EVIDENCE BASE IN DESIGN

When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.

In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

· Milstead, J. A., & Short, N. M. (2019). 
Health policy and politics: A nurse's guide (6th ed.). Jones & Bartlett Learning.

· Chapter 5, “Public Policy Design” (pp. 87–95 only)

· Chapter 8, “The Impact of EHRs, Big Data, and Evidence-Informed Practice” (pp. 137–146)

· Chapter 9, “Interprofessional Practice” (pp. 152–160 only)

· Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 183–191 only)

· American Nurses Association (ANA). (n.d.). 


Advocacy

Links to an external site.
. Retrieved September 20, 2018, from https://www.nursingworld.org/practice-policy/advocacy/

· Centers for Disease Control and Prevention (CDC). (n.d.). 


Step by step: Evaluating violence and injury prevention policies: Brief 4: Evaluating policy implementation

Links to an external site.
. Retrieved from https://www.cdc.gov/injury/pdfs/policy/Brief%204-a.pdf

·

Congress.govLinks to an external site.
. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/

· Klein, K. J., & Sorra, J. S. (1996). 

The challenge of innovation implementationLinks to an external site.
. 
Academy of Management Review, 21(4), 1055–1080.

· Sacristán, J., & Dilla, T. D. (2015). 

No big data without small data: Learning health care systems begin and end with the individual patientLinks to an external site.
. 
Journal of Evaluation in Clinical Practice, 21(6), 1014–1017.

· Tummers, L., & Bekkers, V. (2014). 

Policy implementation, street level bureaucracy, and the importance of discretionLinks to an external site.
. 
Public Management Review, 16(4), 527–547.

To Prepare:

· Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.

· Review the health policy you identified and reflect on the background and development of this health policy.

BY DAY 3 OF WEEK 7

Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Which social determinant most affects this policy? Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.

BY DAY 6 OF WEEK 7

Respond to at least 
two of your colleagues
* on two different days by either supporting or respectfully challenging their explanation on whether there is an evidence base to support the proposed health policy they described.

PEER REVIEW

#1 Briana – WEEK 7 DISCUSSION MAIN POST

H.R. 1712 – Rural Health Innovation Act of 2023

     Emergency medical services in the rural community setting can be challenging. Along with the area being large and sparsely populated in some places, there may also be difficult terrain, and the providers may need to travel further to transport the patient to the hospital (Rural Health Information Hub, 2022). This bill would provide two grant programs to help increase access to emergency care in these rural areas (CRH, 2023). The first grant funds federally qualified healthcare centers in these areas, including urgent care, triage, and other services (CRH, 2023). The second grant would also increase funding for rural emergency services, but this grant provides funding to health departments (CRH, 2023). There has been a long-standing history of the need to increase emergency services to rural areas, and slowly, we are working to provide these services. Telehealth has also impacted this in that it allows easier access to services in these rural areas; however, emergency care still needs to be improved.

     Social determinants of healthcare should always be considered whenever a new law or policy is being developed. The social determinant of healthcare that is the most addressed by this bill would be access to affordable, quality healthcare (World Health Organization, 2023). Some rural areas are undereducated, and residents may live in poverty, causing them not to seek out regular healthcare services. It is commonly seen that those with lower socioeconomic statuses are more at risk for poor health (World Health Organization, 2023). Expanding emergency services would allow these residents to at least be cared for in urgent need. Increased funding would improve the accessibility of healthcare and its support services. Increasing services in these areas would improve the population health of these areas now and in the future.

References

CRS. (2023). H.R.1712 – Rural Health Innovation Act of 2023. Congress.gov; Library of Congress. 
https://www.congress.gov/bill/118th-congress/house-bill/1712?q=%7B%22search%22%3A%22health+policy%22%7D&s=1&r=31
Links to an external site.

Rural Health Information Hub. (2022). Rural Emergency Medical Services (EMS) and Trauma Introduction – Rural Health Information Hub. Ruralhealthinfo.org; U.S. Department of Health and Human Services. 
https://www.ruralhealthinfo.org/topics/emergency-medical-services
Links to an external site.

World Health Organization. (2023). Social determinants of health. World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

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#2 ANDERSON /Discussion- Week 7

H.Res.434

The H. Res.434-Declaring a mental health crisis among youth in the United States, and expressing the pressing need for historic investments in mental health care for students was authored by Democrat Seth Moulton, District 6 114th-118th, Massachusetts. It was introduced on the house on 5/22/23; the bill focus on the mental health crisis affecting youth in the United States; it acknowledges that the Covid-19 pandemic has exacerbated depression with an increase of 30% in emergency room admissions from adolescents, the World Health Association cites suicide as the fourth leading cause of death between ages 15-19, The National Institutes of Health states that low-income population, and those living in rural areas are by far the most affected, state mental health resources are scarce or its funds are mismanaged (Congress.gov, 2023).

To alleviate the ongoing crisis, the bill proposes to: increase mental health training of school educators, invest robust funding toward on-campus mental health resources, preserve the continuity of mental health treatment to lower-income students despite of their legal status in the country, recognize that physical health and mental health are intertwined, educate the public on mental health disorders to reduce its stigma, develop a highly efficient method to contact high-risk and isolated population to support children/adolescent suffering from mental health disorders, curb prejudice and discrimination in schools towards students diagnosed with mental health disorders, and to regularly screen incarcerated juveniles whose mental health issues are often times overlooked (Congress.gov, 2023).

Social Determinants  

There are two main social determinants linked to the mental health crisis among children; the covid-19 pandemic and the “digital depression”.  The pandemic altered the lives of children all over the world. In the United States, it has forced school shut-downs as classroom attendance became remotely driven leading children to feel more isolated due to loss of physical/emotional contact with their schoolmates. Lower-income children/adolescents were the most affected by the pandemic because some of their parents have lost their jobs and struggled to make ends meet. The isolation caused decrease in physical activity and an overwhelming increase in social media screen time. When in-person classes resumed, school districts were made aware that the pandemic had increased depression among their students; however schools firmly believed that discussing mental health issues with students equated to putting “ideas” into their heads (Ayer & Colpe, 2022) also, school districts were already overwhelmed with other issues such as food insecurities, student housing instability, and teachers burnout. Studies show that 72% of children/adolescents did not receive mental health treatment and that schools did not initiate depression screenings as a way to curb teen suicide. School teachers spend long hours with their students, they are likely to best recognize signs of depression and other mental health disorders affecting their students with the assist of a school nurse. The federal government added $122 billion in school programs which part of that fund had been allocated to suicide prevention (Ayer & Colpe, 2022) therefore 72% of children not having had received mental health screening/care raise alarming questions whether or not schools are well-equipped and safe to mentally afflicted  students; another obstacle is that 77% of parents did not report suicide ideation or other ongoing mental health ailments to the school possibly fearing that their children would be treated poorly, “downgraded ” to special ED, or be bullied by their classmates. In addition to parental overlook, there is limited mental health training in the school system particularly to provide support to gay and nonbinary/trans students who are more victimized and harassed by their classmates.

The second social determinant it is digitalization. The average time adolescents spend on social media averages nine hours daily. The pandemic inevitably led children to spend more time using smart phone and computers in lieu of physical activity and healthier socialization with other children. It is likely that during the pandemic, their parents began to dedicate more time to social media by simply working from home; parenting style has also “softened” as younger parents are less restrictive to their children screen time. Although social media was not created to harm children (Ghaemi, 2020) it does impact their mental health negatively because children/adolescents often go to sleep with their phones on causing day-time anxiety/mood disorders secondary to sleep deprivation; adolescents have partially developed brain maturation, particularly on the frontal lobe; therefore they are at higher risk to engage in dangerous sexual behavior/encounters, participate in peer-pressured bullying towards their schoolmates, pick up unsafe habits such as e-smoking, and take part in substance abuse. Cyber bullying has grown with its hate speech nuances causing targeted teenagers to become depressed, anxious and/or die of suicide.

Evidence-based support

Prevention is the key to manage depression and suicide among children and adolescents. Depression is still underreported  and under diagnosed in children (Patra & Kumar, 2022), suicide deaths have surpassed automobile accident deaths, and one in ten adolescents in high school have verbalized suicide ideation. Pediatricians are still reluctant to screen/treat children who present symptoms of mental health disorders fearing that they might over diagnose their clients based on false-positive screening scores; however there is more benefit in identifying and initiating treatment rather than ignoring the issue. There are multiple assessment tools available nowadays that use questionaries, parent interviews or child-self-report tools; providers who may not feel confident about treating these children should make a referral to a qualified mental health provider because early identification is key to prevent teen suicide.

Also, healthcare providers should not focus on making the ” right” diagnosis because in depression the mood is always ” negative” followed by visible signs and symptoms such as feelings of sadness, isolation, decrease in physical activity, poor eyes contact, lack of energy, and poor academic performance. Some providers also believe that discussing mental health issues with children could lead them to embrace these ideas which is a misconception because there are more benefits than risks to obtaining early detection and treatment. The main downfall is parental denial of children's poor mental health due to strict religious views on pharmacological treatments ( scientologists for example do not believe in prescription drugs) or the fear that their children will be perceived differently and be mistreated. The National Suicide Prevention warns that depression and suicide ideation should be taken seriously (Patra & Kumar, 2022) as there are multiple resources available today to prevent this ill fate among youth; healthcare providers who feel uncomfortable treating these disorders should make swift referrals, and school bodies should immediately utilize the money allocated to them to kick off school-based screening programs. 

When digitalization issues are concerned, it is vital that parents become more vigilant and monitor their children online activities closer. Given the availability of smart phones facilitated through texting and chatting, teenagers have gained easier access to sex, drugs, and pornography (Ghaemi, 2020). The goal is not to ban social media from children and adolescents; the recommendations are straightforward to follow: delay screen time to younger children, remove smart phones from the bedroom to promote sleep hygiene, limit screen time to one hour daily to mildly depressive children, and restrict social media altogether to severely depressive children presenting suicide thoughts (Ghaemi, 2020).

Current treatment options to depression are SSRI antidepressants, counseling and psychotherapy accompanied by diet and exercise. The most important content of H.Res.434 is educating parents, school bodies, and healthcare providers about recognizing  mental health disorders among children particularly to those living in rural areas where resources are oftentimes scarce. Also, it is important to work with low-income families who may not see mental health as a priority over housing and food. 

    

References

Ayer, L., & Colpe, L. J. (2022). The Key Role of Schools in Youth Suicide Prevention. 
Journal of the American Academy of Child & Adolescent Psychiatry, 
62(1). 
https://doi.org/10.1016/j.jaac.2022.06.022
Links to an external site.

Congress.gov. (2023). 
Congress.gov | Library of Congress. Congress.gov. 
https://www.congress.gov/
Links to an external site.

Ghaemi, S. N. (2020). Digital depression: a new disease of the millennium? 
Acta Psychiatrica Scandinavica, 
141(4), 356–361. 
https://doi.org/10.1111/acps.13151
Links to an external site.

Patra, K. P., & Kumar, R. (2022). 
Screening For Depression and Suicide in Children. PubMed; StatPearls Publishing. 
https://www.ncbi.nlm.nih.gov/books/NBK576416/
Links to an external site.

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