Continuing a history of inequity, private insurers have placed restrictions and limitations on coverage for mental health conditions making access to treatment services increasingly more challenging. A state-by-state advocacy movement has led to the enactment of various state laws to require mental health parity. With the Clinton Administration’s attempt at health care reform, mental health parity became part of the health reform debate and led to the passage of the Mental Health Parity Act of 1996. The inadequacies of this law were partially corrected in the Mental Health Parity and Addiction Equity Act of 2008, which included mandated coverage for substance use conditions. The Obama Administration in 2011 included these provisions in the Patient Protection and Affordable Care Act, which does not require compliance monitoring nor does it provide a definition for “mental health,” which leaves insurers to define it and hence determine what coverage will actually be available.
Daniel Eisenberg and Ramesh Raghavan
One of the most important unanswered questions for any society is how best to invest in children’s mental health. Childhood is a sensitive and opportune period in which to invest in programs and services that can mitigate a range of downstream risks for health and mental health conditions. Investing in such programs and services will require a shift from focusing not only on reducing deficits but also enhancing the child’s skills and other assets. Economic evaluation is crucial for determining which programs and services represent optimal investments. Several registries curate lists of programs with high evidence of effectiveness; many of these programs also have evidence of positive benefit-cost differentials, although the economic evidence is typically limited and uncertain. Even the programs with the strongest evidence are currently reaching only a small fraction of young people who would potentially benefit. Thus, it is important to understand and address factors that impede or facilitate the implementation of best practices. One example of a program that represents a promising investment is home visiting, in which health workers visit the homes of new parents to advise on parenting skills, child needs, and the home environment. Another example is social emotional learning programs delivered in schools, where children are taught to regulate emotions, manage behaviors, and enhance relationships with peers. Investing in these and other programs with a strong evidence base, and assuring their faithful implementation in practice settings, can produce improvements on a range of mental health, academic, and social outcomes for children, extending into their lives as adults.
Cecilia Ayón, Tanya Nieri, and Maria Gurrola
Latinx immigrants represent a large segment of the immigrant population in the United States. While immigrants tend to be healthier than native-born people, they experience a number of health disparities. Latinx immigrants experience many barriers to accessing health care, including immigration policy barriers related to undocumented or recent permanent resident status, lack of culturally and linguistically responsive services, challenges during the access verification process, discrimination by providers, and external resource constraints (e.g., cost). Many are uninsured or underinsured and experience limited access to care. Existing models to understand health are examined. A social determinants of health framework is used to understand immigrants’ health outcomes. Within this framework immigration is a social determinant of health. Substantial empirical evidence illustrates how the immigration policy context impacts on immigrants’ health through exposure to enforcement activity, threat of detainment and deportation, and actual deportation. Enforcement activity is racialized to effect all Latinxs regardless of status. Other domains including economic insecurity, education, and community and social support are other sources that may disadvantage immigrants and impact on their health. The search for economic opportunity is a primary motivation for Latinxs to migrate to the United States, yet many face economic challenges and live in poverty. Education has significant impact on immigrants across the development spectrum as they experience disparities in access. Social ties are critical to the wellbeing of Latinx, evidence suggests disparities in access to support by status. Immigrants contend with a number of challenges as they integrate into society. Social determinants of health, through multiple domains, affect immigrants’ health.
Jessica M. Black
Sleep is required for healthy and adaptive neurobehavioral and psychosocial functioning throughout the life course. Sleep is restorative, facilitates memory consolidation, improves immune function, and regulates emotional responses. Sleep deprivation, whether due to sleep disorders or other life conditions and transitions, is a significant risk factor for negative developmental outcomes at all stages in the life course. This article adheres to the biopsychosocial model to review current research describing the benefits of adequate sleep and ways in which insufficient sleep, as determined by developmental needs throughout the life course, can undercut healthy development. Particular attention is paid to social issues of relevance to social workers, with a closing discussion of policy and implications for future work within the field.
Emily Q. Ahonen, Sherry L. Baron, Lisa M. Brosseau, and Alejandra Vives
Standard employment arrangements—where the relationship between employers and employees is clear and employment is full-time, understood to be lasting, and with full protections—coexist with nonstandard employment (NSE) relationships. A variety of terms have been used to describe specific types of NSE including temporary, contingent, contract, freelance, on-call, gig, and app-based employment. These forms of employment, in combination with larger social and economic forces, structural power dynamics, and advances in technology, can work together to limit the ways in which employment supports health, and undermine workplace health protections. Nonstandard employment brings with it particular concerns for health and safety related to work, and in a broader public health sense. Health can be protected in NSE through intervention at national, state and province, and local levels to proactively shape the quality of employment arrangements.
King Davis and Hyejin Jung
This entry defines the term disparity as measurable differences between groups on a number of indices. The term disparity originated in France in the 16th century and has been used as a barometer of progress in social justice and equality in the United States. When disparity is examined across the U.S. population over a longitudinal period, it is clear that disparities continue to exist and that they distinguish groups by race, income, class, and gender. African American and Native American populations have historically ranked higher in prevalence and incidence than other populations on most indices of disparity. However, the level of adverse health and social conditions has declined for all population groups in the United States. The disparity indices include mortality rates, poor health, disease, absence of health insurance, accidents, and poverty. Max Weber’s theory of community formation is used in this entry to explain the continued presence and distribution of disparities. Other theoretical frameworks are utilized to buttress the major hypothesis by Weber that social ills tend to result from structural faults rather than individual choice. Social workers are seen as being in a position to challenge the structural origins of disparities as part of their professional commitment to social justice.