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Author: teamnyshealth

A Wish List for 2025

Posted on by teamnyshealth

It’s become a December tradition for me to share a wish list for how New York can be a healthier place in the upcoming year. As 2024 winds down, here’s what I’m wishing for in 2025:

1. A shot in the arm for primary care. This one stays on the list for another year. Primary care has the best return on investment of any type of health care service — a rare “win-win” associated with both better health outcomes and lower costs. Yet, we chronically underinvest in primary care, spending only 5–7 cents of every health care dollar in this area. We can and should do better, by devoting a greater share of total health spending to primary and preventive care. Doing so wouldn’t require spending more; it would mean spending in smarter and better ways.

I’m optimistic we will get there. New York was selected to participate in the Centers for Medicare & Medicaid Services’ AHEAD Model, designed “to curb health care cost growth; improve population health; and advance health equity by reducing disparities in health outcomes.” States participating in AHEAD must set a specific target for primary care spending, giving New York the perfect opportunity to rebalance our health care spending. Let’s take advantage of this unique moment to get more bang for our health care buck.

2. Preservation of core public health functions. In a column about investing in the public health infrastructure in the wake of COVID, I wrote, “Too often in the U.S., we take for granted that we have safe drinking water, that our kids are protected from lead poisoning, that disease outbreaks can be monitored and contained.” Now, we cannot take those things for granted.

The President-elect’s key health nominees are unconventional contrarians, with histories of promoting misinformation and opposition to life-saving vaccines. Robert F. Kennedy Jr.’s misguided opposition to community water fluoridation has fostered skepticism about its safety. And just last week, it was reported that RFK’s lawyer has asked the Food and Drug Administration to revoke approval of the polio vaccine. Rough seas are ahead for public health. (Some ideas on the table could be promising — cracking down on pesticides and food additives and improving the quality of school meals — but it’s unclear how those might play out.)

Given the atmosphere at the federal level, New York State needs to protect the gains we’ve seen in childhood vaccination rates, community water fluoridation, and basic public health monitoring and data reporting. We’ve largely put COVID in the rearview, but chances are we’ll see another public health crisis before too long — and we’ve got to be ready for it.

3. Sustained, more equitable progress addressing the overdose epidemic. Here’s some good news: the State Health Department’s latest data show a decrease in opioid-related overdose deaths and emergency department visits statewide. Overdose deaths in New York dropped by more than 20% between July 2023 and July 2024, according to the Centers for Disease Control & Prevention. Sustained efforts — making naloxone widely available, expanding access to substance use treatment, and establishing the nation’s first Overdose Prevention Centers in New York City — are starting to pay off.

But the fight’s not over. On nearly every measure related to opioid use and overdose statewide, Black and Latino New Yorkers fare worse than their white counterparts. In New York City, residents of the Bronx and Staten Island; Black and Latino residents; and those living in neighborhoods with very high rates of poverty are most likely to die of an overdose. Even as rates of overdose declined among white New York City residents between 2022 and 2023, rates among Latinos increased — so in some cases, disparities are widening rather than shrinking.

4. Finish the job on healthy school meals. Free school meals improve physical health, mental wellbeing, and academic performance. And when meals are free to all, the stigma and shame associated with school lunch decreases and participation increases.

We are so close to healthy school meals for all. The State’s budget includes $145 million for free school meals, which means that more than 80% of New York public school students are getting the food they need to be healthy and learn well. But close is not complete. We are not done until free school meals are truly universal, so that every public school student can participate, regardless of where they live.

Just wishing doesn’t make things come true. Success will take hard work, persistence, coordination, and some luck. Let’s be ready to work together to make these wishes a reality in 2025. And please share your own wishes for the new year in the comments.

My final wish: a healthy and happy holiday season for you and your loved ones.

By David Sandman, President and CEO, New York Health Foundation
Published on Medium on December 17, 2024

NYHealth Testimony on Supporting Veteran Families in New York City

Posted on by teamnyshealth

NYHealth Senior Program Officer Derek Coy submitted the following testimony to the October 29, 2024, New York City Council Committee on Veterans oversight hearing on supporting the families of veterans coping with PTSD:

Thank you for the opportunity to testify on behalf of the New York Health Foundation (NYHealth) regarding the urgent mental health needs of veterans and the essential role of family support. NYHealth is a private, independent, statewide foundation dedicated to improving the health of all New Yorkers—including more than 133,000 veterans who call New York City home. My name is Derek Coy; I’m a Senior Program Officer at NYHealth. I am also a proud veteran, having served as a Sergeant in the United States Marine Corps.

The Foundation has worked for more than 15 years on behalf of veterans by engaging in grantmaking, policy analysis, advocacy, and convenings to understand and support military veterans’ health needs. Our work has found gaps in services and helped develop effective, promising programs to address them. We have supported a range of community-based organizations, health care providers, and peer mentor programs to ensure New York’s veterans receive high-quality, culturally competent care and support that meets their health needs and preferences. NYHealth has supported the work of organizations like Military Family Clinics, the Headstrong Project, and partnerships with the Unified Behavioral Health Center because of their unique focus on serving veterans alongside their families and caregivers. By addressing the mental and behavioral health needs of those who support New York’s veterans, these programs help create a more resilient and capable network of support for those who have served.

Understanding the Mental Health Challenges Facing New York City’s Veteran Population
Recent research highlights the mental health challenges veterans face and the need for family-centered approaches to mental health care, especially for those dealing with post-traumatic stress disorder (PTSD). According to an NYHealth-commissioned study published by RAND in October of this year, 26% of New York State veterans who recently separated from the military have a probable PTSD diagnosis—a 60% increase since 2010. (One caveat: it is important to consider that factors like improved screenings, reduced stigma related to mental health, and greater access to care may have contributed to this increase.) Almost two-thirds of these veterans reported having a disability and 20% rate their health as “fair” or “poor”—meaning that veterans have more health problems than their civilian peers. Additionally, more than one in five veterans reported an unmet need for mental health care. For those with suicidal ideation in the past year, 43.4% had unmet mental health needs.[1]

The invisible wounds of war—PTSD, suicidal ideation, and substance use—contribute to poor outcomes for veterans. An NYHealth analysis found that New York City veterans had a 2.5 times higher rate of “deaths of despair” (suicide and alcohol- and drug-related deaths) than civilians in New York City from 2012–2021. Substantial disparities in deaths of despair exist across different demographic groups. For example, the Bronx reported the highest rates of any borough—nearly double the citywide average. Citywide, deaths of despair rates were highest among veterans ages 55–64, particularly among Black and Hispanic veterans.

Secondary Trauma: The Overlooked Mental Health Burden on Veterans’ Families
Mental health challenges often extend beyond veterans, to affect their families, who may experience “vicarious trauma” or secondary trauma, which mirrors PTSD symptoms and places families under significant strain.[2] Veterans’ families, especially caregivers, often bear additional emotional and mental burdens. U.S. Department of Veterans Affairs (VA) studies highlight that children of veterans with elevated PTSD symptoms show increased behavioral issues and emotional distress.[3] Children of combat veterans with PTSD can feel sadder and more anxious compared to children of non-combat veterans without PTSD.[4] Caregivers are also heavily affected: according to the Elizabeth Dole Foundation, nearly half of caregivers of veterans under age 60 meet the criteria for depression. One in three caregivers sought mental health care in the past year but could not access it; 78% of them cited time constraints as the main barrier to care.[5]

The Importance of Inclusive Research on Veteran and Family Needs
It is crucial that research on veterans’ mental health include diverse samples that reflect the veteran population. A 2012 review revealed that most studies focused on male veterans and their female partners, which may mask important differences in risk factors and outcomes by gender and sexual orientation.[6]

There is promising research on interventions to support veterans with PTSD and their families. Research on interventions for caregivers of veterans with PTSD—particularly those focused on coping strategies and managing PTSD-related concerns—found that, after the intervention, caregivers reported reduced burdens, lower levels of depression and anxiety, less stress, and decreased time spent providing care, among other outcomes.[7] Furthermore, having families involved in a veteran’s treatment can reduce their potential for dropping out of care.[8]

To support veterans with PTSD and their families, we offer the following recommendations:

  1. Expand and invest in integrated services for veterans and families. Programs that support both veterans and their families (such as Military Family Clinics, the Headstrong Project, and partnerships with Unified Behavioral Health Center) should be expanded and replicated. These models provide holistic mental health care that addresses the interconnected needs of veterans and their loved ones, reducing PTSD symptoms and alleviating family stress for improved household wellbeing.
  2. Increase awareness and outreach efforts. Recent national research indicates that a significant portion of veterans (25%) and their families (64%) are unaware of available mental health resources.[9] Family members often face additional barriers when navigating these resources. Targeted outreach and educational campaigns can bridge this gap, helping veterans and families understand and access available benefits and support.
  3. Expand peer support services for family members and caregivers. Peer support offers invaluable guidance for families, who benefit from shared experiences. Expanding peer support networks—including those funded through the New York City Department of Veterans’ Services Request for Proposals for the Joseph P. Dwyer Veterans’ Support Program initiatives, as well as networks specifically tailored for families and caregivers—could provide essential emotional support and practical resources to those affected by a loved one’s PTSD.

NYHealth remains dedicated to advancing these recommendations, and we believe New York City can play an important role in meeting the growing mental health needs of veterans and their families. By prioritizing family-centered care and awareness, we can help mitigate the effects of PTSD on veterans and create healthier, more resilient families. We invite you to look to the New York Health Foundation as a resource in this work. You can learn more about our veterans’ health initiatives by visiting our website, www.nyhealthfoundation.org.

 

[1] RAND. 2024. “Understanding Veterans in New York”. New York Health Foundation. New York, NY. Available at: https://nyhealthfoundation.org/wp-content/uploads/2024/10/RAND_Understanding-Veterans-in-New-York.pdf.

[2] Diehle, J. Brooks, S. K. Greenberg, N. 2016. “Veterans are not the only ones suffering from posttraumatic stress symptoms: what do we know about dependents’ secondary traumatic stress?” Social Psychiatry: Psychiatric Epidemiology. doi: 10.1007/s00127-016-1292-6

[3] Lambert, J. E. Holzer, J. Hasbun, A. 2014. “Association between parents’ PTSDD severity and children’s psychological distress: A meta-analysis.” Journal of Traumatic Stress 27(1). https://doi.org/10.1002/jts.21891

[4] U.S. Department of Veterans Affairs, “PTSDD: National Center for PTSDD. When a Child’s Parent has PTSDD,” https://www.PTSDd.va.gov/family/effect_parent_PTSDd.asp#:~:text=Some%20children%20of%20combat%20Veterans,nightmares%20about%20the%20parent’s%20trauma., accessed October 2024.

[5] Ramchand, R. Dalton, S. Dubowitz, T. Hyde, K. Malika, N. Morral, A.R. Ohana, E. Parks, V. Schell, T.L. Swabe. G. et al. 2024. “America’s Military and Veteran Caregivers. Hidden Heroes Emergency from the Shadows.” RAND. Available at: https://www.rand.org/pubs/research_reports/RRA3212-1.html.

[6] Lambert, J. E. Engh, R. Hasbun, A. Holzer, J. 2012. “Impact of posttraumatic stress disorder on the relationship quality and psychological distress of intimate partners: a meta-analytic review. Journal of Family Psychology. doi: 10.1037/a0029341.

[7] Martindale-Adams, J. L., Zuber, J., Graney, M. J., Burns, R., & Nichols, L. O. (2021). “Effect of a Behavioral Intervention on Outcomes for Caregivers of Veterans with PTSDD. Military Behavioral Health. doi: 10.1080/21635781.2021.1927916.

[8] Thompsons-Holland, J. Lee, D.J., Sloan, D. M. (2021). “The Use of a Brief Family Intervention to Reduce Dropout Among Veterans in Individual Trauma-Focused Treatment: A Randomized Controlled Trial.” Journal of Traumatic Stress 38:4. doi: 10.1002/jts.22680.

[9] Ramchand, R. Dalton, S. Dubowitz, T. Hyde, K. Malika, N. Morral, A.R. Ohana, E. Parks, V. Schell, T.L. Swabe. G. et al. 2024. “America’s Military and Veteran Caregivers. Hidden Heroes Emergency from the Shadows.” RAND. Available at: https://www.rand.org/pubs/research_reports/RRA3212-1.html.

What Do New York’s Veterans Need?

Posted on by teamnyshealth

New York State is home to nearly 600,000 military veterans, most of whom return home without major difficulties. They go to school, work, raise families, and contribute to their communities.

But some veterans struggle with the transition back to civilian life. They may be dealing with physical and mental health challenges related to their service, or they may find it tough to get back into a rhythm after having been away from home.

How can New York best support those returning veterans? What do they need and want when it comes to health care, mental health, and social services? What needs to be done to fill existing gaps?

The best way to answer those questions is to ask veterans themselves and to listen. That’s exactly what the New York Health Foundation did. We commissioned the RAND Corporation to conduct a statewide needs assessment of recent veterans. RAND surveyed more than 1,100 New York veterans who recently separated from the military. The study is a follow-up to a 2010 needs assessment, so it also offers some useful comparative data.

Here are some key takeaways:

  • Demographic Composition: The cohort of new veterans in New York is relatively young, with 62% under age 45. It is also diverse: approximately 15% are women and nearly 40% are non-white. Mental health and health care providers need to be properly trained to meet the unique needs and challenges of a changing veteran population.
  • Mental Health Challenges: About 25% of veterans surveyed have probable depression or post-traumatic stress disorder (PTSD) — compared to 16% in 2010. The proportion of veterans reporting suicidal thoughts is twice as high as estimates for the general New York adult population, and the latest data show that suicide rates have remained relatively unchanged over a 10-year period. It’s clear that the veteran population has substantial mental health needs. One bright spot is that more veterans surveyed today — one-third compared to one-quarter in 2010 — are using mental health services, perhaps because of decreasing stigma. We need to shore up services, continue investing in veteran-specific suicide prevention programs, do more to ensure veterans know about their options, and make it easier for veterans to get the services they need.
  • Physical Health Issues: More than 60% of survey respondents are living with a disability — twice as many as in 2010. And 20% of veterans rate their health as “fair” or “poor.” These high rates of disability and less than optimal health will affect the types of services and support that both health care and mental health services providers will need to deliver to veterans.
  • Unmet Care Needs: Although 97% of new veterans have health insurance, many report having unmet mental and/or physical health needs and not having a health care provider they typically see. For those with unmet mental health needs, more than 1 in 4 say they don’t know where to find the right services, while nearly 40% say they believe mental health care won’t be effective. One veteran who participated in a recent panel discussion about the new report findings likened finding the right provider to finding the right pair of blue jeans; you may have to try on a few before discovering a comfortable fit. Peer mentors can extend the reach of culturally competent mental health support from people who understand the veteran experience.
  • Care Preferences: When they do get care, New York’s newest veterans report positive experiences in both U.S. Department of Veterans Affairs (VA) facilities and those in the community paid for by VA. But nearly 60% say that if they could choose to get care anywhere, they would prefer to go to a community provider. Some veterans mix and match: they may opt to see a pulmonologist at the VA but get women’s health services from a community provider. Like all of us, veterans want choices and control when it comes to their health care.

Only 6% of adult Americans are veterans, and that proportion has been steadily declining. So it’s not surprising if you don’t know any veterans or understand much about military and veteran culture. But that 6% is more than 16 million people. They’ve served their country, and some have sacrificed their physical and mental health by doing so. Most veterans I know are ambivalent when a stranger offers a casual “thank you for your service.” The real way to thank them is by ensuring that their needs are met and that they can thrive when they complete their service. That starts by asking, listening, and then acting.

By David Sandman, President and CEO, New York Health Foundation
Published on Medium on October 29, 2024

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