John Morales, Author at PPM Healthcare

April 4, 2023

Closing the gender data gap in healthcare

Now more than ever, data is at the center of engagement and decision making. Healthcare and life sciences are no exception: data is central to discussions about public health and is core to enabling continued scientific advancement. The accelerated digitalization of healthcare during the pandemic has only expanded the amount of health-related data available—and cemented the key role that it plays in care delivery, disease prediction and diagnosis, biopharma and medtech innovation, and patient outcomes.

Despite the exponential growth in data generated across the healthcare ecosystem, notable gaps remain. One such area is women’s health, in which gaps span the entire data value chain—from defining women’s health (pre–data generation) to diagnosing (data generation) to tracking at the national level (data collection) to translating data into insights at the global level through epidemiological studies (data analysis). These data disparities ultimately influence health outcomes for women globally by creating blind spots in the insights that drive research design, investment decisions, and pipeline priorities. Certain subsets of women, such as those of different backgrounds, sexual orientations, and gender identities, are more vulnerable to the gaps and negative effects of these blind spots. Furthermore, insufficient availability and analysis of women-specific health data undermine advancements in disease-state understanding and limit asset discovery opportunities across medical conditions with meaningful unmet need.

This article highlights these disparities and explores options to remedy them.

Understanding the data value chain

Health-related data has numerous sources and is analyzed for different applications. This article explores examples of data gaps in women’s health at key moments across the health data value chain (Exhibit 1).

Shortcomings exist at each stage of the data value chain in women’s health.

The following sections examine these examples in greater detail.

Pre–data generation: Defining women’s health

Good data sets begin with good definitions. Without clear definitions, the metrics to track and the conclusions to draw remain murky. However, at present there is no one definition of “women’s health.”

Historically, women’s health was largely defined as “reproductive health.” More recently, academics and clinicians have used a more expansive lens, recognizing that sex is a significant factor in the development and progression of many diseases. The National Academy on Women’s Health Medical Education defines women’s health as “devoted to facilitating the preservation and wellness of and prevention of illness in women and includes screening, diagnosis and management of conditions that are unique in women, are more common in women, are more serious in women, and have manifestations, risk factors or interventions that are different in women.”

For the purposes of this analysis, we define “women’s health” as encompassing both female-specific conditions, including those tied to female reproduction or female biology, and general health conditions that may affect women differently, such as cardiovascular diseases, or disproportionately, such as autoimmune diseases (Exhibit 2). It is crucial to understand sex-driven differences, as today’s care models often ignore those differences, resulting in health outcomes that can vary by sex (often to women’s disadvantage).

The definition of women’s health goes beyond reproductive health.

Data generation: Documenting women’s diagnoses in claims data

Insurance claims data—particularly in the United States—provides critical insight into the nature of health conditions and how they are treated. These data sets have inherent limitations, as their primary use for physicians is for billing purposes. However, this data is high quality and widely used, and thus the analysis for this article uses diagnosis codes on claims as a proxy for overall diagnosis rates.

According to US claims data from January 2019 through August 2022, the prevalence of women’s health conditions (estimated by epidemiological data sources) is roughly five times that of their documented diagnoses. In other words, for every one woman diagnosed with a women’s health condition, roughly four go undiagnosed. In comparison, the difference between epidemiological prevalence and documented diagnoses for men’s health conditions narrows to roughly 1.5 times (Exhibit 3).

There is meaningful variation between prevalence and diagnosis of women’s health conditions.

While this disconnection between prevalence and diagnosis indicates an inconsistency in women’s health data across various sources, such sex-based differences may also reflect structural drivers, such as biases in care delivery. Implicit biases, defined as “attitudes and beliefs about race, ethnicity, age, ability, gender, or other characteristics that operate outside our conscious awareness and can be measured only indirectly,” have been found to be associated with “diagnostic uncertainty.” This phenomenon is corroborated by surveyed patients: 20 percent of women say a healthcare provider has ignored or dismissed their symptoms, compared with 14 percent of men.

Furthermore, we found that the sex of the diagnosing physician appears to be correlated with the likelihood of being diagnosed with a condition. In other words, in the claims data we analyzed, women appear to be more likely to be diagnosed with a female-specific condition, including menopause, polycystic ovary syndrome (PCOS), and endometriosis, if their physician is a woman. In our analysis of claims data, women represent approximately 40 percent of primary care physicians (PCPs) but nearly 50 percent of PCPs documenting diagnoses of these key women’s health conditions (Exhibit 4).

Female primary-care physicians are disproportionately the physicians diagnosing women’s health conditions.

As Caroline Criado Perez writes in her book Invisible Women: Data Bias in a World Designed for Men, “It’s not always easy to convince someone a need exists if they don’t have that need themselves.” Given that claims data informs life sciences investment decisions, “blind spots” in these data sets may contribute to a perception of less unmet need and less need for continued innovation.

These biases in care delivery are also likely reinforced during medical training. Out of 112 internal-medicine residency programs reviewed in a 2016 study, approximately 25 percent did not include menopause in the core curriculum, 30 percent did not include contraception, nearly 40 percent did not include PCOS, and more than 70 percent did not include infertility. These educational gaps are present even in programs dedicated to women’s health: a survey of US obstetrics and gynecology residents found that fewer than two in ten receive formal training in menopause medicine, but seven in ten would like to receive it.

The rate of underdiagnosis for women is more striking in light of data that shows that women are, on average, more likely to seek out care. A 2013 Kaiser survey found that 68 percent of men and 81 percent of women identified a clinician they see for routine care, and women were more likely than men to have seen a provider in the past two years (91 percent versus 75 percent).

Data collection: Reporting sex-disaggregated health data at the national level

Globally, the quality and quantity of women’s health data collection is uneven. The World Bank tracks country-level reporting rates of gender-specific healthcare indicators and finds significant gaps. For example, in 2020, less than 10 percent of countries reported data related to female access to contraception. This lack of visibility undermines the ability to understand drivers of maternal and child health, maternal mortality, and sexually transmitted infections (STIs) such as HIV/AIDS. And while data availability related to contraceptive use has improved, many countries still only provide data for married women. Less than 5 percent of countries reported 2020 data on menstrual material usage, which is a critical indicator of public health, gender equity, and human rights.

The availability of sex-specific health data also differs by country. During the COVID-19 pandemic, for instance, 76 percent of high-income countries reported COVID-19 case data by sex, compared with 37 percent of low-income countries. Sex-disaggregated data provides important insights into the biological mechanisms and socioeconomic risk factors that drive disease prevention and may translate to the development of more effective biopharma (and other) interventions by sex. Without it, the picture of global women’s health remains incomplete, particularly in lower-income countries.

Data analysis: Improving the metrics of epidemiological studies

In addition to data published by individual nations, the global burden of disease (GBD) is often used by clinicians, payers, researchers, analysts, and policy makers to understand the evolving global healthcare landscape. The GBD is the world’s most comprehensive observational epidemiological study, spanning 204 countries, 369 diseases and injuries, and 87 risk factors.

However, traditional metrics tracked in the GBD may not capture the full scale of need in women’s health. Using the GBD tool of the Institute for Health Metrics and Evaluation (IHME), we investigated the prevalence and burden of disease associated with select women’s health conditions (Exhibit 5). Of the conditions defined in this analysis, nearly 60 percent of prevalence data was attributed to female-specific diseases such as maternal health, contraception, and menopause. However, these same female-specific conditions represent less than 25 percent of disability-adjusted life years associated with women’s health conditions. In other words, traditional health metrics do not accurately reflect the widespread suffering associated with female-specific conditions.

Traditional health metrics do not accurately reflect the prevalence and burden of women’s health conditions.

A delta between prevalence and disability-adjusted life years is not surprising in itself. However, the low disability-adjusted life years associated with female-specific conditions (some of which, such as menopause, are not tracked at all in the GBD) appear to meaningfully understate the disruption and suffering associated with female-specific conditions. For example:

Menopause. Approximately 80 percent of women indicate that menopause interferes with their lives, and roughly one-third of these women also experience depression. Furthermore, with an estimated $810 billion in healthcare spending and productivity losses, menopause places a significant economic burden on the global economy.
Infertility. About 40 percent of women with infertility are reported to experience depression, and another 35 percent are reported to experience anxiety. These rates are an estimated 1.5 to 2.0 times higher in low- and middle-income countries than in high-income countries.
Endometriosis. Women with endometriosis have about three times higher healthcare costs on average. The time to diagnosis is estimated to be more than seven years, with an even more pronounced delay for Black women. Furthermore, approximately half of women with endometriosis reported earning less money as a result of the impact of endometriosis symptoms.
Dysmenorrhea. Period pain can disrupt women’s lives, with about 40 percent of young women reporting negative effects on classroom performance and about 20 percent reporting school absences due to pain. This impact is more pronounced in low- and middle-income countries.

Steps to close the data gaps in women’s health

Data is foundational to our understanding of disease states and is a crucial catalyst for continued life-sciences innovation. A 2023 report from the Enterprise Strategy Group and Splunk found that leaders in key data-maturity metrics also excelled in product innovation; these leaders report a higher number of product launches per year and a higher share of revenue accounted for by new innovations.

In women’s health, data gaps coincide with lower rates of clinical development focused on women’s health: excluding oncology, just 1 percent of biopharma pipeline assets and 2 percent of medtech novel approvals are directed at addressing women’s health conditions. (Including oncology, the rates increase to 5 and 4 percent, respectively.) Without data to accurately document the extent and nature of conditions, there is a limited fact base to fuel innovation—in women’s health specifically and in life sciences overall. But the opportunities to close gaps are plentiful and represent exciting opportunities for industry participants with a stake in improving women’s health outcomes.

Acknowledge the importance of sex in the definition and treatment of disease. The data gap is substantial and will take many hands and substantial effort to bridge. Today’s clinical trials, diagnoses, and treatment plans are built on existing data sets, only some of which include thorough analysis of robust sex-disaggregated data. Fortunately, working to close the data gap in women’s health could bring forth opportunities throughout the data value chain for life-sciences organizations, providers, payers, academics, and investors alike. The starting point is building a widely acknowledged definition of women’s health that includes all relevant conditions—not just those related to reproductive health—and highlights the biological relevance of sex to health outcomes.

Reinforce incentives at every step of the women’s health data value chain. At the regional and national levels, clinicians, academics, and researchers could benefit from updated guidance on the impact of sex-based differences on clinical outcomes, which demographic data to collect, and mechanisms for the collection of women’s health data. Improving visibility into women’s unmet medical needs will also require new mechanisms, incentives, and infrastructure to facilitate the generation of sex-disaggregated data. Some changes, such as those enhancing the understanding of sex-based differences in clinical outcomes, could have a substantial impact by creating a stronger foundation for women’s health data collection and analysis. Incumbent health and life sciences companies could also take the lead in working with companies that have unanalyzed sex-disaggregated data.

Improve the generation and use of data in care delivery. Clinician training in sex-specific biology and the implicit biases we know about today, with an emphasis on narrowing the gap between the prevalence of its condition and the volume of diagnoses, could help to improve health outcomes for women and critical sources of data generation. Once an expanded set of sex-disaggregated data is collected and assessed, that data can also guide future training on sex-based differences as data relates to healthcare research, clinical trials, pharmaceutical development, treatment, and more. Organizations that use clinical decision support systems to assist in clinical training may consider how a more robust set of sex-disaggregated data could improve models. The goal is to equip everyone—from researchers to providers to payers—with comprehensive training and tools built on best-in-class data practices.

Fund new ventures related to women’s health data. Investors could also seek out opportunities to fund new ventures focused on generating women’s health data and understanding the impact of sex-driven differences on health outcomes. The successful models that led to the proliferation of precision medicine in other therapeutic areas, such as oncology-focused electronic medical records companies, could guide these new ventures. Investors, entrepreneurs, and established life-sciences incumbents each have a role to play in investing in this white space.

Rethink traditional epidemiological metrics. Finally, stakeholders can consider how health metrics and studies are used, as well as the implications of those choices. Both key health outcome metrics and population-level analyses (for example, global epidemiological studies) should aim to accurately reflect the patient experience of different subpopulations. Revisiting and expanding these metrics could be a joint effort among governments, academics, clinicians, and public-health experts.

Our collective understanding of disease burden drives not only health outcomes but also investment decisions—and yet that understanding does not benefit from a comprehensive data set on women. The gaps are many, and women of different demographics feel the effects to varying degrees—but a new commitment to raising the bar in women’s health data could unlock the next generation of life-sciences innovations and care delivery for women globally. Moreover, taking care of women is taking care of communities. Everyone will benefit from a world with a comprehensive definition of women’s health, diagnosis rates more in line with condition prevalence, nationally reported sex-disaggregated data, and global epidemiological studies that consider the full breadth of women’s health experiences. The future of innovation in women’s health is only as strong as the data value chain that supports it. It’s time to close these gaps.

April 4, 2023

Recovery high schools build a culture of mental health to help kids thrive : Shots

5280 High School in Denver is one of 43 secondary schools in the U.S. with a program designed for students recovering from substance use disorder and related mental health disorders.

Stephanie Daniel/KUNC

hide caption

toggle caption

Stephanie Daniel/KUNC

5280 High School in Denver is one of 43 secondary schools in the U.S. with a program designed for students recovering from substance use disorder and related mental health disorders.

Stephanie Daniel/KUNC

Every weekday at 5280 High School in Denver starts the same way.

Students in recovery from drug and alcohol addiction gather on the steps of the school’s indoor auditorium to discuss a topic chosen by staff members. One recent morning, they talked about mental health and sobriety. A teenage boy dressed in tan corduroys, a black hoodie, and sneakers went first.

“I didn’t want to have, like, any emotion,” he said. “So I thought, like, the best way to, like, put it down would be to do more and more and more drugs.”

A classmate said she started doing drugs for fun and then got hooked. Another student said his addiction negatively impacts his mental health. A third announced an upcoming milestone.

“In, like, two days, I’ll be six months sober,” she said, as her classmates cheered.

The students attend Colorado’s only recovery high school — one of 43 nationwide. These schools are designed for students who are recovering from substance use disorder and might also be dealing with related mental health disorders. The Denver school opened in 2018 as a public charter school that today enrolls more than 100 students.

One of those cheering classmates was sophomore Alexis Castillo, 16, who listened supportively during that recent morning meeting. She is in recovery for alcohol and fentanyl addictions. Several of her friends attended the school when she enrolled during her freshman year and initially loved it. But after a while some of Castillo’s friends left and she grew disillusioned. She stopped going to class and wasn’t motivated to work her recovery steps.

“They give you a lot of accountability,” she said. “That was not something I wanted.”

Castillo relapsed and school staffers helped her get into rehab. Three months later she was back at the school, in recovery and ready to do the work.

The school’s mission is to help kids learn to live a substance-free life while receiving an education. This includes attending recovery meetings and wellness activities, and taking traditional high school classes like English, math, and Spanish.

“They can go on to college or a career and really handle anything that life throws at them,” said 5280’s founder and executive director, Dr. Melissa Mouton.

In 2022, nearly a third of 12th graders and 1 in 5 10th graders reported using an illicit drug in the previous year, according to a national survey from the Monitoring the Future project conducted by the University of Michigan Survey Research Center. Those numbers have steadily decreased over the past 25 years. However, data from UCLA shows overdose deaths among teens doubled in the first year of the pandemic, mainly attributed to the increased prevalence of fentanyl-laced drugs.

The first recovery high school opened in Silver Spring, Md., in 1979 and similar programs now operate in 21 states. Compared with their peers at regular schools who have gone through treatment, recovery high school students have better attendance and are more likely to stay sober, and their graduation rate is at least 21{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} higher, according to one study.

A mosaic in the computer lab at 5280 High School in Denver. Colorado’s only high school with a recovery program opened in 2018 as a public charter school and today enrolls more than 100 students.

Stephanie Daniel/KUNC

hide caption

toggle caption

Stephanie Daniel/KUNC

A mosaic in the computer lab at 5280 High School in Denver. Colorado’s only high school with a recovery program opened in 2018 as a public charter school and today enrolls more than 100 students.

Stephanie Daniel/KUNC

“For this particular group of young people who have these disorders, this can be a lifesaver,” said John Kelly, director of the Recovery Research Institute at Massachusetts General Hospital. “It can help them create a social norm of recovery.”

There are three components to effective drug and alcohol treatment, according to Dr. Sharon Levy, a pediatrician and addiction medicine specialist at Boston Children’s Hospital. The first part is medical, which includes seeing a doctor, drug testing, and using medications like buprenorphine to treat opioid addiction. The second is emotional support from counseling to address co-occurring mental health disorders. And there is a behavioral component that, for kids, can include receiving positive feedback from parents, peer support and recovery schools.

“Recovery schools offer an opportunity really for peer support and mutual aid in a kind of a supervised and structured way,” Levy said.

Recovery high schools often weave components of treatment into the school day — activities like 5280’s daily recovery program meeting. In the afternoon, the school offers wellness electives such as spiritual principles and journaling. The school also employs a director of recovery and recovery coach to work with and counsel the students individually.

Recovery schools do face challenges. Most are publicly funded charter or alternative schools that carry a higher cost of educating students than traditional schools do. This is due to a smaller enrollment, the need for mental health and recovery personnel, higher faculty-to-student ratios, and other factors.

The Denver school enrolls about 100 students annually, making it one of the biggest recovery high schools in the nation. This year, the per-pupil cost is about $25,000 per student but the school receives only about $15,000 from federal, state, and local funding, according to Mouton. The remaining money comes from donors.

Given the complex needs of the students, “recovery schools will always be small,” she said.

Pooling such students together may also raise a concern that students will trigger one another to use drugs and alcohol and relapse, but, Levy said, that’s a risk with any social interaction.

“So, if you’re in an environment where the recovery is kind of front and center and people are watching and monitoring and supervising,” she said, “I think that’s helpful for a lot of kids.”

The school in Denver purposely keeps enrollment under capacity so additional teens can enroll anytime during the school year. A student won’t get kicked out if they relapse, but there are two requirements: They must want to be sober and attend an outside recovery program.

“The No. 1 step is just letting them know out of the gate, no matter what’s going on, that we love them,” said Brittany Kitchens, the school’s recovery coach. “We are here for them.”

Kitchens teaches students how to navigate recovery and regulate their emotions. She likens herself to a hall monitor, constantly checking in with students and looking for changes in behavior.

“I tend to be the first kind of line that the kids will come to when they’re experiencing something that is just a little bit too big for them to process,” she said.

Some of these difficulties stem from traumas students have experienced, including sex and drug trafficking, and abandonment. Students also deal with traumas they have caused, Kitchens said, actions that landed them in jail or on probation.

Kitchens, who is in recovery herself, shares coping mechanisms with the students.

“A lot of times it just starts with, ‘Hey, take a breath, breathe in through the nose and out through the mouth,'” she said.

Alexis has been in recovery for nearly a year, she said. The morning meetings where she and her classmates talk about mental health, sobriety, and other topics are an opportunity to build a community of friends who support one another, something she said she didn’t have when she was using drugs.

“It’s really hard to get sober young,” she said.

This article is part of a partnership that includes KUNC, NPR, and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

April 4, 2023

Southwest Healthcare Services Announces Data Breach Affecting Patients’ SSNs and PHI | Console and Associates, P.C.

On March 31, 2023, Southwest Health care Companies (“Southwest”) filed a observe of details breach with the Montana Lawyer General right after the group uncovered that an unauthorized bash was able to entry confidential client details saved on its laptop or computer method. Dependent on the company’s formal filing, the incident resulted in an unauthorized social gathering gaining accessibility to consumers’ names, dates of birth, addresses, Social Stability numbers, driver’s license quantities, health insurance information and facts and secured overall health data. Just after confirming that customer knowledge was leaked, Southwest commenced sending out information breach notification letters to all people who were being impacted by the new data stability incident.

If you are a latest or previous affected person at Southwest Healthcare Expert services Healthcare facility, it is crucial you realize what is at chance and what you can do about it. As we have beforehand reported, healthcare amenities are becoming the most popular focus on of quite a few hackers owing to the large sum of sensitive info in their possession. For the reason that of this, hackers can often acquire anything they need to dedicate identity theft and other frauds soon after a healthcare info breach, primarily those people involving more substantial hospitals and health care products and services organizations. To learn a lot more about how to safeguard yourself from getting a target of fraud or identification theft and what your authorized options are in the wake of the Southwest Healthcare Services knowledge breach, achieve out to an knowledgeable data breach attorney for aid.

What We Know So Significantly About the Southwest Healthcare Providers Breach

News of the Southwest Healthcare Solutions facts breach is nonetheless clean even so, what we know at this stage comes from the company’s filing with the Montana Legal professional Typical, as very well as a “Notice of Info Protection Incident” posted on the Southwest website. In accordance to this source, recently, Southwest acquired that a poor actor could have obtained accessibility to patients’ shielded well being information. Though the enterprise does not indicate how it acquired of the intrusion, in reaction, Southwest carried out an investigation with the help of outside cybersecurity professionals in hopes of studying extra about the incident and no matter whether any affected person info was jeopardized as a final result.

On January 31, 2023, the Southwest investigation verified that the unauthorized actor was able to obtain certain documents stored on the organization’s laptop or computer network amongst October 28, 2022 and Oct 29, 2023. Subsequently, Southwest discovered that some of these information contained private affected individual details.

On finding that delicate consumer details was built readily available to an unauthorized bash, Southwest Healthcare Expert services began to critique the afflicted data files to identify what information was compromised and which shoppers ended up impacted. While the breached information differs relying on the specific, it might consist of your title, date of delivery, deal with, Social Stability number, driver’s license selection, health and fitness insurance data and secured health and fitness facts.

On March 31, 2023, Southwest Health care Services sent out facts breach letters to all people today whose facts was compromised as a final result of the new facts safety incident.

Additional Details About Southwest Health care Products and services

Southwest Health care Products and services is a non-income healthcare products and services company centered in Bowman, North Dakota. Southwest Health care Services was established in 2001, with the consolidation of St. Luke’s Tri-Condition Hospital and Sunset Treatment Company. Subsequently, Bowman Ambulance Services became a section of Southwest Health care Companies of Bowman in September 2002. The organization also operates Sunrise Village Assisted Dwelling, the Sunset Nursing Property and the Southwest Healthcare Clinic. Southwest Health care Providers employs a lot more than 138 persons and generates around $27 million in yearly income.

April 4, 2023

The Pet Shop that Makes Anybody’s Furry Friends Feel Loved and Part of the Family

Here’s to all owners in look for of a trustworthy, excellent, and price range-pleasant pet shop for their cute, loveable, furry, and fluffy good friends they look at family members – Introducing, https://www.fluffypuppy.ca/!

As an on-line shop, the Fluffy Puppy dog pet store aims to provide its community of pet homeowners with a wide variety of pet product supplies with superb buyer assistance and helpful assist.

Their on the net local community permits all members registered to continue to keep current on the hottest developments in pet products and solutions by means of the publication they publish, editor’s decide in merchandise, or even the very best discounts or presents they have available earning a more shut-knit database of fluffy and furry pet lovers in will need of high-quality goods for their pets.

Not an Common Dog On line Store

The passions of their customers and community are their precedence!

The Fluffy Pup manufacturer will make needs arrive true for their clientele by constantly checking on trending merchandise and on-demand objects observed in their collections for all pet- homeowners around the globe.

Listed here is a swift overview of their wide variety of pet item supplies that are certainly created with enjoy:

Beds

Discover the greatest animals beds for just about every type of fluffy pooch, created to fulfill their requires and supports their joints, made with security to start with, breathable and superior top quality products that are safe and sound and nutritious for all animals.

From handmade crafts of cat swings, blankets, and hammocks, Fluffy Pup pet solutions give pet beds that make sure coziness and comfort for any canine or feline pet.

Trending merchandise as very well these types of as teepee tents and playpens for all fluffy mates alike, are also available and convenient to keep after wanted.

Clothing

Large-quality material, protected, breathable not just stylish.

Make a pet-perfect fashion statement with a wide wide range of apparel for what ever reason that their on line collection has.

Costumes for Halloween, jackets, pajamas, and sweaters for the holidays are all accessible, with so numerous more to pick out from!

Carriers

Fluffy Pup offers a selection of airline-authorised pet carriers that have been analyzed for protection.

Portable vacation luggage, knapsack carriers, car or truck seats, and outdoor journey purses are quickly out there with a broad range of models manufactured fitting for animals in what ever sizing and form.

Now, traveling and strolling with pets can be created effortless and enjoyment with these items!

Meals

Healthier pet food items and snacks are also equipped and can be requested as a result of their internet site. Loaded with vitamins and protein, and vitamins and minerals from grains, fruits, and greens. Even dental treats that can support in gum and teeth wellness.

This helps make certain that the animals consuming or consuming these treats and treats are an assist and advantage to their all round wellbeing and wellness – supporting well being, aiding growth, and endorsing healing, all for a happy and wholesome pet!

Add-ons

Awesome types and high-quality products from Fluffy Puppy dog: mugs, leashes, collars, keychains, necklaces, and even pet dog pools and tote luggage for the homeowners are getting bought conveniently with the Fluffy Pet on the net retailer.

Quirky and pet adorable items that accompany the fluffy, furry canine and feline pets that are sure to make heads convert and look accredited lovable what ever occasion and wherever they are.

Fluffy Puppy dog is absolutely sure to be the “buddy” to the fluffy and furry ideal buddy that enables them to appreciate lifetime in their own very little way through the wide array of pet items seen on their web site and online store.

Their pet goods are out there on their site and ensure to spoil all the furry and fluffy buddies and make them feel portion of the spouse and children, just like how their owners do.

Fluffy Dog Launches On-line Store Committed To Pet Proprietors

Social Media Accounts:

Instagram

Media Call
Company Identify: Fluffy Pet
Call Human being: Nick
E-mail: Send Email
Region: Canada
Web-site: https://www.fluffypuppy.ca/

April 4, 2023

Mental health funding changes may cut services

In summary

Gov. Gavin Newsom is proposing to shift more money to housing severely mentally ill homeless people. Some officials at mental health organizations fear that funding will come from cuts to other services they provide.

Lea este artículo en español.

For the second time in as many years, Gov. Gavin Newsom is pushing for major reform of California’s mental health system, this time by overhauling the way counties spend mental health dollars and placing a bond measure before voters to build more psychiatric beds.

County behavioral health advocates and local service providers fear programs will be cut, and, much like the controversial CARE Courts legislation — which passed last year and allows individuals to petition a court to force seriously mentally ill people into treatment and housing — say Newsom’s initial announcement came as a shock.

“We listened to the press conference just like you,” said Christine Stoner-Mertz, executive director of the California Alliance of Child and Family Services, which represents organizations that provide child welfare, foster care, juvenile justice and youth behavioral health services.

The proposal is being pitched as a solution to the state’s ballooning homelessness crisis, but experts doubt it will make any kind of meaningful dent. No one has published bill language for the proposal, but Newsom unveiled two major changes during his March state-of-the-state tour:

Divert 30{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of existing Mental Health Services Act money toward housing people living on the streets who are severely mentally ill;
Use a bond measure to generate between $3 billion and $5 billion for 6,000 residential psychiatric treatment beds.

Voters passed the Mental Health Services Act nearly two decades ago as a ballot initiative that levied a 1{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} tax on state millionaires to fund local mental health programs. Substantial changes to the act are subject to voter approval because it originally passed as a ballot measure in 2004.

The proposal aims to reprioritize a significant portion of the state’s existing behavioral health system to focus on what Newsom characterized as the state’s “most acute challenge,” which is the number of homeless people with mental illness and substance use disorders. Only about 20{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of California’s approximately 172,000 homeless people have a severe mental illness, according to the U.S. Department of Housing and Urban Development, but the issue plays an outsized role in state politics.

“It’s unacceptable what we’re dealing with at scale now in the state of California,” Newsom said. “We have to address and come to grips with the reality of mental health in this state and our nation.”

Newsom, who made reducing homelessness a key part of his gubernatorial campaign in 2018, is contending with the reality of homelessness increasing by nearly 32{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} in the past four years. Though he has called out counties for not acting aggressively enough and dedicated nearly $10 billion to address the problem, he has also faced harsh bi-partisan criticism for what many view as a political stunt in threatening to withhold money from counties and failing to significantly increase the state’s housing stock.

“The question in our minds is what is the approach and process to solving some of these problems. We would welcome greater partnership around that.”

Christine Stoner-Mertz, executive director of the California Alliance of Child and Family Services

Newsom’s proposal is backed by several lawmakers, including former Assemblymember and current Sacramento Mayor Darrell Steinberg, who co-authored the original act, and Sen. Susan Talamantes Eggman, a Democrat from Stockton who co-authored the CARE Court legislation and who has staked the remainder of her term on advancing mental health changes.

Those who do the on-the-ground mental health work in the state, however, say they have major concerns about such a large system shake-up. The focus on housing and the need for more behavioral health treatment beds is welcome, Stoner-Mertz said, but shouldn’t detract from the current workforce crisis and other problems exacerbated by the COVID-19 pandemic.

“One-third is a big chunk of money,” Stoner-Mertz said. “The question in our minds is what is the approach and process to solving some of these problems. We would welcome greater partnership around that.”

What the mental health funding proposal would change

On Wednesday, state officials revealed new details about the proposal. It changes the categories counties would be required to invest in, focusing most of the money on homeless adults. Counties would be required to spend 30{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc}, or roughly $1 billion annually, of their Mental Health Services Act dollars on housing homeless people with serious mental illness or drug addiction. They would also direct 35{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} of the funds to full-service partnerships for these individuals, which include clinical treatment and social supports co-designed by the client and the program.

The remaining 35{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} could be used for a combination of existing programs like mental health prevention and early intervention, infrastructure and workforce investments, although officials made it clear that workforce would be a priority. Innovation grants that have historically been part of the program do not have any dedicated funds. The proposal also opens the door to using the money for people who struggle with addiction but don’t have additional mental health needs.

In contrast, current regulations give counties broad flexibility in using the money. A minimum of 38{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} must be spent on full-service partnerships, although counties can spend up to 70{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} on these services. (Full-service partnerships are intensive wraparound services designed to do “whatever it takes” to meet the client’s long-term needs. They can include things like 24/7 case management, clinical treatment, and housing.) About 19{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} is reserved for prevention and early intervention programs, much of which focuses on children, and 5{35112b74ca1a6bc4decb6697edde3f9edcc1b44915f2ccb9995df8df6b4364bc} for innovation. Some counties choose to use a portion of the funds for workforce and infrastructure needs.

There are some concerns about whether counties have historically met minimum spending requirements, particularly for full-service partnerships, but there’s no question that the money has become an integral part of the state’s behavioral health system, making up nearly one-third of all spending. Last year the tax generated about $3.8 billion. Newsom’s proposal introduces standardized accountability measures and reduces the amount of money counties are allowed to keep in reserves.

In addition, language will be placed on the 2024 ballot asking for a general obligation bond to pay for 6,000 psychiatric and substance abuse treatment beds. These beds would serve approximately 10,000 people annually, according to a fact sheet from Newsom’s office, by providing long-term residential treatment. An undetermined portion of the bond funds would be used to house homeless veterans.

For many mental health organizations, the bond to increase residential care capacity is much easier to swallow than prescriptive changes to how mental health dollars are spent. The state faces a shortage of more than 7,700 adult psychiatric beds, according to a 2021 RAND report commissioned by the County Behavioral Health Directors Association.

“We really appreciate the administration looking at the report that we did, and the focus on building out infrastructure is wonderful,” said Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association. “But we continue to need the same kind of focus on workforce and funding for services ongoing.”

At the same time that Newsom is advancing this proposal, his January budget delays $1.1 billion in other behavioral health investments over the next two years, including money intended to increase treatment capacity for adults and kids in crisis, and money for workforce development.

What are the primary concerns?

There’s no telling how exactly existing mental health priorities will get reallocated, but cuts are nearly inevitable given how heavily counties rely on the dollars. The money is “braided into the fabric of all things in our safety net,” Doty Cabrera said.

But some of the most pressing questions come from those who work with children and families. Currently, at least half of the money earmarked for prevention and early intervention must be used for children and young adults.

“This is the only protection from our perspective that is actually going to keep a focus on young people and keep a focus on more upstream services,” said Adrienne Shilton, director of public policy for the nonprofit California Alliance of Child and Family Services.

That money is potentially on the chopping block under the new proposal, as are innovation grants that have catalyzed multi-county programs to improve services for communities of color and LGBTQ folks.

Historically, Medi-Cal — the state’s public health insurance program for extremely low-income residents — has not covered behavioral health prevention programs, which is where the Mental Health Services Act becomes important. The money was intended to allow counties the greatest amount of flexibility in meeting local needs, particularly when other funding streams came with restrictions, said Toby Ewing, executive director of the Mental Health Services Oversight and Accountability Commission.

“It is designed to be a counterpoint to historic restrictions that were in place for Medi-Cal,” Ewing said.

The public perception that California’s homelessness crisis is caused by psychiatric emergencies and drug addiction is a false one.

At the same time that the money gives counties the ability to provide services beyond Medi-Cal, they also use qualifying program expenses to draw down matching Medi-Cal federal funds, effectively expanding local mental health programs. Collectively, counties use about half of the money on services that qualify for matching federal dollars, Doty Cabrera said.

With about $1 billion earmarked for housing, which the federal government will not pay for, the mental health system may face between $500 million and $1 billion in lost federal revenue, Shilton said, if Newsom’s proposal is approved.

Dr. Mark Ghaly, state secretary for Health and Human Services, disagrees with the assumption that these changes mean cuts will happen. The administration’s team has heard the same concerns in stakeholder meetings following the announcement and will work with counties “to try to maintain as much as we possibly can with them,” Ghaly said.

“There is no reason why we won’t be able to do a lot on the prevention and early intervention side,” Ghaly said.

He also notes that this proposal can’t be considered alone. It is part of a larger strategy to improve mental health services in the state, which includes sweeping changes to Medi-Cal, a children’s behavioral health initiative and investments in crisis response. One piece of the puzzle seeks permission from the federal government to use Medi-Cal dollars on housing, which would allow counties to still draw down a significant portion of matching funds.

“All of these things come together, build on each other, and I would like to say catalyze one another to promote the transformation,” Ghaly said. “This is, in my mind, government doing well.”

Will this help homelessness? Not really.

The proposal has been couched as a solution to California’s explosive homelessness problem, which consistently tops the list of voter issues.

“We’re fooling ourselves that if we don’t address that fundamental need that we can turn this thing around,” Newsom said during his press conference, backed by more than a half dozen officials who detailed homeless issues from state, county, city and personal perspectives.

But the public perception that California’s homelessness crisis is caused by psychiatric emergencies and drug addiction is a false one. Rather, decades of politicians upholding restrictive zoning laws and obstructive environmental policies have pushed California to the bottom of affordable housing rankings and are the primary drivers of homelessness in the state. Other factors, like changes to the state’s criminal justice system, also contribute. Dr. Margot Kushel, director of the UC San Francisco Benioff Homelessness and Housing Initiative, said no amount of spending on mental health will improve the state’s overall homelessness problem.

Still, she and other medical professionals who work primarily with unhoused people say the most vulnerable people on the streets are those with untreated mental illness, and prioritizing housing is the most important thing the state can do for that population’s physical and mental health. People living without shelter also face dismal health outcomes, and discharging a patient back to the street is a recipe for swift deterioration.

Even local and county behavioral health groups that have raised concerns about the proposal acknowledge the need for more housing for their clients, but they fear an inversion of the current problem — housing without services — will result.

“My concern is robbing Peter to pay Paul,” said Debbie Manners, president and CEO of Sycamores, a Los Angeles behavioral health and child welfare agency. Sycamores serves about 500 children and families daily through its school-based mental health program. Two years ago the state allocated $4.4 billion to a Children and Youth Behavioral Health Initiative, but it’s a one-time investment.

“I’m not sure how that will fill in the gap. I don’t think it will fill the gap,” Manners said.

Unfortunately, limited funding is the reality of this year’s budget cycle, with the Legislative Analyst’s Office projecting a $24 billion deficit.

“You don’t want to pit one need for money against another, and I get that,” Kushel said. “On the other hand, it isn’t really possible to serve this population without their having housing.”

April 4, 2023

Healthy Meal Plan for April 3, 2023

Welcome to Begin Now. Indication up for our totally free Commence Right now newsletter to obtain day-to-day inspiration despatched to your inbox. Then, be part of us on the Commence Nowadays Fb group for ideas and inspiration, to hook up with other people following the plan — and to get authentic-time information from coach Stephanie Mansour!

You questioned, we answered! Hundreds of Begin Right now members explained to us they desired far more healthful, balanced meal thoughts to aid them get to their overall health ambitions. This dietitian-created meal program offers you the versatility to ease into a new 12 months — all whilst studying the setting up blocks of balanced ingesting.

What to Consume This Week, April 3, 2023

If your goal is to take in more healthy this spring, we have acquired you included with a lot of nourishment tactics in this week’s program. For breakfast, you’ll get lots of protein — which keeps you fuller for lengthier intervals of time — and when eaten at breakfast, may aid reduce cravings later on in the working day. Hearty plant-forward lunches minimize your meat usage when maintaining you contented. And the array of dinners exhibit how straightforward seasonings can elevate any dish, so healthy foods pack a flavorful punch.

Start TODAY meal plan for the week of April 3, 2023

>>Download and print the meal strategy

Breakfast

Get your working day off to the right get started with these protein-packed alternatives. We recommend sitting down even though you try to eat, but these foods can conveniently be taken to-go.

Lauren Salkeld

This recipe would make four burritos that get wrapped and frozen. Commit 15 minutes prepping this on the weekend for heat-and-try to eat foods during the week.

JS Wellness

Whilst you can swap Greek yogurt for the protein powder in this smoothie, the advisable quantity will not offer the exact same degree of hunger- and cravings-busting protein. To pick a protein powder, seem for one with negligible, very simple components and no synthetic sweeteners.

Lunch

Crops dominate the plate on the world’s healthiest diet programs. These filling, plant-centric foods will preserve you fueled and centered all afternoon.

Courtesy of Website page Street Publishing Co.

Prep the soup in advance of you go to mattress, and allow it cook dinner by the night time. Have a slice of whole grain toast topped with mashed avocado or melted cheese on the facet.

Zach Pagano / Nowadays

Established aside 15 minutes in excess of the weekend or just one night to make this protein-packed pasta dish.

Veggie-Packed Sandwich

Mash some rinsed and drained canned chickpeas into retail store-purchased hummus. Distribute the mixture more than 2 slices of toasted full grain bread. Layer jarred, roasted red peppers and infant spinach concerning the two bread slices and fold into a sandwich. Serve with some toddler carrots.

Meal

We’ve available five mouth watering recipes this week, but there’s no require to make them all. A wonderful meal prep approach is to make more than enough for leftovers, so select the most tempting kinds to make this week. We have also bundled a further handy food prep strategy–using balanced advantage food items, like frozen mashed cauliflower and brown rice. As usually, sense totally free to browse previous weeks and swap in any recipes you really like. Do not fail to remember to incorporate the veggie facet dishes, as well.

Nathan Congleton / Currently

However the component record appears to be like prolonged, this recipe is shockingly effortless to make. Serve it with frozen brown rice or get a lot more veggie electrical power by mixing brown rice with frozen riced cauliflower.

Maneet Chauhan

A frittata will work for any food, but we like it for a very low-upkeep dinner. This a single makes use of frozen veggies to maintain factors especially low-vital. Have it with a piece of entire grain avocado toast on the facet.

Pan-Roasted Chicken Thighs with Mushrooms and Thyme

Lanna Apisukh / Lanna Apisukh

Rooster thighs are fewer high priced and far more tender than chicken breasts. This nominal-ingredient drop-off-the-bone chicken thigh dish is very simple to prep, but tends to make an spectacular meal. Serve it with completely ready-to-warmth frozen mashed cauliflower or make a mashed potato-cauliflower blend using premade mashed potatoes.

Spicy White Bean Soup with Greens and Turkey

Constantine Poulos for The New York Occasions

You can not go completely wrong with a veggie-packed, protein-wealthy soup. Don’t let the extensive component checklist spook you — only a couple of components need to have prepping, so the meal arrives with each other speedily. Provide with a piece of bread (this kind of as sourdough) if you like.

Nathan Congleton/Currently

Use total grain tortillas when building these very simple enchiladas, and serve them with sliced avocado, diced tomatoes and a simple facet salad to include some veggie goodness to the meal.

Snacks

Snacks that contain entire foods resources of protein and fiber supply a successful method that retains you comprehensive for hrs. Here are a few concepts:

Infant carrots with creamy taco dip. To make the dip, add some taco seasoning to Greek yogurt and blend.
Ricotta cheese topped with sliced grape tomatoes
Frozen spiced bananas with tahini. To make, sprinkle cinnamon and cacao powder around banana slices and freeze until finally organization. Drizzle with tahini.
Red peppers and edamame
Medjool dates with nut or nutless butter