Health Literacy Is for the Healthy

“Health Literacy” is the ability to read, understand and act upon health information. And, more than half of the American population is not proficient on this topic. Unfortunately, the above definition is the point after which most head into the wrong direction. Unless a significant misnomer, by definition, the focus of health literacy should be two-fold, enhancement of functional literacy (period) and increased attention to the issues of health.

The general public reads very little non-commercial, health-related materials, the content being very challenging. Additionally, people consume too much sugar, consume alcohol and excesses of red meats, processed grains, artificial chemical additives, too few and unvaried fruits and vegetables, and eat too much. Many also smoke, use recreational drugs, misuse prescription drugs, exercise too little and engage in other social and recreational activities that are harmful to them physically and psychologically. Much of that which I just described and many more contributors to poor personal and public health are legally accessible and even marketed to you. The question is, who is responsible for your health knowledge and healthy behaviors (health care) versus your medical status (medical care)?

Your mechanic recommends selecting quality fuels, lubricants, and other fluids, and changing them regularly. You should manage your tires’ pressure and watch tread wear. You check your brakes’ function and monitor all for all other signs of possible malfunction. And, although there are plenty of after-market and alternative products and services by which to care for your vehicles, no clear-thinking person deviates demonstrably from use/maintenance recommendations if expecting vehicles to perform well and last. Such is because motor vehicles are sold with maintenance recommendations and schedules that you read, developing your “automotive care literacy”.

The western medical professional community markedly fails to train its cadre well in subjects of prevention, health maintenance, and safe. high performance, physical fitness for the masses. This also includes failure to train them to care substantially about the health literacy of their clientele. Nationally, we spend a lot of money on a Center for Disease Control, Planned Parenthood [primarily STD/STI and services for sex-related diseases], and local public health agencies (focus upon epidemiology, primary medical care, local epidemics management). And, we wrangle politically over the role of government versus the private sector for the provision of all services, particularly those that are values-based. However, public health literacy (education) is a non-revenue generating activity and receives minimal attention.

While in the public many clamor for inalienable rights to comprehensive medical care, the general public doesn’t march for the rights to universal health literacy. Nor does it ask the government to require the market to be more responsible for promoting products, services and social behaviors consistent with universal health. Yet, we must not allow the government, nor the socially and financially empowered to suggest that speaking against “unhealthy” environments, foods, untoward products and behaviors (and effects of) is inappropriate, and thereby “politically incorrect” behavior, unless you want current vocal ideologies to drive health care and not literacy.

Wellness Coordinators: Approach Employee Health Holistically (You Can’t Afford Not To!)

There are multiple determinants to health. And you do want to address as many as you can through your work site wellness program, correct?

Essentially, in the workplace setting, employee health is determined as a function of individual practices, organizational practices and the greater community in which the organization resides. In order to approach employee health holistically then, the workplace wellness program must address these three levels.

Individual Health Determinants

Researchers estimate that the individual determinants of health account for up to an estimated 40% of how healthy an individual is. At the individual level, biology, genetics, age and gender all impact individual health. Researchers estimate that these physiological determinants of health account for approximately 10% of how healthy an individual is.

Researchers have also found that an individual’s experiences in childhood impact how healthy they are in adulthood. Experiencing trauma in childhood adversely influences how healthy they are in adulthood.

Individual lifestyle factors, personal health practices and coping skills also play a significant role in how healthy an individual is. Researchers estimate that these could account for up to 40% of how healthy an individual is.

The traditional approach to worksite wellness has typically focused on individual health and lifestyle factors and personal health practices in particular.

Organization Determinants of Health

Researchers have clearly established that a person’s health is also determined by social and economic factors, as well as individual factors. These are commonly classified as the social determinants of health. Research has estimated that the social determinants of health account for between 15 – 40% of how healthy the individual is.

Management practices in the workplace contribute significantly to employee health and wellbeing. Management practices can either contribute to or detract from employee health and wellbeing.

The work environment clearly influences and impacts the health and psychosocial wellbeing of employees. There is extensive evidence on the connection between the workplace and employee health and wellbeing. Many workplace conditions profoundly influence employee behavior, health and wellbeing.

If the workplace is unhealthy, why would we ever expect employees to be healthy? It is for this reason that effective, successful 21st century worksite wellness programs focus just as much on organizational health, as they do individual employee health.

Community Determinants of Health

Employees and employers do not exist in isolation. Both are influenced by the community in which they live, work, play and operate. Typical community determinants of health include the physical environment (air quality, water quality, sanitation, etc.), the social environment and the cultural environment. Included in the environment is access to healthcare and social services.

While healthy employees are good for an employer, healthy work places are good for the community. Being seen as a great place to work is good for the employer, but also good for the community. The more great places to work there are in the community, the healthier the community will be.

Through corporate social responsibility type initiatives, employers are also contributing to the health of the community.

Worksite wellness in the 21st century is more than just a focus on the health status of employees. Worksite wellness encompasses programming and interventions at the organizational and community levels as well.

Sensory Loss in Older Adults – Vision – Behavioral Approaches For Caregivers

As we age, our sensory systems gradually lose their sharpness. Because our brain requires a minimal amount of input to remain alert and functioning, sensory loss for older adults puts them at risk for sensory deprivation. Severe sensory impairments, such as in vision or hearing, may result in behavior similar to dementia and psychosis, such as increased disorientation and confusion. Added restrictions, such as confinement to bed or a Geri-chair, increases this risk. With nothing to show the passage of time, or changes in the environment, the sensory deprived person may resort to repetitive problem behaviors (calling out, chanting, rhythmic pounding/rocking) as an attempt to reduce the sense of deprivation and to create internal stimulation/sensations.

This article is the first in a series of three articles that discuss the prominent sensory changes that accompany aging, and considers the necessary behavioral adjustments or accommodations that should be made by professional, paraprofessional, and family caregivers who interact with older adults. Though the medical conditions are not reviewed in depth, the purpose of this article is to introduce many of the behavioral health insights, principles, and approaches that should influence our caregiving roles. This article addresses age-related visual changes.

CHANGES IN VISION THAT ACCOMPANY AGING

A. The changes in vision that accompany aging include:

1. A loss of elasticity of the lens; this means the person is no longer able to focus or accommodate to changes in lighting conditions. (Starting in our 40’s, glasses are needed to see fine print). It also means the older person cannot adjust to sudden changes in lighting, resulting in an uneasiness when leaving a bright room to enter a dark hallway, or finding seats in the dark in recreation rooms, or theater. Going in the reverse direction can be equally difficult: from a dark room to a bright area.

2. Decreased pupil size; the light reaching the retina is reduced, requiring more light to see. This results in the need for lighting 3x to 4x what younger people need to see clearly

3. A loss of transparency; with age, there is a yellowing of the lens in the eyes, making color discrimination more difficult, especially blue and green. Warmer colors, such as reds and yellows are perceived best, explaining why bright colors are preferred.

4. More susceptibility to glare, and longer time is needed to recover from the effects of glare;

5. Eye diseases and disorders, such as cataracts causing a clouding of the lens; glaucoma, resulting from increased pressure of fluids in the eye, damaging the optic nerve and impairing vision. Glaucoma, the number one cause of blindness in U.S., in advanced stages results in yellow halos around images. Macular degeneration may occur, where vision is distorted, and images appear different sizes or different shapes, and are missing a central element. Visual disorders may be secondary to stroke, in which the eye can see the image but the brain cannot interpret the images. Diabetes may result in disrupted blood flow to the retina, causing diabetic retinopathy and a loss of vision, and blindness, in extreme cases.

B. What are the effects of visual loss on the older adult?

1. An increased dependency on others;

2. A sharply reduced quality of life (changes in activities in daily living and instrumental activities of daily living, reduced connection with outside world);

3. And, a fearfulness and reduced tendency to venture outside.

C. What are the effects of vision changes on demented elderly?

1. With the losses in visual acuity, other problems in cognitive functioning are heightened, such as difficulty processing unfamiliar faces and settings;

2. Because the person with dementia already has difficulty learning new behaviors, he or she is less able to learn new habits to compensate for the visual losses (e.g., learning to use visual aids to identify articles of clothing or other possessions;

3. There is likely to be an increased disorientation and confusion, as the search for structure and external cues is strained.

PRINCIPLES FOR CAREGIVERS

The following principles apply to caregiving approaches with older adults who have diminished sensory function. Increased sensitivity and insight to the needs of these individuals improves their quality of life and improves our effectiveness:

1. Observe the behavior of the person, and look for cues and signs of pain or discomfort;

2. Help the person work through the emotional impact of the sensory changes, allowing expression, acceptance, and support of the grief and sadness accompanying these losses;

3. Do not try to fix the unpleasantness; acceptance and support goes a longer way toward healing than a quick fix or a patronizing attitude;

4. Reduce excess disability by maximizing whatever functioning is still left, such as proper eyeglass prescriptions, or functioning hearing aids;

5. Consider assistive devices (phone amplifiers, large text books, headphones, and the Braille Institute for a variety of useful visual aids).

Approaches for impairments in vision:

1. Address the person before you touch him or her, identify yourself, let him or her know when you are leaving, speak normally, and do not shout;

2. Describe his or her surroundings to help orient and familiarize the person to the environment, tell him or her location of belongings, and if things have been moved;

3. Use as much contrast as possible, e.g., red objects on white background is better than black on a gray background, or blue on green background, (consider switch plates on walls, toothbrushes, combs);

4. Avoid moving quickly from a bright room to a darkened room, or v.v. Make sure the visually-impaired person takes the time for the pupils to adapt to the changes in lighting;

5. Introduce yourself every time you come into contact with the person, and explain what you are going to do because there are no visual cues;

6. Help to identify others in their environment with colored clothing, name tags with large print, etc.

7. Clean eyeglasses regularly, provide adequate lighting, and avoid glare;

8. Provide night lights, and arrange furnishings in the environment for safety and ease of mobility.

Even with normal aging, functioning of our five senses is not like it was when we were younger adults. This article offers caregivers who work with visually-impaired older adults some insights into the special needs and adjustments that will turn unpleasant, frustrating situations into more caring, helpful, and sensitive interactions. By integrating these behavioral approaches in the delivery of the health care with older adults, we can favorably impact the management of these conditions.

Copyright 2008 Concept Healthcare, LLC

11 Points For Mental Health Care Reform

Due to greater understanding of how many Americans live with mental illnesses and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges mental-health organizations across the U.S. are determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental-health and substance use disorders are properly addressed and integrated into healthcare reform.

In anticipation of parity and mental healthcare reform legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform..

MENTAL HEALTH SERVICE DELIVERY

1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.

2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.

3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.

4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of course, part of this initiative includes helping mental illness patients find a mental health clinic nearby.

MENTAL HEALTH SYSTEM MANAGEMENT

5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges.

6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.

7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.

MENTAL HEALTHCARE INFRASTRUCTURE

8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental-health and substance use performance measures that will be used to improve delivery of mental-health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.

9. Health Information Technology: Federal and state HIT initiatives need to reflect the importance of mental-health and substance use services and include mental-health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.

10. Healthcare Payment Reform: Payers and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.

11. Workforce Development: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors. Provider organizations will need to participate in these efforts and be ready to ramp up their workforce to meet unfolding demand.

School-Based Mental Health

School-based mental health services are sorely needed to deal with mental health issues that are often barriers to learning. Such services need to be a critical component in schools to combat barriers to academic success. Unfortunately, schools are often poorly equipped to deal with such problems. Because states tend to bundle educational and mental health services, funds are directed primarily toward education and not treatment. In many school districts communities are also lacking in emotional support services and families do not have the means to purchase needed medical insurance to support outside treatment. Transportation to mental health clinics may not be available. Parents are often reluctant to send their children out of district to such centers. School psychologists are overloaded with assessment responsibilities while school counselors deal mostly with classroom problems, college applications, and day-to-day crises. Additional services from trained psychologists, social workers, and psychiatrists are badly needed to treat emotional problems and for prevention of future problems.

A number of studies report on the prevalence of mental health problems in children. A report of the Surgeon General (1999) indicates that 20.9 percent of children and adolescents, aged 9-17, have mental or addictive disorders. Other studies support the statement that one in five students in school may have mental health concerns. At least two to three students in every classroom may have emotional problems of varying degrees of severity. One estimate is that 4.3 million students nationally suffer from mental illness that impairs their functioning at home, in school, and with peers. A report by Katoka, Zhang & Wells (2002) indicates that 78 percent of children aged 6 to 17 with mental disorders and 88 percent of Latino children do not receive needed mental health care. Mental health concerns are likely to increase in response to the recent economic downturn.

Mental health is not only the absence of mental illness but also includes the skills needed to deal with life’s challenges. Emotional and behavioral health problems represent serious barriers to academic success and behavioral adjustment in school. Children and adolescents with emotional problems have the highest failure rates; fifty percent of such children drop out of high school. Emotional disability is the fastest growing special education in schools. In Ohio, one in five high school students reported seriously considering a suicide in the previous twelve months. Suicide is the third leading cause of death among young people and is considered a public health crisis by both the Centers for Disease Control and Prevention and the World Health Organization.

Federal and state requirements mandate that schools attend to mental health issues since behavioral problems are treatable. Students who receive social and emotional support and decision-making skills have better overall grades and higher standardized test scores. Youth who received mental health services in schools showed significant reductions in psychiatric symptoms as measured by both parent and teacher ratings., Trained therapists serving on a consultant basis coordinate their efforts with school counselors and social workers. The cost of their services is often offset by savings from maintaining students in public schools who might otherwise need to attend more expensive specialized private facilities at the expense of the school district.