Health Policy Initiative Agenda.

Posted: November 1st, 2022

Health Policy Initiative Agenda.


For this assessment, evaluate the effectiveness of a current U.S. health care policy and propose adding this topic to the organization’s health care policy initiatives advocacy agenda. You will need to present data in a convincing and strategic manner in support of your recommendations.Health Policy Initiative Agenda.


If you have not done so yet, make sure to complete the media activity Vila Health: Health Policy Agenda (linked in the Resources) before completing this assessment. The presentation will walk you through the process needed for this assessment, and is critical to your success.Health Policy Initiative Agenda.

Continuing your role as an intern for your selected organization, as a relative newcomer to the group, your work supervisor is interested in your observations and insights regarding the group’s advocacy position and the effectiveness of its political process to take on a new health care policy initiative.

You will present your case to your supervisor in the form of an executive summary that is intended to convince senior leadership to financially support a health policy change initiative.

Include the following elements in your executive summary:

The health policy focus.
Value proposition.
The supporting evidence.
Proposed solutions.
Use the Capella University Library, the Policy and Legislative Resources (found in Resources), and the Internet to ensure you are familiar with the structure, strategies, and resources related to health care policy development. Once you are comfortable with the resources available, identify a specific health care policy important to the organization that is in need of change.Health Policy Initiative Agenda.

Health Policy Analysis
Organize Your Ideas
Note: Executive summaries do not spring fully formed from anyone’s mind. If there is ever a time to be reminded about the need for developing habits and practices of a skilled writer, it is when you are tasked with creating a concise executive summary. The most effective way to synthesize your research, impressions, and ideas is to break your task down to smaller, workable steps.

Each of the following sections should be “pre-written” so that you can look at them a second time and then summarize each section for your final deliverable.

The Health Policy Focus
Describe a health care policy issue where one or more changes in a specific health care policy are needed.
Identify the driving forces behind why the policy should be changed.
Explain who the proposal would impact and how retaining the status quo has a negative impact on this population.
Value Proposition
Describe why the special interest group should support this proposal and how changing the policy would serve to advance the mission, vision, values, and goals of the organization.
Supporting Evidence
Describe the provisions of the current law the proposal would change or, if no law exists, explain and analyze the problems this causes. Cite your sources.
Determine the strategic impact of the health policy issue (enacted or possible), projecting the strategic influence on population health and impact on the health industry over the next 3–5 years and beyond, and future needs for the policy. Support your determination with authoritative sources.
Proposed Solutions
Suggest improvements to the community health and national health care policy identified:Health Policy Initiative Agenda.

Outline a specific vision for the change and how the change would impact those affected.
Describe the legislative process to accomplish the change.
Cite studies supporting the proposed action.
Executive Summary
Create a 3–5-page executive summary of your analysis. Your summary should challenge the status quo by comparing the existing policy to an ideal vision. Your summary must contain the following elements:

A description of the problems and how the health policy change initiative would resolve them.
Summary of the evidence that supports the reasons the organization should fund a health policy change initiative.
A recommendation for a strategy to deliver the message or vision for change to those affected. Include methods for influencing the legislative process to achieve change.

Leading Health Initiatives
Health Care Costs and Outcomes | Transcript.
Begun, J. W., & Malcolm, J. (2014). Leading public health: A competency framework. New York, NY: Springer.
World Health Organization. (2016). Strategizing national health in the 21st century: A handbook. Retrieved from
Zangerle, C. M., Harris, D. A., Rimmasch, H., & Randazzo, G. (2016). From volume- to value-based care: Leading population health initiatives. Nurse Leader, 14(5), 318–322.
“Chapter 5: Invigorate Bold(er) Pursuit of Population Health.”
Health Care Initiative Examples
Brewin, D., & Nannini, A. (2013). Health reform policy initiatives to promote older women’s health. Journal of Gerontological Nursing, 39(3), 16–21.
Health Affairs. (2016). Conversations. Retrieved from
Policy and Legislative Development Resources
These links may be helpful in setting the framework for personal research expected of MHA-FP5032 learners. A number of the links in this document are “bookmarked” by professionals in the field of policy development as “go to” resources used repeatedly on the job.

Advocacy Strategies
These readings provide information in how to advocate for health policy, and the policy process.

Lusting, S. L. (2012). Advocacy strategies for health and mental health professionals: From patients to policies. New York, NY: Springer.
CARE International. (n.d.). Southern voices advocacy toolkit. Retrieved from
Centers for Disease Control and Prevention. (2015). CDC policy process. Retrieved from
American Hospital Association. (n.d.). Advocacy issues. Retrieved from;=All&sort;_by=search_api_relevance
American Public Health Association. (n.d.). Advocacy for public health. Retrieved from
SOPHE. (n.d.). Advocating for public health. Retrieved from
Policy Evaluation
This website from the CDC provides information on the evaluation process using the CDC framework.Health Policy Initiative Agenda.

Centers for Disease Control and Prevention. (2016). Practical evaluation using the CDC evaluation framework—A webinar series for asthma and other public health programs. Retrieved from

American Government – History (n.d.). How a bill becomes a law. Retrieved from
Anonymous. (1993). How a bill becomes a law. Transportation & Distribution, 34(9), 54. [Note: You must be logged into the Capella courseroom to access this reading via the Capella University Library.] (n.d.). Policy making: Political interactions. Retrieved from
University of Virginia Miller Center. (n.d.). U.S. presidents. Retrieved from
University of Texas Austin. (n.d.). Congress. Retrieved from
Government Resources – General
U.S. Library of Congress. (n.d.). Retrieved from
United States Copyright Office. (2016). Podcasts. Retrieved from
Health Care Research, Data and Statistics
American Public Health Association. (n.d.). State fact sheets. Retrieved from
American Hospital Association. (n.d.). Research and trends. Retrieved from
Centers for Medicaid and Medicare Services (n.d.). National health expenditure data. Retrieved from
Centers for Disease Control and Prevention. (n.d.). National Center for Health Statistics. Retrieved from
U.S. Department of Labor Bureau of Labor Statistics. (n.d.). Databases, tables & calculators by subject. Retrieved from
Laws and Regulations
U.S. Department of Health and Human Services. (n.d.). Laws & regulations. Retrieved from
Social Security. (2010). Patient protection and affordable care act of 2010. Retrieved from
National Conference of State Legislators. (2016). Tracking state laws for health care transformations, 2015–2016. Retrieved from
CBS News (Producer). (2011). Jack Abramoff: The lobbyist’s playbook [Video]. Retrieved from
Gerald R. Ford Presidential Library and Museum. (1975). Regulation of lobbying [PDF]. Retrieved from
The National Institute for Lobbying and Ethics. (n.d.). Retrieved from
National Conference of State Legislatures. (n.d.). Lobbyist regulation. Retrieved from
Policy Statements
American College of Healthcare Executives. (n.d.). ACHE’s policy statements. Retrieved from
American Medical Association (n.d.). PolicyFinder. Retrieved from
American Nurses Association. (n.d.). ANA official position statements. Retrieved from
American Public Health Association. (n.d.). Policy statement database. Retrieved from

Health Policy Focus
The Mental Health Parity and Addiction Equity Act was signed into law the year 2008 with an aim of expanding access to mental health services. It lays emphasis on the need for insurers to provide similar treatment for substance use disorders and mental health disorders as provided for physical health since they are both medical issues. The act has contributed too much progress in reducing and addressing more obvious disparities in the management of mental disorders through; separation of deductibles from copays, eliminating precertification requirements which were overly strict and removing strict limits on the number of outpatient and inpatient mental health visits.
Despite the great strides made, there are still a lot of gaps created by the Act such as: it does don’t have a requirement for employers to start coverage on mental health and substance use disorders if they presently do not and it also doesn’t apply to Medicare plans. This leaves most insurers are with ways of making mental health benefits to be less available to users to an extent of not meeting non-quantitative treatment limitations (NQTL). NQTL refers to nonnumerical limits on the duration or scope of treatment or techniques of management that may be used to curb the use of behavioral health treatments (Peterson & Busch, 2018). This has resulted to; limitations on behavioral health services given in provider networks, lowered reimbursements for providers of behavioral health and disparities in the enactment of utilization management by health plans and how medical necessity is defined.Health Policy Initiative Agenda.
Besides, the Act has failed to address the needs of individuals with severe mental illness whose MHPAEA were expanded by the ACA. This therefore means that, although most individuals with severe mental illnesses are likely to be covered by Medicaid, it is also important that the resultant effects of the MHPAEA with reference to the NQTL management in the Medicaid population are addressed.
It is important that a number of changes are made in the MHPAEA Act of 2008 in order to attain full parity and make mental healthcare services easily accessible to the public. Besides, it should be noted that, individuals with severe mental illnesses require complex and comprehensive multidisciplinary treatment which often involves assertive involvement of community resources, supported employment and family psychoeducation which are difficult to find as compared to medical/surgical treatments (Friedman, Xu, Harwood, Azocar, 2017). Should the status quo be retained, it is undeniable that continuous discrimination in the coverage of mental health disorders and substance use disorders by insurance firms will continue to exist (Peterson & Busch, 2018). As a result, it should be expected that: the rate and incidence of violent crimes will continue to increase, the probability of those suffering from severe mental illnesses gaining full-time employment is reduced, school-going children can easily drop out of school and most of those affected and their families will live a poor quality of life and lost productivity.Health Policy Initiative Agenda.
Value Proposition
Mental Health America should support the proposal of urgently addressing the non-compliance of insurers with NQLT which will also ensure that individuals with severe mental illness are covered in the MHPAEA in Medicaid managed care. This will help to solve issues with access to behavioral health services and the discrimination witnessed in health insurance against individuals who suffer from or are at risk of behavioral health disorders (Barry, Frank & McGuire, 2006). In addition, it resolves unavailability of real protection in the present law against such discriminations, and the loss of health, life and productivity attributed to various insurance barriers. All these solutions are a noble course that aligns with the mission, vision, goal and values of Mental Health America (Friedman, Xu, Harwood, et al. 2017). Besides, it is of essence to ensure that private and public health plans equalize the structures in behavioral and medical health.
As a special interest group that impacts mental and behavioral health through service, advocacy and awareness, by supporting this proposal, Mental Health America will help to build a society that is healthy and humane where all patients are accorded dignity, respect and the opportunity to maximize on their full potential without prejudice or stigmatization as aligned to its mission and vision (Friedman, Xu, Harwood, Azocar, 2017). Besides, this proposal will bring justice to every person in need of behavioral or mental health services irrespective of socio-economic status, ethnicity or race and ensure their full recovery to live productively and healthy (Peterson & Busch, 2018). It is also worth noting that, when insurers become compliant to the NQLT and ensure that MHPAEA is included Medicaid managed care, all consumers will be guaranteed of culturally competent, integrated, behavioral and mental health services irrespective of the ability to pay in line with the values of Mental Health America.Health Policy Initiative Agenda.
Supporting Evidence
Despite the fact that the Act is an essential step forward, presently the law does not adequately address issues with access to mental and behavioral health treatment since the Act has no provision for Medicare Plans. It is undeniable that the Affordable Care Act expanded the provisions of the MHPAEA to most enrollees of Medicaid (McConnell, Gast, Ridgely, 2012). Going by the fact that most individuals with severe mental illnesses have high chances of being covered by Medicaid, the effects of the MHPAEA Act in the Medicaid population in relation to the provisions of NQLT management have a lot of significance.
As a result, most consumers are unable to afford care while others lack knowledge on where to receive behavioral and mental health services. This discrimination also frustrates the government’s interest to equally safeguard all Americans at various coverage levels that an employer or those insured can afford (Peterson & Busch, 2018). Besides, the current law does not also have a provision to ensure compliance with NQTL requirements, an avenue that creates barriers to treatment and requires more efforts in law enforcement to realize.Health Policy Initiative Agenda.
The strategic Impact of this health policy issue is that it will probably add to the cost of healthcare according to the National Business Group on Health. However, parity studies reveal that the attempt to equalize NQRT compliance to provide behavioral health and overall medical benefits can either fail to increase the overall healthcare expenses or can increase total healthcare premiums with a modest amount (Buchmueller, Cooper, Jacobson & Zuvekas, 2007).
Research indicates that currently, approximately 43. 8 million adults in the US suffer from serious mental illnesses. Most mental healthcare providers in the US currently refuse private insurance, Medicaid and Medicare patients at significantly high rates as compared to other medical professionals and this increases the prevalence of mental health disorders. Besides, the US faces a serious shortage of mental health providers, which can partly be attributed to a high turnover, an aging workforce or inadequate compensation (Barry, Frank & McGuire, 2006). Should this proposal be adopted and implemented, in the next 5 years, it is certain that the number of patients suffering from mental health disorders will reduce significantly. This is attributed to the fact that The MHPEAA will include Medicaid managed care hence increasing access to treatment (Peterson & Busch, 2018). Besides, most healthcare plans and health insurances will be compliant with the non-quantitative treatment limits enabling access to high quality care based on individual patient needs.Health Policy Initiative Agenda.
Proposed Solutions
In order to achieve parity from the MHPEAA Act of 2008 and improve access to treatment, it is imperative that Mental Health America pushes for a provision in law that guarantees NQLT compliance from insurance firms and healthcare plans (Buchmueller, Cooper, Jacobson & Zuvekas, 2007). This can possibly be achieved through additional requirements for public disclosure on processes of plan management, educating consumers, employers, clinicians, policy makers and the entire public on the requirements of MHPEAA and having a structured form of competition for healthcare plans to incentivize compliance with NQLT. Through increased disclosure, regulators and patients will be able to readily identify different management strategies. With regards to competition to increase NQLT compliance, in a managed competition framework, plan payments may be adjusted based on the healthcare profile of every member (Peterson & Busch, 2018). Based on this, it should be noted that risk adjustment underpays for most mental health disorders. Therefore, incentive plans can easily help to let these patients access treatment.Health Policy Initiative Agenda.

Changes in health policy don’t just happen. They happen because activists, legislators, researchers, and others work together, sometimes for long periods of time, to advocate for change. For advocates of change, successful advocacy requires a thorough knowledge of the issues at hand, familiarity with the ongoing problems and their causes, and the solutions that might address those problems.
In this activity, you will be asked to seek information from others so that you can help with advocacy on an important health policy issue: veterans who need more access to behavioral and mental health services in rural areas.

Learning Objectives
After completing the activity, you will be prepared to:
• Identify changes needed in the health policy, outlining the vision for the changes and the legislative process to accomplish the change.
• Describe the problems and how the proposal would resolve them.
• Challenge the status quo by comparing it to an ideal vision of change.
• Define a strategy for delivering the message or vision for change to those affected, including methods of influencing the legislative process to achieve the change.
• Evaluate the impact of the health policy issue (enacted or possible), projecting the strategic influence on population health and impact on the health industry over the next 3–5 and greater years.
Health Policy Agenda
You are a new staff member at the recently created Barnes County Telehealth Alliance, a consortium of nonprofits, providers, and other organizations that want to advocate for funding to support telehealth initiatives to improve mental health services and outcomes for veterans in Barnes County.
You’ll be working with Peggy Trueblood, the executive director of the Alliance. She’s going to be traveling a lot in the days to come, so she’ll be counting on you to help get the campaign to advocate for telehealth off the ground.
Voicemail from Peggy Trueblood
Hi, and welcome to the Barnes County Telehealth Alliance! Sounds fancy, doesn’t it? I’m glad you’ll be working with us. I’m afraid I’ll have to throw you right in; we’ll be going before the legislature to ask for some funding for a telehealth clinic, and there’s a lot to get done before the session opens. I’ll be on the road a lot, so I’m going to need to lean on you.Health Policy Initiative Agenda.
First, I’d like you to get up to speed on the background. Hopefully someone explained that we’re an alliance of several organizations that are on board with solving the problems veterans in our county are having with accessing behavioral and mental health services. Basically, we’ve got a large population of veterans in the county, and they’re encountering some roadblocks to getting good care, whether it’s for pain management or PTSD or general mental health help. We need to find some better ways to deliver that care, and the Alliance is pushing for us to use telehealth (it’s also called telemedicine) to deliver it. I’m about to send you some files that I hope will give you some context.
After you’ve had a chance to review them, I’ve set up some interviews for you with stakeholders around the county who will explain more about what’s going on. Let’s connect again after you’ve had a chance to talk to them. Thanks, and good luck!
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Documents #1
Legislative Environment and Interested Groups
Barnes County Quickfacts from the US Census Bureau
PTSD and Telehealth
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Stakeholder Interviews
Joseph Turner, Barnes County Veterans Service Office Director
What is your involvement or interaction with the veterans living in Barnes County?
I’m the county Service Officer for the North Dakota Department of Veterans Affairs. I help veterans who live in the county to get the benefits they’re entitled to through the VA. Sometimes I help veterans from other counties too, because the VA’s clinics and offices often cross county lines, but it’s mostly the ones in Barnes County.
What unique problems do they face?
I’m a veteran myself, but I can’t speak for all of them. We’ve got our share of both Iraq and Afghanistan vets – some of them served in both theaters – and it really depends. Almost any vet might have a tough time getting used to being out of combat and around civilians all the time. But some of them have it rougher, depending on what happened during their service. Health Policy Initiative Agenda.The thing is, I think we’re getting a lot of the ones who did have it worse. I don’t know if you’ve heard of that Eagles Healing Nest place in Minnesota? It’s an abandoned reform school this woman has turned into a place for veterans to live for free. It’s in a little town, can’t remember the name, but it’s 100 miles from the city and it’s quiet and veterans can go there and avoid the traffic and the noise and the crowding that can sometimes trigger PTSD episodes. Anyway, people have been coming here with the same idea. We got a few after Desert Storm, a few more after the first few years of Afghanistan, and a lot after Desert Shield. These guys seem to need more quiet, they kind of operate on a hair trigger, and they don’t want to be crowded. So they move to the family farm or live in town and try not to have episodes.
Do they have access to the treatment and services they need?
It can be tough to get services through the VA. I’m not supposed to say that, and I wouldn’t say it publicly, but it’s a problem. Some of them go to the VA clinic in Jamestown when they can’t get what they need here, but the problem with that is they often just get a referral to someone in Fargo or even Minneapolis. That’s not where these guys want to go – hell, that’s why they’re here in the first place!Health Policy Initiative Agenda.
What happens when they can’t get that access?
It’s not good. There’s a guy who had a place on the river, maybe 15 or 20 miles northwest of the airport? That guy stepped on an IED in Iraq in 2009. They took, I don’t know, about 50 pieces of shrapnel out of his legs, but there’s still a good bit in there. That guy’s in pain all the time, and while he can walk, he couldn’t walk all that well, or for long. Anyway, he killed himself two years ago. Left a note, said he couldn’t take the pain anymore. I don’t blame him. Who knows what he went through? But maybe if he’d gone on different meds, gotten different physical therapy, something, he’d still be here. I don’t know.
What do you think would be a good solution to their problems of access?
There’s a VA clinic in Devils Lake that vets can use to get care. It’s staffed by nurses, and there’s a doctor who oversees the clinic, but he isn’t there much. But it doesn’t matter, because it has monitors that let patients talk to doctors in Fargo, Minneapolis, Grand Forks, wherever they’ve got the equipment and staff! If we had one of those clinics in Valley City, it would make it so much easier for vets to see a doctor without having to drive forever in bad weather and maybe risk a PTSD episode.
Richard Waters, North Dakota Veterans Affairs Commissioner
What is your involvement or interaction with the veterans living in Barnes County?
I’m in charge of making sure that all the veterans in North Dakota get the benefits they’ve earned. I’m basically the liaison between the state and national VA and the county Service Officers. And of course, I’m a veteran myself. Desert Storm.
What unique problems do they face?
Some have physical problems from combat injuries. Prosthetic limbs, serious wounds, sometimes both. When you combine that with visible disfigurement, it’s tough on some of them. They don’t all live out in the sticks, but plenty of them do, and that military training of self-reliance is big. We’re soldiers! We’re supposed to tough it out, right? But the problem is you can only tough it out for so long, and some of these guys have real serious physical limitations and a lot of pain. And unfortunately, whether they’ve had serious injuries or not, a lot of them have PTSD – but they don’t all realize it.
Do they have access to the treatment and services they need?
Sometimes. For the physical stuff, the hospital is pretty good. But for the mental stuff, there’s not much to go around. I mean, there are some services available, but this is a rural area. All the hotshot psychiatrist types would rather practice in a city where they can spend their money, right? And for guys who don’t really like running around town or being seen anyway, it’s not great to have to drive down Main Street or 6th Avenue and walk from a parking spot to some therapist’s office.
What happens when they can’t get that access?Health Policy Initiative Agenda.
Well, military guys will tough it out. We don’t always know. I think there’s something like 1,000 veterans in the county, and you can’t keep track of them all. Some of them get hooked on painkillers, or drink a lot, and there’s harder stuff to be had if that doesn’t do the trick. I’m glad we’re not closer to the fracking, because the drugs up there…yikes. We do what we can, and there are addiction counselors around town, and of course there’s the three or four AA meetings around town. But when the underlying problem doesn’t get solved – the pain, the PTSD, whatever it is – it’s not easy for guys to quit once they’re hooked on something. Especially if the Twelve-Step model doesn’t really work for them.
What do you think would be a good solution to their problems of access?
It’s a small town, so whatever isn’t here, they’ve got to go to it. I’d like to get one of those telehealth clinics operating here, like the one in Devils Lake. But there’s no money in the VA’s budget for another one, and there may not be next year either. Those damn politicians will horsetrade and grandstand and shut the government down, and meanwhile my fellow service members just have to wait and hope.Health Policy Initiative Agenda.
Don Gruman, Barnes County Sheriff
What is your involvement or interaction with the veterans living in Barnes County?
Personally, I’m friends with some guys who are vets, but other than that, not much. Professionally, though, my deputies and I have noticed a bit of an uptick in the number of times calls involve the vets around here. Now, it’s not that they’re robbing banks or breaking and entering! The vets I know are law-abiding guys, even if a few of them have pretty wicked tempers. It’s just…I don’t know, when we go on domestic violence calls, they don’t always involve vets. But when they do, they’re the ones that come out of nowhere and get scary fast. The vets with a lot of combat time don’t all operate on a hair trigger, but man, the ones who do…
And it’s not just that. We’re doing more welfare checks than we used to. We’ll get a call from someone’s boss or estranged wife or whatever, and they want us to go out there and make sure they’re okay. It’s part of the job, but it worries me. A couple of times we’ve found guys – and once, a woman – who had killed themselves. In a county where that almost never happened, now it’s happened more than once. Know what I mean?
What unique problems do they face?Health Policy Initiative Agenda.
I don’t know. I only know what I see when we get into it with them or have to go check in on them. They’re not necessarily different than other people, but these emergency situations seem to be happening more.
Do they have access to the treatment and services they need?
It sure doesn’t seem like it. And isn’t the VA notorious for that kind of thing? I know it took my fishing buddy a year and a half to get his disability officially recognized or whatever it is they do.
What happens when they can’t get that access?
Well, not always, but sometimes, we get called. That’s what happens. You get someone who’s had an argument with his girlfriend and waves his gun, and off we have to go. Not that there aren’t civilian guys around here who would do that, but they also get into fights at the bar and get tossed for driving drunk. Not the vets. These are law-abiding guys, otherwise.
What do you think would be a good solution to their problems of access?
Get ’em the care they need! I mean, who can blame a guy for drinking to kill the pain when he’s had a leg blown off?
Joann Reese, Admissions and Discharge Director at Valley City Regional Hospital
What is your involvement or interaction with the veterans living in Barnes County?
Some of the veterans are coming to us for physical care, behavioral care, or both. Of course, they need treatment for the same things civilians do – accidental injuries, disease management, that sort of thing. But for the ones with needs for wound care or prosthetic limb management, we’re pretty much the only game in town. We get some vets coming through the ER, mostly for pain problems, although a few come in with prescription drug intoxication or alcohol poisoning. Our psychiatric services unit is set up for mental health or substance abuse crisis management, and we have one doctor who does medication management consultations. But he’s not full-time staff here, he just has visiting privileges, and if I remember right he’s only here one day a week. It’s not easy to get specialists here, and we don’t really have the revenue base to sustain them.Health Policy Initiative Agenda.
What unique problems do they face?
Well, they’re not the only ones who have PTSD, but they’re the population we’re least surprised to see it in. And although we’re getting better at it, hospital staff aren’t always as familiar with military culture as they could be. That can be a problem in care coordination. After-care reviews often reveal that staff missed opportunities to ask about depression or anxiety when veterans are here for other types of treatment. Plus, when they do ask, they don’t know how strong the instinct for self-reliance is, so they miss the signs or they don’t follow up. We’re getting better at it, because we’re making an effort to be. But I don’t know what happens at outpatient clinics or other providers.
Do they have access to the treatment and services they need?
Yes and no. For example, like I said a moment ago, we can provide medication management consultations. But not every day of the week. You’re talking about asking people who never wanted to come to the hospital in the first place to come back later in the week, or the next week. That doesn’t really work. And as far as managing PTSD symptoms, we’re limited. We can help resolve a crisis. Sometimes ex-soldiers show up at the ER because they’re hallucinating or feeling suicidal, and we can help them get stabilized and on meds. But we can’t make them take their meds afterward. And we don’t have the capacity to offer regular, ongoing treatment, which is really a good idea with PTSD. People need to learn skills for managing those symptoms, and they need to practice them, but we don’t have the staff. And the rest of the mental health providers in town are generalists. It’s like we’ve got the capacity to manage a crisis, but not enough to head off the crisis before it happens.Health Policy Initiative Agenda.
What happens when they can’t get that access?
Mental health and physical health go hand in hand. So it depends. Some people just troop it out. Some people get better. But a lot of folks come in to the ER more than a few times a year. Sometimes we don’t know what’s going on, but we’ll have one veteran come in here one month with alcohol poisoning, the next month with injuries from a fistfight, and the next with severe depression…it just doesn’t tend to get better unless there’s some kind of intervention. And it often tends to get worse.
What do you think would be a good solution to their problems of access?
The hospital has been talking for years about a telehealth initiative, and I think that’s the best idea we’ve got. I’ve visited the Devils Lake clinic. They’ve got small individual rooms with monitors for patients to use when they have a tele-appointment, and three nurses on staff for testing or hands-on treatment. Veterans go into their own room for their appointment, and they don’t have to drive to Fargo or Duluth or Minneapolis but they can still get an appointment with a psychiatrist or a pain specialist or other specialists.Health Policy Initiative Agenda.
Ned Walsh, Barnes County Health Department Director
What is your involvement or interaction with the veterans living in Barnes County?
I encounter them in the data I look at, or at least I’m reasonably certain I do. As Health Department director, I keep an eye on the county-level statistics. They tell me about the different health challenges folks in this county are facing. Lately, what they’re telling me is that more veterans are having physical and mental health outcomes that we don’t want.
What unique problems do they face?
Well, let’s look at the data for suicides in the county. There were three times as many suicide attempts – 27! – in Barnes County in 2014 as there were in 2001. And that’s not an outlier or a weird year; it’s been climbing, if slowly. And it’s not just that our population is growing too. It’s out of proportion to the county’s growth rate, which is climbing much more slowly. The hospital data shows that more of their emergency hospitalizations for suicidal ideation, overdose, and accident-related injuries involve veterans than they used to. So I suspect we have a problem. But frankly, even if we didn’t, veterans with injuries, PTSD, or other combat-related problems deserve to have reasonable access to care. And they don’t, at least in this county.Health Policy Initiative Agenda.
Do they have access to the treatment and services they need?
I’ve heard anecdotally of veterans who finally force themselves to make an appointment with one of the town’s three psychiatrists, only to be told that they’ll have to wait three weeks. Now, in the bigger cities, even civilians might have to wait three months, so I get that that isn’t a veteran-specific access issue. But it’s still an issue. There has to be a way to get these people some treatment so that the ER isn’t their first point of contact. The stakes are higher with someone who has untreated PTSD.
What happens when they can’t get that access?Health Policy Initiative Agenda.
It’s not always suicide or violence or an obvious bad outcome. But when you think about how closely related behavioral health and physical health are, I suspect there’s a cost even when we don’t see it. Diabetes, heart disease, other illnesses that can be managed but have a behavioral component…you get the idea.
What do you think would be a good solution to their problems of access?
If vets here could get connected to the same kinds of distance solutions that vets in other part of the state can, that would be a great start.
Christopher Wilshire, Veteran who lives in Valley City
What is your involvement or interaction with the veterans living in Barnes County?
I’m with the VFW Post 2764. We’ve got an office right on Main. I know a lot of the guys – and gals – who live in Valley City, and some of the ones who live farther out in the county. We have something like a thousand veterans in the county, from what I hear, though I’m not sure that’s still true. Anyway, I talk to a lot of them, if not all the time. I’m more likely to know them if they’re members of the Post, and not all of them are.
What unique problems do they face?
Well, they’re not all the same. Some of them came back just fine. Not everybody was stepping on IEDs in Iraq or getting in firefights in Kandahar! I think everybody who’s been in combat feels a little weird about normal life. But there are some guys who had it rougher. Some are in wheelchairs, some are missing part of an arm or a leg, that kind of thing. And they feel really different from other people. They don’t like being stared at, they don’t like being asked what it was like in Afghanistan, and they don’t like going to the doctor. At all.
Do they have access to the treatment and services they need?
I think it’s more a question of whether they want to use that access. Sure, guys can get appointments, but do they want to go to them? Road trips are great when the weather’s okay, but it can be hairy to get to Fargo or Minneapolis. There’s a guy named Mike who has an eye injury from the Second Battle of Fallujah. He lives out near Lisbon, not far from Sheyenne. Technically he can drive, but his depth perception isn’t great, and he hates to drive, especially if it’s overcast. That makes it worse for some reason. Anyway, maybe he can get appointments, but he doesn’t make them. He knows he needs to get his eye looked at, he knows he’s kind of paranoid and doesn’t sleep well, but Fargo is just not the place for him.Health Policy Initiative Agenda.
What happens when they can’t get that access?
Sometimes they just tough it out. And sometimes they can’t. We’ve had more than our share of funerals in the last couple of years. One guy wrecked while he was drinking, another just died but they think pills were involved…it’s terrible to make it through a war and then not be able to survive the aftermath.
What do you think would be a good solution to their problems of access?
Valley City is a small place, and for the ones who actually need treatment, it would be great if they could come here and not have to go anywhere else.
Pam Miller, Pastor of Faith Lutheran Church of Valley City
What is your involvement or interaction with the veterans living in Barnes County?
I have much more interaction with wives, girlfriends, mothers, fathers, and friends of veterans, actually. In the last couple of years, I’ve been having a lot more conversations with people who are worried about a veteran and who don’t know how to help them. Not every veteran has PTSD. That’s a myth. But a lot of the veterans who do have PTSD have been moving to rural areas, and that’s us. And when a veteran has untreated PTSD, the odds are just higher that someone in their life – spouses, children – are going to suffer along with them.
What unique problems do they face?
Mostly I hear about drinking, painkiller abuse – or at least dependence – and unwillingness to go see somebody. And I can’t blame them, because it can be very difficult to get in to see someone here. We’re in a small city and an underpopulated county, and we just don’t have the revenue base to support the specialists who practice in larger cities.
Do they have access to the treatment and services they need?
It sounds to me like they do, but I’m sure it depends. And of course access is important, but access doesn’t matter if there are obstacles that prevent the person from taking advantage of it. So I hear about secret drinking, for example. But it’s not just the veteran; their wife or girlfriend maybe starts drinking more because of the stress. And family members can’t get treatment at the VA, so they have fewer options. Shame and embarrassment at “not being able to deal with it” are big obstacles.Health Policy Initiative Agenda.
What happens when they can’t get that access?
It depends. But if they can’t, it affects everyone around them, not just them.
What do you think would be a good solution to their problems of access?
I don’t know.
Deborah McNary, communications director of Mental Health America North Dakota
What is your involvement or interaction with the veterans living in Barnes County?
I don’t have much direct interaction, but our organization promotes mental health through education, advocacy, understanding, and access to quality care. My job is to stay in touch with all areas of North Dakota about the state of mental health in general. And it’s not good.
What unique problems do they face?
They face what other people with a need for mental health services face: budget cuts. Critical services like suicide prevention, mobile on-call crisis, residential services for crisis patients, and other resources have been gutted by a legislature that seems determined to pay for everything else by cutting mental health. So any veteran with a mental health disorder is going to have a hard time getting the care they need if they venture outside the VA system. And with no VA clinic in Barnes County, they have to drive to Jamestown or Grand Forks or even farther to get help in the VA system.
Many people with mental health disorders will remain on waiting lists and receive no services at all. Families and advocates are left to scramble to find any help to prevent or address a crisis. People end up homeless, in jail or hospitalized without available preventive services.
Do they have access to the treatment and services they need?
I don’t know, but there are a lot of people across the state who just stay on waiting lists and don’t get any help. They end up homeless or in jail or worse, and it’s because there aren’t services for them. I’d guess veterans have the same problems with access as others, but with the VA in the picture I’m not sure.Health Policy Initiative Agenda.
What happens when they can’t get that access?
What happens to anyone when they can’t get access? They get worse. It’s the same problems, only if the veteran in question has PTSD and a combat injury, they’re probably even more challenged.
What do you think would be a good solution to their problems of access?
If the legislature would demonstrate that they care about this problem, that would be a good start. I’m sure they’re good people but they seem to see mental health services as an add-on, a sort of nice-to-have thing, rather than a necessity for a healthy community.
It would also be good if they would help distribute resources more efficiently. There are a lot of resources in the cities, not so much in the small towns. If people in the more rural areas could take advantage of the expertise in the more urban areas, I think the crisis wouldn’t be so acute.
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Email #1
Telehealth and Veterans Report
From: Peggy Trueblood, Executive Director
Now that you’ve gotten some background on the issue, I’d like you to take a look at a report that an intern at my office prepared. Nobody in the Alliance has seen it yet, but we’re planning eventually to include it as part of our pitch to the Legislative Assembly. The trouble is that I haven’t had a chance to read it in detail and make sure that it has everything we need.
Can you give it a close read and take note of which sections are solid and which ones still need some work? We’ll talk about what you found when you’re ready.
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Documents #1
Veterans in Barnes County: Gaps in Care
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Meeting with Peggy Trueblood
Peggy Trueblood
Hey there! I finally have a few minutes. Let’s go through the report ‘Veterans in Barnes County: Gaps in Care’ section by section, and you can tell me what you thought of the different parts within each section. Let’s start with Section 1: Background of the Issue.
Section 1: Background of the Issue
This first section is supposed to describe the provisions of current law or policy. How would you rate it?
Poor You’re absolutely right. There’s no discussion of any law or policy in North Dakota as it relates to telehealth, so we’ll need to add that information. Let’s move on.
How do you think this section explains the current problems veterans are facing and the changes needed?
FairI agree. It does describe the problems that veterans are facing, but it doesn’t connect those problems to a specific solution for addressing them. Having explained what veterans are struggling with (distance from providers that could help them with their health issues), the report needs to say that needed changes include making it easier for veterans to connect to those providers. Let’s move on.Health Policy Initiative Agenda.
As a whole, what do you think about this section’s treatment of the issue’s strategic impact?
Poor I agree. The section describes the impact of poor health access on veterans. But it doesn’t describe the impact on the industry; that part is missing. What’s more, the report has to project that impact three to five years out, and detail the likely needs in that time frame. When we advocate for the clinic, we need to be able to show what will happen if the problem isn’t solved. Let’s move on to Section 2: Proposed Solution.
Section 2: Proposed Solution
How would you rate this section on how well it articulates our specific vision of change?
Fair I agree, this needs some work. It does articulate a general vision (telehealth). But our specific vision is a telehealth clinic like the one in Devils Lake. The report needs to make it clear that we’re not asking for money for generally improving telehealth access — it has to show that we have a specific plan for making that happen. Let’s move on.
How would you rate the section’s description of the legislative process?
Poor I agree. The section doesn’t address the legislative process at all, so we’ll need to add that. Let’s move on.Health Policy Initiative Agenda.
How would you rate it on how well it explains the status quo regarding veterans in the area?
Good I agree, there’s a good bit of detail in here about the status quo and what it looks like. If we can find more numbers that support what we’ve said, that would improve it, but the basic information is here. Let’s move on.
How would you rate this section on its comparison of the status quo to our vision for change?
Poor I agree, this part needs to be more explicit. Part of the problem is that the report doesn’t articulate our specific vision for change. Using that specific vision — the clinic — this part has to explain how it would change the status quo. Let’s move on to Section 3: Justification.
Section 3: Justification
Okay, this section needs to start by articulating the problems and how the proposal would resolve them. What do you think?
Fair I agree. The report does talk about the problems connected to veterans’ lack of health access here. But it doesn’t say how the proposal would solve them, so we need to make that connection explicit. Let’s move on.
This section should include some studies that support our proposal of a telehealth clinic. What do you think?
Poor I agree. The section doesn’t cite any studies in support of our proposal. There are some studies listed in that VA article I sent you that would probably work well here. Let’s move on to Section 4: Advocacy.
Section 4: Advocacy
This section needs to start by identifying the special interest groups that support our proposed policy and explaining our political action structure. How would you rate it?
Fair I agree. The report does identify all the groups in the Alliance, but it doesn’t explain our political action structure. Let’s move on.
This section should include a description of who would be impacted by the proposal. How would you rate it?
Fair I agree. Once we have a more specific vision articulated — the clinic — this part will be easier to improve. It does say who will be impacted, but we need to say more about how the proposal will affect the different interest populations, not just that it will affect them. Plus, even if it seems redundant, we need to say why we, the Telehealth Alliance, are supporting it. Let’s move on.
What do you think of this section’s description of our strategy for delivering the message?
Fair I agree. It’s good that this part talks about the tactics we want to use, and which ones will be best to reach more people. But the report needs to detail a strategy. We need to explain who we want to influence and how we think that will help us. From there, we can articulate what kind of messages and what kind of media would be most effective in reaching those specific people. So we need to talk here about who we think would be most likely to help us promote this proposal, and then articulate what kind of messages and what kind of media would be most effective in reaching those specific people. Let’s move on.
This section is supposed to describe our methods for influencing the legislative process. What do you think?
Poor I agree. The report doesn’t discuss how to influence the legislative process at all. Richard Starzynski had some good ideas about how to get some support for the clinic, and we need to get those in this section. Okay, let’s check out the last part.
How would you rate this lat part on describing potential barriers to implementing the proposal?
Poor I agree. It’s true that this section talks a little about using multiple methods of advertising. I assume the writer was thinking that one barrier might be figuring out how to reach the people who might support us. But the report needs to state that specifically. There are also plenty other barriers that aren’t discussed. What about legislators who don’t want to fund this? Or doctors at the hospital who don’t think the clinic should be housed there? Or veterans who just don’t hear about the clinic, or don’t want to use it because it’s unfamiliar? There are a lot of potential barriers and we need to get them listed here. Our proposal will be better — and more successful — if we show that we’ve thought it through and come up with potential solutions for those barriers.
Thanks for your help! The report is a good start but it’s going to need some additions and polishing before it’s ready to use. So I guess we’ll put that on our to-do list!
Now that you’ve learned about how a telehealth clinic might help veterans in the area get better health care, and seen a report on the topic that had some flaws, you should have a better understanding of how to write your own report on the health care issue you’ve selected.
The choices you’ve made at each step of this activity have been logged for you. If you would like to see how different decisions affect your outcome, you may go through the activity again. Doing so will not remove any previous attempts from your activity log.Health Policy Initiative Agenda.

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