Health Affairs, 22, no. 5 (2003): 235-240 doi: 10.1377/hlthaff.22.5.235 © 2003 by Project HOPE	New Online   How Would Obama, McCain Cover The Uninsured?   Debating Cost Of Uninsured   Try Medicare-For-All   HA Blog Top 10

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Grantwatch

Grants & Grant Outcomes

Top Grants Grant Outcomes

$600,000 for six one-year planning grants and $900,000 for one three-year implementation grant. Funded equally by the California Endowment and the California HealthCare Foundation (CHCF).

Mental Health Care National Alliance for the Mentally Ill of New York City (NAMI-NYC Metro). This funding supports the Parity Project, which aims to achieve "equality of benefits in private health insurance" coverage for mental and physical conditions, in New York State, according to NAMI-NYC Metro’s proposal to the van Ameringen Foundation, submitted in 2002. The grantee stated that lack of parity "most directly affects working people" and their families who "receive some form of health insurance through their employers." The grantee contends, "To the degree that parity keeps working people productive and on the job, reducing absenteeism and disability [costs], large private employers can benefit..., with the increase in productivity more than making up for the small rise" in the cost of mental health coverage. Project activities include strengthening and enlarging a parity coalition; developing public relations materials supporting parity; participating in "campaigns for parity legislation at the state and federal levels"; and conducting a campaign for "voluntary parity" among New York City employers.

$120,000 over two years. Funded by the New York Community Trust.

$100,000 over two years. Funded by the van Ameringen Foundation, which funds in the New York City and Philadelphia metropolitan areas only.

United Hospital Fund, New York, NY. In this planning and research project, the grantee is zeroing in on the problem of depression in elderly people who receive home care services in New York City and is identifying opportunities, impediments, and possible solutions for remedying it. Project activities will include reviewing "government and private insurance policies that control reimbursement for mental health services to home care patients" and also surveying home care agencies and patients in New York City, according to the New York Community Trust’s newsletter. Researchers, directed by Alene Hokenstad, then "will describe the current capacity to provide mental health services" and the effect of reimbursement policies and other regulations on service provision. An advisory panel—including representatives from associations and city government agencies, as well as "researchers and clinical experts in geriatric mental health"—is working closely with the project, said the grantee’s Web site. The fund plans to release a working paper on depression and elderly home care recipients in early 2004.

$70,000 over ten months. Funded by the New York Community Trust.

University of Massachusetts Medical Center, Worcester, MA. This funding supports the Massachusetts Mental Health Diversion Program, which seeks "to divert mentally ill offenders who commit non-serious crimes [from] the criminal justice system" to a "model Crisis Triage Unit," according to Boston Foundation materials. The unit will probably be at or near a hospital emergency department in Boston. Overseen by a public-private coalition with representatives from such entities as the state mental health and public health departments, Boston Medical Center’s HealthNet plan, and NAMI’s Massachusetts affiliate, this pilot project will have a "treatment protocol" that will address the person’s mental illness as well as "co-occurring problems of addictions and homelessness." The project is providing "local police with training in de-escalating crisis situations and transporting individuals to treatment sites." Anticipated outcomes include getting "appropriate treatment" for these "minor criminal offenders" who are mentally ill. Intake and treatment "will be modeled on a ‘no wrong door’ strategy" now being used in Seattle. In this way, the Crisis Triage Unit "will not turn away mentally ill persons because they have other problems," such as being intoxicated or homeless, project director Maurice Richardson, a retired Massachusetts trial judge (now on the medical school faculty), told Health Affairs. In recent years the Clipper Ship, Eastern Charitable, Gardiner Howland Shaw, John H. and H. Naomi Tomfohrde, and Arthur Ashley Williams Foundations; the George Harrington Trust; the George H. and Jane A. Mifflin Memorial Fund; the Greater Boston Council on Alcoholism; and Eli Lilly and Company have provided funding for the project, he said.

$40,000 over one year. Funded by the Boston Foundation.

University of North Carolina at Chapel Hill, School of Medicine. "The issue of decisional capacity" (being able to provide consent) for human research participation "is a critical one for the future of psychiatric research," especially when studies go on for months or even years, according to Greenwall Foundation materials. In such instances, "investigators may be uncertain how to deal with subjects who are competent at the time they agree to enter a study but whose competence may fluctuate or disappear as the study proceeds." This grant funds an evaluation of the use of "subject advocates" in schizophrenia research. The ethics committee of the National Institute of Mental Health (NIMH)–funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), a schizophrenia research project, developed this concept. In CATIE each research subject chooses a subject advocate, who is involved in the initial discussion about consent and helps with decision making if the subject’s ability to make decisions lapses. Greenwall, which funds only in bioethics and arts and humanities, noted that "schizophrenia research has been a particular focus of ethical concern." This project will use "a combination of qualitative and quantitative methods" to determine how using subject advocates "affects the autonomy of subjects and the conduct of the trial," Scott Stroup, principal investigator, told Health Affairs.

$99,422 over two years. Funded by the Greenwall Foundation.

University of Virginia Law School, Charlottesville, VA. This continuing funding supports the multidisciplinary Research Network on Mandated Community Treatment. "Mandated treatment," a controversial issue, means the various ways that "people with serious mental illness are compelled or induced to participate in treatment while they are living in the community," according to a John D. and Catherine T. MacArthur Foundation press release. "There is considerable debate about the rights of individuals to refuse treatment and how to require some people with specific mental disorders to follow a treatment plan." Different types of leverage (such as benefits, subsidized housing, or "favorable disposition" of a court case in which a person with a mental illness is the defendant) are used "to assure treatment adherence in the community," said a network fact sheet. Staff, directed by John Monahan, are researching how often different types of leverage are used, how applying leverage works, and "what the outcomes of leveraged treatment are—for the individual, for the mental health system, and for society." To inform policy, an "evidence-based approach" must be used, the network said. Participants in the network, which is concerned with "all forms of mandated treatment," include lawyers, psychiatrists, psychologists, and sociologists. MacArthur, which in 2003 is celebrating twenty-five years of grant making, supports several research networks in mental health.

$3.9 million over three years. Funded by the John D. and Catherine T. MacArthur Foundation.

Minority Health Care RAND, Santa Monica, CA. This funding is for an evaluation of the Robert Wood Johnson Foundation’s (RWJF’s) national program, Hablamos Juntos: Improving Patient-Provider Communication for Latinos. According to its Web site, this multisite program, based at the Tomás Rivera Policy Institute at Claremont Graduate University, aims "to help improve access to quality health care for Latinos with limited English" through use of medical interpreting and a variety of other interventions. The program’s approach includes developing "cost-effective and accurate" interpretation technologies and advancing "an understanding of the business implications of medical interpreter services." The evaluation will provide "interim feedback" containing "sufficiently detailed descriptions" of interventions used and costs incurred and will assess the program’s outcomes for Latino patients, according to RWJF materials. The data collected will help "to address the important policy questions regarding the delivery of cost-effective interpreter/translation services." RAND evaluators will prepare case studies and a cost analysis and conduct focus groups and telephone surveys of both patients and providers at each site—before each project starts and after the projects’ interventions have been implemented, Yolanda Partida, program director, explained to Health Affairs.

$2,049,980 over forty months. Funded by the Robert Wood Johnson Foundation.

University of South Carolina (USC), Arnold School of Public Health, Columbia, SC. This grant "is designed to reduce health disparities among African Americans" and other minority groups, according to a USC press release. USC is collaborating with South Carolina’s historically black colleges and universities in two ways. The first is by getting faculty to team up to conduct research on health disparities. The second is by trying "to increase the number of minorities entering public health fields"; the initiative includes programs to get academically gifted high school students into the pipeline, as well as financial aid and "research opportunities for undergraduate and graduate students." Saundra Glover, project director, told Health Affairs that another aim of the initiative is to train faculty at the various institutions in "community-based research methods and cultural competence." African Americans in the state "have a disproportionate share" of such health problems as stroke, heart disease, diabetes, HIV/AIDS, and prostate cancer, USC President Andrew Sorensen (a former director of the University of Massachusetts–Amherst’s public health school) said in the release. This effort "could become a model for the rest of the nation," he added.

$2.75 million over five years. Funded by the W.K. Kellogg Foundation.

Grant Outcomes

Top Grants Grant Outcomes

 
Mental health was among the indicators discussed in several sessions at Grantmakers In Health’s (GIH’s) annual meeting, entitled "The Nation’s Leading Health Indicators: Measuring Progress, Taking Action," held in February 2003 in Los Angeles. At one session, "Mental Health Grantmaking in a Multicultural Context," panelists Soo-Jin Yoon of the Colorado Trust, which is funding the $7.4 million Supporting Immigrant and Refugee Families Initiative, and Karen Linkins of the Lewin Group, which is evaluating the California Endowment’s forty-six-grantee mental health initiative, mentioned the problem of stigma surrounding mental health in multicultural communities. Linkins said that the endowment’s initiative had to develop strategies to overcome stigma, such as using the term "emotional support," instead of "mental health."

Another session, chaired by Laurie Garduque of the MacArthur Foundation, was on "Integrating Mental Health Services and Primary Care." Allen Dietrich of Dartmouth Medical School, director of a MacArthur initiative on depression and primary care, noted that major depression is a "big, big problem" in the United States, and primary care is important because that is the "common point of access" to care. In response to a comment from the audience about some insurers who "are good at getting out of paying" for mental health services, Connie Pechura of the RWJF said that the case needs to be made "about value—what it costs them to not treat" people. Garduque said that MacArthur is trying to create an evidence base on the value of mental health care—to show, for example, how it improves patients’ productivity. She remarked that state mental health departments’ budgets are being "slashed," so "it’s time [for foundations] to collaborate."

For more information, call Donna Langill at GIH at 202-452-8331.

Project IMPACT (Improving Mood—Promoting Access to Collaborative Treatment for late-life depression) is featured in the John A. Hartford Foundation’s 2002 Annual Report released in June 2003. Hartford is the lead funder; the CHCF, however, also made a substantial contribution. In addition, the RWJF and the Hogg Foundation for Mental Health supported various aspects of the project. In this "groundbreaking team model" for treating depression in the elderly, nurses or psychologists collaborated with primary care doctors and psychiatrists, Hartford board chairman Norman Volk explained in the report. Preliminary outcomes of IMPACT, a seven-site, randomized controlled trial, were originally published in the Journal of the American Medical Association. They showed that after a year, "about half" of patients using the IMPACT model had "a 50 percent or more reduction in depression symptoms, compared with 19 percent of those in ‘usual care,’" the annual report said. Also, "IMPACT is now a nationally recommended" Kaiser Permanente care model. "The project is comparing costs of patient care under IMPACT with ‘usual care’ costs, to see if better depression care lowers" overall health care costs, and a report on this topic is planned for a late 2003 release. It is hard to measure all of the economic outcomes, though, one site director said. Other people, including Jürgen Unützer, who directs IMPACT’s coordinating center at the University of California, Los Angeles, said in the report that they find it regrettable that the health care community wants mental health interventions to "save money" when "traditional medical" treatments are not held to the same standard. Elizabeth Lin, a primary care physician at Group Health Cooperative of Puget Sound and a "pioneer" in this field, called Hartford "visionary." She said, "Without these clinical trials to provide scientific evidence, we can’t change policy and... move the whole field forward."

Volk also noted in the annual report that "Hartford’s financial well-being was adversely affected by the bursting of the Internet bubble, followed by a series of corporate scandals and international events." The amount of its assets declined in 2002, so it "is reluctantly reducing its near-term grantmaking in order to maximize its future contribution to the aging field."

For details, see the annual report, available on Hartford’s Web site, www.jhartfound.org.

Publications Access to HIV Prevention: Closing the Gap was released in May 2003 by the Global HIV Prevention Working Group, which was convened by the Bill and Melinda Gates Foundation and the Henry J. Kaiser Family Foundation in 2002. There is a large gap between current "annual global spending on prevention" for low- and middle-income nations and "what will be needed" in future years, a press release explained. "Globally, fewer than one in five people have access to basic HIV prevention programs," the report, citing research published in Science, states. However, most of the "new HIV infections that are projected to occur between now and 2010 could be averted, if proven prevention strategies, used in combination, are dramatically scaled up," the report says, citing previous research, by a team led by UNAIDS and the World Health Organization, that was published in Lancet. The report identifies prevention priorities by world region. The working group estimates that foundations and nongovernmental organizations awarded $160 million in 2002 for HIV prevention efforts in low- and middle-income countries. The group recommends that global spending on prevention "from all sources...increase three-fold by 2005 to $5.7 billion," though, and that international aid and policy reforms "address the social and economic conditions that increase vulnerability to, and facilitate the rapid spread of, HIV/AIDS." Other report recommendations include focusing "on bringing to scale cost-effective, high-impact interventions" and integrating prevention and treatment efforts—so that, for example, those receiving treatment are able to avoid infecting others.

The report is available online at www.gatesfoundation.org/GlobalHealth/HIVAIDSTB.

Can’t Make the Grade: NMHA State Mental Health Assessment Project, an information-laden report released in May 2003 by the National Mental Health Association (NMHA), provides the "first detailed grading of key mental health services" in all states plus Washington, D.C., said a press release. The advocacy group warns, "Without dramatic changes, states will continue to pay for the underfunding of badly needed mental health services in the form of emergency room visits, criminal justice costs," and increased inpatient care. The report suggests three "state mental health priorities": parity, protections from managed care, and access to psychiatric drugs by Medicaid beneficiaries. Funded through the W.K. Kellogg Foundation’s Community Voices Initiative, the report—accurate as of August 2002—is aimed at advocates, consumers, the media, patients’ families, and policy-makers. Replete with tables of state rankings, the report also mentions "additional key issues," such as "decreasing the number of people with mental illnesses in the justice system" (for example, by using prebooking diversion programs for nonviolent offenders), that should be discussed with policymakers and others. Because states’ Medicaid policies on access to mental health drugs change frequently and the report’s discussion is only accurate as of October 2002, the NMHA has produced a Web-only update on this topic.

For a copy of the report, go to www.nmha.org/bookstore/freeDownloads.cfm or call 800-969-6642. The update on medications is at www.nmha.org/cantmakethegrade/accessUpdate.cfm.

The Mental Health Workforce: Who’s Meeting California’s Needs? says that "from 2001 to 2010, overall demand for mental and behavioral health care workers" in the state "can be expected to grow" by 16–30 percent. The report was released by the California Workforce Initiative of the University of California, San Francisco, Center for the Health Professions; the CHCF and the California Endowment fund the initiative. Marriage and family therapists constitute 37 percent of the state’s mental health workforce. Noting that "California is one of only four states that licenses psychiatric technicians," the report adds that people in this lesser-known job category—one of the allied health professions—are heavily used in "state hospitals and correctional institutions and their employment is rising" in those sites, and they are supervised by psychologists, nurses, or physicians. Among the report’s conclusions are that a "disconnect" seems to exist between the various mental health services offered in the state and the "needs of a population that is both culturally diverse and aging." One of the report’s recommendations is that the state legislature and "regulatory boards should reduce barriers that limit the development of a culturally competent and talented" mental and behavioral health workforce—specifically, "reciprocity processes" that "keep qualified practitioners from other states from practicing in California" should be improved.

The February 2003 report is on the center’s Web site, www.futurehealth.ucsf.edu/publications/index.html.

Resolving the Medical Malpractice Crisis: Fairness Considerations was released in June 2003 by the Project on Medical Liability in Pennsylvania, which is funded by the Pew Charitable Trusts. Author Maxwell Mehlman, who directs the Law-Medicine Center at Case Western Reserve University’s law school, writes that "fairness matters" because "if changes to the malpractice system are viewed as fair, they are more likely to be enacted and retained." In a malpractice system, the most important thing is "fairness to patients and potential patients," he says, while acknowledging that physicians must also be treated fairly. After defining the "core components" of fairness, Mehlman concludes that the existing malpractice system "performs poorly on many benchmarks" of the two components (substantive and procedural fairness). For instance, the system "imposes its costs disproportionately on providers of high-risk care and their patients." In his conclusion, he remarks on a trade-off—a real Hobson’s choice—when resources are not unlimited: "At some point, even severely injured patients would lose more by being denied access to health care than by not being fairly compensated for their injuries." Mehlman also questions whether we should look at reforming "the tort system generally," not just the medical malpractice system.

For a copy of this ninety-nine-page report, go to medliabilitypa.org/research/mehlman0603.

Key Personnel Changes The Community Health Foundation of Western and Central New York, located in Buffalo, has named Ann Monroe to be its first president. Created in late 2001, the foundation has not yet begun grant making. Monroe formerly directed the CHCF’s Quality Initiative.

The Kansas Health Foundation’s vice-president of communications, Tami Bradley, has resigned to start a Wichita-based business, Bradley Consulting, "to provide strategic communications and social marketing services to foundations, non-profits and businesses," she wrote in an e-mail message.

The David and Lucile Packard Foundation announced that Richard Schlosberg III, president and chief executive officer, will retire as of January 2004. Upon relinquishing the helm he plans to "pursue his other civic interests, travel, spend time with his family," and help with the leadership transition at Packard, according to a press release.

The Rhode Island Foundation elected Pablo Rodriguez chairman of the board. Associate chief of obstetrics and gynecology at Women and Infants Hospital in Providence and medical director of Planned Parenthood of Rhode Island, he "was actively involved in the drafting of the legislation that created RIte Care" (the state’s Medicaid managed care program), according to a foundation press release.

The Rockefeller Foundation announced that Fernando Henrique Cardoso, a former president of Brazil, was one of two new appointees to its board. Cardoso served two terms as president, and his presidential legacy includes an initiative to "reform [Brazil’s] national health care system," according to a Rockefeller press release.

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