Whitney Howell

Healthcare. Politics. Family.

Catching Emotional and Developmental Problems in Homeless Children

Published on the March 2, 2015, North Carolina Health News website

A new study shows children experiencing homelessness are at more risk of mental health and developmental problems.

By Whitney L.J. Howell

Four-year-old Aiden and his mother came to a Raleigh Salvation Army Women & Children’s Shelter for the 30-day overnight program in October. They had no car and had shuttled between the homes of friends and family in Raleigh and Durham, but Aiden’s mother was determined to find the services her son needed.

Aiden, whose name is changed for his privacy, screamed and cried frequently, couldn’t focus and couldn’t sit still. He had language delays, couldn’t convey his needs and wants and couldn’t interact in age-appropriate ways.

Unfortunately, Aiden isn’t alone. A look inside the state’s homeless shelters quickly reveals a sobering fact – many residents are children. And a substantial number of those kids need mental health services they’re not getting.

Luckily for Aiden, a Community Action Targeting Children who are Homeless (CATCH) case manager got involved, screening his developmental and social-emotional status. Aiden scored extremely low, completed additional testing and was diagnosed with autism. The CATCH case manager referred him to Child Find, an exceptional-needs children’s initiative, where he entered a half-day program.

“The Child Find office works closely with CATCH and understands the barriers unique to homelessness. It was extremely helpful to the mom, as the half-day program lets her seek employment and stable housing,” said Jennifer Tisdale, a Project CATCH coordinator who works with Aiden’s case manager.

“Without CATCH case management, it’s entirely possible this child would’ve never been identified and wouldn’t have received the services and placement in an appropriate setting beneficial to them both,” she said.

According to a new NC State University and Salvation Army-funded study, 25 percent of homeless children – from infants to early-elementary school age – need mental health services to avoid developmental delays.

“In North Carolina, the fastest growing homeless population is families, not individuals. It’s really important to see how this situation impacts them, especially young children,” said Jenna Armstrong, an NCSU doctoral student and study co-author. “We found there’s a significantly higher proportion of homeless children experiencing developmental and social-emotional delays than those who aren’t homeless.”

The situation in North Carolina

Nationally, there are 2.5 million homeless children. According to the 2014 National Center on Family Homelessness report, North Carolina falls in the bottom half, at 29th, in addressing this issue. Statewide, there are more than 55,000 homeless children, making North Carolina one of the 15 worst nationwide.

North Carolina has 650 emergency shelters and nearly 1,900 additional transitional or supportive housing spaces for homeless families. A newly formed interagency group on homelessness also exists. But few existing intervention programs focus on young children.

The NCFH report also revealed that North Carolina’s homeless children fall below national averages in academic performance. Only 22 and 29 percent of fourth-graders meet educational standards in reading and math, respectively. By eighth grade, those numbers decline to 19 and 23 percent.

What are the risks?

The NCSU/CATCH study evaluated 328 children, aged two months to six years, in 11 Wake County homeless shelters. They observed children and conducted 20-minute assessments with their parents. Most homeless children adapt and function well, but researchers found a quarter of the group suffer negative effects.

“Many homeless children have experienced prolonged poverty, exposure to family and neighborhood violence, separation from parents due to child protective-services involvement and inadequate parenting,” said Mary Haskett, an NCSU psychology professor and lead study author. “Residing in shelters adds the stress of living in a chaotic, crowded, often unsafe environment, and access to services is extremely limited for young children who are homeless.”

Based on CATCH-conducted assessments, homeless children have greater communication and language development delays – in fact, existing research shows 60 percent have significant communication delays. In this study, toddlers had particularly low communication development scores.

Learning to read is harder for children who don’t hit milestones on time, Haskett said, placing them at higher academic failure risk.

The team assessed physical development in babies, Armstrong said, by whether infants could sit up unsupported, which happens at about 4 to 7 months, and when they began babbling and talking not long afterwards. Investigators also examined social-emotional development by observing whether older children threw tantrums and how well they handled their emotions. By comparing a child’s behavior to large, national pediatric behavioral studies, the team concluded many homeless children, such as Aiden, fell outside normal behavioral development ranges.

These delays could emerge at any age, Haskett said. Boys appeared to be at greater risk than girls for delayed social-emotional development, based on parental reports. Parents of 28 percent of at-risk boys and 21 percent of at-risk girls expressed concerns about their child’s social-emotional development.

But determining the extent of the difference and why it exists requires more research, she said.

What can be done?

Older school-age children receive some mental health services, Haskett said, through the federal McKinney-Vento Homeless Assistance Act. The law requires that schools have an education liaison to help students enroll in school and coordinate transportation for the student to attend. It also mandates other needed services, such as vocational or technical training, free or reduced school meals and before-and-after-school care.

But services for younger children are rare, she said.

“When these children arrive at a shelter, the priorities are housing and other basic needs of families,” Haskett said. “If children’s developmental and mental health needs are severe and obvious to shelter staff, a referral for appropriate services might be made. But if the delays are subtle, it’s unlikely. Untreated minor delays and mental health concerns tend to simmer and worsen over time.”

That’s why screening children, like Aiden, is vital, she said. Early identification can increase their access to existing beneficial programs, such as Early Head Start, a free child-development program for low-income families. The program teaches parents activities to bolster their children’s learning and offers day care center-based learning programs that help kids meet developmental and social-emotional milestones.

Other programs, such as the Nurse-Family Partnership, Incredible Years and the Triple P-Positive Parents Program, also give at-risk children support for improved growth and future academic performance, she said.

Through the Nurse-Family Partnership, maternal and child health nurses work with at-risk and low-income first-time parents, teaching them healthy habits and skills to support their infant’s early development. Incredible Years focuses on ensuring children’s healthy social and emotional development. Triple-P also strives to teach parents effective coping strategies to shepherd their child’s emotional development.

A Child’s Place, a school for homeless children in Charlotte, exemplifies early-intervention success. Ninety-two percent of the homeless children with whom they work read at grade level, compared to 48 percent nationally.

Having early-intervention service representatives participate in screening homeless children could make early assessments more effective, Haskett said. They could help determine whether a child is eligible for targeted programs.

“But the workforce must have competencies in young children’s mental health and development to serve this group,” she said. “Unfortunately, most communities lack mental health providers who can service children ages birth to 5.”

However, the NCFH recently made policy recommendations for promoting development and mental health functioning in homeless children. The hope, Armstrong said, is that this research will support those recommendations, as well as prompt legislators to advocate for expanding assessment screenings and create more support services.

Too often, Armstrong said, children like Aiden fly below the radar.

“They’re not paid attention to in shelters and they’re not noticeable in the school system,” she said. “We’re lucky to be at the forefront of this problem, to advocate for making these invisible children more visible to policymakers who have the power, through money, to remediate the problem.”

To read the article at its original location: http://www.northcarolinahealthnews.org/2015/03/02/catching-emotional-and-developmental-problem-in-homeless-children/

March 2, 2015 Posted by | Healthcare | , , , , , , , , , , , , , , , , | Leave a comment

Business of Radiology: Marketing

Published on the Feb. 27, 2015, DiagnosticImaging.com website

Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed. 

By Whitney L.J. Howell

Ask any of your peers, and they’ll likely agree – health care as you’ve known it is changing. The patient population has ballooned under the Affordable Care Act. Larger practices and health systems are gobbling up competitors. And, reimbursement dollars are tighter. It’s never been more important to make yourself stand out from the crowd.

Maybe you’ve had a marketing plan for years. Maybe the concept is new to you. Either way, industry experts said, it’s a crucial – and mandatory part – of maintaining a successful radiology practice.

“Radiologists are continuously marketing themselves, whether they recognize it or not. We are at a critical crossroads in our profession, with health care reform and dramatic changes in the health care industry,” Reginald Munden, MD, DMD, MBA, chair of the Houston Methodist Hospital radiology department, wrote in the February Journal of the American College of Radiology. “Radiologic services are in the crosshairs because of the expenses to patients, hospitals, and third-party payers. Perhaps we have done a poor job of marketing ourselves and our profession.”

That’s why, he said, radiologists must improve their marketing for the specialty to survive and flourish.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/articles/business-radiology-marketing?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=27022015

February 27, 2015 Posted by | Healthcare | , , , , , , , , , , , , , | Leave a comment

Latino Newborns May Be at Risk Due to Immigration Law Fears

Published on the North Carolina Health News website in February 2015

Regulations that give local law-enforcement officers the authority to act on federal immigration laws could have a chilling effect on the use of health care services within Hispanic communities.

By Whitney L.J. Howell

The health of North Carolina’s Hispanic newborns could be at risk from an immigration law.

The federal Immigration and Nationality Act – the same law that led to a racial profiling lawsuit against the Alamance County Sheriff’s Office in 2012 – could also be having a negative impact on the health of unborn babies in North Carolina’s Hispanic communities, according to new research from Wake Forest University.

According to researchers from Wake Forest’s School of Medicine, the heightened fear of deportation generated by this and other laws, in addition to Latinos’ lack of understanding of their rights under immigration laws, has played a role in the unwillingness of North Carolina’s pregnant Hispanic women to seek out the medical services they need.

The study reveals these women are less likely than women of other ethnicities to receive timely and sufficient prenatal care.

“Regardless of the status of the mother or father, a child born here is an American citizen under the Constitution, and we would hope that all children born in this country are healthy and can avoid preventable illness,” said Mark Hall, a Wake Forest law professor with expertise in health care law and public policy who participated in the study. “So it’s certainly important that all expectant mothers receive adequate prenatal care.”

Delaying prenatal care

But that’s not what’s happening, Hall said.

Based on a data review and personal interviews conducted in 2012, Hall and his fellow researchers discovered approximately 30 percent of Hispanic women in North Carolina don’t start prenatal care until after the first trimester.

The American Congress of Obstetricians and Gynecologists recommendations suggest the initial visit occur between eight to 10 weeks. In comparison, according to the same study data, only 10 percent of non-Hispanic women delayed receiving care. Additionally, 30 percent of Hispanic women – versus 8 percent of all other women – received less than half of the 14 doctor examinations recommended in ACOG guidelines.

Unfortunately, said Angeline Echevarria, executive director of El Pueblo, a Latino community-advocacy group, North Carolina’s Hispanic residents often forego preventive health care services out of fear associated with their citizenship status.

“We’ve found that when community members feel they’re being singled out or targeted by law enforcement, it puts a damper on their willingness to seek health services that aren’t associated with any type of emergency,” she said. “We see this especially in rural areas where public transportation isn’t really an option. A lack of good mobility options limits their willingness to drive around and take a chance for what they deem as unnecessary care. So they put off preventive services, even though we don’t recommend it.”

Although N.C. Healthy Start reports first-generation Hispanics maintain the state’s lowest infant mortality rate – 3.7 per 1,000 live births – pregnant women in this community still face risks if they don’t receive proper medical services. Inadequate prenatal care has been linked to low birth weight; neural tube defects, such as spina bifida; congenital illnesses, impaired heart and brain development; and increased infant mortality. Newborns who don’t receive proper prenatal care are 40 percent more likely to die within the first month of life, according to the Guttmacher Institute.

It’s also possible, Hall said, that this group’s rate of inadequate prenatal care could create a significant public health issue for North Carolina. Based on 2013 U.S. Census Bureau estimates, there are more than 875,000 Hispanics in North Carolina, nearly 9 percent of the state’s population.

Effects of the law?

Using vital records data from 2012, six focus groups, and 17 in-person interviews, the study analyzed how expectant Hispanic women accessed and used prenatal care services for nine months before and nine to 18 months after the Immigration and Nationality Act went into effect. The researchers reviewed data from seven counties that adopted the law and seven that didn’t.

Under the INA’s section 287(g), U.S. Immigration and Custom Enforcement can effectively deputize state and local agencies, giving them the authority to uphold federal immigration laws during routing law-enforcement activities. The U.S. Department of Justice cited traffic stop data to argue that the Alamance County sheriff’s department was being overly aggressive in targeting Latinos under the aegis of the INA.

In 2012, federal officials terminated the county’s participation in the program. This past year, Terry Johnson, the Alamance County sheriff, was tried in a federal court on charges of discriminatory policing. A judge has yet to rule in the case.

Researchers can’t say definitively whether immigration regulations caused the drop in access of prenatal care services, Hall said, but the data did indicate fewer women sought care after its enactment than before.

In the interviews, pregnant women frequently reported a lack of insurance contributed to their foregoing prenatal care.

Data from the Henry J. Kaiser Family Foundation reported 43 percent of N.C. Hispanics don’t have health insurance. This amount mirrors the Pew Research Center statistic of 43 percent of Hispanic 18-to-64-year-olds nationally who are without health insurance.

For some women, transportation was an issue, Hall said. Many were concerned they would be pulled over en route to the doctor’s office for a routine traffic violation and have their immigration status discovered. This is what happened in Alamance County, where a review of traffic stops showed deputies from the sheriff’s department were more likely to stop Latinos for minor traffic violations, such as riding without a seat belt.

Another group of women in the study feared the doctor would report them to immigration officials.

Greater clarity

To combat these concerns, North Carolina’s public policy and medical leaders must improve communication around patients’ rights and access to care, Hall said. Greater clarity about whether immigration enforcement can even affect medical care – medical providers are neither required nor expected to check immigration status when providing services – could also be helpful.

In addition, he said, knowing there’s no real risk of being reported by the doctor’s office could encourage more women to find some type of reliable transportation to their appointments.

Ultimately, Hall said, improving prenatal care for Hispanic women could have a positive impact on North Carolina’s health overall.

“As a society, we have concern over everyone’s health, particularly those of children. If reluctance or fear affects the willingness to get immunizations, it could impact communicable diseases,” Hall said. “In general, there’s a larger implication. We need to think beyond just enforcing immigration policy to the labor and economic impacts on families, as well as the public health impacts that aren’t fully recognized.”

To read the article at its original location: http://www.northcarolinahealthnews.org/nc-research-news/

February 23, 2015 Posted by | Healthcare | , , , , , , , , , , , , , , | Leave a comment

How To Be The Perfect Radiology Group

Published on the DiagnosticImaging.com website on Feb. 19, 2015

By Whitney L.J. Howell

You have reimbursement woes. You worry about your billing practices. You wonder if you’re doing the right things to demonstrate your value to partner hospitals. The daily stresses can be nearly overwhelming – but, if you were a perfect radiology group, these worries wouldn’t exist.

The perfect radiology group has tweaked its day-to-day activities. Their streamlined coding process ensures proper payment. Their targeted marketing attracts more referring physicians, and personnel tactics secure a seat at the administrative decision-making table. Every day, for the perfect radiology group, operations are smooth.

But, is the perfect radiology group really attainable? Not really, industry experts acknowledge, but it’s possible for you to get close. Later this year, the American College of Radiology (ACR) will release a road map for creating your “optimal” radiology practice or department. In it, according to Mark Bernardy, MD, chair of the ACR Managed Care Committee, you’ll find a list of best practices that were tested at the ground level, and can help you on your way. Consider it an expansion of ACR’s Imaging 3.0.

“Imaging 3.0 has laudable big picture ideas. Everyone nods their head that it sounds good and right. But, then, exactly what is it that you want me to do?” said Bernardy, who is also a practicing Georgia-based radiologist. “There’s a big gap. I thought it would be useful to go through the exercise of writing down what it is we mean when we say, ‘This is what the perfect radiology group looks like.’”

As a compilation of best practices gathered from large medical centers and small private practices nationwide, it will be a living document, open to modification with new, effective ideas, he said.

Read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/how-be-perfect-radiology-group?cid=tophero

February 23, 2015 Posted by | Healthcare | , , , , , , , | Leave a comment

What Can Radiologists Really Do About Unnecessary Imaging?

Published on the Jan. 15, 2015, DiagnosticImaging.com website

By Whitney L.J. Howell

Unnecessary imaging and appropriateness criteria. These two phrases have dominated radiology discussions for the past several years. It’s a complicated topic that has an even more complex, and elusive, answer.

And, according to industry leaders, one of the most critical components to the discussion is the role radiologists play in limiting the number of unnecessary and duplicative imaging studies performed.

“Radiologists get painted as these selfish people who are self-interested and who are going to fight against change,” said Jeremy Bikman, chief executive officer for peer60, a big data survey company that provides analysis based on conversations with on-the-ground professionals. “But, they didn’t create their reimbursement structure. It comes from the Centers for Medicare & Medicaid Services, and radiologists are just doing the best they can.”

That performance includes responding to and meeting referring physicians’ needs and desires, which, frequently, he said, can be wasteful. A recent peer60 report puts the nationwide cost of unnecessary imaging between $7.47 billion and $11.95 billion annually.

To reach the article in its entirety at its original location: http://www.diagnosticimaging.com/practice-management/what-can-radiologists-really-do-about-unnecessary-imaging

January 15, 2015 Posted by | Uncategorized | , , , , , , , , , , , , , , , | Leave a comment

Radiology and Pathology: Time to Integrate

Published on the Jan. 12, 2015 DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — For several years, there’s been a push in health care – particularly in pharmaceuticals – toward personalized medicine. By using a patient’s genetics to better target their medications and therapies, the medical industry has achieved improved patient outcomes.

But, what if you could launch individualized care at an earlier stage – at the point of pathological diagnosis? According to radiology and pathology experts at the 2014 Radiological Society of North America annual meeting, this could be the next wave that takes personalized medicine to the next level.

“The idea is to personalize how we treat patients based on their unique characteristics,” said Mitch Schnall, MD, PhD, radiology department chair, University of Pennsylvania. “The idea of developing data that characterizes someone really gets to the heart of what diagnosis is about. It’s crucial to realizing any benefit.”

To read the article in its entirety at its original location: http://www.diagnosticimaging.com/rsna-2014/radiology-and-pathology-time-integrate

January 13, 2015 Posted by | Uncategorized | , , , , , , , , , , , , | Leave a comment

No Such Thing as Big Data in Health Care

Published on the Dec. 3, 2014, DiagnosticImaging.com website

When it comes to big data, health care doesn’t really have any. And, for radiology, that’s a good thing. Small and medium data will work just fine – especially for testing and designing new reimbursement models, according to speakers at this year’s Radiological Society of North America (RSNA) meeting.

Industry experts at this year’s RSNA say the data hospitals and health care systems already have can help providers identify ways to maximize their influence in the design of any future payment models.

“We’re currently in the lowest life form of payment policy. We get paid for events – it’s a transactional delivery system,” said Richard Duszak, MD, vice chair for health policy and practice, department of radiology and imaging sciences, Emory University School of Medicine. “Increasingly, we’re moving to models where we’ll be paid by encounters and engagements.”

The question, he said, is how those models will be designed to ensure radiologists receive appropriate reimbursement for services rendered in a correctly incentivized way. To date, there’s no clear-cut answer, but there are steps radiologists can take – armed with small-to-medium data – to ensure their seat at the decision table.

To read the article in its entirey at its original location: http://www.diagnosticimaging.com/rsna-2014/no-such-thing-big-data-health-care

January 1, 2015 Posted by | Healthcare | , , , , , , , , , , , , , | Leave a comment

RSNA Collaborates, Sets to Improve Radiology Reporting

Published on the Dec. 16, 2014, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — It has been six years since the Radiological Society of North America (RSNA) launched its Reporting Initiative. In that time, radiologists across the country have benefited from the tools it offers, according to the Initiative’s leaders and other industry experts, who revealed its accomplishments to date and discussed what’s yet to come.

“Our goal, in part, was to improve the quality of radiology reports, making it easier for referring physicians, patients, and other radiologists to use and have the information that we can extract from reports,” said Charles Kahn, MD, chair of the RSNA’s Radiology Informatics Committee Structured Reporting Subcommittee. “We wanted to develop a better, more robust system that could go beyond speech and voice recognition and really empower the capture of information as radiology becomes more quantitative.”

Rather than dictating to radiologists and practices exactly how they were to create reports, this initiative was designed to collect a sampling of best practice templates that providers could modify to meet their own needs, he said.

To read the article in its entirety at its original location: http://www.diagnosticimaging.com/rsna-2014/rsna-collaborates-sets-improve-radiology-reporting

January 1, 2015 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , | Leave a comment

To Avoid Malpractice, Radiologists Must Communicate

Published on the Dec. 22, 2014, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — With the roll-out of the Affordable Care Act (ACA) still ongoing and the move toward some type of accountable care organization model still underway, it’s unclear how radiology will fare in any medical malpractice lawsuits.

But, industry experts at this year’s Radiological Society of North America meeting all point to one key component of financial survival – communication. Communication with referring physicians, the patient, and each other.

“You have to remember there are three factors to communication – the referring physician, the radiologist, and the patient,” said Leonard Berlin, MD, a radiologist with NorthShore University Health System. “Communication is the link between all three. It’s obviously a real problem when there’s a failure to communicate emergency or acute findings, but it’s significant that there’s a large amount of significant and unexpected findings that don’t get communicated either.”

To read the article in its entirety at its original location: http://www.diagnosticimaging.com/rsna-2014/avoid-malpractice-radiologists-must-communicate

January 1, 2015 Posted by | Healthcare | , , , , , , , , , , , , , , , , | Leave a comment

Why Radiologists Should Care About Clinical Decision Support

Published on the Dec. 24, 2014 DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — The buzz about clinical decision support and the need for appropriateness guidelines isn’t new, but implementing and using such tools correctly will soon become even more critical.

According to industry experts at this year’s Radiological Society of North America annual meeting, if your referring physicians don’t master their clinical decision support (CDS) and use it consistently, it’s going to cost the radiologists money.

As of Jan. 1, 2017, said Ramin Khorasani, MD, vice chair of the Brigham & Women’s Hospital radiology department, under the Protecting Access to Medicare Act, radiologists won’t be paid for outpatient, non-emergent services rendered if their claims don’t include a number that proves the referring physician consulted a CDS tool.

But it still isn’t clear how radiology can best teach other providers about diagnostic imaging appropriateness. A recent pilot initiative, the Medicare Imaging Demonstration (MID), showed some improvement in how referring physicians prescribed imaging, but many doctors and surgeons reported dissatisfaction with the CDS software.

To read the article in its entirety at its original location: http://www.diagnosticimaging.com/rsna-2014/why-radiologists-should-care-about-clinical-decision-support

January 1, 2015 Posted by | Healthcare | , , , , , , , , , , , | Leave a comment

Follow

Get every new post delivered to your Inbox.

Join 940 other followers

%d bloggers like this: