Caring for immigrant women. Physicians' roles range from detective work to advocacy.
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Biomedical subjects
Publications and source records attributed to S L Ivey.
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The authors examine recent trends in the supply and earnings of various mental health providers from 1989 to 1995. The makeup of the mental health workforce is fundamentally different now than a decade ago. The number and earnings of psychiatrists have been relatively flat. The number of psychologists increased by 24%, with their earnings rising rapidly in the 1980s, and remaining level since 1990. The number of clinically trained social workers increased by 87% over the same period, and the number of advanced practice nurses certified in mental health specialties almost doubled, with the earnings of these master's-level providers increasing steadily over the period described. These trends are discussed in the context of major changes in the financing and delivery of mental health care.
The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.
This paper examines temporal changes in staffing ratios and configuration of mental health providers per 100,000 members within two full-service staff-model health maintenance organizations (HMOs). Overall workforce reductions in all classes of mental health professionals occurred in the two HMOs from 1992 to 1995. Staffing ratios decreased in both HMOs for psychiatrists and psychologists. In one HMO, the ratio of clinical social workers also decreased over this period. Provider ratios from 1995 are benchmarked against state ratios per 100,000 population. Workforce mix for the two HMOs is contrasted with a single-year average for a large managed behavioral health (carve-out) organization. The authors discuss potential implications of the findings for training of several categories of mental health professionals.
This article discusses the Personal Responsibility and Work Opportunity Reconciliation Act and the Illegal Immigration Reform and Immigrant Responsibility Act and their potential impact on immigrant women's access to medical services. Current federal mandates assuring access to emergency medical services and new restrictions on financing of health care under federal programs such as Medicaid and Medicare would appear to be on a collision course. Both acts specifically reaffirm federal law on delivery of emergency services without addressing the financing of that care. Unfunded mandates in an era of diminished ability to shift costs onto insured patients are problematic for the institutions that provide uncompensated care. Specific protections for victims of domestic violence are also discussed.
The authors describe a continuum of collaborative interdisciplinary professional practice which can be used for teaching students in health care settings. Choices about the nature of interdisciplinary practice can be made not only on the imperatives of patient care but also on the interpersonal characteristics of health care providers as well as their needs for professional autonomy. This model can enable students to make clear career decisions about the types of interdisciplinary practice best suited to their interpersonal style and professional needs.
Perinatal nurses were surveyed to determine their knowledge, attitudes, and fears concerning AIDS. Nurses' knowledge correlated positively with attendance at conferences and in-service programs. More than 85% of the respondents reported moderate to high fear of AIDS. No correlation was found between knowledge and self-reported fear scores. A discrepancy occurred between the nurses' beliefs that persons with AIDS deserve the same care as any other patient and the nurses' willingness to volunteer to care for these patients. Further research to test and evaluate coping strategies to help perinatal nurses care for mothers and newborns with AIDS must be conducted.