A Model of Advocacy to Inform Action.

The need for effective advocacy on the part of health professionals has never been greater. The recent COVID-19 pandemic has made the connection between human health and social conditions clear, while highlighting the limitations of biomedical interventions to address those conditions. Efforts to increase the frequency and effectiveness of advocacy activities by health professionals have been hampered by the lack of a practical framework to define and develop advocacy competencies among trainees as well as to plan and execute advocacy activities. The authors of this article propose a framework which defines advocacy as occurring across three domains of influence (practice, community, and government) using three categories of advocacy skills (policy, communication, and relationships). When these skills are successfully applied in the appropriate domains of influence, the resulting change falls into three levels: individual, adjacent, and structural. The authors assert that this framework is immediately applicable to a broad variety of health professionals, educators, researchers, organizations, and professional societies as they individually and collectively seek to improve the health and well-being of those they care for.

Integrating legal services to improve behavioral health, a challenge met from a different angle.

The United States' current healthcare delivery system is not prepared to address the expanding behavioral health (BH) crisis without treatment of upstream social determinants that contribute to downstream BH exacerbations. Medical Legal Partnerships (MLP) utilize lessons from integrated BH to create efficiencies, augment the reach of the current BH workforce, network community resources, and likely provide BH prevention at the family unit. Payment policy changes are needed, however, to provide sustainable access to these services. The current surge of federal and state funding for BH care needs may provide the policy window necessary to sustainably fund MLP lawyers as a novel, high-impact, professional on the integrated healthcare team. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Inequities in behavioral health: What do we really know?

Behavioral health problems are ubiquitous in today's society. Social, environmental, and physical stressors impact our daily activities and wellness, contributing to mental health conditions, both diagnosed and undiagnosed, as well as substance use. We know that populations and identities are not equally impacted. Populations who experience greater stressors suffer more. Structures and systems cause and reinforce inequities in health, inclusive of behavioral health. Still, there is insufficient understanding of the existing disparities in behavioral health. Right now, what do we know? And perhaps more importantly, what do we know that we do not know? Behavioral health itself is an inequity in health care. Predominantly isolated from physical health, we still have not achieved parity in preventive measures, access, management, or reimbursement for care. We cannot let what we do not know prevent us from advocating for adequate resource allocation and prioritizing community driven solutions for populations with the greatest needs. These efforts must shift from programmatic interventions to full-scale paradigm shifts in public policy and adoption of disaggregated racial data to effectively narrow the gaps in equality and help us address behavioral health with the respect deserved to balance inequities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Policy pathways to address American youth firearm injury and death.

Context: The burden of firearm violence and death are uniquely American problems. Over 90% of firearm deaths among children and adolescents in high income countries occur in the United States. Despite similar overall crime rates, the gun homicide rate is about 25 times higher in the U.S. than other Western democracies, and 49 times higher for those aged 15-24 years. Firearm-related injuries are a leading cause of child and adolescent deaths, second only to motor vehicle crashes. Approximately 4.6 million children are living in U.S. homes with at least one loaded, unlocked firearm. Reducing gun violence injuries and deaths is imperative and requires a multifaceted approach. Objectives: Review the impact of gun violence on youth across the U.S.; articulate the evidence base for gun safety policies; describe the current landscape of federal and state firearm laws. Study Design: Policy analysis and literature review. Results: The history of U.S. firearm policy demonstrates laws in evolution from 1791-2021, regulating both gun owner rights and restrictions. These firearm policies, existing in a variety of forms in states and nationally, reveal evidence that gun safety legislation saves lives: Child Access Prevention; Safe Storage; Universal Background Checks; Permit to Purchase; Extended Waiting Periods; Extreme Risk Protection Orders; Assault Weapon and High Capacity Magazine Ban. The dearth of federal law has resulted in more extensive state legislation but with variability and inconsistencies. No single law or policy reduces all forms of gun violence, but states with a variety of firearm policies have a cumulative impact on reducing injuries and death. Conclusions: We aim to promote education, physical safety, and behavioral health so that children can achieve their highest potential. Decreasing firearm injury and death is achievable with education, collaboration, research, and policies. To protect children and youth from firearm injury and death, we must: strengthen federal laws building on evidence from state policies; protect current evidence-based state laws from dismantling efforts; invest in public health firearms research; overcome the inequities suffered by disproportionately affected populations.

Something Republicans and Democrats can agree on: Support for integrated behavioral health.

Barriers to the spread of integrated behavioral health and primary care continue to limit progress on meeting critical needs for mental health and substance use disorder services. The recent Bipartisan Policy Center Report (2021) provides key policy recommendations to address these barriers and accelerate the adoption of integrated behavioral health in Medicaid and Medicare. Having bipartisan support presents a policy window of opportunity to advance integrated behavioral health through advocacy for implementation of these recommendations, parallel changes to occur in employer-based and other commercial insurance plans, and development of operationalized standards for core service delivery elements. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

What to do with that policy paper (and why).

In this editorial we describe the clinician/administrator/researcher experience of frustration or confusion around how to effectively advocate for policy change in health care. By the end of the piece the reader will (a) understand the importance of health professionals' advocacy; (b) know how to use policy papers to advocate; and (c) understand how policy organizations use policy papers. We also discuss the National Academies of Medicine, Science, & Engineering High Quality Primary Care report as an example of a policy paper, introduce our new coeditors for the Policy and Management Department, and describe the Collaborative Family Health Care Association's new policy principles. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Assessing cross-sector stakeholder readiness to advance and sustain statewide behavioral integration beyond a State Innovation Model (SIM) initiative.

Integrated care is recognized as a promising approach to comprehensive health care and reductions in health care costs. However, the integration of behavioral health and primary care is complex and often difficult to implement. Successful and sustainable integration efforts require coordination and alignment both within health care organizations and across multiple sectors. Furthermore, implementation progress and outcomes are shaped by the readiness of stakeholders to work together toward integrated care. In the context of a Colorado State Innovation Model (SIM) effort, we examined stakeholder readiness to advance and sustain partnerships for behavioral health integration beyond the period of grant funding. Partnership readiness was assessed using the Readiness for Cross-sector Partnerships Questionnaire (RCP) in spring 2019. Participants from 67 organizations represented seven sectors: government, health care, academic, practice transformation, advocacy, payer, and other. RCP analyses indicated a moderate level of readiness among Colorado stakeholders for partnering to continue the work of behavioral health integration initiated by SIM. Stakeholders indicated their highest readiness levels for general capacity and lowest for innovation-specific capacity. Five thematic categories emerged from the open-ended questions pertaining to partnership experiences: (a) collaboration and relationships, (b) capacity and leadership, (c) measurement and outcomes, (d) financing integrated care, and (e) sustainability of the cross-sector partnership. Partnering across sectors to advance integrated behavioral health and create more equitable access to services is inherently complex and nonlinear in nature. The RCP usefully identifies opportunities to strengthen the sustainability of integrated care efforts.

The Advocacy Portfolio: A Standardized Tool for Documenting Physician Advocacy.

Recent changes in health care delivery systems and in medical training have primed academia for a paradigm shift, with strengthened support for an expanded definition of scholarship. Physicians who consider advocacy to be relevant to their scholarly endeavors need a standardized format to display activities and measure the value of health outcomes to which their work can be attributed. Similar to the Educator Portfolio, the authors here propose the Advocacy Portfolio (AP) to document a scholarly approach to advocacy.Despite common challenges faced in the arguments for both education and advocacy to be viewed as scholarship, the authors highlight inherent differences between the two fields. On the basis of prior literature, the authors propose a broad yet comprehensive set of domains to categorize advocacy activities, including advocacy engagement, knowledge dissemination, community outreach, advocacy teaching/mentoring, and advocacy leadership/administration. Documenting quality, quantity, and a scholarly approach to advocacy within each domain is the first of many steps to establish congruence between advocacy and scholarship for physicians using the AP format.This standardized format can be applied in a variety of settings, from medical training to academic promotion. Such documentation will encourage institutional buy-in by aligning measured outcomes with institutional missions. The AP will also provide physician-advocates with a method to display the impact of advocacy projects on health outcomes for patients and populations. Future challenges to broad application include establishing institutional support and developing consensus regarding criteria by which to evaluate the contributions of advocacy activities to scholarship.