During 2008, the Institute on Disability, the UNH Survey Center, the Bureau of Behavioral Health, and New Hampshire's 10 regional Community Mental Health Centers (CMHCs) collaborated on a unique project to learn consumer perspectives on the quality of mental health services received. The results from the survey provide the best statewide consumer perspective to date on the quality and effectiveness of New Hampshire's community mental health service system.
This research aims to better understand the ways that scientists explain child mental health and the dominant patterns in how the public thinks and talks about this concept. The research with both these groups is designed to reveal specific areas where the understanding of scientists and that of the general public are dissonant -- where gaps or holes between these two groups exist in thinking and understanding the topic of child mental health. These missing links then represent promising areas for reframing strategies designed to close the gap between the scientific knowledge and the public's understanding of the policy implications of this knowledge.
The Oral Health Education Program was created for Wentworth-Douglass Hospital's Seacoast Cancer Center and Wound Healing Institute. The publication includes surveys, patient data, oral health product recommendations, oral hygiene instructions and information for family dentists. As more and more patients were treated in the Dental Center, it became evident to the staff that many struggle with chronic or serious medical issues. In addition, WDH staff realized that patients undergoing specialty medical care were adversely impacted due to oral health issues.
This study aims to better understand what helps immigrant and refugee families from Latin America and Africa settle into their new life in New Hampshire. For those who struggle to adjust, experiencing some form of mental distress, we explore how this is expressed in their own cultural context and consider what kinds of services might be most appropriate for them.
The primary objective of this project is to create trauma informed systems within New Hampshire by strengthening awareness of treatment gaps, the intersection of resettlement, immigration, culture and trauma and making informed decisions about necessary next steps for better addressing traumatic stress among resettled refugee youth.
As many as 55,756 children, ages 5 – 19 have a diagnosable mental health disorder and almost 14,000 have a serious emotional disturbance. Most of these children are educated in the New Hampshire public school system. Understanding if, and how, public schools manage the behavioral health issues of their students is of obvious public policy significance.
Despite this policy significance, comprehensive information about the role of schools in mental health services in New Hampshire is not available. This work – combining surveys of both school districts and schools and interviews with community mental health centers across the state – is designed to be an initial assessment of how this system is administered and funded, the mental health conditions driving this system, the services that it provides, and the manner in which the system assesses its progress in ensuring the mental well being of its children.
Early Childhood Mental Health is the social/emotional well being of children aged birth to six years, and promotes the capacity to experience, manage and express emotions; develop and sustain stable relationships with others; safely explore the environment and learn; and demonstrate developmentally appropriate behavior. This study examines the availability, accessibility and quality of early childhood mental health supports and services for New Hampshire's youngest children and their families.
Emergency Department personnel deal not only with individuals requiring immediate and necessary medical care but also with preventable and non-emergent visits that may be managed by primary care providers. Not all ED-preventable visits are completely unavoidable. In some cases, even the best care can't prevent the progression of a health condition to a state that requires an ED visit and possibly hospitalization. This study looks at ED visits for chronic disease conditions. Of particular note is the increase in ED rates for dental conditions.
This report examines the condition of the direct-service workforce in children's behavioral settings in New Hampshire. Many programs are under significant stress due to the tightening fiscal climate and changes to state policy that increasingly favors intensive in-home services over residential treatment for children diagnosed with mental, emotional and behavioral problems.
Staff in residential agencies report that they are working long and erratic schedules, and that their programs are understaffed and under-resourced. Despite their generally high educational levels, direct-service workers are poorly paid and some benefits, such as tuition reimbursement, are eroding. Weaknesses in the workforce are expensive for agencies and can affect client care. Yet it is likely that they will grow more crippling in the near future, as residential treatment becomes a last resort reserved for the most challenging young people. This report recommends a series of supports to bolster the direct-service workforce, and urges agencies to use this transition in services to craft creative solutions to workforce problems.
The high cost of health insurance is a financial burden for small businesses. This brief outlines the results of a recent poll of NH small business owners, the majority of whom say they want and need health care reform.
The 2009 update to our popular healthcare policy tool, challenging the perception that NH is one of the healthiest states in the nation.
According to Executive Director Steve Norton, New Hampshire’s overall average dashboard score is 78.2%, which places the Granite State at twenty percent of the best ranked states. “New Hampshire’s dashboard score is helped considerably by favorable average score values on quality (98.6%). New Hampshire’s overall score is hindered by poorer score values on infrastructure (69.0%), access (72.9%) and cost (74.5%),” said Norton.
New Hampshire’s quality indicators demonstrate a high level of care. However, New Hampshire’s healthcare is expensive, causing New Hampshire to receive a less favorable score on that indicator.
As an example of the potential for healthcare cost reduction within the New Hampshire system, the Center used the Dashboard methodology to compare the Granite State to the top “low cost, high quality” states. The best states for low cost and high quality are South Dakota, Hawaii, Utah, Colorado, and Virginia.
“If New Hampshire had healthcare costs equivalent to the top ‘low cost, high quality’ states, New Hampshire healthcare costs, (currently about $10 billion per year), would shrink by $2 billion,” said Norton.
“These results should be a source of concern for policy makers, as they suggest that the state’s relatively high cost of healthcare and high quality care is not necessarily translating into a healthy population, or one with high access to care.,” according to Norton. “It is important to monitor the entire healthcare system in New Hampshire. The Dashboard provides an effective way of judging the progress New Hampshire is making in improving the health of our citizens.”
This report analyzes the six-year financial history and current financial condition of the ten community mental health centers currently serving close to 50,000 mental health clients in the State of New Hampshire. Medicaid payments account for approximately 75% of total revenue sources (including grants and contracts as well as patient service revenues) and roughly 85% of patient service revenue alone. Most centers do not have sufficient financial reserves to fund substantial operating losses. Future Medicaid cuts could result in a marked reduction in services, affecting more than 3,000 people.
This paper provides an overview of the currently available data on access to dental services and the availability of dental providers across the state. This report will also review, to the extent possible, the implications of workforce on those with Medicaid coverage and the uninsured and will raise questions regarding whether the current dental workforce providing care for this population is sufficient to meet the state’s needs.
An estimated 17 million low-income children in America go without dental care each year. This represents one out of every five children between the ages of 1 and 18 in the United States. Twice as many Americans lack dental insurance as lack health insurance. The $106 billion that Americans are expected to spend on dental care in 2010 includes many expensive treatments -- from fillings to root canals -- that could be mitigated or avoided altogether through earlier, cheaper and easier ways of ensuring adequate dental care for kids. States do not have to start from scratch. A number already have implemented effective approaches. Too many, however, have not. Pew's analysis shows that about two-thirds of states do not have key policies in place to ensure proper dental health access to care for children most in need.
More than one in ten New Hampshire households experience food insecurity, and there is considerable variation across the counties in the state. Food insecurity is significantly related to both household income and the distance a household must travel to shop for groceries. Limited access to quality, affordable groceries makes it hard for families to provide sufficient nutritious food, which has been linked to poor diet and obesity as well as greater risk for chronic disease, such as diabetes and heart disease. This mapping project and study bears out the national research and illustrates the dynamic of "food deserts" in New Hampshire as well as their impact on the health of our people.
A number of national studies have shown that exposure to violence in the home, as well as direct abuse of a child, has a detrimental effect on children, with a wide range of responses, including long-term effects on mental health. This project was designed to develop regional and local strategies to improve the mental health outcomes of children and their families who are exposed to violence in their homes, as well as to identify ways to strengthen the systems of care.
Five listening sessions were held around New Hampshire in early 2009 to hear testimony and discuss the Ten-Year Mental Health Plan. That plan has outlined the impacts of the broken system and the stress it is putting on local law enforcement, hospital emergency rooms, the court system and county jails. Most importantly, under-treated mental health conditions cause harm to NH citizens and their families.
Policy makers, families and providers were invited to attend the sessions which brought forth some very moving testimony that demonstrated a need for a long-term commitment to improve and restore the mental health system in the state.
New Hampshire is the second healthiest state in the nation but not every documented group meets national guidelines for good health. The collection of accurate data to measure health status by race, ethnicity and language will help support health equity in New Hampshire.
This report contains a description of the prevalence of co-occurring disorders among young Granite Staters, as well as the challenges facing them and their families, including barriers to accessing integrated, appropriate treatment and support. Drawing upon existing expertise in New Hampshire, the Project Advisory Group convened a Scientific Advisory Board comprised of leaders in the mental health, primary care and substance abuse treatment fields to make specific recommendations for implementing consistent, integrated treatment throughout the state.
In this MessageMemo, Frameworks Institute reports the findings from a series of studies that set out to: (1) document the cultural models available to ordinary people when they think about children's mental health, (2) observe these models in action as small groups of people negotiate conversations about child mental health, (3) identify the major challenges for communicating about these issues, and (4) develop, refine and test frame elements -- specifically, values and simplifying models -- that might deepen understanding of the core tenets of the science of child mental health, and evoke a more productive public discussion.
By the year 2020, New Hampshire’s shift towards an increasingly older population will reach a peak. And by 2030, nearly half a million Granite Staters will be over the age of 65, representing almost one-third of the population. This trend will influence nearly every critical policy debate, perhaps none more so than health care. Released today, the Center’s latest report, “New Hampshire’s Silver Tsunami,” analyzes the potential impacts of this demographic shift on the state’s health care systems.
According to the report’s findings, the move towards an older population in New Hampshire will:
reshape the state’s private insurance market
force a reassessment of the public long-term-care system
put increased pressure on the state’s health care providers
exacerbate existing problems in recruiting and retaining a health care workforce.
New Hampshire's future depends, in part, on the size, composition, and distribution of its population. This report provides insights into the patterns of demographic change under way in the state using the latest data available. For New Hampshire to continue to grow and prosper, policymakers, businesses, and nonprofits must be aware of these demographic trends as they consider the future needs of its people, institutions, and organizations.
The Basic Health Program (BHP) is often described as providing an affordability bridge between public and private insurance coverage. The BHP allows states to offer eligible individuals lower premium and cost sharing than what would be required in the Exchange. This has the potential to increase participation and reduce the number of uninsured residents.
The cost of personal health care is rising in New Hampshire. In the Granite State, personal health care, which includes visits to doctors, hospitalizations, medicine, and so on, consumes 18 percent of our economy, or 18 cents of every dollar. In 2007, that amounted to $10.6 billion. Twenty years ago, spending on personal health care was less than 10 percent of New Hampshire's economy. Twenty years from now, health care spending is projected to reach nearly 22 to 25 percent of economic activity.
Perhaps most striking in this analysis is the degree to which healthcare plays an even larger role in the economic landscape in New Hampshire. Hospitals are often the single largest employer in the labor market areas across New Hampshire. More generally, the health and social services industries account for a significant share of economic activity -- as measured by wages -- particularly in rural areas of the state.
This paper is one of a series of reports commissioned to inform policy-makers about the status of mental health in New Hampshire. This analysis is designed to answer basic questions about the mental health status of New Hampshire’s children through an assessment of mental health prevalence estimates and an analysis of service use in the public Medicaid and privately insurance systems.
In an environment in which the public payers – which account for almost 50 percent of health care expenditures – pay less than the costs of services and some of the uninsured are provided services through hospital-based charitable care, the hospital industry has to find ways to support patient care services. One way of financing these deficits has been through allocation of unrecovered costs of one patient population to above-cost revenue collected from other patient populations – largely the privately insured. This phenomenon is called ‘cost-shifting.’ Hospitals also generate positive operating margins. Operating margins are the share of revenues for patient care services that exceed expenses for providing that care.
The 2003 New Hampshire Health Insurance Survey was conducted by the University of New Hampshire Survey Center in September 2003. The survey was sponsored by the New Hampshire Endowment for Health and the HNHfoundation.
The main purposes for the survey included:
To estimate incidence of health insurance and uninsurance in New Hampshire;
To understand who is uninsured and why, and;
To determine the attitudes of New Hampshire residents toward reform of the health insurance system in the state.
In order to better understand New Hampshire nursing home residents' access to dental services, the Endowment for Health provided a grant to develop and administer a survey of state nursing homes. The purpose of the survey was to gather information for nursing home administrators about dental services provided to nursing home residents and how these needs may be better met in the future.
According to the 1999 U.S. Surgeon General report, one in five children has a diagnosable mental health disorder, and the vast majority of these youth – even those with the most severe impairments – receive no or inappropriate care. In New Hampshire, mental health practitioners have pointed to a shortage of providers, particularly child psychiatrists, as a primary cause of these unmet needs. These practitioners have described long waiting lists for appointments and the need for children living in rural areas to travel long distances for treatment. This paper provides an overview of the currently available data on mental health providers across the state.
Data on mental health service use is critical to understanding the system of mental health care for children. In addition, such data can provide a baseline against which policymakers can assess access to mental health services in light of prevalence estimates or future policy interventions designed to increase access to mental health services. This analysis assesses private insurance claims data, Medicaid data, and data on care provided to those without insurance from hospital discharge data and from the community mental health system. This report is one of a series of reports commissioned to inform policy-makers about the status of mental health in New Hampshire. This analysis is designed to answer basic questions about the mental health service system by analyzing the services that are being provided to those with mental illnesses.
As part of ongoing efforts to assess our work and inform strategic and operational planning, the Endowment for Health periodically solicits feedback from a variety of stakeholders. In Spring 2007, the Endowment contracted with Louis Karno & Company Communications to conduct a study to gauge knowledge of the Endowment and its work amongst opinion leaders. The study was also aimed at understanding perceptions about the foundation's effectiveness and credibility, as well as organizational strengths and weaknesses. This document is a summary of the survey findings and how we are using them.
This paper introduces the findings of a new healthcare dashboard designed to assess different aspects of the performance of the healthcare system in New Hampshire. In collaboration with a workgroup of participants in the Citizen's Health Initiative, the Center developed a set of indicators designed to assess and monitor key dimensions of the healthcare system in New Hampshire. The key dimensions are cost, the healthcare infrastructure, access to services, the quality of care and the public's money.
A growing segment of New Hampshire's population lacks health insurance. Using 2001 as its benchmark of 100.0, in the third quarter of 2007, the Center's "Index of the Population Lacking Health Insurance" registered 117.7. This means the number of uninsured persons in New Hampshire has potentially risen above 130,000.
This report is part of an investigation designed to inform the current knowledge base regarding evidence-based practices (EBPs) both nationally and in NH, the current status of EBP implementation in the state, and areas policy makers might consider as it supports improvements in access to EBPs in mental health services for New Hampshire children and adolescents. National literature on best practices and interviews with national and regional mental health experts serve as the basis for this report.
The NH Center for Public Policy Studies has been conducting research under grants from the Endowment for Health. This research focuses on public polices and private practices that affect the cost of health care, where it is provided, who gets it, and who pays for it. The ultimate goal of the project is to identify policies and practices that would maintain or enhance every resident’s ability to obtain quality health care at a reasonable price.