The Affordable Care Act in North Carolina : A Look Back and Review of Coverage Changes.

Prior to the passage of the Affordable Care Act, many individuals across the state and country faced numerous barriers to accessing affordable and quality health care. This paper provides a review of health coverage in North Carolina before the ACA, the impact the ACA has had on access to health care, and how North Carolina could continue to benefit from "complete" implementation of the ACA.

Medicaid Coverage for Pregnant Women: A Pathway to Healthy Outcomes for Moms and Children.

Medicaid is an essential source of health coverage that finances more than half of all births in North Carolina. This paper examines current eligibility for pregnant women and its impacts on health outcomes for mothers and children. The authors provide suggestions to increase access to this vital health insurance program and better promote the health of North Carolina's families.

Lost in Transition: Consumers' Concerns About Navigating North Carolina's New Medicaid System.

Medicaid consumers face some uncertainty concerning the proposed Medicaid reform plan. Concerns focus on continuity and quality of care and support for consumer protections and rights. Despite updated Medicaid managed care rules that include consumer protections, the North Carolina Department of Health and Human Services must implement further safeguards to address consumer concerns.

Barriers to senior centre implementation of falls prevention programmes.

This study examined the prevalence of senior centres providing multi-component falls prevention education and the perceived barriers in implementing this education. A telephone interview was conducted in 2006 with 500 senior centres nationwide. Centre directors were asked about the types of multi-component falls prevention education offered (ie, balance exercise classes, medication management, home safety information) and barriers to offering this education. Seventy percent of senior centres offered balance exercise classes, 68% offered medication management and 53% provided home safety information. Thirty-two percent offered all three components. Lack of staff, time and staff not feeling they had sufficient knowledge to deliver falls prevention education were the leading barriers to providing multi-component education. Senior centres provide components of effective falls prevention education and, while some may not address all components of a multifaceted programme, many have existing resources that may be adapted for translation of evidence-based programmes.

Parent and teacher mental health ratings of children using primary-care services: interrater agreement and implications for mental health screening.

OBJECTIVE: To examine interrater agreement when screening for child mental health problems during primary-care visits. METHODS: Children aged 5 to 10 (n = 227) and one of their parents were systematically recruited from the waiting rooms of 15 primary-care sites located in Baltimore, Md; Washington, DC; and rural New York from 2002 to 2005. The parent and teacher of the child completed the Strengths and Difficulties Questionnaire to measure the child's emotions, behaviors, and functional impairment. RESULTS: Parents and teachers identified a similar proportion of children as having high symptoms (25% vs 23%) and high impairment (27% vs 32%) but rarely agreed in their assessments of specific children. Parent ratings alone missed 52% of children rated by teachers as having both high symptoms and high impairment (kappa = 0.15). Only 6% of these discrepant visits were for mental health problems, making it unlikely that teacher reports would have been solicited. CONCLUSIONS: Parent reports failed to detect half of school-aged children considered to be seriously disturbed by their teachers. Efforts to improve detection of mental health problems by using screening tools in primary care may require algorithms that help providers judge when to solicit teacher reports and how to interpret conflicting information from parents and teachers.

Improving child and parent mental health in primary care: a cluster-randomized trial of communication skills training.

OBJECTIVE: We examined child and parent outcomes of training providers to engage families efficiently and to reduce common symptoms of a range of mental health problems and disorders. METHODS: Training involved three 1-hour discussions structured around video examples of family/provider communication skills, each followed by practice with standardized patients and self-evaluation. Skills targeted eliciting parent and child concerns, partnering with families, and increasing expectations that treatment would be helpful. We tested the training with providers at 13 sites in rural New York, urban Maryland, and Washington, DC. Children (5-16 years of age) making routine visits were enrolled if they screened "possible" or "probable" for mental disorders with the Strengths and Difficulties Questionnaire or if their provider said they were likely to have an emotional or behavioral problem. Children and their parents were then monitored for 6 months, to assess changes in parent-rated symptoms and impairment and parent symptoms. RESULTS: Fifty-eight providers (31 trained and 27 control) and 418 children (248 patients of trained providers and 170 patients of control providers) participated. Among the children, 72% were in the possible or probable categories. Approximately one half (54%) were white, 30% black, 12% Latino, and 4% other ethnicities. Eighty-eight percent (367 children) completed follow-up monitoring. At 6 months, minority children cared for by trained providers had greater reduction in impairment (-0.91 points) than did those cared for by control providers but no greater reduction in symptoms. Seeing a trained provider did not have an impact on symptoms or impairment among white children. Parents of children cared for by trained providers experienced greater reduction in symptoms (-1.7 points) than did those cared for by control providers. CONCLUSION: Brief provider communication training had a positive impact on parent mental health symptoms and reduced minority children's impairment across a range of problems.

Receiving advice about child mental health from a primary care provider: African American and Hispanic parent attitudes.

BACKGROUND: Primary care providers (PCPs) play a critical role in the identification and treatment of child and adolescent mental health problems but few studies have examined parents' attitudes on receiving advice about child mental health from a PCP and whether attitudes are associated with race or ethnicity. OBJECTIVE: To determine if race and ethnicity were associated with parents' attitudes on receiving advice about child mental health from a PCP. SUBJECTS: Data were collected during 773 visits to 54 PCPs in 13 diverse clinics. Families were 56.5% white, 33.3% African American, and 10.1% Hispanic. MEASURES: The parent reported attitudes associated with receiving advice about child mental health from the PCP. The parent completed the Strengths and Difficulties Questionnaire to report youth mental health. PCPs completed measures of psychosocial orientation, confidence in mental health treatment skills, and the accessibility of mental health specialists. RESULTS: Hispanics were more likely than Non-Hispanics to agree that PCPs should treat child mental health and were more willing to allow their child to receive medications or visit a therapist for a mental health problem if recommended by the PCP. African Americans were significantly less willing than whites and Hispanics to allow their child to receive medication for mental health but did not differ in their willingness to visit a therapist. CONCLUSIONS: Race and ethnicity were associated with parents' attitudes on receiving advice about child mental health from a PCP. Primary care may be a good point of intervention for Hispanic youth with mental health needs.