly five times larger.

Conclusion: The prevalence of ADRD in LTC settings is much larger than in the community, but there is little difference in the proportions receiving anti-dementia drugs across residential settings. However, LTC residents are more likely to be treated with atypical antipsychotics (risperidone, olanzapine, and quetiapine), presumably for behavioral symptoms.

Advocacy, especially for children and young people living away from home or getting children’s social care services, is something that is important to safeguarding and promoting children’s rights. This report sets out children’s own views on what advocacy is (and isn’t); what makes a good advocate; how a child or young person gets an advocate when they need one; and how well advocates do at speaking up for children.

Smoking is the largest avoidable cause of death in England. As well as being individual tragedies, these deaths have a wider impact on the strength and cohesion of our communities. Stop Smoking Services play a key role in the overall tobacco control approach, along with measures like tackling contraband tobacco and working with young people. Like all public services, Stop Smoking services must be accessible to a diverse range of people. This document aims to support Stop Smoking Managers who are trying to make their services accessible to people from Black and Minority Ethnic (BME) communities. This is particularly important because some BME communities have high levels of smoking, and are more likely to experience poor health.

June 6, 2008

Trends in opium poppy cultivation in Afghanistan have been on an upward trajectory since the early 1990s, accelerating quickly after the fall of the Taliban government. In 2007, opium poppy cultivation reached an all-time high of 193,000 ha with the majority of cultivation (69 percent) occurring in the five southern provinces. Concomitant with the rise in opium poppy cultivation has been the rise in opium production. 2007 witnessed a substantial 34 percent increase in opium production reaching 8,200 metric tons. This increase in production in Afghanistan combined with effective efforts at limiting production in other countries has made Afghanistan virtually the sole supplier of opium, accounting for 93 percent of global production. Approximately two-thirds of the opium produced in Afghanistan is converted into heroin or morphine before export. Traditionally, the processing of opium into heroin occurred in Afghanistan’s neighboring countries, notably Pakistan, Iran and Turkey, with very few heroin production facilities located within Afghanistan. Recent years however have seen an increase in the number of laboratories moving upstream along smuggling routes and Afghanistan itself is now a major centre not just for opium production but also for its conversion.

This paper estimates trends in absolute poverty in urban China from 1988 to 2002 using the Chinese Household Income Project (CHIP) surveys. Poverty incidence curves are plotted, showing that poverty has fallen markedly during the period regardless of the exact location of the poverty line. Income inequality rose from 1988 to 1995 but has been fairly constant thereafter. Models of the determination of income and poverty reveal widening differentials by education, sex and party membership. Income from government anti-poverty programs has little impact on poverty, which has fallen almost entirely due to overall economic growth rather than redistribution.

She won’t make an appointment,come to your office, explain why she needs a lawyer, and provide supporting documents. You must forge a relationship with your client for trust to develop so that communication occurs. This article explains how to build solid relationships that lead to strong advocacy for LGBTQ youth.

This report investigates the relationship between alcohol availability, type of alcohol establishment, distribution policies and violence and disorder at the block group level in the District of Columbia. We test whether density of alcohol outlets influences: (1) aggravated assault incidents, (2) calls for service for social "disorder" offenses, and (3) calls for service for a domestic incident, and examine variation in outcomes by time of day/day of week. Spatial econometric regression models are estimated using an information theoretic approach. The findings indicate that on-premise outlets, but not off-premise outlets are a significant predictor of aggravated assault.

Young people know when the adults who are working with them don’t like them or are uncomfortable with them, and they react to those negative feelings. As child welfare professionals, it is important to explore our attitudes about people who differ from us based on race, gender, socioeconomic class, sexual orientation or gender identity. Once we identify those attitudes, we must consider whether they have a negative impact on our relationships with children and youth.

This report explains how federal Community Development Block Grants (CDBG) can be used to support youth programs and facilities and illustrates options and strategies.

In juvenile court dependency proceedings, judges determine whether parents have abused or neglected their children and assess whether children can remain safely at home. On any given day, over half a million children are in foster care as a result of a dependency case. Dependency courts are required to review cases at least annually, considering whether children should be reunified with their families, adopted, or remain in foster care. Significant matters are at stake in dependency cases, with fundamental questions about the child - where will she live? Who will take care of her? What services will she receive? - constantly at issue. Yet unlike any other litigation, in the dependency case, the one person whose life is most in the balance is hardly ever present. This Article analyzes the strange world of dependency court, highlighting the procedural and substantive failings that result when children are not active participants in their own cases, and suggesting that states take a more active role in ensuring that the voices of youth are heard.

June 5, 2008

This paper examines whether the chances of job placements improve if unemployed persons are counselled by caseworkers who belong to the same social group, defined by gender, age, education, and nationality. Based on an unusually informative dataset, which links Swiss unemployed to their caseworkers, we find positive employment effects of about 4 percentage points if caseworker and unemployed belong to the same social group. Coincidence in a single characteristic, e.g. same gender of caseworker and unemployed, does not lead to detectable effects on employment. These results, obtained by statistical matching methods, are confirmed by several robustness checks.

In terms of drug seizures and arrests, the Russian Federation experienced significant changes in overall drug trends in 2006. For example, the weight of heroin seizures increased by almost two times while the weight of seizures for opium has practically not changed. The weight of cocaine seizures however increased by almost six times and there is increasing concern among law enforcement agents that Russia could experience a dramatic increase in cocaine abuse in the next two years or so. At almost USD150 per gram, many more affluent young people (the so-called “golden youth”) will undoubtedly be drawn to this drug. As far as heroin is concerned, figures from medical institutes in charge of treatment of drug addicts and law enforcement agencies report the average price for 1 gram of heroin sold in the streets of Moscow at USD 40. Russia now has a 1 percent HIV prevalence rate among its young people and the fastest growing HIV/AIDS epidemic in the world. While the epidemic is still predominantly fuelled by injecting drug users and confined to their ranks, there are clear signs that the epidemic continues to spread to the general population, especially the youth. Drug abuse prevalence rates, although decreasing according to official statistics, appear to be higher than those in European countries.

Numerous news stories in the popular print and electronic media have documented suicides among servicemembers and veterans returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). In the United States, there are more than 30,000 suicides annually. Suicides among veterans are included in this number, but it is not known in what proportion. There is no nationwide system for surveillance of suicide specifically among veterans. Recent data show that about 20% of suicide deaths nationwide could be among veterans. It is not known what proportion of these deaths are among OIF/OEF veterans. Veterans have a number of risk factors that increase their chance of attempting suicide. These risk factors include combat exposure, post-traumatic stress disorder (PTSD) and other mental health problems, traumatic brain injury (TBI), poor social support structures, and access to lethal means. Several bills addressing suicide in veterans have been introduced in the 110th Congress. On November 5, 2007, the Joshua Omvig Veterans Suicide Prevention Act (P.L. 110-110) was signed into law, requiring the Department of Veterans Affairs (VA) to establish a comprehensive program for suicide prevention among veterans. More recently, the Veterans Suicide Study Act (S. 2899) was introduced. This bill would require the VA to conduct a study, and report to Congress, regarding suicides among veterans since 1997. The VA has carried out a number of suicide prevention initiatives, including establishing a national suicide prevention hotline for veterans, conducting awareness events at VA medical centers, and screening and assessing veterans for suicide risk. This report discusses data sources and systems that can provide information about suicides in the general population and among veterans, and known risk and protective factors associated with suicide in each group. It also discusses suicide prevention efforts by the VA. It does not discuss Department of Defense (DOD) activities, or VA's treatment of risk factors for suicide, such as depression, PTSD, and substance abuse.

This article discusses: (1) factors judges and lawyers should consider to assure safety, permanency, and positive well-being outcomes for LGBTQ youth; (2) tools for involving youth in their case planning, including court appearances; and (3) tips to help LGBTQ youth find their voices in the dependency court process. This article assumes the lawyer has established a strong relationship with the youth and focuses on in- and out-of-court advocacy.

Adoption and Safe Families Act of 1997 (ASFA) clearly and unequivocally establishes three national goals for children in foster care: safety, permanency, and well being. ASFA was in part “a response to the fact that more children were entering the foster care system than were exiting.” Five principles underlie the ASFA and apply to professionals working with families through public and private agencies as well as state courts. These principles are:
- Safety is the paramount concern that must guide all child welfare services.
- Foster care is temporary.
- Permanency planning efforts should begin as soon as the child enters care.
- The child welfare system must focus on results and accountability.
- Innovative approaches are needed to achieve the goals of safety, permanency, and well-being.

Parliamentary Under-Secretary of State for Children, Young People and Families, Kevin Brennan, has written to remind all schools and local authorities of their responsibilities in relation to the important child protection issue of forced marriage and to alert them to further planned action this year. The Government is committed to safeguarding children from all forms of abuse. This includes the risk of forced marriage to which we have been giving particular attention recently in response to a Home Affairs Select Committee Inquiry.

June 4, 2008

Geared toward jail practitioners who are working to improve reentry in their jurisdictions, The Jail Administrator's Toolkit for Reentry provides key elements of the reentry process from jail staff issues and assessment screens to identifying community resources and coordinating stakeholders. The Toolkit also offers examples and materials taken from around the country to assist jail practitioners in developing reentry strategies that can serve a variety of jail populations, whether pretrial or sentenced, and in a variety of jail jurisdictions.

This publication provides a snapshot of each state’s health care landscape by providing comparable state-level and national data for over 30 indicators. Data are presented for each state and the District of Columbia in regard to demographics, Medicare, Medicaid, and health insurance coverage. Limited data are presented for the Commonwealth of Puerto Rico and the U.S. Virgin Islands. This publication is adapted from the State Profiles series that was published annually from 1990 to 2000 and biennially from 2001 to 2005 by the AARP Public Policy Institute. Quick Health Facts is not a continuation of the State Profiles series; therefore, comparisons should not be made with information contained in past editions of State Profiles.

The American Psychological Association urges jurisdictions that impose capital punishment not to execute certain persons with mental disabilities under the following circumstances:
1. Persistent Mental Disability
2. Mental Disorder or Disability at the Time of the Offense
3. Mental Disorder or Disability After Imposition of Death Sentence

In February of 2007 the National Council of Juvenile and Family Court Judges and the Association of Family and Conciliation Courts brought together a working group of thirty-seven experienced practitioners and researchers to identify and explore conceptual and practical tensions that have hampered effective work with families in which domestic violence has been identified or alleged. Five central sets of issues were raised at the conference and are discussed in this report. These include the following: differentiation among families experiencing domestic violence; screening and triage; participation by families in various processes and services; appropriate outcomes for children; and family court roles and resources. The report emphasizes the need for continued multidisciplinary collaboration in order to better serve families affected by domestic violence and it includes an appendix of consensus points as well as suggestions for formation of ongoing work groups.

There have been significant policy developments across the UK in the last decade to address youth homelessness. The introduction of homelessness strategies has placed a new emphasis on prevention, paying explicit attention to young people. Statutory protection has also been strengthened with the extension of priority need categories (particularly 16 and 17 year olds and care leavers aged 18–20) under the homelessness legislation in England, Wales and Scotland (with Northern Ireland soon to follow). There have also been country-specific developments relevant to youth homelessness. In Scotland, there are plans for providing permanent rehousing to all homeless households by 2012. In 2007, England launched a National Youth Homelessness Scheme with a particular focus on the provision of mediation services and supported lodgings schemes, Northern Ireland published a strategy for the social inclusion of homeless people, and Wales produced a special report on youth homelessness. This study included a review of available statistics and literature and six detailed case studies (Belfast, Edinburgh, Lambeth, Leicester, Sedgefield and Swansea), including interviews and focus groups with a total of 148 young people (including those with and without children) and 121 agency representatives. It also incorporated the findings from two national consultations with young people led by Centrepoint, and a policy roundtable event with national experts.

This guidance fulfils a commitment between Communities and Local Government and the Department for Children, Schools and Families to work together to achieve key strategic objectives. The guidance focuses on four groups of children and young people who have been identified as being at particular risk of poor outcomes in the absence of effective joint working between Housing Services, Children’s Services and their partners:
• 16 and 17 year olds who are homeless or at risk of homelessness
• care leavers aged 18 to 21
• children of families living in temporary accommodation
• children of families who have been, or are at risk of being, found intentionally homeless by a housing authority.
The Government recognises that some people will feature in more than one of these groups, so that for example a care leaver may also be a single parent living in temporary accommodation as result of experiencing homelessness. Services must be flexible enough to address the different ways in which homelessness affects individuals.

June 3, 2008

Nonprofit boards are receiving increased attention from policymakers, media, researchers and the public. Yet most research, policy proposals, and best practice guidelines have been oriented toward large organizations. This brief helps fill a major gap in our understanding by focusing on governance among midsize nonprofits, identifying certain problem areas, and suggesting strategies that those engaged with midsize nonprofits may find helpful in strengthening their boards. The discussion uses data on the subset of 1,862 midsize organizations in our Urban Institute National Survey of Nonprofit Governance, the first national representative study of nonprofit governance.

Opium cultivation and production in Central Asia is minimal, with over 99 percent of opiates in the region originating from Afghanistan. There are no known production facilities for converting opium into heroin located in Central Asia. Consequently, all opiates transiting Central Asia are either processed in Afghanistan or will remain as opium until processed elsewhere. Opiate seizures in Central Asia are concentrated in Tajikistan, where the majority of drugs are assumed to cross the border from Afghanistan following the “northern route” towards their primary markets in the Russian Federation and Europe. Over the past decade, Central Asia’s aggregate opiate seizure trend has been fairly flat with average seizure volumes of just under 10,000 kg. The dynamics of opiate seizures in the region appear to follow a cyclical trend: from 1996 to 2003 heroin accounted for a steadily growing proportion of opiate seizures, however, post 2003 the proportion of opium seizures has been steadily increasing.

Pakistan’s geographic location next to Afghanistan, the world’s largest producer of illicit opium, places the country in a vulnerable position in terms of drug trafficking as well as drug abuse. Patterns of illicit drug production, distribution and abuse change as a result of social, economic and political developments. Such changes underscore the necessity of analysis and research on drug trends in the country and region as a crucial first step in terms of policy making and drug interdiction efforts. This report aims to enhance the understanding of drug trends in Pakistan in order to place it within the wider context of global drug developments.

The 110th Congress maintains a keen interest in the effects of crime and gang violence in Central America and its spillover effects on the United States. Since February 2005, more than 1,758 alleged members of the violent Mara Salvatrucha (MS-13) gang have been arrested in cities across the United States. These arrests have raised concerns about the transnational activities of Central American gangs, and governments throughout the region are struggling to find the right combination of suppressive and preventive policies to deal with them. Some analysts assert that increasing U.S. deportations of individuals with criminal records to Central American countries may be contributing to the gang problem. Several U.S. agencies have been actively engaged on both the law enforcement and preventive side of dealing with Central American gangs. An inter-agency committee worked together to develop a U.S. Strategy to Combat Criminal Gangs from Central America and Mexico, announced at a July 2007 U.S.-Central American Integration System (SICA) summit on security issues. The strategy, which is now being implemented, states that the U.S. government will pursue coordinated antigang activities through five broad areas: diplomacy, repatriation, law enforcement, capacity enhancement, and prevention.

Recent research has identified a growing number of low-income single mothers who tend to be very poor and face serious barriers to achieving economic self-sufficiency for their families. This group includes long-term welfare recipients as well as those who left welfare without stable employment, often referred to as “the disconnected.” Those remaining on welfare are a heterogeneous group, including short- and long-term recipients whose low wages or limited hours do not disqualify them from TANF as well as families who use the program during short-term economic disruptions in their lives. However, about 40 to 45 percent of the caseload is made up of long-term recipients who are not working or who work very sporadically. Compared to women who left welfare and are working, the disconnected tend to have more barriers to employment, with less education, younger children, higher rates of mental and physical health problems, higher rates of substance abuse, and a greater history of domestic violence. This brief recommends the development of a Temporary and Partial Work Waiver Program (TPWWP) to assist disconnected single mothers who face multiple barriers to securing and sustaining employment. A TPWWP would link families to medical and economic supports to prevent extreme poverty while providing more intensive case work assistance to ease the severity and duration of employment barriers.

This report covers the consultation exercises conducted from 24 October 2007 to 24 January 2008 on the draft revised Code of Practice to the Mental Health Act 1983 and on the secondary legislation to be made in the light of the Mental Health Act 2007. It details the process, analyses the responses received and explains which comments were accepted and which discarded and why.

June 2, 2008

There is increasing recognition by AARP and other aging advocates and researchers that many of the solutions for successful aging will arise through multi-faceted local planning and decision-making-be it land development planning, zoning, transportation planning, road design, or housing policy. Each element of the planning process offers opportunities to create more livable areas. But success is often dependent on overcoming one or more seemingly intractable barriers, many of which are discussed in this report. Despite these barriers, many communities are making great strides and developing innovative strategies to promote livability for people of all ages. AARP's Public Policy Institute hopes that the framework introduced in this report will provide planners, regulators, policymakers, and community advocates with a clear understanding of how these common barriers affect the housing and transportation choices of older adults, as well as spark new ideas for discussion and implementation in their communities.

There are 30.1 million Hispanic adults in the United States and 14.4 million of them—or 48%—are women, according to recent U.S. Census Bureau estimates.1 This fact sheet describes the demographic, employment and income characteristics of Hispanic women in the U.S. using data from the 2007 Current Population Survey. It focuses on differences between Hispanic and non-Hispanic women, between native-born and foreign-born Hispanic women, and among immigrant Hispanic women from different countries of origin.

This paper reviews the main lessons from existing social protection programmes in low-income countries for the development of social protection in these countries. It is taken for granted that introducing social protection in low income countries is that much harder due to constraints arising from underdevelopment, fragmented political and policy processes, reduced tax base, and weak administrative capacity. The paper examines existing social protection programmes in order to illuminate on the strength of these constraints, and the nature of potential remedies. The paper concludes that the experience of low-income countries shows there are many policy options available to them. It also concludes that while deficits in finance and operational capacity are much less tractable, global partnerships can work effectively to lift these constraints.

Each year, U.S. jails process an estimated 12 million admissions and releases. Substance addiction, job and housing instability, mental illness, and a host of health problems are part of the day-to-day realities for a significant share of this population. Given that more than 80 percent of inmates are incarcerated for less than one month, jails have little time or capacity to address these deep-rooted and often overlapping issues. Life After Lockup synthesizes key findings from the Jail Reentry Roundtable and examines opportunities on the jail-to-community continuum where reentry-focused interventions can make a difference.

Beginning early April, Haiti was gripped by a nation-wide mobilization to protest high food prices, reaching a crescendo on Thursday the 10th, as thousands of people took to the streets. Some protestors burned tires, blocking national highways and city streets in Port-au-Prince, and a few looted local stores. Clashes with police and UN troops resulted in an official count of five dead.

The Government of India is implementing a new policy which dramatically increases funding for a cash transfer program targeted to the poor elderly. The expansion of this ‘social pension’ in terms of coverage and benefit levels is taking place with little understanding of poverty among India’s elderly or its determinants. This paper finds that households with elderly members do not have higher poverty rates than non-elderly households. This result is robust under various measures that take into account the size and composition of households. Separate evidence suggests that part of the explanation for this phenomenon is that the poor have higher mortality rates and are therefore underrepresented. This explanation has important implications for social pension policy and suggests that programs that reduce elderly mortality may actually increase the relative poverty levels of the elderly.

This guidance has been developed as a cross-governmental initiative on behalf of Department of Health, Department for Children, Schools and Families, the Youth Justice Board and the Prison Service. The guidance is set out in a pathway approach, with best practice case studies used to identify when, what, where and how information needs to be shared to ensure improved outcomes for children and young people, as outlined in Every Child Matters: Change for Children.

MT 3.121